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Remarks to the Advisory Committee on Training in Primary Care Medicine and Dentistry
by HRSA Deputy Administrator Dennis Williams
February 12, 2004
Bethesda, Md.
Good morning. I am delighted to be here at this meeting of the Advisory Committee on Training in Primary Care Medicine and Dentistry. Let me commend each of you for your willingness to serve in this most important capacity. To all of us concerned about the quality of medical education in this country, your work has far-reaching impact.
By advising the Secretary and Congress about issues and policies relating to training in the areas of primary care medicine and dentistry, you have a tremendous opportunity to address significant health care training needs that exist in every part of this vast country of ours.
At this meeting, I know your focus is on what changes are needed now to make sure we have the right number and mix of primary care professionals to meet the increasing health care demands of the future. And, of course, we all look forward to your next report -- the fourth in a series – which looks closely at the future of primary care and looks at what we’ve accomplished in our administration of Title VII, section 747 programs. These training initiatives are important because they ensure that students in family medicine, internal medicine, pediatrics, dentistry, and physician assistants are better prepared than ever and more willing to serve in areas where health care services are scarce. It is through these kinds of training efforts that we help underserved communities better meet the health care needs of the millions of people they serve.
In my time with you today, I’d like to discuss the progress we’ve made in reaching the goals President Bush set in two Presidential initiatives he assigned to HRSA: expanding the health center system and reforming and expanding the National Health Service Corps.
I’d also like to tell you about important responsibilities Congress and the President have recently given us in the area of counter-terrorism, primarily through HRSA’s new Hospital Preparedness program. Success in these endeavors will bring access to health care to millions more Americans and protect our people from terrible harm.
In terms of our health professions agenda, all three efforts have the potential to dramatically impact the career choices and destinations of health professionals across America.
Each initiative requires skilled health care professionals in greater number, diversity and geographic distribution than we have today. And all of them will need new skills that we never envisioned a decade ago.
The expansion of the health center network offers immediate job opportunities for thousands of health professionals who want to use their skills to help the neediest among us. National Health Service Corps resources are now in reach of more health professions students than ever before.
And the hospital preparedness program creates new demand for health professionals with special expertise in responding to disasters and in tracking, treating and containing mass threats to public health.
Right now, HRSA is hard at work implementing President Bush’s health centers initiative. This plan will add 1,200 new or expanded health centers and clinics and increase the number of people served annually from about 10 million in 2001 to more than 16 million – ultimately doubling the number of patients served.
As 2004 begins, HRSA is entering the middle years of our efforts to meet the goals of President Bush’s health center expansion initiative. So far we’re ahead of schedule. In 2002, the first year of the expansion, HRSA created 171 new center sites and expanded capacity at 131 existing centers. In 2003, year two, we funded 100 new centers and expanded capacity at more than 150 existing centers.
HRSA now supports nearly 3,600 health center sites, which we estimate served 12.5 million people in 2003. That’s an increase of more than 2.2 million patients in just two years.
One of the biggest challenges we face in implementing the expansion is in finding the right people to fill the new positions. We estimate that we’ll need to add 36,000 new health center staff through 2006 to meet the President’s goals, including more than 11,000 clinicians.
This is a difficult task, no doubt about it. We did pretty well in FY 2002, exceeding one goal, just missing another. Our goal in 2002 was to add 7,200 additional staff to the health center network; we added 7,600. We wanted to add 2,200 additional clinicians; we added 2,000.
National Health Service Corps clinicians have a fundamental role in our staffing strategy. As part of his plan to expand the health center system, President Bush also directed us to reform and expand the Corps – that’s the second Presidential initiative HRSA is responsible for. And the move, of course, makes sense, because about half of the more than 2,700 current NHSC scholars and loan repayors work in health centers.
The NHSC’s 2003 budget of $171 million was an increase of about $26 million over 2002, and it will pay for hundreds of new Scholars and Loan Repayors. The President’s budget for 2004 requests yet another increase, this time of $42 million. That, too, will pay for additional hundreds of more NHSC clinicians.
But you can see by those numbers that not even the NHSC expansion will cover the slots we’ll need to fill at the health centers.
How will we do it? Well, we’ll need to develop new recruitment and retention strategies, improve existing ones, and work with residency and educational training programs. And frankly, we’ll ask our friends and partners – folks like you -- for help reaching the people we need and persuading them to join us in our quest to extend access to health care to those who need it most.
The situation is challenging, but it also expands opportunities for health care professionals who want to serve America. We welcome your help and advice on meeting these staffing goals.
Another certain area of growth for health care professionals in the 21st century is in the field of disaster preparedness. HRSA has three programs that form a major part of the federal government’s response to the challenges posed by terrorist groups.
In terms of funding increases during my years here at HRSA, nothing matches the infusion of funds and responsibility that occurred with the creation of the National Bioterrorism Hospital Preparedness Program. Funded at just over half a billion, the Hospital Preparedness program is the base of three HRSA programs that form a major part of the federal government’s response to the challenges posed by terrorist groups. The President is asking for another $476 million for the program in 2005, a slight drop in funds during the two preceding years.
Launched in 2002, the Hospital Preparedness program is structured to develop and sustain emergency “surge capacity” at hospitals sufficient to handle mass casualty events.
It goes without saying that hospitals – along with health centers and other first-responders -- will play a critical role in identifying and responding to terrorist attacks or outbreaks of infectious disease.
Program funds pay for more hospital beds; the development of isolation areas; and the establishment of hospital-based pharmaceutical caches. Funds also are used to identify health care personnel who would be called on in a surge, and to provide personal protective equipment, extra mental health services, and trauma and burn care.
The second counter-bioterror program HRSA administers is a new “Bioterrorism Training and Curriculum Development Program,” which provides $26.5 million in grants for continuing education and training for health care professionals and to add bioterrorism-related curricula in medical education.
The third element in HRSA’s counter-bioterrorism arsenal, funded at $1.5 million annually, is our poison control incentive grant program, which supports efforts to improve collaboration between poison control centers and local public health agencies.
These are our priorities right now at HRSA. And you can see how each of these impacts our future planning in the area of health care workforce education and training.
In the weeks and months ahead, I can assure you that we will continue our work to ensure that an adequate and culturally competent health care workforce is available to meet the health care needs of all Americans, regardless of where they live or how much they make.
In closing, let me say I greatly appreciate the work that you have done, and the work that you will do in the future. Please continue to look to Kerry and her staff – and the rest of HRSA – for the support you need to continue the outstanding job you have been doing.
Now I’d like to close my remarks and answer any questions you may have. Thank you.
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