[Congressional Record Volume 163, Number 132 (Thursday, August 3, 2017)]
[Senate]
[Pages S4831-S4833]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
By Ms. COLLINS (for herself, Mr. Tester, Mr. Cochran, Mr.
Manchin, Mr. Daines, Ms. Harris, and Mr. Boozman):
S. 1754. A bill to reauthorize section 340H of the Public Health
Service Act to continue to encourage the expansion, maintenance, and
establishment of approved graduate medical residency programs at
qualified teaching health centers, and for other purposes; to the
Committee on Health, Education, Labor, and Pensions.
Ms. COLLINS. Madam President, I rise today to introduce legislation
with my colleague from Montana, Senator Tester, that would extend an
important program to fund Teaching Health Centers, which support the
health and well-being of families in rural and medically underserved
communities. I am pleased that Senators Cochran, Manchin, Daines,
Harris, and Boozman, have joined us as cosponsors.
In the background of the health care debate, there is another crisis
that looms. We are facing a severe shortage of doctors. By 2025, we
will need more than 100,000 new primary care doctors to meet the
growing demand for health care services across the Country. The
shortage is especially critical in rural and underserved communities,
which are often those that have been hit hardest by the opioid
epidemic. The most significant shortages are in family medicine,
general internal medicine, pediatrics, obstetrics and gynecology,
psychiatry, and dentistry.
These shortages have reached crisis levels in many places. In clinics
and health centers in Aroostook County, Maine's northernmost county
where I grew up, I hear stories about vacancies forcing Mainers to
travel many miles simply to see a primary care doctor or dentist.
For the past six years, one program, the Teaching Health Centers
Graduate Medical Education Program, has worked to fill these gaps. This
program helps to train medical residents in community-based settings,
including low-income, underserved rural and urban neighborhoods. For
example, since 2011, the Penobscot Community Health Care Center has
trained 31 residents and served more than 15,000 dental patients in
Bangor, Maine.
We need to meet people in the communities in which they live and
work. This program is training the next generation of physicians, and
has produced real results. When compared with traditional Medicare
graduate medical education residents, those who train at teaching
health centers are significantly more likely to practice primary care
and remain in underserved or rural communities. The numbers speak for
themselves: 82 percent of Teaching Health Center, or THC, residents
choose to practice primary care, compared to 23 percent of traditional
Medicare Graduate Medical Education residents; and 55 percent of THC
residents choose to remain in underserved communities, compared to 26
percent of traditional Medicare GME residents.
Teaching health centers are serving Americans from coast to coast. A
total of 742 THC residents are serving in 27 states and the District of
Columbia. The program is competitive, and trains the best of the best.
For each residency position, THC programs receive more than 100
applications. In 2017, THC residents and faculty will provide more than
one million primary care medical visits to underserved communities.
Teaching Health Centers have demonstrated a record of success, and it
is imperative that we support them. Our legislation would reauthorize
the Teaching Health Centers Graduate Medical Education Program for
three years. It would also allow new programs to expand within existing
centers and the creation of entirely new teaching health centers.
This bill is widely supported by leading community health and
physician organizations, including the American Association of Teaching
Health Centers, National Association of Community Health Centers,
American Academy of Family Physicians, American Association of Colleges
of Osteopathic Medicine, American Osteopathic Association, American
Council of OB/GYNs, Society of Teachers of Family Medicine, and Council
of Academic Family Medicine. We have also received letters of support
from teaching health centers in Maine, Montana, Tennessee, Iowa,
Oklahoma, North Carolina, California, Mississippi, Pennsylvania,
Washington, Texas, Connecticut, New York, Illinois, Massachusetts, and
Idaho.
In the face of nationwide physician shortages, our legislation would
provide a solution for communities today and a path forward to train
the physicians of tomorrow. I urge all of my colleagues to join in
support of this important legislation, the Training the Next Generation
of Primary Care Doctors Act of 2017.
Ms. COLLINS. Madam President, I ask unanimous consent that the
letters be printed in the Record.
