Advancing the Next Generation of America’s Health Care Workforce

[Gavel sounds.] The subcommittee will come to order. Welcome to today's hearing on advancing the next generation of America's health care workforce. Without objection, the chair is authorized to declare a recess at any time. I now recognize myself for an opening statement. Today, we are here to discuss a critical issue facing our nation: the growing shortage of health care professionals and the need to bolster our health care workforce for the future. Across the country, patients are facing longer wait times for appointments, and many communities, particularly in rural and underserved areas, lack access to essential medical services. This shortage is not just a matter of convenience; it is a matter of public health and national security. We must take proactive steps to ensure that we have a robust and diverse pipeline of health care workers to meet the needs of our aging population. In today's hearing, we will hear from a panel of experts who will share their insights on the challenges and opportunities in health care workforce development. We will explore innovative models for training and education, the role of technology in expanding access to care, and the importance of supporting our current health care professionals. I look forward to a productive discussion on how we can work together to build a stronger, more resilient health care workforce for all Americans. I now recognize the ranking member, Mr. Doggett, for his opening statement.

Thank you, Mr. Chairman. I appreciate you holding this hearing on such a vital topic. The health care workforce crisis is one that affects every corner of our country, and it requires a comprehensive and bipartisan response. As we look to the future, we must ensure that our health care workforce reflects the diversity of the communities they serve. We also need to address the high cost of medical education and the burden of student debt, which can deter talented individuals from pursuing careers in health care. I am particularly interested in hearing from our witnesses about how we can better support community-based training programs and expand the use of telehealth to reach patients in remote areas. Thank you again, Mr. Chairman, and I yield back.

Thank you, Mr. Doggett. I would now like to introduce our witnesses. First, we have Dr. Andrew Racine, President of the American Academy of Pediatrics. Welcome, Dr. Racine.

Thank you, Chairman Buchanan, Ranking Member Doggett, and members of the subcommittee.

Next, we have Dr. Emily Hawes, Professor and Director of the Sheps Graduate Medical Education Technical Assistance Center at the University of North Carolina at Chapel Hill. Welcome.

Thank you, Mr. Chairman.

We are also joined by Mr. Jason Shenefield, President and CEO of Phelps Health. Welcome, Mr. Shenefield.

Thank you, Chairman.

Our fourth witness is Dr. Jennifer Trilk, Director of Lifestyle Medicine Programs at the University of South Carolina School of Medicine Greenville. Welcome.

Thank you, Mr. Chairman.

And finally, we have Dr. Thomas Mohr, Dean of the Sam Houston State University College of Osteopathic Medicine. Welcome, Dr. Mohr.

Thank you, Chairman Buchanan.

Each of your written statements will be made part of the record. We ask that you summarize your testimony in five minutes. Dr. Racine, you are recognized for five minutes.

Chairman Buchanan, Ranking Member Doggett, and members of the subcommittee, thank you for the opportunity to testify today on behalf of the American Academy of Pediatrics. The AAP represents 67,000 pediatricians, pediatric medical subspecialists, and pediatric surgical specialists dedicated to the health and well-being of all infants, children, adolescents, and young adults. The pediatric workforce is at a crossroads. While we have made significant strides in improving child health outcomes, we are facing a growing shortage of pediatricians and pediatric subspecialists. This shortage is particularly acute in rural and underserved urban areas, where children often have to travel long distances to see a specialist. One of the primary drivers of this shortage is the high cost of medical education and the resulting debt burden. Pediatricians, on average, earn less than their counterparts in adult medicine, making it difficult for many to choose pediatrics as a career path. We must expand programs like the National Health Service Corps and the Pediatric Subspecialty Loan Repayment Program to help alleviate this burden. Furthermore, we need to invest in Graduate Medical Education, or GME, to ensure that we are training enough pediatricians to meet the needs of our children. The Children's Hospital GME program is a critical component of this effort, providing funding for the training of nearly half of all pediatric residents in the United States. In addition to increasing the number of pediatricians, we must also focus on diversifying the workforce. Children benefit from seeing doctors who share their cultural background and life experiences. We need to support programs that encourage underrepresented minorities to pursue careers in medicine. Finally, we must address the mental health crisis facing our children. The shortage of pediatric mental health professionals is even more severe than the shortage of primary care pediatricians. We need to integrate mental health services into primary care settings and expand the use of telehealth to reach children in need. Thank you for your commitment to the health of our nation's children. I look forward to your questions.

Thank you, Dr. Racine. Dr. Hawes, you are recognized for five minutes.

Chairman Buchanan, Ranking Member Doggett, and members of the subcommittee, thank you for the opportunity to discuss the critical role of Graduate Medical Education in addressing our nation's health care workforce needs. At the Sheps Center, we focus on how GME policy can be used to improve the distribution and composition of the physician workforce. The current GME system, while successful in many ways, has not kept pace with the changing needs of our population. We have a significant geographic maldistribution of physicians, with many rural areas facing severe shortages. Additionally, we have a shortage of primary care physicians and certain specialists, such as psychiatrists and geriatricians. To address these challenges, we need to modernize our GME policies. This includes increasing the number of Medicare-funded residency slots, particularly in primary care and underserved areas. We should also provide incentives for hospitals to establish residency programs in rural communities. Another important strategy is to support community-based training models. Research shows that physicians are more likely to practice in the types of communities where they were trained. By expanding residency training in community health centers and other outpatient settings, we can encourage more physicians to practice in underserved areas. We also need to improve the transparency and accountability of GME funding. Currently, it is difficult to track how GME funds are being used and whether they are achieving their intended goals. We should require hospitals to report on the outcomes of their residency programs, such as the percentage of graduates who go into primary care or practice in underserved areas. Finally, we must address the administrative burden associated with GME. Small and rural hospitals often lack the resources to navigate the complex GME regulations. Providing technical assistance and streamlining the application process can help these hospitals participate in GME programs. Thank you for your leadership on this issue. I look forward to our discussion.

Thank you, Dr. Hawes. Mr. Shenefield, you are recognized for five minutes.

Chairman Buchanan, Ranking Member Doggett, and members of the subcommittee, thank you for inviting me to share the perspective of a rural health care provider. Phelps Health is a regional health system based in Rolla, Missouri, serving a six-county area with a population of over 200,000 people. Like many rural health systems, we face significant challenges in recruiting and retaining health care professionals. The shortage of physicians, nurses, and other clinical staff is a constant concern. This shortage is driven by several factors, including the aging of our workforce, the high cost of living in rural areas, and the lack of professional opportunities for spouses. To address these challenges, we have implemented several innovative programs. We have partnered with local universities to create training programs for nurses and other health care workers. We also offer sign-on bonuses and loan repayment programs to attract new graduates. However, these efforts are not enough. We need federal support to expand our workforce. This includes increasing funding for the National Health Service Corps and other loan repayment programs. We also need to address the Medicare reimbursement rates for rural providers, which are often lower than those for urban providers. Another critical issue is the need for more residency slots in rural areas. As Dr. Hawes mentioned, physicians are more likely to practice where they train. By establishing residency programs in rural hospitals like Phelps Health, we can create a pipeline of physicians who are committed to serving our community. Finally, we need to leverage technology to expand access to care. Telehealth has been a game-changer for our patients, allowing them to see specialists without having to travel long distances. We need to ensure that telehealth services are adequately reimbursed and that our rural communities have access to high-speed internet. Thank you for the opportunity to testify. I look forward to your questions.

