Title VII's Decline: Shrinking Investment in the Primary Care Training Pipeline

One Pagers | Oct 15, 2009 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 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.

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


  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. http://bhpr.hrsa.gov/medicine-dentistry/actpcmd/report2001.htm. 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. 

The information and opinions contained in research from the Graham Center do not necessarily reflect the views or the policy of the AAFP. 

Published in American Family Physician, Oct 15, 2009. Am Fam Physician. 2009;80(8):872. This series is coordinated by Sumi Sexton, MD, AFP Associate Medical Editor.