November 19, 2008 CONGRESSIONAL RECORD — SENATE S10671 

by creating a corps of principals who 

are well-prepared, supported, and effective in improving student academic 

achievement in high-need schools and 

ensuring our schools are provided the 

leadership they need to prepare our 

children to compete in the 21st century. 

The U.S. Department of Labor estimates that nearly 40 percent of the 

90,000 principals in this country are 

nearing retirement, and over half the 

Nation’s school districts are facing immediate administrator shortages. This 

problem is particularly prevalent in 

urban and rural districts with large 

concentrations of high-poverty schools, 

where turnover rates can reach as high 

as 20 percent per year, and academic 

achievement is persistently low. 

That is why I’m introducing the National Principal Recruitment, NPR, 

Act, which seeks to address the impending shortage by establishing a 

corps of principals who are well-prepared, supported, and effective in improving student achievement in highneed schools. This corps is created 

through the recruitment of results-oriented candidates who possess personal 

leadership and management skills, 

knowledge of effective instruction, and 

commit to serve in high-need schools 

for over 5 years. Once selected, these 

candidates would undergo a year-long 

principal residency program, and receive support and mentoring to help 

them develop and maintain a datadriven, professional learning community. 

This bill leverages non-Federal dollars with targeted funding to performance-based work done in partnership 

with school districts. It also includes 

an evaluation to capture knowledge 

and best practices and creates a prototype of a performance-based Federal 

education program by tying funding 

levels to an evaluation of student 

achievement results. 

An effective and capable school leader can make the difference in providing 

the tools and instructional support 

needed to foster the type of school environment conducive to student academic success. The NPR Act will ensure that our neediest schools have effective leaders, who are well-equipped 

and supported, to close the achievement gap and prepare our students to 

compete in a global economy. 

I am hopeful that my Senate colleagues from both sides of the aisle will 

join me today to move this legislation 

to the floor without delay. 

By Mrs. CLINTON: 

S. 3708. A bill to amend the Public 

Health Service Act with respect to 

health professions education, and for 

other purposes; to the Committee on 

Health, Education, Labor, and Pensions. 

Mrs. CLINTON. Mr. President, today, 

I am introducing the Health Professions and Primary Care Reinvestment 

Act in order to improve access to quality health care for all Americans. By 

significantly reinvesting in the training and education of our health professionals, we are reinvesting in our communities where care is most needed. 

This bill reinvests in health professional training in three ways—by expanding the training our health professionals receive, by improving our efforts to recruit and retain health professionals, and by increasing incentives 

for health professionals who are serving in community settings, particularly in rural and urban underserved 

areas. 

Most Americans prefer to get their 

health care through a personal physician operating as part of a team-based 

primary care practice, yet the number 

of health professional students entering these fields is decreasing. We need 

more workers in primary care at the 

front lines of the health care system. 

Primary care professionals can help to 

establish a ‘‘medical home’’ for patients, providing preventive care to 

help people stay healthy and provide 

coordination of care for those with 

multiple or chronic diseases. This bill 

would achieve this goal by providing 

incentives for training primary care 

professionals, by strengthening primary care departments at the school 

and community level, and by supporting improved infrastructure to assist those serving in primary care settings. 

Minorities, disadvantaged and rural 

students are underrepresented in our 

health professional workforce. We need 

to increase their numbers in the medical fields, and provide incentives for 

them to return to underserved areas to 

practice. As an example of what can be 

done, one program targeting rural students has returned eight times the 

usual number of trained family physicians to rural settings. We need to 

train people from all backgrounds— 

from underrepresented minorities, 

from disadvantaged backgrounds, from 

rural and urban underserved communities. This bill helps to achieve this 

goal by strengthening pipeline programs, expanding loans and scholarships, and by increasing the availability of care in underserved communities. 

We need health care where people 

live and work. Americans should be 

able to access care in communities 

that are located far from hospitals and 

medical centers, in the poorest neighborhoods of cities and isolated rural 

areas. We need to support the institutions that the most vulnerable rely on 

for care, like community health centers, local departments of health, and 

nursing homes. This bill supports new 

models of care for training, recruiting, 

supporting and retaining faculty to 

serve in underserved settings, and provides infrastructure support for training students in community settings 

outside of the hospital, where patients 

need care. 

