AAMC Reporter: April 2006

Emme Chapman, student at West Virginia University School of Medicine

Budget Cuts Threaten Title VII Programs

This May, Emme Chapman will add the initials "M.D." to her name when she graduates from the West Virginia University School of Medicine (WVUSOM). Chapman believes she might not have attained her dream of becoming a doctor without help from the school's Health Careers Opportunity Program (HCOP).

"I didn't have a clue how to do it, but they said, 'We want you to get there, too, and we're going to help you,'" Chapman says. "It's a program that finds people who have the desire and who love medicine, and it helps those people. They make good doctors."

Chapman appreciates everything the WVUSOM HCOP did for her — chemistry tutoring, MCAT preparations, help with her medical school application, and constant emotional support.

But she worries about the aspiring doctors who will follow in her footsteps, because next year the program may no longer exist.

"I think it's sad that no one may be able to go through this program again, because it was so good for me," Chapman says.

The HCOP is just one of several federal programs that have been "zeroed out" in President Bush's 2007 budget proposal. The program is part of the federal Health Resources and Services Administration's Title VII programs — which supports facilities, initiatives, and individuals engaged in health professions training, with an emphasis on recruiting practitioners for rural and other medically underserved areas.

The administration's  proposed budget eliminates funding for all Title VII programs in fiscal year 2007 except the Scholarships for Disadvantaged Students program, which is set to receive $10 million. Health professions programs exist in all 50 states and include school Centers of Excellence, Faculty Loan Repayment, Area Health Education Centers, rural training, Geriatric Education Centers, and others.

The proposed elimination of these programs amounts to a 92 percent funding cut of Title VII and follows a cut of more than 50 percent to Title VII for the current fiscal year.

Ann Chester, Ph.D., assistant vice president of health sciences for social justice at WVUSOM and head of the school's HCOP, says Chapman, a native of Webster County, W.V. (population 9,848 as of 2004), plans to return to that area to practice medicine and is a perfect example of the kinds of students HCOP and other Title VII programs were designed to develop.

"If we don't have these programs, we won't have kids returning to underserved areas, and we won't have high enough numbers of health care providers to even think about filling the need for health care in these communities," Chester says. "We've already got a horrible situation with disparities in health, and the best way to help is to end the disparities in health care providers."

Scott Milburn, a spokesman for the federal Office of Management and Budget, which prepares the president's budget each year, says Title VII was an outmoded program that no longer served the public good.

"[Title VII health professions programs] were created 40 years ago in response to an anticipated national shortage of physicians that does not exist today," Milburn says.

"Given this, continuing subsidies to entice people to enter medical careers that already pay handsomely isn't the best use of taxpayers' dollars. Additionally, the program is unable to demonstrate how long those it trains actually stay in jobs that serve the targeted populations," Milburn says.

Milburn adds that the budget proposal "prioritizes the distribution of health professionals" by maintaining funding for the National Health Service Corps, with a recommended FY 2007 budget of $126 million.

Erica Froyd, senior legislative analyst in the AAMC's Office of Governmental Relations, notes that the association and other organizations and experts in the field predict physician demand will significantly outweigh supply by 2020, if current trends continue. Froyd also says a wide chasm exists between the needs of disadvantaged communities and the availibility of health care providers, partly due to the lack of diversity in the health workforce. (By 2050 nearly half of the U.S. population will consist of racial or ethnic minorities, but the AAMC estimates they will constitute less than 10 percent of U.S. physicians and surgeons.)

"Programs such as Centers of Excellence and HCOP recruit and nurture individuals from disadvantaged backgrounds interested in becoming health professionals. These individuals are then likely to go back to their hometowns, and serve those communities, which is a primary aim of Title VII. Our institutions have made clear that they need these programs to train providers from underrepresented populations," says Froyd.

Froyd does acknowledge, however, that program participants are difficult to track under the current system.

"As the Title VII programs have grown to add more health professionals and purposes, so has the need for better data in terms of who is being trained and how many choose to practice in underserved areas. With this information, the programs could be tailored to address particular workforce needs," Froyd says.

Title VII programs train not only new physicians but also other health care professionals already in the workforce. One example is Geriatric Education Centers (GECs). These centers are collaborative arrangements among health professions schools and health care facilities that provide interdisciplinary training of health professional faculty, students, and practitioners in the diagnosis, treatment, and prevention of health problems affecting the aged.

"GECs are the only federal program training those who offer face-to-face care to the nation's elderly," says Elyse Perweiler, M.P.P., R.N., head of the New Jersey GEC and president of the board of the National Association of Geriatric Education Centers.

"The 2006 Title VII cuts had a direct impact, and the 2007 proposal is a frightening prospect. You have to ask yourself where we're going with health care in this country. With the nation's baby boomers aging so rapidly, if we don't have properly trained health care professionals for them, that presents a pretty bleak picture," Perweiler says.

According to Perweiler, in 2005 the nation's 50 GECs trained 50,000 health care professionals from 35 different disciplines, who then logged 8.5 million face-to-face encounters with elderly patients. She calls it "ironic" that the GEC cuts followed the 2005 White House Conference on Aging. One of the conference delegates' 10 resolutions submitted to President Bush and Congress encouraged lawmakers to "support geriatric education and training for all health care professionals, paraprofessionals, health profession students, and direct care workers."

Specialized geriatric training is important, Perweiler says, because elderly patients sometimes display disease symptoms differently from younger patients. She adds that health care professionals must be aware that senior populations also have their own set of physical and psychological issues, ranging from depression to the ability to take medication. 

Future Prospects

Froyd predicts an uphill battle to persuade Congress to restore Title VII programs in Washington's current political climate.

She adds, however, that the AAMC is working with Congress not only to re-establish program funding but also to retool the programs themselves. Title VII has been due for congressional reauthorization since 2002.

"I think it's going to be extremely difficult to get these programs up to the funding level where they need to be. Congress is facing tough choices right now," Froyd says. "But we need to get the money back now for these programs. Their absence would hurt the patients and the providers in many communities. But in the longer term, we also see the need to revitalize."

"The more Title VII languishes, the worse off it is. We look forward to coming up with some viable options on how to improve these programs and their longevity," Froyd says.

In June 2005, the AAMC Executive Council approved six recommendations for Congress to consider during Title VII reauthorization, including authorizing $3 million for a new national workforce database to track the location of health professionals educated and trained in programs receiving Title VII support. The council also called for a restructuring of the Title VII grant system so that primary care training grants are preferentially awarded to those who enter a formal relationship with a clinic or health center that treats medically underserved patients, as a way of tying Title VII training to providing care for underrepresented populations.

Chester, who estimates that 600 students have gone through the WVU HCOP since she took the reins in 1985, with 85 percent to 90 percent moving through the health care education pipeline, says that losing Title VII programs would be a major blow, both for disadvantaged students and for patients.

"This would have a devastating effect. These students come from families who have never been to college, and have been through generations of poverty. They go right back to their home and practice where others don't. People you would never have thought would make it through — and they wouldn't have done it without these programs. The barriers are fierce without help. These kids have the potential. They just don't have the path. It's still not easy, but at least, through these programs, the path is there."

—By Scott Harris

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