HPNEC: FY 2003 Recommendation



Home Members Working Group Testimony Correspondence Profiles of Success Events Photo Galleries Funding by State	FY 2003 Recommendation Recommendations by cluster: Minority and Disadvantaged Health Professions Primary Care Medicine and Dentistry Interdisciplinary, Community-Based Linkages Health Professions Workforce Information and Analysis Public Health Workforce Development Nurse Education Act Student Financial Assistance "Well-trained health professionals are the cornerstone of the nation's complex health system, and there is an ever-increasing need for programs that improve the quality of health care education and training. Titles VII and VIII of the Public Health Service Act authorize a variety of programs for students and institutions to improve the geographic distribution, quality, and racial and ethnic diversity of the health care work force." Letter to Chairman Tom Harkin and Ranking Member Arlen Specter, Senate Labor- Health and Human Services Appropriations Subcommittee, signed by 32 Senators July 18, 2001 The letter quoted above was signed by a bipartisan group of Senators last year in support of the health professions and nursing education and training programs authorized under Titles VII and VIII of the Public Health Service Act. These Senators recognized the necessity of ensuring that health care professionals are trained to provide quality care, represent the diverse makeup of the general population, and are available to communities across the country, particularly those in underserved areas. Through loans, loan guarantees, and scholarships to students, and grants and contracts to academic institutions and non-profit organizations, the Title VII and VIII health professions programs are designed to: · Meet the nation's needs to increase the supply of primary medical and dental care providers, public health and allied health professionals, and nurses; · Educate and train more health professionals in fields experiencing shortages, such as the current shortages in nursing, pharmacy, dentistry, public health, and allied health; · Improve the geographic distribution of health professionals and nurses; · Increase access to health care for underserved populations; and · Enhance minority representation in the practicing health professional workforce. These programs are administered by the Bureau of Health Professions within the Health Resources and Services Administration (HRSA). The Health Professions and Nursing Education Coalition (HPNEC) has determined that these programs require $550 million in FY 2003 to educate and train a health care workforce that meets the public's health care needs. Last year, we recommended $440 million as the first step of a two-year effort to reach this goal. HPNEC is an informal alliance of over 40 organizations representing a variety of schools, programs, communities and individuals dedicated to ensuring that Title VII and VIII programs continue to help educate the nation's health care personnel. The members of the coalition believe these programs are essential to the development and training of tomorrow's health professionals and are critical to providing quality health services to underserved and minority communities. The Health Professions Education Partnerships Act of 1998 [Public Law 105-392] consolidated the Title VII and VIII programs into seven categories: · Minority and Disadvantaged Health Professions · Primary Care Medicine and Dentistry · Interdisciplinary, Community-Based Linkages · Health Professions Workforce Information and Analysis · Public Health Workforce Development · Nurse Education Act · Student Financial Assistance Listed below are descriptions of each of these categories. Success stories illustrating the positive impact of these programs are provided in italics. List of health professions acronyms: COE- Centers of Excellence HCOP- Health Careers Opportunity Program SDS- Scholarships for Disadvantaged Students AHEC- Area Health Education Center HETC- Health Education and Training Center NEA- Nurse Education Act NSL- Nurse Student Loan PCL- Primary Care Loan HPSL- Health Profession Student Loans LDS- Loans for Disadvantaged Students MINORITY AND DISADVANTAGED HEALTH PROFESSIONS The Minority and Disadvantaged Health Professions training programs are designed to improve health care access in medically underserved areas and to indigent populations by increasing minority representation in the health professions. This need for the expansion of the health care workforce is driven by the country's increasingly diverse population. The program provides support for health professions schools that have demonstrated the greatest commitment to and success in training minorities for health professions careers. Scholarship support also is provided for disadvantaged and minority students who attend health professions or nursing schools. The total funding for Diversity Programs within Health Professions is $117.2 million in FY 2002. Minority Centers of Excellence (COE) Meharry Medical College School of Medicine's (Nashville, Tenn.) Center of Excellence has three overarching purposes aimed at increasing the number of African Americans and other underrepresented groups in medical education and research: (1) Improving student competencies in professional practice, research, and clinical training; (2) Increasing the level of electronic connectivity for students and faculty both on campus and at remote sites; and (3) Enhancing the professional development of junior faculty to improve their scholarship and qualification for promotion. The curriculum has been revised to keep pace with current pedagogies in medical education to assure graduates are better prepared for the upcoming national board clinical skills assessment examination, a final step toward licensure. The pass rate on part one of the licensure exam increased from 63 percent in 1996 to the current rate of 89 percent. Over the same period, the part two pass rate increased from 58 percent to 91 percent. On average, 45 percent of each graduating class has gained experience in basic science and clinical research pertaining to minority health disparities. In addition, Meharry has increased the use of web-based instructional materials that students can access from remote sites. Beginning in 1997 the Centers of Excellence faculty development program has helped facilitate the promotion of 15 junior minority faculty members to senior faculty status. This represents an increase in the total number of senior minority faculty from 60 to 75. The purpose of the Minority Centers of Excellence program is to assist schools that train minority health professionals through support for programs of excellence in health professions education. Centers of Excellence (COE) programs support the development of a larger, more competitive applicant pool through linkages with institutions of higher education, local school districts and other community-based entities to establish an educational pipeline for health professions careers. The COE program focuses on improving student recruitment and performance; improving curricula and cultural competence of graduates; facilitating faculty/student research on minority health issues; and training students to provide health services to minority individuals by providing clinical teaching at community-based health facilities. In FY 2001, 31 grants were awarded to COEs throughout the country. The FY 2002 appropriation for the Centers of Excellence program is $33.6 million. Initiated in 1993, the Center of Excellence of the University of Pennsylvania School of Medicine has had a regional and national impact on minority faculty recruitment and development, curricular models of physician education on minority health issues, and the training of minority faculty and students in research aimed at understanding and eliminating health disparities. Since the inception of this Center, the School of Medicine has increased the number of underrepresented minority (URM) faculty from 27-65 (138 percent) with an increase since 1999 from 37 to 65 (73 percent); has implemented curricular changes related to minority health and cultural competence involving the entire medical student class; has facilitated campus-wide minority health research programs including a recently funded Center for Health Equity Research and Promotion and; has implemented an array of programs aimed at increasing the applicant pool of minority health professionals. Two of the Center's secondary school programs (one predominantly African American and the other predominantly Hispanic) are unique models in the Philadelphia area. To accomplish its aims, the Center collaborates with secondary and undergraduate schools, and community organizations. The student performance activities focus on developing future leaders in academia by concentrating on the development of general research skills. Faculty and student research programs link URM faculty and students with senior investigators with stellar programs relevant to health disparities research. Health Career Opportunity Programs (HCOP) The Hispanic Center of Excellence at the University of California, San Diego School of Medicine, and its partners have established a pipeline of qualified URM and disadvantaged students that begins in the fifth grade and extends through faculty recruitment and retention in medical schools. Since 1994, over 200 students have participated in the program. 