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GAO-13-709R: 

GAO:
United States Government Accountability Office: 
441 G St. N.W. 
Washington, DC 20548: 

August 15, 2013: 

Congressional Requesters: 

Subject: Health Care Workforce: Federally Funded Training Programs in 
Fiscal Year 2012: 

A well-trained and diverse health care workforce is essential for 
providing Americans with access to quality health care services. As 
part of ensuring a sufficient supply of physicians, nurses, dentists, 
and other direct care health professionals for the nation, the federal 
government supports health care workforce training through various 
efforts.[Footnote 1] These efforts include federal programs that 
directly train health professionals, award grants or make payments to 
institutions training health professionals, and provide financial 
assistance to health professional students through stipends, 
scholarships, loans, or loan reimbursement. For example, titles VII 
and VIII of the Public Health Service Act (PHSA) authorize multiple 
grant and financial assistance programs in order to increase the 
supply, diversity, and geographic distribution of primary care 
providers and nurses.[Footnote 2] In addition, primarily through 
Medicare payments to teaching hospitals, the federal government is 
also the largest supporter of graduate medical education (GME)--
postgraduate residency training programs for physicians and others. 
More recently, the Patient Protection and Affordable Care Act of 2010 
(PPACA) reauthorized many of the existing PHSA workforce training 
programs as well as established several new programs aimed at 
improving and diversifying the health care workforce.[Footnote 3] 
Federal departments have also developed grant programs and programs 
that directly train health professionals in order to meet their 
statutory missions. 

To better understand the scope of the federal government's role in 
health care workforce training, you asked us to provide information on 
federally funded health care workforce training programs. This report 
identifies federal programs that supported postsecondary training and 
education for direct care health professionals in fiscal year 2012, 
including information about program purpose, funding, and targeted 
health professionals. 

To identify these federal programs, we reviewed reports by 
organizations that have examined health care workforce issues, 
[Footnote 4] reviewed federal department budgets, searched the Catalog 
of Federal Domestic Assistance (CFDA),[Footnote 5] reviewed the Fiscal 
Year 2012 Budget of the United States Government, and reviewed 
relevant federal laws and regulations. For federal departments 
identified as having at least one health care workforce training 
program, we administered a structured request to identify any 
additional programs and obtain information on each program's purpose, 
authority, funding obligations, and the number of health professional 
trainees supported by program funds in fiscal year 2012.[Footnote 6] 
We also reviewed additional program information from websites and 
materials, such as budget justifications and grant announcements, from 
agencies within the departments that administered programs. To assess 
the reliability of the agency-provided information on funding levels 
and the number of trainees supported by program funds, we asked 
officials questions about source data and conducted follow-up 
interviews as necessary. We determined that the data are sufficiently 
reliable for our purposes. 

Our review focused on federal programs that provided postsecondary 
training or education for direct care health professionals or 
supported the costs of such training in fiscal year 2012,[Footnote 7] 
the most recently completed fiscal year at the time of our review, by 
directly providing or funding one or more of the following services: 
[Footnote 8] 

* instruction (e.g., degree programs) or formal training opportunities 
(e.g., internships) for health professional students; 

* on-the-job clinical training for postgraduate health professionals 
(e.g., residencies); 

* financial assistance for health professional students or 
professionals (e.g., stipends, scholarships, loans, or repayment or 
cancellation of educational loans); or: 

* patient care-related continuing education for direct care health 
professionals if such training was the main program service provided. 
[Footnote 9] 

We conducted this performance audit from March 2013 through August 
2013 in accordance with generally accepted government auditing 
standards. Those standards require that we plan and perform the audit 
to obtain sufficient, appropriate evidence to provide a reasonable 
basis for our findings and conclusions based on our audit objectives. 
We believe that the evidence obtained provides a reasonable basis for 
our findings based on our audit objectives. 

Results in Brief: 

In fiscal year 2012, we found that four federal departments--the 
Department of Health and Human Services (HHS), Department of Veterans 
Affairs (VA), Department of Defense (DOD), and Department of Education 
(Education)--administered 91 programs that supported postsecondary 
training or education specifically for direct care health 
professionals. The departments reported obligating about $14.2 billion 
for these programs in fiscal year 2012 with the majority (78 percent) 
of funding going to programs that supported GME--postgraduate 
residency training for physicians and certain other health 
professionals. 

Background: 

The U.S. health care workforce includes a spectrum of health 
professionals requiring varying levels of postsecondary education and 
training, ranging from diploma programs to graduate degrees and 
postgraduate training.[Footnote 10] Some professionals who deliver 
direct health care services to patients require clinical training, 
such as internships, residencies, or fellowships, through a health 
care institution in addition to completing graduate-level educational 
requirements before being eligible for full licensure. These 
professionals include physicians, certain pharmacists, podiatrists, 
clinical psychologists, and dentists seeking a dental specialty. Table 
1 provides the general education levels for common health 
professionals that provide direct clinical or rehabilitative services. 

Table 1: Direct Care Health Professionals' Education and Training: 

Health professional: Audiologist; 
Typical education and training: Doctoral degree and clinical 
externship. 

Health professional: Chiropractors; 
Typical education and training: Doctoral or professional degree. 

Health professional: Dental hygienist; 
Typical education and training: Associate's, bachelor's, or master's 
degree. 

Health professional: Dentist; 
Typical education and training: Doctoral or professional degree and 
optional residency. 

Health professional: Medical assistant; 
Typical education and training: Associate's degree, diploma, or 
certificate. 

Health professional: Nurse - advanced practice registered nurse, which 
includes nurse practitioners, nurse midwives, nurse anesthetists, and 
nurse specialists; 
Typical education and training: Master's doctoral degree. 

Health professional: Nurse - registered nurse; 
Typical education and training: Associate's or bachelor's degree or 
diploma program. 

Health professional: Nurse - licensed practical nurse; 
Typical education and training: Postsecondary nondegree award. 

Health professional: Occupational therapist; 
Typical education and training: Master's degree. 

Health professional: Optometrist; 
Typical education and training: Doctoral or professional degree. 

Health professional: Pharmacist; 
Typical education and training: Doctoral or professional degree and 
optional residency. 

Health professional: Physical therapist; 
Typical education and training: Master's or doctoral degree and 
optional residency or fellowship. 

Health professional: Physician (including doctor of medicine and 
doctor of osteopathy); 
Typical education and training: Doctoral degree and internship and or 
residency training with possible fellowship. 

Health professional: Physician assistant; 
Typical education and training: Master's degree. 

Health professional: Podiatrist; 
Typical education and training: Doctoral degree and residency. 

Health professional: Clinical psychologist; 
Typical education and training: Doctoral degree and internship. 

Health professional: Clinical social worker; 
Typical education and training: Master's degree and supervised 
clinical experience. 

Source: GAO analysis of information from the Bureau of Labor 
Statistics and professional organizations. 

[End of table] 

Four Departments Administered 91 Programs That Supported Health Care 
Workforce Training in Fiscal Year 2012: 

In fiscal year 2012, we found that four federal departments 
administered 91 programs that supported postsecondary training or 
education specifically for direct care health professionals. All 
together, the four departments reported obligating about $14.2 billion 
for health care workforce training programs in fiscal year 2012, with 
HHS funding the most programs (69) and having the largest percentage 
of total reported funding (82 percent).[Footnote 11] Specifically, HHS 
reported about $11.7 billion in funding for workforce training 
programs in fiscal year 2012, VA reported about $1.7 billion in 
funding for 12 programs, DOD reported about $0.9 billion in funding 
for 7 programs,[Footnote 12] and Education reported about $2 million 
in funding for 3 programs in fiscal year 2012. (Enclosure I provides 
information on each of the HHS-administered health care workforce 
training programs, including program authority, purpose and 
description, targeted health professionals, and reported funding in 
fiscal year 2012; enclosure II provides similar information on each of 
the VA-administered programs; enclosure III provides information on 
each of the DOD-administered programs; and enclosure IV provides 
information on each of the Education-administered programs.) 

In total, across all four departments, the majority (78 percent) of 
federal funding for health care workforce training in fiscal year 2012 
went to programs that supported GME (see fig. 1). Two programs 
administered by HHS's Centers for Medicare & Medicaid Services (CMS)--
Medicare payments to teaching hospitals and other entities for Direct 
Graduate Medical Education (DGME) and Medicare payments to teaching 
hospitals for Indirect Medical Education (IME)--accounted for about 66 
percent of total reported health care workforce training funding. 
[Footnote 13] CMS's Medicaid program also made payments to teaching 
hospitals for GME and the Health Resources and Services Administration 
(HRSA), another agency within HHS, administered 2 programs that 
supported GME in settings other than teaching hospitals.[Footnote 14] 
VA and DOD also supported GME in their medical facilities; however, 
the funding information VA provided to us accounted for resident 
salaries and benefits, and the funding information provided by DOD 
accounted for only certain administrative costs to operate its GME. 

