Primary Care Training Programs Headed for Level Funding in FY '08

On June 21, the Senate Appropriations Committee passed a fiscal year 2008 spending bill that would continue funding Title VII primary care training programs at current levels, greatly increasing the chances that Congress overall will approve level funding for the programs, according to analysts interviewed by AAFP News Now.

The U.S. Senate Committee on Appropriations funded Title VII of the Public Health Service Act at $184.7 million, with primary care training programs accounting for $48.8 million of that figure, the same amount as was provided in the FY 2007 budget.

The House Appropriations Committee, meanwhile, approved $228.2 million for Title VII in early June, a 23 percent increase over FY '07. However, the House funded primary care training programs at the same level as the Senate.

"Several programs that we value in Title VII were increased," said Hope Wittenberg, director of government relations for the Society of Teachers of Family Medicine, or STFM. "However, the family medicine and dentistry cluster was not increased, even though we believe its value to the nation's physician work force is extremely high. We are disappointed primary care training did not receive an increase."

The Bush administration's FY 2008 budget requests only $10 million for Title VII for scholarships for disadvantaged students and seeks to eliminate funding for the rest of Title VII.

Every administration since the Reagan administration has proposed the elimination of Title VII's primary care training programs. But in the past, presidential administrations proposing the elimination of the programs were confident that Congress would provide funding for Title VII, according to Wittenberg.

"It was kind of a game played between the administration and Congress as a way of balancing the budget," Wittenberg said. "The administration would say, 'We know Congress is going to put this money back because they like Title VII.'"

The Bush administration, however, has described primary care training programs under Title VII as ineffective, making it more difficult to secure funding for the programs, according to Wittenberg. Administration officials are more interested in service delivery programs and not training programs, which may make Title VII expendable in the eyes of administration officials, she added.

"This is not just an academic issue, this is a pipeline issue," said Terrence Steyer, M.D., of Charleston, S.C., who is assistant professor of family medicine at the Medical University of South Carolina in Charleston and chair of the STFM Legislative Affairs Committee. "If we don't have this kind of money to train future family physicians and to train medical students to attract them to family medicine, we are not going to have practicing family physicians out there 10 or 15 years from now."

The Senate Appropriations Committee bill also contained the following provisions: