[Congressional Record Volume 154, Number 176 (Wednesday, November 19, 2008)]
[Senate]
[Pages S10671-S10674]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mrs. CLINTON:
  S. 3708. A bill to amend the Public Health Service Act with respect 
to health professions education, and for other purposes; to the 
Committee on Health, Education, Labor, and Pensions.
  Mrs. CLINTON. Mr. President, today, I am introducing the Health 
Professions and Primary Care Reinvestment Act in order to improve 
access to quality health care for all Americans. By significantly 
reinvesting in the training and education of our health professionals, 
we are reinvesting in our communities where care is most needed.
  This bill reinvests in health professional training in three ways--by 
expanding the training our health professionals receive, by improving 
our efforts to recruit and retain health professionals, and by 
increasing incentives for health professionals who are serving in 
community settings, particularly in rural and urban underserved areas.
  Most Americans prefer to get their health care through a personal 
physician operating as part of a team-based primary care practice, yet 
the number of health professional students entering these fields is 
decreasing. We need more workers in primary care at the front lines of 
the health care system. Primary care professionals can help to 
establish a ``medical home'' for patients, providing preventive care to 
help people stay healthy and provide coordination of care for those 
with multiple or chronic diseases. This bill would achieve this goal by 
providing incentives for training primary care professionals, by 
strengthening primary care departments at the school and community 
level, and by supporting improved infrastructure to assist those 
serving in primary care settings.
  Minorities, disadvantaged and rural students are underrepresented in 
our health professional workforce. We need to increase their numbers in 
the medical fields, and provide incentives for them to return to 
underserved areas to practice. As an example of what can be done, one 
program targeting rural students has returned eight times the usual 
number of trained family physicians to rural settings. We need to train 
people from all backgrounds--from underrepresented minorities, from 
disadvantaged backgrounds, from rural and urban underserved 
communities. This bill helps to achieve this goal by strengthening 
pipeline programs, expanding loans and scholarships, and by increasing 
the availability of care in underserved communities.
  We need health care where people live and work. Americans should be 
able to access care in communities that are located far from hospitals 
and medical centers, in the poorest neighborhoods of cities and 
isolated rural areas. We need to support the institutions that the most 
vulnerable rely on for care, like community health centers, local 
departments of health, and nursing homes. This bill supports new models 
of care for training, recruiting, supporting and retaining faculty to 
serve in underserved settings, and provides infrastructure support for 
training students in community settings outside of the hospital, where 
patients need care.
  In addition to addressing primary care, the legislation also works to 
address other health fields which are often inaccessible to patients. 
Dental care in the United States has become a luxury that is 
unaffordable to many people. Dentists are often unable to sustain 
careers by teaching in dental schools training the next generation of 
professionals, or to work in communities where the need is greatest. 
This bill provides support for dentists to pursue academic teaching 
careers and to provide general care to both adults and children. It 
targets underrepresented minority dentists and those who will serve in 
communities where the need is greatest.
  One impediment to good health for people with mental health problems 
is lack of care coordination. Too often the psychological problem goes 
undiagnosed or untreated, because our health care system operates in 
silos. Patients are often asked to go one place to meet physical health 
needs and another place to meet mental health needs. This bill provides 
support for training and care where the health professionals work 
together to co-manage mental health and physical health problems toward 
better overall health.
  We, as a nation, are getting older. As we age, our health concerns 
change. Many seniors take multiple medications which need to be 
coordinated by a team of doctors, pharmacists, and other caregivers. 
The Health Professions and Primary Care Reinvestment Act reinvests in 
our geriatric training programs by expanding opportunities for doctors, 
pharmacists, psychologists, dentists and others to work with patients 
in rehabilitation centers, at home, in nursing homes or other settings 
where people live or work.
  Our public health and preventive medicine professionals respond to 
crises like SARS, anthrax, and other infectious disease outbreaks. But 
they also work to educate the public about ways to stay healthy, and 
prevent chronic diseases. They contribute to the health care safety net 
with services like adult and childhood vaccinations. This bill helps to 
support these efforts by reinvestment in training for prevention. It 
links schools of public health with local and State departments of 
health in order to train professionals to work and serve in settings 
where they are most needed.
  Finally, and very importantly, we must better understand the demands 
that will be made upon our health professional workforce. This bill 
provides authorization for the formation of a national and multiple 
regional health workforce analysis centers, along with an advisory 
committee comprised of administrative and health professional 
leadership. These entities will assess, review and oversee health 
professional workforce needs so that we can plan and prepare a new 
generation of health professionals in our schools and communities.
  The Health Professions and Primary Care Reinvestment Act addresses 
the multiple challenges facing healthcare workforce development in our 
country.

