October 2002 • Volume 8 • Number 10 |
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Title VII is under threat. The specialty's federal funding for family practice training comes from Title VII of the Public Health Service Act, and the administration and Congress are hacking away at the funds. Your help is needed to try to stave off severe budget cuts.
For fiscal year 2002, Title VII received $295 million. The Senate Appropriations Committee voted this summer for only $160 million for Title VII in FY 2003. And the House Appropriations Committee was expected to make a similar or lower recommendation last month.
The specialty's leaders fear Congress may even take the route recommended by the Bush administration (and prior administrations): zero funds for Section 747 of Title VII -- the section supporting family practice and other primary care training programs. For FY 2002, $93 million was reserved for Section 747 programs, with about half those funds supporting family practice training.
What would $0 mean?
"We'll be severely affected if our Title VII funds disappear," said Carlos Jaen, M.D., chair of the family and community medicine department at the University of Texas Health Science Center at San Antonio.
The department has all four types of Title VII grants -- for predoctoral training, residency training, faculty development and the academic unit. The support amounts to $700,000 per year or 12 percent of the department's budget, said Jaen.
"The predoctoral resources are allowing us to develop a family practice clerkship in collaboration with pediatrics and internal medicine in a regional academic health center in the lower Rio Grande Valley, one of the most underserved areas in the country," said Jaen. "Our students there deal with severe medical need and border health issues. Many students work in community health centers that don't discriminate on the basis of nationality -- the students are getting excellent training there."
The family practice department at the University of Vermont, Burlington, relies heavily on Title VII. "Our predoctoral and residency grants provide us with a tremendous ability to 'buy' faculty out of practice," said John Fogarty, M.D., department chair. "This year, we have a little over $200,000 in Title VII funds, about 20 percent of our department's budget, which is separate from our clinical budget."
Fogarty described the remote learning model his department set up a few years ago through Title VII funds, a model that's now part of the medical school's revised curriculum. The federal funding helped pay for laptops for students who took family medicine clerkships at remote sites in Vermont and Maine. "The students did problem-based case studies by laptop and could contact the author of the studies on the Web. The students also taught computer skills to some of their preceptors, improving their access to e-mail and the Web -- it's been a wonderful interchange," said Fogarty.
Richard Brunader, M.D., directs the family practice network at the University of California, Davis. The network is composed of seven community-based family practice residencies affiliated with the university. In one Title VII-supported project, the network is testing how well the residents are learning about asthma. "Our programs are doing different types of teaching interventions on asthma," said Brunader. One program is simply giving its residents personal digital assistants so they can obtain clinical information at the point of patient contact. Another has set up an asthma clinic the residents can work in. Still another combines didactic teaching with a day of treating patients with asthma.
"I think the study will show that when you lecture and reinforce it in clinic, at the end of the day, the residents really have it down," said Brunader.
He added, "I believe half of the family practice residencies in the country get some Title VII funds. If Title VII support were eliminated, I would not be surprised to see program closures."
Why so little support?
There are reasons for the drought of support for Title VII.
Some former Title VII champions on congressional appropriations committees have moved on to other committees. Even though the specialty has found new supporters on both sides of the aisle, they don't have the seniority of the earlier proponents, said AAFP EVP Douglas Henley, M.D.
As in the past, the Office of Management and Budget claims there is no proof Title VII has been effective in improving health care for the nation. "We have data from the Robert Graham Center in Washington, showing Title VII has increased the supply of primary care physicians, especially family physicians, in shortage areas," said Henley. "It's frustrating not to have OMB's backing, now that we've got research on Title VII's impact."
He added, "It appears HHS and its Health Resources and Services Administration -- which administers Title VII grants -- are not backing Title VII."
What's AAFP doing?
What can you do?This month, the House and Senate are expected to vote on their committees' recommendations. So this month is prime time to ask lawmakers to protect the Title VII funding for the specialty. Here's how to seek support for Title VII:
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To help bolster HRSA support for family practice training, Henley and other senior staff members scheduled a meeting with the head of HRSA for late last month. "The administration clearly intends to beef up Title VIII, for nursing education, but that doesn't mean it should let Title VII slip," said Henley.
The Academy also is lobbying Congress, trying to defend the funds that make possible the training described above.
AAFP leaders and staff have stormed Capitol Hill to argue Title VII's case. Family physicians who serve as key contacts with legislators have asked their lawmakers to defend the funds. About 200 family physicians have used AAFP's Speak Out: Legislative Action Center to send their lawmakers e-mails seeking support for Title VII.
And AAFP chapters in the states of lawmakers on the Appropriations Committees have issued statewide alerts on Title VII to chapter members. "These alerts, asking members to contact their lawmakers, have been highly successful," said Kevin Burke, director of the Government Relations Division. "But the country's facing hard times economically, and we fear the specialty's Title VII funds may get the budget axe."
The Academy took out an ad (depicted above) in the Sept. 9 and Sept. 12 Roll Call, a newspaper distributed to all congressional offices and widely read in Washington. The ad noted counties that are already short on primary care physicians -- counties that just happen to be in Appropriations Committee members' jurisdictions.
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Copyright © 2002 by
American Academy of Family Physicians.