In addition to addressing primary 

care, the legislation also works to address other health fields which are 

often inaccessible to patients. Dental 

care in the United States has become a 

luxury that is unaffordable to many 

people. Dentists are often unable to 

sustain careers by teaching in dental 

schools training the next generation of 

professionals, or to work in communities where the need is greatest. This 

bill provides support for dentists to 

pursue academic teaching careers and 

to provide general care to both adults 

and children. It targets underrepresented minority dentists and those 

who will serve in communities where 

the need is greatest. 

One impediment to good health for 

people with mental health problems is 

lack of care coordination. Too often 

the psychological problem goes 

undiagnosed or untreated, because our 

health care system operates in silos. 

Patients are often asked to go one 

place to meet physical health needs 

and another place to meet mental 

health needs. This bill provides support 

for training and care where the health 

professionals work together to co-manage mental health and physical health 

problems toward better overall health. 

We, as a nation, are getting older. As 

we age, our health concerns change. 

Many seniors take multiple medications which need to be coordinated by 

a team of doctors, pharmacists, and 

other caregivers. The Health Professions and Primary Care Reinvestment 

Act reinvests in our geriatric training 

programs by expanding opportunities 

for doctors, pharmacists, psychologists, dentists and others to work with 

patients in rehabilitation centers, at 

home, in nursing homes or other settings where people live or work. 

Our public health and preventive 

medicine professionals respond to crises like SARS, anthrax, and other infectious disease outbreaks. But they 

also work to educate the public about 

ways to stay healthy, and prevent 

chronic diseases. They contribute to 

the health care safety net with services 

like adult and childhood vaccinations. 

This bill helps to support these efforts 

by reinvestment in training for prevention. It links schools of public health 

with local and State departments of 

health in order to train professionals 

to work and serve in settings where 

they are most needed. 

Finally, and very importantly, we 

must better understand the demands 

that will be made upon our health professional workforce. This bill provides 

authorization for the formation of a 

national and multiple regional health 

workforce analysis centers, along with 

an advisory committee comprised of 

administrative and health professional 

leadership. These entities will assess, 

review and oversee health professional 

workforce needs so that we can plan 

and prepare a new generation of health 

professionals in our schools and communities. 

The Health Professions and Primary 

Care Reinvestment Act addresses the 

multiple challenges facing healthcare 

workforce development in our country. 


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S10672 CONGRESSIONAL RECORD — SENATE November 19, 2008 

It will invest in primary care, expand 

the number of health professionals 

truly representative of the communities they serve, and improve the 

availability of care in places where 

Americans need it most. I look forward 

to working with my colleagues in the 

Senate on the many issues of our 

health care workforce, and I would 

urge their support of this legislation. 

Multiple organizations, including Advocating for Family Medicine, American Academy of Family Physicians, 

American Academy of Physician Assistants, American Association of Colleges of Osteopathic Medicine, American College of Preventive Medicine, 

American Dental Association, American Dental Education Association, 

American Geriatrics Association, 

American Osteopathic Association, 

American Psychological Association, 

Association of Departments of Family 

Medicine, Association of Family Medicine Residency Directors, Association 

of Minority Health Professions 

Schools, Inc., Association of Schools of 

Public Health, Hospital Association of 

New York State, National AHEC Organization, National Council for Diversity in the Health Professions, North 

American Primary Care Research 

Group, Society of General Internal 

Medicine, and the Society of Teachers 

of Family Medicine have endorsed this 

legislation. 

Mr. President, I ask unanimous consent that letters of support be printed 

in the RECORD. 

There being no objection, the material was ordered to be placed in the 

RECORD, as follows: 

ADVOCATING FOR FAMILY MEDICINE, 

Washington, DC, November 18, 2008. 

Hon. HILLARY RODHAM CLINTON, 

U.S. Senate, 

Washington, DC. 

