TITLE VII: REVISITING AN OPPORTUNITY

Through the Health Resources and Services Administration (HRSA), the Title VII (Section 747) Program is an opportunity for residency programs in family medicine to obtain additional financial resources. Specifically, the announcement for this program provides an excellent summary:

The Primary Care Medicine and Dentistry Programs provide grants to public or nonprofit private hospitals, schools of medicine, osteopathic medicine, dentistry, physician assistants and other public or private nonprofit entities that prepare primary care physicians through predoctoral education, residency training, faculty development, and establishment or substantial expansion of academic administrative units. … Funds are also provided for cooperative agreements and contracts to develop, implement and disseminate innovative curriculum.¹

Henderson and Scanlon point out that practitioners who spend part of their training providing care for the underserved are 3 to 10 times more likely to practice in underserved areas.² Medical schools that received Title VII grants during the last 16 years produced twice as many family physicians as schools that did not receive funds.³ As of September 2004, over a 25-year history of the program, 438,000 predoctoral students and 64,000 residents in family medicine, 36,000 residents in general internal medicine and pediatrics, 40,000 physician faculty, 4,500 dental residents, and 61,000 physicians assistants have been trained.⁴

Title VII grants serve as an additional funding source to accomplish many goals including curricular innovation. Early successes included curricular development in geriatrics, family-centered maternity care, sports medicine, third-year family medicine clerkships, rural health, fellowship training, and community-oriented primary care aimed at vulnerable populations affected by HIV, family violence, chronic disease, mental illness, and multicultural issues. Newer areas of creativity include e-commerce for the clinical office, genetics, and innovation spurred by the Future of Family Medicine. According to Freeman and Kruse, “These grants are the foundation for programs that train academic leaders of the future who are more likely to instill in their students an understanding of the importance of personal medical homes and a sense of obligation to serve communities and populations.”⁵ For fiscal year 2007, more than 55 awards totaling nearly $7.9 million were provided to family medicine residency training programs in 28 states.

As noted by Carlisle, a majority of community-based residency programs do not receive Title VII funding.⁶ Since community-based residency programs comprise more than 85% of family medicine residency programs, efforts should be developed to encourage these programs to better take advantage of this funding opportunity. Especially important for these residencies are the possibilities of getting funding for research infrastructure such as contracted research assistants for design and project implementation or contracted statisticians for data management.

Each year, Title VII funds have been under assault. Preservation of the program has been due to the advocacy efforts of the organizations of family medicine and membership under the leadership of Hope Wittenberg, MA, the Academic Family Medicine Advocacy Alliance government relations director. For paying attention to our concerns this year, Hope credits Marcia Brand, PhD, associate administrator of the Bureau of Health Professions, and Marilyn Biviano, director of the Division of Medicine and Dentistry, new to their present positions, but long time supporters of primary care. Because of the President’s veto, issues remain in both the House and Senate FY08 spending bills in which the primary care cluster of Title VII was level funded at $47.998 million. Now any new version needs to preserve or increase the current funding levels.⁷

Scholarly activity can be promoted throughout the entire process—choosing a project, involving residents and faculty, writing the grant and submitting an institutional review board application. Title VII grants are an opportunity to gain additional funding, work cooperatively with other family medicine residency programs/departments, and add to the academic basis of our discipline.

• © 2008 Annals of Family Medicine, Inc.