garding URM physicians, they do exemplify the use of funds to address specific workforce goals.
Arkansas has had a program of community family physician residency programs for more than 25 years. The goal of the program is to distribute physicians to underserved populations throughout the state. Developed in collaboration with the state’s AHEC, the program has six community-based family medicine residency practices outside Little Rock, the state’s largest city. Credited with providing most of the state’s rural physicians, it provides opportunities for 45 percent of graduating medical residents to practice in communities with populations of less than 20,000.
The Arkansas state legislature recently agreed to appropriate $4 million of the state’s tobacco settlement to support the community residency programs. According to Henderson, the legislature is interested in tying the program to the state’s Medicaid GME program in order to receive additional federal Medicaid matching funds for the teaching hospitals that are affiliated with the community residencies.
Colorado, which has had a program for 25 years, directs its efforts to the needs of rural and urban underserved communities for family physicians. Run by a committee of academic, provider, and consumer representatives, the program includes 10 family practice residencies that currently train approximately 200 residents. While 80 percent of the residents in the program are from medical schools outside Colorado, two-thirds of the graduates remain in the state to practice, with about 25 to 30 percent opting for a rural or urban underserved area practice. The Colorado legislature makes an annual appropriation of about $2.4 million to the program.
Texas has a program, also 25 years old, to fund postgraduate training in family medicine. By the late 1990s, the state provided approximately $11 million to 26 programs for more than 700 positions, sponsored by medical schools in the state. It requires the schools to have substantial support from other sources, such as patient revenues and local funds.
The National Center for Health Workforce Analysis offers the following statistics for 1994–1998 on allopathic medical school graduates characterized as URMs, with 10.5 being the U.S. average and Texas providing the only overlap with Henderson’s analysis (National Center for Health Workforce Analysis, 2001):