Evaluating the Impact of the Title VII, Section 747 Programs

Background

Overview of Title VII, Section 747 Programs

Funds from the Title VII, section 747 Program support the education and training of physicians, dentists, and physician assistants. Primary care has been a particular emphasis for Title VII, section 747 programs. Title VII, section 747 defines primary care as the specialties of family medicine, general internal medicine, and general pediatrics, general dentistry, pediatric dentistry, and physician assistants. The Program was created in part to counteract National trends showing a disproportionate increase in the number of medical specialists.

Legislative Acts from 1963 to 1998 have continually shaped the Title VII, section 747 health workforce training programs. The initial legislative purpose of the Program, created in 1963, was to increase the general supply of physicians. In successive reauthorizations, the focus of the Program shifted to the education and training of primary care providers, later to addressing geographic distribution problems of healthcare providers and, more recently, to education and training of primary care providers to serve medically and dentally underserved communities. Thus, the legislative intent for Title VII, section 747 has evolved over the years in response to changing healthcare workforce needs and demands. Key milestones in the legislative history include:

• The initial legislative purpose of the programs was to increase the general supply of physicians and to ensure the financial viability of health professions schools as specified by the 1963 Health Professions Education Assistance Act (Public Law 88-129).
• Under the 1968 Health Manpower Act (Public Law 90-490), the Program expanded to fund additional initiatives to strengthen, improve, or expand programs to train health professionals.
• The 1971 Comprehensive Health Manpower Training Act (Public Law 92-157) increased support for training primary care medical and dental providers, including for the first time physician assistants, improving the geographic maldistribution, and increasing the number of minorities in health professions. It also provided for start-up and conversion grants, financial distress grants, student loans, health professions scholarships, special projects, health manpower education initiative awards, family medicine training grants, postgraduate training of physicians and dentists, and health professions faculty development.
• The 1976 Health Professions Education Assistance Act (Public Law 94-484) represented a major redesign in primary care training funding and was designed to address specialty and geographic distribution problems.
• In 1992, the Health Professions Education Extension Amendments (Public Law 102-408) redefined training in primary care to include increasing the number of primary care providers for medically underserved communities (MUCs), increasing the number of students entering family medicine, and exposing students to primary care in ambulatory settings. This Act added to Title VII, section 747 a focus for providing for MUCs and targeting primary care providers to fill this need. It continued training in family medicine pre-doctoral, graduate, departmental, and faculty development programs; general internal medicine and general pediatrics graduate training and faculty development programs; dentistry graduate programs; and physician assistant programs.
• In 1998, the Title VII, section 747 programs were reauthorized under the Health Professions Education Partnerships Act of 1998 (Public Law 105-392). The 1998 Act made programmatic changes including allowing BHPr additional flexibility in allocating funds among disciplines and in modifying grant programs. In addition, the Advisory Committee on Training in Primary Care Medicine and Dentistry was authorized under section 748 of Title VII.