This is not a call for funding cuts, it is a call for careful use of the funds!
We should be careful regarding Title VII funding positions.
The studies that demonstrate effectiveness are marginal at best. The studies that I have done in the area of Title VII and the rural graduation rate of family practice residency programs reveal that Title VII funding at the graduate level has no effect. The General Accounting Office does note that the funds have some effect, but notes that the funds are poorly targeted. This appears to be true.
Title VII funds used in specific ways may certainly have an impact, especially when used in the early medical school years and before. Given what we know about the importance of admissions and working with students before medical school to get them admitted, and Rabinowitz’ work on the importance of rural background and FP interest upon matriculation into medical school, this makes sense.
Title VII has rarely been used to support rural medical education. There are some programs in rural areas that have received funds. There was one faculty development program.
Title VII has build Family Medicine infrastructure and indirectly this has helped build a foundation for rural training, since we are dependent on family medicine as the source of training chosen by those who are interested in best preparing for rural practice. Unfortunately Family Medicine has a lot of interests and rural interests are tolerated but not encouraged, especially given the large number of family physicians in rural areas or with interest in rural practice.
The political journey to restore Title VII funding each year takes up much of the potential legislative energy of several associations. These efforts could be concentrated on other important areas or the development of new sources of funding.
The safety net for the underserved, underinsured, homeless, indigent, etc. has continued to gain attention. Family Medicine is not mentioned as a member of this safety net even though our programs and practitioners deliver many of these services, we have the best distribution of practitioners, and we are the ones teaching about the safety net (or lack thereof) in medical education. We should claim this through studies and legislative work and embrace the underserved in important areas. The most important area to claim is work with Community Health Centers. This should be easy since we have had similar clinics and patient populations for decades. We have examples of CHC, FQHC, and other forms of clinic funding throughout Family Medicine. We have failed to replicate these models effectively.