[House Hearing, 115 Congress]
[From the U.S. Government Publishing Office]
SUPPORTING TOMORROW'S HEALTH PROVIDERS: EXAMINING WORKFORCE PROGRAMS
UNDER THE PUBLIC HEALTH SERVICE ACT
=======================================================================
HEARING
BEFORE THE
SUBCOMMITTEE ON HEALTH
OF THE
COMMITTEE ON ENERGY AND COMMERCE
HOUSE OF REPRESENTATIVES
ONE HUNDRED FIFTEENTH CONGRESS
FIRST SESSION
__________
SEPTEMBER 14, 2017
__________
Serial No. 115-57
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Printed for the use of the Committee on Energy and Commerce
energycommerce.house.gov
__________
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COMMITTEE ON ENERGY AND COMMERCE
GREG WALDEN, Oregon
Chairman
JOE BARTON, Texas FRANK PALLONE, Jr., New Jersey
Vice Chairman Ranking Member
FRED UPTON, Michigan BOBBY L. RUSH, Illinois
JOHN SHIMKUS, Illinois ANNA G. ESHOO, California
TIM MURPHY, Pennsylvania ELIOT L. ENGEL, New York
MICHAEL C. BURGESS, Texas GENE GREEN, Texas
MARSHA BLACKBURN, Tennessee DIANA DeGETTE, Colorado
STEVE SCALISE, Louisiana MICHAEL F. DOYLE, Pennsylvania
ROBERT E. LATTA, Ohio JANICE D. SCHAKOWSKY, Illinois
CATHY McMORRIS RODGERS, Washington G.K. BUTTERFIELD, North Carolina
GREGG HARPER, Mississippi DORIS O. MATSUI, California
LEONARD LANCE, New Jersey KATHY CASTOR, Florida
BRETT GUTHRIE, Kentucky JOHN P. SARBANES, Maryland
PETE OLSON, Texas JERRY McNERNEY, California
DAVID B. McKINLEY, West Virginia PETER WELCH, Vermont
ADAM KINZINGER, Illinois BEN RAY LUJAN, New Mexico
H. MORGAN GRIFFITH, Virginia PAUL TONKO, New York
GUS M. BILIRAKIS, Florida YVETTE D. CLARKE, New York
BILL JOHNSON, Ohio DAVID LOEBSACK, Iowa
BILLY LONG, Missouri KURT SCHRADER, Oregon
LARRY BUCSHON, Indiana JOSEPH P. KENNEDY, III,
BILL FLORES, Texas Massachusetts
SUSAN W. BROOKS, Indiana TONY CARDENAS, California
MARKWAYNE MULLIN, Oklahoma RAUL RUIZ, California
RICHARD HUDSON, North Carolina SCOTT H. PETERS, California
CHRIS COLLINS, New York DEBBIE DINGELL, Michigan
KEVIN CRAMER, North Dakota
TIM WALBERG, Michigan
MIMI WALTERS, California
RYAN A. COSTELLO, Pennsylvania
EARL L. ``BUDDY'' CARTER, Georgia
Subcommittee on Health
MICHAEL C. BURGESS, Texas
Chairman
BRETT GUTHRIE, Kentucky GENE GREEN, Texas
Vice Chairman Ranking Member
JOE BARTON, Texas ELIOT L. ENGEL, New York
FRED UPTON, Michigan JANICE D. SCHAKOWSKY, Illinois
JOHN SHIMKUS, Illinois G.K. BUTTERFIELD, North Carolina
TIM MURPHY, Pennsylvania DORIS O. MATSUI, California
MARSHA BLACKBURN, Tennessee KATHY CASTOR, Florida
CATHY McMORRIS RODGERS, Washington JOHN P. SARBANES, Maryland
LEONARD LANCE, New Jersey BEN RAY LUJAN, New Mexico
H. MORGAN GRIFFITH, Virginia KURT SCHRADER, Oregon
GUS M. BILIRAKIS, Florida JOSEPH P. KENNEDY, III,
BILLY LONG, Missouri Massachusetts
LARRY BUCSHON, Indiana TONY CARDENAS, California
SUSAN W. BROOKS, Indiana ANNA G. ESHOO, California
MARKWAYNE MULLIN, Oklahoma DIANA DeGETTE, Colorado
RICHARD HUDSON, North Carolina FRANK PALLONE, Jr., New Jersey (ex
CHRIS COLLINS, New York officio)
EARL L. ``BUDDY'' CARTER, Georgia
GREG WALDEN, Oregon (ex officio)
C O N T E N T S
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Page
Hon. Michael C. Burgess, a Representative in Congress from the
State of Texas, opening statement.............................. 1
Prepared statement........................................... 3
Hon. Gene Green, a Representative in Congress from the State of
Texas, opening statement....................................... 4
Hon. Janice D. Schakowsky, a Representative in Congress from the
State of Illinois, opening statement........................... 6
Hon. Greg Walden, a Representative in Congress from the State of
Oregon, prepared statement..................................... 61
Hon. Frank Pallone, Jr., a Representative in Congress from the
State of New Jersey, prepared statement........................ 62
Witnesses
Neil S. Calman, MD, FAAFP, President and CEO, Institute for
Family Health, Chair, Department of Family Medicine and
Community Health, Icahn School of Medicine at Mount Sinai/Mount
Sinai Hospital, President, American Association of Teaching
Health Centers................................................. 8
Prepared statement........................................... 10
Adrian Billings, MD, PhD, FAAFP, Chief Medical Officer,
Preventative Care Health Services, Associate Professor,
Department of Family and Community Medicine, Texas Tech
University Health Sciences..................................... 20
Prepared statement........................................... 22
Janice A. Knebl, DO, MBA, Dallas Southwest Osteopathic Physicians
Endowed Chair and Professor in Geriatrics, University of North
Texas Health Science Center, Medical Director, James L. West
Presbyterian Special Care Center............................... 32
Prepared statement........................................... 35
Juliann G. Sebastian, PhD, RN, Faan, Dean and Professor, College
of Nursing, University of Nebraska Medical Center.............. 45
Prepared statement...........................................
Submitted Material
Statement of the Council of Academic Family Medicine, submitted
by Mr. Kennedy................................................. 63
Statement of the American Medical Association, submitted by Mrs.
McMorris Rodgers............................................... 66
Statement of the American Academy of Family Physicians, submitted
by Mrs. McMorris Rodgers....................................... 67
Statement of seven medical organizations, submitted by Mrs.
McMorris Rodgers............................................... 72
Statement of the Oncology Nursing Society, submitted by Mr. Lance 74
Statement of the Eldercare Workforce Alliance, submitted by Mr.
Burgess........................................................ 76
Statement of the Health Professions and Nursing Education
Coalition, submitted by Mr. Burgess............................ 83
Statement of the Healthcare Leadership Council, submitted by Mr.
Burgess........................................................ 90
Whitepaper entitled, Cap Flexibility: Putting GME Dollars to
Work, submitted by Mr. Burgess \1\
Statement of the National Association for Geriatric Education,
submitted by Mr. Burgess....................................... 92
Statement of Congressman Jeff Denham, submitted by Mr. Burgess... 98
Statement of the American Association of Nurse Anesthetists,
submitted by Mr. Burgess....................................... 99
----------
\1\ The information can be found at: http://docs.house.gov/
meetings/if/if14/20170914/106404/hhrg-115-if14-20170914-
sd007.pdf.
SUPPORTING TOMORROW'S HEALTH PROVIDERS: EXAMINING WORKFORCE PROGRAMS
UNDER THE PUBLIC HEALTH SERVICE ACT
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THURSDAY, SEPTEMBER 14, 2017
House of Representatives,
Subcommittee on Health,
Committee on Energy and Commerce,
Washington, DC.
The subcommittee met, pursuant to call, at 10:15 a.m., in
room 2123, Rayburn House Office Building, Hon. Michael Burgess,
M.D. (chairman of the subcommittee) presiding.
Present: Representatives Burgess, Guthrie, Murphy,
Blackburn, McMorris Rodgers, Bilirakis, Brooks, Hudson,
Collins, Green, Engel, Schakowsky, Butterfield, Matsui,
Sarbanes, Kennedy, and Eshoo.
Also Present: Representative Denham.
Staff Present: Adam Buckalew, Professional Staff Member,
Health; Paul Edattel, Chief Counsel, Health; Jay Gulshen,
Legislative Clerk, Health; Edward Kim, Senior Health Policy
Advisor; Katie McKeogh, Press Assistant; Kristen Shatynski,
Professional Staff Member, Health; Waverly Gordon, Minority
Health Counsel; Samantha Satchell, Minority Policy Analyst;
Andrew Souvall, Minority Director of Communications, Outreach
and Member Services; and C.J. Young, Minority Press Secretary.
OPENING STATEMENT OF HON. MICHAEL C. BURGESS, A REPRESENTATIVE
IN CONGRESS FROM THE STATE OF TEXAS
Mr. Burgess. The hearing will now come to order. The chair
will recognize himself for 5 minutes for an opening statement.
Today's hearing provides us with an opportunity to begin
discussion on how to best address provider shortages in our
country and how to ensure that today's medical students have
the skills and resources to succeed in the 21st century. As a
physician, I have supported programs that improve access to
care and enhance patient experience, and the programs that we
are examining today seek to accomplish this goal.
When looking at the data, our mission is clear. The
Association of American Medical Colleges estimates by the year
2030, the United States will have a projected physician
shortage, anywhere from just over 40,000 to over 100,000
providers.
To address this issue, our hearing will focus on four sets
of unique programs: the National Health Service Corps, Teaching
Health Center Graduate Medical Education, Physician Workforce
Programs under Title VII of the Public Health Service Act, and
Nursing Workforce Programs under Title VIII of the Public
Health Service Act. Each of these programs seeks to increase
access to providers in underserved areas and promote the
training opportunities for medical students and providers to
maintain their skills.