53 students graduated from high school. All attended university, 19 are enrolled at UCSD. Three students entered medical school. Recruitment and retention of URM medical students and faculty is one of our top priorities. The five-year retention and graduation rate of URM medical students at UCSD is 91 percent compared to a national graduation rate of URM medical students of 84 percent. We have maintained this high rate of graduation solely because federal funding supports our summer and academic year tutorial, pre-matriculation, medical licensure exam review, and learning skills development programs. The numbers and percent of Hispanic faculty at UCSD SOM has steadily increased from 12 faculty members in 1993 prior to the HCOE, to 28 in 2001. Grants made to health professions schools, educational entities, and community-based organizations under the Health Careers Opportunity Program (HCOP) enhance the ability of individuals from disadvantaged backgrounds to improve their competitiveness to enter and graduate from health professions schools. HCOP funds activities that are designed to develop a more competitive applicant pool through partnerships with institutions of higher education, school districts, and other community-based entities. HCOP also provides for mentoring, counseling, primary care exposure-activities and information regarding careers in a primary care discipline. Sources of financial aid are provided to students as well as facilitating entry assistance into the health professions school. The HCOP awards in FY 2001 supported 88 programs. The FY 2002 appropriation for HCOP is $34.8 million. The University of Montana School of Pharmacy's diversity programs include the Native American Center of Excellence (NACOE), and the Health Careers Opportunity Program (HCOP). The NACOE is the only one out of the four COE programs at schools of pharmacy in the nation that will train American Indians to become faculty members. The NACOE grant will provide three faculty trainee fellowships for clinical instructors and one faculty trainee fellowship for a campus-based instructor. This will be of considerable importance nationally because at the moment there are very few American Indian faculty in schools of pharmacy. The grant will also help introduce culturally relevant materials in the curriculum and help develop an American Indian/American Native clerkship pathway. As the grant progresses a goal will be to have students complete a American Indian Pathway program where they take relevant classes, complete research projects and clinical experiences which will help them become well-rounded practitioners. Faculty Loan Repayment and Faculty Fellowships The Faculty Loan Repayment and Faculty Fellowships program is designed to assist health professions and nursing schools in increasing the number of underrepresented minority individuals in faculty positions. Grant funds are made available on a matching basis for three years for the school to identify, recruit and select underrepresented minority individuals who demonstrate potential in teaching, administration, or research at a health professional school. The school provides the fellow with the necessary skills to obtain a tenured position. These skills include: pedagogical, program administration, research design, grant writing and preparation for publication in a peer-reviewed journal. The school also assists the fellow in the preparation for an academic career, as well as providing an experience in health services in rural or medically underserved areas. In FY 2001, 30 awards were made, totaling approximately $1 million. The FY 2002 appropriation for faculty loan repayment and faculty fellowships is $1.3 million. The Morehouse School of Medicine's (Atlanta) Primary Care Faculty Development Program began in 1993 in the Department of Family Medicine. It is one of the most effective programs in the nation for recruiting and training underrepresented minority faculty for careers in academic medicine. The longitudinal program has trained 99 full-time faculty and community-based preceptors in teaching methods, educational theory, computer skills, audiovisual media, grant writing, primary care research, and writing for the medical literature. The curriculum also covers cross-cultural communications and career issues for minorities in academic medicine. The program has also produced faculty leaders who facilitate other workshops. Scholarships for Disadvantaged Students (SDS) The Scholarship for Disadvantaged Students program was established to make scholarship funds available to eligible students from disadvantaged backgrounds who are enrolled (or accepted for enrollment) as full-time students. Funds are awarded to accredited schools of allopathic medicine, osteopathic medicine, dentistry, optometry, pharmacy, podiatric medicine, veterinary medicine, nursing (associate, diploma, baccalaureate and graduate degree), public health, chiropractic, and allied health (baccalaureate and graduate degree programs of dental health, medical laboratory technology, occupational therapy, physical therapy, radiologic technology, speech pathology, audiology, and registered dieticians). Also included are schools offering graduate programs providing training of physician assistants and programs in marriage and family therapy and behavioral and mental health practice, which includes clinical psychology, clinical social work, and professional counseling. Sixteen percent of the funds available must be provided for schools of nursing. To be eligible for funding, a school must have in place a program to recruit and retain students from disadvantaged backgrounds, including racial and ethnic minorities, and demonstrate that the program has achieved success, based on the number or percentage of disadvantaged students who graduate from the school. The Health Professions Education Partnership Act of 1998 gave priority to schools based on the proportion of graduating students going into primary care, the proportion of underrepresented minority students, and the proportion of graduates working in medically underserved communities. In FY 2001, 380 schools received awards under this program. The FY 2002 appropriation for SDS is $46.2 million. Hampton University (Hampton, Va.) School of Nursing has participated in the Scholarship for Disadvantaged Students for almost a decade. During this time the noticeable increase in the numbers of disadvantaged students enrolling in Hampton University has helped in leveraging other funds to assist this population. Specifically, the federally funded BEST (Blacks Educated Successfully for Tomorrow) was instrumental in increasing education opportunities for over 50 nurses by providing financial assistance and academic support. The School also successfully demonstrated its ability to recruit, retain, and graduate an increased number of disadvantaged students, especially minorities, through a federally funded project, which served 181 disadvantaged nursing students over a three-year period. Currently, the School of Nursing has two federal projects to increase the number of disadvantaged students choosing nursing. One project is a K-12 pre-entry program and the other is a mentorship program to increase retention and graduation rates. PRIMARY CARE MEDICINE AND DENTISTRY "Investment in education to provide primary care has effects that touch the largest number of people in the country. No other group of health care providers can exert such broad influences on the kind and quality of health care in the United States. Primary care training programs are ideally positioned to react quickly to meet ever-changing health care needs and issues, whether they are related to HIV/AIDS, growing numbers of elderly with chronic illnesses, implications of the modern genetic revolution, the threat of bioterrorism, or other issues that will continue to emerge and demand educational intervention." Comprehensive Review and Recommendations: Title VII, Section 747 of the Public Health Service Act Advisory Committee on Training in Primary Care and Dentistry Washington, DC, November 2001 Primary care providers touch the lives of more Americans than any other group of clinicians: two-thirds of all Americans interact with a primary care provider every year. Encompassing family medicine, general internal medicine, general pediatrics, physician assistants, general dentistry and pediatric dentistry, the Title VII, section 747 primary care and dentistry programs are the only federal funding programs dedicated to the education and training of the primary care provider workforce. These programs graduate substantially higher percentages of primary care practitioners, underrepresented minorities, practitioners from disadvantaged backgrounds, and practitioners who practice in underserved areas. The Title VII, section 747 primary care and dentistry grants program received $93 million in FY 2002. PRIMARY CARE MEDICINE The mission of the medicine/pediatrics program at Brown Medical School in Providence, Rhode Island is to provide an academically oriented residency that will improve the health status of the populations in the region. Title VII funding has helped the program, which launched in 1995, enhance and expand its curriculum, its services to patients, and the number of faculty and residents. The program operates in an area with a significant population of financially disadvantaged ethnic minorities. The medicine/pediatrics residency program successfully recruited two ethnic-minority