[Congressional Record Volume 155, Number 122 (Thursday, August 6, 2009)]
[Senate]
[Pages S9025-S9027]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. UDALL, of Colorado (for himself and Mrs. Hagan):
  S. 1628. A bill to amend title VII of the Public Health Service Act 
to increase the number of physicians who practice in underserved rural 
communities; to the Committee on Health, Education, Labor, and 
Pensions.
  Mr. UDALL of Colorado. Mr. President, I rise today to introduce an 
important piece of legislation on behalf of myself and Senator Kay 
Hagan of North Carolina, the Rural Physician Pipeline Act of 2009.
  In making my way across my home State, I have listened to rural 
constituents from all over Colorado, and their message is clear: rural 
communities are being hit hard by America's health care crisis.
  The life expectancy for women in many rural counties across the 
Nation has declined significantly over the past several decades, and 
health outcomes for Hispanic, Native American, and other minority 
populations are at unacceptable levels. Low-income rural Americans in 
these areas have very few options for affordable access to health care, 
if they have any at all.
  Just over 2 weeks ago, I reached out to health care providers and 
professionals in rural regions of Colorado that have been most impacted 
by our ailing health system to hear directly from those on health 
care's front lines. While there are many factors contributing to the 
lower health outcomes we are seeing in these regions, including 
regulatory hurdles and low reimbursement rates for rural clinics and 
hospitals, the physicians and health professionals I spoke with were 
pretty clear about the overwhelming culprit: lack of primary care 
doctors.
  Invoking imagery of the black bag toting doctor from decades ago 
making house calls to treat all that ailed you and your family, primary 
care physicians are still the lynchpin of our health care system. These 
physicians are the most familiar to Americans--they are the family 
doctor, general practitioner, and pediatrician, and they are many times 
the only point of contact that people have with the health care system. 
They are the first line of defense for keeping our families healthy.
  Unfortunately, as the entire Nation suffers from a shortage of 
primary care doctors, our rural areas are hit the hardest. For a 
variety of socioeconomic and resource-related reasons, rural 
communities struggle to compete with big cities in recruiting from an 
already scarce pool of doctors. Some of these barriers are inherent to 
these areas--lack of job opportunities for spouses or a general lack of 
desire to live the lifestyle offered by our rural communities. But some 
barriers can be overcome if we use our resources wisely and work toward 
solutions to break them down, particularly with respect to how we as a 
nation train and compensate our front line doctors.
  Medical school is where we develop and educate our new doctors, yet 
the 4 years of training they provide more often than not nudge students 
into more lucrative specialty care or toward practice in higher paying 
cities. While we certainly rely on our cardiologists, orthopedists, 
neurologists, and the many other medical specialists to provide the 
top-notch care that only they are trained to provide, we cannot 
continue to push students into these areas to the detriment of primary 
care. A balance needs to be found.
  Today, I am proud to introduce, along with Senator Kay Hagan of North 
Carolina, the Rural Physician Pipeline Act of 2009, a bill that I hope 
can be part of the solution to our rural physician shortage. This 
legislation would make grants available to medical schools across the 
country for establishing programs designed to recruit students from 
rural areas who have a desire to practice in their hometowns. These 
programs would cultivate and strengthen the rural commitment of these 
future ``homegrown'' doctors, provide them the specialized training 
necessary to excel in the unique environment of sparsely populated 
regions, and assist them in finding postgraduate training programs that 
specialize in training doctors for practice in underserved rural 
communities.
  Primary care doctors in rural areas face challenges that urban 
doctors do not. When a physician is the only health care provider for 
an entire county, he or she cannot refer patients down the hall to a 
specialist. The rural training programs encouraged by this bill would 
give students additional training in pediatrics, emergency medicine, 
obstetrics, and behavioral health, among other areas, which will allow 
them to better serve their communities and hopefully lower the 
disturbing disparities of health outcomes we have seen over the years.
  I was prompted to write this bill after seeing the promising results 
of a similar program at the University of Colorado School of Medicine. 
Faculty like associate dean for rural health, Dr. Jack Westfall, and 
rural health track director, Dr. Mark Deutchman, have found that 
reaching out to rural communities for student recruitment and 
reinforcing their rural commitment throughout their training is the 
best way to get them back into the communities that need them most.
  My hope is that an expansion of similar programs nationwide will 
provide a ``one, two punch'' for the rural physician workforce--it will 
train more rural doctors, and it will train them better.
  I recognize that this legislation would play only a modest role in 
tackling the immense workforce challenges our health care system faces. 
We need more equitable payments for low-paid primary care doctors, 
loan-forgiveness programs must be expanded to allow medical graduates 
to practice primary care without going into budget-crushing debt, and 
graduate medical education dollars need to be more flexible so that 
rural residency programs can be established to train graduates.
  Health care reform needs to address these areas.
  As my fellow Senators and I depart Washington for our home States to 
listen to the ideas, needs, and concerns of our constituents over the 
remainder of the month, We do so with the knowledge that there is much 
to accomplish

