Skip to main content

Main menu

  • Home
  • Current Issue
  • Content
    • Current Issue
    • Early Access
    • Multimedia
    • Podcast
    • Collections
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • Plain Language Summaries
    • Calls for Papers
  • Info for
    • Authors
    • Reviewers
    • Job Seekers
    • Media
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • Podcast
    • E-mail Alerts
    • Journal Club
    • RSS
    • Annals Forum (Archive)
  • Contact
    • Contact Us
  • Careers

User menu

  • My alerts

Search

  • Advanced search
Annals of Family Medicine
  • My alerts
Annals of Family Medicine

Advanced Search

  • Home
  • Current Issue
  • Content
    • Current Issue
    • Early Access
    • Multimedia
    • Podcast
    • Collections
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • Plain Language Summaries
    • Calls for Papers
  • Info for
    • Authors
    • Reviewers
    • Job Seekers
    • Media
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • Podcast
    • E-mail Alerts
    • Journal Club
    • RSS
    • Annals Forum (Archive)
  • Contact
    • Contact Us
  • Careers
  • Follow annalsfm on Twitter
  • Visit annalsfm on Facebook
OtherOn TRACK

Funding for Primary Care (or Lack Thereof) and Community Health Centers: Impact of Title VII Training Programs

John J. Frey
The Annals of Family Medicine November 2008, 6 (6) 562-563; DOI: https://doi.org/10.1370/afm.928
John J. Frey III
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • eLetters
  • Info & Metrics
  • PDF
Loading

An article in the last issue of Annals explored the effect of Title VII training programs on community health center (CHC) staffing and participation in the National Health Service Corps.1 Ferrer makes suggestions for 3 different approaches to increasing the primary care workforce, 2 of which look at targeted funding for such training and a third that produces more overall doctors in CHCs. Some way other than Title VII—both in addition to or instead of—is worth modeling. A lift-all-boats model that increases production at all medical schools, not just those that are Title VII funded, would require, in Ferrer’s words, “accepting students predisposed to social service, and should achieve better results.” A 2% increase in students who graduate in the United States and serve in CHCs would almost double other strategies based on Title VII targeting.2 Lopez similarly suggests broadening the base to move beyond CHCs into all communities.3

Of course, as Bowman outlines, doing that requires “common sense and leaders that stay in touch with each other and with the needs of most Americans,”4 which may not be a hallmark of US medical schools in 2008.

Lesko5 cites the American Association of Medical Colleges policy that “medical students and physicians should be free to determine for themselves…,” which promotes the widely discredited notion that the market cures all things. Academic medicine seems determined to boldly go where we have been before. “Free to Be… You and Me” was a song from the 1970s about individuality and self-esteem. We need a new jingle if we are to figure what we, collectively and as a society, need. How about “Solidarity Forever”?

O’Malley,6 whose work has identified the CHC workforce crisis, supports both the analysis by Rittenhouse et al and the prescription that increasing targeted support will help production and recruitment of doctors.

Vinson7 says, “send the [Rittenhouse] article to your senator.” Who wouldn’t agree? Good idea.

THE CHINESE PHYSICIAN WORKFORCE IN COMMUNITIES

In response to the article by Yang et al,8 Kushner and Wang9 elaborate on the rapid changes that are being pursued for primary care in China and the challenges that still lie ahead. Bowman’s commentary10 points out a number of aspects of primary care and the difficulties that are mirrored in both China and the United States: access, distribution of clinicians, education of a non-elite workforce, an aging population with chronic illness, and rural and urban disparities. These tensions lie in all societies that seek to find better care for everyone where economic and ethnic differences are strong.

ALCOHOLISM IS A CHRONIC HEALTH PROBLEM

Vinson11 and Saxon12 both point out this obvious fact but both also point out the lack of serious attention by primary care clinicians to better screening, intervention, and prevention. Primary care reengineering is insisting on chronic disease registries for all practices, but has anyone seen a call for a registry of alcoholics or substance abuse patients? Probably not. But anyone in practice knows that these unregistered chronic illnesses are more problematic than anything else in a community. We can’t work to improve something for which the dimensions of the problem are not known.