Thank you, Mr. Shenefield. Dr. Trilk, you are recognized for five minutes.

Chairman Buchanan, Ranking Member Doggett, and members of the subcommittee, thank you for the opportunity to testify today. I am here to discuss the importance of lifestyle medicine in addressing our nation's chronic disease epidemic and the need to train our health care workforce in this critical field. Chronic diseases, such as heart disease, diabetes, and obesity, are the leading causes of death and disability in the United States. They also account for the vast majority of our health care spending. Many of these diseases are preventable and even reversible through lifestyle changes, such as a healthy diet, regular physical activity, and stress management. Despite the clear benefits of lifestyle medicine, most medical students and residents receive very little training in this area. At the University of South Carolina School of Medicine Greenville, we have integrated lifestyle medicine into all four years of our curriculum. Our students learn how to counsel patients on nutrition, exercise, and other healthy behaviors. We need to expand this type of training to all medical schools and residency programs. This will require federal support for curriculum development and faculty training. We also need to change our reimbursement models to reward providers for spending time with patients on lifestyle counseling. In addition to training physicians, we also need to train other health care professionals, such as nurses, physician assistants, and dietitians, in lifestyle medicine. A team-based approach is essential for helping patients make lasting lifestyle changes. By investing in lifestyle medicine, we can improve the health of our nation and reduce our health care costs. We can also improve the well-being of our health care workforce, as many providers find it deeply rewarding to help patients achieve better health through lifestyle changes. Thank you for your time and for your interest in this important topic.

Thank you, Dr. Trilk. Dr. Mohr, you are recognized for five minutes.

Chairman Buchanan, Ranking Member Doggett, and members of the subcommittee, thank you for the opportunity to testify today. As the Dean of a new osteopathic medical school, I am here to discuss the role of osteopathic medicine in addressing the physician shortage and the challenges of starting a new medical school. Osteopathic physicians, or DOs, are a critical part of the health care workforce. We are trained to take a holistic approach to patient care, focusing on the whole person and the interconnectedness of the body's systems. DOs are also more likely to practice in primary care and in rural and underserved areas. At Sam Houston State University, we established our College of Osteopathic Medicine specifically to address the physician shortage in Texas. Our mission is to train physicians who are committed to serving the needs of our state, particularly in rural and underserved communities. Starting a new medical school is a significant undertaking. It requires a substantial investment in facilities, faculty, and technology. We also face challenges in securing clinical training sites for our students, as many hospitals are already at capacity with students from other schools. To support the growth of new medical schools, we need federal programs that provide funding for infrastructure and faculty development. We also need to address the shortage of residency slots, which is a major bottleneck in the physician pipeline. Without enough residency slots, we cannot fully realize the benefits of increasing the number of medical students. Furthermore, we need to support innovative models of medical education, such as community-based training and the use of simulation technology. These models can help us train more physicians more efficiently and effectively. Thank you for your commitment to building a strong health care workforce. I look forward to your questions.

Thank you, Dr. Mohr. We will now move to the question and answer portion of the hearing. I will recognize myself for five minutes. Dr. Hawes, you mentioned the geographic maldistribution of physicians. In my home state of Florida, we have many rural areas that are struggling to attract doctors. What are some of the most effective strategies you've seen for encouraging physicians to practice in rural communities?

Thank you, Mr. Chairman. One of the most effective strategies is to recruit students from rural areas into medical school. Research shows that students who grow up in rural communities are much more likely to return to those communities to practice. We should also provide financial incentives, such as loan repayment and scholarships, for students who commit to practicing in rural areas. Another key strategy is to establish residency programs in rural hospitals. As I mentioned earlier, physicians are more likely to practice where they train. By providing residents with positive experiences in rural settings, we can encourage them to stay in those communities after they complete their training.

Thank you. Mr. Shenefield, you mentioned the challenges of recruiting and retaining staff at Phelps Health. How has the use of telehealth impacted your ability to provide care to your patients, and what are some of the barriers you face in expanding your telehealth services?

Telehealth has been a vital tool for us, especially during the pandemic. It has allowed us to provide care to patients who might otherwise have gone without. However, we still face several barriers. One of the biggest is the lack of reliable high-speed internet in many of our rural communities. Without a stable connection, telehealth is simply not an option for many of our patients. Another barrier is the uncertainty around reimbursement. While many of the telehealth flexibilities introduced during the pandemic have been extended, we need permanent policies that ensure telehealth services are adequately reimbursed. This will give us the confidence to invest in the technology and training needed to expand our telehealth programs.

Thank you. Dr. Racine, you spoke about the shortage of pediatric mental health professionals. This is a major concern for many families. How can we better integrate mental health services into primary care settings to improve access for children?

That's a critical question, Mr. Chairman. One approach is the collaborative care model, where a primary care pediatrician works closely with a mental health specialist...

...and the 100 percent match for the first three years of a new residency program. These are all things that we've done to try to help build that workforce. But we also know that we need to do more. And that's why we're here today. I want to thank all of our witnesses for being here. And I now recognize the ranking member, Mr. Doggett, for his opening statement.

Thank you very much, Mr. Chairman. And thanks to our witnesses for your testimony. We are facing a crisis in our healthcare workforce. It's a crisis that was exacerbated by the pandemic, but it's one that has been building for a long time. We have a shortage of physicians, particularly in primary care and in rural and underserved areas. We have a shortage of nurses, of mental health professionals, and of direct care workers. And this shortage is only going to get worse as our population ages and as more people gain access to health insurance. We need to find ways to increase the supply of healthcare workers and to ensure that they are distributed where they are needed most. I'm particularly interested in hearing from our witnesses today about how we can improve the Graduate Medical Education program. GME is the primary way that we train physicians in this country, but the current system is not meeting our needs. It's heavily weighted towards specialty care and towards urban hospitals. We need to find ways to encourage more residents to go into primary care and to practice in rural and underserved areas. I'm also interested in hearing about how we can support other types of healthcare workers, such as nurses and direct care workers. These workers are the backbone of our healthcare system, and they are often underpaid and overworked. We need to find ways to improve their wages and working conditions and to provide them with the training and support they need to succeed. I look forward to the testimony of our witnesses today. I yield back.

Thank you, Mr. Doggett. I now recognize the gentleman from Nebraska, Mr. Smith, for five minutes.

Thank you, Mr. Chairman. And thank you to our witnesses for being here today. This is a very important topic, especially for those of us who represent rural areas. In Nebraska, we have a significant shortage of healthcare providers in many of our rural communities. Mr. Shenefield, in your testimony, you mentioned the challenges that rural hospitals face in recruiting and retaining healthcare workers. Can you elaborate on some of those challenges and what you think the federal government can do to help?

