Teaching hospitals are limited in their ability to receive additional federal funding for new residency programs or the expansion of existing programs because of the Balanced Budget Act of 1997, which established a cap on funding for residency positions at teaching hospitals. To mitigate the impact of funding limitations, teaching hospitals must be creative in lowering costs and finding other methods to support training programs. Partnerships with Federally Qualified Health Centers (FQHCs) provide opportunities to reduce costs and/or lower the incremental costs of training more residents while improving the quality of the training.
Depending on the specialty, residents can spend up to a third of their time in an outpatient setting, typically referred to as the resident continuity clinic. These clinics often have a significant negative impact on the bottom line of the teaching hospitals that sponsor the programs due to an unfavorable payer mix and a lack of predictive scheduling of faculty and resident time. The patient populations at residency clinics resemble those of FQHCs, which are specially designated community-based healthcare providers that receive funds from the Health Resources & Services Administration’s Health Center Program to provide primary care services in underserved areas. FQHCs provide cost-effective access to care as an alternative to patients presenting to local emergency departments. Integrating primary care programs (i.e., family medicine, internal medicine, pediatrics, and OB/GYN ) into community-based FQHCs can enhance collaborative patient care, support the teaching mission, and improve delivery capacity. A well-structured partnership creates a win-win for both the residency program and the FQHC. We will review how these organizations can collaborate to address critical community needs by improving and expanding physician training and access to high-quality care for vulnerable populations.