Title VII Programs Work
September 9th, 2008 by Candice Chen (email author)A timely new article by Rittenhouse et al. in the Annals of Family Medicine finds a significant positive association between exposure to Title VII training programs and subsequent physician work in Community Health Centers (CHCs).
These findings are particularly noteworthy as just four weeks ago, the National Association of Community Health Centers (NACHC) released their report – Access Transformed: Building a Primary Care Workforce for the 21st Century – in which they estimate a current deficit of 1,843 primary care providers in CHCs and a need for an additional 15,585 primary care providers if they are to reach their goal of 30 million patients by 2015.
Since the 1970s, Title VII has supported programs aimed at increasing primary care, underserved areas and minority physicians. However, funding for these programs has been severely slashed in recent years. The program was cut in half in 2006. This year, as in previous years, the President’s FY08 budget all but eliminates the program. On July 18, the House approved $228 million for Title VII programs – a 24% increase from FY07, but the Senate approved only $188 million for the program on June 21 (AAMC)
As the need for primary care physicians, particularly in underserved areas, grows, it is time to invest in the programs that produce these needed physicians. And the Rittenhouse article shows us that Title VII programs clearly work.
September 30th, 2008 at 4:34 pm
While I certainly respect those who support any form of primary care training and the few remaining that research such training, proper controls are often not included that have much more to do with primary care and health access.
Those who choose health access careers are those who share origins with the 65% of the population in the United States that are in most need of health access and only have 23% of physicians.
Logistic regression studies indicate the following about physician practice locations in rural, underserved, and less served areas (n = 316,000 grads from 1987 - 2000 class years, all medical school sources as in the 2005 Masterfile).
Birth origins shared at 2 - 3 times odds ratios of being found in a location in need of physicians.
Family practice at 2 - 4 times odds ratios from urban underserved to rural underserved locations
Older graduates, those age over age 29 at medical school graduation have 1.3 times odds ratios of optimal location.
Graduates of osteopathic, allopathic public, and lower scoring MCAT medical schools have 1.3 - 1.8 times odds ratios of optimal health access.
These are the major factors and they serve as controls for one another when included in the same logistic regression equation.
Exclusive origins result in half of the probability of distribution. Exclusive careers or all other than family practice have average to poor distribution. Exclusive age groups that are the youngest with the least life and health experience prior to medical school have 30% lower distribution. Exclusive training has half of the probability of distribution as found in allopathic private and top ranking MCAT medical schools.
In final analysis, there are failures in primary care and health access only in the physicians with exclusive origins, physicians with exclusive career choices, physicians with exclusive training, and physicians influenced by exclusive health policy that distributes 10 - 15% of resources to locations with 65% of the population spread across 96% of the land area.
These are factors that must be considered for physician career and location choices involving health access, such as primary care.
There is little chance that Title VII measures up to these factors.
Medical schools select physicians, train physicians, influence career choice, and influence national health policy. When medical schools admit more normal students, train on more normal population needs, place emphasis on normal health career choices, and work to influence normal distributions of health resources, then 65% of the American public might just have a chance at more than 23% of physicians, more than 10% of health resource distributions, and the jobs, services, economics, and leadership that come with such distributions.
The real issue is not Title VII. The issue is seeing beyond Title VII to fully fund the family practice training that will graduate the 8000 family physicians that the nation must have as soon as possible, the only shot at restoration of health access before 2050.
The real issue is making sure that the primary care that we have, stays primary care. Also the new graduates must have reasonable $170,000 plus salaries, commensurate with the most complex health care careers of all - serving the 65% of lower and middle income American that has the most complex health care needs and gets the least support.
Other forms of primary care have become flexible due to market forces and health policy. Family physicians stay in family practice and primary care and where they are most needed.
Robert C. Bowman, M.D., Professor
A T Still School of Osteopathic Medicine Arizona