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Testimony
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(PDF, 6 pages)
Testimony of the Health Professions and Nursing
Education Coalition (HPNEC) concerning Title VII & VIII Health Professions
Programs
before the
House Appropriations Subcommittee on Labor, Health
and Human Services, and Education
presented
March 18, 2009, at 2 p.m.
by
Tina L. Cheng, M.D., M.P.H.
Chief, General Pediatrics & Adolescent Medicine
Professor of Pediatrics & Public Health
Johns Hopkins University School of Medicine
Bloomberg School of Public Health
Baltimore, Maryland
President, Academic Pediatric Association
Summary:
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The health professions education programs, authorized
under Titles VII and VIII of the Public Health Service Act and administered
through the Health Resources and Services Administration, support
the training and education of health care providers to enhance the
supply, diversity, and distribution of the health care workforce,
filling the gaps in the supply of health professionals not met by
traditional market forces. They are the only federal programs designed
to train providers in interdisciplinary settings to meet the needs
of special and underserved populations, as well as increase minority
representation in the health care workforce.
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According to HRSA, an additional 30,000 health
practitioners are needed to alleviate existing health professional
shortages. Combined with faculty shortages across health professions
disciplines, racial/ethnic disparities in health care, and a growing,
aging population, these needs strain an already fragile health care
system.
-
Numerous recent, highly regarded publications recommend
increased support for the health professions programs to help meet
these needs, including a December 2008 Institute of Medicine (IOM)
report which characterized HRSA's health professions programs as "an
undervalued asset."
-
HPNEC recommends $550 million in FY 2010 for the
Title VII and VIII programs. This investment is consistent with
President Obama's pledge to invest in strengthening the health professions
workforce in the FY 2010 budget, will help sustain the health workforce
expansion supported by the American Recovery and Reinvestment Act,
and will restore funding to critical programs that sustained drastic
funding reductions in FY 2006 and remain well below FY 2005 levels.
Good afternoon.
My name is Tina Cheng, and I am Chief of the Division
of General Pediatrics and Adolescent Medicine and Professor of Pediatrics
and Public Health at the Johns Hopkins University School of Medicine
and Bloomberg School of Public Health. It is a pleasure to submit
this testimony on behalf of the Health Professions and Nursing Education
Coalition (HPNEC) in support of $550 million in fiscal year (FY)
2010 for the health professions education programs authorized under
Titles VII and VIII of the Public Health Service Act and administered
through the Health Resources and Services Administration (HRSA).
HPNEC is an informal alliance of more than 60 national
organizations representing schools, programs, health professionals,
and students dedicated to ensuring the health care workforce is trained
to meet the needs of our diverse population.
As you know, the Title VII and VIII health professions
and nursing programs are essential components of the nation's health
care safety net, bringing health care services to our underserved
communities. These programs support the training and education of
health care providers to enhance the supply, diversity, and distribution
of the health care workforce, filling the gaps in the supply of health
professionals not met by traditional market forces. Through loans,
loan guarantees, and scholarships to students, and grants and contracts
to academic institutions and non-profit organizations, the Title VII
and VIII programs are the only federal programs designed to train
providers in interdisciplinary settings to meet the needs of special
and underserved populations, as well as increase minority representation
in the health care workforce.
We are thankful to the Subcommittee for the $200 million
provided for the health professions programs in the American Recovery
and Reinvestment Act (P.L. 111-5). We also greatly appreciate that
the recently enacted FY 2009 Omnibus Appropriations bill (P.L. 111-8)
provides some increases for most Title VII and VIII programs. These
investments provide a crucial springboard to begin to wholly reverse
chronic underfunding of these programs and address existing and looming
shortages of health professionals.
According to HRSA, an additional 30,000 health practitioners
are needed to alleviate existing health professional shortages. Combined
with faculty shortages across health professions disciplines, racial/ethnic
disparities in health care, and a growing, aging population, these
needs strain an already fragile health care system. Because of the
time required to train health professionals, we must make appropriate
investments today. Yet, despite some increases in recent years, many
of the health professions programs remain well below their comparable
FY 2005 funding levels.
HPNEC's $550 million recommendation for the Title VII
and Title VIII health professions programs in FY 2010 will help sustain
the health workforce expansion supported by funding in the recovery
package. Further, this appropriation will restore funding to critical
programs that sustained drastic funding reductions in FY 2006 and
remain well below FY 2005 levels.
We are grateful to President Obama for his support for
the health professions programs throughout his tenure in the Senate.
We also appreciate the pledge in his FY 2010 budget overview to invest
in strengthening the health professions workforce. This strategy is
in line with numerous recent, highly regarded recommendations. In
a December 2008 Institute of Medicine (IOM) report, HRSA's health
professions programs were characterized as "an undervalued asset"
and the Department of Health and Human Services was encouraged to
support additional investments in the programs. Another IOM report
on the future workforce for older Americans from April 2008 also called
for increased funding for the health professions programs. The November
2008 issue of the peer-reviewed journal Academic Medicine chronicles
the effectiveness of the programs, and the primary care programs in
particular, while the December 2008 issue of the Mt. Sinai Journal
of Medicine highlights the impact of the diversity programs.
