Primary Care Organizations Urge HRSA to Boost Funds for Primary Care Training, Education Grants

The AAFP and four other primary care organizations have sent a letter (3-page PDF; About PDFs) to Mary Wakefield, Ph.D., R.N., the new administrator of the Health Resources and Services Administration, or HRSA, asking her to use money from the economic stimulus bill to double the funds for primary care training and education grants and to open a two-year cycle for primary care medicine training grants.

Although the recently enacted American Recovery and Reinvestment Act, or ARRA, provides $200 million for primary care and other health care professionals trained through Titles VII and VIII of the Public Health Service Act, it gives the new HRSA administrator the discretion to determine how to allocate the funds within the agency.

"As HRSA determines how to allocate the remaining $200 million, we urge you to focus on those training activities and educational research activities that prepare graduates for the realities of future practice," says the March 2 letter, which was signed by AAFP President Ted Epperly, M.D., of Boise, Idaho, as well as by the presidents of the Society of Teachers of Family Medicine, the Association of Family Medicine Residency Directors, the Association of Departments of Family Medicine and the North American Primary Care Research Group.

Section 747 of Title VII provides the only federal grants for training family physicians. Doubling the funds for Title VII would be an important step in helping meet the nation's health care workforce needs, says the letter. It also would serve as an appropriate distribution of economic recovery dollars, which are vital to supporting medical education and training.

"Medical schools that receive primary care training dollars produce more physicians who work in community health centers (CHCs) and serve in the National Health Service Corps (NHSC) compared to schools without Title VII primary care funding," says the letter, citing research published in the September/October 2008 Annals of Family Medicine.

"Community health centers are central to federal efforts to expand access for the underserved," the letter continues. However, despite attempts to double their capacity between 2002 and 2006, CHCs have found it difficult to recruit a sufficient number of primary care physicians, and they suffer from hundreds of vacant positions.

In addition, the primary care organizations are calling for the opening of a new grant cycle, which will allow primary care departments and residency programs to develop training curricula and programs for new models of care, including the patient-centered medical home, or PCMH. The new training efforts are needed as the nation's health care system enters a period of reform focused on access, quality and accountability.

"Although the government and others have been financing demonstrations of the PCMH, less support has been available to transform the training programs where young doctors will learn to practice in this manner," says the letter. "New models require the development of new training programs and the ability to evaluate those new programs."

Funding is needed to support development, evaluation and personnel in these programs, the letter states. "… we know that the release of these funds into the departments and residency programs would increase the number of students choosing primary care careers."

The letter compares medical schools and residency programs with other employers across the country, noting that some of these programs are at risk of losing faculty and staff members. "These new grants can help employ people that might otherwise have to be laid off."

In addition, says the letter, graduates who enter into primary care practice help grow the economy of their practice region. According to a 2003 study by the AAFP's Robert Graham Center, the average family physician had a positive economic impact of more than $900,000 on his or her local community.