University of Arizona Creating a Primary Care Tuition Waiver Program!

Great news. The UA Colleges of Medicine in Tucson and Phoenix are creating a new tuition waiver program for medical students specializing in primary care fields that agree to work in rural under-served areas in Arizona.  Up to 94 students who attend the UA Colleges of Medicine in Phoenix or Tucson can receive free tuition if they agree to practice in a rural area for at least 2 years after they graduate.

Kudos to the UA Administration for making the decision to spend a big chunk of the $8M that had appropriated to the medical schools in last year’s state budget for this innovative and badly needed intervention. 

In addition to the $8M appropriation to those medical schools, last year’s budget included an additional $750,000 for the State Loan Repayment Program (to make a total of $1.75M/year) and $12.5M more for Graduate Medical Education ($7M rural and $4.5M urban).

The new UA tuition waiver program will be a new resource to help carry some of the additional load already carried by the state’s loan repayment program.  That program was enhanced back in 2015 with the success of Senate Bill 1194 which enhanced Arizona’s State Loan Repayment Program by expanding the types of providers who can receive loan repayment assistance, increasing the award amounts for the initial and succeeding commitment years, and removing the 4-year service cap.  

The list of practitioners that can qualify for the state loan repayment program now include primary care physicians, dentists, advanced practice providers like nurse practitioners, physician assistants, nurse midwives, mental health providers, pharmacists and geriatrics. 

The AZ loan repayment program makes up to $65,000 available (for a 2-year commitment) for physicians and dentists.  Advanced practice providers can qualify for up to $50,000.  The incentives even get better as providers stay longer in the program. 

For each year of continued service in the under-served area after the first two years, physicians and dentists can receive up to $35,000.  Actually the loan repayment funds are worth even more than these figures because it is loan relief that isn’t counted as income for tax purposes.

AZ Center for Rural Health Workforce Reports

The UA Center for Rural Health (AzCRH) recently release healthcare workforce data briefs on Maternal Health and the Obstetrician and Gynecologist Physician Workforce in Arizona.  Access to timely and high-quality women’s health and primary care services is an essential component of a supporting maternal health. In the report, you’ll see that Greenlee and La Paz counties are maternal care deserts and Cochise, Graham Pinal, and Santa Cruz counties have limited access to maternal care.

Women in rural Arizona face barriers to maternal health care including a lower ratio of Ob-gyn providers per population. In general, women in rural areas have additional barriers like longer drive-times and fewer facilities offering obstetric services. 

Reports like this are important as they can be used to inform and influence both elected officials in the legislature and appointed officials in state agencies and universities.  Thoughtfully used- this kind of data can help inform legislative and administrative policy initiatives that can help improve the system of care for women (like the new tuition waiver program mentioned above).

Good News about Childhood Obesity in new MMWR Report

We got some good news from the childhood obesity public health front this week!  This week’s Morbidity and Mortality Weekly Report  found that the obesity rate among WIC participants aged 2–4 years went down in most states between 2010 and 2016 in most states including Arizona.  Arizona’s rate went from 15% in 2010 to 12% in 2016.  The study  looked at kids between 2 and 4 years old that participate in WIC between 2010 and 2016  obesity.  Very encouraging.

Here’s an news article that summarizes the Arizona results.

A big factor was undoubtedly a public health policy initiative from back in 2009 which revised the content of the foods that qualify under the program- to better align with nutrition research and practice guidelines of the American Academy of Pediatrics.  The revised food packages included a broader range of healthy food options and promotes fruit, vegetable, and whole wheat product purchases; support breastfeeding; and gave states more flexibility to accommodate cultural food preferences.

The study was among WIC participants- but WIC interventions are likely not the only intervention at play here.  Other state initiatives were under way in Arizona during the 2010 – 2016 study period, including:

  • Working with the county health departments to implement the Health in Arizona Policy Initiative. This initiative focused on school health, worksite wellness, healthy community design, procurement of healthy foods (like having healthy alternatives in vending machines), preventive clinical care, and inclusion of children with special health care needs.

  • The implementation of the CDC public health prevention grant in 2013, which, like the Health in Arizona Policy Initiative, which made healthy living easier by supporting healthy environments in workplaces, schools, early childhood education/child care, and in the community. Arizona was one of 32 states to be awarded enhanced funding that year and received $2M per year for 5- years. That grant resulted in a host of statewide interventions.

  • Arizona’s county health departments implemented Health Impact Assessments, action plans, and initiatives during the study period aimed at increasing healthy eating and active living by using tools like the Arizona Health in Policy and Practice Resources and the Urban Land Institute’s Community Plan, both of which help local officials to focus on a holistic approach to land use planning, zoning, transportation, economic development, real estate development and finance.

  • School Health Advisory Councils were started in 2012 which helped schools to identify and incorporate best practices for obesity prevention including standards that promote healthy eating and physical activity, like focusing on serving fruits and vegetables, limiting sugary beverages, and providing more opportunities for physical activity, and reducing screen time- like the ADHS’ 2010 nationally-recognized Empower program does.

  • State level legislative policy also may have been a factor. Back in 2013 we were able to pass ARS 33-1551 which addresses liability concerns of schools when opening outdoor facilities to the public outside of the school day- making it easier for schools to open playgrounds to the public so children have more places to play and be physically active.


WIC at a Glance

As a federal grant program inside the USDA, WIC is administered by states, territories, and Indian Tribal Organizations to provide supplemental nutritious foods, breastfeeding support, health care referrals, and nutrition education for low-income children aged <5 years and pregnant, postpartum, or breastfeeding women. WIC PC is a biennial census in even years of all participants certified to receive WIC benefits.

To be eligible for WIC, participants must live in the states in which they apply, have gross household income ≤185% of the federal poverty guidelines or be eligible for other programs (e.g., Supplemental Nutrition Assistance Program, Medicaid, and Temporary Assistance for Needy Families), and be at nutrition risk. Children’s weight and height are measured by WIC staff members during certification and recertification clinical visits.

Congress Passes Temporary Continuing Resolution- Keeping the Federal Government Open until December 20

This year’s federal fiscal year started October 1, but there’s still not a budget for this year.  At least there’s a new continuing resolution.  Last week the US House and Senate passed a continuing resolution that temporarily funds the federal government through December 20.  It’s called the Further Continuing Appropriations Act, 2020 and Further Health Extenders Act of 2019, and it continued current funding levels through December 20, 2019.

The previous continuing resolution had expired last Thursday.  Here’s a section-by-section summary of the bill can be found funding bill and here’s the full text.  Public health programs will continue to be funded at the current level, for now. Congress now has 3 weeks to continue work on FY20 (current year) budget negotiations.