Title VII Funding, Primary Care Research Focus of FP Testimony Before House Subcommittee

Congress should strengthen the nation's primary care infrastructure by providing additional funds for Title VII primary care education grants and setting aside more money for primary care research, according to FP Jerry Kruse, M.D., M.P.H., of Quincy, Ill., who testified before a House appropriations subcommittee here on March 18.

Kruse, who is a professor and chair of the family and community medicine department at Southern Illinois University, told the House Appropriations Labor/HHS/Education Subcommittee that primary care is an "essential foundation of a well-performing health system. So for the best health care system, we need to train more family physicians."

During the past three years, only 15 percent of U.S. medical school graduates chose careers in primary care, one-third of the number needed, said Kruse, who testified on behalf of the Academic Family Medicine Advocacy Alliance.

According to Kruse, Title VII primary care education grants, along with funding for primary care research at the Agency for Healthcare Research and Quality, or AHRQ, and NIH are essential components to producing more primary care physicians. He pointed out that the Institute of Medicine, or IOM, the Government Accountability Office and the Medicare Payment Advisory Commission all have testified to the fact that these programs are effective but undervalued.

Kruse called on Congress to provide an annual appropriation of $215 million for Title VII's primary care medicine and dentistry cluster and a base funding level of $405 million for AHRQ. "The IOM believes AHRQ is critical to retooling the American health care system," said Kruse.

He also called for increases in NIH funding directed toward primary care research and population-based translational research. This type of research is "key to building the type of practice that attracts and supports family physicians," said Kruse.

"As the U.S. moves toward major health care reform, we urge the subcommittee to support programs that emphasize an increased supply of family physicians and that emphasize primary care research," he added.

During the past six years, the federal government has doubled funding for community health centers, or CHCs, by $2 billion; the recently enacted American Recovery and Reinvestment Act, or ARRA, provides a one-time infusion of $1.5 billion for CHCs.

Although this is laudable, said Kruse, funding for Section 747 of Title VII -- the only federal grants for training family physicians -- has been cut by 55 percent, making it difficult to adequately staff CHCs with trained primary care physicians.

"Do you think that new sports stadiums would be built if there were not a pipeline of players and coaches to fill the seats?" asked Kruse. "No, of course not. Likewise, funding for CHCs must be accompanied by corresponding significant increases in funding to train family physicians."

The ARRA provides $200 million for primary care and other health care professionals trained through Title VII and Title VIII, but it gives the director of the Health Services and Resources Administration discretion to determine how to allocate the money.

"We don't know how much of the $200 million available will be distributed to primary care medicine and dentistry," said Kruse.