Background and Objectives: This study assessed the impact
of the Balanced Budget Act (BBA) of 1997 on family
practice residency training programs in the United
Methods: We surveyed 453 active family practice residency
programs, asking about program closures and new program
starts (including rural training tracks), changes in the
number of residents and faculty, and curriculum changes.
Programs were classified according to their urban or
rural location, university or community hospital setting,
and rural and/or urban underserved mission emphasis.
Results: A total of 435 (96%) of the programs responded.
Overall, the impact of the BBA was relatively small. In
1998 and 1999, nationwide, there were 11 program
closures, a net decrease of only 82 residents, and a net
increase of 52 faculty across program settings and
mission emphasis. The rate of family practice residency
program closures increased from an average of 3.0 per
year between 1988-1997 to 4.8 per year in the 4 years
following passage of the BBA.
Conclusions: The 1997 BBA did not have an immediate
significant negative impact on family practice residency
programs. However, there is a worrisome increase in the
rate of family practice residency closures since 1997. A
mechanism needs to be established to monitor all primary
care program closures to give an early warning should
this trend continue.