[[Page S10672]]

It will invest in primary care, expand the number of health 
professionals truly representative of the communities they serve, and 
improve the availability of care in places where Americans need it 
most. I look forward to working with my colleagues in the Senate on the 
many issues of our health care workforce, and I would urge their 
support of this legislation.
  Multiple organizations, including Advocating for Family Medicine, 
American Academy of Family Physicians, American Academy of Physician 
Assistants, American Association of Colleges of Osteopathic Medicine, 
American College of Preventive Medicine, American Dental Association, 
American Dental Education Association, American Geriatrics Association, 
American Osteopathic Association, American Psychological Association, 
Association of Departments of Family Medicine, Association of Family 
Medicine Residency Directors, Association of Minority Health 
Professions Schools, Inc., Association of Schools of Public Health, 
Hospital Association of New York State, National AHEC Organization, 
National Council for Diversity in the Health Professions, North 
American Primary Care Research Group, Society of General Internal 
Medicine, and the Society of Teachers of Family Medicine have endorsed 
this legislation.
  Mr. President, I ask unanimous consent that letters of support be 
printed in the Record.
  There being no objection, the material was ordered to be placed in 
the Record, as follows:

                               Advocating for Family Medicine,

                                Washington, DC, November 18, 2008.
     Hon. Hillary Rodham Clinton,
     U.S. Senate,
     Washington, DC.
       Dear Senator Clinton: On behalf of the undersigned 
     organizations, we would like to thank you for introducing the 
     Health Professions and Primary Care Reinvestment Act. Health 
     professions programs, authorized under Title VII of the 
     Public Health Service Act, are vital to enhancing and 
     expanding our nation's health workforce. The Health 
     Professions and Primary Care Reinvestment Act reauthorizes, 
     improves, and revitalizes these programs.
       Within the primary care cluster (Section 747) we are very 
     pleased to see the following:
       Continued support for programs that have proven 
     successful--training in primary care and capacity building in 
     primary care.
       New recognition that an environmental scan of the community 
     and region is a necessary precursor to development of 
     creative training programs that will get primary care 
     physician training out into the community, rather than 
     training remain mostly within the academic health centers.
       Recognition that production of primary care physicians must 
     be increased.
       Recognition that funding for these programs must increase 
     in order to provide a well-prepared workforce for the 21st 
     century, particularly as we move to health care reform.
       In addition, within the scope of the bill as a whole, we 
     appreciate the modification of the statute so that all of the 
     programs authorized by the bill have similar goals and 
     expected outcomes.
       As the Senate begins its work on overall health care 
     reform, we support your efforts to have this bill serve as 
     one of the foundations of reform. True health reform in this 
     country will not be possible without including programs that 
     increase the number of well-trained health professionals. As 
     the Massachusetts experience clearly demonstrates, increasing 
     the number of insured individuals will not ensure increased 
     access to care if there are not enough doctors to treat the 
     newly insured.
       As you know, Title VII Health Professions Programs, 
     particularly those authorized under Section 747, are designed 
     to strengthen our primary care infrastructure. Studies have 
     shown that areas which depend more heavily on primary care 
     within their health care system spend less on health care and 
     have better health outcomes. For example, a study published 
     in Health Affairs from April, 2004 found, ``States with more 
     general practitioners use more effective care and have lower 
     spending, while those with more specialists have higher costs 
     and lower quality.'' (Baicker and Chandra) We know that 
     health reform has two goals: bettering the health of our 
     nation and keeping it as cost efficient as possible. 
     Increasing the proportion of primary care medicine is a major 
     step towards meeting both of these goals, and Title VII, 
     Section 747 programs are the only federal programs that aim 
     to increase the number of primary care physicians.
       Title VII programs have also demonstrated the ability to 
     produce physicians that serve in underserved areas. A recent 
     article in Annals of Family Medicine (Rittenhouse, et al 
     2008) shows that students and residents exposed to Title VII 
     funding are more likely to participate in the National Health 
     Service Corps or practice in a community health center upon 
     completing their training. Both of these programs 
     successfully place physicians where they are most needed.
       Thank you for all of your hard work on the Health 
     Professions and Primary Care Reinvestment Act and for your 
     continued leadership and dedication to health care throughout 
     your career. We urge you to ensure that this important piece 
     of legislation makes its way through the legislative process 
     and is passed as quickly as possible.
           Sincerely,
     Scott Fields, MD,
       President, Society of Teachers of Family Medicine.
     Eilssa Palmer, MD,
       President, Association of Family Medicine Residency 
     Directors.
     Michael K. Magill, MD,
       President, Association of Departments of Family Medicine.
     Ted Epperly, MD, FAAFP,
       President, American Academy of Family Physicians.
     Allen Dietrich, MD,
       President, North American Primary Care Research Group.
                                  ____