There being no objection, the letters were ordered to be printed in
the Record, as follows:
Penobscot Community Health Care,
August 2, 2017.
Hon. Susan Collins,
U.S. Senate,
Washington, DC.
Dear Senator Collins: On behalf of Penobscot Community
Health Care's General Practice Dental Residency program, a
Teaching Health Center training 3-6 residents a year (with
over 28 residents trained since 2011) and serving 15,000
dental patients in Bangor, Maine, I want to express our
appreciation for your relentless efforts to develop
legislation to continue funding and expand the Teaching
Health Center Graduate Medical Education (THCGME) program. We
know that you and your staff have worked long and hard with
multiple stakeholder organizations, including the American
Association of Teaching Health Centers, to create the best
possible legislation that will fund
[[Page S4832]]
adequately this vital program for at least another three
years and provide for expansion to additional medically
underserved areas of our country.
THCs currently train more than 742 residents nationally and
are providing more than a million patient visits in
underserved rural and urban communities. The continuation of
this program is vital in all of the communities they are
located, and preserving this program is critical to the
health of hundreds of thousands around the country. This
investment of federal funding in the THCGME program, coupled
with private, nonfederal resources, guarantees that every
dollar is used exclusively for primary care training, all in
community-based settings. Residents trained in community-
based settings are three times more likely than traditionally
trained residents to practice primary care in a community
based setting ensuring that doctors trained in these settings
remain in communities where they are needed most.
Penobscot Community Health Care appreciates your leadership
on this important issue and is pleased to support your
legislation, which is helping to address the doctor and
dentist shortage that plagues so many communities, both urban
and rural. You have always championed Community Health
Centers, and concurrently Teaching Health Centers,
recognizing the need for accessible, affordable health care
for all no matter if you live in Caribou, Maine or New York
City.
Thank you for your tireless efforts and leadership in the
United States Senate as you strive to preserve and improve
health care for all Americans.
Sincerely,
Kenneth Schmidt, MPA,
President and CEO.
____
Resurrection Family Medicine,
Memphis, TN, August 1, 2017.
Hon. Susan Collins,
U.S. Senate,
Washington, DC.
Dear Senator Collins: On behalf of Resurrection Health
Family Medicine Residency, a Teaching Health Center training
25 residents and providing 15,000 patient visits per year in
Memphis, TN, I write to express our appreciation for your
relentless efforts to develop legislation to continue funding
and expand the Teaching Health Center Graduate Medical
Education (THCGME) program. We know that you and your staff
have worked long and hard with multiple stakeholder
organizations, including the American Association of Teaching
Health Centers, to create the best possible legislation that
will fund adequately this vital program for at least another
three years and provide for expansion to additional medically
underserved areas of our country.
THCs currently train more than 742 residents nationally and
are providing more than a million patient visits in
underserved rural and urban communities. The continuation of
this program is vital in all of the communities they are
located and preserving this program is critical to the health
of hundreds of thousands around the country. This investment
of federal funding in the THCGME program, coupled with
private, nonfederal resources, guarantees that every dollar
is used exclusively for primary care training, all in
community-based settings. Residents trained in community-
based settings are three times more likely than traditionally
trained residents to practice primary care in a community
based setting ensuring that doctors trained in these settings
remain in communities, where they are needed most.
Resurrection Health Family Medicine Residency appreciates
your leadership on this important issue and is pleased to
support your legislation, which is helping to address the
doctor shortage that plagues so many communities, both urban
and rural.
Sincerely,
Jeremy Crider, MD,
Residency Director.
____
The American Congress of
Obstetricians and Gynecologists,
Washington, DC, August 3, 2017.
Hon. Susan Collins,
U.S. Senate,
Washington, DC.
Hon. Jon Tester,
U.S. Senate,
Washington, DC.
Dear Senators Collins and Tester: The American Congress of
Obstetricians and Gynecologists (ACOG), with more than 58,000
physicians and partners dedicated to advancing women's
health, is pleased to endorse the Training the Next
Generation of Primary Care Doctors Act of 2017. Your bill
would help improve access for women in rural and underserved
areas to timely, high quality health care by training primary
care physicians, including obstetrician-gynecologists.
