Sen. Collins Speaks About Legislation to Fund Teaching Health Centers

WASHINGTON, Aug. 5 -- Sen. Susan M. Collins, R-Maine, issued the following statement, which was published in the Congressional Record on Aug. 3, on legislation (S. 1754) 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:

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 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 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.