Thank you, Congressman. Yes, the challenges are significant. One of the biggest challenges is simply the lack of a pipeline. We don't have enough students from rural areas going into healthcare professions. And when students from urban areas go to school, they often don't want to move to a rural community to practice. Another challenge is the cost of education. Many healthcare students graduate with significant debt, and they feel like they need to work in a high-paying specialty in an urban area to pay off that debt. The federal government can help by providing more support for rural health education programs and by expanding loan repayment programs for healthcare workers who choose to practice in rural areas. We also need to look at the GME program. As Mr. Doggett mentioned, the current system is weighted towards urban hospitals. We need to find ways to encourage more residency programs to be located in rural areas.

Thank you. Dr. Mohr, you're the dean of a new osteopathic medical school in Texas. How is your school working to address the physician shortage in rural and underserved areas?

Thank you, Congressman. That is a core part of our mission. We intentionally located our school in a rural area, and we recruit students from rural and underserved communities. We also have a curriculum that emphasizes primary care and rural medicine. And we are working with local hospitals to develop new residency programs in rural areas. We believe that if we train students in rural areas, they are more likely to stay and practice in those areas.

Thank you. I think that's a very important point. My time is about to expire, so I'll yield back. Thank you, Mr. Chairman.

Thank you, Mr. Smith. I now recognize the gentleman from Illinois, Mr. Davis, for five minutes.

Thank you, Mr. Chairman. And I want to thank the witnesses for being here. Dr. Racine, in your testimony, you talked about the importance of diversity in the healthcare workforce. Why is that so important, and what can we do to increase diversity?

Thank you, Congressman. Diversity is critical for several reasons. First, research shows that patients often have better outcomes when they are treated by providers who share their background and culture. This is especially true for minority populations who have historically faced barriers to care. Second, a diverse workforce brings a wider range of perspectives and experiences to the table, which can lead to better decision-making and more innovative solutions to healthcare challenges. To increase diversity, we need to start early. We need to provide more support for minority students in K-12 and in college to encourage them to pursue careers in healthcare. We also need to address the financial barriers to medical education, which disproportionately affect minority students. And we need to ensure that our medical schools and residency programs are inclusive and welcoming to students from all backgrounds.

Thank you. Dr. Trilk, you've done a lot of work on lifestyle medicine. How can incorporating lifestyle medicine into medical education help to address the healthcare workforce crisis?

Thank you, Congressman. That's a great question. Lifestyle medicine focuses on the root causes of chronic disease, such as poor diet, lack of physical activity, and stress. By teaching future physicians how to help their patients make healthy lifestyle changes, we can prevent and even reverse many chronic diseases. This can reduce the burden on our healthcare system and free up resources to address other needs. It can also improve the well-being of healthcare workers themselves, who are often at high risk for burnout and chronic disease.

Thank you. I think that's a very important perspective. My time has expired, so I'll yield back. Thank you, Mr. Chairman.

Thank you, Mr. Davis. I now recognize the gentleman from Pennsylvania, Mr. Kelly, for five minutes.

Thank you, Mr. Chairman. And thank you to our witnesses. Dr. Hawes, you've done a lot of research on the GME program. One of the issues that has been raised is the cap on the number of residency positions that Medicare will fund. That cap was set in 1997 and has only been slightly increased since then. Do you think that cap should be lifted, and if so, how should we distribute the new positions?

Thank you, Congressman. Yes, I do believe the cap should be lifted. The physician shortage is real and it's growing, and we need to train more doctors. However, simply lifting the cap is not enough. We also need to ensure that the new positions are used to address our most pressing needs. I would recommend that any new positions be targeted towards primary care and other shortage specialties, and towards hospitals in rural and underserved areas. We should also consider providing incentives for hospitals to develop new residency programs in community-based settings, such as Federally Qualified Health Centers and rural health clinics.

Thank you. Mr. Shenefield, you mentioned the importance of the 340B program for rural hospitals. How does that program help you to recruit and retain healthcare workers?

Thank you, Congressman. The 340B program is a lifeline for us. It allows us to purchase outpatient drugs at a discount, and we use the savings to support a wide range of services, including our recruitment and retention efforts. For example, we use 340B savings to provide sign-on bonuses and relocation assistance for new employees. We also use it to fund professional development and continuing education for our current staff. Without the 340B program, it would be much harder for us to compete with larger, urban hospitals for talent. It's a critical tool for ensuring that our community has access to high-quality healthcare.

Thank you. I appreciate that. My time is up, so I'll yield back. Thank you, Mr. Chairman.

Thank you, Mr. Kelly. I now recognize the gentleman from California, Mr. Thompson, for five minutes.

Thank you, Mr. Chairman. And thank you to our witnesses. Dr. Racine, I want to go back to the issue of diversity. You mentioned the importance of starting early. Can you talk about some specific programs that have been successful in encouraging minority students to pursue healthcare careers?

Certainly, Congressman. There are several great examples. One is the Health Careers Opportunity Program, or HCOP, which provides grants to schools and organizations to support minority students from disadvantaged backgrounds who are interested in healthcare. Another is the Area Health Education Centers, or AHEC, program, which works to improve the distribution and diversity of the healthcare workforce, especially in rural and underserved areas. These programs provide mentoring, tutoring, and clinical experiences for students, and they help to build a pipeline of diverse healthcare professionals. We need to continue to support and expand these types of programs.

Thank you. Dr. Hawes, you mentioned the importance of community-based residency programs. Can you talk about some of the benefits of training residents in community settings rather than just in large academic medical centers?

Yes, Congressman. There are several benefits. First, residents who train in community settings are more likely to practice in those settings after they graduate. This is especially important for rural and underserved areas. Second, community-based training provides residents with a more realistic view of the challenges and rewards of primary care and community medicine. They get to see patients in the context of their families and communities. Third, community-based programs can be more flexible and responsive to the needs of the local community. They can tailor their training to address the specific health issues that are most prevalent in that area.

Thank you. I think that's very important. My time is up, so I'll yield back. Thank you, Mr. Chairman.

Thank you, Mr. Thompson. I now recognize the gentleman from Florida, Mr. Steube, for five minutes.

Thank you, Mr. Chairman. And thank you to our witnesses. Dr. Mohr, you mentioned the importance of osteopathic medicine in addressing the physician shortage. Can you explain what osteopathic medicine is and how it differs from allopathic medicine?

Certainly, Congressman. Osteopathic medicine is a distinct branch of medical practice. While both DOs and MDs are fully licensed physicians who can prescribe medication and perform surgery, DOs have a slightly different philosophy. We emphasize a whole-person approach to care, focusing on prevention and the body's natural ability to heal itself. We also receive extra training in the musculoskeletal system and in osteopathic manipulative treatment, or OMT, which is a hands-on technique used to diagnose and treat illness and injury. Historically, a higher percentage of DOs have gone into primary care and have practiced in rural and underserved areas. That's why we believe that expanding osteopathic medical education is a key part of the solution to the physician shortage.

Thank you. Dr. Trilk, you mentioned the importance of lifestyle medicine. How can we encourage more physicians to incorporate lifestyle medicine into their practice?

