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Title VII's decline: Shrinking investment in the primary care training pipeline

Title VII, Section 747 is a source of federal funding intended to strengthen the primary care workforce. Despite evidence that Title VII has been successful, its funding has declined over the past three decades, threatening the production of primary care physicians.

Bridget Harrison, MD MPH; Andrew Bazemore, MD MPH; Martey S. Dodoo, PhD; Bridget Teevan, MS; Hope R. Wittenberg, MA; and Robert L. Phillips, Jr. MD MSPH.

Title VII, Section 747 of the Public Health Services Act is intended to increase the quality, quantity, and diversity of the primary care workforce, with special emphasis on increasing capacity to care for the underserved. It supports the development of innovative primary care curricula and programming at the medical school, residency, fellowship, and departmental levels.

The nation's physician training pipeline is steadily producing fewer primary care physicians. The number of graduating U.S. allopathic medical students choosing primary care declined steadily over the past decade, and the proportion of minorities within this workforce remains low.1,2

Title VII is associated with increased primary care physician production and practice in underserved areas.3,4 Despite this, funding has declined since 1978 (see accompanying figure).5,6

Access to primary care is in jeopardy. The nation needs renewed or enhanced investment in programs like Title VII that support the production of primary care physicians and their placement in underserved areas.



  1. Klein LS, Ruddy GR, Phillips RL, McCann JL, Dodoo MS, Green LA. Who filled first-year family medicine residency positions from 1991 to
    2004? Am Fam Physician. 2005;72(3):392.
  2. Lindsay D, Bazemore AW, Bowman R, Petterson S, Green LA, Phillips RL. Will medical school expansion help diversify the physician
    workforce? Am Fam Physician. 2007;76(1):38.
  3. Fryer GE Jr, Meyers DS, Krol DM, et al. The association of Title VII funding to departments of family medicine with choice of physician
    specialty and practice location. Fam Med. 2002;34(6):436-440.
  4. Rittenhouse DR, Fryer GE Jr, Phillips RL Jr, et al. Impact of Title VII training programs on community health center staffing and national
    health service corps participation. Ann Fam Med. 2008;6(5):397-405.
  5. U.S. Department of Health and Human Services. Advisory Committee on Training in Primary Care Medicine and Dentistry. Comprehensive
    review and recommendations: Title VII, Section 747 of the Public Health Service Act. November 2001. Accessed September 4, 2009.
  6. Departments of Labor, Health and Human Services, and Education, and related agencies. Appropriations bills: Public Laws 107-116, 108-7, 108- 199, 108-447, and 109-149; H.R. 5647, H.R. 3043, and S.3230. Fiscal years 2002-2009.


Harrison B, Bazemore AW, Dodoo MS, Teevan B, Wittenberg H, Phillips RL Jr. Title VII's decline: Shrinking investment in the primary care training pipeline. Am Fam Physician. 2009 Oct 15;80(8):872.

October 2009