Graham Center Policy One-Pager

Title VII's Decline: Shrinking Investment in the Primary Care Training Pipeline


Am Fam Physician. 2009 Oct 15;80(8):872.

Title VII, Section 747 is a source of federal funding intended to strengthen the primary care workforce. Despite evidence that Title VII has been successful, its funding has declined over the past three decades, threatening the production of primary care physicians.

Title VII, Section 747 of the Public Health Services Act is intended to increase the quality, quantity, and diversity of the primary care workforce, with special emphasis on increasing capacity to care for the underserved. It supports the development of innovative primary care curricula and programming at the medical school, residency, fellowship, and departmental levels.

The nation's physician training pipeline is steadily producing fewer primary care physicians. The number of graduating U.S. allopathic medical students choosing primary care declined steadily over the past decade, and the proportion of minorities within this workforce remains low.1,2

Title VII is associated with increased primary care physician production and practice in underserved areas.3,4 Despite this, funding has declined since 1978 (see accompanying figure).5,6

View/Print Figure


Total appropriation of Title VII funding over time, adjusted to 2008 dollars.

Information from references 5 and 6.


Total appropriation of Title VII funding over time, adjusted to 2008 dollars.

Information from references 5 and 6.

Access to primary care is in jeopardy. The nation needs renewed or enhanced investment in programs, like Title VII, that support the production of primary care physicians and their placement in underserved areas.

note: The information and opinions contained in research from the Graham Center do not necessarily reflect the views or the policy of the AAFP.

Policy One-Pagers are available from the Graham Center at The Robert Graham Center: Policy Studies in Family Medicine and Primary Care, Washington, DC (telephone: 202-331-3360; fax: 202-331-3374; e-mail:


show all references

1. Klein LS, Ruddy GR, Phillips RL, McCann JL, Dodoo MS, Green LA. Who filled first-year family medicine residency positions from 1991 to 2004? Am Fam Physician. 2005:72(3):392....

2. Lindsay D, Bazemore AW, Bowman R, Petterson S, Green LA, Phillips RL. Will medical school expansion help diversify the physician work-force? Am Fam Physician. 2007:76(1):38.

3. Fryer GE Jr, Meyers DS, Krol DM, et al. The association of Title VII funding to departments of family medicine with choice of physician specialty and practice location. Fam Med. 2002:34(6):436–440.

4. Rittenhouse DR, Fryer GE Jr, Phillips RL Jr, et al. Impact of Title VII training programs on community health center staffing and national health service corps participation. Ann Fam Med. 2008:6(5):397–405.

5. U.S. Department of Health and Human Services. Advisory Committee on Training in Primary Care Medicine and Dentistry. Comprehensive review and recommendations: Title VII, Section 747 of the Public Health Service Act. November 2001. Accessed September 4, 2009.

6. Departments of Labor, Health and Human Services, and Education, and related agencies. Appropriations bills: Public Laws 107–116 and 109–149; H.R. 5647, H.R. 3043, and S.3230. Fiscal years 2002–2009.



Copyright © 2009 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions

More in AFP

Editor's Collections

More in Pubmed


Jul 2021

Access the latest issue of American Family Physician

Read the Issue

Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article