Find out how you can support changes to the laws and rules governing graduate medical education that are hindering your ability to train future family physicians.
Medicare GME
Broad Medicare GME reform is needed. Family medicine is currently revising its policy on overall Medicare GME reform.
Rural training under Medicare is hindered by low reimbursement and “gotcha” rules. For this reason, we have supported more targeted rural training reforms as we await overall GME Medicare reform – the Rural Physician Workforce Production Act.
Legislators introduced the Rural Physician Workforce Production Act starting in the 115th Congress in 2018 with the latest iteration introduced during the 119th Congress. This bipartisan, budget-neutral bill tackles the geographic maldistribution of physicians in rural areas stemming from the current structure of Medicare-funded GME and complements other GME initiatives already introduced.
On February 10th, 2025 Reps. Diana Harshbarger (R-TN), Kim Schrier (D-WA), and Don Bacon (R-NE) reintroduced the Rural Physician Workforce Production Act, H.R. 1153. The bill addresses the unequal distribution of physicians in rural and underserved communities across the country stemming from the current structure of Medicare-funded graduate medical education (GME). CAFM was quoted in the bill press release and issued a separate statement.
Policymakers should introduce the Senate bill version soon.
The groups that join CAFM in supporting the bill include: the American Academy of Family Physicians, American Association of Colleges of Osteopathic Medicine, American College of Osteopathic Family Physicians, American Osteopathic Association, GME Initiative, and National Rural Health Association.
The links below describe the bill, display CAFM’s involvement in moving the bill forward, and provide proposal drafts.
- Rural Physician Workforce Production Act of 2025 (H.R. 1153)
- Coalition letter on the Rural Physician Workforce Production Act 2025 (PDF)
- Rural Physician Workforce Production Act of 2023 (HR. 834/S. 230)
- Rural Physician Workforce Production Act Section-by-Section (PDF)
- Rural Physician Workforce Production Act One-pager (PDF)
- Senate Finance Committee Hearing on Rural Health Care: Supporting Lives and Improving Communities” CAFM Testimony, May 16, 2024 (PDF)
- GME proposal from Senate Finance (PDF)
- CAFM Response to Senate Finance GME Proposal (PDF)
Teaching Health Center GME
The Teaching Health Center Graduate Medical Education Program (THCGME), administered by the Health Resources and Services Administration (HRSA), plays a vital role in increasing the number of primary care medical and dental residents trained in community-based settings across the nation.
Teaching Health Centers (THCs) are community-focused training programs that equip physicians to address the unique health needs of their communities. By embedding training in these settings, THCs are on the leading edge of innovative educational programming dedicated to ensuring a sufficient supply and distribution of primary care physicians.
On November 14, 2023, the US House of Representatives passed a “laddered” Continuing Resolution (CR) to temporarily fund the federal government through early 2024, which included an extension of the THCGME program.
The US Senate approved the measure on November 15, 2023, and President Joe Biden signed the Fiscal Year 2024 Consolidated Appropriations Act shortly after. This legislation allocated baseline funding of $164 million for the THCGME program through December 2024. Furthermore, the Biden-Harris Administration later approved a short-term extension of the program, extending its funding through March 31, 2025.
In recent years, THC funding has primarily come through the appropriations process. However, CAFM strongly advocates for a multi-year authorization to provide greater stability and sustainability for the program.
To this end, CAFM has collaborated with a coalition to fund, expand, and reauthorize the THCGME program. Our coalition partners include the American Association of Teaching Health Centers, American Academy of Family Physicians, National Association of Community Health Centers, American Osteopathic Association, American Association of Colleges of Osteopathic Medicine, American College of Obstetricians and Gynecologists, and the Society of General Internal Medicine.
Below are resources highlighting our efforts to support and strengthen the THCGME program:
- THCGME Coalition Letter to House of Representatives Speaker Mike Johnson, March 15, 2024 (PDF)
- THCGME Coalition Letter to House Committee on Energy & Commerce, September 12, 2023 (PDF)
- THCGME Coalition Letter to Speaker Johnson, December 1, 2023 (PDF)
- S. 2840 Amendment #2 (PDF)
- PATIENT Act (H.R. 3651)
Find out what primary care research is and how we can support primary care research funding at the Agency for Health Care Research and Quality (AHRQ) and the Patient Centered Outcomes Research Institute (PCORI).
AHRQ
The Agency for Healthcare Research and Quality (AHRQ) is an agency within the Department of Health and Human Services that supports Practice Based Research Networks (PBRNs), independent investigator research in health services, and primary care research, among other things. CAFM works to adequately fund AHRQ through our coalition partner Friends of AHRQ Research.
CAFM has also worked to fund the AHRQ Center for Primary Care at a level of $5 million. The Center serves as the AHRQ coordinating entity for their many primary care research programs; AHRQ remains the principal source of funding for clinical primary care practice research.
Because of CAFM's advocacy, starting in FY 2022, the House Labor, Health and Human Services Subcommittee committed to the full $5 million in funding for the Center. Ultimately, we secured $2 million in funding for the Center.
In FY 2023, both the House of Representatives and Senate appropriators funded the Center at $5 million in their individual bills; the final larger funding agreement again funded the Center at $2 million. In a tight funding year, the Center maintained $2 million in funding in FY 2024.
Here are some additional resources about our work supporting AHRQ:
- CAFM's FY 2025 House Labor, Health and Human Services, Education, and Related Agencies Subcommittee Testimony for the Record (PDF)
- CAFM's FY 2025 Senate Labor, Health and Human Services, Education, and Related Agencies Subcommittee Testimony for the Record (PDF)
- AHRQ Center for Primary Care FY 2025 Request (PDF)
The Primary Care Training and Enhancement (PCTE) program funds training of primary care physicians by providing support for: family medicine and internal medicine outpatient clerkships; preceptors (community teachers), including faculty development; mentors (formalized programs or mentor support, structure, curriculum on how to be a mentor, etc.); Family Medicine Interest Groups (FMIGs); faculty development of advisors, outside speakers, etc.; and longitudinal curricular pathways: experiences in rural training, primary care tracks, underserved care, public health, and leadership development for primary care faculty.
Multiple studies have recognized the value of this program including the Advisory Committee on Training in Primary Care Medicine and Dentistry’s December 2014 report that the available resources for the program are “currently inadequate to support the [needed] system changes.”
For many years, CAFM has supported more funding for the PCTE program through its own advocacy efforts as well as participation in the Health Professions and Nursing Education Coalition (HPNEC). CAFM supported $59 million in fiscal year (FY) 2025 funding for the PCTE program (PDF). Funding levels for PCTE for the past several years follow:
- FY 2025—Currently funded at FY2024 levels of $49.9 million
- FY 2024—$49.9 million
- FY 2023—49.9 million
Please find further information about how HRSA has implemented the PCTE program including grant funding under the PCTE section of the Public Health Service Act.
CAFM supported the following rural bills not included in other website sections during the 118th Congress:
- S. 3968/H.R. 7258: The Community TEAMS Act establishes a new HRSA grant program that partners medical schools with Federally Qualified Health Centers, Rural Health Clinics or other health care facilities located in medically underserved communities to increase medical school clinical rotations in rural and underserved areas.
- S. 5456/H.R 7855: The Rural Residency Planning and Development Act increases the number of authorized Rural Residency Planning and Development programs to ensure that they continue to be prioritized and receive federal funding for future years.
- S. 5308/H.R. 10187: The Rural Hospital Flexibility Act of 2024 reauthorizes and modifies the Medicare Rural Hospital Flexibility Program which provides states with funding needed to support Critical Access Hospitals (CAHs).