faculty to the program - one in a full-time leadership role. Of the 25 residents who have been enrolled in the program to date, 20 percent have been minorities. One of the program's goals is to encourage medical residents to seek work either locally or in other similarly underserved areas. Three of last year's four graduating residents obtained positions in primary care, practicing medicine and pediatrics in medically underserved areas - a rate of placement made possible by the curriculum's focus, as supported by the grant. Of the ten graduates to date, five have entered practice in underserved areas, all in primary care. HRSA funding also enabled the program to successfully implement on-site medical Spanish courses, a continuity clinic, additional faculty precept time, and the development of a curriculum in transitional medicine to train residents to care for children through adolescence and into adulthood. The grant's impact goes beyond direct support, too. Rhode Island Hospital has provided additional funding and space to expand, renovate, and modernize the clinic. This year there are 124 applicants for four intern positions in the medicine/pediatrics residency. General Pediatrics The University of Maryland-Baltimore has used Title VII funds to establish an innovative residency training and education program that helps pediatricians provide better care to underserved communities. Located in a federally-designated "empowerment zone," the University combines workshops, discussions, and clinical experiences to improve residents' understanding of the impact of cultural diversity on the practice of medicine, the primary skills needed to care for underserved patients, and the potential for technology to facilitate care. The program also allows residents to gain insight into the basic principles of managed care through a one-month rotation focusing on the administrative aspects of managed care practice. Residents then have the opportunity to apply what they have learned during their own community clinic placements Through innovative residency training, faculty development and postdoctoral programs, Title VII training grants in general pediatrics equip future pediatricians with the tools they need to provide quality health care to the nation's infants, children, adolescents and young adults. Title VII grants offer medical students and pediatric residents educational and training opportunities in a variety of ambulatory and community-based settings, including community health centers, homeless shelters, child nutrition programs, community clinics and childcare centers. In addition, the Title VII training grants reflect the generalist nature of pediatrics. Over 70 percent of pediatric residents pursue generalist pediatrics, and recent data suggests that patient care is the main professional activity of 95 percent of pediatricians nationwide. The challenges facing future generalist pediatricians are enormous. Significant numbers of children now live in medically underserved areas - rural and urban - throughout the country. The racial and ethnic diversity of the pediatric population continues to increase. Estimates indicate that by the year 2020, approximately 40 percent of school-aged children will be of non-white racial or ethnic backgrounds. Now, more than ever, America's children need primary care pediatricians who are educated in diverse settings, culturally competent, and trained to meet the unique health care needs of their local communities. Children's National Medical Center in Washington D.C., in conjunction with the George Washington University, has used Title VII funds to launch an innovative postgraduate pediatric fellowship training program that prepares pediatricians for academic-focused community based careers emphasizing the health needs of the underserved. Through the General Academic Pediatrics and Community Oriented Pediatric Care (COPC) fellowship, new general pediatric faculty members divide their time between clinical work, educational training and child health advocacy. Over the course of two years, COPC fellows conduct a comprehensive community needs assessment, develop a community based health intervention plan with local input, and complete a Masters of Public Health. COPC graduates have remained in underserved communities, as health care providers and as leaders, teachers, and advocates for their patients and families. General Internal Medicine Title VII funding provides critical support for four initiatives in general internal medicine programs: medical student training, residency training, faculty development, and the development of academic administrative units. Over the past 15 years, these programs have supported the training of approximately 16,000 primary care internists. As the only federal funding dedicated to the education and training of the general internal medicine workforce, Title VII support is crucial to increasing access to health care for underserved populations: · More than 69 percent of graduates from general internal medicine residencies funded by Title VII practice primary care after graduation. This rate is nearly twice that of residency programs that do not receive such support. · Graduates of general internal medicine residencies supported by Title VII are three to ten times more likely to practice in medically underserved communities than graduates of programs that do not receive Title VII funding. · General internal medicine Title VII residency programs graduate two to five times more minority and disadvantaged students than programs that do not receive such support. Title VII funds are also crucial for attracting volunteer faculty members who increase the diversity of medical residency experiences. Approximately half of the faculty in internal medicine teaching units are volunteers and are located away from university or medical school settings. The Department of Medicine at Mount Sinai Hospital in Chicago has utilized Title VII general internal medicine grant funding to establish community-based primary care training sites in health professional shortage areas in Chicago. With these funds, the department developed a Spanish language elective that trains residents in medical Spanish, which is then utilized in Spanish-speaking ambulatory care settings. Additionally, Mount Sinai's residency has been able to recruit new faculty because of the presence of the training program, attract superior resident trainees, and develop new curricula. Moreover, since the initiation of the grant, the department increased the number of minority primary care physicians working at the institution. Because of the grant funding, the residency has also been able to initiate faculty development training sessions for its faculty. By providing a targeted funding stream for primary care training in general internal medicine, Title VII continues to be essential to the education and distribution of general internists in rural medically underserved communities. Family Medicine The Health Professions Education Partnership Act is the only federal program that provides targeted funding through grants for family medicine residency training and academic departments, predoctoral programs and faculty development in family medicine. Under the 1998 law, not less than $49.3 million must be provided to family medicine, of which $8.6 million must go to family medicine departments. These programs are producing the outcomes that Congress has requested. In a current study (currently submitted for peer reviewed publication), the Robert Graham Center for Policy Studies in Family Practice and Primary Care has shown that Title VII federal funding of family medicine departments, predoctoral programs, and faculty development has made a difference. The study shows that: · All three types of grants made a difference in producing more family physicians, and more primary care doctors. · Predoctoral and department development grants made a difference in producing more primary care doctors serving in rural areas, and more primary care doctors serving in primary care health professional shortage areas. · Sustained funding during the years of medical school training had a more positive impact than intermittent funding. We must conclude from this data that this funding means that many physicians are making different career choices, choices that positively affect millions of patients in underserved areas and in primary care. Moreover, if this money were to "go away" fewer students would be making these career choices. The Congressionally mandated Advisory Committee on Training in Primary Care Medicine and Dentistry (ACTPCMD) released its first report to Congress recommending increased funding for Title VII primary care training programs. Specifically, for the Primary Care Medicine and Dentistry Cluster, they recommend funding of $198 million. ACTPCMD's report lays out the necessities for well-trained primary care providers. According to ACTPCMD, additional funds must be made available for Title VII programs in order for primary care providers to properly respond to current and emerging health care issues. The Title VII grant has been instrumental in the development of the Rural Medicine Education Program (RMED) at Upstate Medical University in Syracuse, New York. The RMED program, which began in 1989, is based on the premise that rural training experiences during medical school are critical as it is during these formative years that career decisions are made and