Statement for the Record on FY 2005 Funding Levels for Section 747, AHRQ & Rural Health Programs submitted to Senate Appropriations Subcommittee on L-HHS-E

Senate Appropriations Subcommittee on Labor/Health and Human Services/Education

FY 2005 Funding Levels for Sections 747 Primary Care Medicine and Dentistry Cluster Agency for Healthcare Research and Quality Rural Health Programs

The 93,700-member American Academy of Family Physicians submits this statement for the record in support of the Section 747 Primary Care Medicine and Dentistry Cluster. The Academy also supports the Agency for Healthcare Research and Quality (AHRQ) and rural health programs.

Section 747 is the only national program that funds family physician training and includes dollars for general internal medicine/ general pediatrics; physician assistants and general/ pediatric dentistry. The FY 2004 spending bill provides only $82 million to Section 747, a figure that is $10 million below the FY 2003 levels. The Congressionally established Advisory Committee on Training in Primary Care Medicine and Dentistry (ACTPCMD) recommends $198 million for Section 747.

Background
Section 747 supports family medicine training programs in medical school and in residency programs. It is specifically designed to meet two goals: increase the number of primary care physicians, and boost the number of people who will provide care to the underserved. The Institute of Medicine defines primary care physicians as family physicians, general internists and general pediatricians.

Family physicians provide comprehensive, coordinated and continuing care to patients of both genders and all ages and ethnicities, regardless of medical condition. These residency-trained, primary care specialists treat babies with ear infections, adolescents who are obese, adults with depression and seniors with multiple, chronic illnesses. And because they focus on prevention, primary care, and integrating care for patients, they are able to treat illnesses early; cost-effectively and when necessary, help patients navigate our complex health system and find the right subspecialists.

Section 747 funding has led thousands of physicians to go into primary care and family medicine and serve millions of patients. A study by the Robert Graham Center for Policy Studies showed that medical schools that received Section 747 family medicine funds produced more medical students who:

The study showed that continued funding during the years of medical school training had more of a positive impact than intermittent funding.

Another Graham Center report revealed that more Americans depend on family physicians than any other medical specialty: without family physicians, the majority of US counties would become Primary Care Health Professions Shortage Areas. Of the 3142 counties in the United States, 1184 (38 percent) are full or partial county HPSAs, which includes more than 41 million Americans.

However, the health professions programs have been under fire for many years, and, as a result, funding has been threatened during several fiscal cycles. For example, the Administration’s FY 2005 budget would eliminate funding for Section 747 and cuts funding severely for Title VII. Reasons differ for these cutbacks, but center mainly around disagreements regarding the long-term role of the federal government in training physicians, and uncertainty about program outcomes and effectiveness.

Most recently, the Office of Management and Budget (OMB) attempted to express these arguments in the 2003 Program Assessment Rating Tool (PART). In that document, OMB criticized all of the Title VII Health Professions programs as lacking a focused objective. However, Section 747, in particular, has a clear purpose and has been successful in achieving its goals. The OMB evaluation lumps all of the programs together and does not evaluate them individually. By definition, these programs will have different goals, different levels of effectiveness and different histories, making the PART evaluation unsophisticated, at best. Additionally, since the federal government has been struggling with a budget shortfall, programs with the slightest amount of negative attention have been tempting targets for budget cutbacks.

Nonetheless, these training programs still enjoy a great deal of support from members of the Appropriations Committees in both the Senate and House, which the Academy appreciates. And, with the exception of the FY 2004 spending bill, Congress has consistently restored funding for these programs.

The Academy strongly believes that the federal government must maintain appropriate funding for Section 747 family medicine training programs. The rationale for this comes from two sources: the steady reliance on family physicians in the current US healthcare system and the Academy’s new proposal to restructure future Section 747 family medicine training programs for the coming healthcare system. In short, family physicians are key to a modern healthcare system and more money is needed to modernize their training.

The Academy supports the Administration's commitment to funding increases to build more Community Health Centers (CHC) and supplement the National Health Service Corps (NHSC). However, we believe that increasing funding for CHCs and the NHSC is only a partial solution. Without support for family physician training, there will be fewer of the physicians who work in these centers or practice in underserved areas. Thousands of family physicians will be needed if the growth in the number of CHCs sites and NHSC staff is to be realized.