[[Page S9026]]

upon our return. And as Congress continues working toward a health 
reform bill that puts the patient in charge of his or her health care 
choices, brings costs down, ensures financial sustainability, and 
brings security and stability for all Americans, there is one other 
thing we must also insist: health reform will not leave rural America 
behind.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                S. 1628

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Rural Physician Pipeline Act 
     of 2009''.

     SEC. 2. RURAL PHYSICIAN TRAINING GRANTS.

       Part C of Title VII of the Public Health Service Act (42 
     U.S.C. 293k et seq.) is amended--
       (1) after the part heading, by inserting the following:

             ``Subpart I--Medical Training Generally''; and

       (2) by inserting at the end the following:

           ``Subpart II--Training in Underserved Communities

     ``SEC. 749. RURAL PHYSICIAN TRAINING GRANTS.

       ``(a) In General.--The Secretary, acting through the 
     Administrator of the Health Resources and Services 
     Administration, shall establish a program to make grants to 
     eligible entities for the purposes of--
       ``(1) assisting eligible entities in recruiting students 
     most likely to practice medicine in underserved rural 
     communities;
       ``(2) providing rural-focused training and experience; and
       ``(3) increasing the number of recent allopathic and 
     osteopathic medical school graduates who practice in 
     underserved rural communities.
       ``(b) Eligible Entities.--In order to be eligible to 
     receive a grant under this section, an entity shall--
       ``(1) be a school of allopathic or osteopathic medicine 
     accredited by a nationally recognized accrediting agency or 
     association approved by the Secretary for this purpose, or 
     any combination or consortium of such schools; and
       ``(2) submit an application to the Secretary at such time, 
     in such form, and containing such information as the 
     Secretary may require, including a certification that such 
     entity--
       ``(A) will use amounts provided to the institution to--
       ``(i) establish and carry out a Rural Physician Training 
     Program described in subsection (d);
       ``(ii) improve an existing rural-focused training program 
     to meet the requirements described in subsection (d) and 
     carry out such program; or
       ``(iii) expand and carry out an existing rural-focused 
     training program that meets the requirements described in 
     subsection (d); and
       ``(B) employs, or will employ within a timeframe sufficient 
     to implement the Program (as described by a timetable and 
     supporting documentation in the application of the eligible 
     entity), faculty with experience or training in rural 
     medicine or with experience in training rural physicians.
       ``(c) Priority.--In awarding grant funds under this 
     section, the Secretary shall give priority to eligible 
     entities that--
       ``(1) demonstrate a record of successfully training 
     students, as determined by the Secretary, who practice 
     medicine in underserved rural communities;
       ``(2) demonstrate that an existing academic program of the 
     eligible entity produces a high percentage, as determined by 
     the Secretary, of graduates from such program who practice 
     medicine in underserved rural communities;
       ``(3) demonstrate rural community institutional 
     partnerships, though such mechanisms as matching or 
     contributory funding, documented in-kind services for 
     implementation, or existence of training partners with 
     interprofessional expertise (such as dental, vision, or 
     mental health services) in community health center training 
     locations or other similar facilities; or
       ``(4) submit, as part of the application of the entity 
     under subsection (b), a plan for the long-term tracking of 
     where the graduates of such entity are practicing medicine.
       ``(d) Use of Funds.--
       ``(1) Establishment.--An eligible entity receiving a grant 
     under this section shall use the funds made available under 
     such grant to--
       ``(A) establish and carry out a `Rural Physician Training 
     Program' (referred to in this section as the `Program');
       ``(B) improve an existing rural-focused training program to 
     meet the Program requirements described in this subsection 
     and carry out such program; or
       ``(C) expand and carry out an existing rural-focused 
     training program that meets the Program requirements 
     described in this subsection.
       ``(2) Structure of program.--An eligible entity shall--
       ``(A) enroll no fewer than 10 students per class year into 
     the Program; and
       ``(B) develop criteria for admission to the Program that 
     gives priority to students--
       ``(i) who have originated from or lived for a period of 2 
     or more years in an underserved rural community; and
       ``(ii) who express a commitment to practice medicine in an 
     underserved rural community.
       ``(3) Curricula.--The Program shall require students to 
     enroll in didactic coursework and clinical experience 
