Article Figures & Data
Tables
- Table 1.
Physicians Attending Title VII–Funded Programs, Working in CHCs and Participating in the NHSC LRP, by Specialty
Characteristic All Specialties No. (%) PCPs Only No. (%) FP/GPs Only No. (%) CHC = community health center; CMS = Centers for Medicare & Medicaid Services; FP = family physician; GP = general practitioner; HRSA = Health Resources and Services Administration; NHSC = National Health Services Corps; LRP = Loan Repayment Program; PCPs = primary care physicians (includes FPs, GPs, general internists, and general pediatricians). a Includes all US physicians who reported their major professional activity as “direct patient care” and who completed residency in 1970 or later. b International and Canadian medical school graduates were excluded because they could not have been exposed to Title VII funds during medical school. c Osteopathic physicians were excluded from residency analyses due to insufficient osteopathic residency data in the AMA Masterfile. General practitioners were excluded from residency analyses because they generally do not undergo full residency training. d Includes all US physicians who completed residency in 1987 or later. International and Canadian medical school graduates were excluded because they are not eligible for the NHSC. Data source: 2004 AMA Physician Masterfile and HRSA Title VII Training Program grantee database; CMS out-patient claims file, 2001, 2002, 2003; and HRSA Bureau of the Health Professions NHSC participant database. Analysis of CHC staffinga Total N for medical school analysisb 412,012 138,197 58,299 Attended Title VII–funded medical school 201,186 (48.8) 78,612 (56.9) 36,326 (62.3) Academic unit grant only 28,363 (6.9) 10,652 (7.7) 4,630 (7.9) Predoctoral grant only 59,535 (14.4) 22,167 (16.0) 10,049 (17.2) Both grants 113,288 (27.5) 45,793 (33.1) 21,647 (37.1) Attended non–Title VII-funded medical school 210,826 (51.2) 59,585 (43.1) 21,973 (37.7) Worked in CHC (2001–2003) 9,943 (2.4) 5,329 (3.9) 3,208 (5.5) Total N for residency analysisc 173,656 59,354 Attended Title VII–funded residency N/A 70,529 (40.6) 25,098 (42.3) Attended non–Title VII-funded residency N/A 103,127 (59.4) 32,256 (57.7) Worked in CHC (2001–2003) N/A 6,759 (3.9) 3,408 (5.7) Analysis of NHSC LRP participationd Total N for medical school analysis 278,975 98,390 41,275 Attended Title VII–funded medical school 192,878 (69.1) 73,405 (74.6) 32,753 (79.4) Academic unit grant only 24,093 (8.6) 8,791 (8.9) 3,624 (8.8) Predoctoral grant only 49,134 (17.6) 17,694 (18.0) 7,657 (18.6) Both grants 119,651 (42.9) 46,920 (47.7) 21,472 (52.0) Attended non–Title VII-funded medical school 86,097 (30.9) 24,985 (25.4) 8,522 (20.6) Participated in NHSC LRP N/A 2,017 (2.1) 1,272 (3.1) Total N for residency analysisc N/A 87,591 34,224 Attended Title VII–funded residency N/A 40,738 (46.5) 14,400 (42.1) Attended non–Title VII-funded residency N/A 46,853 (53.5) 19,824 (57.9) Participated in NHSC LRP N/A 1,678 (1.9) 997 (2.9) - Table 2.