These most recent publications showcase the network
of Title VII and VIII initiatives across the country supporting the
education and training of the full range of health providers. Together,
the programs work in concert with other programs at the Department
of Health and Human Services - including the National Health Service
Corps and Community Health Centers (CHCs) - to strengthen the health
safety net for rural and medically underserved communities.
The Health Professions Education Partnerships Act of
1998 (P.L. 105-392) consolidated the programs into seven general categories:
- The purpose of the Minority and Disadvantaged Health Professionals
Training programs is to improve health care access in underserved
areas and the representation of minority and disadvantaged health
care providers in the health professions. Minority Centers of Excellence
support programs that seek to increase the number of minority health
professionals through increased research on minority health issues,
establishment of an educational pipeline, and the provision of clinical
opportunities in community-based health facilities. The Health
Careers Opportunity Program seeks to improve the development of
a competitive applicant pool through partnerships with local educational
and community organizations. The Faculty Loan Repayment and Faculty
Fellowship programs provide incentives for schools to recruit
underrepresented minority faculty. The Scholarships for Disadvantaged
Students (SDS) make funds available to eligible students from
disadvantaged backgrounds who are enrolled as full-time health professions
students. Nurses received $15.1 million in FY 2007 from SDS grants,
32 percent of funds appropriated for SDS.
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The Primary Care Medicine and Dentistry programs,
including General Pediatrics, General Internal Medicine, Family
Medicine, General Dentistry, Pediatric Dentistry, and Physician
Assistants, provide for the education and training of primary
care physicians, dentists, and physician assistants to improve access
and quality of health care in underserved areas. Two-thirds of all
Americans interact with a primary care provider every year. Approximately
one half of primary care providers trained through these programs
go on to work in underserved areas, compared to 10 percent of those
not trained through these programs. The General Pediatrics, General
Internal Medicine, and Family Medicine programs provide
critical funding for primary care training in community-based settings
and have been successful in directing more primary care physicians
to work in underserved areas. They support a range of initiatives,
including medical student training, residency training, faculty development
and the development of academic administrative units. The General
Dentistry and Pediatric Dentistry programs provide grants
to dental schools and hospitals to create or expand primary care dental
residency training programs. Recognizing that all primary care is
not only provided by physicians, the primary care cluster also provides
grants for Physician Assistant programs to encourage and prepare
students for primary care practice in rural and urban Health Professional
Shortage Areas. Additionally, these programs enhance 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.
-
Because much of the nation's health care is delivered
in areas far removed from health professions schools, the Interdisciplinary,
Community-Based Linkages cluster provides support for community-based
training of various health professionals. These programs are designed
to provide greater flexibility in training and to encourage collaboration
between two or more disciplines. These training programs also serve
to encourage health professionals to return to such settings after
completing their training. The Area Health Education Centers (AHECs)
provide clinical training opportunities to health professions and
nursing students in rural and other underserved communities by extending
the resources of academic health centers to these areas. AHECs, which
have substantial state and local matching funds, form networks of
health-related institutions to provide education services to students,
faculty and practitioners. Geriatric Health Professions programs
support geriatric faculty fellowships, the Geriatric Academic Career
Award, and Geriatric Education Centers, which are all designed to
bolster the number and quality of health care providers caring for
our older generations. Given America's burgeoning aging population,
there is a need for specialized training in the diagnosis, treatment,
and prevention of disease and other health concerns of the elderly.
The Quentin N. Burdick Program for Rural Health Interdisciplinary
Training places an emphasis on long-term collaboration between
academic institutions, rural health care agencies and providers to
improve the recruitment and retention of health professionals in rural
areas. This program has received no funding since FY 2006. The Allied
Health Project Grants program represents the only federal effort
aimed at supporting new and innovative education programs designed
to reduce shortages of allied health professionals and create opportunities
in medically underserved and minority areas. Health professions schools
use this funding to help establish or expand allied health training
programs. The need to address the critical shortage of certain allied
health professionals has been acknowledged repeatedly. For example,
this shortage has received special attention given past bioterrorism
events and efforts to prepare for possible future attacks. The Graduate
Psychology Education Program provides grants to doctoral, internship
and postdoctoral programs in support of interdisciplinary training
of psychology students with other health professionals for the provision
of mental and behavioral health services to underserved populations
(i.e., older adults, children, chronically ill, and victims of abuse
and trauma, including returning military personnel and their families),
especially in rural and urban communities.
