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1 Department of Family and Community Medicine and Center for California Health Workforce Studies, University of California, San Francisco
2 Department of Pediatrics, New York University School of Medicine, New York
3 The Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC
4 North Carolina Institute of Medicine, Morrisville
5 Department of Pediatrics and Center for the Clinical Evaluative Science, Dartmouth Medical School, Hanover, New Hampshire
CORRESPONDING AUTHOR: Diane Rittenhouse, MD, MPH, Department of Family and Community Medicine and Institute for Health Policy Studies, University of California, San Francisco, 500 Parnassus Ave, Room MU 308-E, San Francisco, CA 94143-0900, Rittenhouse{at}fcm.ucsf.edu
PURPOSE Community health centers (CHCs) are a critical component of the health care safety net. President Bush’s recent effort to expand CHC capacity coincides with difficulty recruiting primary care physicians and substantial cuts in federal grant programs designed to prepare and motivate physicians to practice in underserved settings. This article examines the association between physicians’ attendance in training programs funded by Health Resources and Services Administration (HRSA) Title VII Section 747 Primary Care Training Grants and 2 outcome variables: work in a CHC and participation in the National Health Service Corps Loan Repayment Program (NHSC LRP).
METHODS We linked the 2004 American Medical Association Physician Master-file to HRSA Title VII grants files, Medicare claims data, and data from the NHSC. We then conducted retrospective analyses to compare the proportions of physicians working in CHCs among physicians who either had or had not attended Title VII–funded medical schools or residency programs and to determine the association between having attended Title VII–funded residency programs and subsequent NHSC LRP participation.
RESULTS Three percent (5,934) of physicians who had attended Title VII–funded medical schools worked in CHCs in 2001–2003, compared with 1.9% of physicians who attended medical schools without Title VII funding (P<.001). We found a similar association between Title VII funding during residency and subsequent work in CHCs. These associations remained significant (P<.001) in logistic regression models controlling for NHSC participation, public vs private medical school, residency completion date, and physician sex. A strong association was also found between attending Title VII–funded residency programs and participation in the NHSC LRP, controlling for year completed training, physician sex, and private vs public medical school.
CONCLUSIONS Continued federal support of Title VII training grant programs is consistent with federal efforts to increase participation in the NHSC and improve access to quality health care for underserved populations through expanded CHC capacity.
Key Words: Title VII training programs • community health centers • National Health Service Corps • medically underserved area/manpower • education, medical • health policy research • primary health care
This article has been cited by other articles:
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  J. J. Frey III Funding for Primary Care (or Lack Thereof) and Community Health Centers: Impact of Title VII Training Programs Ann. Fam. Med, November 1, 2008; 6(6): 562 - 563. [Full Text] [PDF]
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K. C. Stange In this Issue: Access to Care, Spirituality, and Relevant Research Ann. Fam. Med, September 1, 2008; 6(5): 386 - 387. [Full Text] [PDF]
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