Figure 1: Proportion of Total Reported Federal Funding Obligated for 
Health Care Workforce Training by Graduate Medical Education (GME) and 
Other Programs, Fiscal Year 2012: 

[Refer to PDF for image: pie-chart] 

Total federal funding obligated for healthcare workforce training, 
fiscal year 2012: $14.2 billion: 

Medicare Indirect Medical Education payments: 47% ($6.7 billion); 
Medicare Direct GME payments: 19% ($2.7 billion); 
Medicaid Payments for GME: 6% ($785 million); 
Other funding for GME: 7% ($942 million); 
Total funding for GMU: 78% ($11.1 billion); 
All 84 other programs: 22% ($3.2 billion). 

Source: GAO analysis of Department of Defense, Department of 
Education, Department of Health and Human Services, and 
Department of Veterans Affairs information. 

Note: Percentages do not add to 100 because of rounding. 

[End of figure] 

The remaining federal funding for health care workforce training went 
toward 84 programs that provided financial assistance to direct care 
health professional students and professionals, provided or supported 
instruction or clinical training for direct care health professionals, 
or provided a combination of these and other training support 
services. Across all 84 programs, trainees received differing levels 
of assistance, ranging from participation in short-term continuing 
education courses to full support for tuition and books and a stipend 
for living expenses. 

For example: 

* Sixty of the 84 programs provided financial assistance to support 
health professionals or students of varying backgrounds either as the 
sole program service or in conjunction with other services. 
Specifically, 18 programs provided scholarships for tuition and other 
costs to students enrolled in a health professional training program, 
and 10 programs provided loan reimbursements to health professionals 
with varying eligibility criteria. Many of these programs provided 
financial assistance in exchange for a commitment by the recipient to 
serve or work in a specific facility or location. Other programs that 
provided financial assistance included four low interest loan programs 
for various eligible health professional students, 1 loan program that 
also provided loan reimbursement, and 27 programs that provided 
stipends or otherwise financially supported students as they completed 
training. 

* Fifty of the 84 programs directly provided training, including 
continuing education training, to health professionals and students or 
provided grants to institutions to support such training, develop 
training programs, or a combination of services.[Footnote 15] For 
example, VA and DOD funded instructional and clinical training 
programs for a variety of health professionals in their medical 
facilities. 

The 84 programs targeted various types of health professionals and 
eligible individuals. Forty-seven of the 84 programs targeted support 
for students, professionals, or faculty in multiple health 
professions, though 18 programs exclusively targeted nurses, 8 
programs exclusively targeted physicians or physician assistants, 6 
programs exclusively targeted dentists or dental hygienists, 4 
programs exclusively targeted behavioral health professionals, and 1 
program exclusively targeted physicians and dentists.[Footnote 16] In 
addition to targeting certain health professionals, 16 of the 84 
programs were specifically targeted to increase participation of 
underrepresented minorities or financially disadvantaged individuals 
in the health care workforce. 

In addition to training programs that specifically targeted health 
professionals, we found that Education administered programs that 
provide general educational support toward the costs of degree-
granting programs, but these programs did not specifically target 
direct care health professionals (enclosure IV provides examples of 
these additional programs). 

Agency Comments: 

We provided a draft of this report to officials from the Departments 
of Defense, Education, Health and Human Services, and Veterans Affairs 
for their review and comment. Health and Human Services and Veterans 
Affairs provided technical comments, which we incorporated as 
appropriate. In its technical comments, HHS specifically commented 
that our use of the term program is inconsistent with HHS's approach 
to defining a program as an organized set of programmatic activities 
defined by a common statutory authority. For the purposes of this 
report, to more completely describe federal health care workforce 
training efforts, we counted separate activities that were funded 
within an authorized program as individual programs with certain 
exceptions, which are noted in the report. This definition is 
consistent with GAO's use of program in a prior report on health care 
professions education programs. The other departments had no comments. 

As agreed with your offices, unless you publicly announce the contents 
of this report earlier, we plan no further distribution until 30 days 
from the report date. At that time, we will send copies to the 
Secretary of Defense, the Secretary of Education, the Secretary of 
Health and Human Services, the Secretary of Veterans Affairs, and 
other interested parties. In addition, the report will be available at 
no charge on the GAO website at [hyperlink, http://www.gao.gov]. 

If you or your staffs have any questions about this report, please 
contact me at (202) 512-7114 or kohnl@gao.gov. Contact points for our 
Offices of Congressional Relations and Public Affairs may be found on 
the last page of this report. GAO staff members who made key 
contributions to this report include Martin T. Gahart (Assistant 
Director), Rebecca Abela, Krister Friday, and Jennifer Whitworth. 

Signed by: 

Linda T. Kohn: 
Director, Health Care: 

Enclosures - 4: 

List of Requesters: 

The Honorable Tom Coburn, MD: 
Ranking Member: 
Committee on Homeland Security and Governmental Affairs: 
United States Senate: 

The Honorable Michael B. Enzi: 
Ranking Member: 
Subcommittee on Children and Families: 
Committee on Health, Education, Labor, and Pensions: 
United States Senate: 

The Honorable Richard Burr: 
Ranking Member: 
Subcommittee on Primary Health and Aging: 
Committee on Health, Education, Labor, and Pensions: 
United States Senate: 

[End of section] 

Enclosure I: 

Department of Health and Human Services (HHS) Health Care Workforce:
Training Programs Funded in Fiscal Year (FY) 2012: 

HHS reported obligating about $11.7 billion for programs that 
supported postsecondary training or education specifically for direct 
care health professionals in FY 2012.[Footnote 17] Table 2 describes 
each of the 69 individual programs administered by seven agencies 
within HHS and provides information on the number of trainees 
supported by each program and related funding obligations in FY 
2012.[Footnote 18] 

Table 2: Department of Health and Human Services (HHS) Health Care 
Workforce Training Programs That Received Funding in Fiscal Year (FY) 
2012, by Agency: 

Administration for Children and Families: 

Program (Statutory authority): 1. Health Profession Opportunity 
Grants; (42 U.S.C § 1397g); 
Purpose and description: Administration for Children and Families: 
Grants to organizations, states, and other entities for the purpose of 
providing education and training to Temporary Assistance for Needy 
Families recipients and other low-income individuals for occupations 
in health care fields that pay well and are expected to either 
experience labor shortages or be in high demand; 
Targeted health professionals[A]: Multiple health professionals; 
such as home health aides, nurses, and nursing assistants; 
Number of trainees supported[B]: 10,327 participants received training; 
Obligations[C]: $79.951 million. 

Centers for Medicare & Medicaid Services (CMS): 

Program (Statutory authority): Medicare; 
Purpose and description: Administration for Children and Families: 
Medicare is the federally financed health insurance program for 
elderly and certain disabled individuals. Medicare provides funding 
for graduate medical education (GME) residency programs and certain 
nursing and allied health education. 

Program (Statutory authority): 2. Medicare Direct GME Payments (DGME); 
(42 U.S.C. § 1395ww(h)); 
Purpose and description: Administration for Children and Families: 
Medicare payments to teaching hospitals and certain community based 
institutions to cover the teaching costs, such as resident stipends 
and supervisory physician salaries, associated with training residents 
in accredited residency programs in allopathic and osteopathic 
medicine, as well as dentistry and podiatry. Payments may include 
funds for training in nonhospital settings; 
Targeted health professionals[A]: Physicians, dentists, and 
podiatrists; 
Number of trainees supported[B]: 85,000 full-time equivalent physician 
residents; 
3,000 dental and podiatry residents; 
Obligations[C]: $2.676 billion[D]. 

Program (Statutory authority): 3. Medicare Indirect Medical Education 
Payments (IME); (42 U.S.C. § 1395ww (d)(5)(B)); 
Purpose and description: Administration for Children and Families: 
Additional Medicare payments to teaching hospitals per Medicare 
discharge to support the higher patient care costs, such as increased 
use of emerging technologies, associated with training residents in 
accredited residency programs in allopathic and osteopathic medicine, 
as well as dentistry and podiatry. Payments may include funds for 
training in department settings; 
Targeted health professionals[A]: Physicians, dentists, and 
podiatrists; 
Number of trainees supported[B]: 77,000 full-time equivalent physician 
residents; 
3,000 dental and podiatry residents; 
Obligations[C]: $6.665 billion[E]. 

