• Teaching Health Centers Funding a Top Priority for 2019

    Oooooooklahoma, where the four-peat is so, so sweet! For my Alabama friends, a gentle reminder of 2014.

    The midterm elections are finally complete. When the U.S. Congress convenes on Jan. 3, 2019, Republicans will control the Senate with a 53-47 majority and Democrats will control the House of Representatives with a 235-200 majority.

    Note that in an Oct. 23 post, your humble author predicted the following:

    • House of Representatives: 235 Democrats, 200 Republicans
    • U.S. Senate: 52 Republicans, 48 Democrats

    Not too shabby, if I say so myself! But I think I will keep my day job, so let's focus on health policy. The composition of the 116th Congress is set, and it is now time to roll up our sleeves and get to work on the AAFP's legislative priorities.

    As I have noted multiple times in this blog, the AAFP has a broad policy agenda that reflects the diversity of the discipline and our membership. Family medicine is unique among physician specialties in its comprehensive scope, variation in service sites and types of practice, and geographic distribution of our members.

    The AAFP has four strategic priorities:

    • payment reform,
    • practice transformation,
    • workforce and
    • clinical expertise.

    Within each of these priority areas are numerous objectives and goals that measure and make actionable the strategic priorities. During the next several weeks, I am going to take deeper dives into a few of the objectives and goals we see as most promising, from a legislative perspective, in the 116th Congress.

    I'll start with the Teaching Health Center Graduate Medical Education (THCGME) program. The THCGME program is central to our workforce strategic priority and is an identified pathway to our objective of increasing the number of residency training positions for family physicians.

    The THCGME program was initially established and funded for five years as part of the Patient Protection and Affordable Care Act in 2010. It was reauthorized and funded for two additional years as part of the Medicare Access and CHIP Reauthorization Act in 2015, and in 2017, Congress reauthorized and funded the program for two more years. The THCGME program is set to expire on Oct. 1, 2019, unless Congress acts to reauthorize and fund it.

    It is hard to identify a public policy that has been more successful during the past decade than the THCGME program. In its first eight years, the program grew from supporting 63 residency positions to more than 700 residency positions in the 2017-18 academic year. Today, there are 59 THCGME programs in 27 states. Of the residents currently training in a THC program, more than 450 (58 percent) will be family physicians.

    The successes of the program continue to pile up. According to the Health Resources and Services Administration,

    • THCs have produced more than 240 primary care physicians and dentists, including 160 family physicians;
    • 55 percent of THC graduates have established a primary care practice in a medically underserved community; and
    • nearly 20 percent have established a primary care practice in a designated rural community.

    It is important to note that the THC program has done all of this at a fraction of the cost of the legacy hospital-based residency programs. In fact, according to the Council of Academic Family Medicine, THCs represent "less than 0.5 percent of the federal annual outlay committed to training physicians." To put this in perspective, for approximately $600 million during a nine-year period, the THC program has produced, or is in the process of producing, more than 1,000 primary care physicians and dentists -- a majority of whom are establishing practices in some of the most underserved communities in our country.

    The return on investment from this program is indisputable, and that's why the AAFP is so strongly committed to securing its reauthorization and funding. I am a lonely voice on this, but I suggest there is a compelling policy argument to be made for why we should pursue a major expansion of the program, not just its continuation at current levels.

    The AAFP has made the THC program a legislative priority for the 116th Congress, and we will be using all resources available to us to secure, at minimum, reauthorization and funding for the program at its current level. We will also continue to pursue the necessary funding to allow the program to expand to more states and more communities.

    Wonk Hard

    When Congress convenes on Jan. 3, there will be 125 women in its ranks -- the largest number and largest percentage (23 percent) of female legislators in the history of our country. Two states -- Arizona and Tennessee -- elected their first female senators in their history. All told, more than 500 women ran for federal office in the 2018 elections -- a record-breaking number.


    Stephanie Quinn, AAFP Senior Vice President of Advocacy, Practice Advancement and Policy.  Read author bio »


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