[Congressional Record Volume 165, Number 20 (Thursday, January 31, 2019)]
[Senate]
[Pages S804-S807]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. COLLINS (for herself, Mr. Tester, Mrs. Capito, Mr. Jones, 
        Mr. Boozman, Mr. Manchin, and Ms. Harris):
  S. 304. A bill to reauthorize section 340H of the Public Health 
Service Act

[[Page S805]]

to continue to encourage the expansion, maintenance, and the 
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.
  Mr. President, I rise today to introduce legislation with my 
colleague from Montana, Senator Tester, to fund Teaching Health 
Centers, a time-tested model for success to train the next generation 
of primary care doctors in communities where they are needed the most. 
I am pleased that Senators Capito, Jones, Boozman, Manchin, and Harris 
have joined us as cosponsors.
  Over the next decade, the severe shortage of primary care doctors 
could reach crisis levels in a growing number of rural and underserved 
communities in Maine and across our Nation. Alarmingly, these 
communities are often those hardest hit by the opioid epidemic. By 
2030, we will need an estimated 120,000 physicians to meet the growing 
demand for health care services across the Country. In clinics and 
health centers in Northern Maine, I frequently hear stories about 
vacancies forcing Mainers to travel many miles simply to see a primary 
care doctor or dentist.
  For the past eight years, one program, the Teaching Health Centers 
Graduate Medical Education Program, has worked to fill these gaps. This 
program trains medical residents in community-based settings, including 
low-income, underserved rural and urban neighborhoods. For example, 
since its inception in 2011, the Penobscot Community Health Care Center 
has trained 34 residents and served more than 15,000 dental patients in 
Bangor, Maine.
  Nationwide, this program has produced real results. Since the program 
began, 632 new primary care physicians and dentists have graduated and 
entered the workforce, and the number of Americans served is in the 
millions. Those who train at teaching health centers are very likely to 
practice primary care and remain in underserved or rural communities. 
Last Congress, this Committee considered and successfully passed my 
legislation to fund teaching health centers for two years. As a result, 
for the 2017-2018 academic year, this program supported the training of 
732 residents in 57 primary care residency programs, across 24 states.
  The legislation I have introduced today would reauthorize the 
Teaching Health Centers Graduate Medical Education Program for five 
years and provide additional funding for expansion and the creation of 
new programs. 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, and Council of Academic Family 
Medicine.
  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 2019.
  Mr. President, I ask to include these letters into the Record.
  Mr. PRESIDENT: With no objection so ordered.

                                                        Council of


                                     Academic Family Medicine,

                                                 January 28, 2019.
     Hon. Susan Collins,
     U.S. Senate, Washington, DC.
     Hon. Shelley Capito,
     U.S. Senate, Washington, DC.
     Hon. Doug Jones,
     U.S. Senate, Washington, DC.
     Hon. Jon Tester,
     U.S. Senate, Washington, DC.
       Dear Senators Collins, Jones, Capito, 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 2019. 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 graduate medical education 
     program your 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 Health Resources and 
     Services Administration (HRSA) funded study identifying a 
     median cost of approximately $157,600 per trainee. It allows 
     for programs to regain previous losses of residency positions 
     due to lower funding levels and instability. We are 
     particularly pleased that the legislation would provide a 
     five year reauthorization, giving the program some much 
     needed financial stability.
       In addition, we are gratified that the proposed legislation 
     supports and funds the creation of new programs and/or 
     centers, with a priority for those serving rural and 
     medically underserved populations and areas. Evidence shows 
     that the THC program graduates are more likely to practice in 
     rural and medically underserved communities. Recognizing the 
     importance of growing this successful program to help address 
     geographic maldistributions of physicians across the country 
     is significant.
       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. Your efforts in 
     support for this program since its inception have been key to 
     keeping it alive. We are grateful to all of you 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,
     Beat Steiner, MD,
       President, Society of Teachers of Family Medicine.
     Fred Miser, MD,
       President, Association of Family Medicine, Residency 
     Directors.
     Judith Belle Brown, PhD,
       President, North American Primary Care Research Group.
                                  ____


