by Tim Henderson and Anna Scanlon
March 2002
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Titles VII and VIII of the Public Health Service Act authorize a variety of initiatives for training programs and students to improve the geographic distribution, quality, and racial and ethnic diversity of the health care workforce. Administered through the Bureau of Health Professions of the Health Resources and Services Administration (HRSA), about 40 programs award competitive grants and contracts to educational institutions and loans, loan guarantees and scholarships to needy and disadvantaged health professions students to increase the supply of primary medical and dental care providers, nurses, mental and behavioral health professionals, and public and allied health personnel. Many of these professions face significant shortages, particularly in medically underserved rural and inner city communities.
Title VII programs support physician, dentist and allied health profession training, with most of the funding dedicated to training in primary care medicine and dentistry and medical student diversity. Title VIII programs fund advanced and basic nursing education and nursing workforce diversity. Most of the Title VIII funds support advanced nurse training. In federal fiscal year 2001, HRSA devoted more than $300 million to health professions education nationwide under the titles VII and VIII programs.
Efforts nationally to study and improve the effectiveness of titles VII and VIII funding to address health workforce needs are ongoing. Two recent examples are included here:
- According to a 2001 study commissioned by the American Academy of Family Physicians, medical schools that received Title VII grants during the last 16 years produced twice as many family physicians as schools that did not receive the funds. In addition, schools that are receiving Title VII funds produced physicians who were more likely to practice primary care in medically underserved areas, particularly rural areas.
- Public Law 105-932, which amended Title VIII in 1998, requires HRSA to develop a funding allocation methodology for Title VIII nursing education funds that better accounts for the purpose and goals of the Title VIII program, the health care needs of the population-including minorities and those residing in rural and medically underserved areas-and changing nursing workforce needs.
- There is also a growing interest to know how these funds are affecting health workforce goals and needs in individual states. This report examines the importance of titles VII and VIII funds to health professions training programs in addressing health workforce goals and needs in three states-Arkansas, Minnesota and Texas.
In the summer of 2001, the National Conference of State Legislatures (NCSL) conducted a mail survey of all educational programs in Arkansas, Minnesota and Texas identified by the Bureau of Health Professions as having been awarded one or more Title VII or Title VIII health professions training grants as of federal fiscal year 2000. The NCSL survey of 136 training programs in nearly 80 sponsoring institutions garnered an overall response rate of 79 percent. Because of difficulties in collecting certain information, NCSL decided to limit its survey to recipients of institutional Title VII or Title VIII training grants and to exclude offices that receive and distribute Title VII or Title VIII scholarships and loans to individual students.
A major objective of this survey was to determine the extent to which the objectives of federally funded Title VII and Title VIII health professions training grants-awarded to improve the geographic distribution, quality, and racial and ethnic diversity of the health care workforce-mirror and support similar state goals and increase access to basic health services.
Survey Findings
There is wide variation among the three states in the number of Title VII and Title VIII grantees. Texas has nearly seven times as many as Arkansas, and Minnesota has almost twice as many as Arkansas.
Highlights of the Survey
- Although most grantees among the states receive minimal funding, the average duration of these funds is significant and suggests that these programs are effectively educating and placing health professionals for underserved communities and populations.
- States are significant supporters of training programs that receive Title VII and Title VIII funds and, in turn, these grant funds are an important factor for these programs to receive state funds. This suggests that these states view Title VII and Title VIII-funded training programs as key partners in addressing state health workforce goals.
- The common mission of Title VII and Title VIII grantees and states, effectively integrated through their funding relationship, is evident in the increased opportunities that grantees provide students to train in settings and with populations that are medically underserved.
- Just more than half of sponsoring institutions in Texas report that underrepresented minorities represent at least 25 percent of the students in their Title VII and Title VIII-funded training programs. Sixty percent of Arkansas' institutions said that between 10 percent and 25 percent of students are underrepresented minorities. In Minnesota, all but one sponsoring institution reported that 10 percent or less of students are identified as underrepresented minorities.
- Title VII and Title VIII grantees are a key resource to states in improving the supply of graduating health professionals who decide to care for underserved populations.
- Between 70 percent and 80 percent of graduates of Title VII and Title VIII-funded programs in the three states are reported to remain in state to practice.
- About half of the program graduates in Texas, 38 percent in Arkansas, and 25 percent in Minnesota are reported to have located in an HPSA or medically underserved area within the state.
- Between a quarter and a third of graduates of Title VII and Title VIII-funded programs in the three states are reported to have gone to work in a community health center, rural health clinic, or other primary care program for the medically underserved. Another 23 percent to 30 percent of graduates in the three states went to work in a rural or inner city community hospital.
- The mission and initiatives of states and Title VII and Title VIII grantees to improve access to care for underserved communities and populations are closely intertwined. Title VII and Title VIII grantees and states in this study enjoy a longstanding relationship and are important partners in the education of health professionals to serve these communities and populations.
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