OTHER VOICES

A wide range of Annals articles13–17 generated important insights for primary care. Handzo18 raises “spiritual distress” as an important idea to address with the terminally ill. Would that be the “the long dark night of the soul” first used by John of the Cross?

Howard Stein, the anthropologist/poet from Oklahoma, reminds us that “through listening deeply to the other person and, at least temporarily suspending one’s protocol, one often receives crucial answers to questions that one could not have known beforehand to ask.”19

Clinician researcher Elizabeth Bayliss20 says, “I am becoming increasingly convinced that there is a role for providing patients individualized (non-MD) contact as part of the ongoing management of multiple conditions within primary care.” Could and should some of those contacts be other patients in the community or in the practice?

The power of positive thinking—and acting—on cardiovascular disease mortality drew continuing comments from many and a response from the author21 in which he discusses what these study results might mean for the clinical process. Continue to take a positive perspective with patients, but, he cautions, “the more we learn about positive thinking and health, the more we need to look closely look at which policy/standardized elements of preventive medicine support this, which seek to overcome it, and what we should do about it”

Finally, Scott Murray, Professor of Primary Palliative Care,22 reaffirms that “an emotional bond between patient and professional, shared decision making, and continuity of care” are the anchors of healing in the care of terminally ill patients.

Please add your voice to the online discussion at http://www.AnnFamMed.org.

  • © 2008 Annals of Family Medicine, Inc.

REFERENCES

  1. ↵
    Rittenhouse DR, Fryer GE, Phillips RL, et al. Impact of Title VII training programs on community health center staffing and National Health Service Corps participation. Ann Fam Med. 2008;6(5):397–405.
    OpenUrlAbstract/FREE Full Text
  2. ↵
    Ferrer RL. Comparing strategies to care for the underserved [eletter]. http://www.annfammed.org/cgi/eletters/6/5/397#10109, 25 Sep 2008.
  3. ↵
    Lopez CC. Need to expand the base [eletter]. http://www.annfammed.org/cgi/eletters/6/5/397#9996, 10 Sep 2008.
  4. ↵
    Bowman RC. Integrating admission, training, and policy for health access results [eletter]. http://www.annfammed.org/cgi/eletters/6/5/397#10014, 11 Sep 2008.
  5. ↵
    Lesko SE. Comparison of Title VII and graduate medical education (GME) funding: the pauper and the prince [eletter]. http://www.annfammed.org/cgi/eletters/6/5/397#10082, 19 Sep 2008.
  6. ↵
    O’Malley AS. Patients are coming, but who is going to take care of them [eletter]? http://www.annfammed.org/cgi/eletters/6/5/397#10107, 22 Sep 2008.
  7. ↵
    Vinson DC. Contact congress [eletter]. http://www.annfammed.org/cgi/eletters/6/5/397#10069, 19 Sep 2008.
  8. ↵
    Yang J, Guo A, Wang Y, et al. Human resource staffing and service functions of community health services organizations in China. Ann Fam Med. 2008;6(5):421–427.
    OpenUrlAbstract/FREE Full Text
  9. ↵
    Kushner KK, Wang J. Interesting looking into workings of the community health service [eletter]. http://www.annfammed.org/cgi/eletters/6/5/421#10074, 19 Sep 2008.
  10. ↵
    Bowman RC. Health system designs in the US and China [eletter]. http://www.annfammed.org/cgi/eletters/6/5/421#10005, 11 Sep 2008.
  11. ↵
    Vinson DC. We can do this [eletter]! http://www.annfammed.org/cgi/eletters/6/5/435#10071, 17 Sep 2008.
  12. ↵
    Saxon AJ. The great promise of medical management for alcohol dependence [eletter]. http://www.annfammed.org/cgi/eletters/6/5/435#10018, 11 Sep 2008.
  13. ↵
    Daaleman TP, Usher BM, Williams SW, Rawlings J, Hanson LC. An exploratory study of spiritual care at the end of life. Ann Fam Med. 2008;6(5):406–411.
    OpenUrlAbstract/FREE Full Text
  14. Sussman AL, Rivera M. ‘Be gentle and sincere about it’: a story about community-based primary care research. Ann Fam Med. 2008;6(5):463–465.
    OpenUrlAbstract/FREE Full Text
  15. Bogner HR, de Vries HF. Integration of depression and hypertension treatment: a pilot, randomized controlled trial. Ann Fam Med. 2008;6(5):295–301.
    OpenUrlAbstract/FREE Full Text
  16. Gramling R, Klein W, Roberts M, Waring M, Gramling D, Eaton CB. Self-rated cardiovascular risk and 15-year cardiovascular mortality. Ann Fam Med. 2008;6(5):302–306.
    OpenUrlAbstract/FREE Full Text
  17. ↵
    Scott JG, Cohen DJ, DiCicco-Bloom B, Miller WL, Stange KC, Crabtree BF. Understanding healing relationships in primary care. Ann Fam Med. 2008;6(5):315–322.
    OpenUrlAbstract/FREE Full Text
  18. ↵
    Handzo GF. Spiritual distress as part of spiritual care [eletter]. http://www.annfammed.org/cgi/eletters/6/5/406#10076, 19 Sep 2008.
  19. ↵
    Stein HF. Good ppplied medical anthropology as good medicine [eletter]. http://www.annfammed.org/cgi/eletters/6/5/463#10057, 15 Sep 2008.
  20. ↵
    Bayliss EA. Integrated care is important for chronic illness [eletter]. http://www.annfammed.org/cgi/eletters/6/4/295#9782, 17 Aug 2008.
  21. ↵
    Gramling R. Self-rated risk, clinical communication and the self-fulfilling prophecy [eletter]. http://www.annfammed.org/cgi/eletters/6/4/302#9857, 24 Aug 2008.
  22. ↵
    Murray SA. Healing relationships are especially important for dying patients [eletter]. http://www.annfammed.org/cgi/eletters/6/4/315#9684, 8 Aug 2008.
PreviousNext
Back to top

