[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.
                                 ______