Impact of Title VII training programs on community health center staffing and national health service corps participation.
OBJECTIVE
Community health centers (CHCs) are a critical component of the health care safety net. President Bush's recent effort to expand CHC capacity coincides with difficulty recruiting primary care physicians and substantial cuts in federal grant programs designed to prepare and motivate physicians to practice in underserved settings. This article examines the association between physicians' attendance in training programs funded by Health Resources and Services Administration (HRSA) Title VII Section 747 Primary Care Training Grants and 2 outcome variables: work in a CHC and participation in the National Health Service Corps Loan Repayment Program (NHSC LRP).


METHODS
We linked the 2004 American Medical Association Physician Master-file to HRSA Title VII grants files, Medicare claims data, and data from the NHSC. We then conducted retrospective analyses to compare the proportions of physicians working in CHCs among physicians who either had or had not attended Title VII-funded medical schools or residency programs and to determine the association between having attended Title VII-funded residency programs and subsequent NHSC LRP participation.


RESULTS
Three percent (5,934) of physicians who had attended Title VII-funded medical schools worked in CHCs in 2001-2003, compared with 1.9% of physicians who attended medical schools without Title VII funding (P<.001). We found a similar association between Title VII funding during residency and subsequent work in CHCs. These associations remained significant (P<.001) in logistic regression models controlling for NHSC participation, public vs private medical school, residency completion date, and physician sex. A strong association was also found between attending Title VII-funded residency programs and participation in the NHSC LRP, controlling for year completed training, physician sex, and private vs public medical school.


CONCLUSIONS
Continued federal support of Title VII training grant programs is consistent with federal efforts to increase participation in the NHSC and improve access to quality health care for underserved populations through expanded CHC capacity.
Rittenhouse
Diane R
DR
Department of Family and Community Medicine and Center for California Health Workforce Studies, University of California, San Francisco, CA 94143-0900, USA. Rittenhouse@fcm.ucsf.edu
Fryer
George E
GE
Phillips
Robert L
RL
Miyoshi
Thomas
T
Nielsen
Christine
C
Goodman
David C
DC
Grumbach
Kevin
K
D002321:Career Choice; D003151:Community Health Centers / Q000191:economics; D005260:Female; D005380:Financing, Government / Q000331:legislation & jurisprudence; D006297:Health Services Accessibility / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D006801:Humans; D007345:Insurance Claim Review; D016015:Logistic Models; D008297:Male; D008507:Medically Underserved Area; D006278:Medicare / Q000706:statistics & numerical data; D010821:Physicians, Family / Q000191:economics / Q000193:education / Q000600:supply & distribution*; D011365:Professional Practice Location / Q000191:economics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012577:Schools, Medical / Q000191:economics / Q000331:legislation & jurisprudence; D014146:Training Support / Q000331:legislation & jurisprudence*; D014481:United States; D014488:United States Health Resources and Services Administration / Q000191:economics / Q000331:legislation & jurisprudence; D000078329:Workforce
J Rural Health. 2006 Fall;22(4):285-93
17010024
Fam Med. 2002 Jun;34(6):436-40
12164620
J Rural Health. 2005 Winter;21(1):3-11
15667004
Arch Pediatr Adolesc Med. 1995 Sep;149(9):1019-21
7655586
Health Serv Res. 2000 Dec;35(5 Pt 3):17-31
16148949
N Engl J Med. 2008 Mar 27;358(13):1321-3
18367733
J Am Board Fam Pract. 1996 Jan-Feb;9(1):23-30
8770806
Health Aff (Millwood). 2005 Mar-Apr;24(2):465-72
15757932
Med Care. 2002 Aug;40(8 Suppl):IV-82-95
12187173
Arch Fam Med. 1997 Nov-Dec;6(6):531-5
9371045
J Health Care Poor Underserved. 2003 May;14(2):256-71
12739304
Am J Public Health. 1993 Mar;83(3):322-8
8438966
N Engl J Med. 2007 Mar 1;356(9):921-34
17329699
JAMA. 2006 Mar 1;295(9):1042-9
16507805
J Am Board Fam Pract. 1997 Jul-Aug;10(4):272-9
9228622