title: Characteristics and Distribution of Graduate Medical Education Training Sites: Are We Missing Opportunities to Meet U.S. Health Workforce Needs?
abstract: OBJECTIVE
  Shortages of generalist physicians in primary care and surgery have been projected. Residency programs that expose trainees to community-based health clinics and rural settings have a greater likelihood of producing physicians who later practice in these environments. The objective of this study was to characterize the distribution of residency training sites in different settings for three high-need specialties-family medicine, internal medicine, and general surgery.
  
  
  METHODS
  The authors merged 2012 data from the Accreditation Council for Graduate Medical Education Accreditation Data System and 2010 data from the Centers for Medicare and Medicaid Services hospital cost report to match training sites with descriptive data about those locations. They used chi-square tests to compare the characteristics and distribution of residency programs and training sites in family medicine, internal medicine, and general surgery.
  
  
  RESULTS
  The authors identified 1,095 residency programs and 3,373 training sites. The majority of training occurred in private, not-for-profit hospitals. Only 48 (of 1,390; 4%) family medicine training sites and 43 (of 936; 5%) internal medicine training sites were community-based health clinics. Seventy-eight (6%) family medicine sites, 8 (1%) internal medicine sites, and 16 (2%) general surgery sites were located in rural settings. One hundred thirty (14%) internal medicine sites were Department of Veterans Affairs medical facilities compared with 78 (6%) family medicine sites and 94 (9%) general surgery sites (P < .001).
  
  
  CONCLUSIONS
  Relatively little training occurs in rural or community-based settings. Expanding training opportunities in these low-access areas could improve physician supply there.
authors.affiliation: J. Blanchard is associate professor, Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC.S. Petterson is research director, Robert Graham Center, Washington, DC.A. Bazemore is director, Robert Graham Center, Washington, DC.K. Watkins is research assistant, Department of Health Policy, Milken Institute School of Public Health, George Washington University, Washington, DC.F. Mullan is Murdock Head Professor of Medicine and Health Policy, Department of Health Policy, Milken Institute School of Public Health, George Washington University, Washington, DC.
authors.forename: Janice
authors.initials: J
authors.lastname: Blanchard
authors.forename: Stephen
authors.initials: S
authors.lastname: Petterson
authors.forename: Andrew
authors.initials: A
authors.lastname: Bazemore
authors.forename: Kayla
authors.initials: K
authors.lastname: Watkins
authors.forename: Fitzhugh
authors.initials: F
authors.lastname: Mullan