Medically Underserved Areas and Populations

Medically Underserved Areas/Populations and GME

Consistent with its mission to improve health care and population health, the ACGME seeks to enhance physician workforce development in communities that face physician shortages in various specialties.

As part of this effort, the ACGME has developed a framework to promote the development of graduate medical education (GME) that will result in enhanced access to and availability of health care in medically underserved areas (MUAs) and medically underserved populations (MUPs). Medically underserved areas and populations (MUA/Ps) are places or communities in which groups of people have unmet health or health care needs.

This new framework outlines initial actions addressing graduate medical education in MUA/Ps.

Rural Initiatives

ACGME Rural Track Program Designation

Consistent with Section II of the MUA/P framework, the ACGME is developing processes addressing ACGME-accredited programs that are also “rural tracks” as defined in rules and regulations of the Centers for Medicare and Medicaid Services (CMS) in 42 CFR §413.79(k).

Under current CMS regulations, urban teaching hospitals have an opportunity to obtain reimbursement for direct GME (DGME) and indirect medical education (IME) financing by partnering with rural hospitals and other rural sites to create separately-accredited rural track programs (RTPs). In RTPs, residents are assigned to certain types of participating sites in rural areas for more than half of the length of their residency program.

While CMS does not limit the creation of RTPs to specific specialties, RTPs have historically been created in the specialty of family medicine only (some RTPs in Family Medicine are often called “1-2 programs.”). Recognizing that alignment of ACGME processes with CMS regulations will facilitate the expansion of opportunities to address the health care needs of medically underserved areas through the development of rural track programs, the ACGME has developed a common, criterion-based process for designating ACGME-accredited RTPs across specialties.

RTPs may share resources with already existing ACGME-accredited programs, and residents/fellows in RTPs may have overlapping rotations with residents/fellows in those programs. Requests for RTP designation may identify the existing programs as Rural Track Related Programs (see definition below).

By providing a standardized method for identifying RTPs in a variety of specialties, this designation will support hospitals seeking to create new pathways for physicians who wish to practice in rural areas.

Review the ACGME RTP Designation Instructions Document for instructions on requesting a designation.

As part of the ACGME RTP designation request, the program director must provide an ACGME RTP Rotation Information Form using the attached template. This form is required in addition to the block diagram that is part of the program’s accreditation application.

For questions about the ACGME Rural Track Program designation, review the ACGME RTP FAQ Guide.

Review the MUA/P Framework and ACGME RTP Designation Summary Document
Review the Rural Track Regulation References Document


ACGME Definition of Terms Specific to MUA/P:

ACGME Rural Track Program (RTP) An ACGME-accredited program with a unique 10-digit identifier in which residents/fellows gain both urban and rural experience with more than half of the education and training for each resident/fellow taking place in a rural area (any area outside of a Core-Based Statistical Area (CBSA)).
ACGME Rural Track Program (RTP) designation A classification provided by the ACGME that identifies Rural Track Programs at the time of application for accreditation.
ACGME Rural Track Related Program A separately accredited program in the same specialty at the same Sponsoring Institution in which residents/fellows have some overlapping education and training experiences with the ACGME Rural Track Program residents/fellows and may share resources.


Rural Health Matters

ACGME President and CEO Dr. Thomas J. Nasca joined University of Nebraska Medical Center and University of Nebraska Omaha Chancellor Jeffrey P. Gold, MD on RFD-TV’s Rural Health Matters in April 2021 to discuss the COVID-19 pandemic’s effects on rural America, GME, physician well-being, the current state of the US health care system, and more. In this excerpt, Dr. Nasca describes pathways for new physicians who want to serve rural communities and the role of academic partnerships in providing education to address health care needs.

Journal of Graduate Medical Education (JGME) Articles

Federal Bills Raise Cap on Medicare-Funded Residency Positions and Modify Graduate Medical Education Policies
K. Schleiter et al., August 2021

Rural Residency Training as a Strategy to Address Rural Health Disparities: Barriers to Expansion and Possible Solutions
E.M. Hawes et al., August 2021

Cultivating Healthy Governance in Rural Programs
R. Longenecker et al., April 2021

Rural Workforce Years: Quantifying the Rural Workforce Contribution of Family Medicine Residency Graduates 
P. Meyers et al., December 2020

A Roadmap to Rural Residency Program Development
E.M. Hawes et al., August 2020

Developing Graduate Medical Education Partnerships in American Indian/Alaska Native Communities
M.A. Sundberg et al., December 2019

Community Health Center Engagement and Training During Obstetrics and Gynecology Residency
A.Y. Cheng et al., October 2019

Preparing Physicians for Rural Practice: Availability of Rural Training in Rural-Centric Residency Programs
D.G. Patterson et al., October 2019

International Medical Graduates in the US Physician Workforce and Graduate Medical Education: Current and Historical Trends
A.A. Ahmed et al., April 2018

A Free Clinic Continuity Experience During Residency Is Associated With Practice in Underserved Areas
S.M. Petrany et al., October 2017

Teaching Health Center Graduate Medical Education Locations Predominantly Located in Federally Designated Underserved Areas
S.C. Barclift et al., May 2016

Boston Health Care for the Homeless Program – Harvard Dermatology Collaboration: A Service- Learning Model Providing Care for an Underserved Population
J. Sheu et al., December 2014

Impact of Global Health Experiences During Residency on Graduate Practice Location: A Multisite Cohort Study
W. Liaw et al., September 2014

Rural Primary Care Physician Workforce Expansion: An Opportunity for Bipartisan Legislation
R.E. Rieselbach et al., December 2013

A Pilot Curriculum to Integrate Community Health Into Internal Medicine Residency Training
J. Catalanotti et al., December 2013

Resident Education in Free Clinics: An Internal Medicine Continuity Clinic Experience
A.T. Pincavage et al., June 2013

An Experiential Community Orientation to Improve Knowledge and Assess Resident Attitudes Toward Poor Patients
E.A. Wallace et al., March 2013

County Jail as a Novel Site for Obstetrics and Gynecology Resident Education
C.B. Sufrin et al., September 2012

Residents’ Attitudes and Behaviors Regarding Care for Underserved Patients: A Multi-Institutional Survey
M.L. Wieland et al., September 2011

An International Health Track Is Associated With Care for Underserved US Populations in Subsequent Clinical Practice
A.W. Bazemore et al., June 2011

Reflective Practice and Competencies in Global Health Training: Lesson for Serving Diverse Patient Populations
J. Castillo et al., September 2010