III. Review of Past History

The Committee has concluded in its previous reports that community-based, interdisciplinary training is the most effective and efficient way to prepare the Nation's future health care workforce, especially those providers who are or will be serving the country's neediest populations. The Committee Members have diligently reviewed selected Federal grant programs that partially support interdisciplinary training activities and have made recommendations aimed at strengthening the capacity of these programs to meet the Nation's needs for a highly qualified, culturally competent health care workforce that is geographically well-distributed in shortage areas.

In its First and Second Reports, the Advisory Committee's actions were based on findings gleaned from testimony, various data sources, and the personal observations and experiences of expert Committee Members. The Advisory Committee feels that certain of these recommendations are as relevant today as they were at the time of their original publication. These priority findings and recommendations are summarized below.

Recommendation: Congress and the Secretary should reauthorize Title VII, Part D, Section 751-756 Grant Programs and provide funding at a level that is no less than and even more than in Fiscal Year 2003.

The Advisory Committee strongly suggests that Congress and the Secretary make every effort to maintain and strengthen these grant programs described under Title VII, Part D, Sections 751 — 756 of the Public Health Service Act. While there is occasional overlap of purpose and activities between the grant programs and not all the programs under the Advisory Committee's jurisdiction are truly "interdisciplinary," each grant program is productive and necessary to meet a present and compelling need for preparing the Nation's health care workforce.

Consequently, the Advisory Committee recommends legislative reauthorization of these programs. It also recommends no less funding for these programs and, if possible, increasing appropriations in order to expand these efforts where they exist and to establish new programs in geographic regions without the full complement of such efforts and in service to the interests of severely medically underserved populations.

Recommendation: The Secretary should use the administrative tools of "preferences and priorities" for making grant awards that are "truly interdisciplinary," and Congress should authorize a new grant program that demonstrates model interdisciplinary training that addresses the Nation's most pressing needs in health care.

The Advisory Committee suggests that the Secretary should use administrative "preferences and priorities" for making grant awards that propose truly interdisciplinary training strategies in health professions education projects. The Advisory Committee, in its 1^st Report, describes the parameters of what constitutes "interdisciplinary." The Committee also suggested that a new grant program known as the "Interdisciplinary Education Demonstration Projects" be established within Title VII. New appropriations would be necessary to implement this particular grant program so as to not jeopardize the national infrastructure of currently funded interdisciplinary, community-based programs.

Recommendation: Federal health agencies, such as NIH, CDC, FDA, and others should establish formal, funding-based links with HRSA in order to engage the participation of the "community-based, interdisciplinary" grantees in addressing the objectives of these other agencies in maintaining the utmost level of competency of the Nation's health care workforce.

The Advisory Committee recognizes that the "interdisciplinary grantees" have developed a strong, highly sophisticated infrastructure of training health professions students, medical residents, and health care practitioners. This workforce development infrastructure is often the only viable link between health care providers who are located in remote geographic areas and/or serve needy patient populations and the educational content that ensures continuously quality improvement. The "center" grant programs, such as AHECs, GECs, and HETCs have significant capacity for such training and continuing professional education.

Other Federal agencies and entities, such as NIH, CDC, and FDA, generate valuable content information that can improve health care services. The Advisory Committee suggests that these Federal agencies establish a programmatic and financial partnership with HRSA to utilize the health professions training infrastructure of the community-based, interdisciplinary grant programs to disseminate this information. Such a partnership should ensure that critical health service-related information will reach primary care and "safety-net" providers in a timely manner. The Advisory Committee recommends that 1 percent of these agencies research budgets be designated for information dissemination and continuing professional education by these grant programs. In view of the potential threat associated with bioterrorism in our nation, this recommendation by the Advisory Committee seems even more important than ever before.

The Advisory Committee had a related recommendation in its initial report; it suggested that the Federal research agencies find ways to encourage the linkage of human research that seeks to be more "population inclusive" with the community-based, interdisciplinary grant programs. In recent years, there has been increased emphasis on including more people who are from minority and disadvantaged populations into human health care research. The community-based, interdisciplinary grant programs have a strong connection with health care providers who serve such populations and their communities. It would seem that promoting a partnership between such research and these grant programs through administrative language would be desirable.

Recommendation: A new grant program known as "Interdisciplinary Education Demonstration Projects" should be enacted by Congress and administered by HRSA under Title VII, Part D of the Public Health Service Act.

The Advisory Committee proposes to establish a new grant program, known as "Interdisciplinary Education Demonstration Projects." This grant program would ask grantees to focus their efforts on developing truly interdisciplinary curriculum and training on health professions students and practitioners who are working in teams that address the objectives of Healthy People 2010 in a community setting. New appropriations by Congress would be necessary to implement this recommendation. The grant program should be administered by HRSA with other similar grant programs.

Recommendation: HRSA and Congress should find new ways to recognize the critical need for training "Allied Health" professionals through better recognition in legislative and administrative language and inclusion in current grant programs.

The Advisory Committee finds that the training of future and current "Allied Health" providers does not seem to have the Federal grant-making priority that is demanded to meet the national need for such health care providers. Therefore, it is recommended that that an Office or Division of Allied Health be established within HRSA to better define "Allied Health" and to find administrative ways to encourage more federally-sponsored training of these disciplines. Such methods may or may not involve new grant programs, but would certainly entail administrative descriptions of current grant programs toward greater participation of "Allied Health" in the current community-based, interdisciplinary grant programs.

Recommendation: The "diversity" of the health care workforce must be improved through measures that enhance the capacity of these grant programs to achieve such outcomes.

The Advisory Committee has documented the continuing need for measures that improve the diversity of the Nation's health care workforce. It has also observed that the community-based, interdisciplinary grant programs make substantial contributions to activities that have greater diversity as a goal.

In its Second Report, the Advisory Committee made various recommendations for administrative changes to strengthen the capacity of the grant programs to achieve these outcomes. The topic of "diversity" will also be the subject of a future meeting of the Advisory Committee.

Recommendation: Several statutory changes would strengthen the capacity of the grant programs to meet the workforce needs on the national agenda.

In its review of the statutes governing the administration of these grant programs, the Advisory Committee found that there were several changes that would strengthen the intent of Congress for these efforts. These changes are discussed in greater detail in the Second Report, but can briefly be described as follows:

• Redefinition of the list of "Allied Health" professions that are eligible for federal sponsorship through grant awards and other related definitions of "Allied Health;"
• Expansion of the Section addressing Chiropractic Research to include health professions education to increase the number of individuals trained in Chiropractic medicine; Development of a new Section regarding training in graduate programs for behavioral and mental health providers that incorporates the current Federal support for graduate psychology and also broadens the scope of sponsorship to include clinical social work; and
• Moving the Section defining the grant program for training podiatric physicians to another Part that includes programs that support training in family medicine, general internal medicine, and other medical disciplines.