     particularly applicable to medical practice in underserved 
     rural communities, including--
       ``(A) clinical rotations in underserved rural communities, 
     and in specialties including family medicine, internal 
     medicine, pediatrics, surgery, psychiatry, and emergency 
     medicine;
       ``(B) in addition to core school curricula, additional 
     coursework or training experiences focused on medical issues 
     prevalent in underserved rural communities, including in 
     areas such as trauma, obstetrics, ultrasound, oral health, 
     and behavioral health; and
       ``(C) any coursework or clinical experience that--
       ``(i) may be developed as a result of the Symposium 
     described in subsection (f); or
       ``(ii) the Secretary finds appropriate.
       ``(4) Residency placement assistance.--Where available, the 
     Program shall assist all students of the Program in obtaining 
     clinical training experiences in locations with postgraduate 
     programs offering residency training opportunities in 
     underserved rural communities, or in local residency training 
     programs that support and train physicians to practice in 
     underserved rural communities, as well as assist all students 
     of the Program in obtaining postgraduate residency training 
     in such programs.
       ``(5) Program student cohort support.--The Program shall 
     provide and require all students of the Program to 
     participate in social, educational, and other group 
     activities designed to further develop, maintain, and 
     reinforce the original commitment of such students to 
     practice in an underserved rural community.
       ``(e) Annual Reporting Requirement.--On an annual basis, an 
     eligible entity receiving a grant under this section shall 
     submit a report to the Secretary on--
       ``(1) the overall success of the Program established by the 
     entity, based on criteria the Secretary determines 
     appropriate;
       ``(2) the number of students participating in the Program;
       ``(3) the number of graduating students who participated in 
     the Program;
       ``(4) the residency program selection of graduating 
     students who participated in the Program;
       ``(5) the number of graduates who participated in the 
     Program who are practicing in underserved rural communities 
     not less than one year after completing residency training; 
     and
       ``(6) the number of graduates who participated in the 
     Program who are not practicing in underserved rural 
     communities not less than one year after completing residency 
     training.
       ``(f) Rural Training Program Symposium.--
       ``(1) Purposes of symposium.--To assist the Secretary in 
     carrying out the Program and making grant determinations 
     under this section, the Secretary shall convene a Rural 
     Training Program Symposium (referred to in this section as 
     the `Symposium') to--
       ``(A) develop best practices that may be incorporated into 
     consideration of applications under subsection (b); and
       ``(B) establish a network of allopathic and osteopathic 
     medical schools that have developed or will develop rural 
     training programs in accordance with subsection (d).
       ``(2) Composition.--The Symposium shall include--
       ``(A) representatives from eligible entities with existing 
     rural training programs;
       ``(B) representatives from all eligible entities interested 
     in developing the Program;
       ``(C) representatives from area health education centers;
       ``(D) representatives from the Health Resources and 
     Services Administration; and
       ``(E) any other experts or individuals with experience in 
     practicing medicine in underserved rural communities the 
     Secretary determines appropriate.
       ``(g) Regulations.--Not later than 60 days after the date 
     of enactment of this section, the Secretary shall by 
     regulation define `underserved rural community' for purposes 
     of this section.
       ``(h) Supplement Not Supplant.--Any eligible entity 
     receiving funds under this section shall use such funds to 
     supplement, not supplant, any other Federal, State, and local 
     funds that would otherwise be expended by such entity to 
     carry out the activities described in this section.
       ``(i) Maintenance of Effort.--With respect to activities 
     for which funds awarded under this section are to be 
     expended, the entity shall agree to maintain expenditures of 
     non-Federal amounts for such activities at a level that is 
     not less than the level of such expenditures maintained by 
     the entity for the fiscal year preceding the fiscal year for 
     which the entity receives a grant under this section.
       ``(j) Authorization of Appropriations.--There are 
     authorized to be appropriated--
       ``(1) to carry out this section (other than subsection 
     (f))--
       ``(A) $4,000,000 for fiscal year 2010;
       ``(B) $8,000,000 for fiscal year 2011;
       ``(C) $12,000,000 for fiscal year 2012;
       ``(D) $16,000,000 for fiscal year 2013; and
       ``(2) to carry out subsection (f), such sums as may be 
     necessary.''.

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