HEALTH PROFESSIONS

Authorizing Legislation: Title VII and Title VIII of the Public Health Service Act

Authorized by Title VII and Title VIII of the Public Health Service Act, the Health Professions program provides both policy leadership and support for health professions workforce enhancement and educational infrastructure development. The current emphasis is on improving the geographic distribution, quality, and diversity of the health professions workforce.

The Administration requests $66.1 million for Health Professions Training.

The Health Professions program is comprised of the following:

Centers of Excellence - Grants to support designated health professions schools to increase diversity in the health professions. No funding is requested for this activity. This program primarily provides funds for infrastructure rather than funding students. In order to improve the distribution of health professionals and improve the health of the underserved, the budget focuses on activities that fund the placement of more doctors, nurses, and other health care professionals in the regions of the country that face shortages.

Scholarships for Disadvantaged Students - Grants to increase diversity in the health professions and nursing workforce by awarding scholarships to financially needy students. No funds are requested for this activity. There are other funding sources available, both public and private, for the education of these students. In order to improve the distribution of health professionals and improve the health of the underserved, the budget focuses on activities that fund the placement of more doctors, nurses, and other health care professionals in the regions of the country that face shortages.

Health Careers Opportunity Program - Grants to increase the diversity of individuals applying to and graduating from health and allied health professions programs. No funding is requested for this activity. This program provides funds primarily for training students early in the education pipeline rather than those who are nearer to entering the health professions workforce. In order to improve the distribution of health professionals and improve the health of the underserved, the budget focuses on activities that fund the more immediate placement of more doctors, nurses, and other health care professionals in the regions of the country that face shortages.

Training in Primary Care Medicine and Dentistry - Grants to support the training of primary care physicians through predoctoral education, residency training, and faculty development; improvement of academic administrative units; training of physician assistants; and residency training in general or pediatric dentistry. No funding is requested for this activity. In FY 2007, this program provided training for 2,609 residents of which 38 percent began practice in an underserved area. The budget focuses on activities that fund the placement of a higher percentage of doctors, nurses, and other health care professionals in the regions of the country that face shortages. Additionally, the number of physicians has grown significantly over the past decade, and salaries for primary care providers have also increased.

Area Health Education Centers - Grants to encourage the establishment and maintenance of community based training programs in off-campus rural and underserved areas. No funding is requested for this activity. The AHEC facilitated training to 44,156 students in FY 2007, primarily as continuing education. The budget focuses on activities that fund the placement of more doctors, nurses, and other health care professionals in the regions of the country that face shortages. Also, the AHEC programs may be supported entirely by State and local resources in the future.

Geriatric Programs - Grants to support training of health professionals in geriatrics and support academic career development of geriatricians. No funding is requested for this activity. The number of physicians has grown significantly over the past decade. In addition, salaries and economic incentives for primary care providers have also increased. In FY 2007, these programs primarily provided continuing education. In order to improve the distribution of health professionals and improve the health of the underserved, the budget focuses on activities that fund the placement of more doctors, nurses, and other health care professionals in the regions of the country that face shortages..

Allied Health and Other Disciplines - Grants to meet the costs associated with expanding and establishing an allied health professions program to improve access to health care. No funding is requested for this activity. In FY 2007, this program trained 86 students of which 63 percent began practice in underserved areas. The budget focuses on activities that fund the placement of a larger number of doctors, nurses, and other health care professionals in the regions of the country that face shortages. Also, many of the community-based interdisciplinary training programs using telemedicine and other distance learning education and training techniques have been institutionalized and will continue to provide training in the future.

Public Health, Preventive Medicine, and Dental Public Health Program - Grants to support the education and training of the public health workforce to deal with anticipated and new problems and placing public health workforce in medically underserved areas. No funding is requested for this activity. These programs are infrastructure components that support capacity building at the State and local level and may be continued through collaborations between and among State and local health departments, schools of public health, residency programs, schools of dentistry, private foundations, and community-based service providers serving underserved populations. In FY 2007, these programs, in addition to infrastructure support, also trained 26 students of which 21 entered practice in an underserved area. In order to improve the distribution of health professionals and improve the health of the underserved, the budget focuses on activities that fund the placement of a larger number of doctors, nurses, and other health care professionals in the regions of the country that face shortages.

