AAFP Member Defends Title VII Funding in Face of Possible Cuts

As Congress debates future funding levels for Title VII of the Public Health Service Act, AAFP member John Franko, M.D., arrived on Capitol Hill to defend the program against possible cuts, explaining its importance in sustaining and strengthening the nation's primary care workforce during a March 23 Capitol Hill briefing.

"There is a consistent body of evidence out there that says not only does Title VII improve and increase the primary care workforce, (the program) puts that primary care workforce into play in medically underserved areas," said Franko, who is professor and chair of the department of family medicine in the Quillen College of Medicine at East Tennessee State University in Johnson City, during a briefing sponsored by the Health Professions and Nursing Education Coalition.

The House recently passed a spending bill that would result in deep cuts in Title VII programs, which added urgency to Franko's call for increased Title VII funding.

Franko pointed out that the number of medical students choosing a career in primary care started to decline as funding for Title VII dropped during the late 1990s and early 2000s. Section 747 of Title VII is the only federal program that provides funds specifically to academic departments and programs to increase the number of primary care health professionals.

"I am not suggesting a cause-and-effect relationship," said Franko, who appeared as part of a two-member panel along with Juliann Sebastian, Ph.D., R.N., professor and dean of the University of Missouri College of Nursing. "But it is certainly curious that as Title VII funding has significantly declined in adjusted 1984 dollars, the number of U.S. medical students choosing primary care is also declining."

Franko cited research that found exposing medical students to primary care fields increases the likelihood that they will pursue careers in primary care, and that Title VII funds were vital to providing services for underserved and vulnerable populations.

Title VII funding has had specific effects at East Tennessee State University, Franko said. He noted that the university has been a consistent recipient of Title VII funds since establishing family medicine and primary care residency programs in 1978. Title VII funds have allowed the university to establish medical school and residency curriculum programs, as well as administration and faculty development programs, according to Franko.

He also discussed the effects of Title VII programs on students' choice of medical specialty and residents' career choices at East Tennessee State. "(The programs) impact how our residents choose their jobs when they finish their residency. We have been rated No. 7 by the AAFP in terms of the percentage of students who choose family medicine for a career."

In fact, Franko noted, university research that found 83 percent of residents who graduated from East Tennessee State's family medicine residency program between 1978 and 2002 located in medically underserved areas or health professional shortage areas.

The university also has used Title VII funding to help establish health fairs for indigent populations in northwestern Tennessee and southwestern Virginia. The health fairs allow medical students, under the supervision of faculty and staff, to provide health screenings to patients who often do not receive regular health care.

"We have documented over 27,000 patient visits in 11 years," said Franko. "That is 27,000 encounters for patients who would not otherwise have preventive services."

If the United States wants to improve health care quality and reduce costs, it needs to shift the nation's physician pipeline toward family medicine and primary care, said Franko. But he also emphasized the importance of having the right balance of physicians and other health care workers.

"Having that right balance can actually decrease our costs significantly in improving the quality we provide to our patients and (can) help address many of the issues that we are trying to deal with relating to our health care system," he said.

Consequently, Franko also called for increases in Title VIII funding, which supports nursing programs. "Some physicians and, potentially, some nurses may be fainting right now that a physician is recommending (increased funding for) a nursing program," he quipped.

"But we are discovering more and more that health care is a team sport, and unless all of the team members are well trained and all of the team members have the right motivation -- the motivation to take care of folks who needed to be taken care of -- our patients are going to be at a disadvantage."