For example, programs like the National Health Service
Corps and the Area Health Education Centers, supported by Title
VII grants, and Teaching Health Centers, tackle these shortages
by connecting young providers with underserved communities.
These programs are essential to addressing the Nation's
provider shortage by connecting providers to those that are not
served.
Additionally, Title VII and Title VIII programs support
opportunities for continuing medication education for the
healthcare workforce, which is not only mandatory for many
providers to keep their licenses, but it is also essential to
providers as they attempt to keep up with evolving issues and
treatments. In an age with modern drugs and the 21st Century
Cures Act supporting future innovation, we must ensure that our
healthcare workforce is ready for these breakthroughs and
prepared for future challenges.
This hearing, however, comes at a precarious time for these
programs as we seek to reauthorize them and extend their
funding. For Title VII and Title VIII, both of which have
expired, yet continue to receive appropriations on a year-by-
year basis, a commitment by this subcommittee to reauthorize
these programs would ensure longer-term stability, particularly
for future generations of providers.
The National Health Service Corps and the Teaching Health
Center Graduate Medical Education Program have funding that
will expire at the end of the fiscal year, and our subcommittee
is working to ensure these programs will continue to operate
and serve communities in coming years. As is the case with all
programs with mandatory funding, finding offsets can be
challenging, but I am committed, and I know others on the
committee are committed, to finding a solution and extending
these programs.
I want to thank each of our witnesses for being here today
and providing their unique insights into the problems ahead.
Dr. Adrian Billings, the Chief Medical Officer of Preventive
Health Services; Dr. Neil Calman, the President of the American
Association of Teaching Health Centers; Dr. Janice Knebl of the
University of North Texas Health Science Center; and Dr.
Juliann Sebastian, Dean of the College of Nursing at the
University of Nebraska Medical Center, are each celebrated
providers and experts in their respective fields, and I look
forward to hearing from each of them.
And to prove that we are in an area of glasnost where the
lion can lie down with the lamb, we have both the University of
North Texas and Texas Tech University at our witness table
today, and for that, I am extremely grateful.
Now, these are not the only programs that support our
Nation's healthcare workforce, but they are each important and
deserve our attention. As we move beyond the immediacy, I look
forward to delving further into this issue and identifying new
opportunities to support providers as well as communities.
And I will yield my remaining time to the gentlelady from
Washington, Mrs. McMorris Rogers.
[The prepared statement of Mr. Burgess follows:]
Prepared statement of Hon. Michael C. Burgess
The Subcommittee will come to order.
The Chairman will recognize himself for an opening
statement.
Today's hearing provides us with an important opportunity
to begin a discussion on how best to address provider shortages
in our country and how to ensure that today's medical students
have the skills and resources to succeed in the 21st century.
As a physician, I have always supported programs that improve
access to care and enhance the patient experience, and the
programs that we are examining today seek to accomplish this
very goal.
When looking at the data, our mission is clear. The
Association of American Medical Colleges estimates that by the
year 2030, the United States will have a projected physician
shortage ranging from 40,800 providers to as many as 104,900
providers.
To address this looming issue, our hearing will focus on
four sets of unique programs: the National Health Service
Corps, Teaching Health Center Graduate Medical Education,
physician workforce programs under Title VII of the Public
Health Service Act, and nursing workforce programs under Title
VIII of the Public Health Service Act. Each of these programs
seeks to increase access to providers in underserved areas and
to promote the training opportunities for medical students and
providers to maintain their skills.
For example, programs like the National Health Service
Corps, Area Health Education Centers which are supported by
Title VII grants, and Teaching Health Centers tackle these
shortages head on by connecting young providers with
underserved communities. These programs are essential to
addressing the nation's provider shortages because they serve
as driving forces that can connect providers to underserved
communities and can support the care needs of individuals that
would otherwise be unavailable without the providers that
participate in these programs.
Additionally, programs under Title VII and Title VIII of
the Public Health Service Act provide an array of opportunities
to support education in health professional schools. These
programs range from supporting disadvantaged students to attend
medical school to supporting fellowships and faculty positions
so that health professional schools can continue to meet the
needs of students.
Title VII and Title VIII also support opportunities for
continuing medical education for the healthcare workforce,
which is not only mandatory for many providers to keep their
licenses, but is also essential to providers as they attempt to
keep up with evolving issues and treatments. In an age with
breakthrough drugs and a 21st Century Cures Act that is
supporting future innovations, we must ensure that our
healthcare workforce is ready for these breakthroughs and is
prepared for future challenges in delivering care.
This hearing, however, comes at a precarious time for these
programs as we attempt to reauthorize them and extend their
funding. For Title VII and Title VIII which have both expired
yet continue to receive appropriations on a year by year basis,
a commitment by this Subcommittee to reauthorize these programs
would ensure longer-term stability and offer future generations
of providers with opportunities to grow and serve our
communities.
And for the National Health Service Corps and the Teaching
Health Center Graduate Medical Education program which have
funding that will expire at the end of the fiscal year, our
Subcommittee is hard at work ensuring that these programs will
continue to operate and serve communities in the coming years.
As is the case with all programs with mandatory funding,
finding offsets can be challenging, but I am committed to
finding a solution and to extending these programs.
I would like to thank each of our witnesses for being here
today and providing their insights on the problems ahead. Dr.
Adrian Billings, the Chief Medical Office of Preventive Care
Health Services, Dr. Neil Calman, the President of the American
Association of Teaching Health Centers, Dr. Janice Knebl, from
the University of North Texas Health Science Center, and Dr.
Juliann Sebastian, the Dean of the College of Nursing at the
University of Nebraska Medical Center, are each celebrated
providers and experts in their respective fields, and I look
forward to hearing from them.
These are not the only programs that support our nation's
healthcare workforce, but they are each important and deserve
our immediate attention. And as we move beyond the immediacy, I
look forward to delving further into this issue and identifying
new opportunities to support providers and underserved
communities.
Mrs. McMorris Rodgers. Thank you, Mr. Chairman.
It is estimated that we could have a nationwide doctor
shortage of 23,000 by 2025, and the physician population ratio
in rural communities, like mine in eastern Washington, is
especially stark. That is why it is so important that we
reauthorize the Teaching Health Center Graduate Medical
Education Program. This program specifically trains residents
in specialties with the largest shortages, such as family
medicine and psychiatry. And when compared with traditional
Medicare GME residents, the Teaching Health Center residents
are more likely to practice primary care, remain in underserved
areas, and work in rural communities.
My legislation, H.R. 3394, aims to not only reauthorize
this critical workforce program, but expand it to ensure
communities have access to primary care doctors and dentists
they desperately need.
I want to thank the committee for holding this hearing, and
also my colleagues, like Representative Denham, who helped this
effort.
Thank you, Chairman.
Mr. Burgess. The chair thanks the gentlelady.
The chair now recognizes the subcommittee ranking member,
Mr. Green of Houston, for 5 minutes for an opening statement.
OPENING STATEMENT OF HON. GENE GREEN, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF TEXAS
Mr. Green. Thank you, Mr. Chairman.
I want to thank our witnesses there, and not only our
Texans because we don't have to have an interpreter to talk to
each other. But I also want to welcome our witness from the
University of Nebraska Medical Center. I have a little tie
there with my daughter and her husband, doctors there, but more
importantly, I have two grandchildren that live in Omaha. So
thank you for being here.
Today we are examining the National Health Service Corps
Program; the Teaching Health Center Graduate Medical Education
Program; H.R. 3728, Educating Medical Professionals and
Optimizing Workforce Efficiency and Readiness, the EMPOWER Act
of 2017; H.R. 959, the Title VIII Nursing Workforce
Reauthorization Act of 2017.
The National Health Service Corps program provides
financial support to health professional students and primary
care providers who commit to provide service in medically
underserved communities. The NHSC program is comprised of four
separate programs.
First, the NHSC Scholarship Program, which provides
scholarships to healthcare professional students who agree to
serve in underserved communities upon the completion of their
education and training.
The NHSC Loan Repayment Program, which provides loan
repayment assistance to primary care providers in exchange for
service in a health professional shortage area.
The NHSC Students to Service Loan Repayment Program, which
provides assistance to the medical and dental students in their
last year of school in exchange for a commitment to primary
healthcare in a health professional shortage area for 3 years.
And finally, the State Loan Repayment Program, which is a
Federal-State partnership grant program that provides loan
repayment to clinicians who practice in a health professional
shortage area in that state.
Together, the program supports a critical workforce in
areas that are much in need. The Teaching Health Center
Graduate Medical Education Program was established under the
Affordable Care Act of 2010 to encourage increased training of
primary care and medical and dental residents in community-
based settings, such as federally qualified health centers or
rural health clinics. It must be reauthorized before the end of
the month or it may go away altogether.
Title VII of the Public Health Service Act established the
Federal Healthcare Workforce Development Grant programs
administered by HRSA that have long enjoyed bipartisan support
in Congress. Colleagues on this committee have legislation to
reauthorize Title VII. I am pleased to support this
legislation.
Finally, we are examining Title VIII of the Public Health
Service Act, which established Federal nursing workforce
development grant programs administered by HRSA. The programs
focus on nursing education, practice, recruitment, and
retention. Nurses play a vital role in our healthcare
workforce, and this program is essential to the success of
delivery of care.
I also want to mention the Health Centers Fund, which
provides substantial funding to federally qualified health
centers or community health centers, which are on the front
line of our healthcare safety net, providing primary care to
millions of Americans. The Health Centers Fund runs out at the
end of the month. This funding cliff threatens their ability to
provide care our constituents depend on, and I cannot stress
the importance of extending this funding enough.
Thank you again to our witnesses. I look forward to their
testimony.
And I would yield the remainder of my time to my colleague
from California, Congresswoman Matsui.
Ms. Matsui. Thank you very much for yielding me time, and I
thank the witnesses for being here today.