attitudes toward rural practice are established. Through RMED, the Department of Family Medicine places third year medical students in rural communities full-time for nine consecutive months to work and learn under the supervision of board-certified family physicians and other primary care providers. Full academic credit is earned for this experience. Students who elect this program live in the rural community, returning to their home campus at the end of the program to complete studies for their medical degree. Osteopathic Medicine The Title VII programs are especially important to osteopathic medical education. The nineteen colleges of osteopathic medicine have a long history of dedication to training primary care physicians to work in America's smaller communities, rural areas and underserved urban areas. Among the Title VII programs that have been particularly significant in enhancing osteopathic medical schools' ability to train the highest quality physicians are: General Internal Medicine Residencies; Family Medicine Training; Preventive Medicine Residencies; Centers of Excellence; Health Careers Opportunity Programs; Scholarships for Disadvantaged Students; Area Health Education Centers; Geriatric Programs; Rural Health and Public Health Programs. These programs facilitate the efforts of osteopathic medical schools to continue to emphasize primary care medicine, health promotion, and disease prevention, and the practice of ambulatory medicine in community-based settings. Through "Project Interact," the Department of Family Medicine at the University of Medicine and Dentistry of New Jersey School of Osteopathic Medicine accomplished an interdisciplinary collaboration for the purpose of training predoctoral students to be culturally competent and skilled in interdisciplinary healthcare. This project has sensitized students to health disparities among underserved populations, and trained them to understand the potential barriers to effectively treating a person from another culture. The predoctoral curriculum has been revised to integrate cultural and interdisciplinary competencies identified as important by the Project Interact Committee. In addition, curriculum modules on cultural competency and interdisciplinary skills have been developed and integrated into the family medicine curriculum. DENTISTRY The General and Pediatric Dental Residency Training Programs train qualified dentists who are likely to practice in underserved areas. These dentists are trained to provide care to patients requiring specialized or complex care, such as developmentally disabled individuals, the elderly, and patients with infectious diseases. Title section 747 funding in dentistry has been limited since 1980 to programs of postdoctoral education in general dentistry. The support of pediatric dental residency training was authorized in 1998 in recognition of the national shortage of pediatric dentists. These programs of advanced education provide a broader range of training than that acquired in dental school. Emphasis is given to care of a broader mix of patients, including the medically compromised and disabled. Specific to dentistry, almost 80 percent of growth in these programs has been through start-up support provided by Title VII funds. About 305 of the graduates from the supported programs established practices or spent 50 percent or more of their time in health professional shortage areas or settings providing care to underserved communities or populations. The Louisiana State University School of Dentistry established an advanced education general dentistry residency in 1995 as well as two rural dental clinics and an underserved student clinic in New Orleans. The Lallie Kemp Medical Center in Independence, Louisiana founded in 1939, did not offer dental care until 1994 when Title VII funding made it possible. A similar program at the University of Louisville School of Dentistry maintains an agreement with the Dixie Health Center, operated by the Jefferson County Health Department. For three days each week, for the entire year, the Advanced Education in General Dentistry (AEGD) Program residents treat patients at the clinic, working under faculty supervision. The University received an expansion grant for its AEGD program, which allows it to provide outreach to indigent patients and children. Research indicates that the number of pediatric dentistry training positions declined during the 1980s and remained flat during most of the 1990s, in spite of the fact that there will be major increases in the pediatric population through 2020. Furthermore, despite substantial overall improvement in children's oral health, 80 percent of pediatric tooth decay is found in 25 percent of U.S. children and adolescents. The greatest unmet treatment needs are seen in children from racial and ethnic minorities and low-income families, particularly among young children. The Dental School at the University of Texas Health Science Center at San Antonio received a pediatric dental grant to increase the number of residents trained in providing care to indigent and underserved populations, especially Hispanic children. The grant also initiated prevention activities for preschool underserved children. Clinic training sites included the Christus Santa Rosa Children's Hospital and two WIC clinics. This type of training initiative directly addresses those disparities in children's oral health highlighted in the U.S. Surgeon General's report and two reports of the GAO in 2000. Over the 20-year history of HRSA funding, 59 new dental residency programs and 560 new positions were created. The federal investment has been the major factor in making these training opportunities available. PHYSICIAN ASSISTANTS The Health Professions Education Partnership Act of 1998 reauthorized awards and grants to schools of medicine and osteopathic medicine, as well as colleges and universities, to plan, develop, and operate accredited programs for the education of physician assistants and faculty, with priority given to training individuals from disadvantaged backgrounds. Physician assistant (PA) programs supported through the Title VII health professions program encourage and prepare students for primary care practice in rural and urban health professional shortage areas. A review of PA graduates from 1991-1999 reveals that 16.5 percent of students graduating from PA programs supported by Title VII are from Underrepresented Minority backgrounds, compared to 7.7 percent of graduates from PA programs that did not receive Title VII support. In the same vein, 13.5 percent of the graduates who attended PA programs receiving Title VII support during the eight-year period practice in underserved settings, compared with 10.1 percent of graduates of programs not receiving such support during the same time period. The 1998 law requires that not less than $6.8 million be available for awards of grants and contracts for programs related to physician assistants. The PA programs' success in recruiting and retaining underrepresented minority and disadvantaged students is linked to their ability to creatively use Title VII funds to enhance existing educational programs: · A PA educational program in Iowa uses Title VII funds to target recruitment efforts to disadvantaged students, providing shadowing and mentoring opportunities for prospective students, increasing training in cultural competency, and identifying new family medicine preceptors in underserved areas. · PA programs in Texas use Title VII funds to create new clinical rotation sites in rural and underserved areas, including new sites in border communities, and to establish non-clinical rural rotations to help students understand the challenges faced by rural communities. · A PA program in Kansas has used Title VII funds to provide a significant portion of the training for 500 PA students in remote, medically underserved communities in the state. · The Duke PA program is highly rated in the United States, with a long history of innovation, including training health care providers from North Carolina rural communities. Title VII funds have supported the focus on rural training, and have also permitted students to be placed in rural settings. Several other PA programs have been able to use Title VII grants to leverage additional resources to assist students with the added costs of housing and travel that occur during relocation to rural areas for clinical training. The Title VII health professions program is the only source of federal funding available, on a competitive application basis, to PA educational programs. Title VII support for educating PAs to practice in underserved communities is particularly important given the market demand for physician assistants. Without the Title VII funding support to expose students to underserved sites during their training, PA students are far more likely to practice in communities where they were raised or attended school. INTERDISCIPLINARY, COMMUNITY-BASED LINKAGES These programs provide support to enhance the community-based training of various health professionals in rural and urban underserved areas. Area Health Education Centers (AHEC) The events of September 11 set in motion heightened community awareness of the need for information on bioterrorism. Southern Nevada AHEC, in partnership with the Nevada State Health Division and the Clark County Health District, responded by: assessing the need for bioterrorism preparedness