BY J. MICHAEL BRODIE
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Family medicine training programs seem to have kept most of their federal support -- for now. But the funding dance continues.
Congressional leaders reached a tentative agreement in November on an omnibus appropriations bill that included funding for Title VII, Section 747, of the Public Health Service Act. Section 747 supports training in family medicine, other primary care specialties and dentistry. The House of Representatives passed the omnibus bill Dec. 8, and the Senate was expected to vote on it in late January. The bill contains an $82.2 million Section 747 allocation for fiscal year 2004, a decrease of $10.2 million from 2003.
At one point last year, it appeared the Section 747 funding would be cut entirely, an action the specialty fought for months and managed to prevent.
The threat of losing Title VII is nothing new for family medicine programs, many of which are financially strapped. The administration often zeroes the funds out of the federal budget only to have Congress restore them at the 11th hour.
"There was always a dance," said Patrick Tranmer, M.D., M.P.H., professor of clinical family medicine and chair of the family medicine department at the University of Illinois College of Medicine, Chicago. "We had a history of our funding being restored."
Commenting on the effort to save the 2004 funds, he said, "This feels different (from the past). We have a president and possibly a Congress that are not committed to primary care education. This time we are getting a different message."
What if Title VII dies?
What would happen if Congress one day decided not to step in and support Title VII, and the specialty's federal funds disappeared?
It could be devastating, according to an Association of Departments of Family Medicine survey of its members in January 2003. Sixty departments reported that their very survival would be in jeopardy without the funding. Many also reported experiencing financial difficulties, even with Title VII dollars: Only 22 percent said they broke even, 73 percent said expenses exceeded revenue, and only 5 percent reported operating in the black.
Confirming the dire message the survey results sent, academic leaders talked recently about the possible demise of Title VII funds.
"We've been worried every year for a long time," said Harold Williamson, M.D., M.S.P.H., professor and chair of the family and community medicine department at the University of Missouri, Columbia. He said a total cut in Title VII funding could damage the department's standing within the academic medical community. Williamson said the fellowship program, which gets much of the department's Title VII funding, would be hardest hit if there were no Title VII support.
"We've produced 60 graduates in this fellowship program since it began in 1982. Many serve in academic roles, and six are department chairs," he said. "That program would be shut down."
Jeannette South-Paul, M.D., professor and chair of the family medicine department at the University of Pittsburgh, said, "Loss of all Title VII funds would destroy our faculty development program and seriously affect the quality of teaching programs in our three residencies. Several nonclinical faculty are funded almost entirely through Title VII."
The family medicine program at Ohio State University, Columbus, could lose as many as three full-time faculty positions and several staffers without Title VII support, said AAFP Director Mary Jo Welker, M.D., chair of Ohio State's family medicine department.
Eventually, the dance will end, and the numbers 747 and Title VII will be relegated to memory, Welker said. "Will I keep writing grants in the meanwhile? Yes. Do I think they will last forever? No."
Losing all Title VII funds "would cut $450,000 a year from a $6 million budget -- that would be an 8 percent to 9 percent cut," said John Saultz, M.D., professor of family medicine and assistant dean of the Oregon Health & Science University, Portland, medical school.
OHSU uses the funds to help pay for faculty development activities, residencies and predoctoral programs, Saultz said. One program takes family medicine residents into underserved communities.
"The government doesn't value family medicine education, society doesn't value it. There is a pervasive attitude," Saultz said. "They don't see it as their problem. A lot of people in government see health care as a personal service commodity. They are saying, 'We believe it is not in our best interest for you to have medical care.'"
University of Illinois' Tranmer said government disdain for primary care also exists on the state level, where funds for the Illinois Department of Public Health's Family Practice Resident Training Act were zeroed out by the governor and restored by the state legislature at the last moment. "It took a heartfelt and significant effort to get those funds restored," he said.
Call to action
The department heads interviewed for this article agreed more needs to be done to make the case to legislators that family medicine is a valued component in medical care. For Williamson, it will mean going back to what he does every year -- writing letters to his representatives in Congress, pleading the case for family medicine.
"That's what I'd like to see all FPs do," he said. "This money isn't our only source of funding, but it helps give us a leg up. It's meant for building up our programs."
To reach writer J. Michael Brodie, e-mail mbrodie@aafp.org.
FP Report is published by the
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Copyright © 2004 by
American Academy of Family Physicians.