Rebuild Primary Care-Based System with Health Professions Grants, Family Medicine Organizations Tell Obama Administration

Thursday, February 19, 2009


WASHINGTON -- The Obama administration can begin to address the primary care physician shortage and improve the efficiency of the U.S. health care system with a single action: allocate $215 million to support primary care medical education through Section 747 of Title VII in the Public Health Services Act.

That action, according to five family medicine organizations, would help fill the educational pipeline with primary care physicians who form the backbone of an efficient, effective health care system and who are most likely to serve the underserved.

“We are grateful to President Barack Obama for making a strong health care workforce a key component of his agenda and recommend that his FY 2010 budget request propose $215 million for primary care training under Title VII, section 747 of the Public Health Services Act,” the organizations state in a Feb. 19 letter to Peter Orszag, PhD, director of the White House’s Office of Management and Budget.

The letter was signed by the American Academy of Family Physicians, the Society of Teachers of Family Medicine, the Association of Family Medicine Residency Directors, the North American Primary Care Research Group and the Association of Departments of Family Medicine.

According to several studies, the key to an efficient, effective health care system is primary care. Reports from the Government Accountability Office and the Medicare Payment Advisory Commission, as well as international research since the 1990s, demonstrate the link between access to primary care and better outcomes and more efficiency.

“Both the Government Accountability Office and the Medicare Payment Advisory Committee have noted research indicating that access to primary care is associated with better health outcomes and lower health care costs,” the letter states. “Yet we have seen a decline in U.S. health care professionals entering primary care.”

In fact, the number of students entering family medicine residency training has fallen from a high of 3,293 in 1998 to 1,172 in 2008, according to National Residency Matching Program data. Fifty-five family medicine residency programs have closed since 2000, while only 28 programs have opened.

That decline has run virtually parallel to declining support for health professions grants under Section 747, which has seen funding decrease from $92.4 million in 2003 to $47.9 million in 2008.

However, the Obama administration can help turn those numbers around by increasing federal support of Section 747. Data demonstrate that schools receiving Section 747 health professions grants graduate a disproportionate number of primary care physicians who go on to work in community health centers and who treat underserved patients during their participation in the National Health Service Corps.

“Increasing the level of federal funding for primary care training would reinvigorate medical education, residency programs, as well as academic and faculty development in primary care to prepare physicians to support the patient centered medical home model,” the organizations write. “ … We strongly urge the President to request in his budget a robust increase in primary care medicine training grant funds if we are to meet the nation’s health care workforce needs.”

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Founded in 1947, the AAFP represents 136,700 physicians and medical students nationwide. It is the largest medical society devoted solely to primary care. Family physicians conduct approximately one in five office visits -- that’s 192 million visits annually or 48 percent more than the next most visited medical specialty. Today, family physicians provide more care for America’s underserved and rural populations than any other medical specialty. Family medicine’s cornerstone is an ongoing, personal patient-physician relationship focused on integrated care.  To learn more about the specialty of family medicine, the AAFP's positions on issues and clinical care, and for downloadable multi-media highlighting family medicine, visit For information about health care, health conditions and wellness, please visit the AAFP’s award-winning consumer website,