The views expressed in this document are solely those of the Advisory Committee on Interdisciplinary, Community-Based Linkages and do not necessarily represent the views of the Health Resources and Services Administration or the U.S. Government.

I. Executive Summary

The integration of "interdisciplinary" and "community-based" concepts into the training of health professionals is an effective way to ensure that there will be a national workforce providing the best possible health care in underserved geographic regions or in service to vulnerable populations. By focusing precious national resources on interdisciplinary, community-based grant programs, the Secretary and Congress are also supporting cost-efficient measures that target the greatest needs for health professions education. The President's intent in expanding services to the Nation's neediest populations through growth in community and migrant health centers is an example of the continuing demand for educational strategies that prepare a workforce to serve in these practices.

In 1998, the Advisory Committee on Interdisciplinary, Community-Based Linkages was created to provide advice and recommendations to Congress and the Secretary on interdisciplinary health professions policy and program development, specifically activities under Section 756, Title VII, Part D of the Public Health Service Act. The Committee was chartered in March 1999, and its initial meeting was held in August 2000. Currently, there are 20 Secretary-appointed members who represent expertise on the various interdisciplinary, community-based grant programs and health professions education, in general. The Advisory Committee met on four additional occasions following its initial organizational meeting.

The Advisory Committee believes that the primary purpose behind the Federal programs created by Title VII, Part D of the Public Health Service Act is creation of academic-community partnerships that prepare a health workforce which is responsive to the needs of the Nation. It is felt that such programs must be sensitive to the evolving system of health care delivery, the changing scope of practice for various disciplines, the socioeconomic and cultural characteristics of an increasingly diverse national population, and the ever-expanding base of scientific knowledge associated with providing the highest quality of health care in the world. The Advisory Committee also understands that training health professionals in interdisciplinary setting leads to the most effective health care as recognized by numerous national reports, health systems, and accrediting agencies.

In its First Annual Report, the Advisory Committee shares its findings and recommendations following an extensive review of the current interdisciplinary, community-based grant programs. In brief, the Advisory Committee makes the following recommendations:

• The Advisory Committee suggests that Congress and the Secretary make every effort to maintain these clearly effective approaches to building the workforce that provides health care services to unserved, underserved and vulnerable populations. The grant programs focus on recruitment and retention of key health personnel, and this is critical to past and present successes and should be promoted in any future legislative actions or administrative policies. Consequently, the Advisory Committee strongly recommends reauthorization of the Federal interdisciplinary, community-based grant programs.
• The Advisory Committee recommends increasing appropriations for the interdisciplinary, community-based grant programs as much as possible in order to continue and expand preparation of a workforce that can meet the health care needs of older Americans, minority and immigrant populations, and people who reside in this Nation's rural and inner city areas. Moreover, legislative language should encourage collaborations between institutions that train minority and immigrant populations and these grant programs. These programs must be recognized and supported as the federally designated "education pipeline" to meet the health workforce needs in the Nation, including a growing network of community and migrant health centers proposed by the President.
• Legislative language should encourage the design and implementation of funded activities that directly relate to the unique health needs of a region or local area. Grant-funded strategies should be designed within the context of community-based input from the populations who will be served by those who are trained in these programs. The Advisory Committee recommends establishing administrative policies that promote use of community advisory groups within the organization of the grant programs as well as training protocols that are uniquely defined for the local service area or population.
• The Secretary should use the administrative policy tools of "preferences and priorities" for making awards to grantees that propose truly interdisciplinary training strategies in their projects.
• Congress should establish a grant program known as "Interdisciplinary Education Demonstration Projects" to encourage cooperative, community-based ventures between two or more of the grant programs described currently in Title VII, Part D, Sections 751 — 755 of the Public Health Service Act. This new program should require that applicants focus on the Healthy People 2010 initiatives and the Secretary's health care initiatives. New appropriations would be necessary to implement this particular grant program so as not to jeopardize the national infrastructure (existing network) of currently funded interdisciplinary, community-based programs.
• The Advisory Committee concurs with many of the National Commission on Allied Health's (1995) observations and with its recommendation to establish an entity within Health Resources Services Administration (HRSA) that would give greater visibility and representation to "allied health," such as an Office or Division.

This new entity should help define allied health in such a manner that it can encompass current and emerging disciplines that serve in support of delivering critical health care in the Nation.

The Advisory Committee's future agenda should include work that recommends a Federal funding level that more adequately reflects the needs for training allied health professionals.

• Federal Agencies, including the National Institutes of Health, the Agency for Healthcare Research and Quality, the Centers for Disease Control and Prevention, the Food and Drug Administration, and others should establish formal, funding-based links with HRSA to enable interdisciplinary, community-based programs such as AHECs, HETCs, and GECs that carry out continuing professional education and other forms of postgraduate training to serve as vehicles for translating research into practice. Such new grant programs funded by the research agencies should focus on training remotely located primary health care providers and practitioners who serve disadvantaged populations, such as the poor, minorities, and the elderly. The Advisory Committee recommends that one percent (1%) of these research agencies' annual appropriations be designated for the interdisciplinary, community-based programs to disseminate critical research findings to community health care providers and providers-in-training.
• Federal agencies that seek to promote more "population inclusive" research should be instructed to formally establish funding relationships with grant programs such as AHECs, HETCs, and GECs. The interdisciplinary, community-based programs can assist Federal research agencies in their objectives to encourage greater participation by minorities and other populations that are often underrepresented in health-related research protocols. It is likely that such relationships and links between the Federal research agencies and these grant programs would reduce the more costly need for creating redundant organizational structures. Such collaborative arrangements should focus on more effective and efficient use of existing funds appropriated to these research agencies.
• The Federal criteria for sharing costs with local sources, such as State or local community government and private foundations, should be maintained for programs that have demonstrated successful outcomes. However, the HETC grant program, as one that typically has limited access to non-federal resources due to the nature of its target population and the economic conditions of the region, should not have a "self-sufficiency" requirement. A legislative desire rather than a requirement for self-sufficiency and cost sharing should be expressed for the HETC grant program.
• The Advisory Committee believes that the podiatric medicine grant program serves an important purpose in training podiatric physicians who meet a crucial health need in the community. However, the Advisory Committee recommends that the legislative authority for this grant program should be placed in Part D, Section 747 in association with the discipline-specific grants such as those that train family physicians, general internal physicians, or other primary health care providers.

The Advisory Committee believes that it is best positioned to continue review of these grant programs and policies regarding interdisciplinary, community-based health professions education. The inaugural year for the Advisory Committee has focused on laying the foundations for understanding present policy and current grant programs. While it has reached some preliminary findings and recommendations, the Advisory Committee believes that the work to date has only set the stage for providing Congress and the Secretary with advice on future policies that will best serve the health of the Nation.