Program (Statutory authority): 4. Medicare Payments for Nursing and 
Allied Health Education; 
(42 U.S.C. § 1395(v)(1)(A)); 
Purpose and description: Administration for Children and Families: 
Medicare payments outside of GME payments to hospitals that operate 
approved nursing and allied health education programs to support 
Medicare's share of the costs of those programs. To qualify for 
nursing and allied health payment, hospitals must operate the programs 
in their entirety; 
Targeted health professionals[A]: Nurses and allied health 
professionals; 
Number of trainees supported[B]: Not available[F]; 
Obligations[C]: $273 million. 

Program (Statutory authority): 5. Medicaid Payments for GME[G]; 
Purpose and description: Administration for Children and Families: 
Medicaid payments to teaching hospitals or as part of capitation rates 
under managed care to account for Medicaid's share of GME; 
Targeted health professionals[A]: Physicians, dentists, and 
podiatrists; 
Number of trainees supported[B]: Not available[F]; 
Obligations[C]: $784.916 million[H]. 

Health Resources and Services Administration (HRSA): 

Program (Statutory authority): 6. Nurse Managed Health Clinics; (42 
U.S.C. § 254c-1a); 
Purpose and description: Administration for Children and Families: 
Grants to nurse-managed clinics that improve access to primary care, 
enhance nursing practice by increasing the number of clinical teaching 
sites for primary care and community health nursing students, and 
develop electronic processes for establishing effective patient and 
workforce data collection systems; 
Targeted health professionals[A]: Nurses (primary care); 
Number of trainees supported[B]: 2,417 trainees[I]; 
Obligations[C]: Not applicable[J]. 

Program (Statutory authority): 7. Rural Health Workforce Development 
Program; 
(42 U.S.C. § 254c(f)); 
Purpose and description: Administration for Children and Families: 
Grants to establish and sustain rural health networks that develop 
innovative community-based educational and clinical health training 
programs to encourage the recruitment and retention of emerging health 
professionals (students and residents) in rural communities; 
Targeted health professionals[A]: Physicians and other primary care 
and allied health professionals; 
Number of trainees supported[B]: 1029 students; 82 physician 
residents[I]; 
Obligations[C]: $3.993 million. 

Program (Statutory authority): National Health Service Corps (NHSC); 
Purpose and description: Administration for Children and Families: 
Provides financial assistance to recruit and retain health care 
providers to serve in and meet the workforce needs of communities 
designated as health professional shortage areas (HPSA). The NHSC 
funded the following activities in FY 2012 to address and target 
various aspects of workforce development. We counted each activity as 
a separate program. 

Program (Statutory authority): 8. NHSC Loan Repayment Program; 
(42 U.S.C. § 254l-1); 
Purpose and description: Administration for Children and Families: 
Loan repayment of up to $60,000 to primary care medical, dental, and 
behavioral health providers in exchange for 2 years of full-time 
service or 4 years of half-time service in an HPSA; 
Targeted health professionals[A]: Physicians (primary care), APRNs, 
physician assistants, dentists, dental hygienists, and behavioral 
health providers; 
Number of trainees supported[B]: 4,267 loan repayment recipients; 
Obligations[C]: $220.680 million. 

Program (Statutory authority): 9. NHSC State Loan Repayment Program; 
(42 U.S.C. § 254q-1); 
Purpose and description: Administration for Children and Families: 
Grants to states to provide loan repayment contracts to providers who 
practice in an HPSA in that state. The state loan repayment serves as 
a complement to the NHSC and provides flexibility to states to place 
providers in underserved areas and help meet their unique primary care 
workforce needs. State grantees are required to match the federal 
funds dollar-for-dollar; 
Targeted health professionals[A]: Physicians, nurses, physician 
assistants, dentists, dental hygienists, behavioral health providers, 
and pharmacists; 
Number of trainees supported[B]: 339 loan repayment recipients; 
Obligations[C]: $11.770 million. 

Program (Statutory authority): 10. NHSC Scholarship Program; (42 
U.S.C. § 254l); 
Purpose and description: Administration for Children and Families: 
Scholarships to students pursuing careers in primary care, who upon 
completing their training, are required to dedicate 2 to 4 years of 
service at a NHSC-approved site in a high-need HPSA; 
Targeted health professionals[A]: Physicians (primary care), APRNs, 
physician assistants, and dentists; 
Number of trainees supported[B]: 222 scholarship recipients; 
Obligations[C]: $52.960 million. 

Program (Statutory authority): 11. NHSC Students to Service Loan 
Repayment Program; (42 U.S.C. § 254l-1); 
Purpose and description: Administration for Children and Families: 
Loan repayment of up to $120,000 to medical students in their last 
year of school who, upon completion of a primary care residency, must 
provide 3 years of full-time or 6 years of half-time primary health 
care service in an NHSC-approved site in a high-need HPSA. The program 
was established as a pilot in FY 2012 to encourage students to choose 
a primary care residency; 
Targeted health professionals[A]: Physicians (primary care); 
Number of trainees supported[B]: 69 loan repayment recipients; 
Obligations[C]: $8.830 million. 

Program (Statutory authority): 12. Native Hawaiian Health Scholarship 
Program; (42 U.S.C. §§ 254s, 11709); 
Purpose and description: Administration for Children and Families: 
Scholarships to native Hawaiian health professional students in 
exchange for providing service after graduation in a medically 
underserved area in the state of Hawaii for a minimum of 2 years to 
address the demand for more health care professionals to deliver 
quality, culturally competent primary health services to native 
Hawaiians; 
Targeted health professionals[A]: Multiple health professionals, such 
as physicians, nurses, physician assistants, dentists, behavioral 
health providers, and pharmacists; 
Number of trainees supported[B]: 14 scholarship recipients; 
Obligations[C]: $1.350 million. 

Program (Statutory authority): 13. Children's Hospitals GME Payment 
Program; (42 U.S.C. § 256e); 
Purpose and description: Administration for Children and Families: 
Payments to freestanding children's hospitals that sponsor residency 
programs for primary care physicians and physicians with pediatric 
medical and surgical subspecialties in order to increase the number of 
those physicians in the workforce. Payments currently include both 
direct medical education and indirect medical education expenses.[K]; 
Targeted health professionals[A]: Physicians (primary care or 
pediatric medical and surgical subspecialists); 
Number of trainees supported[B]: 6,185 residents[I]; 
Obligations[C]: $256.161 million. 

Program (Statutory authority): 14. Grants to States to Support Oral 
Health Workforce Activities; 
(42 U.S.C. § 256g); 
Purpose and description: Administration for Children and Families: 
Grants to states to develop and implement innovative programs to 
address dental workforce needs of designated dental HPSAs. States are 
authorized to use grant funds for various activities, including loan 
forgiveness and repayment programs for dentists who agree to practice 
in dental HPSAs; establishment of dental residency programs; placement 
and support of dental students, dental residents and advanced 
dentistry trainees; continuing dental education; and establishment of 
faculty recruitment programs; 
Targeted health professionals[A]: Dentists; 
Number of trainees supported[B]: 386 trainees[I]; 
Obligations[C]: $11.779 million. 

Program (Statutory authority): 15. Teaching Health Centers GME Payment 
Program; (42 U.S.C. § 256h); 
Purpose and description: Administration for Children and Families: 
Payments to qualified teaching health centers--community-based 
institutions that sponsor residency programs for primary care 
physicians and dentists--in order to bolster the primary care 
workforce, and improve the distribution of that workforce into 
outpatient community-based care. Payments include direct medical 
education and indirect medical education expenses; 
Targeted health professionals[A]: Physicians (primary care) and 
dentists (primary care); 
Number of trainees supported[B]: 63 residents[I]; 
Obligations[C]: $17.210 million. 

Program (Statutory authority): 16. Loans for Disadvantaged Students; 
(42 U.S.C. §§ 292q-292y); 
Purpose and description: Administration for Children and Families: 
Grants to accredited health professions schools to provide low-
interest loans to health professional students from disadvantaged 
backgrounds enrolled in approved health professional degree programs 
in order to improve recruitment and retention of the disadvantaged and 
to increase health professions workforce diversity; 
Targeted health professionals[A]: Multiple health professionals, such 
as physicians, dentists, optometrists, and pharmacists; 
Number of trainees supported[B]: 869 received loans[I]; 
Obligations[C]: $0.895 million[L]. 

