Article Figures & Data
Figures
- Figure 1
Title VII funding levels, adjusted to 2008 dollars.
Reprinted with permission from Fitzhugh Mullan. Data source: Health Resources and Services Administration.22
Tables
Specific Area of Strategic Funding Annual Funding Level Focus Within Strategic Funding Area Investment in community-based training and longitudinal experiencesa $200 million Residency position creation and maintenance, 2000 residency positions in community-based sites and Teaching Health Centers $100 million Expansion of undergraduate medical education training to create longitudinal experiences, financially support those relationships in the community, and create school-based or AHEC resources to support them $30 million Support for Rural Training Tracks; undergraduate and graduate level Expand primary care faculty $50.5 million 50 faculty development fellowships annually ($200,000 each to offset salary, benefits, fellowship support, travel), support for a full FTE faculty position at each medical school (150 schools, $270,000 salary, benefits, overhead) Establish high-functioning academic ambulatory practice models for training $100 million $500,000 in ongoing support, 200 sites; to support infrastructure and team-based training Reconnect training hospitals to their communities $50 million Grants to involve trainees and faculty in community evaluation, description, priority-setting, intervention, and evaluation Innovation grants $25 million 10–20 grants annually to test new models of training, population management, and community engagement; support rigorous evaluation Evaluation, analysis, data management $4.5 million Funding for evaluation and analysis of Title VII outcomes, data platforms to support impact assessments, and accountable transparency Total $560 million -
AHEC = Area for Health Education Center; FTE = full-time equivalent.
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↵a The primary care residency expansion program requires about $50,000,000 annually to maintain at current levels; likewise, the Teaching Health Center Program requires about $50,000,000 annually to maintain at current levels. This estimate seeks to double the expansion.
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The Article in Brief
The Next Phase of Title VII Funding for Training Primary Care Physicians for America's Health Care Needs
Robert L. Phillips, Jr , and colleagues
Background Health reform will add millions of Americans to the ranks of the insured; however, their access to health care is threatened by a deep decline in the production of primary care physicians. Poorer access to primary care risks poorer health outcomes and higher costs. Meeting this increased demand requires a major investment in primary care training, but Title VII, section 747 of the Public Health Service Act, which is intended to increase the quality, quantity, and diversity of the primary care workforce, has been severely cut during the past two decades. This article describes the shrinking production of primary care physicians and its adverse consequences for the health of the US population.
What This Study Found To revitalize the national primary care workforce and ensure access to care after the passage of the 2010 Patient Protection and Affordable Care Act, policy makers should increase funding for Title VII. New and expanded Title VII initiatives are required to increase the production of primary care physicians; establish high-functioning academic, community-based training practices; increase the supply of well-trained primary care faculty; foster innovation and rigorous evaluation of these programs; and ultimately to improve the responsiveness of teaching hospitals to community needs. Failure to launch a national primary care workforce revitalization program would put the health and economic viability of the United States at risk.
Implications
- The authors call on the US Congress to increase funding for Title VII, Section 747 roughly 14-fold to $560 million annually-a small investment in light of the billions that Medicare currently spends to support graduate medical education.