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The Health Professions Workforce Information and
Analysis program provides grants to institutions to collect and
analyze data on the health professions workforce to advise future
decision-making on the direction of health professions and nursing
programs. The Health Professions Research and Health Professions Data
programs have developed a number of valuable, policy-relevant studies
on the distribution and training of health professionals, including
the Eighth National Sample Survey of Registered Nurses (NSSRN), the
nation's most extensive and comprehensive source of statistics on
registered nurses. However, the Workforce Information and Analysis
program has received no appropriation since FY 2006.
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The Public Health Workforce Development programs
are designed to increase the number of individuals trained in public
health, to identify the causes of health problems, and respond to
such issues as managed care, new disease strains, food supply, and
bioterrorism. The Public Health Traineeships and Public Health
Training Centers seek to alleviate the critical shortage of public
health professionals by providing up-to-date training for current
and future public health workers, particularly in underserved areas.
Preventive Medicine Residencies, which receive minimal funding
through Medicare GME, provide training in the only medical specialty
that teaches both clinical and population medicine to improve community
health. Dental Public Health Residency programs are vital to
the nation's dental public health infrastructure. The Health Administration
Traineeships and Special Projects grants are the only federal
funding provided to train the managers of our health care system,
with a special emphasis on those who serve in underserved areas. However,
the traineeships have received no appropriation since FY 2006.
- The Nursing Workforce Development programs under Title VIII
provide training for entry-level and advanced degree nurses to improve
the access to, and quality of, health care in underserved areas. These
programs provide the largest source of federal funding for nursing education,
providing loans, scholarships, traineeships, and programmatic support
to 51,657 nursing students and nurses in FY 2008. Health care entities
across the nation are experiencing a crisis in nurse staffing, caused
in part by an aging workforce and capacity limitations within the educational
system. Each year, nursing schools turn away between 50,000 and 88,000
qualified applications at all degree levels due to an insufficient number
of faculty, clinical sites, classroom space, clinical preceptors, and
budget constraints. At the same time, the need for nursing services
and licensed, registered nurses is expected to increase significantly
over the next 20 years. Congress responded to this dire national need
by passing the Nurse Reinvestment Act (P.L. 107-205) in 2002,
which increases nursing education, retention, and recruitment. The Advanced
Education Nursing program awards grants to train a variety of advanced
practice nurses, including nurse practitioners, certified nurse-midwives,
nurse anesthetists, public health nurses, nurse educators, and nurse
administrators. For example, this funding has been instrumental in doubling
nurse anesthesia graduates in the last eight years. However, even though
the number of graduates doubled, the vacancy rate for nurse anesthetists
has remained the same at 12 percent, due to a retiring nursing profession
and an aging population requiring more care. Workforce Diversity
grants support opportunities for nursing education for disadvantaged
students through scholarships, stipends, and retention activities. Nurse
Education, Practice, and Retention grants are awarded to help schools
of nursing, academic health centers, nurse managed health centers, state
and local governments, and other health care facilities to develop programs
that provide nursing education, promote best practices, and enhance
nurse retention. The Loan Repayment and Scholarship Program repays
up to 85 percent of nursing student loans and offers full-time and part-time
nursing students the opportunity to apply for scholarship funds. In
return these students are required to work for at least two years of
practice in a designated nursing shortage area. The Comprehensive
Geriatric Education grants are used to train RNs who will provide
direct care to older Americans, develop and disseminate geriatric curriculum,
train faculty members, and provide continuing education. The Nurse Faculty
Loan program provides a student loan fund administered by schools of
nursing to increase the number of qualified nurse faculty.
- The loan programs under Student Financial Assistance support
needy and disadvantaged medical and nursing school students in covering
the costs of their education. The Nursing Student Loan (NSL)
program provides loans to undergraduate and graduate nursing students
with a preference for those with the greatest financial need. The Primary
Care Loan (PCL) program provides loans covering the cost of attendance
in return for dedicated service in primary care. The Health Professional
Student Loan (HPSL) program provides loans covering the cost of
attendance for financially needy health professions students based on
institutional determination. The NSL, PCL, and HPSL programs are funded
out of each institution's revolving fund and do not receive federal
appropriations. The Loans for Disadvantaged Students (LDS) program
provides grants to health professions institutions to make loans to
health professions students from disadvantaged backgrounds.
These programs work collectively to fulfill their unique,
three-pronged mission of improving the supply, diversity, and distribution
of the health professions workforce. Profiles of aspiring and practicing
health professionals who attribute their success in part to participation
in the health professions programs are available by state and by program
at: http://www.aamc.org/advocacy/hpnec/profiles.htm.
These profiles comprise only a small sampling of the health professionals
that have benefited from past support for the health professions programs.
HPNEC members respectfully urge support for funding
of at least $550 million for the Title VII and VIII programs,
an investment essential not only to the development and training of
tomorrow's health care professionals but also to our nation's efforts
to provide needed health care services to underserved and minority
communities. We greatly appreciate the support of the Subcommittee
and look forward to working with Members of Congress and the new Administration
to reinvest in the health professions programs in FY 2010 and into
the future.
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