Number (%) of Physicians Attending Title VII–Funded Training Programs That Worked in Community Health Centers (2001–2003) or Ever Participated in the NHSC Loan Repayment Program
Characteristic All Specialties No. (%) PCPs Only No. (%) FP/GPs Only No. (%) CHC = community health center; CMS = Centers for Medicare and Medicaid Services; FP = family physician; GP = general practitioner; NHSC = National Health Service Corps; HRSA = Health Resources and Services Administration; LRP = Loan Repayment Program; PCPs = primary care physicians (includes FPs, GPs, general internists, and general pediatricians). a Includes all US physicians who reported their major professional activity as “direct patient care” and who completed residency in 1970 or later. b International and Canadian medical school graduates excluded because they could not be exposed to Title VII during medical school. c GPs and osteopathic physicians excluded from residency analyses because GPs generally do not undergo full residency training, and because there are insufficient osteopathic residency data in the AMA Masterfile. d Includes all US physicians who completed residency in 1987 or later. International and Canadian medical school graduates were excluded because they are not eligible for the NHSC LRP. e Significant at P <.001 for comparisons between physicians who attended Title VII–funded programs and physicians who attended non–Title VII-funded programs, using χ2 tests. f Significant at P <.05 for comparisons between physicians who attended Title VII–funded programs and physicians who attended non–vTitle VII-funded programs, using χ2 tests. g Significant at P <.01 for comparisons between physicians who attended Title VII–funded programs and physicians who attended non–Title VII-funded programs, using χ2 tests. Data source: 2004 AMA Physician Masterfile; HRSA Title VII Training Program grantee database; CMS outpatient claims file, 2001, 2002, 2003; and HRSA Bureau of the Health Professions NHSC participant database. Physicians that worked in CHCsa Medical school analysisb Attended Title VII-funded medical school 5,934 (3.0)e 3,515 (4.5)e 2,258 (6.2)e Academic unit grant only 847 (3.0)e 506 (4.8)e 301 (6.5)e Predoctoral grant only 1,624 (2.7)e 914 (4.1)e 574 (5.7)e Both grants 3,465 (3.1)e 2,095 (4.6)e 1,383 (6.4)e Attended non–Title VII-funded medical school 4,007 (1.9)e 1,814 (3.0)e 950 (4.3)e Residency analysisc Attended Title VII–funded residency N/A 3,130 (4.4)e 1,698 (6.8)e Attended non–Title VII-funded residency N/A 3,629 (3.5)e 1,710 (5.0)e Physicians that participated in NHSC LRPd Medical school analysis Attended Title VII–funded medical school 1,828 (0.9)e 1,508 (2.1) 1,011 (3.1) Academic unit grant only 204 (0.8) 169 (1.9) 99 (2.7) Predoctoral grant only 494 (1.0)e 413 (2.3)f 292 (3.8)g Both grants 1,130 (0.9 e 926 (2.0) 620 (2.9) Attended non–Title VII-funded medical school 626 (0.7) 509 (2.0) 261 (3.1) Residency analysisc Attended Title VII–funded residency N/A 891(2.2)e 524 (3.6)e Attended non–Title VII-funded residency N/A 787(1.7) 473 (2.4) - Table 3.
Logistic Regression Analysis of the Effects of Physicians Attending Title VII–Funded Training Programs and Work in Community Health Centers (2001–2003)
Characteristic All PhysiciansaOR (95% CI) PCPs OnlyaOR (95% CI) Family Physicians OnlyaOR (95% CI) All PhysiciansbOR (95% CI) PCPs OnlybOR (95% CI) Family Physicians OnlybOR (95% CI) CI=confidence interval; CMS = Centers for Medicare and Medicaid Services; HRSA = Health Resources and Services Administration; NHSC = National Health Service Corp; OR = odds ratio; PCPs = primary care physicians (family physicians, general practitioners, general internists, and general pediatricians). Note: Includes all US physicians who reported their major professional activity as “direct patient care” and who completed residency in 1970 or later. Osteopathic physicians excluded because of insufficient osteopathic residency data in AMA Masterfile. International and Canadian medical school graduates excluded because they could not have attended Title VII–funded medical school. General practitioners excluded because they generally do not undergo full residency training. a Referent group: attended non–Title VI-funded medical school and residency program. b Referent group: male, attended public medical school, completed residency training after 1999, NHSC nonparticipant, attended non–Title VII-funded medical school or residency program. c Statistically significant (P<.001). d Statistically