training in the medical community; developing training materials and modules; and conducting training for medical professionals. The AHEC began coordinating educational programming for health care professionals and offered classes almost daily in Clark County. Training focuses on: teaching recognition of signs and symptoms of potential bioterrorist agents; increasing the index of suspicion for unusual occurrences of disease; and increasing understanding of the link between disease reporting and disease control and prevention. Over 700 providers participated in this training between October and December 2001. Continuing Education credit is given for physicians and nurses. In response to training requests from other parts of the state and neighboring states, Southern Nevada AHEC began working to identify potential trainers and coordinate a train the trainer approach to bioterrorism, with the longer-term goal to standardize the content of the training to be offered throughout the state and beyond. Area Health Education Centers (AHEC) are designed to improve the supply and distribution of health care professionals with an emphasis on primary care and to increase access to quality health care through community/academic educational partnerships. AHECs provide clinical training opportunities to health professions and nursing students in rural settings and communities in need of health care by extending the resources of academic health centers to these areas. Through this linkage, AHEC programs, which eventually become self- or state-supported, form networks of health-related institutions to provide educational services to students, faculty, and practitioners. AHECs are an essential component of the federal/state partnership in addressing health care delivery in rural, underserved areas. The AHEC network consists of 45 campus-based AHEC programs affiliated with 170 community-based AHEC centers. It is estimated that each year, AHECs train 32,000 health professions students in community-based sites and sponsor recruitment activities for 25,000 students grades 9-12. AHECs received $33.4 million in the FY 2002 appropriation. The City of Fredericksburg, Hill Country Memorial Hospital, Fredericksburg Independent School District, the Alamo AHEC (a regional Center of the South Texas AHEC), Austin Community College (ACC), and The University of Texas Health Science Center at San Antonio (UTHSCSA) all teamed up to develop the Hill Country Education Project when the vocational nursing program in the area shut down . ACC agreed to extend its nursing program into the community through a combination of on-site faculty instruction and distance learning, which would be supported by interactive audio-video telecommunications equipment provided by ACC, the Alamo AHEC, and UTHSCSA's Distance Learning and TeleHealth Network. In addition, the Alamo AHEC provided support for a full-time Educational Liaison to work with the various partners to make full use of the educational opportunities afforded by the telecommunications equipment. Since its inception in 1997-98, the program has thrived, graduating an eager group of nurses each year. Health Education and Training Centers (HETC) The Health Education and Training Center program was created to improve the supply and distribution of health professionals along the border between the United States and Mexico. HETC projects incorporate a strong emphasis on wellness through public health education activities for disadvantaged populations. Also, each project supports at least one training and education program for physicians and one for nurses so that a portion of the clinical training for students is in the service area. The HETC programs received $4.4 million for FY 2002. The Kentucky Health Education and Training Centers (HETC) provide cultural competence training to health care facilities, providers, and students. The HETC staff work in their communities to facilitate interpreting services and culturally appropriate health education and health promotion programs for the Hispanic population. The NorthWest HETC has implemented a health education class for six to thirteen year olds at the Americana Community Center, an inner city housing complex, as well as providing cultural competence training session to local providers. The Kentucky HETC program with the University of Kentucky sponsored the first Cultural Competence Conference in the State in August 2000. As a statewide program encompassing the eight AHEC regions, the HETC works to prepare a culturally diverse health care workforce and emphasize health careers preparation early in the educational pipeline. Geriatric Health Professions The Geriatric Health Professions Programs support three initiatives: geriatric faculty fellowships train faculty in geriatric medicine, dentistry, and psychiatry; the Geriatric Academic Career Award program supports the development, through $50,000 grants over a five-year period, of newly trained geriatric physicians into academic medicine; and the Geriatric Education Centers (GECs) program provides grants to support collaborative arrangements involving several health professions schools and health care facilities that facilitate training in the diagnosis, treatment, and prevention of disease and other health concerns of the elderly. Within a defined geographic area, GECs provide services to and foster relationships among organizations or institutions that sponsor geriatric educational programs for health care professionals. Since its inception, the GEC program has successfully trained over 350,000 health professionals in the unique health issues of an aging population, with just over half of this number currently in the workforce. The program has resulted in more effective diagnosis and intervention, leading to decreased rates of early institutionalization and significant cost savings for both public and private health and long-term payers. Given America's burgeoning older population and the retirement of the first wave of health professionals trained in geriatrics, all 50 states should be served by a fully funded GEC, versus the 36 that exist now. For FY 2002, the geriatric health professions programs received $20.4 million. In FY 2002, the 15 geriatric academic career award grantees have been involved in impressive and diverse activities. Award recipients' activities include traditional academic activities such as curriculum development and participation in administrative duties at their medical schools, providing care and teaching in a wide range of clinical settings, clinical research; participating in education programs to build their own skills; and providing continuing education to already practicing health professional working with other sponsored health education programs. A grantee at the Brookdale Department of Geriatrics and Adult Development, Mt. Sinai School of Medicine (New York) is focusing on palliative care throughout the five years of her award and is developing a four year module slot for teaching palliative care to first and second year medical students. Quentin N. Burdick Program for Rural Interdisciplinary Training This program provides grants to improve access to health care services in rural areas by increasing the recruitment and retention of health professionals in these areas. The program funds projects that develop new and innovative methods to train health care practitioners to provide services in rural areas. Also, an emphasis is placed on long-term collaboration between academic institutions, rural health care agencies, and health care providers to improve access to rural health care by strengthening the distribution, diversity, and quality of the providers. Over the past 10 years, nearly 13,000 health care providers, teachers, and students in 29 states have been trained through this rural training program. Experts estimate that 5,570 professionals are still needed to meet an adequate provider to population ratio for rural shortage areas. In FY 2002, 27 grants were supported with this funding. For FY 2002, the program was allotted $ 7.0 million. Allied Health and Other Disciplines The University of Nebraska Medical Center established medical technology education sites in four communities in rural Nebraska, including a student laboratory in central Nebraska, under an Allied Health Project Grant. As of 2001, of 89 graduates, 97 percent took their first job in a rural community, and 74 percent took their first job in rural Nebraska. Some allied health professions, such as medical technology, cytotechnology and radiological technology, are experiencing workforce shortages, and the Allied Health Project Grants are a proven solution to the vacancy problem. The Allied Health Special Project Grants help health profession schools, academic health centers, state and local governments, and other public or private nonprofit entities to establish or expand allied health training programs. Since 1990, 141 allied health grants have been funded and in fiscal year 2001, 20 projects were awarded monies. The allied health workforce includes more than three million health professionals who provide services in a wide range of settings, including hospitals, clinics, physicians' offices, hospices, extended-care facilities, health maintenance organizations, community programs and schools. For 2002, $9.5 million was appropriated for these programs. The Southeast Alaska Regional Health Consortium reflects the kind of success familiar to Allied Health