As we move forward to improve our healthcare system,
bolstering our workforce is a critical piece to the puzzle. I
am pleased that we are holding this hearing today to discuss
the reauthorization of multiple important healthcare workforce
programs, including the Geriatric Workforce Program in Title
VII that I worked on with Representative Schakowsky, the Title
VIII Nursing Workplace Program, that I worked with on with
Representative David Joyce, the National Health Service Corps,
and the Teaching Health Centers.
It is estimated by 2030 over 3 million trained healthcare
workers will be needed just to maintain the current needs of
our Nation's seniors. My geriatrics workforce bill with
Congresswoman Schakowsky, included in the Title VII bill we are
discussing today, will help meet that need by investing in our
geriatric workforce and incentivizing the creation of training
programs in underserved communities.
Our Nation's aging population will especially increase the
demand on our nursing workforce, and a reauthorization of Title
VIII would ensure that critical nursing education programs can
continue.
Investments in our healthcare workforce are investments in
the long-term prosperity of our healthcare ecosystem. And I do
appreciate the committee's attention to these issues, and I
yield back the balance of my time.
Mr. Green. I yield back my time.
Mr. Burgess. The chair thanks the gentleman. The gentleman
yields back.
Not seeing the chairman of the full committee here, is
there a member on the Republican side who would seek the
chairman's time. Seeing none, is there a member on the
Democratic side who would seek the ranking member's time?
For what purpose does the gentlelady from Illinois seek
recognition? You are recognized 5 minutes for an opening
statement.
OPENING STATEMENT OF HON. JANICE D. SCHAKOWSKY, A
REPRESENTATIVE IN CONGRESS FROM THE STATE OF ILLINOIS
Ms. Schakowsky. Thank you.
I am so pleased we are here today to consider these
critical health workforce bills. I would like to thank the
distinguished panel for their work in support of these
programs. I am pleased to cosponsor H.R. 3728, the EMPOWER Act,
to reauthorize the healthcare workplace development grant
programs, which we are considering today.
Additionally, as a co-chair of the Seniors Task Force, I
was delighted to introduce H.R. 3713, the bipartisan Geriatric
Workforce and Caregiver Enhancement Act, with Representative
Matsui. This bill works to fully achieve the goals of this
hearing, supporting tomorrow's health providers.
Our Nation is facing a severe and mounting shortage of
healthcare professionals to meet the needs of older Americans.
This growing need is reflected in Illinois. By 2030, it is
estimated that the older adult population will increase to 3.6
million and represent almost a quarter, 24 percent, of the
Illinois population.
The reauthorization of the Geriatrics Workforce Enhancement
Program and the Geriatric Academic Career Awards are critical
in addressing this shortage. In Chicago, Rush University
Medical Center is one of the outstanding health and education
institutions to receive a grant from the Health Resources and
Service Administration, HRSA, and have a geriatric workforce
enhancement program. At Rush, providers are trained to better
care for older adults.
We must continue to support this vital work. I look forward
to working with my colleagues on this committee to advance this
important bill.
Thank you. And I now yield to Congressman Kennedy.
Mr. Kennedy. Thank you to my colleague from Illinois, and
many thanks to all the witnesses today. Thank you to the
chairman and the ranking member for calling this important
hearing.
By bringing the expertise of all of the witnesses and their
experiences to Washington today, you are helping us strengthen
the future of our community healthcare system, including
Teaching Health Centers and the National Health Service Corps.
Thank you for your commitment and thank you for your work.
A few weeks ago, I visited a community behavioral health
center in a town in my district that has been devastated by the
opioid epidemic. A staffer there told me that she volunteers
pro bono to ride with the local police department to the homes
of every single person who had overdosed, the following day
after their episode, to offer compassion, support, and any care
that they and their family need. They have been to hundreds of
homes. And not once have they ever been turned away.
In our medically underserved and most vulnerable
communities there will always be the need for more providers.
And there always be providers willing to work long, hard hours,
underpaid, to care for their neighbors and to fill the gaps in
the hopes that our government at some point catches up. By
investing in these workforce programs, we can inspire a new
generation of health practitioners who are trained for the
communities where they will work and serve and live in for
years.
Instead of once again asking our local leaders to bear the
burden of our inaction, we should address the healthcare
shortage today, starting with these bills, extending the
community health centers, and reauthorizing CHIP.
Thank you. And, Mr. Chairman, I would ask to submit for the
record the following letter from the Council of Academic Family
Medicine. I yield back.
Mr. Burgess. Without objection, so ordered.
[The information appears at the conclusion of the hearing.]
Mr. Burgess. Does the gentleman yield back?
Mr. Kennedy. Yes, I yield back.
Mr. Burgess. The chair wishes to note the presence of our
colleague, Mr. Denham from California, not a member of the
committee, but certainly has been a valuable Member in
providing expertise and emphasis on some of the bills that we
are considering today.
That concludes opening statements. The chair would remind
members that pursuant to committee rules, all members' opening
statements will be made part of the record.
We do want to thank our witnesses for being here today and
taking time to testify before the subcommittee. Each witness
will have the opportunity to give an opening statement,
followed by questions from members.
Today, we will hear from Dr. Neil Calman, Chief Medical
Officer, Preventive Health Care Services; Dr. Adrian Billings,
President of the American Medical Association of Teaching
Health Centers; Dr. Janice Knebl, Dallas Southwest Osteopathic
Physicians Endowed Chair and Professor in Geriatrics at the
University of North Texas Health Science Center; and Dr.
Juliann G. Sebastian, Dean and Professor, College of Nursing,
the University of Nebraska Medical Center.
We appreciate your being here today.
And, Dr. Calman, you are now recognized for 5 minutes to
give an opening statement.
STATEMENTS OF NEIL S. CALMAN, MD, FAAFP, PRESIDENT AND CEO,
INSTITUTE FOR FAMILY HEALTH, CHAIR, DEPARTMENT OF FAMILY
MEDICINE AND COMMUNITY HEALTH, ICAHN SCHOOL OF MEDICINE AT
MOUNT SINAI/MOUNT SINAI HOSPITAL, PRESIDENT, AMERICAN
ASSOCIATION OF TEACHING HEALTH CENTERS; ADRIAN BILLINGS, MD,
PHD, FAAFP, CHIEF MEDICAL OFFICER, PREVENTATIVE CARE HEALTH
SERVICES, ASSOCIATE PROFESSOR, DEPARTMENT OF FAMILY AND
COMMUNITY MEDICINE, TEXAS TECH UNIVERSITY HEALTH SCIENCES;
JANICE A. KNEBL, DO, MBA, DALLAS SOUTHWEST OSTEOPATHIC
PHYSICIANS ENDOWED CHAIR AND PROFESSOR IN GERIATRICS,
UNIVERSITY OF NORTH TEXAS HEALTH SCIENCE CENTER, MEDICAL
DIRECTOR, JAMES L. WEST PRESBYTERIAN SPECIAL CARE CENTER; AND
JULIANN G. SEBASTIAN, PHD, RN, FAAN, DEAN AND PROFESSOR,
COLLEGE OF NURSING, UNIVERSITY OF NEBRASKA MEDICAL CENTER
STATEMENT OF NEIL S. CALMAN
Dr. Calman. Thank you, Chairman Burgess, Ranking Members
Green, and distinguished members of the subcommittee. Thank you
for inviting me to speak to you about the THCGME, or Teaching
Health Center Graduate Medical Education Program.
I am a family physician in practice for 40 years in the
South Bronx and the Lower East Side of Manhattan. I am
President and CEO of the Institute for Family Health, a
nonprofit network of 31 federally qualified community health
centers, and three family medicine residency programs.
In 2012, we began participating in the new THCGME Program
to expand resident training into two severely underserved rural
New York communities, and also in Harlem and the South Bronx.
As President of the American Association of Teaching Health
Centers, and on behalf of the 57 teaching health centers, I
implore you to reauthorize the THCGME Program before it expires
on September 30, and to do so for a minimum of 3 years. It is a
unique and critically important initiative aimed at ending the
primary care physician shortage which plagues our county.
The shortage of primary care in the U.S. creates an
underemphasis on basic preventive healthcare, the delayed
detection and treatment of serious disease, and the overuse of
emergency care and acute hospitalization for many preventable
conditions. All of this has driven our healthcare costs to
unsustainable levels. Sixty million Americans lack access to a
primary care doctor, and by 2020, the U.S. may face a deficit
of 20,000 primary care doctors.
The THC programs are accountable for every dollar of
funding, and they produce results. Eighty-two percent of
teaching health center graduates remain in primary care,
compared to 23 percent of other graduates. Twice as many
practice in underserved communities, 4 times as many in rural
areas, and 16 times as many in federally qualified health
centers.
Congresswoman Cathy McMorris Rodgers is very familiar with
the THC program in Spokane and has been a champion for
increasing our health workforce in medically underserved areas,
especially in rural America. We are so grateful to her for
introducing bipartisan legislation to reauthorize the program
sustainably for 3 years and to fund expansion to help satisfy
the pent-up demand throughout the country for new teaching
health centers.
We appreciate that Congresswoman Tsongas and 67 other
Members of Congress cosponsored this legislation, including
Congressman Jeff Denham, who not only cosponsored it, but also
introduced his own legislation that would appropriate even more
funds for expansion.
Traditional graduate medical education occurs almost
exclusively within hospitals, but primary care takes place in
the community and doctors officers and in community health
centers. To get more doctors in primary care, especially in the
areas most in need, teaching health centers move training into
the community where residents and their faculty do over 600,000
patient visits each year.
Primary care providers are the first place a person goes to
find out if their cough is from common cold or from pneumonia,
whether their headache is from stress, an impending stroke, or
a brain tumor. They learn to identify and treat anxiety and
depression. And they learn to treat pain, while minimizing a
patient's risk of developing opioid dependence.
