Cantwell Questions Health Secretary on Cuts to Physician Training, Sequestration Impacts on Innovative Research

Press Release

By:  Maria Cantwell
Date: April 17, 2013
Location: Washington, DC

Today, U.S. Senator Maria Cantwell (D-WA) expressed concerns over the impact of cuts to Graduate Medical Education (GME) in the President's fiscal year 2014 budget proposal, saying that these cuts could negatively impact a dwindling primary care workforce, particularly in rural and underserved areas such as Eastern Washington.

Cantwell also expressed concern over the impact of sequestration on critical biomedical research that occurs at the University of Washington and other research centers across the nation. She also praised the inclusion in President Obama's budget proposal of a $1 billion investment in mental health services.

Cantwell's comments occurred today during a Senate Finance Committee hearing with Department of Health and Human Services Secretary Kathleen Sebelius on President Obama's fiscal year (FY) 2014 budget request for the department.

President Obama's FY14 budget includes a 10 percent decrease in funding for Indirect Medical Education (IME) at teaching hospitals. IME is designed to meet costs not currently covered by Medicare funding and supports physician training for treating the sickest or most critically injured patients, such as those in burn units or trauma centers. These include Level 1 trauma centers and burn centers, such as those at Harborview Medical Center, and pediatric Intensive Care Units like those at Seattle Children's Hospital.

"I wanted to follow up on my colleague from Pennsylvania's question particularly as it related to Graduate Medical Education," Cantwell said at today's hearing. "This is a big issue for all of us in the country with the shortage that we are looking at -- something like 90,000 specialists and primary care physicians by 2020. For us in the WWAMI region (Washington, Wyoming, Alaska, Montana, and Idaho), we are even below the national average now. So that's why we care so much about this issue.

"When it comes to figuring out the impact on -- he mentioned children's hospitals which I could say probably the same about Seattle Children's Hospital -- but the issue is also trauma centers or burn centers like Harborview Medical Center," Cantwell continued. "So when you look at this reduction in Indirect Medical Education, it impacts that workforce they have residents there that are not reimbursed under the Medicare model. So how do we look at this issue when there's specialized training that goes on at these trauma centers, they want to get their graduate medical? How do we look at this and make sure these facilities can keep running and operating during this time period?"

Cutting funding for physician training could negatively impact teaching hospitals like the University of Washington Medical Center, and the primary care workforce the hospitals produce. The Association of American Medical Colleges (AAMC) projects a shortage of more than 90,000 specialists and primary care physicians by the year 2020. The physician shortage is even worse for the five-state WWAMI region (Washington, Wyoming, Alaska, Montana, and Idaho), where, with the exception of Western Washington, physician supply is below the national average.

The University of Washington School of Medicine is consistently ranked among the top primary-care medical schools in the nation by U.S. News & World Report. About 50 percent of UW graduates elect to go into primary care. Only 40 new medical students per year are trained in eastern Washington -- half in Spokane, half in Pullman. Eastern Washington imports more than 80 percent of its physicians from other states and countries.

During the health care debate in 2009, Cantwell worked to include measures that expand the number of medical students pursuing careers as primary care physicians. Primary care doctors can play a significant role in cutting health care costs by skillfully coordinating and overseeing patient care. However, the current system underpays these care-givers, making primary care an unattractive option for medical students and ultimately reducing patient access to necessary care.

The law's new measure expands training capacity for primary care physicians and includes incentives for medical students who opt for a career in primary care, increasing the availability of care, especially for those in rural and underserved communities. For a summary of Cantwell's key reforms included in the law, click here.

Also during today's hearing, Cantwell questioned Secretary Sebelius on the five percent budget reduction for the National Institutes of Health (NIH) due to sequestration. NIH funding has led to major advances in the understanding of diseases like Alzheimer's, cancer and Parkinson's disease, and is a major source of funding for research institutions like the University of Washington (UW) in Seattle. UW is one of the top five public recipients of NIH funding. Nearly 60 percent of UW's total federal research funding comes from NIH, which produces 8,800 jobs, according to the university.

Cantwell said: "And if you could comment too, at the University of Washington we train so many primary care physicians. I think we are number one in the nation. But we're also very high on the list in the top five of institutions with National Institutes of Health funding so this NIH budget issue is a very big issue. Â…Given what's already in the budget and what's being discussed as far as sequestration, are we having a chilling effect on this investment in science? What can we do to help mitigate the sequestration's impact on NIH funding?"

Secretary Sebelius: "Well I think that the President has proposed a budget going forward and a way to have a sustained and balanced approach, to both reducing the deficit but making some of the critical investments that we need to make."

Senator Cantwell: "We're all cheers. Sorry to interrupt. I should just add that we are all cheers for the magnificent contribution for brain research. Thank you."

Secretary Sebelius: "And I think that's an example of the President's belief that we cannot cut our way to prosperity in the future. We must invest. Certainly scientific research is one of the most critical investments to keep the innovation and research at the front end. So he very much supports outlining the mapping strategy, which could have a huge impact. Not only on cures of the future but when you think about health cost from everything related to autism to Alzheimer's.

"And if we really want to get our arms around what's happening to health costs in the future, this kind of brain mapping has an enormous impact. And as you say I think Doctor Collins estimates there's about a $7 to $1 return -- for every dollar of research grant generates about $7 dollars in economic activity in the community -- where those research grants end up in terms of jobs and scientists. So this is clearly a win-win investment the president very strongly believes in and supports."

Senator Cantwell: "Well I hope as we continue to talk about and see the impacts of sequestration the Administration will speak out on this. Because it's a very short-sighted approach particularly when it comes to the NIH budget and I hope that we can get organizations and institutions --whether it is the Institute of Medicine or others -- to put pencil to paper and really measure this as you just did with that $7 to $1 ratio. But we may be saving a few dollars now but it will cost us millions if not billions more if we don't continue the investment in research. So I hope we can make that point to our colleagues here."

