Budget Requests for Physician Training Programs Are Focus of AAFP Testimony to Congress

March 27, 2013 11:35 am News Staff

The AAFP is urging Congress to invest in the nation's primary care workforce by providing adequate funding levels in the 2014 fiscal year budget for programs that are vital to the education and training of family physicians.

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In written testimony(5 page PDF) submitted to the House Appropriations Subcommittee on Labor, Health and Human Services, and Education, the AAFP reminded lawmakers that the United States faces a shortage of primary care physicians at the same time that millions more patients may be gaining access to the health care system as a result of health care reform.

The number of office visits to primary care physicians totaled 462 million in 2008 and is expected to reach 565 million in 2025, an increase that will require nearly 52,000 additional primary care physicians, said the AAFP, citing a 2012 study in the Annals of Family Medicine(www.annfammed.org).

According to the AAFP, the Health Resources and Services Administration (HRSA), the agency charged with administering the nation's health professions education and training programs, will need at least $7 billion in the fiscal year 2014 appropriations budget to meet increasing patient demand. The Academy also called for specific funding amounts for several HRSA-administered education and training programs, including

story highlights

  • The AAFP is urging Congress to invest in the nation's primary care and family physician workforce by providing adequate funding for programs that are key to producing enough primary care physicians to meet increasing patient demand.
  • In written testimony to a House Appropriations subcommittee, the AAFP stressed the importance of investing in primary care programs as the health care reform law creates a greater demand for primary care physicians and services.
  • In its testimony, the AAFP spells out the need for each of the requested budget amounts.
  • at least $71 million for primary care training authorized under Section 747 of the Public Health Service Act, which is the only federal program providing funds specifically to academic departments and programs to increase the number of primary care physicians;
  • $10 million for teaching health centers development grants;
  • $4 million for rural physician training grants;
  • $122.2 million for the Office of Rural Health programs;
  • at least $305 million for the National Health Service Corps (NHSC);
  • $120 million for the Primary Care Extension Program;
  • $3 million for the National Health Care Workforce Commission; and
  • $430 million for the Agency for Healthcare Research and Quality.

In its testimony, the AAFP provided a brief justification for each of the requested budget amounts, saying, for example, that "failure to provide adequate funding for the Title VII, Section 747 Primary Care Training and Enhancement program will destabilize education and training support for family physicians."

"Between 1998 and 2008, in spite of persistent primary care physician shortages, family medicine lost 46 training programs and 390 residency positions, and general internal medicine lost nearly 900 positions," the AAFP said.

The Academy pointed out how the various training and education programs are interrelated and interdependent in some respects. For example, the AAFP cited a study in the Annals of Family Medicine(www.annfammed.org) that says physicians who work with the underserved in community health centers and the NHSC are more likely to have trained in Title VII-funded programs.

"Title VII primary care training grants are vital to departments of family medicine, general internal medicine and general pediatrics; they strengthen curricula; and they offer incentives for training in underserved areas," the AAFP said.

The Academy also told lawmakers that it supports the training of primary care residents in nonhospital settings, which is where most primary care is delivered. "Federal financing of graduate medical education has led to training mainly in hospital inpatient settings, even though most patient care is delivered outside of hospitals in ambulatory settings," said the AAFP, adding that "the teaching health center program (authorized as part of the Patient Protection and Affordable Care Act) provides resources to any qualified community-based, ambulatory care setting that operates a primary care residency."

In its testimony, the AAFP discussed the role of the NHSC in providing primary care in underserved areas, saying that the NHSC "recruits and places medical professionals in health professional shortage areas to meet the need for health care in rural and medically underserved areas."

"The NHSC provides scholarships or loan repayment as incentives for physicians to enter primary care and provide health care to Americans in health professional shortage areas," the AAFP said. "By addressing medical school debt burdens, the NHSC also helps to ensure wider access to medical education opportunities."