Thank you, Congressman. There are several ways. First, we need to provide more education and training in lifestyle medicine, both in medical school and in residency. We also need to provide continuing education for physicians who are already in practice. Second, we need to change the way we pay for healthcare. Currently, our payment system is focused on treating disease rather than preventing it. We need to provide incentives for physicians to spend time with their patients talking about lifestyle changes. Third, we need to provide more support for physicians who want to incorporate lifestyle medicine into their practice. This could include providing access to health coaches, nutritionists, and other professionals who can help patients make healthy changes.

Thank you. I think those are all great suggestions. My time is up, so I'll yield back. Thank you, Mr. Chairman.

Thank you, Mr. Steube. I now recognize the gentleman from Pennsylvania, Mr. Evans, for five minutes.

Thank you, Mr. Chairman. And thank you to our witnesses. Dr. Racine, I want to talk about the impact of the physician shortage on children. How is the shortage affecting access to care for children, especially those in underserved communities?

Thank you, Congressman. The impact is significant. Children in underserved communities already face many barriers to care, and the physician shortage only makes it worse. They often have to wait longer for appointments, and they may have to travel long distances to see a specialist. This can lead to delays in diagnosis and treatment, which can have long-term consequences for their health and development. We also see a shortage of pediatric subspecialists, such as pediatric cardiologists and neurologists. This means that children with complex medical needs may not be able to get the care they need close to home. We need to find ways to encourage more medical students to go into pediatrics and pediatric subspecialties.

Thank you. Dr. Hawes, you mentioned the importance of the Children's Hospital Graduate Medical Education, or CHGME, program. Can you explain what that program is and why it's so important?

Yes, Congressman. The CHGME program is critical. Most GME funding comes through Medicare, but children's hospitals treat very few Medicare patients. The CHGME program provides federal funding to support residency training at independent children's hospitals. This program is essential for training the next generation of pediatricians and pediatric subspecialists. Without it, many children's hospitals would not be able to afford to train residents, and the shortage of pediatric providers would be even worse.

Thank you. I think that's a very important point. My time is up, so I'll yield back. Thank you, Mr. Chairman.

Thank you, Mr. Evans. I now recognize the gentlewoman from West Virginia, Mrs. Miller, for five minutes.

Thank you, Mr. Chairman. And thank you to our witnesses. Mr. Shenefield, in West Virginia, we have a lot of small, rural hospitals that are struggling to stay open. How can we help these hospitals to remain viable and to continue to provide care to their communities?

Thank you, Congresswoman. That's a very important question. One of the most important things we can do is to ensure that rural hospitals are fairly reimbursed for the services they provide. Many rural hospitals have a high percentage of Medicare and Medicaid patients, and the reimbursement rates for these programs often don't cover the cost of care. We also need to provide more support for telehealth. Telehealth can be a great way for rural hospitals to provide access to specialty care that they might not otherwise be able to offer. And as I mentioned earlier, we need to continue to support programs like 340B and the National Health Service Corps, which help rural hospitals to recruit and retain healthcare workers.

Thank you. Dr. Mohr, you mentioned the importance of recruiting students from rural areas. How do you identify and recruit these students, and what kind of support do you provide them once they are in medical school?

Thank you, Congresswoman. We have a very intentional recruitment process. We work with high schools and colleges in rural areas to identify students who are interested in healthcare. We also have a holistic admissions process that looks at more than just grades and test scores. We look for students who have a commitment to serving rural and underserved communities. Once they are in medical school, we provide them with a lot of support, including mentoring, tutoring, and financial assistance. We also have a rural medicine track that provides students with extra training and clinical experiences in rural areas. We want to make sure that they have the skills and the confidence they need to succeed in a rural practice.

Thank you. I think that's a great model. My time is up, so I'll yield back. Thank you, Mr. Chairman.

Thank you, Mrs. Miller. I now recognize the gentleman from Nevada, Mr. Horsford, for five minutes.

Thank you, Mr. Chairman. And thank you to our witnesses. Dr. Racine, I want to talk about the importance of the National Health Service Corps. How does that program help to address the physician shortage in underserved communities?

Thank you, Congressman. The National Health Service Corps is a vital program. It provides scholarships and loan repayment to healthcare professionals who agree to practice in underserved areas. This is a powerful incentive for students and young professionals who are often burdened with significant debt. The program has been very successful in placing providers in areas that would otherwise have little or no access to care. We need to continue to support and expand the National Health Service Corps to meet the growing need.

Thank you. Dr. Hawes, you mentioned the importance of the Teaching Health Center Graduate Medical Education, or THCGME, program. Can you explain what that program is and why it's so important?

Yes, Congressman. The THCGME program is very important. It provides federal funding to support residency training in community-based settings, such as Federally Qualified Health Centers and rural health clinics. This is different from traditional GME funding, which goes to hospitals. The THCGME program is specifically designed to train residents in the settings where they are most needed. It has been very successful in producing primary care physicians who practice in underserved areas.

Thank you. I think that's a very important program. My time is up, so I'll yield back. Thank you, Mr. Chairman.

Thank you, Mr. Horsford. I now recognize the gentleman from Oklahoma, Mr. Hern, for five minutes.

Thank you, Mr. Chairman. And thank you to our witnesses. Dr. Mohr, you mentioned the importance of the osteopathic medical school model. How can we encourage more states to support the development of new osteopathic medical schools?

Thank you, Congressman. That's a great question. States can support the development of new osteopathic medical schools by providing startup funding and by creating a favorable regulatory environment. They can also work with local hospitals to develop new residency programs. We've seen a lot of success with this model in Texas, and we believe it can be replicated in other states. The key is to have a strong partnership between the state, the medical school, and the local community.

Thank you. Dr. Trilk, you mentioned the importance of lifestyle medicine. How can we encourage more insurance companies to cover lifestyle medicine services?

Thank you, Congressman. That's a critical issue. Insurance companies are more likely to cover services that have been shown to be effective and cost-efficient. We need to continue to build the evidence base for lifestyle medicine and to demonstrate its value. We also need to work with insurance companies to develop new payment models that reward physicians for helping their patients make healthy lifestyle changes. This could include providing value-based payments or bundled payments for lifestyle medicine services.

Thank you. I think that's a very important point. My time is up, so I'll yield back. Thank you, Mr. Chairman.

Thank you, Mr. Hern. I now recognize the gentlewoman from California, Ms. Chu, for five minutes.

Thank you, Mr. Chairman. And thank you to our witnesses. Dr. Racine, I want to talk about the importance of mental health services for children. How is the physician shortage affecting access to mental health care for children?

Thank you, Congresswoman. The shortage of mental health providers is even more acute than the shortage of primary care physicians. We have a severe shortage of child and adolescent psychiatrists, as well as psychologists and other mental health professionals. This means that many children with mental health needs are not getting the care they need. This can lead to a range of problems, including poor school performance, substance abuse, and even suicide. We need to find ways to encourage more professionals to go into child and adolescent mental health.

