Health Workforce the Impact of Title VII Physician Workforce Training Programs on Physician’s Practice Location

Research Objective This study examined the association of HRSA Primary Care Training and Enhancement (PCTE) program and physicians’ practice locations in the United States. Study Design This is a cross‐sectional study linking data from HRSA grantee information from 2010 to 2017, the American Medical Association Masterfile 2017, and three federal designations: Health Professional Shortage Areas (HPSAs), Medically Underserved Areas (MUA), and Rural‐Urban Commuting Area code. Data were analyzed using descriptive statistics and multiple logistic regressions to examine the associations between HRSA PCTE funding and physicians’ practice location, adjusting for covariates (age, sex, ownership, school region, primary care physicians, internal medical graduate, patient care, and practice setting). Population Studied The physicians who graduated from US medical schools between 2002 and 2017 (N = 364 198). Principal Findings Overall, among US physicians graduating between 2002 and 2017, 65% graduated from medical schools or training institutions that had received PCTE funding. The majority were male (53%) and worked in hospital settings (40%). Among PCTE funded schools or training institutions, physicians graduating between 2010 and 2017 were more likely to practice in HPSA areas compared to those who graduated between 2002 and 2009 (respectively 18.6% vs 17.4%, P  < .001). In contrast, physicians graduating between 2010 and 2017 were less likely to practice in MUA areas compared to those who graduated between 2002 and 2009 (respectively 6.4% vs 7.7%, P  < .001). Around 4% of physicians practiced in rural areas, and there was no difference between the two‐time periods. After adjusting for covariates, physicians graduating after 2010 from schools/training institutions with PCTE funding were more likely to practice in rural areas (Odds Ratio [95%CI]: 1.25[1.16‐1.35]). The same pattern was found for those practicing in HPSAs, but it was not statistically significant (1.01[0.98‐1.04]). In terms of practicing in MUAs, physicians who graduated from schools/training institutions receiving PCTE funding were less likely to practice in MUA, but it was not statistically significant (0.96[0.91‐1.02]). Additionally, the study found that physicians who graduated from schools/training institutions receiving funding for physician faculty development in primary care and physician assistant training in primary care were less likely to practice in HPSAs (respectively 0.94[0.89‐0.99], 0.90[0.85‐0.96]). Conclusions HRSA training program funding has a positive impact on physicians’ location choice. HRSA‐funded schools/ training institutions produced a greater percentage of physicians practicing in rural areas and low‐income communities than those without HRSA‐funded programs, thus improving access to, and the delivery of, healthcare services to underserved populations. Implications for Policy or Practice Our study provides preliminary evidence that physicians graduating from schools/training programs receiving HRSA training funding have an increased likelihood of practicing in rural areas. HRSA’s Title VII Primary Care Training and Enhancement (PCTE) program funding is associated with physicians’ chosen practice locations. However, future studies are needed to understand the mechanism of the effect of training program on physicians' practice location choices.