Primary care saves lives and saves money, and the Teaching
Health Center Graduate Medical Education Program helps solve
our primary care crisis. However, it is 2 weeks away from
extinction. We need it reauthorized now and at the level
recommended in the HRSA-funded study published last year of
$157,000 per resident per year. We need a 3-year authorization
at $116.5 million per year so that centers will not terminate
their training programs and continue recruiting new residents.
When our center extends an offer to a resident, we make a
commitment to them for 3 years. A 2-year Federal funding
commitment is insufficient to stabilize our programs.
In addition, we have had grossly inadequate funding for the
past 2 years, as low as $95,000 per resident. As a result, some
centers were forced to stop recruiting. In my program at the
Institute, the decrease in funding from the initial level of
$150,000 per resident per year created a loss of $2 million a
year and forced us to reduce our Harlem residency from 36 to 18
doctors.
The McMorris Rodgers-Tsongas legislation funds $157,000 in
training costs per resident for all 732 current residents and
additional funds for up to 10 new programs. This will add
another 120 primary care residents.
In closing, I want to stress that the health of all
Americans requires that the other programs that you will hear
about today are also funded timely and adequately: the National
Health Service Corps, which provides doctors who serve in our
Nation's community health centers, the community health centers
themselves that provide care to 24 million Americans, and Title
VII and Title VIII, which support training in the critical
disciplines of medicine, nursing, dentistry, and others.
Thank you for giving me the opportunity to testify this
morning.
[The prepared statement of Dr. Calman follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Mr. Burgess. The chair thanks the gentleman.
The chair observes that there is a vote on, on the floor,
and we are going to need to take a recess in order to allow
members to vote. Unfortunately, this is a fairly long series,
so I can't tell you the exact timing, but the committee will
reconvene after the series of votes concludes on the floor.
The committee stands in recess.
[Recess.]
Mr. Burgess. We had heard testimony from Dr. Calman. I
believe we are prepared to hear testimony from Dr. Billings.
Dr. Billings, you are recognized for 5 minutes, please.
STATEMENT OF ADRIAN BILLINGS
Dr. Billings. Thank you, Chairman.
Chairman Burgess, Ranking Member Green, and members of the
subcommittee, my name is Dr. Adrian Billings, and I am a full
spectrum family medicine physician with Presidio County Health
Services, a federally qualified health center practicing in
rural Alpine, Texas. I am here today as a board member of the
Association of Clinicians for the Underserved, which was
founded by National Health Services Corps alumni over 20 years
ago. The mission of the ACU is to improve the recruitment and
retention of primary care providers in underserved communities,
and the Corps is a critical component of that effort.
I am also a fellow with the American Academy of Family
Physicians, an organization that strongly supports the National
Health Service Corps program. The Corps was created 45 years
ago in a bipartisan manner, and since then, has proven to be a
very effective program placing healthcare providers in our
Nation's most medically underserved areas. As an alumnus of the
National Health Service Corps scholarship program, I am honored
to be here to describe the significance of this program upon
medical students, healthcare professionals, and underserved
communities.
In 1999, as a first-year medical student, I
enthusiastically submitted an application for the National
Health Service Corps scholarship program, knowing that it would
allow me to accomplish my dream of practicing family medicine
on the Texas-Mexico border without the burden of school loans
that may have forced me down a different path. After completing
my family medicine residency and surgical obstetrics
fellowship, I moved to Alpine to fulfill my Corps scholarship
commitment. I fulfilled my 4-year commitment in the private
practice option, as there was little in the way of healthcare
infrastructure at the time. When I arrived in Alpine in 2007, I
was one of only three family doctors in a 12,000 square mile
area serving a total population of 25,000 patients in the vast
Big Bend region. In those first 4 years of practice, I was on
call 24 hours a day, 7 days a week. My work, although rewarding
in many ways, was exhausting.
I was able to graduate medical school debt free because of
the National Health Service Corps. And I have chosen to stay
because of the sense of calling I still feel to be practicing
along the Texas-Mexico border. But our community needed more
healthcare access, and so did I. So I made the decision to
merge my private practice with a federally qualified health
center in the neighboring community, Presidio County Health
Services.
Once we were part of PCHS, the practice received both
Federal funding and malpractice coverage that enabled me to
recruit family physician partners to share the load. Access was
increased, and my working schedule became far more manageable.
Thanks to Texas Tech University Health Science Center, I have
hosted 300 medical students and residents, four of whom have
returned to practice in the Big Bend region, which now has
seven practicing family physicians up from three when I first
arrived.
I am pleased to report that my story is not rare among
Corps alumni. A majority of Corps providers continue to
practice in a shortage area 10 years after completing their
service obligation, just as I have.
In the last year, the Corps has placed more than 10,000
providers, serving more than 11 million people.Despite this
level of service, it would still require around 20,000 more
providers to meet today's existing need of our Nation's 15,000
designated shortage areas.
While I could talk about the impact the Corps has had on me
and my community all day long with you, I want to be sure to
highlight the importance of preserving the program and the
urgency of doing so. Without immediate action from this
subcommittee, funding for the Corps will expire in 2 weeks.
This potential lapse in funding will cause an immediate and
severe impact in underserved areas across the country such as
my own.
No new awards or continuations will be made after October
1, effectively eliminating the need for the next generation of
Corps clinicians and jeopardizing access to healthcare services
for millions of people, including my patients. The Corps will
continue to function, but only administratively, not
programatically. I can assure you as an alumnus that the Corps
is one of the most effective programs this country has to
enable clinicians like me to choose primary care and to serve
in underserved communities.
I truly believe that, based on the merits of the program,
the Corps can withstand any kind of debate that focuses on
value, impact, and long-term savings. We know that access to
primary care saves lives and saves money. And the Corps is
designed to increase access to primary care services where we
need it most.
I want to thank the subcommittee for the longstanding
bipartisan support consistently shown for the Corps, and I
appreciate the opportunity to testify before you today on
behalf of the Corps, ACU, AASP, and most importantly, the
millions of patients living in underserved communities who rely
on healthcare services provided by Corps clinicians. Thank you.
[The prepared statement of Dr. Billings follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Mr. Burgess. The chair thanks the gentleman for his
testimony.
Dr. Knebl, you are recognized for 5 minutes, please.
STATEMENT OF JANICE A. KNEBL
Dr. Knebl. Thank you, Chairman.
Dr. Burgess, Ranking Member Green, and distinguished
members of the subcommittee, thank you for the opportunity to
appear before you today and discuss the workforce programs
under the Public Health Service Act on behalf of the Eldercare
Workforce, which is a group of 31 national organizations
representing consumers, family caregivers, healthcare
professionals, that includes direct care workers joined
together to address the immediate and future need for more
expert health professionals to care for all of as we age.
I am also very pleased to be joined by colleagues from
across the country who work tirelessly to improve the health of
our Nation's population.
Today, I am here to discuss the Title VII Geriatrics Health
Professions programs, which are focused on enhancing the
ability of America's healthcare workforce to provide high-
quality care for older adults. These Title VII funds support 44
geriatric workforce enhancement programs we call GWEPs, and we
are GWEPsters, which trained almost 19,000 emerging health
workers or trainees in over 45 professions and disciplines from
2015 to 2016 academic year.
Collectively, the GWEPs are leveraging the skills of
geriatric health professionals already in short supply across
different professions to educate other members of the
workforce, caregivers, and direct healthcare workers. Many of
our trainees had little or no exposure to geriatric principles
before our programs.
I would like to tell you a story about how GWEP changes the
lives in my home State of Texas, where the current population
of older adults is 5.9 million and growing, so I have constant
job opportunities in Texas. I am at the University of North
Texas Health Science Center, located in Fort Worth, Texas,
where I am faculty and I am a practicing geriatrician. Our GWEP
is called the Workforce Enhancement and Healthy Aging and
Independent Living, or the WE HAIL program.
Since January of 2016, we have offered rural communities
free programs focused on Alzheimer's disease education to
almost 500 older adults and their family caregivers. Caregiving
for someone with Alzheimer's disease is extremely stressful and
unpredictable. I can speak to this, not only professionally,
but personally as both my grandmothers and my mother now is
afflicted with Alzheimer's disease. So we really need to try
and reduce that stress and help them with problem-solving
skills so that they can continue to keep their loved ones at
home where they would like to have them.
We have also had training for our physical therapy students
and medical students in trying to teach older adults about
falls prevention, which, as you know, can be very serious
consequences for them. They participated in an evidence-based
program called A Matter of Balance that is lay leader training.
The students in turn then go out and do falls preventions
workshop in senior centers. And we have basically gone to about
14 of them, touching almost 300 older Texans.
Across health professions training there is a paucity of
content focused specifically on ensuring the healthcare
workforce of tomorrow has the skills and competence to care for
all of us as we age. Our GWEP is filling that role in Texas and
the gap because we have trained, to date, almost 2,000 students
to be our future doctors, nurses, social workers, pharmacists,
physical therapists, dieticians, and physician's assistants,
and we have them working as inner professional team training.
We are also working with primary care practices, healthcare
systems, and the aging network social services by training
inner professional teams of current practicing professionals to
try and help them with patient-centered primary care for older
adults and looking into the new integrated delivery systems. In
fact, we have six more training teams that are going to start
Friday, tomorrow, at our university.
This year, WE HAIL has received innovation awards from the
National Association for the Area Agencies on Aging and the
American Public Health Association. And we believe this
demonstrates the widespread recognition for the need for high
quality integrated and collaborative geriatrics training for
health professions. There are 43 other GWEPs across the United
States, and they are trying to improve this current and future
care. But the need for the programs will be greater.
As you know, by 2030, we are going to have 20 percent of
our population over the age of 65, that will be about 70
million people, and we already have about 19 million caregivers
trying to help older adults. And our GWEPs, we are definitely a
community of learners and collaborators. We love to share our
ideas. We have a national GWEP network, the National
Association of Geriatric Education and the John A. Hartford
Foundation GWEP Coordinating Center out of the American
Geriatric Society.
