Primary Care at the University of California-San Francisco.But despite support from those in the field, Title VII health professions training like many public health-related efforts often lands on the budgetary chopping block. In spite of years of cuts and flat funding, President Bush's fiscal year 2009 federal budget proposal, which was released in early February, recommends slashing HRSA's budget by about $1 billion, including a 70 percent cut to the agency's overall health professions training programs and a proposed elimination of Title VII funding."Title VII funding is essential for us," said James King, MD, president of the American Academy of Family Physicians. "Everybody knows that we don't have enough primary care physicians and yet we go through this every year."Even though Congress is expected to provide Title VII funding in the 2009 budget, King noted that tighter budgets and competing national priorities are making it more and more difficult to secure needed funds. Policy-makers acknowledge that a primary care system based on prevention works, and yet they are not making decisions to support that, he said.One way to begin strengthening that support, King told The Nation's Health, is to start closing the income gap between primary care physicians and those in the specialty fields. Most times, medical students graduate with debts in the hundreds of thousands of dollars, and primary care services simply don't bring in the dollars that specialty services do and that needs to change, King said. While there will always be a fee-for-service component, health payers should also reward primary care physicians for the substantial amounts of time they spend managing patients' health, he said. On a daily basis in his own practice, King said he spends up to 40 percent of his time working with patients on sustaining good health, such as helping patients manage chronic illnesses. Unlike many specialists who serve patients who are already sick, King added, primary care physicians focus heavily on preserving health."We need to turn around the way we pay for prevention," he said. "In geographic areas with more primary care (professionals), health is better and costs are less."And in areas with primary cares shortages, it is often already under-served communities facing health care access problems and health disparities that suffer worst, King noted. As part of a solution, U.S. policy recruits medical graduates trained abroad to come to the United States and practice in communities with low health access. In fact, according to GAO's findings, the decline in U.S. medical school graduates choosing primary care residencies is being offset by incoming international medical graduates. However, the ethics and practicalities of recruiting international medical providers to make up for domestic gaps have been questioned for some time, and many advocates are calling for a stop to the practice. In fact, a recent editorial published in the Feb. 23 issue of the Lancet discussed whether actively recruiting health workers from developing regions such as sub-Saharan Africa should be seen as a crime."The quick fix has been to recruit internationally... but we're being pushed to look at what that means globally in stripping resource-poor countries