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July 2001 Volume 7 Number 7
Bush budgets $0 for FPs' training
Specialty fights back in contacts with CongressBY JANE STOEVER
Exactly nothing -- that's what President George W. Bush allocated for family practice training in his proposed 2002 budget. Academy staff discovered this threat to the specialty's future as they analyzed budget specifics before the specialty made its spring legislative visit to Congress.
Pete Modaff points to a map of his state, Washington, as he studies maps several FPs brought to him and his boss, Rep. Norman Dicks. From left are Bob Moser, M.D., of Tribune, Kan.; Modaff; Erika Bliss, M.D., of Seattle; and Mary Frank, M.D., of Rohnert Park, Calif. See page 2 for more on the maps.About 50 FPs flew to the capital, learned of the threat and came to the specialty's defense in contacts with reporters, lawmakers and their aides.
"There's a dramatic decrease in the number of students interested in family medicine," Daniel Onion, M.D., told a reporter at the Capitol May 21. Onion directs the Maine-Dartmouth Family Practice Residency in Augusta.
"Our residency had 63 applicants this year versus 101 four years ago. It's a damn disaster. If this (Title VII) money goes away, I'm worried about the pipeline, the students we want to attract to family practice," said Onion. "We have patients banging on our doors. We can't let patients in because we already don't have enough family physicians."
President Bill Clinton had several times zeroed out the specialty's Title VII funds "with a wink and a nod," expecting Congress to replenish the Title VII money anyway, which it did, said Kevin Burke, director of the AAFP Government Relations Division.
"President Bush is saying he wants Title VII cut because of the 'glut of physicians,' and with the tax cut, there'll be less funding for discretionary spending, including Title VII," said Burke.
Bush has proposed building 100 new community health centers and expanding another 100. Family physicians would be prime candidates for staffing those centers, Burke said. "But without support from Title VII grants for family practice training, the community health centers will not be able to fulfill the added expectations. It's a formula for failure."
Burke added, "We need to let Congress know there's already a shortage of family physicians in many areas."
FPs hit the Hill
The FPs took the Title VII challenge and ran with it, straight up Capitol Hill, during the May 20 - 22 lobbying effort sponsored by AAFP and the Organizations of Academic Family Medicine.
Erika Bliss, M.D., a first-year resident at Swedish Family Medicine Residency in Seattle and a graduate of the University of California in San Diego, was one of four AAFP members who talked about Title VII with Pete Modaff, an aide to Rep. Norman Dicks, D-Wash.
"My work at the San Diego Free Clinic -- which started small with Title VII support -- very much sustained my desire to go into primary care during my four years in medical school," Bliss told Modaff. "These programs have a ripple effect." She said 75 percent of UCSD medical students are now involved in the clinic, which has become part of the local health care safety net.
"I'm worried about the pipeline," says Daniel Onion, M.D., right, explaining how cutting Title VII funds could clog the flow of medical students to family practice. Reggie Beekner, reporter with Medill News Service, listens.Dicks serves on the House Appropriations Committee; Academy members addressed Title VII issues with several members of the House and Senate Appropriations Committees because of the committees' influence in shaping the federal budget.
Modaff related Title VII concerns to the then-proposed tax cut: "Norm (Dicks) thinks the size of the tax cut is a big mistake. This Title VII situation is the chickens coming home to roost. Norm will vote with you guys on this."
Visits cover various issues
In the office of Sen. Ted Stevens, R-Alaska, (then) chair of the Senate Appropriations Committee, aide Liz Connell gave the Academy members some insights into the committee's agenda this year. "The Labor/HHS bill may be the last to move (through the committee) this year," said Connell. "And there are caps on discretionary spending. But the senator is interested in student loan forgiveness, and we are looking at a community health centers bill."
"That would really help out Anchorage Neighborhood Health Center," said Dwight Smith, M.D. He should know. He's a faculty member of Alaska Family Practice Residency in Anchorage; the residents care for many of the center's patients.
Discussing possible legislation on a patient safety reporting system, Rep. Mark Kirk, R-Ill., agreed with the FP visitors on the need to keep the system nonpunitive, so physicians won't fear that their reports could trigger lawsuits. Kirk told the family physicians, "We're all for patient safety, but I don't want you to be afraid to practice medicine."
First-timers find niche
Some FPs joined the legislative visits to the Capitol for the first time. "A lot of our members look at Washington as being a big black box -- the less we know about it, the more comfortable we are," said James North, M.D., of Toledo, president-elect of the Ohio AFP, after his first lobbying effort in Washington.
"I learned a lot. It hit home, how interested the lawmakers and their staffs are in hearing our viewpoint," said North. "They appreciate us because we're patient advocates -- we're lobbying for things for our patients. They've got a lot of constituents who are our patients."
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FP Report is published by the AAFP News Department.
Copyright © 2001 by American Academy of Family Physicians.
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