Washington, D.C.
November 4, 2003

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I am delighted to be here today for this Health Professions Partnership Forum.
 
Kerry Nesseler and David Rutstein will follow me to tell you more about the vision they have for the Bureau of Health Professions and the goals they have set for this meeting.
 
I’d like to begin by discussing the progress we’ve made in reaching the goals President Bush set in two Presidential initiatives he assigned to HRSA: expanding the health center system and reforming and expanding the National Health Service Corps.
 
I’d also like to tell you about important responsibilities Congress and the President have recently given us in the area of counter-terrorism, primarily through HRSA’s new Hospital Preparedness program.
 
Over the next few years, HRSA’s value as an instrument of federal policy will -- to a large degree -- be judged by our ability to reach the goals set by the two Presidential initiatives and to implement the hospital preparedness program.   Success in these endeavors will bring access to health care to millions more Americans and protect our people from terrible harm.
 
All of these efforts require skilled health care professionals in greater number, diversity and geographic distribution than we have today.  And all of them will need new skills we never envisioned a decade ago.  We all need a greater knowledge of public health and recognition of the links between the health care and public health systems.
 
All of three efforts have the potential to dramatically impact the career choices and destinations of health professionals across America .
 
The expansion of the health center network offers immediate job opportunities for thousands of health professionals who want to use their skills to help the neediest among us.   National Health Service Corps resources are now in reach of more health professions students than ever before.
 
And the hospital preparedness program, together with related investments at the Centers for Disease Control and Prevention, creates new demand for health professionals with special expertise in responding to disasters and in tracking, treating and containing mass threats to public health.  
 
Let me begin by telling you where we are in administering the President’s Health Center Expansion Initiative.  In 2002 HRSA exceeded our targets by funding 171 new health center access sites and expanding capacity at 131 centers – 41 sites beyond our goal.
 
And we also surpassed the goals we set for 2003 of 90 new access grants and 80 grants to expand medical capacity.  We exceeded the new access grant target by an even dozen and the target for expanded medical capacity by seven grants.  
 
When the Uniform Data System figures for 2003 come in next summer, we fully expect that our 2003 grants will continue the unprecedented gains in service delivery achieved in 2002, the first full year of the expansion:
 

• In 2002 health centers served more than 11.3 million patients, an increase of more than a million patients over 2001.  Total patient encounters grew from 40.3 million in 2001 to just under 44.8 million in 2002, and health centers treated 373,000 more uninsured patients than in the previous year.
  
  
• Health centers continued to serve their traditional patient base during the expansion.  In 2002, 39 percent of patients had no health insurance; 88 percent earned 200 percent or less of the poverty line; and 64 percent were minorities.
  
  
• And health centers continued in 2002 the trend of expanding the services they offer – 68 percent had mental health services, 69 percent pharmacy services, and 72 percent offered preventive dental care.

One of the biggest challenges we face in implementing the expansion is in finding the right people to fill the new positions.  We estimate that we’ll need to add 36,000 new health center staff through 2006 to meet the President’s goals, including more than 11,000 clinicians.
 
This is a difficult task, no doubt about it.  We did pretty well in FY 2002, exceeding one goal, just missing another.  Our goal in 2002 was to add 7,200 additional staff to the health center network; we added 7,600.  We wanted to add 2,200 additional clinicians; we added 2,000.
 
National Health Service Corps clinicians have a fundamental role in our staffing strategy.  As part of his plan to expand the health center system, President Bush also directed us to reform and expand the Corps – that’s the second Presidential initiative HRSA is responsible for.  And the move, of course, makes sense, because about half of the more than 2,700 current NHSC scholars and loan repayors work in health centers.
 
The NHSC’s 2003 budget of $171 million was an increase of about $26 million over 2002, and it will pay for hundreds of new Scholars and Loan Repayors.  The President’s budget for 2004 requests yet another increase, this time of $42 million.  That, too, will pay for additional hundreds of more NHSC clinicians.
 
But you can see by those numbers that not even the NHSC expansion will cover the slots we’ll need to fill at the health centers.
 
How will we do it?  Well, we’ll need to develop new recruitment and retention strategies, improve existing ones, and work with residency and educational training programs.  And frankly, we’ll ask our friends and partners – folks like you -- for help reaching the people we need and persuading them to join us in our quest to extend access to health care to those who need it most.
 
