A traditional part of educating medical students -- using medical residents and interns -- is absent in the Athens and Gainesville, Ga., areas. But officials said they are working on it, and other forms of clinical teaching can be used if need be, even if it is only until residencies are established.

Last year, the Georgia General Assembly authorized $500,000 to look at establishing residencies in Athens and Gainesville, and the money was used to hire Boston-based ECG Management Consultants.

"We wanted to make sure, before we started moving forward, that the hospitals, the three in the area, understood the complexity," said Ben Robinson, the executive director of the Georgia Board for Physician Workforce.

The three are Athens Regional Medical Center, St. Mary's Health Care System in Athens and Northeast Georgia Health System in Gainesville. The board wanted to make sure the hospitals know the costs, faculty commitments, reimbursement issues and other complications from having residents and interns, he said.

"For us, it was really an educational process more than anything," said Jack Drew, the CEO of Athens Regional.

Then the question became, "Now that you know what it means to run a residency program, are you still interested in continuing to explore it?" Mr. Robinson said. "What they said is, yes they are."

The hospitals want to form a consortium that seeks accreditation, hires faculty and staff and oversees the program, Mr. Robinson said.

"It's just a very efficient way of doing things," Mr. Drew said.

Another study will look at what the actual costs and requirements for residencies would be. The Tripp Umbach report envisions 60 residencies in the Athens area by 2020, but Mr. Robinson said the hospitals have talked about having 90 positions.

"The challenge is, quite frankly, how you manage to cover the costs of it," he said.

Athens Regional is looking forward to have residents around, Mr. Drew said.

"Teaching enlivens an institution in a lot of ways," he said.

That's one reason University Hospital was happy to welcome back MCG residents last year after a few years' hiatus in a relationship that dates back to 1818, said Randolph R. Smith, the chairman of University Health Inc.

"The overall view is, one, to be of help, knowing that's how we got where we are," he said. "We came through that system, many of us rotated through University Hospital. And it was a very positive experience."

Only three residents are back at University, but the hospital recently found it has approval for 14 slots and could increase it to 41 or more, Dr. Smith said.

"We could take more in just about every specialty one could think of," he said.

The Joseph M. Still Burn Center at Doctors Hospital has a rotation by two MCG fellows, said Dr. Fred Mullins, the medical director.

"They mainly do critical-care medicine on the burn patients. They can do a lot of the small, minor procedures; they learn to put in IVs and central lines," he said.

But it's not just what the residents and interns learn -- it's also what they teach the medical students who pass through the same clinics on rotations, Dr. Smith said.

"It's imperative that the interns and residents also pass along their knowledge to the students," he said. "Obviously the key is to have good, strong graduate medical education people ahead of you in order for you to get a good education."

Recognizing that Athens has no residents yet, consultant Paul Umbach said there is no requirement that they be used to teach medical students and that hospitalists -- doctors hired to staff inpatient wards at the hospitals -- could fill that role. But Dr. D. Douglas Miller, the dean of MCG School of Medicine, said the ideal would be the traditional resident-student relationship.

Residency programs are critical to keeping doctors. An oft-cited statistic is that two-thirds of doctors stay in the state where they did their residencies, which led some Georgia legislators to say that increasing residencies should be the way to get more doctors. However, only about half the doctors who did their residency in a state and went to school elsewhere stay in the state of their residency, Mr. Umbach said.

Still, it is another factor for improving the relationship between MCG and University and increasing residencies, Dr. Smith said.

"It's very important to not only have the residents and interns for teaching purposes but also to have them stay in the community," he said.

The Tripp Umbach report called for a minimum increase of 104 residencies by 2020: Augusta would increase by 11 from 429 to 440; Savannah would grow by 22 from 118 to 140; and Albany would get 11 more to go from 19 to 30.

Mr. Robinson said it was imperative that residencies increase with medical school enrollment to retain those doctors.

Otherwise, "you're training North Carolina's doctors," he said.