Primary Care Training Key to Affordability, Quality and Access

RECOMMENDATION
We recommend an appropriation for the Health Professions Training Programs authorized under Title VII of the Public Health Services Act of at least $300 million, to include $92 million for the Primary Care Medicine and Dentistry Cluster, which will restore this vital program to its fiscal year 2003 level. This cluster received $48.9 million in the FY 2007 spending resolution, but the President’s budget for FY 2008 eliminates Title VII Health Professions Grants, except for $10 million in Scholarships for Disadvantaged Students.

Family Physicians Can Help Increase Quality and Lower Costs in the US
An article in Health Affairs (April 2004) found that states spending more money on Medicare had lower quality of care. The authors suggest that more specialists and fewer primary care physicians mean higher costs and lower quality. A small increase in the number of primary care physicians in a state was associated with a large boost in that state's quality ranking. Without funding for Section 747, fewer family doctors will be available to provide high-quality, lower-cost care.

Health Professions Primary Care Cluster Is Effective: Produces Doctors Who Work in CHCs and Serve in the National Health Service Corps
An unpublished 2006 article from the University of California San Francisco and the Robert Graham Center shows that medical schools that receive primary care training dollars produce more physicians who work in CHC’s and serve in the National Health Service Corps compared to schools without Title VII primary care funding. This finding is particularly true for family physicians.

Without funding for primary care training, fewer family physicians will be trained to work in CHCs and serve in the Corps. Almost 4,000 family physicians and general practitioners exposed to Title VII funding during medical school subsequently chose to work in a CHC. Without this exposure, we would anticipate more than 750 fewer family physicians would have been working in a CHC in 2003. The JAMA article mentioned below shows currently 600 vacancies for family physicians in CHCs. Without Title VII dollars, these data show there would be twice as many vacancies.

Community Health Centers: Understaffed with Shortages of Family Physicians
A March 1, 2006 article in the Journal of the American Medical Association (JAMA), found that in 2004, Community Health Centers (CHCs) were understaffed and could not fill all clinical positions (Rosenblatt, et al.). Rural health centers had more openings that took longer to fill than those in urban areas. More than 13 percent of family physician positions at CHCs were vacant. This is critical since primary care physicians make up nearly 90 percent of doctors working in CHCs -- and most are family physicians.

The President’s FY 2008 budget proposes an increase of nearly $2 billion for CHCs. However, his budget zeroes out Section 747 of the Public Health Service Act, the Primary Care Medicine and Dentistry Cluster, the only federal program that trains family physicians. Without family physicians, CHCs staffing problems will get worse.

Impact of Funding Cuts on Family Medicine Training
In FY06, funding for the Primary Care Medicine and Dentistry Cluster was cut by 54%. The effect was to prevent any new grant applications for that year and to cut the funding of grants in their second or third year. Below are just some examples of the impact of the loss of almost $50 million dollars of federal funding.

University of Iowa: At Iowa, we furloughed 5 individuals (that means let them go) related to our educational and academic mission. We have had to shift funding from other core areas and reduce or eliminate programs that focused mostly on primary care fellowship training, academic development, preceptor education development and travel support to rural Iowa communities. Our department had consistently received about $800,000 to $1,000,000 a year over the last 30 years and now we have none of that support. Paul James, MD, Chair, Department of Family Medicine

University of Buffalo: Here at the University at Buffalo we have laid off a PhD Clinical Psychologist who had been with the Department for 9 years. He participated actively in our clerkship training and in our residency training. He taught both students and residents about helping patients change behaviors (quit smoking, etc) and trained residents in dealing with difficult or non-compliant patients as well as the more difficult and time consuming issues of long term family therapy. We also laid off a master degree medical education specialist. We are the only medical school department to have had a person like this on our staff but she assured that our exams measured the goals of our training and our curriculum taught to these goals. Tom Rosenthal, MD, Chair, Department of Family Medicine

Tufts University, Division of Family Medicine: At Tufts, we hired three minority faculty to increase the diversity of our faculty and now we will have to let go of one of them and reduce the time significantly of the other two because of our loss of funding.

We also have an educational program that teaches students how to interview patients who do not speak English through a medical interpreter. We will have to cut that program as well. Wayne Altman, MD FAAFP

Montana Family Medicine Residency: Many of our successes, including the integration of a top notch primary care mental illness management and collaborative program and a Northern Plains Indian cultural education program, have been possible only through Title VII funding. Our growth as a rather isolated residency – the only one in the state in any specialty, and remote from our affiliated University -- is dependent on grant programs that are specifically designed for family medicine resident training. .….Geographically isolated programs like ours in Montana and also Alaska, and Wyoming also need to develop their own infrastructure… Roxanne Fahrenwald MD, Director, Montana Family Medicine Residency

University of North Carolina, Department of Family Practice: We cut one of our objectives [in our continuation grant] because there was not enough money to pay for it. It was a session on health disparities that we intended to introduce to all of our clerkship students, and then have them look at the issue during their clinical experience in a practice. The money we had intended to pay for the faculty involved was eliminated and she had to make it up from patient care time. Bob Gwyther,MD

Thomas Jefferson University, Department of Family and Community Medicine: ….Predoctoral - Unable to expand our rural Physician Shortage Area Program (which has successfully increased the rural physician supply in Pennsylvania) to the state of Delaware; and unable to develop and implement new curricula focusing on vulnerable populations in the areas of health literacy, oral health, domestic violence, and medical professionalism. Howard Rabinowitz, MD [This entry was extracted from a longer list of six program areas that were deeply affected by these cuts]