April 2001 • Volume 7 • Number 4
More funds needed for family practice training, AHRQ, rural programs, says AAFP
AAFP Director James Martin, M.D., of San Antonio recently asked a panel of U.S. representatives to consider life without family doctors.
What difference does an FP or GP make? Martin's answer: Without them, more than two-fifths of the nation's counties would overnight become whole-county primary care health professions shortage areas (see charts below).
By contrast, removing the other three kinds of primary care physicians from their counties would convert only about 6 percent of U.S. counties into new whole-county primary care shortage areas.
"Without family physicians, counties around the United States would not receive essential services," said Martin March 22 to the House Appropriations Subcommittee on Labor, Health and Human Services, and Education.
A recent study by the Robert Graham Center in Washington shows that receipt of Title VII Section 747 funds for family practice training makes a significant difference in medical students' choice of a career in primary care (including family practice), rural practice or a health professions shortage area. "Without Section 747 funding, fewer students would be making these career choices," said Martin.
He addressed the need to turn around the family physician shortage. "Medicare payment policies have contributed to the increase in subspecialist physicians and have fundamentally skewed the market," said Martin. "These policies have promoted training in the expensive inpatient specialties -- rather than in family medicine and other primary care fields. Moreover, National Institutes of Health grants, totaling billions of dollars, go primarily to subspecialist research."
Referring to Congress' interest in diversity in the medical workforce, Martin said 9.5 percent of family practice residents in 1978 were from minority groups, and by 1997, that rate had risen to 24 percent.
Section 747 includes support for family medicine, general internal medicine, general pediatrics, physician's assistants, and general and pediatric dentistry. The AAFP is seeking an increase from $91 million for Section 747 programs in 2001 to $158 million in 2002.
"The Academy is especially pleased by the boost in funding Title VII received for fiscal year 2001," said Martin, referring to the 17 percent increase over the 2000 funding of $78 million.
The AAFP testimony also requests more funds for the Agency for Healthcare Research and Quality and for federal rural programs.
AHRQ. The agency emphasizes primary care research, and Martin highlighted the need for the most effective treatment plans for patients with numerous serious conditions. He gave as an example a patient with diabetes, hypertension, depression, low back pain and heart disease.
"Traditional, disease-specific treatment is not useful in this situation," said Martin. "Treatment for one disease may exacerbate the other conditions."
The Academy is calling for 2002 funding for AHRQ to be set at $400 million, much higher than the 2001 funding of $270 million and the 2000 funding of $199 million.
Rural programs. The Academy is seeking continued support for rural health programs including area health education centers, the programs of the federal Office of Rural Health Policy, the National Health Service Corps, and the Community and Migrant Health Center Program.
The AAFP testimony has also been submitted in writing to the Senate Appropriations Committee.
FP Report is published by the AAFP News Department.
Copyright © 2001 by American Academy of Family Physicians.
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