I know that, like us, my colleagues at the other GWEPs are
leveraging their GWEP funding to create lasting change on how
they deliver care at their institutions and in their
communities, and we are learning from each other about what
works and what may not. We may be a small workforce, but we are
mighty, and we are tireless advocates on behalf of improving
the care for older adults.
This funding offers each of us a platform for making that
possible, for demonstrating how attention to core geriatric
principles can improve the care we all provide. In just 1 year,
according to the Health Resource Service Administration, we
have collectively trained almost 19,000 trainees in over 45
professions and disciplines. About 11 percent of our trainees
come from disadvantaged backgrounds or underrepresented
minorities in their chosen health professions, and we have
partnered with almost 400 healthcare delivery sites to provide
the trainees with that clinical training experiences in
geriatrics. Thanks to our work, over 100,000 faculty and
practicing professionals have experienced nearly 1,200
continuing education programs. No surprise to someone who has
worked in the field of geriatrics, about 75 percent of our GWEP
graduates receive training in medically underserved
communities, and upon completion of the training, are actually
going to go back and serve in those communities.
I am very grateful and encouraged by the hard work that
this committee has done on the reauthorization of these
programs. I am especially grateful to Representative Jan
Schakowsky for her leadership in introducing the Geriatrics
Workforce and Caregiver Enhancement Act legislation that would
increase funding for the only Federal geriatrics program and
reestablish the Geriatric Academic Career Award, which was a
previously funded program for developing clinician educators
that ensures that the geriatric academic workforce will be
prepared to train our future geriatric workforce needs.
So, Mr. Chairman, Dr. Burgess, Ranking Member Green, and
distinguished members of the subcommittee, addressing the elder
care workforce crisis and the other vital health professions
programs under the Public Health Service Act is an opportunity
we cannot afford to ignore. We appreciate the hard work the
committee has undergone to reauthorize all the important health
professions program. I thank you so much for this opportunity
today, and I look forward to your questions.
[The prepared statement of Dr. Knebl follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Mr. Burgess. Thank you, Doctor.
Dr. Sebastian, you are recognized for 5 minutes, please.
STATEMENT OF JULIANN G. SEBASTIAN
Ms. Sebastian. Good afternoon. My name is Juliann
Sebastian, and I serve as the chair of the board for the
American Association of Colleges of Nursing. I want to
sincerely thank Chairman Burgess and Ranking Member Green for
holding this important hearing, and for the opportunity to
testify today on behalf of H.R. 959, the Title VIII Nursing
Workforce Reauthorization Act of 2017.
I would also like to extend my gratitude to two members on
this subcommittee, Representatives Doris Matsui and Kathy
Castor, who introduced this legislation with their bipartisan
colleagues, Representatives David Joyce, Tulsi Gabbard, Rodney
Davis, Suzanne Bonamici, and Patrick Meehan.
I also wish to thank House Energy and Commerce Committee
members who have cosponsored this legislation, Representatives
Anna Eshoo and Eliot Engel.
AACN represents 810 baccalaureate and graduate schools of
nursing across all 50 states and the District of Columbia. Our
membership extends to over half a million individuals,
including 19,000 full-time faculty members, more than 497,000
nursing students, and the deans who lead these institutions.
AACN, along with 50 other national nursing organizations,
fully supports the reauthorization of these programs. This bill
is a necessary step toward ensuring that not only direct
recipients continue to benefit from Title VIII, but that
patients and communities across the country are afforded high-
quality nursing care through a workforce that is highly
educated, innovative, and diverse.
At my school, Title VIII funding has provided vital
learning and career opportunities for nursing students in each
of our academic programs. As an example, Title VIII funding has
allowed us to expand rural emergency and acute care courses for
nurse practitioner students planning to work in critical access
hospitals.
Nebraska has a large number of critical access hospitals,
64 in total. Many rely on nurse practitioners for important
clinical care needs. Because nurse practitioners at critical
access hospitals must be able to meet health needs across the
gamut, from primary care, to urgent and emergency care, and
critical care, our faculty are committed to finding ways to
help students learn to meet the health needs across this full
continuum.
Our advanced rural hospital care program was initiated with
Title VIII funds. So far, 34 nurse practitioners have completed
courses that will help them meet needs in critical access
hospitals, and another 14 nurse practitioner students are in
process. Faculty also recently received Title VIII funding
through the advanced nursing education workforce program that
will expand the number of family nurse practitioner and
psychiatric mental health nurse practitioners able to practice
in rural and underserved areas.
This grant allows us to support both students and the
preceptors by using telehealth, which, as you know, is an
increasingly important part of care in rural areas. The
majority of the counties in our State are rural, so it is
important to us to educate undergraduate and graduate students
in this way. Mine is only one of hundreds of examples of how
Title VIII dollars yield an invaluable return on investment.
I would like to highlight a couple more stories. At
Vanderbilt University School of Nursing in Nashville,
Tennessee, Title VIII funding has been used to support nurse
managed health clinics, which not only provide clinical
training, but provide primary care services to over 900
patients a year. Ninety percent of the individuals served by
Vanderbilt's nurse managed clinic live below 200 percent of the
Federal poverty line. From 2012 to 2016, the clinic improved
blood pressure control in patients with hypertension from 18 to
61 percent.
Another example, at Western Carolina University School of
Nursing, a recently graduated student received financial
assistance through the Nursing Workforce Diversity Program,
which aims to increase the number of individuals
underrepresented in the profession of nursing. She was an honor
student and has taken a position as a registered nurse in a
rural community hospital in the western part of the state.
I hope these several examples show how Title VIII is a
critical pipeline for students, faculty, institutions, and the
patients they serve.
I thank the subcommittee members for this opportunity to
share the tremendous impact of Title VIII programs and how its
recipients' careers have and will continue to improve our
Nation's health. I applaud the subcommittee for bringing H.R.
959 to this hearing, as it is a necessary legislative step to
modernize the programs and support America's patients, their
families, and the communities in which they live. Thank you.
[The prepared statement of Ms. Sebastian follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Mr. Guthrie [presiding]. Thank you.
I thank the witnesses for their testimony, and we will now
move to questions, the first portion of the Q&A. And I will
begin the questioning and recognize myself for 5 minutes for
that.
For Dr. Calman, I like the approach that the Teaching
Health Centers program helps local providers like community
health centers grow their own workforce. Can you explain how
this residency program boosts staff ranks at rural and
community health centers over the long term?
Ms. Calman. I am sorry, could you repeat the last sentence?
Mr. Guthrie. Oh, could you explain how this residency
program boosts the staff ranks at rural and community health
centers over the long term?
Dr. Calman. Sure. The program is really geared towards
taking medical students and bringing them into programs in
rural and underserved areas. And when they train in those
areas, they have a much higher probability of staying in those
areas. So if you think about bringing people who might normally
train in a regular big hospital in the city, but now moving
them out into the community for their 3 years, they develop
relationships in those communities. It is a different style of
practice to practice in a small rural community. You learn
different skills, you learn to be more self-reliant, as Dr.
Billings explained. You get a sense of self-reliance that
allows you to go out into places where there are not a lot of
doctors and not a lot of specialists. And so, we are creating
that pipeline for people so that you can go into these
communities and serve.
Mr. Guthrie. Thank you.
Dr. Knebl, in your testimony, you mentioned that a majority
of geriatrics workforce graduates who receive this training
announce commitments to further pursue training or in a
practice in medically underserved communities. In your
experience, how do these programs specifically help medically
underserved communities?
Dr. Knebl. So as we were talking about, number one, it is
underserved, but through these programs, because they are
interprofessional, we are training members of the whole
healthcare team to go out. And so those trainees that will go
out to those areas, obviously, will all then have more
knowledge and skills. And I know that a lot of our trainees are
going to these areas because we partner with our county
hospital, John Peter Smith Hospital, which has one of the
largest family medicine residencies in the whole country. And
so they actually track where their residents are going.
And so to have the enhanced training in geriatric care,
where a lot of the older adults are actually living, if you
look at the data as to rural communities, and so to get, then,
those trainees back out there, along with, then, the other
members of the healthcare team, nursing, physical therapy,
pharmacy, PAs, et cetera, we believe that is going to help
enhance that, and then the care ultimately for the older
adults.
Mr. Guthrie. OK. Good. This is for you, but I will also let
Dr. Sebastian go first, and then anybody else can add to this.
But many of the Title VII and VIII programs has curriculum
development and continuing education components. How do your
programs help the health professions workforce quickly adapt to
the Nation's most pressing healthcare concerns? So how are the
continuing education components of these programs addressing
you in emerging public health issues? So Dr. Sebastian?
Ms. Sebastian. The Title VIII funds are the ones I will
speak to initially. And those funds, we are unable to secure
those funds unless we propose programs that, in fact, are
nimble and highly responsive to local healthcare concerns and
to national health priorities. So the curricular enhancements
and the curricular changes that are put in place as a result of
these funds are inherently focused on contemporary issues, such
as mental health concerns, education, and more primary care
providers for rural and underserved areas, incorporation of
telehealth, which I mentioned was one example in our local
school, as well as the opioid crisis and more specific kinds of
contemporary health issues.
Mr. Guthrie. OK. Thank you.
Dr. Knebl?
Dr. Knebl. Yes. I will just add to that, that what we have
tried to do out of the GWEPs, my personal GWEP, the WE HAIL
program, we actually did a community needs assessment in
collaboration with our health systems in our community. And we
heard from them what the major issues were. And that then gave
us the focus for the CME programs for the healthcare
practitioners.
So the areas that came up, just to share with you, is
Alzheimer's disease, falls and fall prevention, medication
management for older adults because of the challenges they can
have, health literacy so that the healthcare workforce can
speak in a way to that older adult and their family so they
understand what they need to do, and chronic disease
management. So we took what the community felt were the issues,
and that is how we developed the curriculum that now we are
disseminating, not only locally, but also throughout Texas and
in many rural communities.