DEAR SENATOR CLINTON: On behalf of the 

undersigned organizations, we would like to 

thank you for introducing the Health Professions and Primary Care Reinvestment Act. 

Health professions programs, authorized 

under Title VII of the Public Health Service 

Act, are vital to enhancing and expanding 

our nation’s health workforce. The Health 

Professions and Primary Care Reinvestment 

Act reauthorizes, improves, and revitalizes 

these programs. 

Within the primary care cluster (Section 

747) we are very pleased to see the following: 

Continued support for programs that have 

proven successful—training in primary care 

and capacity building in primary care. 

New recognition that an environmental 

scan of the community and region is a necessary precursor to development of creative 

training programs that will get primary care 

physician training out into the community, 

rather than training remain mostly within 

the academic health centers. 

Recognition that production of primary 

care physicians must be increased. 

Recognition that funding for these programs must increase in order to provide a 

well-prepared workforce for the 21st century, 

particularly as we move to health care reform. 

In addition, within the scope of the bill as 

a whole, we appreciate the modification of 

the statute so that all of the programs authorized by the bill have similar goals and 

expected outcomes. 

As the Senate begins its work on overall 

health care reform, we support your efforts 

to have this bill serve as one of the foundations of reform. True health reform in this 

country will not be possible without including programs that increase the number of 

well-trained health professionals. As the 

Massachusetts experience clearly demonstrates, increasing the number of insured 

individuals will not ensure increased access 

to care if there are not enough doctors to 

treat the newly insured. 

As you know, Title VII Health Professions 

Programs, particularly those authorized 

under Section 747, are designed to strengthen 

our primary care infrastructure. Studies 

have shown that areas which depend more 

heavily on primary care within their health 

care system spend less on health care and 

have better health outcomes. For example, a 

study published in Health Affairs from April, 

2004 found, ‘‘States with more general practitioners use more effective care and have 

lower spending, while those with more specialists have higher costs and lower quality.’’ (Baicker and Chandra) We know that 

health reform has two goals: bettering the 

health of our nation and keeping it as cost 

efficient as possible. Increasing the proportion of primary care medicine is a major step 

towards meeting both of these goals, and 

Title VII, Section 747 programs are the only 

federal programs that aim to increase the 

number of primary care physicians. 

Title VII programs have also demonstrated 

the ability to produce physicians that serve 

in underserved areas. A recent article in Annals of Family Medicine (Rittenhouse, et al 

2008) shows that students and residents exposed to Title VII funding are more likely to 

participate in the National Health Service 

Corps or practice in a community health 

center upon completing their training. Both 

of these programs successfully place physicians where they are most needed. 

Thank you for all of your hard work on the 

Health Professions and Primary Care Reinvestment Act and for your continued leadership and dedication to health care throughout your career. We urge you to ensure that 

this important piece of legislation makes its 

way through the legislative process and is 

passed as quickly as possible. 

Sincerely, 

SCOTT FIELDS, MD, 

President, Society of 

Teachers of Family 

Medicine. 

EILSSA PALMER, MD, 

President, Association 

of Family Medicine 

Residency Directors. 

MICHAEL K. MAGILL, MD, 

President, Association 

of Departments of 

Family Medicine. 

TED EPPERLY, MD, 

FAAFP, 

President, American 

Academy of Family 

Physicians. 

ALLEN DIETRICH, MD, 

President, North 

American Primary 

Care Research 

Group. 

AMERICAN ACADEMY OF

PHYSICIAN ASSISTANTS, 

Alexandria, VA, November 19, 2008. 

Hon. HILLARY RODHAM CLINTON, 

U.S. Senate, 

Washington, DC. 

DEAR SENATOR CLINTON: On behalf of the 

nearly 75,000 clinically practicing physician 

assistants (PAs) in the United States represented by the American Academy of Physician Assistants (AAPA), I thank you for introducing the Health Professions and Primary Care Reinvestment Act of 2008. The reauthorization of the Public Health Service 

Act’s Title VII Health Professions Programs 

is a top priority of the AAPA. Accordingly, 

AAPA is pleased to support this legislation, 

and looks forward to working with you and 

your colleagues in the Senate and House of 

Representatives to secure the strongest possible investment in and reinforcement of the 

nation’s primary care workforce. 