                     Joint Statement for the Record


   Hearing of the Health, Education, Labor, and Pension Committee on 
      Access to Care: Health Centers and Providers in Underserved 
                     Communities, January 29, 2018

       On behalf of the more than 145,000 osteopathic physicians 
     and medical students we represent, we applaud the committee's 
     leadership and bipartisan effort to address the shortage in 
     our health care workforce. We are thankful for the Chairman 
     and Ranking Member for introducing legislation that would 
     reauthorize the Teaching Health Centers Graduate Medical 
     Education Program (THCGME) In anticipation of the upcoming 
     hearing, Access to Care: Health Centers and Providers in 
     Underserved Communities, we would like to highlight the need, 
     and encourage the committee, to support funding for growth in 
     the reauthorization of the THCGME program to help address the 
     shortage in our health care workforce.
       The majority of THCGME programs are currently accredited by 
     the AOA or are dually accredited (DO/MD) programs, supporting 
     nearly 800 osteopathic resident physicians through their 
     training since the program's inception. Located in 27 states 
     and the District of Columbia, THCGME programs train residents 
     in much-needed primary care fields that have the largest 
     shortages nationally, including family medicine, internal 
     medicine, pediatrics, obstetrics and gynecology, psychiatry, 
     geriatrics, and dentistry. It is a vital source of training 
     for primary care residents to help expand access to care in 
     rural and underserved communities throughout the country.
       Osteopathic physicians (DOs) are fully-licensed to practice 
     in all specialty areas of medicine, with nearly 57% of active 
     DOs in primary care. Our training emphasizes a whole-person 
     approach to treatment and care, where we partner with our 
     patients to help them get healthy and stay well. Osteopathic 
     medical education also has a long history of establishing 
     educational programs for medical students and residents that 
     target the health care needs of rural and underserved 
     populations. 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.
       Residents who train in THC programs are far more likely to 
     specialize in primary care and remain in the communities in 
     which they have trained. Data shows that, when compared to 
     traditional postgraduate trainees, residents who train at 
     THCs are more likely to practice primary care (82% vs. 23%) 
     and remain in underserved (55% vs. 26%) or rural (20% vs. 5%) 
     communities. It is clear that a well-designed THCGME program 
     not only plays a vital role in training our next generation 
     of primary care physicians, but helps to bridge our nation's 
     physician shortfall. The program also tackles the issue of

[[Page S806]]

     physician maldistribution, and helps address the need to 
     attract and retain physicians in rural areas and medically 
     underserved communities. In the 2016-2017 academic year, 
     nearly all residents received training in primary care 
     settings and 83% of residents trained in Medically 
     Underserved Communities.
       However, reauthorizing the THCGME program at its current 
     level funding, for the next five years, would lead to a 
     reduction of approximately 70 residency slots from the 
     currently funded 737 residency positions.
       We respectfully ask the committee to consider legislation 
     by Senators Susan Collins (R-ME), Doug Jones (D-AL), Shelley 
     Moore Capito (R-WV), and John Tester (D-MT) the ``Training 
     the Next Generation of Primary Care Doctors Act of 2019.'' In 
     addition to reauthorizing the THCGME program for the next 
     five years, this bill also provides funding and a pathway for 
     growth in the number of residents trained in underserved 
     rural and urban communities. This represents a much needed 
     expansion to address the physician shortages in our country.
       We would also like to briefly highlight the broader role 
     osteopathic physicians have in reducing our nation's 
     physician shortage. Since 2010, the number of DOs has 
     increased by 54%. Today, more than 65% of all DOs are under 
     the age of 45, and if current enrollment trends continue, DOs 
     are projected to represent more than 20% of practicing 
     physicians by 2030. Because of the whole-person approach to 
     patient care that is inherent in osteopathic medicine, the 
     increasing share of DOs in the physician workforce, and the 
     number of DOs in primary care specialties, we have a unique 
     and important perspective on the needs of our nation's health 
     care workforce and would welcome the opportunity to 
     contribute to your work on this issue.
       We appreciate your bipartisan effort to address the 
     shortage in our country's health care workforce, and we stand 
     ready to assist in your effort.
           Sincerely,
     American College of Osteopathic Family Physicians.
     American College of Osteopathic Internists.
     American College of Osteopathic Obstetricians and 
     Gynecologists.
     American College of Osteopathic Neurologists and 
     Psychiatrists.
     American College of Osteopathic Pediatricians.
     American Osteopathic Association.
                                  ____