The situation is challenging, but it also expands opportunities for health care professionals who want to serve America .  We welcome your help and advice on meeting these staffing goals.
 
Another certain area of growth for health care professionals in the 21st century is in the field of disaster preparedness.  HRSA has three programs that form a major part of the federal government’s response to the challenges posed by terrorist groups.
 
HRSA’s main counter-terror responsibility, funded this year at half a billion dollars – that’s billion with a “b” – is our National Bioterrorism Hospital Preparedness Program.  Launched in 2002 in the wake of the September 11 attacks, the Hospital Preparedness program is structured to develop and sustain “surge capacity” at hospitals sufficient to handle mass casualty events.  It goes without saying that our hospitals – along with health centers and other first-responders -- will play a critical role in identifying and responding to terrorist attacks or outbreaks of infectious disease.

Two months ago Secretary Thompson gave us HRSA’s FY 2003 hospital preparedness funds.  At the same time he sent $870 million to the Centers for Disease Control and Prevention.  Those funds will be used to strengthen public health systems by improving surveillance and epidemiology, biological and chemical lab capacity, and communications technology.
 
The FY 2003 hospital preparedness dollars support investments identified in plans devised last year by states.  These include more hospital beds, the development of isolation capacities, and the establishment of hospital-based pharmacy stocks.  Funds also will be used to identify additional health care personnel who would be called on in an emergency “surge,” and to provide personal protective equipment, extra mental health services, and trauma and burn care.
 
The HRSA and CDC funds go directly to state governments, but the funds don’t stay there.  In HRSA’s hospital preparedness program, for example, 80 percent of the funds must go to local hospitals and clinics, health centers, EMS centers and the like.  In this effort, CDC and HRSA will support the public health infrastructure of the states and local governments.  This is a positive step in our counter-terrorism effort and it is also providing much needed reinforcement of our public health system, which has been neglected for too long.
 
Many observers attribute the impressive response by state and local officials to the recent health threats posed by SARS, monkeypox and the West Nile virus to the coordination stimulated by the HHS grants.
 
The second counter-bioterror program HRSA is responsible for is a new “Bioterrorism Training and Curriculum Development Program,” which provides continuing education and training for health care professionals and adds bioterrorism curricula in medical education.
 
Last month the Secretary announced $26.5 million in FY 2003 competitive grants under the program.  The continuing education grants, which totaled $22.3 million, went to grantees in 19 states; the curriculum development grants totaled $4.2 million and went to grantees in 12 states.  Most of the grants were won by major academic health centers, many of which have designed partnerships with local and state health departments to do the training.
 
President Bush has proposed $60 million for bioterrorism training and curriculum development in FY 2004, with the goal of providing continuing education for 38,000 health care professionals over the 2003-04 period.
 
The third element in HRSA’s counter-bioterrorism arsenal is our poison control incentive grant program.  Last month I announced 11 grants, worth about $1.5 million, which went to poison control centers and universities in 11 states to improve services and boost collaboration among poison control centers and local public health agencies.

Let me close by saying that at HRSA, as career civil servants – of which I am one – we are proud to accept the responsibilities that President Bush and the Congress have entrusted to us.
 
The biggest challenge we face as we go forward, however, may be this one: HRSA can expect no more full-time employees in the near future, no more FTEs, even as our workload increases substantially with the health center expansion and the new hospital preparedness program.
 
In response to this crunch, HRSA has over the last two years reorganized and streamlined many structures and processes, especially at the Bureaus of Primary Health Care and Health Professions.  Additionally, we have completed the enormous task of centralizing and standardizing the process of rating, distributing and overseeing the 6,500 grants that HRSA awards each year.
 
We made these changes because we knew we had to work smarter and more efficiently to reach the goals President Bush and Secretary Thompson set for us.  We had no alternative.
 
But I assure you that we have based this process of change at HRSA on a foundation of consultation and dialogue with our many partners.  It is a theme that runs through all the internal improvements we’ve made, and it continues today with this visit to talk with and listen to all of you.
 
I thank you for the invitation to be here.  Now I’d like to close my remarks and answer any questions you may have.  Thank you.