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Am Fam Physician. 2010;81(2):132

Author disclosure: Drs. Rittenhouse and Grumbach hold an academic appointment in a department that receives Title VII training funds.

Community health centers (CHCs) and the National Health Service Corps (NHSC) are essential to a functioning health care safety net, but they struggle to recruit physicians. Compared with physicians trained in residency programs without Title VII funding, those trained in Title VII-funded programs are more likely to work in CHCs and the NHSC. Title VII funding cuts threaten efforts to improve access to care for the underserved.

Since 1972, federal Title VII, Section 747 primary care training grants to medical schools and residency programs have aimed to increase the number of physicians who select primary care specialties and work in underserved areas. These grants help establish and maintain departments of family medicine, general internal medicine, and general pediatrics; strengthen primary care curriculum; and offer incentives for training in underserved areas. Previous analyses have shown that the grants are fulfilling their objectives.1,2 A recent study found that physicians who work with the underserved in CHCs and NHSC sites are more likely to have trained in Title VII-funded programs (Figure 1).3

If physicians from Title VII-funded residencies had chosen practices similar to those from nonfunded programs, CHCs would have had as many as 648 additional primary care physician vacancies from 2001 to 2003, doubling CHC vacancy rates. In 2004, there were 644 full-time equivalent vacancies for primary care physicians in CHCs.4 In 2009, more than 3,400 NHSC primary care physician positions were unfilled.5 CHC capacity has expanded rapidly, yet Title VII funding has declined dramatically.6,7 Federal efforts to enhance access to care may fail without better funding of the primary care pipeline through programs such as Title VII.

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

This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

A collection of Graham Center Policy One-Pagers published in AFP is available at One-Pagers are also available at

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