                                               American Academy of


                                         Physician Assistants,

                                Alexandria, VA, November 19, 2008.
     Hon. Hillary Rodham Clinton,
     U.S. Senate,
     Washington, DC.
       Dear Senator Clinton: On behalf of the nearly 75,000 
     clinically practicing physician assistants (PAs) in the 
     United States represented by the American Academy of 
     Physician Assistants (AAPA), I thank you for introducing the 
     Health Professions and Primary Care Reinvestment Act of 2008. 
     The reauthorization of the Public Health Service Act's Title 
     VII Health Professions Programs is a top priority of the 
     AAPA. Accordingly, AAPA is pleased to support this 
     legislation, and looks forward to working with you and your 
     colleagues in the Senate and House of Representatives to 
     secure the strongest possible investment in and reinforcement 
     of the nation's primary care workforce.
       The Title VII safety net programs are essential to the 
     development and training of primary health care professionals 
     and, in turn, provide increased access to care by promoting 
     health care delivery in medically underserved communities. 
     Title VII funding is especially important for PA programs as 
     it is the only federal funding available on a competitive 
     application basis to these programs.
       A review of PA graduates from 1990-2006 demonstrates that 
     PAs who have graduated from PA educational programs supported 
     by Title VII are 59 percent more likely to be from 
     underrepresented minority populations and 46 percent more 
     likely to work in a rural health clinic than graduates of 
     programs that were not supported by Title VII.
       The AAPA is very pleased to see included in this 
     legislation several very important updates and additions to 
     the Title VII statute related to physician assistant 
     training. Specifically, the updated definition of PA 
     education programs is long overdue and accurately reflects 
     the educational preparation of PAs, as well as the definition 
     and standards of the approximately 140 PA programs in the 
     U.S. Additionally, we strongly support the inclusion of a set 
     15 percent carve-out for PA programs within the primary care 
     medicine and dentistry cluster. Finally, we support the 
     inclusion of PA education programs within many new or 
     expanded programmatic sections of the bill, including 
     geriatric training centers and continuing education programs 
     for health professionals in underserved areas.
       The AAPA applauds your efforts to support and expand 
     America's primary care workforce through a clarified and 
     strengthened Title VII. We are pleased to work with you and 
     to support the Health Professions and Primary Care 
     Reinvestment Act of 2008.
           Sincerely yours,