Mr. Guthrie. Well, thank you very much. My time has just
expired. So I will yield back, and I will recognize the ranking
member, Mr. Green of Texas, for 5 minutes for questions.
Mr. Green. Thank you, Mr. Chairman.
Dr. Billings, I want to thank you for joining us, and the
whole panel today. And I know we talked earlier about the
National Health Service coordinated issue with community-based
clinics. Dr. Billings, can you explain how the National Health
Service Corps helps community health centers like the Presidio
County Health service recruit providers?
Dr. Billings. The National Health Service Corps is a vital
workforce pipeline to community health centers throughout the
country and our territories. Approximately 5,000 providers
every year fulfill their loan repayment and/or scholarship
repayment within a community health center. Without the
National Health Service Corps, community health centers
undoubtedly would close down because they would not have
providers to take care of the patients.
Mr. Green. I have a very urban district in Houston and our
FQHCs are so valuable in our area, it is a safety net. By the
way, this committee actually proposed, and we passed finally,
to give volunteer doctors in FQHCs tort claims protections. So
a doctor maybe wants to cut half their practice, they can still
work and treat people.
Could you explain what a failure of Congress to extend the
National Health Service Corps would mean to community health
centers like yours?
Dr. Billings. That would be in 2 weeks when we go off the
cliff, if we go off the cliff, there will be an immediate
cessation of loan repayment beginning October, November. That
is the first round of loan repairs. So there will be an
immediate and drastic effect on taking care of patients and the
patients that need the access to care the most.
Mr. Green. Thank you.
Dr. Sebastian, the numbers I have heard, according to the
Health Resources and Service Administration, we are expected to
experience a nursing shortage of approximately 150,000 people,
2030. I understand that one cause for this is shortage of
sponsors in nursing schools due to the limited supply of
nursing faculty. Would you elaborate on the challenges
attracting students and professionals into the nursing faculty
workforce?
Ms. Sebastian. Yes. Nursing faculty, one of the challenges
that we experience is the competition in terms of wages with
the clinical practice arena. So that is often a big challenge
in terms of recruiting nursing faculty. We are working very
hard and, actually, with the support of the Nurse Faculty Loan
Program, to attract more students into faculty roles. And that
particular component of Title VIII has been very helpful to
attract students who then can, in fact, look towards some
relief from their loans as a result of the provisions of the
Nurse Faculty Loan Program.
Mr. Green. Some numbers we see is that graduations in
baccalaureate programs in nursing, U.S. nursing schools turned
away 64,000 qualified applicants from baccalaureate or graduate
studies in 2016 due to the insufficient number of faculty,
clinical sites, classroom space, clinical preceptors, and
budget constraints. Most nursing schools responding to the
survey pointed that the faculty shortage is the reason for not
accepting all of these qualified applicants.
How does Title VIII programs help increase the supply of
nursing faculty and the number of students accepted in nursing
programs?
Ms. Sebastian. Well, a prime example is the Nurse Faculty
Loan Program, and as you pointed out, all of those factors
influence our ability to hire faculty, not just the salary
issue. Salaries have actually improved in some components of
the nursing faculty ranks, but also issues related to budget,
inability to provide additional clinical site placements. So I
would say that the Nurse Faculty Loan Program is one huge
example.
But the other opportunities that are provided by the
advanced nurse education workforce, which is a slightly new
program this year, help us get more students into graduate
programs, who then may be interested in the future in faculty
careers.
Mr. Green. Thank you. Mr. Chairman, I yield back my time.
Mr. Burgess [presiding]. The chair thanks the gentleman.
The gentleman yields back.
The chair recognizes the gentleman from Florida, Mr.
Bilirakis, 5 minutes for questioning.
Mr. Bilirakis. Thank you, Mr. Chairman. I appreciate it so
much, and I thank the panel for their testimony today.
Dr. Knebl, according to the Alzheimer's Association, more
than 5 million Americans are living with this disease, with
projections rising up to 16 million by 2050. How do these
geriatric workforce programs integrate Alzheimer's disease and
related dementias education to families and caregivers of older
adults?
Dr. Knebl. Well, thank you so much for that question. We
actually had an opportunity to have a separate addition onto
our grant funding to actually address the Alzheimer's disease
and related disorders education. How we are doing it, and I can
give you that example from our program, is that we actually
have partnered with the North Central Texas Chapter of the
Alzheimer's Association, in addition to a dementia-specific
care center, in terms of delivering certain types of programs
actually to patients and their caregivers. There are evidence-
based programs. One is a stress-busting program, one is a REACH
program where you actually are able to send in a dementia care
specialist into the home to give the family member respite and
also education. And so we are doing that collaboration with
those programs and actually assisting them with some funding to
expand the reach.
We then also have our students as part of this so that then
they can learn from this, and some of our family medicine
residents are actually getting to get exposure to these
programs.
Another thing we are doing is, you know now we have the
Medicare Annual Wellness Visit, where you have to do screening
for memory disorders. So what we are doing through our county
hospital--and many people don't know how we got this to happen
and I probably shouldn't say it too loud, because maybe they
will say don't do it. But, basically, what they are doing is we
have an electronic health record at the county hospital called
Epic, and some of you may be familiar with that.
So through the Epic, we are now building platforms within
it to be able to more adequately assess older adults,
particularly those with cognitive impairment. We then make
referrals to the community-based organizations, such as
Alzheimer's Association. They can now look at the Epic
platform. We are giving them access so they can see what is
going on with that patient. They can then follow up. They can
then reach out to the family to help them, and then they put
notes in there about what their providing to that patient and
family that then when the primary care doctor sees the patient
back in the clinic, we see it. We close the loop between the
primary care doctor, the referral to the community agency, and
we make sure that patient and family is getting taken care of.
So that is something we are doing out of our GWEP that I am
very excited about.
Mr. Bilirakis. Can I ask you, when you said the welcome to
Medicare, which actually my dad, Congressman Bilirakis,
authored many years ago, so I want to brag about that.
Dr. Knebl. You should.
Mr. Bilirakis. He is a wonderful person, and he has done an
outstanding job over the years. But does that include a mental
health screening? Is it required? It is required?
Dr. Knebl. Yes. Well, we are adding in extra tools, because
this is a geriatric clinic that is out of our county hospital.
So we are putting mental health for depression screen, we are
doing fall risk assessments, we are doing basic assessments of
daily living, instrumental daily living. We are doing all those
types of assessments as part of this. So there might be a
patient that is determined to be a fall risk, we will then
refer them to the senior citizens services, it is called 60 and
Better, who does the congregant meal programs and actually
provides the Matter of Balance classes. We would then have that
person follow up. And again, they would have access to seeing
the information.
Mr. Bilirakis. How widespread is that throughout the United
States, what you are doing?
Dr. Knebl. It is not. Our hope is, if you are
reauthorizing, we can now apply to now take this out beyond
Fort Worth, Texas.
Mr. Bilirakis. OK. Thank you.
A question for Dr. Billings. You and your colleagues are
certainly no strangers to the growing shortage of medical
professionals across the country. And someone probably has
touched on this, but in your testimony, you acknowledged the
National Health Service Corps as an effective, even popular way
to overcome the recruitment barrier for medical shortage areas.
What other ways are stakeholders working together to recruit
and retain medical talent in historically underserved areas,
and why are they not as successful? And how can they be
improved?
Dr. Billings. Sure. Thank you for the question. So through
the National Health Service Corps, there is a state loan
repayment component where approximately at least 37 states take
advantage of Federal money to utilize in for state-specific
needs that perhaps health professional shortage area scores
don't go down low enough to fund because of the overwhelming
need that is out there in the United States.
Currently, only 10 percent of scholarship applicants are
able to be funded every year, and only 40 percent of loan
repayment applicants are currently funded. There is certainly a
huge need, and there is interest by health students throughout
the disciplines, and we are not meeting that need for the
interest that the students have, that want to go into primary
care. And we want to be able to enable that.
The other huge need is, of course, we have about 10,000
field strengths within the National Health Service Corps every
year. To meet the need of the patients, the health centers, the
critical access hospitals, the rural health clinics, the Bureau
of Prisons, Indian Health Service facilities, we need a field
strength of 28,000 to meet the basic need of today. There is
just a huge need. There is a lot of work to be done, and it is
very, very important that we continue to support and enable
these students that have expressed a desire to go out and serve
the underserved, that we somehow enable them to realize that
dream and train them in that setting as well.
Mr. Bilirakis. OK. Thank you.
I yield back, Mr. Chairman.
Mr. Burgess. The gentleman's time has expired.
The chair recognizes the gentlelady from California, Ms.
Eshoo, 5 minutes for questions, please.
Ms. Eshoo. Thank you, Mr. Chairman.
I want to thank each one of you for what you do, first of
all. I want to thank you for the passion that you have brought
into this hearing room. A lot of hearings are very dry, and
they are always full of important information. But there is no
doubt in my mind, and I think all of my colleagues, that you
care so deeply, so passionately about what you do. I think you
are a blessing to the American people. You really are, and I
thank you for that.
I am really privileged to represent Lucile Packard
Children's Hospital, Stanford University Medical Center, and,
of course, the school. All of these issues are interwoven into
my congressional district, as well as a community health center
in one of--most people don't think that there are poor people
in Silicon Valley, but there are, there are. There are really
underserved people that now are being served so much better
because of the new community health center in East Palo Alto,
which has always been a poor community.
So, the extensions of these programs and the Affordable
Care Act, as well as the Teaching Health Center Graduate
Medical Education, which was established in the Affordable Care
Act, are a real source of pride to me in supporting them and in
the architecture that the ACA had, underappreciated by some,
unknown by others, but certainly you have highlighted what that
infrastructure--we talk about infrastructure in the country.
