1. Sustaining Fellowship Funding Tina L. Cheng, MD, MPH Johns Hopkins University Academic Pediatric Association

2. DISCLOSURE STATEMENT Tina Cheng has documented that she has no relevant financial relationships to disclose.

3. Fellowships and their Funding Fellowships and their Funding Funding Challenges Funding Challenges Advocacy to Ensure Funding Advocacy to Ensure Funding

4. Strengthening Academic General Pediatric Fellowships Academic Pediatric Association Guidelines

5. How Many AGP Fellowships Are There? APA Website –23 General Pediatrics –5 Health Services Research –2 Hospitalist, 3 Child Abuse, 1 Environ H JPeds annual listing for General Pediatrics –2006: 17 –2007: 23 –2008: 17

6. Does your Division have a fellowship program focusing on clinical care, education, or research? 31% have a fellowship (36) 31% have a fellowship (36) Of those, 76% offer a degree Of those, 76% offer a degree 15% one yr, 50% two yr, 35% three yr 15% one yr, 50% two yr, 35% three yr 65% funded by federal/foundation $ 65% funded by federal/foundation $ 32% funded by hospital/department 32% funded by hospital/department 13% plan to start a new fellowship within 2 yrs 13% plan to start a new fellowship within 2 yrs Pediatrics. 2007; 119:e46-52

7. Fellowship Funding Sources Federal Grants –Title VII Faculty Development Grants Primary Care Clinician Research Fellowship Primary Care Master Educator Fellowship Community Preceptor Faculty Development –HRSA and AHRQ NRSA Program Grants –NIH T-32 Program Grants, Center Grants –NIH individual NRSAs, K99/R00

8. Fellowship Funding Sources Division/Department/Institution Clinical Contracts Other Sources

9. Challenges in Fellowship Funding  Where in the pipeline should the focus be?  What generalists (educators, researchers, practitioners) should be priority?  What performance measures?

10. Fellowship Funding Challenges Title VII 747 Faculty Development Grants –Poor review by Office of Personnel Management –President zeros out in budget every year –Big funding cuts, no pediatric awards last year –Last RFA cut out research fellowships but replaced after advocacy efforts –Up for reauthorization

11. Title VII Faculty Development Goals Training teachers of: –Primary care physicians in the workforce –Primary care academic faculty –Other physicians and health professionals Training minority physicians and minority academic faculty

12. Title VII Faculty Development Goals Training researchers & leaders to address: –Healthy People 2010 and 2020 objectives –Racial, ethnic and economic disparities in access to health care, health outcomes –Primary care practice issues, practice models, and health outcomes

13. Fellowship Funding Challenges HRSA and AHRQ NRSA Grants –NIH pass through to HRSA & AHRQ legislative language glitch NIH Training Funds –Flat NIH budget

14. Opportunities for Advocacy Title VII Faculty Development –Make clear successful performance outcomes/Publicize the success of trainees to HRSA and to Congress APA Policy Brief for HRSA APA Policy Brief for HRSA HRSA Advisory Committee HRSA Advisory Committee Publications Publications Legislative advocacy Legislative advocacy –Work on reauthorization

15. Opportunities for Advocacy Title VII Reauthorization: APA-led FOPO letter emphasizing: –Enhancing Pediatrics funding –Training PCPs in the workforce serving underserved –Training all physicians about primary care, underserved, emerging health need –Training minority physicians and faculty

16. Opportunities for Advocacy Title VII Reauthorization: APA-led FOPO letter emphasizing: –Training primary care researchers and leaders to address HP 2010, disparities, primary care practice and health outcomes –Funding research and innovations in primary care training and health care delivery with demonstrated impact on health care quality

17. Opportunities for Advocacy NIH and others –Need to fund new investigators AGP Accreditation Project Creative institutional funding