                                         William F. Leinweber,

                                    Executive Vice President/Chief
     Executive Officer.
                                  ____

                                               American College of


                                          Preventive Medicine,

                                                November 18, 2008.
     Hon. Hillary R. Clinton,
      Russell Senate Office Building,
     Washington, DC.
       Dear Senator Clinton: On behalf of the American College of 
     Preventive Medicine I write to express our sincere 
     appreciation and thanks for your efforts to reauthorize the 
     Title VII health professions training programs at the Health 
     Resources and Services Administration, HRSA. As a result of 
     your steadfast commitment to bolstering our health care 
     safety net in underserved communities and extending the 
     reaches of preventive medicine physicians, health care 
     services--including important preventive services--will reach 
     the doorsteps of countless Americans who currently lack 
     access to a health care provider.
       With your legislation the time has now come to reinvigorate 
     and refinance the Title VII health professions training 
     programs at the necessary levels in order to protect access 
     to health care for vulnerable populations, improve disease 
     prevention and health promotion efforts, and maintain our 
     graduate medical education commitment to quality and 
     workforce diversity.

[[Page S10673]]

       While a limited number of preventive medicine residency 
     training programs in New York and other states have benefited 
     from Title VII funds, it is important that Congress act now 
     to expand the reaches of Title VII's mission to enhance the 
     supply, diversity, and distribution of the health care 
     workforce in all underserved communities across the country. 
     A key step toward addressing health system reform is ensuring 
     availability of services across all communities.
       We thank you for recognizing the importance of preventive 
     medicine physicians in securing our health care safety net 
     and promoting disease prevention and health promotion 
     programs. We look forward to our continued dialogue and thank 
     you for the opportunity to work with you and your staff to 
     address this very important issue.
           Sincerely,

                                     Michael D. Parkinson, MD,

                                                       MPH, FACPM,
     President.
                                  ____



                              ADA/American Dental Association,

                                Washington, DC, November 19, 2008.
     Senator Hillary Rodham Clinton,
     Russell Office Building,
     Washington, DC.
       Dear Senator Clinton: The American Dental Association, ADA, 
     which represents 156,000 dentists, congratulates you on 
     introducing the ``Health Professions and Primary Care 
     Reinvestment Act.'' The ADA greatly appreciates the attention 
     that you and your staff have given to the unique needs of 
     Title VII federal dental programs and believe that many of 
     the changes incorporated in this bill will help greatly to 
     advance these programs.
       We are especially pleased that your bill provides general 
     practice and pediatric dental residency programs with a 
     funding line. This acknowledgement underscores that oral 
     health care is as equally important as medical care and 
     should not be a subset of medical program funding. We believe 
     that by creating Section 748 Training in General and 
     Pediatric Dentistry that Congress will be better able to 
     effectively address dental education training needs.
       We also appreciate the inclusion of dentists in Section 9, 
     which focuses on geriatric training. The ADA has placed a 
     high priority on addressing the oral health needs of 
     ``vulnerable'' older adults--individuals over age 65 with 
     limited mobility and/or limited resources and/or complex 
     health status. Older adults face a variety of special oral 
     health challenges, including root and coronal caries, 
     periodontal disease, tooth wear, edentulousness, oral cancer, 
     complications from taking prescription and over-the-counter 
     medications and other medical concerns that affect oral 
     health. We recognize that a key component in addressing these 
     needs is to enhance the educational infrastructure and 
     dentist education and training. We believe that your bill has 
     opened the door to accomplish these goals.
       Addressing the oral health care needs of the older 
     generation often overlaps with providing care to children and 
     adults with intellectual and developmental disabilities. 
     While the bill does not include a new section to address the 
     training of dentists to work with these patients, we 
     understand the time constraints your staff faced in getting 
     this bill introduced this year. We look forward to continuing 
     to work with you on this issue and remain hopeful that we 
     will be able to include a provision dealing with this 
     important issue next year.
       Thank you and your staff, particularly Dr. Kathleen Klink, 
     for working with the American Dental Association to enhance 
     dental education programs. We believe that the ``Health 
     Professions and Primary Care Reinvestment Act'' will 
     contribute to the ADA's own efforts to improve dental 
     education programs and improve the oral health care of all 
     Americans.
           Sincerely,
                                          John S. Findley, D.D.S.,
     President.
                                  ____