Program (Statutory authority): 17. Health Professions Student Loans; 
(42 U.S.C. §§ 292q-292y); 
Purpose and description: Administration for Children and Families: 
Grants to accredited health professions schools to provide low-
interest loans to health professional students in order to alleviate 
the shortage of health professionals and to ensure that qualified 
students are not denied a health professional career because of lack 
of financial resources; 
Targeted health professionals[A]: Dentists, optometrists, pharmacists, 
and podiatrists; 
Number of trainees supported[B]: 4,017 received loans[I]; 
Obligations[C]: $4.261 million[L]. 

Program (Statutory authority): 18. Primary Care Loans; (42 U.S.C. §§ 
292q-292y); 
Purpose and description: Administration for Children and Families: 
Grants to medicals schools to provide low-interest loans to full-time 
medical students in exchange for agreement to train and practice as 
primary care physicians. Participating medical schools must meet 
certain requirements regarding participation of graduates in primary 
health care practices and residencies; 
Targeted health professionals[A]: Physicians (primary care); 
Number of trainees supported[B]: 281 received loans[I]; 
Obligations[C]: $14.186 million[L]. 

Program (Statutory authority): 19. Centers of Excellence; (42 U.S.C. § 
293); 
Purpose and description: Administration for Children and Families: 
Grants to certain health professions schools to support education and 
training enhancement programs that increase health professions 
opportunities for underrepresented minority students and faculty 
through activities, including: improving faculty development or 
retention, educational pipeline development, developing minority 
health curricula, providing health services training to 
underrepresented minority individuals in community-based health 
facilities, and providing stipends to students or faculty; 
Targeted health professionals[A]: Physicians, dentists, pharmacists, 
and behavioral health professions; 
Number of trainees supported[B]: 3,243 trainees (1,217 of whom 
received financial assistance)[I]; 
Obligations[C]: $22.901 million. 

Program (Statutory authority): 20. Scholarships for Disadvantaged 
Students; (42 U.S.C. § 293a); 
Purpose and description: Administration for Children and Families: 
Grants to accredited health professions schools to provide 
scholarships to health professional students from disadvantaged 
backgrounds enrolled in approved health professions degree programs in 
order to increase the diversity of the health care workforce; 
Targeted health professionals[A]: Multiple health professionals, such 
as chiropractors, dentists, nurses, physician assistants, pharmacists, 
physical and occupational therapists, and podiatrists; 
Number of trainees supported[B]: 22,407 received scholarships[I]; 
Obligations[C]: $47.452 million. 

Program (Statutory authority): 21. Faculty Loan Repayment Program; (42 
U.S.C. § 293b); 
Purpose and description: Administration for Children and Families: 
Repayment of up to $40,000 of educational loans to qualified health 
professionals from disadvantaged backgrounds in exchange for a 
commitment to serve as faculty at an approved health professions 
institution for a minimum of 2 years. The employing institution must 
also make matching loan payments unless it faces undue financial 
hardship; 
Targeted health professionals[A]: Multiple health professionals, such 
as physicians, podiatrists, dentists, pharmacists, optometrists, 
nurses, physician assistants, and behavioral health professionals; 
Number of trainees supported[B]: 20 loan repayment recipients; 
Obligations[C]: $1.230 million. 

Program (Statutory authority): Primary Care Training and Enhancement; 
(42 U.S.C. § 293k); 
Purpose and description: Administration for Children and Families: 
Grants to hospitals, medical schools, academically affiliated 
physician assistant training programs and other entities to improve 
the quality, quantity, distribution, and diversity of the primary care 
workforce through curriculum enhancement and training program 
expansion. The program supported six activities in FY 2012 that we 
counted as individual programs; 
Obligations[C]: $38.910 million. 

Program (Statutory authority): 22. Academic Administrative Units in 
Primary Care; 
Purpose and description: Administration for Children and Families: 
Funds the establishment, maintenance, or improvement of academic 
administrative units that provide clinical instruction in family 
medicine, general internal medicine, general pediatrics, or 
combination of these disciplines; 
Targeted health professionals[A]: Physicians (family medicine, general 
internal medicine, general pediatrics, and med-peds); 
Number of trainees supported[B]: 5,064 trainees (15 of which received 
financial assistance)[I]. 

Program (Statutory authority): 23. Physician Faculty Development in 
Primary Care; 
Purpose and description: Administration for Children and Families: 
Funds the planning, development, and operation (including financial 
assistance to trainees) of programs that train physicians to teach 
family medicine (including geriatrics), general internal medicine, 
general pediatrics, or combination of these disciplines; 
Targeted health professionals[A]: Physicians (family medicine, general 
internal medicine, general pediatrics, and med-peds); 
Number of trainees supported[B]: 980 trainees (42 of which received 
financial assistance)[I]. 

Program (Statutory authority): 24. Pre-Doctoral Training in Primary 
Care; 
Purpose and description: Administration for Children and Families: 
Funds the planning, development, operation, or participation 
(including financial assistance to medical students) in predoctoral 
programs in family medicine, general internal medicine, general 
pediatrics, or combination of these disciplines; 
Targeted health professionals[A]: Physicians (family medicine, general 
internal medicine, general pediatrics, and med-peds); 
Number of trainees supported[B]: 10,049 trainees (191 of which 
received financial assistance)[I]. 

Program (Statutory authority): 25. Physician Assistant Training in 
Primary Care; 
Purpose and description: Administration for Children and Families: 
Funds the planning, development, operation, and maintenance of 
programs that train physician assistants and prepare faculty to train 
physician assistants. The program also increases the number of 
enrolled and graduated physician assistants by providing stipend 
support; 
Targeted health professionals[A]: Physician assistants; 
Number of trainees supported[B]: 2,602 trainees (318 of which received 
financial assistance)[I]. 

Program (Statutory authority): 26. Residency Training in Primary Care; 
Purpose and description: Administration for Children and Families: 
Funds the planning, development, operation, or participation 
(including financial assistance to residents) in approved residency 
programs in family medicine, general internal medicine, general 
pediatrics, or combination of these disciplines. The program also 
increases the number residents trained in primary care by providing 
stipend support to residents; 
Targeted health professionals[A]: Physicians (family medicine, general 
internal medicine, general pediatrics, and med-peds); 
Number of trainees supported[B]: 2,072 trainees (217 of which received 
financial assistance)[I]. 

Program (Statutory authority): 27. Interdisciplinary and 
Interprofessional Joint Graduate Degree; 
Purpose and description: Administration for Children and Families: 
Funds the planning, development and operation of joint degree programs 
to provide interdisciplinary and interprofessional graduate training 
in public health and other health professions to provide training in 
environmental health, infectious disease control, disease prevention 
and health promotion, epidemiological studies, and injury control; 
Targeted health professionals[A]: Physicians (primary care) and 
physician assistants; 
Number of trainees supported[B]: 1,131 trainees[I]. 

Program (Statutory authority): Training in General, Pediatric and 
Public Health Dentistry; (42 U.S.C. § 293k-2); 
Purpose and description: Administration for Children and Families: 
Grants to dental or dental hygiene schools or approved residency or 
advanced education programs in the practice of general, pediatric, or 
public health dentistry to improve access to and the delivery of oral 
health care services for underserved populations by increasing the 
supply of oral health care professionals and enhancing oral health 
care workforce education and training. The program supported four 
activities in FY 2012 that we counted as individual programs; 
Obligations[C]: $20.575 million. 

Program (Statutory authority): 28. Predoctoral Training in General, 
Pediatric and Public Health Dentistry and Dental Hygiene; 
Purpose and description: Administration for Children and Families: 
Funds the planning, development, operation of, and participation in 
approved professional training programs in general, pediatric, or 
public health dentistry and dental hygiene for students and provides 
financial assistance to dental or dental hygiene students; 
Targeted health professionals[A]: Dentists (general, pediatric, public 
health) and dental hygienists; 
Number of trainees supported[B]: 1,916 trainees (25 of which received 
financial assistance)[I]. 

Program (Statutory authority): 29. Postdoctoral Training in General, 
Pediatric and Public Health Dentistry and Dental Hygiene; 
Purpose and description: Administration for Children and Families: 
Funds the planning, development, operation of, and participation in 
approved professional training programs in general, pediatric, or 
public health dentistry for dental residents, practicing dentists, or 
other approved primary care dental trainees; 
grantees may also provide financial assistance to dental residents or 
practicing dentists; 
Targeted health professionals[A]: Dentists (general, pediatric, public 
health) and dental hygienists; 
Number of trainees supported[B]: 674 trainees (62 of which received 
financial assistance; 
119 continuing education trainees)[I]. 