Project Grants programs. Using distance-learning techniques, this group has implemented a Community Wellness Advocate Training Program. After completing four courses offered by the University of Alaska, Southeast campus, consortium participants live and work in isolated communities that do not have access to physicians or even midlevel practitioners. Along with community health aides and community family service workers, they provide health prevention and promotion information to these populations. The program has been very successful: · All four members of the first graduating class are employed in their communities. · Two graduates cross-trained in other health professions (Emergency Medical Technician and nursing) and thus have improved their effectiveness and two students, as part of their independent project for the training program, have applied for and received $17,000 in state funding · 4 of 12 Alaskan Native American Regional Health Consortia are committed to support the program or are working to become involved. · The project is well on its way toward becoming self-sustaining, using state support that will begin in 2005. HEALTH PROFESSIONS WORKFORCE INFORMATION AND ANALYSIS The Health Professions Workforce Information and Analysis program supports projects that evaluate the impact of Bureau of Health Professions programs and compile and analyze data on the health workforce. It also includes a uniform health professions data reporting system. In working with states and other partners to develop data and determine how to best improve the distribution of the health care workforce, the program focuses on some key issues, such as health data, health workforce distribution studies, medical education research, and health services research. Accurate and timely data are essential to evaluating how effectively the current health care workforce is meeting the health care needs of the public. Through this program, the Bureau has developed and collected data on various facets of the health professions population. One such information system enables policymakers, researchers, planners and others to analyze the current state of health care access at the county level. Another computer simulation model allows researchers to forecast how many primary care practitioners a given region or service area will need, depending on changes in the overall health care system. In addition, the Seventh National Sample Survey of Registered Nurses was conducted in 2000 and published February 22, 2002. It is the nation's most extensive and comprehensive source of statistics on all those with current licenses to practice in the United States, whether or not they are employed in nursing. These information tools developed by the Bureau are invaluable in evaluating the quality, diversity, and distribution of providers in this country. However, significantly increased funds are necessary to compile a fully comprehensive analysis of the health care workforce. The research and data programs received a total of $824,000 in FY 2002. PUBLIC HEALTH WORKFORCE DEVELOPMENT Health professions schools including schools or programs of public health, preventive medicine, dental public health, and programs in public health, health administration, and health management; academic health centers; state or local health departments; and other appropriate public or private nonprofit entities are eligible for funding through the following programs: · Public Health Training Centers · Public Health Traineeships · Preventive Medicine and Dental Public Health Residencies · Health Administration Programs The public health, preventive medicine, and dental programs received $11.7 million in FY 2002. Public Health Training Several public health workforce experts in both government and academia estimate that as many as 80 percent of the 400,000 individuals currently working in state or local health departments have no formal education in public health. Furthermore, these same experts estimate that less than 50 percent of the directors of the local health departments, many of whom are physicians, have no public health training. There is a critical need to provide these professionals with the most up-to-date public health training available. According to HRSA and expert panels, there are personnel shortages in several public health occupations. These include, among others, epidemiologists, biostatisticians, environmental health workers, public health nurses, physicians (both public health and preventive medicine experts), and dentists, maternal and child health administrators, behavioral and social scientists, and nutritionists. Many state and local health officials have reported that the lack of practical knowledge and skills in the core sciences of public health has restricted the effectiveness of their agencies and personnel. Many national health groups, especially those representing maternal and child health agencies, agree that regional shortages of adequately trained professionals present the most significant barrier to providing population-based prevention initiatives, and ensuring the delivery of quality health care to underserved individuals and underrepresented populations. Public health professionals trained to handle the unique demands of rural and inner-city public health issues are the shortest in supply. The recent focus on potential bioterrorist attacks on the United States has led many to question the ability of the current public health workforce to deal with such emergencies, including outbreaks of infectious diseases. For example, there has not been a case of smallpox since the early 1970s, and few public health professionals are trained to recognize the symptoms of this deadly disease. This lack of formal training in infectious diseases extends to other biological agents such as anthrax, tularemia, botulinin toxin, and plague. To detect and respond to a bioterrorist attack, the U.S. needs public health professionals who can: conduct epidemiological surveillance; design and use the tools to detect terrorist biological attacks; and understand the principles of containment. Currently, there is a shortage of these public health professionals. According to HRSA officials, with the shortage of well-trained public health professionals in various disciplines, communities are left vulnerable to increased infectious diseases, toxic environmental situations, contaminated food, and other threats to public health. Training for public health professionals is vitally important in medically underserved communities, where serving disadvantaged populations is critical. In FY 2000, this funding supported 8 public health training centers and 33 public health traineeships. Funded by a public health project grant by HRSA, through the Association of Schools of Public Health, a program at the University of Pittsburgh Graduate School of Public Health is directed toward practicing public health personnel in state and local health departments in the Northeast United States. The goal of this project is to assess the skill and knowledge needs of the public heath workforce and prepare course materials and provide training assistance necessary to keep them current in areas such as bioterrorism preparedness. To achieve this goal, an advisory board, consisting of representatives from Northeastern state and local health departments, Area Health Education Centers, and national public health organizations such as HRSA, CDC, National Association of City and County Health Officials, American Public Health Association, Public Health Foundation and the Council for Education for Public Health, provided guidance on policy issues and distance learning training issues. One outcome of the project has been broad curricular direction for the public health workforce of the 21st century, recognizing the increased use of the Internet and satellite based courses. This project has introduced real world experience by using the Allegheny County (Pennsylvania) Health Department as an active partner. The project has developed a laboratory for the evaluation of training capacity and curriculum offerings. The project has developed a model training resources inventory to address agency training needs. The inventory, available as a hard copy and on-line tool, will be helpful to other health agencies as it is refined. Preventive Medicine and Dental Public Health Residencies Fifty percent of all premature deaths in this country, as many as one million per year, can be prevented through measures that target risk factors, such as tobacco, drug, and alcohol use; diet and sedentary lifestyle; and environmental factors. Physicians certified in preventive medicine are needed to assure the population-based services, clinical prevention, and community education that will reduce the suffering, disability, and death resulting from preventable conditions. Preventive medicine is the only medical specialty that provides extensive training in both clinical medicine and community health to provide leadership for these prevention efforts. A new residency in preventive medicine was established at Nova Southeastern University College of Osteopathic Medicine (Ft. Lauderdale, Fla.) as a result of funds from a Title VII grant. The only preventive medicine residency in the osteopathic medical profession, the program is based at the Palm Beach County Health Department and also includes rotations at the West Palm Beach Veterans Affairs Medical Center. This residency program