         ADEA and AAPD,
                                                November 19, 2008.
     Hon. Hillary Clinton,
     U.S. Senate,
     Washington, DC.
       Dear Senator Clinton: The American Dental Education 
     Association (ADEA) and the American Academy of Pediatric 
     Dentistry (AAPD) are pleased to endorse the Health 
     Professions Primary Care Reinvestment Act. Our organizations 
     represent dental education and the practicing pediatric 
     dentists.
       The primary care dental provisions contained in the 
     legislation continue and enhance the cost-effective General 
     Dentistry and Pediatric Dentistry residency training 
     programs. The bill also authorizes support of dental loan 
     repayment for those who teach or conduct research in General 
     or Pediatric Dentistry residencies, which is particularly 
     important to maintaining a cadre of well-trained dentists to 
     meet the oral health care needs of the nation. Most 
     importantly, we are delighted with the language which allows 
     dental schools to apply for grants for faculty development 
     and academic administrative units. We applaud the decision to 
     provide a guideline authorization of $20 million for these 
     important programs.
       Our Associations appreciate the time and effort that you 
     and your staff made to consider our analysis of important 
     trends and needs in dental education, and to address our 
     concerns about the bill. The Health Professions Primary Care 
     Reinvestment Act is a significant improvement over 
     legislation in the last Congress in terms of provisions 
     affecting health workforce, information, evaluation and 
     analysis, and geriatric training. Your staff is to be 
     commended for drafting legislation that is performance-based 
     and ensures that important strides made to date will not be 
     diminished.
       Please contact our legislative representatives if we can be 
     of further assistance: Myla Moss at ADEA 202-289-7201 or 
     Scott Litch at AAPD 312-337-2169 ext. 29.
           Sincerely,
     Beverly Largent, D.M.D.,
       AAPD President.
     John S. Rutkauskas, D.D.S., M.B.A., CAE,
       AAPD Chief Executive Officer.
     Charles N. Bertalomi, D.D.S., D.M.Sc.,
       ADEA President.
     Richard W. Valachovic, D.M.D., M.P.H,
       ADEA Executive.
                                  ____

         Association of Minority Health Professions Schools, Inc.,


                            Washington, DC, November 19, 2008.

     Senator Hillary Rodham Clinton,
     U.S. Senate, Russell Senate Office Building, Washington, DC.
       Dear Senator Clinton: The Association of Minority Health 
     Professions Schools (AMHPS) applauds your introducing the 
     Health Professions and Primary Care Reinvestment Act. The 
     Title VII Health Professions programs help strengthen and 
     diversify our nation's primary care workforce. The Health 
     Professions and Primary Care Reinvestment Act reauthorizes 
     these vital programs while greatly improving them.
       AMHPS is particularly interested in your efforts to 
     continue to strengthen the diversity cluster of the Title VII 
     programs--Centers of Excellence (COI), Health Careers 
     Opportunities Program (HCOP), Faculty Loan Repayment, and 
     Scholarships for Disadvantaged Students (SDS). These programs 
     have been a tremendous federal government investment into the 
     institutions that focus on increasing the number of health 
     professionals and the diversity of the health professions. In 
     the November 2008 issue of Academic Medicine, the article 
     ``Funding the Diversity Programs of the Title VII Health 
     Professions Training Grants: An Urgent Need,'' written by two 
     AMHPS institution presidents--Dr. John Maupin of Morehouse 
     School of Medicine and Dr. Wayne Riley of Meharry Medical 
     College--confirms that your efforts making a tremendous 
     effort towards improving the health of all Americans.
       Again. thank you for introducing the Health Professions and 
     Primary Care Reinvestment Act. Your continued leadership and 
     dedication to health care is greatly appreciated. We urge you 
     to do all that you can to see that building a stronger 
     workforce of primary care professionals that is more diverse 
     is a top priority during the current health care debate. 
     Ensuring passage of your important bill would be a very good 
     first step,
           Sincerely,
     Wayne Harris, Ph.D.,
       Chairman, Board of Directors, Association of Minority 
     Health Professions Schools.
                                  ____