Specifically, nearly half of the physicians who staff the nation’s Community Health Centers are family physicians. And, since 1971, the National Health Service Corps has placed more than 18,000 health care providers in underserved areas: almost half of the NHSC doctors were family physicians. Finally, according to data from the National Association of Community Health Centers, in 2002, the majority of CHC employees were primary care physicians who were responsible for almost 22 million patient visits.

Unlike all other developed countries, the US does not have a primary care-based health care system. While other developed countries have about equal numbers of primary care doctors and subspecialists, less than one-third of the US physician workforce is primary care doctors (including family physicians). As a result, about 2/3 of the US physician workforce is made up of subspecialists.

In addition, compared to those in other developed countries, we spend the most per capita on healthcare but have the worst healthcare outcomes. More than 20 years of evidence have shown that a primary care-based health system produces greater health and economic benefits. Boosting support for Section 747, which funds training for family physicians and for other primary care disciplines, could allow patients in the US to enjoy those benefits.

Specifically, research reveals that primary care is effective: leading to reduced all-cause mortality and mortality due to cardiovascular and pulmonary diseases; less emergency department and hospital use; better preventive care; better detection of breast cancer, and reduced incidence and mortality due to colon and cervical cancer. Studies have also shown proof of efficiency: fewer tests; higher patient satisfaction; lower medication use and lower care-related costs. Finally, the data indicates that primary care promotes equity among different populations: health disparities are reduced, particularly for areas with the highest income inequality, resulting in improved vision, more complete immunization, better blood pressure control, and better oral health. Supporting Section 747 family medicine training would produce more family physicians, physicians who are cost-effective and provide high quality care.

The Academy recommends $443 million for the Agency for Healthcare, Research and Quality (AHRQ). AHRQ conducts primary care and health services research geared to physician practices, health plans and policymakers that helps the American population as a whole. In short, the agency translates research findings from basic science entities like the National Institutes of Health (NIH) into information that doctors can use every day in their practices. Another key function of the agency is to support research on the conditions that affect most Americans.

Congress has provided billions of dollars to the National Institutes of Health, which has resulted in important insights in preventing and curing major diseases. AHRQ takes this basic science and produces information that physicians can use every day in their practices. AHRQ also distributes this information throughout the health care system. In short, AHRQ is the link between research and the patient care that Americans receive.

For example, research shows that that beta blockers reduce mortality. AHRQ supported research to help physicians determine which patients with heart attacks would benefit from this medication.

AHRQ Supports Research on Conditions Affecting Most Americans
Most typical Americans get their medical care in doctors’ offices and clinics. However, most medical research comes from the study of extremely ill patients in hospitals

AHRQ studies and supports research on the types of illness that trouble most people. In brief, AHRQ looks at the problems that bring people to their doctors every day – not the problems that send them to the hospital.

For example, AHRQ supported research that found older antidepressant drugs are as effective as new antidepressant medications in treating depression, a condition that affects millions of Americans.

In addition, the new Medicare law also directs the agency to study the "clinical effectiveness and appropriateness of specified health services and treatments." While the law authorizes $50 million for this effort, the Academy supports the $75 million figure that is included in the Senate budget resolution.

Moreover, the law asks the agency to establish a new "Citizens' Health Care Working Group," to initiate a nationwide public debate about improving the health care system with the goal of providing every America high quality and affordable health care coverage. The AAFP also supports funding for this new commission.

Continued funding for rural programs is vital to provide adequate health care services to America's rural citizens. We support the Federal Office of Rural Health Policy; Area Health Education Centers; the Community and Migrant Health Center Program; and the NHSC. State rural health offices, funded through the National Health Services Corps budget, help states implement these programs so that rural residents benefit as much as urban patients.

The Academy urges Congress to increase funding for Section 747 family medicine training (the Advisory Committee on Training in Primary Care Medicine and Dentistry $198 million for Section 747); $443 million for AHRQ and support for rural health programs. Federal support is vital to sustain and improve America's health care system.