The Title VII safety net programs are essential to the development and training of 

primary health care professionals and, in 

turn, provide increased access to care by promoting health care delivery in medically underserved communities. Title VII funding is 

especially important for PA programs as it is 

the only federal funding available on a competitive application basis to these programs. 

A review of PA graduates from 1990–2006 

demonstrates that PAs who have graduated 

from PA educational programs supported by 

Title VII are 59 percent more likely to be 

from underrepresented minority populations 

and 46 percent more likely to work in a rural 

health clinic than graduates of programs 

that were not supported by Title VII. 

The AAPA is very pleased to see included 

in this legislation several very important updates and additions to the Title VII statute 

related to physician assistant training. Specifically, the updated definition of PA education programs is long overdue and accurately reflects the educational preparation 

of PAs, as well as the definition and standards of the approximately 140 PA programs 

in the U.S. Additionally, we strongly support 

the inclusion of a set 15 percent carve-out for 

PA programs within the primary care medicine and dentistry cluster. Finally, we support the inclusion of PA education programs 

within many new or expanded programmatic 

sections of the bill, including geriatric training centers and continuing education programs for health professionals in underserved areas. 

The AAPA applauds your efforts to support 

and expand America’s primary care workforce through a clarified and strengthened 

Title VII. We are pleased to work with you 

and to support the Health Professions and 

Primary Care Reinvestment Act of 2008. 

Sincerely yours, 

WILLIAM F. LEINWEBER, 

Executive Vice President/Chief 

Executive Officer. 

AMERICAN COLLEGE OF

PREVENTIVE MEDICINE, 

November 18, 2008. 

Hon. HILLARY R. CLINTON, 

Russell Senate Office Building, 

Washington, DC. 

DEAR SENATOR CLINTON: On behalf of the 

American College of Preventive Medicine I 

write to express our sincere appreciation and 

thanks for your efforts to reauthorize the 

Title VII health professions training programs at the Health Resources and Services 

Administration, HRSA. As a result of your 

steadfast commitment to bolstering our 

health care safety net in underserved communities and extending the reaches of preventive medicine physicians, health care 

services—including important preventive 

services—will reach the doorsteps of countless Americans who currently lack access to 

a health care provider. 

With your legislation the time has now 

come to reinvigorate and refinance the Title 

VII health professions training programs at 

the necessary levels in order to protect access to health care for vulnerable populations, improve disease prevention and 

health promotion efforts, and maintain our 

graduate medical education commitment to 

quality and workforce diversity. 


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November 19, 2008 CONGRESSIONAL RECORD — SENATE S10673 

While a limited number of preventive medicine residency training programs in New 

York and other states have benefited from 

Title VII funds, it is important that Congress act now to expand the reaches of Title 

VII’s mission to enhance the supply, diversity, and distribution of the health care 

workforce in all underserved communities 

across the country. A key step toward addressing health system reform is ensuring 

availability of services across all communities. 

We thank you for recognizing the importance of preventive medicine physicians in 

securing our health care safety net and promoting disease prevention and health promotion programs. We look forward to our 

continued dialogue and thank you for the opportunity to work with you and your staff to 

address this very important issue. 

Sincerely, 

MICHAEL D. PARKINSON, MD, 

MPH, FACPM, 

President. 

ADA/AMERICAN DENTAL ASSOCIATION, 

Washington, DC, November 19, 2008. 

Senator HILLARY RODHAM CLINTON, 

Russell Office Building, 

Washington, DC. 

DEAR SENATOR CLINTON: The American 

Dental Association, ADA, which represents 

156,000 dentists, congratulates you on introducing the ‘‘Health Professions and Primary 

Care Reinvestment Act.’’ The ADA greatly 

appreciates the attention that you and your 

staff have given to the unique needs of Title 

VII federal dental programs and believe that 

many of the changes incorporated in this bill 

will help greatly to advance these programs. 