Program (Statutory authority): 30. Faculty Development in General, 
Pediatric, and Public Health Dentistry and Dental Hygiene; 
Purpose and description: Administration for Children and Families: 
Funds the planning, development, and operation of programs for the 
training of oral health care providers who plan to teach in general, 
pediatric, and public health dentistry or dental hygiene and provides 
financial assistance through traineeships and fellowships to dentists 
who plan to teach or are teaching in general, pediatric, or public 
health dentistry; 
Targeted health professionals[A]: Dentists (general, pediatric, public 
health) and dental hygienists; 
Number of trainees supported[B]: 148 trainees (127 of which received 
financial assistance)[I]. 

Program (Statutory authority): 31. Dental Faculty Loan Repayment 
Program; 
Purpose and description: Administration for Children and Families: 
Funds the planning, development, and operation of a program to provide 
loan repayment to dental faculty engaged in general, pediatric, and 
public health dentistry and dental hygiene in exchange for a 
commitment to serve as full-time faculty members; 
Targeted health professionals[A]: Dentists (general, pediatric, public 
health) and dental hygienists; 
Number of trainees supported[B]: 35 received financial assistance[I]. 

Program (Statutory authority): 32. Area Health Education Centers; 
(42 U.S.C. § 294a); 
Purpose and description: Administration for Children and Families: 
Grants to medical and nursing schools to develop and maintain area 
health education centers (AHEC) and programs that improve the 
distribution, diversity, and supply of the primary care health 
professional workforce that serves medically underserved areas. AHECs 
provide community-based interdisciplinary education and training for 
health professional students, continuing education for professionals, 
field placements, and health career recruitment and outreach to 
underrepresented minority or disadvantaged individuals, and 
educational pipeline development; 
Targeted health professionals[A]: Multiple health professionals with 
focus on primary care; 
Number of trainees supported[B]: 648,166 trainees (245,075 of which 
received continuing education)[I]; 
Obligations[C]: $27.230. 

Program (Statutory authority): Education and Training Relating to 
Geriatrics; (42 U.S.C. § 294c); 
Purpose and description: Administration for Children and Families: 
Grants to support the education and training of health professionals 
in the needs specific to the geriatric patient population. The program 
supported three activities in FY 2012 that we counted as individual 
programs; 
Obligations[C]: $30.624 million. 

Program (Statutory authority): 33. Geriatric Education Centers; 
Purpose and description: Administration for Children and Families: 
Funds accredited health professional schools and graduate programs to 
establish and operate centers that provide interprofessional geriatric 
training and education to health professional students, faculty, and 
practitioners, including clinical training, faculty development, and 
continuing education in geriatrics; 
Targeted health professionals[A]: Multiple health professionals, such 
as physicians, and other geriatric-related health professionals; 
Number of trainees supported[B]: 79,521 trainees (60,259 of which 
received continuing education)[I]. 

Program (Statutory authority): 34. Geriatric Training for Physicians, 
Dentists, and Behavioral and Mental Health Professions; 
Purpose and description: Administration for Children and Families: 
Funds accredited medical schools, teaching hospitals, and GME programs 
to support fellowships and other training efforts that assist 
physicians, dentists, and behavioral and mental health professionals 
who plan to teach in geriatrics medicine; 
Targeted health professionals[A]: Physicians (primary care, 
psychiatrists), dentists, and behavioral health professionals; 
Number of trainees supported[B]: 63 received financial assistance[I]. 

Program (Statutory authority): 35. Geriatric Academic Career Awards; 
Purpose and description: Administration for Children and Families: 
Grants to eligible individuals to support, through financial 
assistance, the career development of junior faculty physicians, 
nurses, social workers, psychologists, dentists, pharmacists, and 
allied health professionals in academic geriatrics who provide 
training in clinical geriatrics including the training of 
interprofessional/interdisciplinary teams of health professionals; 
Targeted health professionals[A]: Multiple health professionals, such 
as physicians, nurses, social workers, psychologists, dentists, and 
pharmacists; 
Number of trainees supported[B]: 66 received financial assistance[I]. 

Program (Statutory authority): 36. Graduate Psychology Education; (42 
U.S.C. § 294e(b)(1)(J)); 
Purpose and description: Administration for Children and Families: 
Grants for the planning, development, or operation of accredited 
graduate, doctoral, doctoral internship, and doctoral psychology 
residency programs that address access for underserved populations by 
providing practice-based training experience (including stipends) for 
psychology students; 
Targeted health professionals[A]: Psychologists; 
Number of trainees supported[B]: 938 trainees (106 of which received 
financial assistance)[I]; 
Obligations[C]: $2.892 million. 

Program (Statutory authority): 37. Mental and Behavioral Health 
Education and Training Grants; (42 U.S.C. § 294e-1); 
Purpose and description: Administration for Children and Families: 
Grants to accredited schools of social work and doctoral psychology to 
strengthen the clinical field competencies of social workers and 
psychologists who pursue clinical service with high-need and high-
demand populations. Grantee services can include funding psychology 
internships or social work field placements or stipends for trainees 
during internships; 
Targeted health professionals[A]: Mental and behavioral health 
professionals (psychologists, social workers, and others); 
Number of trainees supported[B]: Not applicable[M]; 
Obligations[C]: $10 million[M]. 

Program (Statutory authority): Advanced Nursing Education Grants; 
(42 U.S.C. § 296j); 
Purpose and description: Administration for Children and Families: 
Grants to accredited nurse education programs to create or expand 
projects that support the enhancement of advanced nursing education 
and practice and traineeships for individuals in advanced nursing 
education programs. The program supported three activities in FY 2012 
that we counted as individual programs; 
Obligations[C]: $63.435 million. 

Program (Statutory authority): 38. Advanced Nursing Education (ANE); 
Purpose and description: Administration for Children and Families: 
Grants to support advanced nursing education programs for RNs 
preparing to become NPs, nurse midwives, nurse anesthetists, nurse 
administrators, and other specialties requiring advanced education. 
ANE also increases the number of enrolled and graduated primary care 
NP and nurse midwifery students by providing students with financial 
assistance, including stipends; 
Targeted health professionals[A]: APRNs; 
Number of trainees supported[B]: 7,825 trainees (368 of which trainees 
received financial assistance)[I]. 

Program (Statutory authority): 39. Advanced Education Nursing 
Traineeship; 
Purpose and description: Administration for Children and Families: 
Funds traineeships which cover tuition and other costs, for enrolled 
RNs to practice as primary care providers, nursing faculty, or both; 
Targeted health professionals[A]: APRNs; 
Number of trainees supported[B]: 8,963 received financial 
assistance[I]. 

Program (Statutory authority): 40. Nurse Anesthetist Traineeship; 
Purpose and description: Administration for Children and Families: 
Funds traineeships, which cover tuition and other costs, for RNs 
enrolled in nurse anesthesia programs to increase the number of nurse 
anesthetists to treat underserved populations; 
Targeted health professionals[A]: APRNs; 
Number of trainees supported[B]: 2,279 received financial 
assistance[I]. 

Program (Statutory authority): 41. Nursing Workforce Diversity; 
(42 U.S.C. § 296m); 
Purpose and description: Administration for Children and Families: 
Grants to accredited nursing schools and other entities for stipends 
and scholarships for nursing students from disadvantaged backgrounds, 
including racial and ethnic minorities that are underrepresented among 
RNs. Stipends are for diploma or associate degree nurses; student 
scholarships or stipends are for accelerated nursing degree programs, 
pre-entry preparation, advanced education preparation, and retention 
activities; 
Targeted health professionals[A]: Nurses and nursing assistants; 
Number of trainees supported[B]: 4,518 trainees (1,824 of which 
received financial assistance)[I]; 
Obligations[C]: $15.789 million. 

Program (Statutory authority): Nurse Education, Practice, Quality, and 
Retention Grants; (42 U.S.C. §§ 296p-§296p-1); 
Purpose and description: Administration for Children and Families: 
Grants to accredited nursing schools, health care facilities, or 
partnerships to address the needs of a growing and aging population's 
demand for nursing services by expanding the nursing pipeline, 
promoting career mobility, providing continuing education and 
supporting retention. The program supported five activities in FY 2012 
that we counted as individual programs; 
Number of trainees supported[B]: 23,157 trainees (43 of which received 
financial assistance, 4,608 continuing education trainees)[I]; 
Obligations[C]: $39.626 million. 