Thank you. Dr. Hawes, you mentioned the importance of the GME program in training mental health professionals. How can we improve the GME program to better address the mental health needs of our population?

Thank you, Congresswoman. There are several ways. First, we need to increase the number of residency positions in psychiatry and other mental health specialties. We also need to encourage more residency programs to incorporate mental health training into their curriculum. Second, we need to find ways to encourage more residents to practice in underserved areas, where the shortage of mental health providers is most severe. This could include providing loan repayment and other incentives. Third, we need to support the development of integrated care models, where mental health professionals work alongside primary care physicians to provide comprehensive care to patients.

Thank you. I think that's a very important point. My time is up, so I'll yield back. Thank you, Mr. Chairman.

Thank you, Ms. Chu. I now recognize the gentleman from Tennessee, Mr. Kustoff, for five minutes.

Thank you, Mr. Chairman. And thank you to our witnesses. Mr. Shenefield, you mentioned the importance of the rural health clinic program. How does that program help you to provide care to your community?

Thank you, Congressman. The rural health clinic program is essential for us. It provides us with enhanced reimbursement for primary care services, which helps us to offset the higher costs of providing care in a rural area. It also allows us to use nurse practitioners and physician assistants to provide care, which is critical given the shortage of physicians. Without the rural health clinic program, many of our patients would have to travel long distances to get basic primary care. It's a vital part of the healthcare safety net in rural America.

Thank you. Dr. Mohr, you mentioned the importance of the GME program in training physicians for rural areas. How can we encourage more hospitals in rural areas to develop residency programs?

Thank you, Congressman. That's a challenge. Developing a residency program is a significant undertaking, and many rural hospitals don't have the resources or the expertise to do it on their own. We need to provide more support for rural hospitals that want to develop residency programs. This could include providing technical assistance and startup funding. We also need to encourage partnerships between rural hospitals and larger academic medical centers, where the academic medical center can provide the expertise and the rural hospital can provide the clinical training site.

Thank you. I think that's a great suggestion. My time is up, so I'll yield back. Thank you, Mr. Chairman.

Thank you, Mr. Kustoff. I now recognize the gentlewoman from New York, Ms. Tenney, for five minutes.

Thank you, Mr. Chairman. And thank you to our witnesses. Dr. Racine, I want to talk about the impact of the physician shortage on rural communities in New York. How is the shortage affecting access to care for families in my district?

Thank you, Congresswoman. The impact is very similar to what we see in other rural areas. Families in rural New York often have to travel long distances to see a doctor, and they may have to wait weeks or even months for an appointment. This is especially true for specialty care. The shortage of physicians also makes it harder for rural hospitals to stay open, which can further limit access to care. We need to find ways to encourage more physicians to practice in rural New York.

Thank you. Dr. Hawes, you mentioned the importance of the GME program in addressing the physician shortage. How can we improve the GME program to better meet the needs of rural communities like mine?

Thank you, Congresswoman. There are several ways. First, we need to increase the number of residency positions in rural areas. We also need to provide more support for rural hospitals that want to develop residency programs.

...and the impact that it has on the community. I'm also interested in the role of the 340B program in supporting your workforce and the services you provide. Can you elaborate on how 340B savings are utilized at Phelps Health?

Thank you, Congresswoman. The 340B program is vital to our mission as a sole community provider. We use those savings to directly support our clinical staff and to provide services that would otherwise be unreimbursed. For example, it helps us fund our oncology coordinators and our rural health clinic outreach. Without 340B, we would have to make very difficult decisions about which services to cut, which would directly impact the access to care for our patients in the 11 counties we serve. It also allows us to offer competitive salaries to attract providers to a rural area, which is one of our biggest challenges.

Thank you. It's clear that these programs are interconnected. I yield back, Mr. Chairman.

The gentlewoman yields back. I now recognize the gentleman from Utah, Mr. Moore, for five minutes.

Thank you, Chairman Buchanan and Ranking Member Doggett. And thank you to our witnesses for being here today. Dr. Mohr, I want to focus on the osteopathic perspective. In Utah, we've seen a significant growth in the need for primary care, especially in our growing suburban and rural areas. You mentioned the importance of community-based training. Can you explain why the teaching health center model is particularly effective for osteopathic medicine and how it helps retain physicians in the communities where they train?

Thank you, Congressman Moore. The teaching health center model aligns perfectly with the osteopathic philosophy of treating the whole person within the context of their community. When we train residents in Federally Qualified Health Centers or rural clinics, they aren't just learning clinical skills; they are becoming part of the fabric of that community. Data shows that residents are far more likely to practice within 100 miles of where they complete their residency. By moving training out of large urban academic centers and into the communities that need them most, we create a natural pipeline. For our students at Sam Houston State, many of whom come from these regions, it's about going back home to serve the people they know. The challenge is that the funding for these slots is often discretionary and short-term, which makes it hard for hospitals to commit to long-term residency programs.

That's a great point about the stability of funding. Dr. Hawes, briefly, you've looked at the GME landscape extensively. What is the one policy change regarding GME caps that would have the most immediate impact on rural physician shortages?

Thank you for the question. The most immediate impact would come from providing more flexibility in how the caps are calculated for rural hospitals and allowing for 're-capping' when a hospital transitions to a rural designation or adds a new rural training track. Currently, the rules are very rigid, and once a cap is set, it's nearly impossible to increase it without significant legislative intervention. Allowing hospitals that partner with rural sites to have a separate, dedicated cap for those specific tracks would encourage more urban-rural partnerships.

Thank you. I yield back.

The gentleman yields back. I now recognize the gentleman from Pennsylvania, Mr. Boyle.

Thank you, Mr. Chairman. Dr. Racine, I want to talk about the pediatric workforce. In Philadelphia, we have world-class children's hospitals, but we still face shortages in pediatric subspecialties. Can you speak to how the Children's Hospital Graduate Medical Education, or CHGME, program is performing and what happens if that funding isn't sustained or increased to match the rising costs of training?

Thank you, Congressman Boyle. CHGME is the lifeblood of pediatric training. Unlike adult medicine, which is largely funded through Medicare, pediatric training relies on this specific appropriation. It funds the training for about half of all pediatricians and the vast majority of pediatric specialists in this country. If CHGME funding remains stagnant, we see a direct correlation in the wait times for children to see specialists like pediatric neurologists or developmental pediatricians. In some parts of the country, those wait times are six months to a year. We are essentially disincentivizing medical students from entering pediatrics because the debt-to-income ratio is so much higher compared to adult specialties, and the training infrastructure is more fragile.

It's a critical point. We can't afford to have children waiting a year for specialized care. Dr. Trilk, I was fascinated by your testimony on lifestyle medicine. How are you seeing this integrated into the actual workflow of a busy clinic? Is it feasible for a primary care doctor to do this given the current reimbursement structures?

It is a challenge, Congressman, but it is feasible with a team-based approach. We teach our students how to lead a team that includes dietitians, health coaches, and physical therapists. The current reimbursement model is still very much 'fee-for-service' and 'volume-based,' which gives a physician maybe 15 minutes with a patient. That's not enough time to discuss nutrition and exercise in depth. We need to move toward value-based care models that reward the time spent on these interventions, which ultimately prevent the expensive chronic diseases that Medicare spends so much on later.