Today, women living in half of all US counties are in areas
without an ob-gyn, including one of Maine's 16 counties, and
35 of Montana's 56 counties. Furthermore, the ob-gyn
workforce is aging and a large number of ob-gyns are retiring
at a time when the female population is expected to increase
36% by 2050. ACOG projects an ob-gyn shortage of 18% by 2030.
Your bill will help alleviate these workforce challenges by
ensuring the Teaching Health Center Graduate Medical
Education (THCGME) program can continue to train ob-gyns and
other primary care physicians in an efficient and effective
manner. Community-based THCGME medical training programs are
critical to filling workforce shortages, as physicians
trained through this program are more likely to practice in
underserved communities. According to the Health Resources
and Services Administration (HRSA), primary care residents
trained in community-based settings are three times more
likely to practice in an underserved community-based setting.
An investment in THCGME to improve access to care in rural
and underserved communities has a long-term impact positive
impact.
Thank you for introducing this legislation to improve
access to high quality care for women. Should you have any
questions or if we can be of assistance in any way, please
contact Mallory Schwarz, ACOG Federal Affairs Manager.
Sincerely,
Haywood L. Brown, MD, FACOG,
President.
____
American Osteopathic Association,
Washington, DC, August 3, 2017.
Hon. Susan Collins,
U.S. Senate,
Washington, DC.
Hon. Jon Tester,
U.S. Senate,
Washington, DC.
Dear Senators Collins and Tester: On behalf of the American
Osteopathic Association (AOA) and the nearly 130,000
osteopathic physicians and osteopathic medical students we
represent, thank you for introducing the ``Training the Next
Generation of Primary Care Doctors Act of 2017.'' This
important bipartisan legislation renews the commitment to the
continued development of the Teaching Health Centers Graduate
Medical Education (THCGME) program to help ensure a robust
primary care workforce in our nation's rural and underserved
communities. We are grateful for your leadership on this
critical issue.
The THCGME program is a vital source of training for
primary care residents to help expand access to care in rural
and underserved communities throughout the country. These
programs, located in 59 teaching health centers in 27 states,
currently train 742 residents in much-needed primary care
fields including family medicine, internal medicine,
pediatrics, obstetrics and gynecology, psychiatry,
geriatrics, and dentistry. The majority of these programs are
accredited by the AOA or are dually accredited (DO/MD)
programs, supporting nearly 800 osteopathic resident
physicians through their training since the program began.
And true to the intent of the THCGME program, residents who
train in these programs are far more likely to practice
primary care and remain in the communities in which they have
trained.
As osteopathic physicians, we are trained in a patient-
centered, hands-on approach to care that focuses on the whole
person, including the physical, mental, and psychosocial
aspects of health. Our training and philosophy includes a
strong emphasis on primary care--in fact, approximately half
of all osteopathic physicians practice in primary care
specialties. Given this strong presence in primary care,
osteopathic medicine aligns naturally with the mission and
goals of the THCGME program that has proven successful in
helping address the existing gaps in our nation's primary
care workforce.
Your legislation provides much-needed stability through
continued funding for the THCGME program, and also creates a
pathway for the expansion of existing centers as well as the
creation of entirely new teaching health centers. We deeply
appreciate your commitment to training the future of the
primary care workforce and thank you for introducing this
important legislation. The AOA and our members stand ready to
assist you in securing its enactment into law.
Sincerely,
Mark A. Baker, DO,
President.
____
Council of Academic
Family Medicine,
Washington, DC, August 3, 2017.
Hon. Susan Collins,
U.S. Senate,
Washington, DC.
Hon. Jon Tester,
U.S. Senate,
Washington, DC.
Dear Senators Collins and Tester: On behalf of the Council
of Academic Family Medicine (CAFM), including the Society of
Teachers of Family Medicine, Association of Departments of
Family Medicine, Association of Family Medicine Residency
Directors, the North American Primary Care Research Group, we
thank you for introducing the Training the Next Generation of
Primary Care Doctors Act of 2017. This legislation is an
important step to providing sustainable funding and growth
for a critical program that helps address the primary care
physician shortage in our country. We appreciate your
leadership on this issue and give you our whole-hearted
support for the legislation.
