Remarks to the Council on Graduate Medical Education 

Prepared Remarks of Elizabeth M. Duke, Ph.D.
Acting Administrator, Health Resources and Services Administration

Council on Graduate Medical Education (COGME) Meeting
Washington, D.C.
December 5, 2001

Thank you for inviting me to be with you today.

We were last together just a few days before the September 11 attacks.  We spoke of presidential initiatives, budget matters, health care trends, ways to improve health care education.  The national conversation now, of course, is dominated by different topics.  But there will again come a day when Americans return to focus their attention on the issues that brought us together that day in early September.  So it is important that our work proceeds and our dedication to the task at hand continues. 

Before I tell you about ongoing business at HRSA – specifically about the internal reorganization we’ve just completed -- let me share with you news about how our people responded to help victims, rescuers and survivors after September 11.

Dozens of commissioned corps members – many from the Bureau of Health Professions – went immediately to New York, Pennsylvania and Northern Virginia to counsel survivors and rescue workers and help in the search for victims.   Others were deployed to Capitol Hill after the anthrax-laced letter was opened in Sen. Daschle’s office to obtain specimens from employees, explain treatment procedures, and administer medication.

In New York, 28 HRSA colleagues were working in the Federal Building, just about a half-dozen blocks from the World Trade Center, at the time of the attack.  They were unharmed, thank God.  They worked for a couple of weeks in temporary quarters in Queens until their building was pronounced safe.

Operations of two community health centers in lower Manhattan were interrupted by the disaster.  The Charles B. Wang Center in Chinatown, about 12 blocks from the towers, was closed for a couple of days because neither staff nor patients could get there.  At the Ryan-NENA Community Health Center on the lower East Side, much further from the towers, operations were interrupted for only a day.

Staff from both centers told us that the need for mental health services is great – and will grow in the weeks and months to come.  And it’s not just patients who’ll need counseling – staff, too, has been shaken by the attack and will need extra care and attention from mental health professionals.

In response to this need, HRSA in early November oversaw the emergency distribution of $10 million to 33 health centers in New York City and northern New Jersey health centers to support services they provided following the tragedy. 

And in mid-November, we oversaw a second emergency distribution of grants totaling nearly $35 million to 131 public and not-for-profit entities in New York, New Jersey, Connecticut, the District of Columbia, Virginia and Pennsylvania.  Grants between $1,000 and $1 million were made to organizations that incurred health care-related expenses or lost revenue as a result of their immediate response to the public health emergency caused by the attacks.

As you can imagine, I’m very proud of our employees and how they’ve responded to this national challenge.

Now let me return to our ongoing business.

I remember telling you on September 6 that President Bush and Secretary Thompson are determined to get as much of HRSA’s money as possible into direct medical services for the people we serve.  As a result, the Secretary directed me to make a number of internal changes to make sure we save money, streamline operations, and increase our efficient delivery of services.

We’ve cut back on unnecessary travel and speaking engagements.  HRSA has a great deal of modern video and computer technology that we can use to give people from remote locations electronic access to meetings and events.  We need to use those resources.  We’re saving money on airplanes, hotels and restaurants because we want to spend as many HRSA dollars as we can on the underserved across America.

We’ve reorganized to improve efficiency and streamline duplicative operations.  These changes, announced over the summer, more equitably distribute the agency’s workload, improve our focus on key Presidential initiatives I told you about at our last meeting, and expand vital health care services to Americans.

The key element of the restructuring was the transfer of the National Health Service Corps, the Division of Scholarship and Loan Repayment, and the Division of Shortage Designation from the Bureau of Primary Health Care to its sister entity within HRSA, the Bureau of Health Professions headed by Dr. Shekar.

The move made sense because it put in a single bureau the entire spectrum of HRSA’s recruitment, training, loan, scholarship and placement programs for health professionals.  Consolidating responsibility for HRSA’s health professions programs within BHPr increases the internal coordination needed to ensure that the right number of health care professionals serve in the right places.

The restructuring also streamlined BPHC, enabling the bureau to target staff and resources on the anticipated expansion of the community health center system that President Bush asked for in his FY 2002 budget.  I mentioned the expansion to you in September.  It would create new or expand existing health center sites by 1,200 over the next five years, and would increase by 50 percent the number of people served annually in health centers.  We are, as you probably know, still awaiting action from Congress on the FY 2002 budget.

The shift of the NHSC to Health Professions also gives Dr. Shekar’s bureau responsibility for a Presidential reform initiative designed to improve the Corps’ service to America’s neediest communities.

More recently, we’ve announced further changes.  We’ve streamlined and centralized functions previously splintered throughout HRSA by creating a single, unified office of communications and a new office of legislation.  Both will be located in my office, the Office of the Administrator.

These functions are logically concentrated there, since communicating the President’s message on our issues to the press, the public and members of Congress calls for discipline, clarity and direction from HRSA’s senior leadership.

Additionally, we’ve transferred the Office of Information Technology into my office.  This change gives additional prominence to OIT, which will play an increasingly decisive role in HRSA’s success, as more and more of our work goes online.  Given the growing complexity and astonishing range of today’s computer and video technology, we decided to establish OIT as an entity that can help us shape the future of HRSA’s initiatives and products – and not just the office we call when the darn computer freezes up.  They’ll still help us with that, of course.

We’re continuing to consolidate entities that do similar or complementary work at the Bureau of Health Professions, building on the earlier restructuring.  The National Health Service Corps, now a division within BHPr, has been bolstered by absorbing the functions of the now defunct Division of Scholarships and Loan Repayments.

And in the HIV/AIDS Bureau, we’ve added two entities: the Office for the Advancement of Telehealth and the Center for Quality, both previously housed in my office.

We moved the Office for the Advancement of Telehealth into the HIV/AIDS Bureau to improve OAT’s ability to manage grants.  From now on, OAT will be part of a bureau that has an established, efficient mechanism to award and manage grants.  That will make OAT more effective and spread the use of telehealth technology to a wider group of health care providers.  From a management standpoint, it’s not good to have operational grants handled out of the administrator’s office.

All of these changes have a single impetus at their core: to further HRSA’s mission to expand access to quality health care for all Americans who need it.  We are duty-bound to take whatever actions e can that will strengthen our ability to provide more direct medical care to the people who rely on us.  That’s what we’ve been doing since I came to HRSA in March, and that’s what we’ll continue to do in the future.