You have spoken to a magnificent part of the infrastructure of
our country and how we need to build on that, because there are
communities that are in need, certainly in rural areas of our
country and elsewhere. So thank you again.
I wanted to come back mostly to thank you. I have a flight
to catch in just a little while, so I will be real quick with
my questions.
To Dr. Billings, are there other specialties within primary
care, dental, and mental health that could benefit from being
eligible to participate in the Public Health Service Corps?
Dr. Billings. That is a really great question. And that has
been a source of debate for many, many years. We know the need
for meeting comprehensive primary care with the current funding
level of the National Service Corps is not being met. That is
evident in the 10,000 field strength that we have. Yet the need
is for 28,000 participants to meet the basic need of
comprehensive primary healthcare that we need. We would be more
than happy to have a conversation once we are meeting in a
current comprehensive primary care need of expanding that.
One of my biggest challenges as a boots on the ground
physician is, when I reach my level of I feel that my patient
needs to go to a specialist, how do I get them to one? Who is
accepting Medicaid?
Ms. Eshoo. I was successful at adding a provision in the
21st Century Cures Act that designated pediatric mental health
professionals to be eligible. A little bit of a fight to do
that, but I prevailed, so that they could participate in the
Public Health Service Corps. So I appreciate your sharing that
with me.
Is the program's current per resident funding level
appropriate? Who can answer that?
Dr. Calman. Yes, I guess that is for me. So the Teaching
Health Center Graduate Medical Education program was originally
funded, as you said, at a level of $150,000 per resident per
year. So that was based on a historical analysis of what it
costs to train a resident.
What actually ended up happening when it was reauthorized
was people forgot to take account of the fact that the number
of programs had been growing, and also the programs had been
ramping up from just having first-year residents to having
first, second, and third-year residents. As a result of that,
the funding was reduced to $95,000 per resident per year, which
is really only two-thirds of the dollars that are needed to
support just the resident salaries and the faculty salaries in
those program. That number is now to up to $116,000.
And so the program should be happy that they got a little
bit more money, but not happy about how it happened. How it
happened was programs dropped out at the lower reimbursement
level. They couldn't support the residents, they couldn't
support the faculty. And so we lost a lot of training slots
through this new program.
As you said, when you think about a program starting, the
remarkable thing was there are 57 new programs that developed
across the country in the short period of time that this
program's been in existence. All of them geared towards one
thing: training doctors for underserved rural and urban
communities. Fifty-seven new programs that just literally grew
out of nowhere, got accredited, went through the enormous
accreditation process, and all expecting that the funding would
be there to continue.
And so we are really in crisis now and about to lose more
programs. Two more programs closed just at the beginning of
this academic year. A critical program in inner city Detroit
and a program in rural Oklahoma, both lost, programs that had
been started up through the initial funding but couldn't
sustain themselves on the inadequate funding that we currently
get.
Ms. Eshoo. Well, we obviously need to reauthorize. That is
absolutely essential, it is critical. But we can't be self-
congratulatory by simply doing that. I think that you have all
made the case, the nurses, everything that you are doing at the
county hospital, that the funding has to be appropriate for it.
Dr. Calman. Totally.
Ms. Eshoo. No one sends their kids off to college and says,
well, I am going to pay for room and board, but I am not paying
for your tuition. What kind of a deal is that? So we have work
to do, and I hope the outcome will be worthy of the work that
you do----
Dr. Calman. Thank you very much.
Ms. Eshoo [continuing]. And what you have chosen to do with
your lives. You really are great Americans. Thank you.
Dr. Calman. Thank you.
Ms. Eshoo. God bless you. Thank you.
Mr. Burgess. The gentlelady's time has expired.
The chair recognizes the gentlelady from Washington, Mrs.
McMorris Rodgers, 5 minutes for questions, please.
Mrs. McMorris Rodgers. Thank you.
And I agree, I still admire the work that you do, and I
appreciate your commitment moving forward.
Just a few questions. Dr. Calman, I wanted you to address,
and I know this has probably somewhat been addressed in other
questions, but how would your health center be able to make up
for the loss in funding for each residency slot if the THCGME
program is allowed to expire on September 30? If this is even
financially possible, how would shifting these dollars impact
core primary care services for your patients?
Dr. Calman. So it is not really possible. The community
health centers that are the sponsors of the vast majority of
the Teaching Health Center slots really don't have excess
income. And so, what we have really seen is a loss of program
slots. You really can't sustain the program on inadequate
funding. We lost 170 positions since the start of this program
just a few years ago with the reduction in the funding that
came with the last inadequate reauthorization. These are 170
doctors that would have been out practicing in needy
communities that can't be replaced at this point.
And so we will continue to lose slots. We will continue to
see programs close, like the two that I just talked about that
have just closed, because you can't sustain the funding for
these programs. These are real costs.
The difference between this program and regular graduate
medical education is that we are accountable for every dollar.
Every dollar goes to either a resident's salary, a faculty
member's salary, or other program costs that we have to account
for in every allocation.
Mrs. McMorris Rodgers. So the legislation H.R. 3394
provides funding for 3 years at, roughly, $157,000 per resident
per year. Would you address why this level is so important to
the teaching health centers like mine in Spokane and across the
country?
Dr. Calman. Sure. So in the original authorization of this
program, there was a demand that the Secretary get an outside
entity to do a study of the actual cost of residency training,
and that study revealed that the actual costs were $157,000 per
resident per year, on average. So if the funding isn't
reauthorized at that level, we are basically putting the
program in deficit to start. And you can't really do that.
And I think we really have to see this as an investment.
This is an investment, because in every study of primary care,
the more primary care providers you have in a community, the
lower the healthcare costs in that community. The more
specialists you have in a community, the higher the healthcare
costs in that community. So this is an investment. We are
investing in the training of primary care people to reduce
healthcare costs and to be able to provide better care in
communities that have no doctors at this point or few doctors.
Mrs. McMorris Rodgers. So building on that just a little
bit, would you agree that the THCGME program is accomplishing
the objectives Congress laid out when it was established? And
how does your association know that this program is actually
producing physicians that go on to practice in primary care?
Dr. Calman. So we tract outcomes. This is an outcome-based
program, like all grant programs. And so we can tell you that
the percentage of regular graduates that go into primary care
is normally 23 percent. Eighty-two percent of the Teaching
Health Center graduates stay in primary care. There are twice
as many that stay in underserved areas. There are four times as
many that stay in rural areas, and 18 times as many graduates
of teaching health center programs go into community health
centers, federally qualified community health centers, than
come out of the normal GME program. So we are responsible for
outcomes.
And, in fact, in your current legislation, there is a whole
new set of criteria and outcome measures that must be reported
from the programs around the country.
Mrs. McMorris Rodgers. Thank you, Dr. Calman.
I have several letters of support in favor of H.R. 3394
that I would like to submit for the record.
And with that, I yield back.
Mr. Burgess. Without objection, so ordered.
[The information appears at the conclusion of the hearing.]
Mr. Burgess. The chair thanks the gentlelady. The
gentlelady yields back.
The chair recognizes the gentleman from New York, 5 minutes
for questions, please.
Mr. Engel. Thank you very much. And I would like to throw
my lot in with Congresswoman McMorris Rodgers.
I am glad, Dr. Calman, that you explained about the
September 30 deadline. And I want to particularly welcome you,
since----
Dr. Calman. Thank you.
Mr. Engel [continuing]. I am a fellow New Yorker. You do
good work in my home city, and we thank you and your very good
institution for what it does.
H.R. 3394, sponsored by Congresswoman McMorris Rodgers,
would provide a 3-year extension to the teaching health center
program. I wanted to focus on that.
I have heard from advocates that an extension of at least 3
years is critical. So, Dr. Calman, can you explain why the
program would benefit from a longer term extension?
Dr. Calman. Sure. When we bring a new resident into our
program, we commit to them for the full length of their primary
care training, which is 3 years. So the residents know this.
And we get questions from applicants. The average program that
runs a teaching health center gets over a 1,000 applications
for a handful of positions. The residents that we want----
Mr. Engel. It is like the House of Representatives.
Dr. Calman. The residents we want are obviously the best
and most committed people. They come in and they ask, how do I
know you are going to be able to complete my training? How do
you know that you are going have the funds to complete the
training? Because the teaching health center funds expire in
very short term. And so it is based on that commitment.
That commitment is built into the accreditation that we all
had to get because the ACGME, the accrediting entity, says that
once we take a resident, we are responsible for the completion
of their training in our program. And so, we need long-term
funding in order to provide that security to the program
applicants and also to the programs.
Mr. Engel. Well, thank you. And H.R. 3394 also contains
additional funding for expansion of the program. So let me ask
you again, Dr. Calman, is there currently demand for new
teaching health centers and new residency slots in the program?
Dr. Calman. So there is enormous demand. As I said, our own
program gets over 1,500 applications for eight positions. So we
know there is demand for more residency training slots. We also
know that there is demand for new programs, because as
president of the American Association of Teaching Health
Centers, I get these inquiries all of the time. We get calls
from community health centers saying they really are interested
in building this sort of pipeline track within their programs
by starting a training program, because maybe that area of
their state has had a problem recruiting or a problem
maintaining an adequate workforce.
And so all over the country there are places that are
contemplating starting new training programs. And the only
thing standing between this and a much larger solution to our
Nation's primary care crisis is the level of funding and the
number of programs we can fund, because every program trains
exclusively in primary care, and according to the new
legislation that is proposed, would be training people in
underserved communities.
Mr. Engel. Thank you. I hope we can pass this bipartisan,
bicameral bill as soon as possible so that teaching health
centers can continue to provide much needed care to our
communities.