We are especially pleased that your bill 

provides general practice and pediatric dental residency programs with a funding line. 

This acknowledgement underscores that oral 

health care is as equally important as medical care and should not be a subset of medical program funding. We believe that by creating Section 748 Training in General and 

Pediatric Dentistry that Congress will be 

better able to effectively address dental education training needs. 

We also appreciate the inclusion of dentists in Section 9, which focuses on geriatric 

training. The ADA has placed a high priority 

on addressing the oral health needs of ‘‘vulnerable’’ older adults—individuals over age 

65 with limited mobility and/or limited resources and/or complex health status. Older 

adults face a variety of special oral health 

challenges, including root and coronal caries, periodontal disease, tooth wear, 

edentulousness, oral cancer, complications 

from taking prescription and over-thecounter medications and other medical concerns that affect oral health. We recognize 

that a key component in addressing these 

needs is to enhance the educational infrastructure and dentist education and training. We believe that your bill has opened the 

door to accomplish these goals. 

Addressing the oral health care needs of 

the older generation often overlaps with providing care to children and adults with intellectual and developmental disabilities. While 

the bill does not include a new section to address the training of dentists to work with 

these patients, we understand the time constraints your staff faced in getting this bill 

introduced this year. We look forward to 

continuing to work with you on this issue 

and remain hopeful that we will be able to 

include a provision dealing with this important issue next year. 

Thank you and your staff, particularly Dr. 

Kathleen Klink, for working with the American Dental Association to enhance dental 

education programs. We believe that the 

‘‘Health Professions and Primary Care Reinvestment Act’’ will contribute to the ADA’s 

own efforts to improve dental education programs and improve the oral health care of all 

Americans. 

Sincerely, 

JOHN S. FINDLEY, D.D.S., 

President. 

ADEA AND AAPD, 

November 19, 2008. 

Hon. Hillary Clinton, 

U.S. Senate, 

Washington, DC. 

DEAR SENATOR CLINTON: The American 

Dental Education Association (ADEA) and 

the American Academy of Pediatric Dentistry (AAPD) are pleased to endorse the 

Health Professions Primary Care Reinvestment Act. Our organizations represent dental education and the practicing pediatric 

dentists. 

The primary care dental provisions contained in the legislation continue and enhance the cost-effective General Dentistry 

and Pediatric Dentistry residency training 

programs. The bill also authorizes support of 

dental loan repayment for those who teach 

or conduct research in General or Pediatric 

Dentistry residencies, which is particularly 

important to maintaining a cadre of welltrained dentists to meet the oral health care 

needs of the nation. Most importantly, we 

are delighted with the language which allows 

dental schools to apply for grants for faculty 

development and academic administrative 

units. We applaud the decision to provide a 

guideline authorization of $20 million for 

these important programs. 

Our Associations appreciate the time and 

effort that you and your staff made to consider our analysis of important trends and 

needs in dental education, and to address our 

concerns about the bill. The Health Professions Primary Care Reinvestment Act is a 

significant improvement over legislation in 

the last Congress in terms of provisions affecting health workforce, information, evaluation and analysis, and geriatric training. 

Your staff is to be commended for drafting 

legislation that is performance-based and ensures that important strides made to date 

will not be diminished. 

Please contact our legislative representatives if we can be of further assistance: Myla 

Moss at ADEA 202–289–7201 or Scott Litch at 

AAPD 312–337–2169 ext. 29. 

Sincerely, 

BEVERLY LARGENT, D.M.D., 

AAPD President. 

JOHN S. RUTKAUSKAS, 

D.D.S., M.B.A., CAE, 

AAPD Chief Executive 

Officer. 

CHARLES N. BERTALOMI, 

D.D.S., D.M.SC., 

ADEA President. 

RICHARD W. VALACHOVIC, 

D.M.D., M.P.H, 

ADEA Executive. 

ASSOCIATION OF MINORITY HEALTH

PROFESSIONS SCHOOLS, INC., 

WASHINGTON, DC, NOVEMBER 19, 2008. 

