Advisory Committee on Training in Primary Care Medicine and Dentistry
Home | Charter | Members | Meeting Minutes | Reports to Congress | Letters

Letter to the Secretary of HHS and to Congress--June 24, 2009

We are writing to share with you the recommendations from the Eighth Report of HRSA’s Advisory Committee on Training in Primary Care Medicine and Dentistry.  Although the full report entitled “Redesign of Primary Care” will not be released until next fall, we are making these recommendations now because they directly relate to pending health care legislation.

A primary care workforce that is adequate both in numbers and preparation is central to the goal of attaining accessible, high-quality, and affordable health care for all of our citizens.  Unfortunately, there are strong indicators that the numbers of primary care practitioners in our country will be insufficient to care for the population under either the current or a reformed health care scenario.   Redesign of health services must emphasize the centrality of primary care in order to achieve goals of improving patient outcomes while controlling costs.  Therefore, we stress the need to 1) develop educational initiatives to rapidly fill the gaps in the primary care workforce, 2) implement system changes that promote efficient interprofessional models of care in which individuals from a variety of areas of expertise collaborate to meet patient health care needs and 3) align financial incentives to support primary care in achieving desired access, quality and efficiency outcomes.

These recommendations are offered in two sections.  Section A addresses Title VII, section 747 programs, the legislative and historic purview of our Advisory Committee.  We strongly believe, however, that Title VII programs can not revitalize primary care in the absence of other policy changes.  For Title VII programs to be successful in preparing a well-trained primary care workforce in sufficient numbers to meet the population’s needs, the systemic changes outlined in Section B will also be required.

We respectfully submit the following recommendations regarding the nation’s primary care workforce. 

A.  Title VII, Section 747 grants should support primary care training in the

Medical-Dental Home and Chronic Care Models.

1. Congress should restore funding for Title VII, Section 747 programs at $235 million for the next fiscal year.
2. Training grants should provide funds to develop, implement, and evaluate training programs that promote inter-professional practice in the Patient-Centered Medical-Dental Home Model of care.
3. Training grants should support primary care clinical training in community-based settings for providers and trainees in various disciplines, including those in Title VII programs (i.e., physician assistants, physicians, dentists) by funding proposals to recruit and support community-based clinical educators.
4. The Bureau of Health Professions should support grantees to evaluate these programs and to track trainees long-term.

B.  Federal policies should work in concert to support primary care as the backbone of the health care system.

1. Congress and CMS should revise funding policies for Graduate Medical Education and other educational programs to foster and support the use of community-based (non-hospital) sites for primary care training for physicians, dentists and physician assistants.
2. Congress should expand the National Health Service Corps loan repayment programs with additional programs to address the severe primary care workforce shortages.
3. Congress should support Medical-Dental Home demonstration projects designed to evaluate innovative funding and reimbursement strategies that promote accessible high-quality care while stemming the growth in healthcare costs.
4. Congress and CMS should restructure health care financing to attract providers to careers in primary care.
5. Congress should direct the Secretary of HHS to establish an independent healthcare workforce planning body that can evaluate need and make recommendations free from outside influence.

Our Committee includes representatives from the primary care medicine, dentistry, and physician assistant communities who are all eager to assist you in any way we can while you consider these recommendations.  Please do not hesitate to contact us if we can provide additional background, documentation, or clarification. 

Contact information for Executive Committee of the Advisory Committee on Primary Care Training in Medicine and Dentistry

Barbara J. Turner MD, MSED
Chairperson, (Medicine), ACPCTMD
1123 Blockley Hall -6021
423 Guardian Dr.
Philadelphia, PA 19104
Professor of Medicine
Director, Primary Care Physician Scientist Fellowship
University of Pennsylvania
Tel:  215-898-2022

Kevin J. Donly, D.D.S., M.S.
Vice-Chairperson (Dentistry), ACPCTMD
Chair and Clinical Director, Department of Pediatric Dentistry, Dental School
University of Texas Health Science Center of San Antonio
7703 Floyd Curl Drive
San Antonio, Texas  78229-3390
Tel:  210-567-3535

Perri Morgan, PA-C, PhD
Vice-Chairperson (Physician Assistant), ACPCTMD
Duke University Physician Assistant Program
Department of Community and Family Medicine
DUMC 104780
Durham, NC 27710
Tel:  919 681 6791