Program (Statutory authority): 42. Nurse Education Practice, Quality, 
and Retention; 
Purpose and description: Administration for Children and Families: 
Funds academic, service, and continuing education projects to 
strengthen and enhance the capacity for nurse education, practice, and 
retention through activities including, implementing internship and 
residency programs to encourage development of specialties, providing 
education in new technologies, and providing career ladder programs; 
Targeted health professionals[A]: Nurses, nursing assistants, nursing 
home, and home health aides. 

Program (Statutory authority): 43. Faculty Development: Integrated 
Technology into Nursing Education and Practice Initiative; 
Purpose and description: Administration for Children and Families: 
Funds nursing collaboratives for faculty development in the use of 
information and other technologies to educate students for 21st 
century health care practice; 
Targeted health professionals[A]: Nurses. 

Program (Statutory authority): 44. Innovative Nurse Education 
Technologies; 
Purpose and description: Administration for Children and Families: 
Funds nurse training programs to develop innovative regional 
approaches to using technology, including competency-based distance 
learning, to enhance nursing education; 
Targeted health professionals[A]: Nurses. 

Program (Statutory authority): 45. Nursing Assistant and Home Health 
Aide Program; 
Purpose and description: Administration for Children and Families: 
Funds infrastructure support for the development, evaluation, and 
demonstration of a competency-based uniform curriculum to train 
qualified nursing assistants and home health aides to meet the growing 
healthcare needs of the aging population; 
Targeted health professionals[A]: Nursing assistants, nursing home, 
and home health aides. 

Program (Statutory authority): 46. Interprofessional Collaborative 
Practice; 
Purpose and description: Administration for Children and Families: 
Funds projects designed to strengthen the nursing workforce, increase 
nurse retention, promote coordinated care, improve the quality of 
patient care, and provide nurses with the skills needed to practice in 
existing and emerging organized health care systems; 
Targeted health professionals[A]: Nurses, APRNs, physicians, 
therapists (occupational, physical, respiratory), physician 
assistants, pharmacists, dentists, behavioral health professionals, 
nursing assistants, nursing home, and home health aides. 

Program (Statutory authority): 47. Nursing Student Loans; (42 U.S.C. § 
297a); 
Purpose and description: Administration for Children and Families: 
Grants to accredited nursing schools to provide low-interest loans to 
nursing students in programs leading to a diploma, associate's, 
bachelor's, or graduate degree in nursing in order to alleviate the 
shortage of nurses. Participating institutions operate their loan 
programs through revolving accounts; 
Targeted health professionals[A]: Nurses; 
Number of trainees supported[B]: 7,063 trainees received loans[I]; 
Obligations[C]: $1.629 million[L]. 

Program (Statutory authority): 48. Nurse Faculty Loan Program; (42 
U.S.C. § 297n-1); 
Purpose and description: Administration for Children and Families: 
Grants to nursing schools to provide loans and loan cancellation to 
RNs and nursing faculty in order to increase the number of qualified 
nursing faculty and address the nursing workforce shortage, including 
loans made to RNs to complete graduate education and loan cancellation 
provided to borrowers in exchange for service as full-time nursing 
faculty; 
Targeted health professionals[A]: APRNs; 
Number of trainees supported[B]: 2,374 trainees (2,227 of which 
received financial assistance)[I]; 
Obligations[C]: $24.537 million[N]. 

Program (Statutory authority): NURSE Corps; (42 U.S.C. § 297n); 
Purpose and description: Administration for Children and Families: 
Provides financial assistance to alleviate the critical shortage of 
nurses and nurse faculty and to recruit and retain nurses to meet the 
workforce needs of health care facilities with a critical shortage of 
nurses known as critical shortage facilities (CSF). CSFs are health 
care facilities located in, designated as, or service a primary 
medical care or mental health HPSA. The NURSE Corps includes the NURSE 
Corps Loan Repayment Programs and NURSE Corps Scholarship Program. 

Program (Statutory authority): 49. NURSE Corps Loan Repayment Program; 
Purpose and description: Administration for Children and Families: 
Repayment of qualified nursing education loans to RNs, including 
APRNs, in exchange for working full-time for 2 to 3 years in a CSF or 
at an accredited school or nursing; 
Targeted health professionals[A]: Nurses; 
Number of trainees supported[B]: 1,452 loan repayment recipients; 
Obligations[C]: $55.490 million. 

Program (Statutory authority): 50. NURSE Corps Scholarship Program; 
Purpose and description: Administration for Children and Families: 
Scholarships to nursing students accepted or enrolled in a diploma, 
associate's, bachelor's, or graduate nursing program in exchange for a 
commitment of 2 to 4 years of service in a CSF upon graduation; 
Targeted health professionals[A]: Nurses; 
Number of trainees supported[B]: 264 scholarship recipients; 
Obligations[C]: $27.750 million. 

Program (Statutory authority): 51. Comprehensive Geriatric Education; 
(42 U.S.C. § 298); 
Purpose and description: Administration for Children and Families: 
Grants to nursing schools, health care facilities, or nurse training 
programs for geriatric curriculum development, geriatric faculty 
development, continuing education in geriatrics, and traineeships for 
individuals who are preparing for advanced education nursing degrees 
in geriatric or long-term care nursing; 
Targeted health professionals[A]: APRNs and allied health 
professionals; 
Number of trainees supported[B]: 7,115 trainees (6,790 of which 
received continuing education)[I]; 
Obligations[C]: $4.484 million. 

Program (Statutory authority): 52. Maternal and Child Health Training 
Program; 
(42 U.S.C. § 701(a)(2)); 
Purpose and description: Administration for Children and Families: 
Grants to public and private nonprofit institutions of higher learning 
to provide leadership training in maternal and child health. The 
program supports multiple training activities, including single 
discipline training activities, interdisciplinary training activities, 
and short-term training initiatives, some of which provide clinical 
skills training and continuing education for trainees. Reported 
funding is for nine specific activities, seven of which provided 
training in patient-related skills[O]; 
Targeted health professionals[A]: Multiple health professionals, such 
as audiologists, physicians, nurses, APRNs, dentists, psychologists, 
and social workers; 
Number of trainees supported[B]: 93,734 received training including 
continuing education[I]; 
Obligations[C]: $8.519 million. 

Program (Statutory authority): 53. The Combating Autism Act Training 
Program; 
(42 U.S.C. § 280i-1(e)(1)); 
Purpose and description: Administration for Children and Families: 
Grants to public and private nonprofit institutions of higher learning 
to provide graduate clinical training to a variety of health 
professionals in skills related to autism and other developmental 
disabilities. Reported funding is for two specific activities that 
provided training in patient-related skills.[P]; 
Targeted health professionals[A]: Multiple health professionals, such 
as audiologists, physicians, nurses, APRNs, dentists, psychologists, 
and social workers; 
Number of trainees supported[B]: 139,089 received training including 
continuing education[I]; 
Obligations[C]: $30.232 million. 

Program (Statutory authority): 54. AIDS Education and Training Centers; 
(42 U.S.C. § 300ff-111); 
Purpose and description: Administration for Children and Families: 
Grants to support a network of centers that conduct targeted, 
multidisciplinary education and training programs, including 
continuing education, for health care providers treating people living 
with HIV/AIDS, with a special emphasis on training minority clinicians 
and primary care clinicians serving minority populations; 
Targeted health professionals[A]: Multiple health professionals, such 
as physicians, physician assistants, nurses, APRNs, dentists, and 
pharmacists; 
Number of trainees supported[B]: 61,108 trainees[I]; 
Obligations[C]: $34.528 million. 

Program (Statutory authority): 55. Community Based Dental Partnership 
Program; 
(42 U.S.C. § 300ff-111); 
Purpose and description: Administration for Children and Families: 
Grants to dental and dental hygiene training programs to train dental 
and hygiene students, dental residents, and community-based dentists 
to deliver HIV/AIDS dental care in community settings and thus improve 
access to oral health care services for patients with HIV; 
Targeted health professionals[A]: Dentists and dental hygienists; 
Number of trainees supported[B]: 3,162 trainees[Q]; 
Obligations[C]: $3.989 million. 

