Impact of the Affordable Care Act on Grant-Supported Primary Care Faculty Development

摘要

Background In the 50?years since its enactment, Title VII Section 747 of the Public Health Service Act1 has shaped health professions workforce development. The legislative authority of Title VII evolved through phases, with funding initially used to avert predicted physician and dentist shortages.2 Subsequent emphases included strengthening primary care, supporting care in community settings, maintaining family medicine departments, and initiating key national policy initiatives.2 The effect of Title VII on primary care includes support of collaboration among primary care specialties, strengthening primary care training, and improving the quality of training and practice through curricular enhancements.3 Title VII funding also directly finances faculty development and supports students, residents, fellows, and faculty pursuing primary care careers.4,5 Access to well-integrated primary care has been shown to improve patient and population outcomes and health care value.6–8 Enhancing access and affordability of care, themes central to the ACA, requires a high-functioning primary care system. To succeed, primary care faculty require support and development to diversify and increase scholarship and leadership opportunities.9 Enhancing faculty development in primary care is considered important to improving patient-centered care.10,11 Faculty must be capable of training a new generation of primary care professionals with substantially different skills,12 including improving the health of individuals and populations.13 Developing clinical teaching faculty members can strengthen primary care by improving their ability to succeed in evolving models and systems, by teaching new competencies, effectively leading change, and improving the quality of care.14,15 A recent review of the general literature on faculty development describes demonstrated improvements and suggests some areas that require further focus, including interprofessional care and understanding evaluation methodologies.16 Title VII appropriations are 1 vehicle to advance the competencies of primary care clinicians and teachers.17 The reauthorization of Title VII under the ACA in 2010 introduced several significant changes informed by the priorities of the primary care community and health care reform, signaling the projected direction of reform to stakeholders through funding opportunities.18 The focus of Title VII is to provide training in team-based medical homes, with 6 funding opportunities that support curriculum enhancement for physician and physician assistant education. One of these, the Physician Faculty Development in Primary Care program, supports faculty development activities for existing primary care faculty and fellows. We analyzed the Physician Faculty Development in Primary Care program before and after ACA reauthorization of Title VII.;Analyzing the ACA's Effect on Primary Care Faculty Development We assessed the changes on the Physician Faculty Development in Primary Care programs by analyzing data for fiscal year (FY) 2008, the last year faculty development funding opportunities were offered before the ACA reauthorization of Title VII and for FY 2011, when the funding opportunity announcements (FOAs) included the changes implemented under the ACA.19,20 The analysis encompassed the text of the legislation, FOAs, and grant activities, and we explored how organizational factors and changes in administration of the grant programs may have influenced grant activities and awards. The analysis was performed by Health Resources and Service Administration (HRSA) public health analysts and program and policy experts, who reviewed FY 2008 and 2011 funded application abstracts and project narrative sections. It focused on 6 content areas: interprofessional/team care, community-based training, patient-centered medical homes, cultural competency, patient safety/quality improvement, and research.21,22 The results provide a unique perspective on the impact of the ACA