Advanced Nursing Education - Grants to support advanced nursing education and practice, and provide traineeships for individuals pursuing advanced nursing education. No funding is requested for this activity. The budget focuses on activities that fund the placement of more doctors, nurses, and other health care professionals in the regions of the country that face shortages.

Nursing Workforce Diversity - Grants to improve the racial and ethnic diversity of the nursing workforce to meet the increasing need for culturally sensitive and quality health care. A total of $16,107,000 is requested for Nursing Workforce Diversity. This is an increase of $281,000 above the FY 2008 Enacted level. The total request will allow for continued support to assist students enrolled in supported projects to reduce the financial burden to nursing education.

Nursing Education, Practice and Retention Grants - Grants to strengthen capacity for nurse education and practice in three priority areas: education, practice and retention. A total of $37,291,000 is requested for Nursing Education, Practice and Retention Grants. This is an increase of $651,000 above the FY 2008 Enacted level. The total request will be used to support targeted initiatives focusing on faculty development, informatics, baccalaureate education, and the statutory funding preference purposes.

Nurse Faculty Loan Program – Loans to assist nurses in completing their graduate education to become qualified nurse faculty. A total of $9,319,000 is requested for the Nurse Faculty Loan Program. This is an increase of $1,459,000 above the FY 2008 Enacted level. The total request will support student loans up to $30,000 in participating institutions.

Comprehensive Geriatric Education - Grants to prepare nursing personnel to care for the aging population. In FY 2009, $3,392,000 is requested for Comprehensive Geriatric Education--this is an increase of $59,000 above the FY 2008 Enacted level. The total request will be used to increase the number of nurses and nursing personnel that have knowledge and skills to care for the unique needs of the elderly.

The Health Professions program is subject to reauthorization.

The Health Professions program received a PART review in 2002. The review rated it Ineffective. The PART review noted that: There is disagreement regarding the purpose of the program. A clear and focused purpose is not found in the authorizing legislation, external reviews, and program documents.

While the program is managed well overall, it has not regularly used performance data to improve program outcomes. It noted, based on a General Accountability Office report, effectiveness has not been shown and impact will be difficult to measure without common grantee goals, outcome measures, and reporting. Evaluations have not linked the Health Professions training grants to changes in supply, distribution and minority representation of physicians and other health professionals. Additionally, there are regions and pockets of the country that face shortages, only two out of every ten providers who benefit from these grants enter shortage areas.

As a result of the PART review, the following actions have been accomplished:

During the review Health Professions developed new long-term and annual performance measures and established baseline data and has since begun regularly collecting data and reporting on performance.

In 2007, 57 percent of graduates and program completers of Titles VII and VIII supported programs were underrepresented minorities and/or from disadvantaged backgrounds. This exceeded the target by 17 percent. The target for FY 2009 is 50 percent. The targets for FY 2008 thru FY 2009 are lower than the FY 2007 result because past performance result levels suggest that the FY 2007 result may be an aberration and may be difficult to sustain.

The long term measure, increase the proportion of persons who have a specific source of ongoing care, does not have yearly targets. Access to a source of ongoing care does not directly reflect all of the specific activities of the Health Professions program. However, over time, HRSA expected this program to contribute to increasing the proportion of persons with a specific source of ongoing care, through its support of training health professions in all settings. It has remained statistically unchanged.

The proportion of trainees in Titles VII and VIII supported programs training in medically underserved communities was 43 percent in 2007 which exceeded the target of 41 percent. A target for this measure was not set for FY 2009 because Title VII programs that contribute data to this measure are not proposed for funding.

The percentage of health professionals supported by the program entering practice in underserved areas was 35 percent in 2007. This exceeded the target by 14 percent. A target for this measure was not set for FY 2009 because Title VII programs that contribute data to this measure are not proposed for funding.

Three independent evaluations of the Health Professions program have been completed: Report to Congress on: The Effectiveness of Title VII programs; Advisory Committee on Training in Primary Care Medicine and Dentistry: Evaluating the Impact of Title VII, Section 747 Programs; and An Annotated Bibliography: Evaluations of Pipeline Development Programs Designed to Increase Diversity in the Health Professions.

* Appropriated amounts do not include the Faculty Loan Repayment/Minority Faculty Fellowship Programs

Notes:

NA = Not Applicable.