Title VII Grants Result in Physicians Who Work in Underserved Communities

Primary care training grants from the federal government, which have received less funding in recent years, strengthen the educational pipeline, helping produce primary care physicians who work in underserved areas of the United States. That was the main finding of researchers in a study published in the September/October Annals of Family Medicine.

In fact, physicians who graduated from U.S. medical schools funded under Section 747 of Title VII of the Public Health Service Act were substantially more likely -- by as much as 50 percent -- to be practicing at a community health center, or CHC, in 2001-2003, than physicians who graduated from medical schools without the funding, according to the study.

Section 747 of Title VII provides the only federal grants for training family physicians. Although the Academy and other primary care professional groups have for years advocated increased funding for Title VII, these grants have been cut severely, from $92.4 million in 2003 to $48 million in 2008.

"Research shows an association between Title VII grants to medical schools and increased production of primary care physicians and a greater likelihood that graduates will practice in underserved areas," said Kevin Grumbach, M.D., one of the authors of the study and professor and chair of family and community medicine at the University of California, San Francisco.

The study found that 3 percent of graduates of medical schools that received funding under Title VII worked at CHCs during the study period, compared with 1.9 percent of graduates from schools not funded by Title VII.

Results were similar for Title VII-funded residency programs. The study found that 6.8 percent of family physicians attending Title VII-funded residencies worked at CHCs during the 2001-2003 period, compared with 5 percent of family physicians who attended residencies not funded by Title VII.

"Title VII funding is an important lifeline for many family medicine departments and residency programs," said Robert Phillips, M.D., M.S.P.H., director of the AAFP's Robert Graham Center in Washington, and a study co-author. "It also supports the exposure of medical students to family medicine in many schools.

"This study confirms that (Title VII) funding is significantly associated with staffing of community health centers and the National Health Service Corps, especially for family medicine, and both are important for securing the health care safety net," said Phillips.

The study linked information from the 2004 AMA physician masterfile to the Health Resources and Services Administration, or HRSA, Title VII grants files; Medicare claims data; and data from the National Health Service Corps. It also analyzed information from HRSA's Bureau of Health Professions on Title VII grant awards to academic medical institutions.

The authors wrote that the study findings "suggest that once physicians have made the decision to enter into primary care and family medicine residency programs, they are more strongly influenced in their practice decisions by exposure to Title VII residency grants."