                                               American Academy of


                                            Family Physicians,

                                                 January 28, 2019.
     Hon. Susan Collins,
     U.S. Senate,
     Washington, DC.
     Hon. Shelley Moore Capito,
     U.S. Senate,
     Washington, DC.
     Hon. Doug Jones,
     U.S. Senate,
     Washington, DC.
     Hon. Jon Tester,
     U.S. Senate,
     Washington, DC.
       Dear Senators Collins, Jones, Capito, and Tester: On behalf 
     of the American Academy of Family Physicians (AAFP), which 
     represents 131,400 family physicians and medical students 
     across the country, I write to support your legislation to 
     reauthorize the Teaching Health Center Graduate Medical 
     Education (THCGME) program Thank you for your commitment to 
     this important, innovative program.
       The AAFP is pleased to support the Training the Next 
     Generation of Primary Care Doctors Act because it updates the 
     THCGME program for five years, authorizes adequate and 
     sustainable funding for existing residency programs, and 
     supports expansion into rural and underserved communities In 
     addition, the legislation maintains the program's strong 
     transparency and accountability requirements. The THCGME 
     program directly addresses three major physician workforce 
     challenges: the serious shortage of primary care physicians, 
     geographic maldistribution of physician training, and the 
     need to increase health care access for medically-underserved 
     populations. Recognizing the importance of supplying well-
     trained primary care physicians into communities that need 
     them most, we look forward to working with you to update and 
     expand the THCGME program early this year.
       Again, we are pleased to support this important 
     legislation. For more information, please contact Sonya Clay, 
     Government Relations Representative.
           Sincerely,
                                            Michael L. Munger, MD,
     FAAFP Board Chair.
                                  ____

         American Academy of Family Physicians, American 
           Association of Colleges of Osteopathic Medicine, 
           American Association of Teaching Health Centers, The 
           American College of Obstetricians of Gynecologists, 
           American Osteopathic Association, Council of Academic 
           Family Medicine, National Association of Community 
           Health Centers.

                           [January 29, 2019]

   Physicians, Medical Educators, Community Health Centers Strongly 
  Support Training the Next Generation of Primary Care Doctors Act of 
                                  2019

       Our organizations applaud the introduction of the Training 
     the Next Generation of Primary Care Doctors Act of 2019 and 
     urge the Senate to quickly pass this important legislation. 
     We thank Senators Susan Collins (R-ME), Doug Jones (D-AL), 
     Shelley Moore Capito (R-WV), Jon Tester (D-MT), and John 
     Boozman (R-AR) for their commitment to ensuring that our 
     nation has a strong and robust primary care workforce. 
     Furthermore, we thank Senate HELP Committee Chairman Lamar 
     Alexander (R-TN) and Ranking Member Patty Murray (D-WA) for 
     their leadership in introducing the Community and Public 
     Health Programs Extension Act, which will extend for five 
     years federal funding for the Teaching Health Center Graduate 
     Medical Education (THCGME) Program, community health centers, 
     the National Health Service Corps, and two other federal 
     health programs. These programs are set to expire at the end 
     of the fiscal year.
       The THCGME Program, established in 2010 and reauthorized in 
     2015 and 2018 has been, by any measure, an overwhelming 
     success. In the 2017-2018 academic year, the program 
     supported the training of 732 residents in 57 primary care 
     residency programs, across 24 states. Since 2011, the program 
     has supported the training of over 630 new primary care 
     physicians and dentists that have graduated and entered the 
     workforce. Importantly, physicians trained in teaching health 
     center programs are more likely to practice in underserved 
     communities, increasing access to care for the country's most 
     vulnerable patient populations.
       The value of primary care is well documented. In fact, 
     individuals who have a continuous relationship with a primary 
     care physician are more likely to be healthier and use fewer 
     health care resources. Research shows that our nation faces a 
     primary care physician workforce shortage. The THCGME Program 
     has proven its ability to efficiently increase the number of 
     primary care physicians trained.
       This highly successful and impactful program is set to 
     expire on September 30, 2019 unless Congress takes action to 
     reauthorize and fund it. The legislation introduced today not 
     only reauthorizes the program, but also provides enhanced 
     funding and a pathway for increasing the number of residents 
     trained. Most important, the legislation will continue to 
     build the primary care physician pipeline necessary to reduce 
     costs, improve patient care, and support underserved rural 
     and urban communities.
       We are extremely pleased that members of both parties are 
     working together to extend this vital program that brings 
     health care to medically underserved communities across the 
     nation. Our organizations strongly support Training the Next 
     Generation of Primary Care Doctors Act of 2019 and call on 
     the House of Representatives and Senate to ensure that the 
     THCGME Program is reauthorized and appropriately financed by 
     September 30.
                                  ____