Senator HILLARY RODHAM CLINTON, 

U.S. Senate, Russell Senate Office Building, 

Washington, DC. 

DEAR SENATOR CLINTON: The Association of 

Minority Health Professions Schools 

(AMHPS) applauds your introducing the 

Health Professions and Primary Care Reinvestment Act. The Title VII Health Professions programs help strengthen and diversify 

our nation’s primary care workforce. The 

Health Professions and Primary Care Reinvestment Act reauthorizes these vital programs while greatly improving them. 

AMHPS is particularly interested in your 

efforts to continue to strengthen the diversity cluster of the Title VII programs—Centers of Excellence (COI), Health Careers Opportunities Program (HCOP), Faculty Loan 

Repayment, and Scholarships for Disadvantaged Students (SDS). These programs have 

been a tremendous federal government investment into the institutions that focus on 

increasing the number of health professionals and the diversity of the health professions. In the November 2008 issue of Academic Medicine, the article ‘‘Funding the Diversity Programs of the Title VII Health 

Professions Training Grants: An Urgent 

Need,’’ written by two AMHPS institution 

presidents—Dr. John Maupin of Morehouse 

School of Medicine and Dr. Wayne Riley of 

Meharry Medical College—confirms that 

your efforts making a tremendous effort towards improving the health of all Americans. 

Again. thank you for introducing the 

Health Professions and Primary Care Reinvestment Act. Your continued leadership and 

dedication to health care is greatly appreciated. We urge you to do all that you can to 

see that building a stronger workforce of primary care professionals that is more diverse 

is a top priority during the current health 

care debate. Ensuring passage of your important bill would be a very good first step, 

Sincerely, 

WAYNE HARRIS, PH.D., 

Chairman, Board of 

Directors, Association of Minority 

Health Professions 

Schools. 

ASSOCIATION OF SCHOOLS OF

PUBLIC HEALTH, 

Washington, DC, November 18, 2008. 

Hon. HILLARY RODHAM CLINTON, 

Russell Senate Office Building, 

Washington, DC. 

DEAR SENATOR CLINTON: On behalf of the 

Association of Schools of Public Health 

(ASPH), I would like to thank you for introducing the Health Professions and Primary 

Care Reinvestment Act. Your leadership in 

introducing legislation that would reauthorize Title VII of the Public Health Service Act 

takes a vital step in providing support to the 

health care delivery system, health care and 

public health professionals. 

By 2012 over 100,000 public health workers 

are eligible to retire (23 percent of the workforce). More importantly, in order to have 

the same public health workforce to population ratio in 2020 as existed in 1980, the 

public health workforce would need to add 

an additional 250,000 workers. As Congress 

begins to consider legislation that would 

overhaul the health insurance system in this 

country, we hope that the Health Professions 

and Primary Care Reinvestment Act will be 

considered to ensure a well trained health 

care workforce will be in place to meet the 

increased demand for basic health care services. 

We would like to thank you for the inclusion of public health in several sections of 

the bill including the Health Professions 

Training for Diversity provisions of the legislation. Expansion of the program to include training for the next generation of researchers and educators is important as public health researchers in the early stages of 

their careers offer novel investigator-initiated research ideas that could transform 

science and policy. 

We applaud the establishment of the Academic Health Department (AHD) Program to 

establish partnerships between accredited 

Schools of Public Health (SPH) and state or 

local public health departments. This program has demonstrated success in expanding 

SPH/health department partnerships with 

the goal of developing models of collaboration in the areas of teaching and service. The 


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S10674 CONGRESSIONAL RECORD — SENATE November 19, 2008 

training programs offered by AHDs will provide learning opportunities for public health 

professionals throughout their careers. We 

also appreciate the continued support of the 

existing Public Health and Preventive Medicine Program which offers vital support to 

train health professionals in this important 

area. 

Again, we would like to thank you for your 

leadership and we look forward to working 

with you as you work to advance this legislation. We are glad to see your commitment 

to addressing workforce shortage issues in 

health care and offer our support of the 

Health Professions and Primary Care Reinvestment Act. 

