title: The effects of the 1997 Balanced Budget Act on family practice residency training programs.
abstract: OBJECTIVE
  This study assessed the impact of the Balanced Budget Act (BBA) of 1997 on family practice residency training programs in the United States.
  
  
  METHODS
  We surveyed 453 active family practice residency programs, asking about program closures and new program starts (including rural training tracks), changes in the number of residents and faculty, and curriculum changes. Programs were classified according to their urban or rural location, university or community hospital setting, and rural and/or urban underserved mission emphasis.
  
  
  RESULTS
  A total of 435 (96%) of the programs responded. Overall, the impact of the BBA was relatively small. In 1998 and 1999, nationwide, there were 11 program closures, a net decrease of only 82 residents, and a net increase of 52 faculty across program settings and mission emphasis. The rate of family practice residency program closures increased from an average of 3.0 per year between 1988-1997 to 4.8 per year in the 4 years following passage of the BBA.
  
  
  CONCLUSIONS
  The 1997 BBA did not have an immediate significant negative impact on family practice residency programs. However, there is a worrisome increase in the rate of family practice residency closures since 1997. A mechanism needs to be established to monitor all primary care program closures to give an early warning should this trend continue.
authors.affiliation: WWAMI Rural Health Research Center, Department of Family Medicine, University of Washington, Seattle 98195-4696, USA. sron@u.washington.edu
authors.forename: Ronald
authors.initials: R
authors.lastname: Schneeweiss
authors.forename: Roger A
authors.initials: RA
authors.lastname: Rosenblatt
authors.forename: Susan
authors.initials: S
authors.lastname: Dovey
authors.forename: L Gary
authors.initials: LG
authors.lastname: Hart
authors.forename: Frederick M
authors.initials: FM
authors.lastname: Chen
authors.forename: Susan
authors.initials: S
authors.lastname: Casey
authors.forename: George E
authors.initials: GE
authors.lastname: Fryer
mesh_terms: D002017:Budgets / Q000331:legislation & jurisprudence*; D003625:Data Collection; D005194:Family Practice / Q000191:economics / Q000193:education*; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000191:economics*; D008297:Male; D011050:Policy Making; D011795:Surveys and Questionnaires; D014146:Training Support / Q000331:legislation & jurisprudence*; D014481:United States