During today's hearing, Cantwell also praised the President's budget for including more than $1 billion for mental health programs at the Substance Abuse and Mental Health Services Administration (SAMSHA). This funding includes $460 million for the Community Mental Health Services Block Grant, which provides funding to states to maintain community-based mental health services for children and adults with serious mental illnesses, including rehabilitation, supported housing, and employment opportunities.

The funding request also includes $130 million to help teachers and other adults recognize the signs of mental illness in students and refer them to help if needed, support innovative state-based programs to improve mental health outcomes for young people ages 16 to 25, and train 5,000 more mental health professionals, with a focus on serving students and young adults.

"Also, thank you for the President's budget as it relates to $1 billion for mental health programs, for substance abuse and mental health services, and $460 million for the mental health block grant services," Cantwell said. "I think that will go a long way in in helping states deal with these issues. So I very much appreciate that."

A transcript of Cantwell's full remarks as delivered today follows:

Senator Cantwell: Madame Secretary, welcome. Thank you for being here and thank you for your help on Basic Health Plan, I appreciate that very much. Also thank you for the President's budget as it relates to one billion for mental health programs, for substance abuse, and mental health services and 460 million for the mental health block grant services. I think that will go a long way to helping states deal with these issues. So I very much appreciate that. I wanted to follow up on my colleague from Pennsylvania's question particularly as it related to Graduate Medical Education (GME).

This is a big issue for all of us in the country with the shortage that we are looking at -- something like ninety thousand specialists and primary care physicians by 2020. For us in the WWAMI region, Washington, Wyoming, Alaska, Montana, and Idaho, we are even below the national average now. So that's why we care so much about this issue.

When it comes to figuring out the impact on -- he mentioned children's hospitals which I could say probably the same about Seattle's children's hospital -- but the issue is also trauma centers or burn centers like Harbor View Hospital. So when you look at this reduction in indirect medical education, it impacts that workforce they have residents there that are not reimbursed under the Medicare model. So how do we look at this issue when there's specialized training that goes on at these trauma centers, they want to get their graduate medical? How do we look at this and make sure these facilities can keep running and operating during this time period?

The Honorable Kathleen Sebelius, Secretary of Health and Human Services, United States Department of Health and Human Services: Well again, Senator, I think that certainly the training of new doctors is of critical importance and we know what an important role Graduate Medical Education funding through Medicare plays in that training. Which is why I would say even in these very difficult budget times there was an attempt to make sure we were funding the direct costs. As well as doing some additional look at where there were some real gaps in services.

A lot of the workforce analysis looking forward indicates that it is in primary care providers, gerontologists, others that we often have significant gaps so we have not only tried to have a budget that supports the direct costs of graduate training but also shift some of the unused GME slots from areas that may have been more focused on specialty care into primary care, pediatrics, gerontology care. Hoping that the effort to address peoples' preventive care needs at the front end will be met with a health care provider. So we would be interested in working with you and hearing from you about the impact of this on critical centers like the burn center and the trauma centers you have in your area.

Senator Cantwell: Thank you.

Secretary Sebelius: Sure.

Senator Cantwell: We'll get you some information on that. I don't know that's the intended consequence but I think people are concerned that that will be the intended consequence because those costs aren't covered. So maybe there is something we can do there. And if you could comment too, at the University of Washington we train so many primary care physicians; I think we are number one in the nation.

But we're also very high on the list in the top five of institutions with National Institute of Health (NIH) funding so this NIH budget issue is a very big issue. And we understand what you have done, obviously these institutions were looking for, hoping to get closer to 32 billion than 31.5. And you think, okay that's close what's the difference? Why does that matter? Well for us the total economic impact for research - 8,800 jobs and 470 million in wages so this will be a big impact to us.

So in fact, one of our professors was quoted in the Wall Street Journal saying, "People are asking me whether I should leave science.' Given what's already in the budget and what's being discussed as far as sequestration are we having a chilling effect on this investment in science? What can we do to help mitigate the sequestration's impact on NIH funding?

Secretary Sebelius: Well I think that the President has proposed a budget going forward and a way to have a sustained and balanced approach, to both reducing the deficit but making some of the critical investments that we need to make.

Senator Cantwell: We're all cheers. Sorry to interrupt. I should just add that we are all cheers for the magnificent contribution for brain research. Thank you.

Secretary Sebelius: And I think that's an example of the President's belief that we cannot cut our way to prosperity in the future. We must invest. Certainly scientific research is one of the most critical investments to keep the innovation and research at the front end. So he very much supports outlining the mapping strategy, which could have a huge impact. Not only on cures of the future but when you think about health cost from everything related to autism to Alzheimer's.

And if we really want to get our arms around what's happening to health costs in the future, this kind of brain mapping has an enormous impact. And as you say I think Doctor Collins estimates there's about a 7 to 1 return -- for every dollar of research grant generates about 7 dollars in economic activity in the community -- where those research grants end up in terms of jobs and scientists. So this is clearly a win-win investment the President very strongly believes in and supports.

Senator Cantwell: Well I hope as we continue to talk about and see the impacts of sequestration the Administration will speak out on this. Because it's a very short sighted approach particularly when it comes to the NIH budget and I hope that we can get organizations and institutions --whether it is the Institute of Medicine or others -- to put pencil to paper and really measure this as you just did with that 7 to 1 ratio. But we may be saving a few dollars now but it will cost us millions if not billions more if we don't continue the investment in research. So I hope we can make that point to our colleagues here. Thank you.