Bush Budget Puts Health Professions Training at Risk

By Suria Santana

Charlie Garcia, assistant dean for multicultural affairs at the University of Washington School of Medicine (UWSOM).

Ever since President George W. Bush announced his FY 2003 budget proposal last February, members of the health care community have voiced concerns over what amounts to the virtual elimination of training programs for health professionals.

These programs - listed under Titles VII and VIII of the Public Health Service Act and administered by the Health Resources and Services Administration (HRSA) - provide a variety of grants aimed at improving the ethnic diversity, geographic distribution, and quality of the health care workforce. Supporters maintain that Title VII and VIII funding is crucial to addressing the nation's health care disparities.

The Bush administration has proposed $94.5 million for Titles VII and VIII, only a quarter of the $378 million in funding allocated last year. While the Nurse Education Loan Repayment Program - not included in past years' budgets - would receive $15 million under the proposal, Centers of Excellence (COEs), primary care medicine, dentistry, public health workforce development, and interdisciplinary programs would be eliminated.

Charlie Garcia, assistant dean for multicultural affairs at the University of Washington School of Medicine (UWSOM), worries that these drastic cuts would significantly hamper his institution's recruitment, retention, and professional development activities involving minority and disadvantaged students.

"Without these programs, we would have less diversity and more disparities in our nation's health care system," says Garcia. "It is quite disturbing that by 2030 one-third of the United States population will be people of color and still, we're facing the threat of health professions programs cuts. We haven't been making the kind of gains we need in order to address our current disparities, and without HRSA funds, we would slip further and further behind with no hope of catching up."

UWSOM relies on COE and Health Career Opportunity Programs (HCOP) grants to advance its recruitment of Native Americans from Washington, Wyoming, Alaska, Montana, and Idaho. Through the COE program, UWSOM identifies potential medical students during high school visits and community workshops, explains Garcia. "After identifying these students, we work with them on a long-term basis, nurturing them in their path to medicine." COE and HCOP activities include summer programs, workshops, tutoring, and counseling sessions.

UWSOM's efforts to target the Native American population, the most underrepresented group in medicine, have paid off, according to Garcia. "About 10 percent of our medical school's students are of Native American descent," he says. "Many of these students choose to go back to their communities to work as primary care providers. We won't be able to keep up with the needs in rural and underserved areas if we don't keep on recruiting students from these very communities."

Graduate medical education programs are also in jeopardy. Rachel Wallace, M.D., is participating in Community Oriented Primary Care and General Academic Pediatrics, a Title VII fellowship that would be eliminated under the president's budget proposal. "This program helps me learn how to treat patients from minority and underserved communities better," explains Dr. Wallace, who is training in a Washington, D.C., community with a predominantly uninsured and non-English-speaking population.

"I am learning what resources are available for patients without health insurance, and I am becoming effective at dealing with their specific problems," she says. "It makes up for the fact that usually we don't spend much time in medical school studying the special needs of these communities."

In addition to fellowship programs such as Dr. Wallace's, historically black colleges and universities play a crucial role in training individuals who eventually choose to practice in underserved areas, says Dale Dirks, president of the Health and Medicine Council of Washington, a group representing patient and health professionals organizations. "Just like an academic health center is recognized for its expertise in a specific area, a minority institution needs to be recognized for its expertise in training students to work in medically underserved areas," he says. "This type of training is inherent in these institutions' missions."

Approximately half of African-American doctors in the country are trained in one of the four historically black medical schools, all of which participate heavily in COE, HCOP, and other diversity programs. "If these universities are weakened through lack of support for COE and HCOP, their ability to train the health professionals needed to solve health disparities problems will also be weakened," predicts Dirks.

Geraldine Bednash, Ph.D., R.N., executive director of the American Association of Colleges of Nursing (AACN), points out that those who would be most affected by the cuts are the ones least able to object. "These proposed cuts end up hurting people who are disenfranchised and who consequently are in the least favorable position to protest the potential impact this could have on their health care," she says.

Although the AACN is pleased with the administration's proposed allocation for the Nurse Education Loan Repayment Program, the association is concerned about the cuts that have been proposed for other health professions' budgets. "Funds supporting health professions education are crucial in facilitating experimentation and the development of programs that are important to the health care of our nation," Dr. Bednash says. "We certainly don't want to receive additional funding at the cost of what's available for other health care professions."

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