In this issue

The Annals of Family Medicine: 6 (6)
The Annals of Family Medicine: 6 (6)
Vol. 6, Issue 6
1 Nov 2008
  • Table of Contents
  • Index by author
  • Annual Indexes
  • In Brief
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on Annals of Family Medicine.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Funding for Primary Care (or Lack Thereof) and Community Health Centers: Impact of Title VII Training Programs
(Your Name) has sent you a message from Annals of Family Medicine
(Your Name) thought you would like to see the Annals of Family Medicine web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
5 + 7 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Citation Tools
Funding for Primary Care (or Lack Thereof) and Community Health Centers: Impact of Title VII Training Programs
John J. Frey
The Annals of Family Medicine Nov 2008, 6 (6) 562-563; DOI: 10.1370/afm.928

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Get Permissions
Share
Funding for Primary Care (or Lack Thereof) and Community Health Centers: Impact of Title VII Training Programs
John J. Frey
The Annals of Family Medicine Nov 2008, 6 (6) 562-563; DOI: 10.1370/afm.928
Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • THE CHINESE PHYSICIAN WORKFORCE IN COMMUNITIES
    • ALCOHOLISM IS A CHRONIC HEALTH PROBLEM
    • OTHER VOICES
    • REFERENCES
  • eLetters
  • Info & Metrics
  • PDF

Related Articles

  • No related articles found.
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Modifying the Measurement Paradigm or Questioning its Very Assumptions
  • On-the-Ground Wisdom About Care Integration
  • The Conversation Continues, as It Should
Show more On TRACK

Similar Articles

Content

  • Current Issue
  • Past Issues
  • Early Access
  • Plain-Language Summaries
  • Multimedia
  • Podcast
  • Articles by Type
  • Articles by Subject
  • Supplements
  • Calls for Papers

Info for

  • Authors
  • Reviewers
  • Job Seekers
  • Media

Engage

  • E-mail Alerts
  • e-Letters (Comments)
  • RSS
  • Journal Club
  • Submit a Manuscript
  • Subscribe
  • Family Medicine Careers

About

  • About Us
  • Editorial Board & Staff
  • Sponsoring Organizations
  • Copyrights & Permissions
  • Contact Us
  • eLetter/Comments Policy

© 2025 Annals of Family Medicine