is integrated with an allopathic medical program and, as a result, is accredited by both professions. Palm Beach County was the site of the first anthrax death and the investigation into this outbreak became an integral part of the program. HRSA currently provides $1.8 million to fund one quarter of all physicians in general preventive medicine/public health residencies. This funding supports 60 physicians in 11 preventive medicine residency training programs nationwide. One-third of the residents funded through these programs are underrepresented minorities, which is three times the average of minority representation among health professionals generally. Forty percent of the residents practice in medically underserved communities, a rate four times the average for all health professions. Because federal funding for preventive medicine programs has not significantly increased since 1986, the number of physicians training slots able to be funded each year has decreased over time. There are currently only 2,755 physicians trained in general preventive medicine and public health in the nation. The number of physicians completing a preventive medicine residency has declined by 25 percent during the last 5 years, leading to major gaps in preventive medicine expertise needed for clinical prevention, community public health, and health services organization and delivery. This means fewer physicians trained to promote public health and disease prevention to reduce preventable morbidity and mortality. Funded by a preventive medicine residency grant, the University of California-San Diego/San Diego State University General Preventive Medicine Residency program has been training residents in underserved areas in San Diego County since 1984. Many of the residents have gone on to direct community health centers in areas serving refugees, Native Americans, undocumented, unfunded patients and the working poor. They have conducted research projects in these populations looking at primary prevention in diet, HIV prevention, hepatitis B, hepatitis C and others. Dental Public Health Residencies are generally one-year programs that prepare trainees for leadership roles in the control and prevention of dental disease and the promotion of oral health through organized community efforts. It is the form of dental practice that treats the community rather than the individual as a patient, and is analogous to preventive medicine training. Although small in number, these trainees are vital to the nation's dental public health infrastructure. Health Administration Programs Funding for Health Administration Traineeships and Special Projects is the federal government's only spending to train the men and women who manage our health care system. This funding permits management students to serve in underserved rural and urban areas and brings expertise and support to the areas that need it most, giving those regions a needed infusion of experienced health care managers. The awards in FY 2000 supported 38 traineeships and special projects. The Health Administration Programs were funded at $1.2 million in FY 2002. Exposure to experiences in rural areas is one recruitment strategy that increases the likelihood of health professionals choosing to work in rural areas. Funds provided by the Health Administration Traineeships and Special Projects at the Medical University of South Carolina over four years were used to place 45 graduate students in rural and medically underserved internships in which they completed special projects such as a primary care effectiveness review and a Medicare/Medicaid policy manual for diabetes and hypertension. Because of this special opportunity, fifteen graduates accepted job positions and fourteen graduates completed one-year administrative residencies in non-profit health entities in rural areas. NURSE EDUCATION ACT (NEA) The Nurse Education Act (Title VIII of the Public Health Service Act) helps schools of nursing and nursing students prepare to meet patient needs in a changing health care delivery system, favoring programs in institutions that train nurses for practice in medically underserved communities and Health Professional Shortage Areas. Reauthorized as the Nursing Workforce Development section in 1998, the new NEA gives the Department of Health and Human Services more discretion over the focus of federal spending, while keeping with previous goals. NEA appropriations for FY 2002 were $82.5 million. Health care providers across the nation are experiencing a crisis in nurse staffing, and employers are having difficulty finding experienced nurses to work in their facilities. The problem is caused in part by a lack of young people entering the profession and an aging workforce. The lack of young people in nursing has resulted in a steady and dramatic increase in the average age of the U.S. nurse. Today, the average working RN is over 43 years old. Only ten percent of all registered nurses is under the age of 30. The average age of working RNs is projected to continue to increase before peaking at age 45.5 in 2010. At that time, large numbers of nurses are expected to retire and it is projected that the total number of nurses in America will begin a steady decline. At the same time, the need for nursing services is expected to continue to increase. America's demand for nursing care is expected to balloon over the next 20 years due to the aging of the population, advances in technology and various economic and policy factors. The Bureau of Labor Statistics ranks the occupation of RN as having the 7th highest projected job growth in the US. The demand for RNs is expected to increase by 22 percent by 2008. This demand, coupled with the imminent retirement of today's aging nurse, will create severe stresses on the health care system. A recent study published in the Journal of the American Medical Association estimates that the overall number of nurses per capita will begin to decline in 2007, and that by 2020 the number of nurses will fall nearly 20 percent below requirements. The examples from the current staffing shortage are indeed striking: In November 2000, 10 percent of the surgical beds at Johns Hopkins Hospital in Baltimore went idle as a direct result of the nurse staffing shortage -- causing delays and cancellations of surgeries. Vacancy rates for nurses are high in many states. These include Vermont with a vacancy rate of 7.8 percent in 2001, up from 4.8 percent the previous year; California with a vacancy rate of 20 percent in 2001 and 2000; Florida with a vacancy rate of 16 percent last year and an average rate of 13 percent. In South Dakota, 72 percent of nurse employers report a nursing shortage. Approximately 500 positions are vacant. This number is projected to increase to 1300 by next year. This shortage will not be filled by graduating students. Only 500 students are expected to graduate with nursing degrees. The NEA will help to bring more nurses into the workforce, in addition to providing more training for those already practicing. Advanced Education Nursing Grants Grants are awarded to schools to educate master's and doctoral students as advanced education nurses, including primary care nurse practitioners, certified nurse midwives, clinical nurse specialists, public health nurses, nurse administrators, faculty, nurse anesthetists, and non-primary care nurse practitioners. It also provides traineeships for master's and doctoral students (limit of 10 percent of appropriations for doctoral traineeships). The NEA funds more than 60 percent of U.S. nurse practitioner (NP) education programs and assists 83 percent of nurse midwifery programs. Of certified nurse midwives (CNM), 80 percent serve low-income or minority women and are in primary care. Over 45 percent of advanced nursing graduates go on to practice in medically underserved communities, in inner city or rural settings, and in areas with large Medicaid populations. Many provide care to minority or disadvantaged patients. It was funded at $60.0 million for FY 2002. · An East Carolina University NEA grant has increased the numbers of advanced practice nurses providing services to high risk and underserved populations in rural areas, including improved quality of life for AIDS patients. It also links hospital and community based services. · About 45 percent of the University of Florida's* past four nurse practitioner graduating classes are employed in rural and medically underserved areas.* · More than 60 percent of graduates of the nurse-midwifery program at the University of Missouri-Columbia* are employed in rural areas and Health Professional Shortage Areas.