Commentary: evaluating Title VII investments in primary care training: drop in the ocean, or levee against the flood?

The Title VII primary care programs have been in place for over thirty years to improve Americans' access to primary care clinicians, especially physicians, through community based, primary care-focused education of students and residents, and preparation of faculty. Despite the long investment in these programs, however, U.S. medical students' interest in primary care has reached new lows. So it might seem obvious why the president's Office of Management and Budget (OMB) declared the Title VII primary care programs "ineffective;" But the OMB analysis aggregates these into an overall assessment of 40 separate Health Resources and Services Administration health professions programs. Furthermore the OMB evaluation of the Title VII primary care programs did not consider the outcomes most readily affected by these grants-those on the individual students, residents, faculty, and institutions. Accordingly, it does not reflect the important role of Title VII in building and sustaining primary care teaching over the years, an impact extensively documented in the accompanying articles. The Title VII primary care programs have struggled with diminishing levels of funding even as sources of support for specialized education have flooded into medical schools and teaching hospitals. What is most impressive about the successes of the Title VII primary care programs documented in the accompanying articles is not just the impressive record of accomplishment but that it occurred despite the powerful forces driving subspecialty care. Hopefully, the next generation of policy makers will use this important history to recommit to a national investment in primary care education.This commentary is part of a theme issue of Academic Medicine on the Title VII health professions training programs.