271 Vol. 40, No. 4
Health Services Research
Community health centers (CHCs) are federally funded
primary care clinics that provide care for underinsured
and uninsured patients. They are the largest network of
clinics providing service to the underserved and now
care for more than 17 million US citizens in more than
6,000 service delivery sites in every state and territory.1
Under the Federal Health Center Growth Initiative of
2002, and supported by $2.2 billion in annual federal
funds, this network is rapidly expanding.2-4 This initia-
tive has increased services by 800 new and expanded
health centers and brought services to 4 million new
As a result of the expansion of CHCs, there has been
a significant increase in the demand for family physi-
cians to staff them.2 Primary care physicians constitute
90% of physicians working in the CHCs, the majority
of whom are family physicians.6 The Health Resources
and Services Administration (HRSA) predicts there
will be an increase in demand for more than 11,000 ad-
ditional clinicians by 2006.3 A recent national survey of
890 CHCs revealed significant shortages of providers.6
The most pronounced shortage was for family physi-
cians. CHCs reported more than 400 family physician
vacancies, and 40% of these vacancies had been open
for more than 7 months.
An innovative collaboration between CHCs and
family medicine residencies (FMRs) may provide
an opportunity to meet the health workforce needs
of CHCs.7-11 Since the 1980s, some family medicine
graduates have been trained in CHCs with the hope
that these residents will be better prepared and more
likely to meet the health workforce demands of CHCs
and their patients. Training in CHCs is considered to
enhance the development of the skills necessary to
optimally care for the unique underserved populations
served by these clinics.11,12
Descriptions of CHC-FMR affiliations and small
case series suggest a high percentage of family medi-
cine residents trained in the CHC setting go on to work
in CHCs.7,8,12-17 Hill et al reported that eight of their
nine graduates from CHC-based training worked in
CHCs following graduation.7 Tallia et al describe a
24% increase in the number of graduating family physi-
cians working in underserved communities following
the implementation of longitudinal community-based
Training Family Physicians in Community Health Centers:
A Health Workforce Solution
Carl G. Morris, MD, MPH; Brian Johnson, MD;
Sara Kim, PhD; Frederick Chen, MD, MPH
From the Department of Family Medicine (Drs Morris, Kim, and Chen) and
School of Medicine (Dr Johnson), University of Washington.
Purpose: For more than 25 years, family medicine residencies (FMRs) have worked with community
health centers (CHCs) to train family physicians. Despite the long history of this affiliation, little
research has been done to understand the effects of training residents in this underserved community
setting. This study compares CHC and non-CHC-trained family physicians regarding practice loca-
tion, job and training satisfaction, and recruitment and retention to underserved areas. Methods: We
conducted a cross-sectional survey of a cohort of the 838 graduates from the WAMI (Washington,
Alaska, Montana, and Idaho) Family Medicine Residency Network from 1986–2002. Results: CHC-
trained family physicians were almost twice as likely to work in underserved settings than their
non-CHC-trained counterparts (64% versus 37%). When controlling for gender, percent full-time
equivalent, and years from graduation, CHC-trained family physicians were 2.7 times more likely to
work in underserved settings than non-CHC-trained family physicians. CHC and non-CHC-trained
family physicians report similar job and training satisfaction and scope of practice. Conclusions:
Training family physicians in CHCs meets the health workforce needs of the underserved, enhances
the recruitment of family physicians to CHCs, and prepares family physicians similarly to their non-
CHC trained counterparts.
(Fam Med 2008;40(4):271-6.)
April 2008 Family Medicine
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