* · A Wisconsin NEA grantee prepares CNMs to care for women and children in underserved areas. A Puerto Rico midwifery program seeks to train professionals to reduce the highest rate of infant mortality in the nation. · The NEA supports education programs and traineeships for future nursing faculty, a serious concern at a time of growing shortages of nurses and declining undergraduate enrollments. Workforce Diversity Grants This section provides grants to increase opportunities for nursing education for disadvantaged students, including underrepresented minorities. It provides scholarships or stipends, pre-entry preparation, and retention activities. In FY 2001, this section had only enough funding to award 10 grants. Racial and ethnic minorities currently comprise more than 1/4 of the nation's population and will comprise nearly 40 percent by the year 2020. The most recent nursing workforce data available document that less than 10 percent of all registered nurses are minority nurses. The program was funded at $6.2 million for FY 2002. A Mississippi NEA grantee enrolled 23 at risk nursing students from disadvantaged backgrounds, and increased retention rates and improved their academic performance by utilizing increased counseling, computer learning, and stipends. A Pittsburgh NEA grant recipient linking academic and social support and stipends prepared 115 African American nurses, many of whom returned to their home underserved community to practice. A Hispanic single parent in this same program became a nurse in a Veterans Administration Hospital and encouraged her son to follow in her footsteps. He did so, graduated with honors from Duquesne University and is now an Air Force nurse. A Virginia grantee has targeted a high school in the state that has a high percentage of poor, minority students. During this three-year grant cycle, 30 of the students in this school will or have received financial assistance and counseling to assist them in receiving their nursing degrees. Nurse Education Loan Repayment Program The Nurse Education Loan Repayment Program (NELRP) repays up to 85 percent of nursing student loans in return for at least two years of practice in a designated nursing shortage area. This program is a favorite of Health and Human Services Secretary Tommy Thompson. Last year, he used his transfer authority to provide $5 million more for the program than Congress originally allocated. For the first two years of service, the NELRP will pay 60 percent of the RN's student loan balance, up to $30,000. If the participant elects to stay for another year, an additional 25 percent of the loan will be repaid, up to an additional $7500. Within 3 years, a nurse can pay off approximately 85 percent of his/her student loans. More than 400 awards were distributed last year. This program was funded at $10.2 million for FY 2002. Basic Nurse Education and Practice Grants Basic Nurse Education and Practice Grants are awarded to schools of nursing to strengthen basic nurse education and practice in seven priority areas: expanding nursing practice in non-institutional settings to increase access to primary health care; training for care of underserved and high risk populations; education for managed care; developing cultural competency; expanding baccalaureate enrollments; increasing nursing career mobility, and nursing education in informatics and use of distance learning. This section awarded 20 grants in FY 2001. It was funded at $16.3 million for FY 2002. · A grant awarded to Marquette University will increase the number of baccalaureate-prepared nurses employed in rural areas of Wisconsin by offering an on-site accelerated nursing program for employed associate degree and diploma-credentialed nurses. The program combines distance learning with traditional classroom instruction. Participants and employers have reacted positively to this program because it allows the students to enhance their education while remaining in the workforce. · At the East Central University (ECU) in Oklahoma, funding provides the university with the ability to extend its nursing program to more remote parts of the state. The extension is vital to the area, because the nursing program in ECU is the only one in one-third of the state. This area of Oklahoma is rural, medically underserved, and poor. A large Native American population lives in this region, and this group is benefiting from the program both as recipients of care and as students and faculty of the program. · The College of Nursing at the Medical University of South Carolina used its grant to establish six school-based clinics for poor children. The goal of the grant is to reach more than 2000 children by providing them with much needed health education and medical services. · Funding was given to the University of Washington to provide continuing education for nurses who care for medically underserved or rural patients with complex wounds. The program is designed to prepare participants to evaluate, effectively treat, and manage wounds that are difficult or slow to heal. These wounds can pose significant health risks and financial burden to afflicted individuals without proper treatment. The need for nurses with specialized knowledge in wound management has and will continue to increase as the proportion of older people with chronic health conditions increases. STUDENT FINANCIAL ASSISTANCE Titles VII and VIII include loan programs that assist needy and disadvantaged medical and nursing school students in covering the costs of their education. · Nursing Student Loan · Primary Care Loan · Health Professional Student Loans · Loans for Disadvantaged Students The Nursing Student Loan program, the Primary Care Loan program and the Health Professions Student Loan program do not receive appropriations. Rather, they are operated through revolving loan funds that currently exist at health professions schools. The Loans for Disadvantaged Students (LDS) program has been funded traditionally through the appropriations process. In the Health Professions Education Partnership Act, the LDS program is authorized to receive $8 million through FY 2002. After FY 2002, the authority for appropriations would be repealed after the revolving funds begin to be paid back by current loan recipients. Nursing Student Loan (NSL) The NSL program loans up to $13,000 total per student to nursing students with a preference for those in financial need. It is open to undergraduates and graduate students. The interest rate is 5 percent and the default rate for NSL loans is 2.87 percent (as of June 30, 1999). The repayment period is 10 years. These funds are loaned out to new students as loans are repaid by those graduating or otherwise leaving school. In FY 2001, $3.5 million was awarded to 146 schools. Primary Care Loan (PCL) The PCL program provides health professions students with financial need and an interest in primary care, the opportunity to obtain a PCL. Recipients of this loan must choose a primary care specialty, enter and complete a residency program in primary care no later than four years after their date of graduation, practice primary care through the date at which the loan in paid in full, and certify to the school, on an annual basis, that he or she is practicing one of the primary care specialties. Primary care specialties include: Family Practice; General Internal Medicine; General Pediatrics; and Preventive Medicine. Awards under the PCL program may be made in amounts that do not exceed the cost of attendance (including tuition, other reasonable educational expenses and reasonable living expenses). This is an increase from the previous limit of full tuition plus $2,500 for educational and living expenses. These loans carry a 5 percent interest rate and generally must be repaid over a period of not less than 10 years nor more than 25 years. This new repayment option must be made available to any borrowers who have not yet completed repayment. The borrower must practice in primary care during the length of the repayment period. Failure to practice primary care during the loan repayment period will result in severe penalties. Although the new law repeals provisions that require service requirement defaulters to repay their PCL loans within 3 years, new provisions increase the interest rate for service requirement defaulters to 18 percent beginning on the date of such noncompliance. In FY 2001, $9.8 million was awarded to 27 schools. Last year, two students at the University of North Texas Health Science Center (Ft. Worth) were awarded Super PCLs of $80,000 each. With these funds, the school was able to repay approximately 90 percent of the loans each student had taken out while attending osteopathic medical school. This was a tremendous help to both students due to the nature of the areas in which they hoped to practice. Health Professional Student Loan (HPSL) The Health Professions Student Loan program provides long-term, low interest rate loans to full-time, financially needy students to pursue a degree in dentistry, optometry, pharmacy, podiatric medicine, or veterinary medicine. In FY 2001, $1.3 million was awarded to 76 schools. Participating schools are responsible for selecting loan recipients, making reasonable determinations of need and providing loans that do not exceed the cost of attendance (tuition, reasonable educational expenses and responsible living expenses). Loans for Disadvantaged Students (LDS) The Loans for Disadvantaged Students program provides long-term, low-interest rate loans to full-time, financially needy students from disadvantaged backgrounds, to pursue a degree in allopathic medicine, osteopathic medicine, dentistry, optometry, podiatric medicine, pharmacy or veterinary medicine. In FY 2001, $146,000 in new loans went to 12 schools. Eligible health professions schools receive LDS funds allowing them to provide loans to disadvantaged students. Participating schools are responsible for selecting loan recipients, making reasonable determinations of need and providing loans which do not exceed the cost of attendance (tuition, reasonable educational expenses and reasonable living expenses). Schools receiving funds must carry out programs for recruiting and retraining students from disadvantaged backgrounds and recruiting minority faculty.