Indian Health Service (IHS): 

Program (Statutory authority): 56. IHS Health Professions Scholarship 
Program for Indians; 
(25 U.S.C. § 1613a); 
Purpose and description: Administration for Children and Families: 
Scholarships to American Indians and Alaska Natives enrolled in 
accredited health professional training programs in order to obtain 
health professionals to serve Indians. Upon completion of their 
education and post-graduate training, scholarship awardees are 
obligated to serve in an IHS, tribal, or urban Indian Health care 
facility located in a HPSA[R]; 
Targeted health professionals[A]: Multiple health professionals, such 
as psychologists, dentists, nurses, pharmacists, physicians, and 
physician assistants; 
Number of trainees supported[B]: 282 scholarship recipients; 
Obligations[C]: $11.875 million. 

Program (Statutory authority): 57. IHS Extern Program; 
(25 U.S.C. § 1614); 
Purpose and description: Administration for Children and Families: 
Provides IHS scholarship recipients and other health professional 
students with up to 120 days of employment (including financial 
assistance) and clinical experience working with IHS and Tribal health 
professionals[R]; 
Targeted health professionals[A]: Multiple health professionals; 
Number of trainees supported[B]: 95 students; 
Obligations[C]: $0.688. 

Program (Statutory authority): 58. IHS Loan Repayment Program; 
(25 U.S.C. §§ 1616a--1616a-1); 
Purpose and description: Administration for Children and Families: 
Repayment of qualified educational loans for health care professionals 
in exchange for a commitment to serve in an IHS, tribal, or urban 
Indian health care facility for the purpose of assuring an adequate 
supply of trained health professionals for Indian Health programs.[R]; 
Targeted health professionals[A]: Multiple health professionals, such 
as behavioral health professionals, dentists, dental hygienists, 
nurses, pharmacists, physicians, and podiatrists; 
Number of trainees supported[B]: 820 loan repayment recipients; 
Obligations[C]: $30.167 million. 

Program (Statutory authority): 59. American Indians into Nursing; 
(25 U.S.C. § 1616e); 
Purpose and description: Administration for Children and Families: 
Grants to nursing schools and nurse training programs to increase the 
number of nurses, nurse midwives, and NPs who deliver services to 
Indians by: providing continuing education to nurses; 
recruiting individuals into nurse, nurse midwife, or NP training 
programs; 
or providing scholarships to nursing students in such training 
programs in exchange for an obligation to serve in an Indian Health 
program facility[R]; 
Targeted health professionals[A]: Nurses; 
Number of trainees supported[B]: 60 students; 
Obligations[C]: $1.762. 

Program (Statutory authority): 60. American Indians into Psychology; 
(25 U.S.C. § 1621p); 
Purpose and description: Administration for Children and Families: 
Grants to colleges and universities to develop programs that encourage 
Indians to enter the mental health field through: outreach and 
recruitment to Indian communities, providing summer enrichment 
programs to expose Indians to psychology, or providing stipends to 
undergraduate and graduate students to pursue a career in psychology 
in exchange for an obligation to serve in an Indian Health program 
facility[R]; 
Targeted health professionals[A]: Psychologists; 
Number of trainees supported[B]: 11 students; 
Obligations[C]: $0.755 million. 

Office of the Surgeon General (OSG): 

Program (Statutory authority): 61. Junior Commissioned Officer Student 
Training and Extern Programs; 
(42 U.S.C § 218a); 
Purpose and description: Administration for Children and Families: 
Provides internship-type experiences, including pay and benefits, at 
sponsoring HHS and non-HHS federal agencies for students in a 
qualifying degree program, including health professional degree 
programs; 
Targeted health professionals[A]: Nurses and pharmacists; 
Number of trainees supported[B]: 80 students; 
Obligations[C]: Not applicable[S]. 

Program (Statutory authority): 62. Senior Commissioned Officer Student 
Training and Extern Programs; 
(42 U.S.C § 218a); 
Purpose and description: Administration for Children and Families: 
Provides financial assistance, pay and benefits, to full time students 
completing a health professional degree program in exchange for a 
commission as an officer in the U.S. Public Health Service and service 
obligation at a sponsoring HHS or non-HHS federal agency; 
Targeted health professionals[A]: Nurses, pharmacists, and physician 
assistants; 
Number of trainees supported[B]: 28 students; 
Obligations[C]: Not applicable[S]. 

Office of Population Affairs: 

Program (Statutory authority): 63. Title X Family Planning Personnel 
Training; 
(42 U.S.C. § 300a-1); 
Purpose and description: Administration for Children and Families: 
Grants to institutions to provide training, including continuing 
education in clinical and other skills, for clinical and non-clinical 
personnel carrying out family planning service programs funded under 
the PHSA Title X Family Planning Program.[T]; 
Targeted health professionals[A]: Counselors, medical assistants, 
nurses, physicians, and physician assistants; 
Number of trainees supported[B]: 1,871 Title X personnel trained; 
Obligations[C]: $4.335 million. 

Substance Abuse Mental Health Services Administration (SAMHSA): 

Program (Statutory authority): 64. Addiction Technology Transfer 
Centers; 
(42 U.S.C. § 290bb-2); 
Purpose and description: Administration for Children and Families: 
Grants to institutions to conduct services such as providing training 
in evidence based treatment and recovery practices for health 
professionals and students, in order to develop and strengthen the 
workforce that provides addiction treatment services; 
Targeted health professionals[A]: Multiple health professionals, 
including behavioral health professionals and others, that provide 
addictions service; 
Number of trainees supported[B]: 25,000 individuals received training; 
Obligations[C]: $9.064 million. 

Program (Statutory authority): 65. Historically Black Colleges and 
Universities (HBCU) Center for Excellence in Behavioral Health; 
(42 U.S.C. §§ 290bb-2, 290bb-32); 
Purpose and description: Administration for Children and Families: 
Grants to HBCUs to expand behavioral health and substance abuse 
services to students on campus, and facilitate workforce development; 
specific grantee services can include, providing learning 
opportunities for HBCU students including health professional students 
through internships and providing other outreach activities to 
increase the number of HBCU students in behavioral health; 
Targeted health professionals[A]: Behavioral health professionals; 
Number of trainees supported[B]: Not available[U]; 
Obligations[C]: $0.500 million. 

Program (Statutory authority): 66. Physician Clinical Support System 
for the Treatment of Substance Use Disorders; (42 U.S.C. § 290bb-2); 
Purpose and description: Administration for Children and Families: 
Grants to specific professional organizations to develop a free 
national mentoring network that will provide clinical support, 
including continuing education training, to health professionals in 
the appropriate use of opioids; 
the specific program is responsible for certifying providers to 
prescribe buprenorphine in the outpatient setting; 
Targeted health professionals[A]: Physicians (primary care, 
psychiatrists) and other health professionals who treat opioid 
dependent patients; 
Number of trainees supported[B]: 499 individuals received training; 
Obligations[C]: $0.499 million. 

Program (Statutory authority): 67. Physician Clinical Support System 
for the Appropriate Use of Opioids in the Treatment of Pain and Opioid-
Related Addiction; (42 U.S.C. § 290bb-2); 
Purpose and description: Administration for Children and Families: 
Grants to specific professional organizations to develop a free 
national mentoring network that will provide clinical support, 
including continuing education training, to health professionals in 
the appropriate use of opioids; the specific program is used to provide 
training in safe and appropriate prescribing of opioids and provide 
mentoring support to providers; 
Targeted health professionals[A]: Physicians, dentists, and other 
health professionals who provide treatment for pain and opioid 
addiction; 
Number of trainees supported[B]: 1,196 individuals received training; 
Obligations[C]: $0.500 million. 

Program (Statutory authority): 68. Screening, Brief Intervention, and 
Referral to Treatment Medical Residency Program; (42 U.S.C. § 290bb-2); 
Purpose and description: Administration for Children and Families: 
Grants to various entities such as teaching hospitals with medical 
residency programs to develop and implement training programs to teach 
physician residents and other health professionals skills in 
screening, brief intervention, and referral and treatment for patients 
with or at risk for a substance use disorder; 
Targeted health professionals[A]: Physicians, nurses, and others; 
Number of trainees supported[B]: 1,582 residents and 3,260 non-
residents received training; 
Obligations[C]: $6.222 million. 

Program (Statutory authority): 69. Minority Fellowship Program; 
(42 U.S. C. § 290bb-32); 
Purpose and description: Administration for Children and Families: 
Grants to professional associations to provide training and financial 
support (stipends) to minority doctoral and post-doctoral students who 
are studying in a mental or behavioral health profession in order to 
improve the quality of such services provided to minority populations 
and increase the number of minority health professionals delivering 
them; 
Targeted health professionals[A]: APRNs, psychologists, physicians 
(psychiatry), social workers, and other behavioral health 
professionals; 
Number of trainees supported[B]: 125 fellows[I]; 
Obligations[C]: $5.604 million. 