Sincerely, 

HARRISON C. SPENCER, MD, MPH, 

President and CEO. 

NATIONAL AHEC ORGANIZATION, 

Oak Creek, WI. 

Hon. HILLARY RODHAM CLINTON, 

U.S. Senate, Russell Senate Office Building, 

Washington, DC. 

DEAR SENATOR CLINTON: On behalf of the 

National Area Health Education Center Organization (NAO), I would like to offer support for the Health Professions and Primary 

Care Reinvestment Act legislation that includes AHEC reauthorization. 

Your ongoing support of the National 

AHEC Organization and the AHEC centers 

and programs that we represent across the 

country are critical to the health professions 

pipeline, quality education and training programs for health care professionals, allied 

health professional and students across the 

county. 

The Health Professions and Primary Care 

Reinvestment Act will ensure the sustainability of the many critical programs offered 

by AHEC’s throughout the nation. 

Please feel free to call upon the NAO for 

additional support as you move forward with 

your efforts and be assured that our support 

and this letter may be used publicly to advance the Health Professions and Primary 

Care Reinvestment Act legislation. 

Sincerely, 

ROSE M. YUHOS, 

NAO President. 

NATIONAL COUNCIL FOR DIVERSITY

IN THE HEALTH PROFESSIONS, 

November 19, 2008. 

Hon. HILLARY RODHAM CLINTON, 

U.S. Senate, Russell Senate Office Building, 

Washington, DC. 

DEAR SENATOR CLINTON: The National 

Council on Diversity in the Health Professions (NCDHP) applauds your introducing 

the Health Professions and Primary Care Reinvestment Act. The Title VII Health Professions programs help strengthen and diversity 

our nation’s primary care workforce. The 

Health Professions and Primary Care Reinvestment Act reauthorizes these vital programs while greatly improving them. 

NCDHP is interested in your efforts to continue to strengthen the diversity cluster of 

the Title VII programs, particularly the reauthorization of Centers of Excellence (COE) 

and Health Careers Opportunities Program 

(HCOP). For many years, these programs 

have demonstrated a tremendous federal 

government investment into the institutions 

that focus on increasing the number of 

health professionals and the diversity of the 

health professions. 

Again, thank you for introducing the 

Health Professions and Primary Care Reinvestment Act. Your continued leadership and 

dedication to health care is greatly appreciated. We urge you to do all that you can to 

see that building a stronger workforce of primary care professionals that is more diverse 

is a top priority during the current health 

care debate. Ensuring passage of your important bill would be a very good first step. 

Sincerely, 

WANDA D. LIPSCOMB, 

Chair. 

SOCIEIY OF GENERAL

INTERNAL MEDICINE, 

Washington, DC, November 17, 2008. 

Hon. HILLARY RODHAM CLINTON, 

Russell Senate Office Building, 

Washington, DC. 

DEAR SENATOR CLINTON: On behalf of the 

Society of General Internal Medicine, I want 

to applaud your leadership in advancing national policies that promote improved patient care for all Americans. In particular, I 

want to commend you on the introduction of 

the Health Professions and Primary Care Reinvestment Act. 

By any measure, primary care, including 

general internal medicine, is the cornerstone 

of our nation’s health care system. Patients 

with primary care physicians have better 

health status, longer life expectancy and 

lower health care costs. Moreover, for the 

poor, the uninsured and the elderly, primary 

care functions as a safety net, serving as the 

first and often the only contact for care and 

treatment. 

For more than three decades, the Title VII 

Training in Primary Care Medicine and Dentistry (TPCMD) program, in particular, has 

contributed significantly to improving the 

quality of education and training of the nation’s primary care workforce, with special 

emphasis on individuals from disadvantaged 

backgrounds and underrepresented minorities. But challenges remain. For example, 

forecasts are that the demand for general internists will increase by 38 percent within 

the next 15 years, while the number of new 

physicians entering the field of general internal medicine continues to decline. 

