The service-education linkage: implications for family practice residency programs and community and migrant health centers.
BACKGROUND
Access to quality primary health care for our country's underserved populations is a challenge for both the government and physicians. The Division of Medicine, through funding priorities and other initiatives, is encouraging family practice educators to train residents and students for work in community and migrant health centers (C/MHCs) in underserved areas. The objective of this research was to study linkages between family practice residency programs and C/MHCs and determine the reasons for affiliation, disadvantages and advantages, predictors of successful linkages, and common errors in the linkage agreement.


METHODS
We conducted in-depth telephone interviews with the directors of 13 of the 19 family practice residency programs identified as having linkages with C/MHCs.


RESULTS
All interviewees at residency programs indicated that their programs had a mission to serve underserved patients. The most commonly cited constraining factor cited by both residency programs and C/MHCs was financial support for residents, on-site faculty, and support staff. Many programs reported that residents training at the C/MHC were able to gain a community health perspective and practice community-oriented primary care. Finally, financing the relationship involved many different approaches, ranging from the residency paying all of the salaries, to a sharing of salaries by the residency, state, and/or hospital, to C/MHC paying the salaries either through its own funds or through grant support.


CONCLUSIONS
These data provide an assessment of the current issues that family practice residencies must address to implement service-education linkages. They provide an empirical basis to outline the steps involved in forming a linkage between a residency and a C/MHC.
Department of Family and Community Medicine, University of Arizona College of Medicine, Tucson.
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Gordon
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Hale
D003151:Community Health Centers; D005194:Family Practice / Q000193:education*; D007396:Internship and Residency / Q000458:organization & administration*; D007407:Interviews as Topic; D008507:Medically Underserved Area; D016730:Program Development; D014171:Transients and Migrants; D014481:United States; D000078329:Workforce