significant (P<.02). e Statistically significant (P<.01). Data source: 2004 AMA Physician Masterfile; HRSA Title VII Training Program grantee database; HRSA Bureau of Health Professions NHSC participant base; and CMS outpatient claims file, 2001, 2002, 2003. Attended Title VII–funded training program Predoctoral grant 1.25c (1.19–1.32) 1.15c (1.08–1.24) 1.12d (1.02–1.22) 1.03 (0.97–1.08) 0.94 (0.87–1.01) 0.86e (0.78–0.95) Academic unit grant 1.28c (1.22–1.35) 1.28c (1.20–1.37) 1.15c (1.08–1.22) 1.11c (1.06–1.17) 1.12 (1.04–1.20)e 1.07 (0.98–1.18) Residency grant 1.16c (1.11–1.20) 1.29c (1.22–1.37) 1.43c (1.33–1.55) 1.08c (1.04– 1.13) 1.23c (1.16–1.31) 1.41c (1.30–1.52) NHSC participant – – – 6.99c (6.51–7.50) 6.16c (5.68–6.69) 5.87c (5.29–6.52) Attended private medical school – – – 1.04 (1.00–1.09) 1.04 (0.97–1.11) 1.17c (1.07–1.27) Female – – – 1.30c (1.25–1.36) 1.20c (1.13–1. 28) 1.44c (1.33–1.56) Year completed residency 1995–1999 – – – 1.20c (1.12–1.28) 1.12e (1.03–1.23) 1.01 (0.91–1.13) 1990–1994 – – – 0.87c (0.81–0.93) 0.88e (0.80–0.97) 0.78c (0.69–0.89) 1985–1989 – – – 0.60c (0.55–0.65) 0.56c (0.51–0.63) 0.46c (0.40–0.53) 1980–1984 – – – 0.56c (0.51–0.61) 0.45c (0.40–0.51) 0.36c (0.31–0.43) 1975–1979 – – – 0.60c (0.54–0.66) 0.48c (0.41–0.56) 0.41c (0.33–0.50) 1970–1974 0.49c (0.43–0.55) 0.47c (0.38–0.58) 0.28c (0.20–0.39) - Table 4.
Logistic Regression Analysis of the Effects of Physicians Attending Title VII–Funded Training Programs on Participation in the National Health Service Corps Loan Repayment Program (1987–2003)
Characteristic PCPs Only n=87,558 OR (95% CI) Family Physicians Only n=34,212 OR (95% CI) CI=confidence interval; HRSA = Health Resources and Services Administration; NHSC = National Health Service Corps; OR = odds ratio; PCPs = primary care physicians (family physicians, general practitioners, general internists, and general pediatricians). Note: Includes all US physicians who completed residency in 1987 or later. International and Canadian medical school graduates excluded because they are not eligible for NHSC participation. Osteopathic physicians excluded because of insufficient osteopathic residency data in the AMA Masterfile. General practitioners excluded because they generally do not undergo full residency training. Referent group: male, attended public medical school, completed residency after 1999, attended non–Title VII-funded medical school and residency program. a Statistically significant (P<.03). b Statistically significant (P<.001). c Statistically significant (P<.01). Data source: 2004 AMA Physician Masterfile; HRSA Title VII Training Program grantee database; and HRSA Bureau of the Health Professions NHSC participant database. Attended Title VII–funded training programs Academic unit grant 0.96 (0.86–1.08) 0.85 (0.73–0.98)a Predoctoral grant 1.15 (1.02–1.30)a 1.17 (0.99–1.38) Residency grant 1.27 (1.15–1.40)b 1.56 (1.37–1.77)b Attended private medical school 1.41 (1.27–1.57)b 1.60 (1.39–1.83)b Female 0.91 (0.83–1.00) 0.80 (0.70–0.91)c Year completed residency 1995–1999 1.42 (1.24–1.63)b 1.38 (1.17–1.63)b 1990–1994 1.72 (1.50–1.97)b 1.32 (1.10–1.58)c 1985–1989 0.74 (0.61–0.90)c 0.57 (0.44–0.74)b
Additional Files
Supplemental Appendix
Supplemental Appendix. Title VII Primary Care Training Grants Descriptions
Files in this Data Supplement:
- Supplemental data: Appendix - PDF file, 1 page, 89 KB
The Article in Brief
Diane R. Rittenhouse , and colleagues
Background There have been substantial cuts in the US Title VII (Section 747) program, which helps medical schools and residency programs produce doctors to work with underserved populations. This study examines whether obtaining medical training in programs with Title VII grants is related to later work in community health centers or the National Health Service Corps, both of which care for underserved populations.
What This Study Found There is a strong association between attending Title VII-funded medical training programs and both practice in community health centers and participation in the National Health Service Corps.
Implications
- Reductions in Title VII funding affect institutions that produce high numbers of doctors who participate in the National Health Service Corps and/or work at community health centers and ultimately harms efforts to improve access to medical care for the underserved.
- The findings of this study help inform efforts to adequately staff community health centers.
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