Thank you. I yield back.

The gentleman yields back. I now recognize the gentleman from North Carolina, Dr. Murphy.

Thank you, Mr. Chairman. As the only practicing surgeon on this committee, I deal with these workforce issues every single day. We have a massive shortage of physicians, but we also have a massive shortage of nurses, CRNAs, and techs. Dr. Hawes, it's good to see a fellow North Carolinian here. You mentioned the GME caps. One of the things I've proposed is looking at how we can incentivize more 'boots on the ground' clinical time versus administrative time. But specifically on the GME side, do you think we should be prioritizing certain specialties that are in high demand, like psychiatry or general surgery, when we talk about expanding these slots, or should it be a general expansion?

Dr. Murphy, it's a balance. While we certainly have acute shortages in psychiatry and primary care, we cannot ignore the need for surgeons and other specialists, especially in rural areas where the 'aging out' of the current workforce is a looming crisis. I believe a tiered approach that provides extra incentives for the most critical shortages, while still allowing for general growth to address the overall physician deficit, is the most prudent path. We also need to look at the 'all-payer' model to ensure that private insurers are also contributing to the cost of this training, not just Medicare.

I agree. And Mr. Shenefield, you're in the trenches in Missouri. We talk a lot about doctors, but tell me about your nursing staff. What is the turnover rate like, and what are you doing to keep nurses from leaving for travel nursing positions that pay double or triple what a community hospital can afford?

It's a constant battle, Dr. Murphy. At one point during the pandemic, our reliance on agency nurses was costing us millions more than our budgeted labor costs. To combat this, we've partnered with local community colleges to create an 'earn while you learn' program. We pay for their tuition and give them a job while they are in school. We've also implemented more flexible scheduling and wellness programs. But the lure of travel nursing is still there. We need federal policies that help stabilize the nursing workforce and perhaps look at the role of international nursing graduates to help fill the immediate gaps.

Thank you. My time has expired. I yield back.

The gentleman yields back. I now recognize the gentlewoman from California, Ms. Sánchez.

Thank you, Mr. Chairman. I want to focus on the diversity of our healthcare workforce. We know that when patients are treated by providers who look like them and understand their cultural background, health outcomes improve. Dr. Racine, can you talk about the importance of programs like the Health Careers Opportunity Program and how they help students from underrepresented backgrounds enter the medical field?

Thank you, Congresswoman Sánchez. Programs like HCOP and the Centers of Excellence are absolutely critical. They provide the mentorship, academic support, and financial assistance that students from disadvantaged backgrounds need to navigate the very expensive and difficult path to medical school. In pediatrics, we see a huge disparity in the number of Black and Latino physicians compared to the population we serve. These programs help bridge that gap. When a child sees a doctor who speaks their language or understands their community's specific challenges, it builds trust. That trust is the foundation of good medicine. If we cut these programs, we are essentially closing the door on a whole generation of talented individuals who could be the solution to our workforce crisis.

Thank you. Dr. Mohr, how is Sam Houston State addressing diversity in its recruitment of medical students, particularly given the diverse population of Texas?

We take a very holistic approach to admissions. We don't just look at MCAT scores; we look at where a student comes from, their life experiences, and their commitment to primary care. We have active outreach programs in East Texas high schools and community colleges to show students that a career in medicine is possible for them. We also ensure our faculty reflects the diversity we want to see in our students. It's about creating an environment where everyone feels they belong and can succeed.

Thank you. I yield back.

The gentlewoman yields back. I now recognize the gentleman from Pennsylvania, Mr. Fitzpatrick.

Thank you, Mr. Chairman. I want to touch on the mental health workforce. We are in the midst of a mental health crisis in this country, and the shortage of providers is staggering. Dr. Hawes, you've mentioned the GME caps. How can we specifically use GME to increase the number of psychiatrists and, importantly, child and adolescent psychiatrists?

Congressman, one of the most effective ways is to incentivize the creation of psychiatry residencies in community-based settings and rural areas. We also need to look at the 'fellowship' problem. For child and adolescent psychiatry, a doctor has to do additional years of training after their general residency. Often, the funding for those fellowship slots is even more limited than for general residency. Providing dedicated funding for these subspecialty fellowships would make a huge difference. Additionally, integrating behavioral health into primary care training—so that every primary care doctor has a higher level of competency in managing basic mental health issues—can help alleviate the pressure on specialists.

Thank you. Mr. Shenefield, in your rural setting, how are you handling the mental health needs of your patients? Are you able to recruit psychiatrists to Rolla?

It is incredibly difficult. We rely heavily on tele-psychiatry, which has been a godsend, but it's not a complete substitute for in-person care, especially for complex cases. We've also integrated behavioral health consultants into our primary care clinics. These are often social workers or counselors who can see a patient immediately during their doctor's visit. But for acute psychiatric needs, our emergency department often becomes a holding area because there are no inpatient beds available in the region. It's a systemic failure that requires more than just more doctors; it requires a whole infrastructure of care.

Thank you. I yield back.

The gentleman yields back. I now recognize the gentleman from Illinois, Mr. Davis.

Thank you, Mr. Chairman. I want to go back to the issue of the nursing workforce and the role of community colleges. In my district in Chicago, we have several community colleges that are doing a great job, but they are limited by a lack of nursing faculty. Mr. Shenefield, you mentioned your partnership. Are you seeing a shortage of people who can actually teach the next generation of nurses, and what can we do about that?

Absolutely, Congressman. The faculty shortage is perhaps the biggest bottleneck in the nursing pipeline. A nurse with an advanced degree can make significantly more money in clinical practice than they can teaching at a community college. We've actually started 'loaning' some of our master's-prepared nurses to the college to serve as clinical instructors, but that's a temporary fix. We need federal grants or loan forgiveness programs specifically targeted at nursing faculty to make those roles financially viable.

...and the community. So, thank you for being here. I yield back.

The gentleman yields back. I now recognize the gentleman from Illinois, Mr. Davis.

Thank you, Mr. Chairman. And I want to thank all of our witnesses for being here. This is a very important hearing. Dr. Racine, it's good to see you again.

Good to see you, sir.

The Health Profession Opportunity Grant program, or HPOG, is a program that I've been very close to. It provides low-income individuals with the education and training needed for well-paying health care careers. It also provides critical support services like childcare and transportation that help students succeed. Dr. Racine, in your testimony, you mentioned the importance of a diverse health care workforce. How does a program like HPOG contribute to building a workforce that reflects the communities it serves?

Thank you, Congressman Davis. Programs like HPOG are essential because they lower the barriers to entry for individuals from underrepresented backgrounds. When we talk about the social determinants of health for our patients, we also have to recognize the social determinants of education for our workforce. If a student is worried about how they're going to get to class or who is going to watch their child, they can't focus on their studies. By providing those wraparound services, HPOG allows talented individuals to enter the nursing and allied health professions who might otherwise be shut out. This directly leads to a more diverse workforce, which we know improves patient outcomes and trust in the medical system.

