Office of Rural Health Policy: Rural Training Track Technical Assistance Demonstration Program

The RTT-TA demonstration program strongly encourages the formation of a consortium of entities to continue to delineate the policy challenges that RTT residency programs face in training family medicine physicians.  This cooperative agreement is an ongoing activity that builds on the work of a previous RTT demonstration (HRSA-10-192).  This project will work to identify and analyze the key policy issues, challenges and barriers that continue to affect these rural training sites, and will provide technical assistance where appropriate to increase the number of family medicine residents who train in RTTs.  The lead organization is a critical component to ensure the success of this project and must demonstrate a proven track record, with extensive prior experience and results in working with RTT programs.  For the purpose of this cooperative agreement, the Office of Rural Health Policy (ORHP) is defining a rural training track as a family medicine residency that operates as a “1-2 program.”  In these programs, the first year of training is completed at central, usually urban sites and the last two years are completed at rural community-based training locations.  The expectation is that the RTT-TA cooperative agreement supports RTTs that train family medicine resident graduates of allopathic, osteopathic, or both types of medical school institutions. 

This demonstration requires an ongoing partnership and a collaborative relationship with ORHP in the selection of projects and in the development and implementation of the activities submitted in the work plan. The overarching goals are:

1)        Support new and existing RTT programs by providing direct technical assistance when requested, including as appropriate a thorough assessment and specific recommendations related to financial sustainability;

2)        Increase medical student interest in RTT residency programs by marketing the RTTs to the right audiences, providing residency interview assistance for students and spouses/partners when needed, and increasing the RTT National Resident Matching Program (NRMP) results for these programs;

3)         Expand the number of RTT programs by working with communities and academic institutions who desire to start new programs by sharing the expertise of RTT faculty veterans. This includes assisting new programs in successfully achieving academic accreditation and qualifying for Medicare graduate medical education funding. Particular attention should also be given for infrastructure enhancement, such as providing financial assistance for purchasing medical textbooks, journals, electronic resources, and/or educational equipment needed for the residency program.

4)         Analyze the specific characteristics of new versus existing programs in terms of viability/sustainability and analyze which interventions of this cooperative agreement prove most effective in enhancing long-term program viability. This is discussed further on page 30 in the “Final Report” section.

The focus areas to achieve these goals include the following:

1)        Identifying, analyzing and translating the key policy issues and challenges affecting the ability of RTT rural training sites to attract potential family medicine residents, including the implications that Medicare and Medicaid regulations have on the viability of RTTs;

2)        Supporting policy meetings around rural health workforce, training, recruitment and retention issues for rural residency directors, rural health researchers, rural medical educators, rural medical students and policymakers;

3)        Providing technical assistance to new and established RTT programs.  Possible examples of technical assistance and activities could include mentoring of new and established RTT programs to increase their fill rate, curriculum development, peer mentorship between RTTs, working with any consortium members to develop strategies to recruit medical school graduates to RTT programs, maintaining an assessment of the match and fill rates for RTT Programs and building a network of all the RTT programs;

4)        Identifying and promoting best practices for RTT programs to increase their viability by identifying successful models and administrative support strategies, as well as planning how technical assistance will be primarily focused on the community-based sites of the RTTs;

5)        Conducting an inventory and developing a narrative of the different RTT programs nationwide, with a particular emphasis on comparing new versus existing programs related to characteristics such as financial underpinnings, revenue sources, number of residents, faculty and community champions, unique challenges related to the RTT model, sustainability strategies, etc. All new programs implemented from January 1, 2013 through July 31, 2016 should be included in this analysis. Special attention should also be given to analyzing the reasons for any program closures that occur during this time frame; and

6)        Maintaining an accurate assessment of the success rates (NRMP and July fill rates) for RTT programs and the long-term rural practice retention rates of their graduates.