Title VII Funding is Associated with More Family Physicians and More Physicians Serving the Underserved
Title VII funding of departments of family medicine at U.S. medical schools is significantly associated with expansion of the primary care physician workforce and increased accessibility to physicians for the residents of rural and underserved areas. Title VII has been successful in achieving its stated goals and has had an important role in addressing U.S. physician workforce policy issues.
Recognizing the versatility of family practice, the Bureau of Health Professions, via section 747 of Title VII, has since 1978 provided grants to departments of family medicine for predoctoral education, departmental support, and faculty development. The two goals of Title VII predoctoral and departmental grants for departments of family medicine are to increase the number of family physicians in America and to increase the number of doctors practicing in rural and underserved communities. Title VII family medicine faculty development grants seek to increase the number of family medicine teachers.
Between 1978 and 1993, 2,268 Title VII grants were awarded to 120 U.S. medical schools for family practice predoctoral programs (1,074), departmental support (737), and faculty development (457). Grants to departments of family medicine in these three programs totaled $290 million over this 16-year period. The average annual grant amount per institution was $127,500.
In a comprehensive analysis of Title VII funding between 1978 and 1993, approximately 180,000 medical school graduates were followed to evaluate their practice specialty and practice location in the year 2000. Students who attended schools that received no family medicine Title VII funding during their four-year tenure chose family practice at a rate of 10.2 percent. Students who attended schools that received funding of any type for one or more years of their enrollment chose family practice at a rate of 15.8 percent. Additionally, Title VII funding was associated with higher rates of practice in whole county primary care health personnel shortage areas (1.2 versus 1.5 percent) and practice in a rural area (9.5 versus 12.7 percent). All associations were statistically significant and remained so after controlling for possible medical school selection bias.
Table. Current Specialty and Location of Physicians Graduating from U.S. Medical Schools from 1981-1993 by Medical Schools' Receipt of Title VII Funding
|Title VII Funding||Family Practice||PCHPSA||Rural|
|Title VII Funding: No funding||Family Practice: 10.2%||PCHPSA: 1.2%||Rural: 9.5%|
|Title VII Funding: Any funding||Family Practice: 15.8%||PCHPSA: 1.5%||Rural: 12.7%|
|Title VII Funding: Additional practicing physicians associated with Title VII funding||Family Practice: 6,968||PCHPSA: 457||Rural: 3,864|
|Title VII Funding: NOTE: Class of 1981 entered medical school in 1978. |
PCHPSA = primary care health personnel shortage area.
Graduates of schools with Title VII faculty development grants were significantly more likely to choose careers in academic family medicine than were graduates of schools without this funding. Title VII funding to departments of family medicine was not associated with an increase or decrease in the number of students entering other primary care specialties.
Review of Title VII family practice funding clearly demonstrates that these grant programs are achieving their legislative intent to the benefit of millions of Americans.
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, Aug 15, 2002. Am Fam Physician. 2002;66:554. This series is coordinated by Sumi Sexton, MD, AFP Associate Medical Editor.