By strengthening and expanding the 

TPCMD program, your legislation recognizes 

that primary care is the linchpin of our 

health care system and that an adequate, 

well-trained primary care workforce is critical to the success of any health care reform 

measures Congress undertakes. 

In addition, your legislation calls for a 

more comprehensive approach to addressing 

the systemic needs of our health care system, including the creation of primary care 

training institutes that will promote all-important collaboration across all primary care 

disciplines, as well as partnering with community health centers in a way that will 

speed the translation of research into community practice. Furthermore, the work of 

these institutes will help contribute to better health outcomes by fostering the development of the patient-centered medical 

home model. 

At a time when 47 million Americans lack 

health coverage, when increasing numbers of 

elderly are entering the age of highest risk 

of chronic disease, and when racial and ethnic disparities persist, the Health Professions and Primary Care Investment Act provides a solid framework for meeting these 

challenges. 

Again, thank you for introducing this important legislation. As in the past, our Society stands ready to assist you in whatever 

way we can. 

Sincerely, 

LISA V. RUBENSTEIN, 

President. 

SUBMITTED RESOLUTIONS 

SENATE RESOLUTION 707—AUTHORIZING THE PRESIDENT OF 

THE SENATE TO CERTIFY THE 

FACTS OF THE FAILURE OF 

JOSHUA BOLTEN, AS THE CUSTODIAN OF RECORDS AT THE 

WHITE HOUSE, TO APPEAR BEFORE THE COMMITTEE ON THE 

JUDICIARY AND PRODUCE DOCUMENTS AS REQUIRED BY COMMITTEE SUBPOENA 

Mr. LEAHY submitted the following 

resolution; from the Committee on the 

Judiciary; which was placed on the calendar: 

S. RES. 707 

Whereas, since the beginning of this Congress, the Senate Judiciary Committee has 

conducted an investigation into the removal 

of United States Attorneys; 

Whereas, the Committee’s requests for information related to its investigation, including documents and testimony from the 

White House and White House personnel, 

were denied; 

Whereas, the White House has not offered 

any accommodation or compromise to provide the information requested that is acceptable to the Committee; 

Whereas, on April 12, 2007, pursuant to its 

authority under Rule 26 of the Standing 

Rules of the Senate, the Senate Committee 

on the Judiciary authorized issuance to the 

Custodian of Records at the White House, a 

subpoena which commands the Custodian of 

Records to provide the Committee with all 

documents in the possession, control, or custody of the White House related to the Committee’s investigation; 

Whereas, on June 13, 2007, the Chairman 

issued a subpoena pursuant to the April 12, 

2007, authorization to White House Chief of 

Staff Joshua Bolten as the White House Custodian of Records, for documents related to 

the Committee’s investigation, with a return 

date of June 28, 2007; 

Whereas, on June 28, 2007, in response to 

subpoenas for documents issued by the Senate and House Judiciary Committees, White 

House Counsel Fred Fielding conveyed the 

President’s claim of executive privilege over 

all information in the custody and control of 

the White House related to the Committee’s 

investigation; 

Whereas, based on this claim of executive 

privilege, Mr. Bolten refused to appear and 

produce documents to the Committee in 

compliance with the subpoena; 

Whereas, on June 29, 2007, the Chairmen of 

the House and Senate Judiciary Committees 

provided the White House with an opportunity to substantiate its privilege claims by 

providing the Committees with the specific 

factual and legal bases for its privilege 

claims regarding each document withheld 

and a privilege log to demonstrate to the 

Committees which documents, and which 

parts of those documents, are covered by any 

privilege that is asserted to apply and why; 

Whereas, the White House declined this opportunity in a July 9, 2007, letter to the Committee Chairmen from Mr. Fielding, while 

reiterating the privilege claim; 

Whereas, on August 17, 2007, Mr. Fielding 

rejected the Chairman’s request for a meeting with the President to work out an accommodation for the information sought by 

the Committee; 

Whereas, on November 29, 2007, the Chairman ruled that the White House’s claims of 

executive privilege and immunity are not legally valid to excuse current and former 


rfrederick on PROD1PC67 with SENATE