                                         Association of Schools of


                                                Public Health,

                                Washington, DC, November 18, 2008.
     Hon. Hillary Rodham Clinton,
     Russell Senate Office Building,
     Washington, DC.
       Dear Senator Clinton: On behalf of the Association of 
     Schools of Public Health (ASPH), I would like to thank you 
     for introducing the Health Professions and Primary Care 
     Reinvestment Act. Your leadership in introducing legislation 
     that would reauthorize Title VII of the Public Health Service 
     Act takes a vital step in providing support to the health 
     care delivery system, health care and public health 
     professionals.
       By 2012 over 100,000 public health workers are eligible to 
     retire (23 percent of the workforce). More importantly, in 
     order to have the same public health workforce to population 
     ratio in 2020 as existed in 1980, the public health workforce 
     would need to add an additional 250,000 workers. As Congress 
     begins to consider legislation that would overhaul the health 
     insurance system in this country, we hope that the Health 
     Professions and Primary Care Reinvestment Act will be 
     considered to ensure a well trained health care workforce 
     will be in place to meet the increased demand for basic 
     health care services.
       We would like to thank you for the inclusion of public 
     health in several sections of the bill including the Health 
     Professions Training for Diversity provisions of the 
     legislation. Expansion of the program to include training for 
     the next generation of researchers and educators is important 
     as public health researchers in the early stages of their 
     careers offer novel investigator-initiated research ideas 
     that could transform science and policy.
       We applaud the establishment of the Academic Health 
     Department (AHD) Program to establish partnerships between 
     accredited Schools of Public Health (SPH) and state or local 
     public health departments. This program has demonstrated 
     success in expanding SPH/health department partnerships with 
     the goal of developing models of collaboration in the areas 
     of teaching and service. The

[[Page S10674]]

     training programs offered by AHDs will provide learning 
     opportunities for public health professionals throughout 
     their careers. We also appreciate the continued support of 
     the existing Public Health and Preventive Medicine Program 
     which offers vital support to train health professionals in 
     this important area.
       Again, we would like to thank you for your leadership and 
     we look forward to working with you as you work to advance 
     this legislation. We are glad to see your commitment to 
     addressing workforce shortage issues in health care and offer 
     our support of the Health Professions and Primary Care 
     Reinvestment Act.
       Sincerely,
                                     Harrison C. Spencer, MD, MPH,
     President and CEO.
                                  ____



                                   National AHEC Organization,

                                                    Oak Creek, WI.
     Hon. Hillary Rodham Clinton,
     U.S. Senate, Russell Senate Office Building, Washington, DC.
       Dear Senator Clinton: On behalf of the National Area Health 
     Education Center Organization (NAO), I would like to offer 
     support for the Health Professions and Primary Care 
     Reinvestment Act legislation that includes AHEC 
     reauthorization.
       Your ongoing support of the National AHEC Organization and 
     the AHEC centers and programs that we represent across the 
     country are critical to the health professions pipeline, 
     quality education and training programs for health care 
     professionals, allied health professional and students across 
     the county.
       The Health Professions and Primary Care Reinvestment Act 
     will ensure the sustainability of the many critical programs 
     offered by AHEC's throughout the nation.
       Please feel free to call upon the NAO for additional 
     support as you move forward with your efforts and be assured 
     that our support and this letter may be used publicly to 
     advance the Health Professions and Primary Care Reinvestment 
     Act legislation.
           Sincerely,
                                                    Rose M. Yuhos,
     NAO President.
                                  ____