To help sustain this important program the proposed
legislation provides suitable funding for current Teaching
Health Center Graduate Medical Education (THCGME) programs to
help address the crisis-level shortage of primary care
physicians. The funding level included in the bill will allow
for a per resident amount to be paid for training that is on
par with the Heath Resources and Services Administration
(HRSA) funded study identifying a median cost of
approximately $157 thousand per trainee. Evidence shows
[[Page S4833]]
that the THC program graduates are more likely to practice in
rural and medically underserved communities. We are pleased
that the proposed legislation supports ten new THC programs,
with a priority for those serving rural and medically
underserved populations and areas, recognizing the importance
of growing this successful program.
The Council on Graduate Medical Education (COGME), an
advisory body empaneled by Congress, has urged Congress to
continue of the THCGME program stating that ``THCGME programs
deliver excellent value in physician training,'' and that the
program encourages training in ``delivery systems that
emphasize team-based care in Patient Centered Medical Homes
that maximize quality at a moderate cost''; Additionally, the
Institute of Medicine (IOM), [now National Academy of
Medicine] in a 2014 report identified the THCGME program as
helping meet the need for primary care physicians, especially
those who provide care to underserved populations and worthy
of a permanent funding source.
The current authorization for this vital program expires at
the end of this fiscal year. Without legislative action, the
expiration of this program would mean an exacerbation of the
primary care physician shortage, and a lessening of support
for training in underserved and rural areas. We are grateful
to you both for your exceptional leadership in supporting and
sustaining this vital program by introducing this bill and
helping to shepherd it toward enactment.
The CAFM organizations and our members are pleased to work
with you to secure this legislation's enactment.
Sincerely,
Stephen A Wilson, MD,
President, Society of Teachers of Family Medicine.
Valerie Gilchrist, MD,
President, Association of Departments of Family Medicine.
Karen B Mitchell, MD,
President, Association of Family Medicine Residency
Directors.
William Hogg, MD,
President, North American Primary Care Research Group.
____
RiverStone Health,
Billings, MT, August 2, 2017.
Hon. Susan Collins,
U.S. Senate,
Washington, DC.
Dear Senator Collins: On behalf of the Montana Family
Medicine Residency and RiverStone Health Clinic, one of the
nation's original eleven teaching health centers training 24
family medicine residents and serving over 15,000 residents
or Yellowstone and Carbon County, NIT, I want to express our
appreciation for your relentless efforts to develop
legislation to continue funding and expand the Teaching
Health Center Graduate Medical Education (THCGME) program. We
know that you and your staff have worked long and hard with
multiple stakeholder organizations, including the American
Association of Teaching Health Centers and the National
Association of Community Health Centers, to create the best
possible legislation that will fund adequately this vital
program for at least another three years and provide for
expansion to additional medically underserved areas of our
country.
THCs currently train more than 742 residents nationally and
are providing more than a million patient visits in
underserved rural and urban communities. The continuation of
this program is vital in all of the communities they are
located and preserving this program is critical to the health
of hundreds of thousands around the country, particularly
those who lack access to healthcare absent their local
community health center and its providers. This investment of
federal funding in the THCGME program, coupled with private,
nonfederal resources, guarantees that every dollar is used
exclusively for primary care training, all in community-based
settings.
Residents trained in community-based settings are three
times more likely than traditionally trained residents to
practice primary care in a community based setting ensuring
that doctors trained in these settings remain in communities
where they are needed most. Some 70% of our residency's over
100 graduates practice in MT, a state with widespread
provider shortage areas and multiple counties with no medical
care provider at all.
RiverStone Health and Montana Family Medicine Residency
appreciate your leadership on this important issue and are
pleased to support your legislation, which is helping to
address the doctor shortage that plagues so many communities,
both urban and rural.
Sincerely,
John Felton, MPH, MBA, FACHE,
President & CEO / Health Officer.
______