A Legislative History of Federal Assistance for Health Professions Training in Primary Care Medicine and Dentistry in the United States, 1963–2008
This article reviews the legislative history of Title VII of the United States Public Health Service Act. It describes three periods of federal support for health professions training in medicine and dentistry. During the first era, 1963 to 1975, federal support led to an increase in the overall production of physicians and dentists, primarily through grants for construction, renovation, and expansion of schools. The second period, 1976 to 1991, witnessed a shift in federal support to train physicians, dentists, and physician assistants in the fields of primary care defined as family medicine, general internal medicine, and general pediatrics. During this era, divisions of general internal medicine and general pediatrics, and departments of family medicine, were established in nearly every medical and osteopathic medical school. All three disciplines conducted primary care residencies, medical student clerkships, and faculty development programs. The third period, 1992 to present, emphasized the policy goals of caring for vulnerable populations, greater diversity in the health professions, and curricula innovations to prepare trainees for the future practice of medicine and dentistry. Again, Title VII grantees met these policy goals by designing curricula and creating clinical experiences to teach care of the homeless, persons with HIV, the elderly, and other vulnerable populations. Many grantees recruited underrepresented minorities into their programs as trainees and as faculty, and all of them designed and implemented new curricula to address emerging health priorities.
This article is part of a theme issue of Academic Medicine on the Title VII health professions training programs.