                                    National Council for Diversity


                                    in the Health Professions,

                                                November 19, 2008.
     Hon. Hillary Rodham Clinton,
     U.S. Senate, Russell Senate Office Building, Washington, DC.
       Dear Senator Clinton: The National Council on Diversity in 
     the Health Professions (NCDHP) applauds your introducing the 
     Health Professions and Primary Care Reinvestment Act. The 
     Title VII Health Professions programs help strengthen and 
     diversity our nation's primary care workforce. The Health 
     Professions and Primary Care Reinvestment Act reauthorizes 
     these vital programs while greatly improving them.
       NCDHP is interested in your efforts to continue to 
     strengthen the diversity cluster of the Title VII programs, 
     particularly the reauthorization of Centers of Excellence 
     (COE) and Health Careers Opportunities Program (HCOP). For 
     many years, these programs have demonstrated a tremendous 
     federal government investment into the institutions that 
     focus on increasing the number of health professionals and 
     the diversity of the health professions.
       Again, thank you for introducing the Health Professions and 
     Primary Care Reinvestment Act. Your continued leadership and 
     dedication to health care is greatly appreciated. We urge you 
     to do all that you can to see that building a stronger 
     workforce of primary care professionals that is more diverse 
     is a top priority during the current health care debate. 
     Ensuring passage of your important bill would be a very good 
     first step.
           Sincerely,
                                                Wanda D. Lipscomb,
     Chair.
                                  ____

                                                Socieiy of General


                                            Internal Medicine,

                                Washington, DC, November 17, 2008.
     Hon. Hillary Rodham Clinton,
     Russell Senate Office Building,
     Washington, DC.
       Dear Senator Clinton: On behalf of the Society of General 
     Internal Medicine, I want to applaud your leadership in 
     advancing national policies that promote improved patient 
     care for all Americans. In particular, I want to commend you 
     on the introduction of the Health Professions and Primary 
     Care Reinvestment Act.
       By any measure, primary care, including general internal 
     medicine, is the cornerstone of our nation's health care 
     system. Patients with primary care physicians have better 
     health status, longer life expectancy and lower health care 
     costs. Moreover, for the poor, the uninsured and the elderly, 
     primary care functions as a safety net, serving as the first 
     and often the only contact for care and treatment.
       For more than three decades, the Title VII Training in 
     Primary Care Medicine and Dentistry (TPCMD) program, in 
     particular, has contributed significantly to improving the 
     quality of education and training of the nation's primary 
     care workforce, with special emphasis on individuals from 
     disadvantaged backgrounds and underrepresented minorities. 
     But challenges remain. For example, forecasts are that the 
     demand for general internists will increase by 38 percent 
     within the next 15 years, while the number of new physicians 
     entering the field of general internal medicine continues to 
     decline.
       By strengthening and expanding the TPCMD program, your 
     legislation recognizes that primary care is the linchpin of 
     our health care system and that an adequate, well-trained 
     primary care workforce is critical to the success of any 
     health care reform measures Congress undertakes.
       In addition, your legislation calls for a more 
     comprehensive approach to addressing the systemic needs of 
     our health care system, including the creation of primary 
     care training institutes that will promote all-important 
     collaboration across all primary care disciplines, as well as 
     partnering with community health centers in a way that will 
     speed the translation of research into community practice. 
     Furthermore, the work of these institutes will help 
     contribute to better health outcomes by fostering the 
     development of the patient-centered medical home model.
       At a time when 47 million Americans lack health coverage, 
     when increasing numbers of elderly are entering the age of 
     highest risk of chronic disease, and when racial and ethnic 
     disparities persist, the Health Professions and Primary Care 
     Investment Act provides a solid framework for meeting these 
     challenges.
       Again, thank you for introducing this important 
     legislation. As in the past, our Society stands ready to 
     assist you in whatever way we can.
           Sincerely,
                                               Lisa V. Rubenstein,
     President.

                          ____________________