I want to take this opportunity to raise another program
facing September 30 deadline, and that is community health
centers. I have heard from community health centers in my
district concerned about this approaching deadline. And one
organization I have heard from is HRH Care, which operates two
centers in my district, but serves about 14,000 of my
constituents. And here is what they told me: They said that if
Congress fails to authorize community health centers, in the
next 2 weeks, centers will be forced to eliminate the Medicaid-
assisted treatment needed by New Yorkers and others struggling
with addiction to opioids, and centers will end weekend and
evening hours, making it much harder for working families to
get to a doctor. The list goes on.
So I want to commend the chairman for having today's
discussion, but obviously, we cannot have it take place in a
vacuum. Congress must enact a long-term, well-funded extension
of the community health center program without delay, and the
health of all of our constituents is at stake.
So thanks to all the witnesses. Thank you, Dr. Calman.
Thank you, Mr. Chairman. I yield back.
Mr. Burgess. The chair thanks the gentleman. The gentleman
does yield back.
I recognize myself for questions.
And, Dr. Calman, let me, just as a point of clarification,
but for someone who is watching this hearing today, I don't
want them to get the mistaken impression that you are paying
your residents $157,000 a year.
Dr. Calman. Oh, thank you. We wouldn't have any problem
recruiting.
Mr. Burgess. That is exactly right. When I was a resident
at Parkland Hospital, my first year, I think it was well under
$10,000 that we earned. But that is the total cost of providing
that educational experience, correct?
Dr. Calman. Exactly. It pays for the residents' salary, all
the faculty salaries, all the administration of the program,
all of the people who are doing recruiting and everything else,
and substantial faculty, because these programs require
faculty. Remember that in primary care, you are being trained
to cross a broad range of areas, and so the faculty have to be
able to teach people how to do minor surgical techniques, and
they have to be able to train in OB/GYN, and they have to be
able to train in train across a broad range of areas.
So all of those costs are built into the 157. It is a total
cost of training.
Mr. Burgess. And I do want to point out that this
committee, early in the year, passed the Improving Access to
Maternity Care Act, to expand the ability to place maternity
healthcare providers in medically underserved areas. It
actually passed on the floor of the House and is awaiting
activity over in the Senate.
There is a recurring theme here that you may encounter
awaiting activity over in the Senate. I shared Mr. Engel's
concern that we finish up our work and both houses get the work
done and get the programs approved.
Let me just ask Dr. Billings and Dr. Knebl, we have the
National Health Service Corps that focuses on the distribution
of primary care providers, and then Title VII and Title VIII
that we are also talking about this morning. So how do Title
VII and Title VIII collaborate with the National Health Service
Corps? What is the coordination between those programs? And,
Dr. Knebl, let me start with you, and then, Dr. Billings, I
would like your input.
Dr. Knebl. So some of the focus, obviously, for us is
really the geriatric training under the Geriatric Workforce
Enhancement Programs, and that is to really try to enhance the
education in geriatrics for primary care, and also for the
whole primary care health profession team.
So I would say that I see the inner phase because we are
very focused on assisting primary care programs to increase the
geriatric content in education. And everything that we develop
is to be shared among all types of education programs in the
area of primary care. And then, as we were talking about
earlier, the continuing medication education programs for
people in practice.
So that we are taking a multipronged approach. We are
starting in the undergraduate area of education for health
professions, then into the residency programs, but then also
when people are in practice.
So I would say the different products and programs that we
develop are then applicable and able to be utilized in these
primary care residency programs.
Mr. Burgess. Great.
Dr. Billings.
Dr. Billings. Healthcare is delivered by a team. It is not
the physician. It is not a midlevel provider. It is truly a
team. And the Title VII and Title VIII dovetail very well with
the National Health Service Corps and with regards to the
training of the students that are entering into service in the
National Health Service Corps. The Area Health Education
Programs that are funded through these programs help to place
students in underserved areas for their training. So it is just
vital. We are a team.
Mr. Burgess. Thank you.
And, Dr. Sebastian.
Ms. Sebastian. Yes, I see the National Health Service Corps
program and Title VIII, particularly, as very complementary. So
the National Health Service Corps Program provides scholarship
and loan repayment for students such as nurse practitioner
students. Close to 90 percent of nurse practitioners actually
practice in primary care areas, again, as part of a team.
Title VIII provides some funding to students, but also
funding for the other costs associated with educating students,
the cost of placing them in underserved areas, faculty
supervision, the curricular issues that we want to provide for
the students--or the curricular opportunities we wish to
provide for the students.
So the two programs are in fact very complementary and I
think work very well side by side.
Mr. Burgess. Very well. Thank you.
I want to thank all of you for being here today. And I
apologize that we had the interruption for votes in the middle
of the hearing. It is an important hearing, quite clearly.
But seeing that there are no further members wishing to ask
questions, once again, we extend our thanks to the witnesses.
We have received outside feedback from a number of
organizations on these bills, so I would like to submit
statements from the following for the record: the Eldercare
Workforce Alliance, the Health Professions and Nursing
Education Coalition, the Healthcare Leadership Council, Doctors
Hospital at Renaissance, the National Association for Geriatric
Education, and of course, the statement from our colleague who
was here earlier, Congressman Denham, also, the American
Association of Nurse Anesthetists.
Without objection, so ordered, those comments will be part
of the record.
[The information appears at the conclusion of the hearing.]
Mr. Burgess. Pursuant to committee rules, I remind members
they have 10 business days to submit additional questions to
our panel for the record. And I ask the witnesses to submit
their response to those questions within 10 business days of
receipt of those questions.
Without objection then, the subcommittee stands adjourned.
[Whereupon, at 1:12 p.m., the subcommittee was adjourned.]
[Material submitted for inclusion in the record follows:]
Prepared statement of Hon. Greg Walden
Today, our country is on the precipice of a health provider
shortage, impairing our ability to meet the increasing demand
for services, especially in primary care. Underserved areas,
like many of the rural counties in eastern Oregon, are acutely
experiencing this shortage now. That is why it is so important
that the federal government maintain its long-standing
investment in the education and training of health
professionals.
Today's hearing will examine four health professional
education and training programs that will prepare current and
future clinicians to meet the nation's growing health needs and
increase access to care. We will hear testimony from experts
who are here to speak about the successes and challenges facing
the different types of workforce programs under the Public
Health Service Act.
Dr. Neil Calman, President and CEO of the Institute for
Family Health, will speak about the Teaching Health Center
Graduate Medical Education program, which supports the training
of residents in primary care.
Dr. Adrian Billings, Medical Director of Presidio County
Health Services will share his experience in the National
Health Service Corps, a program that has been improving
recruitment and retention of health practitioners in
underserved areas through scholarships and loan repayments
since the 1970s.
Both of these programs face a reauthorization deadline. It
is my goal to move forward in a bipartisan manner on these
extenders before the end of the month and ensure they are fully
and responsibly offset.
We will also hear from Dr. Janice Knebl, Chair and
Professor in Geriatrics at the University of North Texas Health
Science Center about Chairman Burgess's H.R. 3728, EMPOWER Act
of 2017, which reauthorizes health professions workforce
programs under Title VII of the Public Health Service Act. This
reauthorization includes the re-organization of the geriatric
health professional grant program to reflect changes that the
Health Resources & Services Administration has pursued to
improve outcomes for geriatric patients.
Finally, we will hear from Dr. Juliann Sebastian, Dean of
University of Nebraska's College of Nursing, about
Representative Joyce's H.R. 959, the Title VIII Nursing
Workforce Reauthorization Act of 2017, important legislation
that reauthorizes critical nursing education workforce
development programs under Title VIII of the Public Health
Service Act.
These are important programs that we rely on, in one way or
another. I'd like to thank our witnesses for being here with us
today to give an update on how these programs are performing,
so we can identify the best path forward in supporting their
critical services.
----------
Prepared statement of Hon. Frank Pallone, Jr.
I'm pleased we are holding this hearing to discuss programs
critical to the success of our health workforce. A strong
health workforce is the bedrock of a strong health system
overall. It's essential that we continue to sufficiently invest
in all our health workforce programs to ensure they are meeting
the country's needs.
The National Health Service Corps (NHSC) Program provides
financial support to health professional students and primary
care providers who commit to provide service in medically
underserved areas. The incentives provided by this program help
place providers in the communities that need them the most.
However, without congressional action, funding for NHSC will
expire on September 30, 2017. I strongly support extending
funding for this program.
Similar to NHSC, funding for the Teaching Health Center
Graduate Medical Education (THC GME) Program is also set to
expire at the end of the fiscal year. Teaching Health Centers
train primary care medical and dental residents in community
based settings such as Community Health Centers. THC graduates
are far more likely to remain in primary care and to practice
in rural and underserved communities compared to traditional
GME graduates. Without renewed funding before September 30th
THC residencies could potentially be interrupted or terminated.
I strongly support H.R. 3394, introduced by Representative
McMorris Rodgers (R-WA), which would fund the program for 3
years at an improved funding level. H.R. 3394 would provide
THCs the financial stability they need to adequately train a
class of residents.
H.R. 3728, the Education Medical Professionals and
Optimizing Workforce Efficiency and Readiness (EMPOWER) Act of
2017, introduced by Representatives Burgess (R-TX), Schakowsky
(D-IL), and Bucshon (R-IN), would reauthorize the programs in
Title VII of the Public Health Service Act that received
funding through the FY 2017 Appropriations process. Title VII
programs provide valuable training to our nation's healthcare
professionals. I support the reauthorization of these programs
and thank the bill's sponsors for their work on this issue.
Finally, H.R. 959, the Title VIII Nursing Workforce
Reauthorization Act of 2017 would reauthorize the Title VIII
programs that received funding through the FY 2017
Appropriations process. Programs in Title VIII of the Public
Health Service Act improve nursing education, practice,
recruitment, and retention. A well trained nursing workforce
benefits all Americans and I strongly support these programs. I
thank the bill's sponsors, Representatives Joyce (R-OH) and
Matsui (D-CA), for their bipartisan work on this issue.
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