Thank you. And we've seen that in Chicago, where HPOG has been very successful. I'm also concerned about the shortage of primary care physicians, especially in underserved areas. Dr. Hawes, you've done a lot of work with Graduate Medical Education in rural areas. How can we better incentivize residents to practice in the communities that need them most?

Thank you, Congressman. The data is very clear: physicians are most likely to practice within 100 miles of where they complete their residency training. If we want doctors in rural or underserved urban areas, we need to train them in those areas. Programs like the Teaching Health Center GME program and the Rural Residency Planning and Development program are vital. They move the training out of the large academic medical centers and into the community clinics and rural hospitals. When residents live and work in these communities, they build relationships, they see the impact they can have, and they are much more likely to stay there long-term.

Thank you very much. My time is about to expire, so I will yield back, Mr. Chairman.

The gentleman yields back. I now recognize the gentlewoman from West Virginia, Mrs. Miller.

Thank you, Chairman Buchanan and Ranking Member Doggett, for holding this hearing today. And thank you to all of our witnesses for being here. In West Virginia, we face significant challenges with our health care workforce, particularly in our rural communities. We have a high rate of chronic disease and an aging population, which makes the need for providers even more acute. Mr. Shenefield, you lead a health system in a rural area. Can you talk about the specific challenges you face in recruiting and retaining staff, and how federal policy could better support your efforts?

Thank you, Congresswoman. The challenges are multifaceted. First, there's the sheer competition for talent. We are often competing with larger urban systems that can offer higher salaries and more amenities. Second, there's the issue of infrastructure. When we recruit a physician or a nurse to a rural area, we're not just recruiting them; we're recruiting their family. They need good schools, job opportunities for their spouses, and reliable high-speed internet. From a policy perspective, flexibility is key. Programs like the 340B drug pricing program are a lifeline for rural hospitals like ours, allowing us to reinvest those savings into our workforce and community services. Additionally, continuing to support and expand telehealth flexibilities is crucial, as it allows our limited staff to reach more patients efficiently.

Thank you. Dr. Mohr, as a dean of a medical school focused on osteopathic medicine, how are you preparing your students for the realities of rural practice? We know that osteopathic physicians are often more likely to go into primary care and practice in underserved areas.

Thank you, Mrs. Miller. At Sam Houston State, our mission is specifically focused on addressing the physician shortage in Texas, particularly in rural and underserved areas. We recruit students from these communities because they are the most likely to return there. Our curriculum emphasizes primary care and community-based medicine from day one. We also partner with small community hospitals for clinical rotations, so our students get hands-on experience in the environments where we hope they will eventually practice. By the time they graduate, they understand the unique challenges and the incredible rewards of rural medicine. They aren't just learning the science; they're learning the community.

Thank you. I appreciate your work. Mr. Chairman, I yield back.

The gentlewoman yields back. I now recognize the gentleman from California, Mr. Thompson.

Thank you, Mr. Chairman. And thanks to the witnesses. Dr. Trilk, I'm very interested in your work on lifestyle medicine. We spend a vast amount of our health care dollars treating chronic diseases that are often preventable or manageable through diet, exercise, and other lifestyle factors. How can integrating lifestyle medicine into medical education help us create a more sustainable and effective health care system?

Thank you, Congressman Thompson. Currently, most medical students receive very little training in nutrition or physical activity. By the time they reach residency, they are focused on acute care and pharmacology. By integrating lifestyle medicine into the four-year medical school curriculum, we empower future physicians to address the root causes of chronic disease. This isn't just about telling a patient to eat better; it's about understanding the science of behavior change and how to prescribe lifestyle interventions with the same rigor as we prescribe medication. When physicians can successfully help patients manage their health through lifestyle, it reduces the burden on the entire system, lowers costs, and, most importantly, improves the quality of life for the patients.

I couldn't agree more. It seems like a common-sense approach that has been overlooked for too long. Dr. Racine, going back to the workforce issue, we've seen a lot of burnout among health care professionals, especially after the pandemic. What can we do at the federal level to support the mental health and well-being of our health care workers?

That is a critical question, Congressman. Burnout is a systemic issue, not an individual failing. We need to address the administrative burdens that take clinicians away from patient care. The 'Dr. Lorna Breen Health Care Provider Protection Act' was a great start, providing grants for mental health services and education. We need to continue and expand that support. We also need to look at how we can streamline documentation requirements and improve EHR usability. If we want a robust workforce for the next generation, we have to make sure the current generation isn't being driven out of the profession by exhaustion and moral injury.

Thank you. I yield back.

The gentleman yields back. I now recognize the gentleman from Florida, Mr. Steube.

Thank you, Mr. Chairman. In Florida, we have a rapidly growing population, and many of those moving to our state are seniors. This puts a tremendous strain on our health care infrastructure. Mr. Shenefield, you mentioned the importance of telehealth. In a state like Florida, where we have both dense urban areas and very rural pockets, how has telehealth changed the way you deliver care, and what barriers still exist?

Telehealth has been a game-changer, especially for specialty care. For a patient in a rural area, seeing a specialist might previously have required a three-hour drive each way. Now, they can have that consultation from their local clinic or even their home. However, the biggest barrier remains the 'digital divide.' Many rural areas still lack the broadband infrastructure necessary for high-quality video visits. Additionally, the uncertainty around the permanent extension of Medicare telehealth flexibilities makes it difficult for systems to make long-term investments in the technology and training. We need certainty from Congress that these services will continue to be reimbursed at sustainable levels.

I appreciate that. Dr. Hawes, regarding the GME slots, there's been discussion about the distribution of these slots. Do you believe the current system effectively prioritizes the areas with the greatest shortages, or is there a better way to allocate these resources?

The current system, which is largely based on historical caps from 1997, does not reflect the current geographic or specialty needs of the country. While Congress has recently added some new slots, the allocation process still tends to favor large, established urban teaching hospitals. We need a more targeted approach that specifically directs new GME funding to hospitals in rural areas, to hospitals that serve high proportions of Medicaid patients, and to primary care and psychiatry programs. We also need to simplify the process for small rural hospitals to start their own residency programs, as the administrative and financial hurdles are currently very high.

Thank you. I yield back.

The gentleman yields back. I now recognize the gentleman from Pennsylvania, Mr. Evans.

Thank you, Mr. Chairman. Dr. Racine, I want to follow up on the diversity issue. In Philadelphia, we have some of the best medical institutions in the world, yet we still see significant health disparities in our neighborhoods. How can we ensure that the 'next generation' of the workforce we're talking about today is actually representative of the people living in those neighborhoods?

Thank you, Congressman Evans. It starts with the pipeline. We need to be reaching into middle schools and high schools in those neighborhoods to show students that a career in medicine is possible for them. Programs like the Health Careers Opportunity Program (HCOP) are vital for this. But it's also about the admissions process in medical and nursing schools. We need to move toward holistic review, where we look at a student's entire journey and the obstacles they've overcome, not just their standardized test scores. And finally, we need to make it affordable. The debt burden of medical education is a huge deterrent for students from low-income backgrounds. Expanding loan repayment programs for those who commit to practicing in underserved areas is a win-win.

