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Impact of Title VII Funding on Community Health Center Staffing

Impact of Title VII Funding on Community Health Center Staffing. AcademyHealth 2007 Annual Research Meeting Diane R. Rittenhouse, MD, MPH Department of Family and Community Medicine University of California, San Francisco. Collaborators. Kevin Grumbach, MD & Christine Nielsen, BA

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Impact of Title VII Funding on Community Health Center Staffing

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  1. Impact of Title VII Funding on Community Health Center Staffing AcademyHealth 2007 Annual Research Meeting Diane R. Rittenhouse, MD, MPH Department of Family and Community Medicine University of California, San Francisco

  2. Collaborators Kevin Grumbach, MD & Christine Nielsen, BA • UCSF Department of Family & Community Medicine and Center for California Health Workforce Studies George E. Fryer, Jr., PhD & Thomas Miyoshi, MSW • New York University, Center for Child Health Research Robert L. Phillips, Jr., MD, MSPH • The Robert Graham Center for Policy Studies in Family Medicine and Primary Care David C. Goodman, MD, MS • Dartmouth Medical School, Department of Pediatrics

  3. Community Health Centers • Federally Qualified Health Centers (FQHCs) are a critical component of the health care safety net. (2004: 6,651 FTE physicians) • President Bush’s Community Health Center Initiative = MAJOR EXPANSION • FQHCs are experiencing difficulty recruiting physicians (2004: 809 vacancies).

  4. Title VII Primary CareTraining Grants • HRSA Title VII Section 747 Primary Care Training Grants to medical schools & primary care residency programs are associated with: • increased production of primary care physicians • choice of practice in underserved areas • Not known whether associated with work in Community Health Centers.

  5. Objective • To examine the association between physicians’ exposure to HRSA Title VII Section 747 Primary Care Training Grants during medical school and residency, and subsequent work in a community health center

  6. Building the “Megafile” • 2004 AMA Masterfile containing updated information on all U.S. allopathic and most osteopathic physicians (N = 936,178). • Added Medicare UPIN numbers and additional residency training information

  7. Title VII Training Program Grantee Database • HRSA’s Bureau of Health Professions • 3 relevant grant categories: • Pre-doctoral Education • Academic Administrative Unit (AAU) • Residency Training • 3606 Pre-doctoral & AAU awards to 137 U.S. medical schools • 6245 residency awards to 819 residency programs

  8. Physician “Exposure” to Title VII Funds “Exposed during medical school” • attended a medical school during at least one year that the school received Title VII funds • (Pre-doctoral grant, AAU grant, or both) “Exposed during residency” • attended a primary care residency program during at least one year that the program received a Title VII residency grant

  9. Identifying Physicians Working in CHCs CMS Outpatient File --all beneficiaries who had Medicare outpatient facility claims filed in 2001, 2002 & 2003 for primary care services • billing physician’s UPIN number • whether the claim was for a visit to a FQHC • Claims data linked to Masterfile at level of individual physician using UPIN numbers

  10. Data Analysis • Compared proportions of “exposed” physicians and “not-exposed” physicians that worked in an CHC (2001-2003). • Looked separately at medical school and residency exposure. • Logistic regression to examine the independent contribution of Title VII exposure during medical school and residency on CHC staffing.

  11. Exposure to Title VII Funding During Medical School

  12. Exposure to Title VII Funding During Residency

  13. Effects of Medical School Title VII Exposure on CHC Staffing, 2001-3

  14. Effect of Title VII Funding During Medical School on Staffing of CHCs, 2001-2003, by Grant Type (All Physicians)

  15. Effect of Title VII During Medical School, by Grant Type, 2001-3, (FPs/GPs Only)

  16. Effect of Title VII During Residency on CHC Staffing, 2001-2003

  17. Independent Effects of Title VII Grant Type on Physicians Work in CHC, 2001-3

  18. Limitations • Cross-sectional study shows association, not causation • Medicare claims data to identify CHC physicians • Osteopathic physicians – 40% have no GME data in AMA Masterfile

  19. Conservative Estimates of Title VII Effect • CHC work cross-sectional during 2001-3 only • FQHCs only • “Exposed to Title VII funds” definition • Pediatricians not well-represented in Medicare claims files

  20. Conclusions • Physician exposure to Title 7 Section 747 grants during medical school and/or primary care residency is associated with subsequent work in CHCs. • Recent reductions in Title VII Section 747 program funding may exacerbate the difficulties CHCs are facing in trying to recruit primary care physicians. • 2,210 fewer physicians – more than double the current vacancy rate for all physicians at CHCs.

  21. Funding Health Resources and Services Administration

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