Exploring Community-Based Residency Programs in High-Need Black Counties

Background and Objectives: Primary care physician (PCP) shortages and uneven geographic distribution are well-documented. Black populations have less access to primary care and worse health outcomes, with a lack of provider-patient racial concordance playing a role. Addressing these disparities requires targeted approaches that produce more Black PCPs in high-need areas, including expanding community-based residency programs (CBRPs), which are more likely to produce physicians in high-need areas. This research explores the relationship between high-need Black counties and the location of CBRPs. Methods: We used geographic information systems to identify high-need counties—defined as those in the bottom quartile for PCP capacity for every year from 2013 to 2020 and in the top quartile for percentages of Black populations (2017–2021). Next, we applied proximity analysis to identify high-need counties within 25 and 50 miles of CBRPs. Results: More than 3 million people live in the 147 high-need counties, which are mostly in the Southern United States. Nearly 60% of the 867,000 Black people living in these counties can be found in Georgia, Mississippi, North Carolina, and Virginia. About one-half of high-need counties do not have any CBRPs located within 50 miles. More than one-third of these counties are in Georgia, Louisiana, and Virginia. Conclusions: Increasing the number of PCPs in high-need areas requires targeted funding for expanding current and creating new CBRPs with the greatest potential of producing physicians in these areas. Future research will explore all family medicine residency programs relative to high-need areas and identify potential new program locations.