Thank you. Dr. Trilk, you mentioned the importance of lifestyle medicine. How can we ensure that these lifestyle interventions are accessible to everyone, regardless of their zip code or income level? Often, the 'healthier' choices are the most expensive or the least available in certain communities.

That is a vital point, Congressman. Lifestyle medicine must be practiced within the context of the patient's reality. This is why we teach our students about food insecurity and 'food deserts.' A physician trained in lifestyle medicine doesn't just say 'eat more vegetables'; they work with the patient to find where they can access affordable produce, perhaps through a community garden or a 'veggie Rx' program. We also need to advocate for policies that make healthy choices the easy choices, such as improving walkability in neighborhoods and ensuring that federal nutrition programs like SNAP allow for the purchase of fresh, healthy foods. Lifestyle medicine is as much about social justice as it is about biology.

Thank you. I yield back, Mr. Chairman.

The gentleman yields back. I now recognize the gentleman from Oklahoma, Mr. Hern.

Thank you, Mr. Chairman. Mr. Shenefield, I'm interested in the role of mid-level providers—Physician Assistants and Nurse Practitioners. In Oklahoma, they play a huge role in our rural health care delivery. How are you utilizing these professionals in your system, and are there any federal regulations that are currently hindering their ability to practice to the full extent of their training?

Thank you, Congressman. PAs and NPs are absolutely essential to our team-based care model. They allow us to expand access and provide more timely care to our patients. One of the biggest hurdles we face is the lack of uniformity in scope-of-practice laws across state lines, which can be confusing for providers and patients alike. At the federal level, there are still some outdated Medicare regulations that require a physician's signature for things that an NP or PA is perfectly qualified to handle, such as ordering certain types of durable medical equipment or home health services. Removing these 'administrative hoops' would allow our entire team to work more efficiently and focus more on the patient.

Thank you. Dr. Mohr, you mentioned the cost of medical education. We've seen a massive increase in student loan debt. How is your institution working to keep costs down for your students, and what can we do to help?

As a public institution, we strive to keep our tuition as low as possible, but the costs of running a modern medical school are significant. We focus heavily on scholarship fundraising and on providing financial literacy training to our students so they can manage their debt responsibly. One thing Congress could do is to increase the funding for the National Health Service Corps. This is one of the most effective tools we have. It provides full scholarships or significant loan repayment in exchange for service in high-need areas. It's a direct way to reduce student debt while simultaneously addressing the workforce shortage in the communities that need it most.

Thank you. I yield back.

The gentleman yields back. I now recognize the gentleman from Nevada, Mr. Horsford.

Thank you, Mr. Chairman. Nevada has one of the fastest-growing populations in the country, but we consistently rank near the bottom in terms of physicians per capita. Dr. Hawes, you've talked about the importance of training doctors where they are needed. In a state like Nevada, where we have a massive urban center in Las Vegas but also vast, sparsely populated rural areas, how do we balance those competing needs for residency slots?

It's a challenge, but it's not an 'either-or' situation. We need to expand GME in both settings. In urban areas like Las Vegas, we need to ensure that residency programs are integrated with the community health centers that serve the most vulnerable populations. In rural Nevada, we should be looking at 'hub-and-spoke' models, where a larger hospital provides the administrative support for residents who spend the majority of their time in smaller rural clinics. The key is to create training pathways that are specific to the needs of the state. Federal policy can support this by providing more flexibility in how GME funds are used and by incentivizing states to develop their own comprehensive workforce plans.

Thank you. Dr. Racine, I'm also very concerned about the lack of diversity in the nursing workforce. We know that patients often have better outcomes when they are cared for by people who share their cultural background. What specific steps can we take to increase the number of Black and Brown nurses in our hospitals?

It requires a multi-pronged approach, Congressman. First, we need to support the nursing schools at HBCUs and other minority-serving institutions, which graduate a disproportionate number of our diverse nursing workforce. Second, we need to address the faculty shortage. Many qualified nursing students are turned away every year simply because there aren't enough instructors. Providing loan forgiveness for nurses who go into education is a critical step. And third, we need to create more 'ladder' programs that allow nursing assistants and LPNs—who are often a very diverse group—to continue their education and become RNs while they continue to work. This provides a clear path for career advancement and increases diversity at all levels of nursing.

Thank you. I yield back.

The gentleman yields back. I now recognize the gentleman from Tennessee, Mr. Kustoff.

Thank you, Mr. Chairman. Mr. Shenefield, we've talked a lot about the challenges of rural health care. One issue that often comes up is the burden of government regulations. Are there specific regulations that you find particularly burdensome or that prevent you from being as innovative as you'd like to be in addressing your workforce needs?

One area that is particularly challenging is the complexity of the various federal grant programs. For a small rural hospital, the administrative overhead required to apply for and manage multiple small grants from different agencies can be overwhelming. Consolidating some of these programs or creating a 'one-stop shop' for rural health care support would be incredibly helpful. Additionally, as I mentioned earlier, the lack of permanent status for telehealth flexibilities is a major hurdle. We want to innovate, we want to invest in new ways of delivering care, but it's hard to do that when the rules might change in a year or two. We need a stable regulatory environment to truly transform rural health care.

Thank you. Dr. Mohr, in the minute I have left, can you speak to the importance of interprofessional education? How are you training your medical students to work effectively with nurses, PAs, and other members of the health care team?

It's a core part of our curriculum. We have joint training sessions where medical students...

...and the other thing is, I think we need to look at the whole system. We've got a lot of work to do, but I think this is a good start. And with that, I'll yield back.

The gentleman yields back. I now recognize the Ranking Member for any closing remarks he may have.

Thank you, Mr. Chairman. And thank you to all of our witnesses for being here today. Your testimony has been very helpful as we look at how to address the healthcare workforce shortage. It's clear that there is no single solution, but rather a need for a multi-faceted approach that includes increasing the number of residency slots, supporting rural health clinics, and investing in nursing and other allied health professions. I'm particularly interested in the role that community health centers can play in training the next generation of healthcare providers. We've heard today about some of the challenges they face, but also about the great work they are doing. I look forward to working with the Chairman and the members of this subcommittee to develop bipartisan solutions to these critical issues. Again, thank you to our witnesses for your time and your expertise. I yield back.

I thank the gentleman. I also want to thank our witnesses for appearing before the subcommittee today. Your testimony has been invaluable as we consider ways to strengthen and expand our healthcare workforce. It is clear that we must take action to ensure that all Americans have access to high-quality care, regardless of where they live. We've heard about the importance of Graduate Medical Education, the need for more primary care physicians, and the vital role of nurses and other healthcare professionals. We've also heard about the unique challenges facing rural and underserved communities. As we move forward, I am committed to working with my colleagues on both sides of the aisle to find common-sense solutions that will support our healthcare workers and improve the health of our nation. Without objection, all members will have five legislative days to submit additional written questions for the witnesses or additional materials for the record. There being no further business, the subcommittee stands adjourned. [Gavel sounds.]