Balancing service and education: linking community health centers and family practice residency programs.

Many medical educators are calling for an increased emphasis on ambulatory care training, but financial constraints are often cited as impediments to developing ambulatory care training sites. A growing number of family practice residency programs (FPRPs) are affiliating with community and migrant health centers (C/MHCs). This movement has the potential to strengthen community-based ambulatory care training, while addressing some of the financial concerns noted above. This article illustrates how FPRPs can establish mutually beneficial linkages with C/MHCs, while operating within the policy parameters established by the Residency Review Committee (RRC) and the Bureau of Health Care Delivery and Assistance (BHCDA). For this to occur, BHCDA and C/MHCs need to calculate the time required for attending physicians to supervise family practice residents and to contribute to the legitimate educational and teaching needs of the FPRP. Conversely, FPRPs must work closely with C/MHCs to ensure that family practice residents maintain acceptable levels of productivity. The RRC can make it more feasible to have pathways at smaller C/MHCs by allowing those attending physicians supervising family practice residents to see a reduced patient load, determined by the number of residents working at the C/MHC.