                                           American Association of


                             Colleges of Osteopathic Medicine,

                                                 January 28, 2019.
     Hon. Susan Collins,
     U.S. Senate,
     Washington, DC.
     Hon. Shelley Moore Capito,
     U.S. Senate,
     Washington, DC.
     Hon. John Boozman,
     U.S. Senate,
     Washington,DC.
     Hon. Doug Jones,
     U.S. Senate,
     Washington, DC.
     Hon. Jon Tester,
     U.S. Senate,
     Washington, DC.
       Dear Senators Collins, Jones, Capito, Tester, and Boozman: 
     On behalf of the American Association of Colleges of 
     Osteopathic Medicine (AACOM), thank you for your unceasing 
     bipartisan commitment and leadership in championing the 
     Health Resources and Services Administration's Teaching 
     Health Center Graduate Medical Education (THCGME) Program by 
     introducing the Training the Next Generation of Primary Care 
     Doctors Act of 2019. We offer our strong support of this 
     legislation.
       AACOM represents the 35 accredited colleges of osteopathic 
     medicine in the United States. These colleges are accredited 
     to deliver instruction at 55 teaching locations in 32 states. 
     In the current academic year, these colleges are educating 
     more than 30,000 future physicians--25 percent of all U.S. 
     medical students. Six of the colleges are public and 29 are 
     private institutions. AACOM was founded in 1898 to support 
     and assist the nation's osteopathic medical schools, and to 
     serve as a unifying voice for osteopathic medical education. 
     The association leads and advocates for the osteopathic 
     medical education community to improve the health of the 
     public.
       With your introduction of the Training the Next Generation 
     of Primary Care Doctors Act of 2019, the osteopathic medical 
     education community commends your bipartisan efforts to 
     support this critical program that produces primary care 
     physicians in medically underserved communities across our 
     country by reauthorizing it for five years

[[Page S807]]

     and providing enhanced funding and a pathway for growth in 
     the number of residents trained.
       Established in 2010 and reauthorized in 2015 and 2018, the 
     THCGME Program has been a notable success. In the 2017-2018 
     academic year, the program supported the training of 732 
     residents in 57 primary care residency programs, across 24 
     states. Since 2011, the program has supported the training of 
     over 630 new primary care physicians and dentists that have 
     graduated and entered the workforce. Importantly, physicians 
     trained in THC programs are more likely to practice in 
     underserved communities, increasing access to care for the 
     country's most vulnerable patient populations.
       As you know, the continuation of this program is vital to 
     addressing primary care physician workforce shortages and 
     delivering health care services to vulnerable patients in 
     need. It has encouraged greater connections and services 
     between traditionally underserved areas and the emerging 
     physician workforce by creating opportunities for medical 
     students to carry out their required training where their 
     services are most needed. The THCGME Program has been highly 
     effective in transitioning residents into medically 
     underserved areas, with more than 80 percent remaining in 
     primary care practice and over half remaining in high-need 
     communities.
       On behalf of the nation's osteopathic medical schools and 
     the students they train, thank you for your steadfast 
     leadership, and I look forward to continuing our work 
     together to support a health care system that will enable 
     osteopathic medical students and future physicians to provide 
     primary health care to the patients they serve. We look 
     forward to working together on this important legislation.
           Respectfully,
                                      Stephen C. Shannon, DO, MPH,
                                                President and CEO.
                                 ______