Source: GAO summary of statutes and HHS information, including grant 
announcements, budget justifications, summary information from HHS 
agency websites, and information provided by agency officials. 

Notes: 

[A] Targeted health professionals are the direct care health 
professionals that are eligible for the program. We provide the health 
professional (e.g. physician) rather than the field (e.g. medicine). 
Some programs target multiple health professionals. "Physicians" 
refers to doctors of allopathic or osteopathic medicine and includes 
all medical specialties unless specified. "Nurses" refers generally to 
any degree level unless specified (RN = registered nurse, APRN = 
advanced practice registered nurse--including NP = nurse practitioner, 
certified registered nurse anesthetist, certified nurse midwife.) 
"Behavioral health professionals" include, for example, clinical 
psychologists and clinical social workers. "Allied health 
professionals" include, for example, audiologists, dental hygienists, 
and physical therapists. 

[B] Programs provided different levels of assistance to direct care 
health professional trainees. The number of trainees supported refers 
to the agency-reported number of trainees who completed a training 
carried out by the program; received financial support from the 
program in the form of scholarships, loans, loan repayment, or 
stipend; were in grantee programs that received support for training; 
or received a combination of these types of program services. When 
known, we specified the number of trainees who received financial 
assistance or continuing education. We did not determine the amount of 
funding provided per trainee because of the range of services that 
programs provided. 

[C] Obligations are as reported by the agencies and include 
obligations for which expenditures were made in FY 2012 unless 
otherwise noted. The term obligation refers to a definite commitment 
by a federal agency that creates a legal liability to make payments 
immediately or in the future. Agencies incur obligations, for example, 
when they award grants or contracts. An expenditure is the actual 
spending of money by the issuance of checks, disbursement of cash, or 
electronic transfer of funds made to liquidate a federal obligation. 
We separated agency-reported direct and indirect funding for CMS's two 
Medicare graduate medical education payment programs. GAO, A Glossary 
of Terms Used in the Federal Budget Process, GAO-05-734SP (Washington, 
D.C.: September 2005). 

[D] Medicare DGME estimates include amounts paid under the Medicare 
Fee-For-Service and Medicare Advantage programs. 

[E] Medicare IME estimates are for the operating inpatient hospital 
prospective payment system (PPS) payments only. Estimates do not 
include Medicare IME payments made under the capital PPS, the 
inpatient rehabilitation hospital PPS, or the inpatient psychiatric 
hospital PPS. IME estimates include amounts paid under the Medicare 
Fee-For-Service and Medicare Advantage programs. 

[F] CMS officials reported that the agency does not track the number 
of students supported by the program. 

[G] Medicaid is the joint federal-state program that finances health 
care for certain low-income individuals. States pay qualified health 
care providers for covered services provided to Medicaid beneficiaries 
and obtain federal matching funds for the federal share of these 
payments. In addition to these regular payments, which are generally 
based on claims submitted by the providers for services rendered, 
states also make and obtain federal matching funds for supplemental 
payments to certain providers to help offset the cost of providing 
care to Medicaid patients. There is no express requirement for 
Medicaid to pay for GME. However, CMS will provide reimbursement to 
states that opt to include GME as part of their hospital payment rate 
structure. 

[H] According to CMS, states reported total Medicaid payments for GME 
of $1,328.907 million in FY 2012; the federal share was $784.916 
million. 

[I] This is the number of trainees supported in FY 2011, the most 
recent year for which data were available. 

[J] HRSA obligated $14.848 million for the Nurse Managed Health 
Clinics from the PPACA Prevention and Public Health Fund in FY 2010 
for 3 year budget and project periods which could be expended by 
grantees in FY 2012. These amounts are not included in the HHS funding 
total. 

[KL] Payments are made for direct expenses associated with sponsoring 
an approved graduate medical residency training program and indirect 
expenses associated with the additional costs relating to training 
residents in such programs. 

[L] HRSA's loan programs are funded out of a revolving fund and do not 
receive an annual appropriation. Obligations reflect, for example, 
loaned funds to students drawn from the school's revolving account, 
which includes money from repaid student loans. Program funding 
returned to HRSA (i.e., when grants close, or when grantees are 
required to pay penalties to HRSA) is reallocated to other grantees 
(and added to their revolving accounts) through new grant awards. 

[M] HRSA obligated $10 million for the Mental and Behavioral Health 
Education and Training Grants program in FY 2012, the first year of 
the program. Trainees started in academic year 2012 - 2013 and 
therefore none had completed training at the time of our review. 

[N] Unlike other HRSA administered loan programs, the Nurse Faculty 
Loan Program received an appropriation in FY 2012 in addition to 
revolving funds. 

[O] We did not count the nine Maternal and Child Health Training 
Program activities as separate programs because they support both 
public health and clinical training. The information included in the 
table is for all nine activities. 

[P] We did not count the two Combating Autism Act Training Program 
activities as separate programs. The information included in the table 
is for both activities. 

[Q] This is the number of trainees supported in calendar year 2012. 

[R] Indian health program facilities include health care facilities 
funded by IHS, Indian tribes or tribal organizations, or urban Indian 
organizations. 

[S] There are no direct programmatic funds distributed by OSG; Senior 
and Junior Commissioned Officer Student Training and Extern officers 
are sponsored and funded by other federal agencies. 

[T] The PHSA Title X Family Planning Program provides individuals, 
with comprehensive family planning and related preventive health 
services, with priority to low-income families. 42 U.S.C. §§ 300-300a-
8. 

[U] SAMHSA does not track internship recipients according to agency 
officials. 

[End of table] 

[End of Enclosure I] 

Enclosure II: 

Department of Veterans Affairs (VA) Health Care Workforce Training:
Programs Funded in Fiscal Year (FY) 2012: 

VA, through the Veterans Health Administration, reported obligating 
about $1.7 billion for programs that supported postsecondary training 
or education specifically for direct care health professionals in FY 
2012. Table 3 describes each of VA's 12 health care workforce training 
programs and provides information on the number of trainees supported 
by each program and related funding obligations in FY 2012.[Footnote 
19] 

Table 3: Department of Veterans Affairs (VA) Health Care Workforce 
Training Programs That Received Funding in Fiscal Year (FY) 2012: 

Program (Statutory authority): Clinical Health Professional 
Education[D]; (38 U.S.C. §§ 7302, 7405-7406); 
Purpose and description: VA medical facilities provide paid and unpaid 
clinical health professional training opportunities to multiple health 
professionals at the undergraduate, graduate, and post-graduate levels 
in accordance with VA's mission to educate for the benefit of VA and 
the nation. VA medical facilities receive an annual educational and 
training allocation to support the cost incurred for hosting clinical 
training programs, such as those for faculty time and administrative 
support. VA also provides stipends for certain trainees in the 
following four areas--graduate medical and dental residency programs, 
nursing programs, associated health programs, and advanced fellowships; 
Targeted health professionals[A]: [Empty]; 
Number of trainees supported[B]: Approximately 117,500 paid and unpaid 
trainees, see paid trainee breakdown below[E]; 
Obligations[C]: $815.506 for costs to administer all training programs 
in addition to $753.885 for stipends and benefits, see breakdown of 
stipend and benefit funding below. 

Program (Statutory authority): 1. Graduate Medical and Dental 
Education; 
Purpose and description: Provides training for medical and dental 
students and residents, including stipends for physician residents in 
accredited medical residency programs and dental residents in 
accredited dental specialty programs who rotate through VA hospitals 
and clinics. Physician residents make up 35 to 40 percent of VA's 
physician workforce; 
Targeted health professionals[A]: Physicians and dentists; 
Number of trainees supported[B]: 10,249 paid positions for physician 
residents, 360 paid positions for dental residents[F]; 
Obligations[C]: $643.257 million. 

Program (Statutory authority): 2. VA Advanced Fellowships Program; 
Purpose and description: Training and stipends for physicians, 
dentists, and other health professionals in post-training fellowships 
that broadly target training in health care education, clinical 
practices, research, and policy initiatives that improve the health 
and well-being of veterans. The program addresses special clinical 
health needs for veterans as well as healthcare system issues, such as 
quality and safety; 
Targeted health professionals[A]: Multiple health professionals; 
Number of trainees supported[B]: 324 paid fellowships[F]; 
Obligations[C]: $17.001 million. 

Program (Statutory authority): 3. Nursing Education Programs; 
Purpose and description: Training and stipends for nurse trainees in 
affiliated and VA-sponsored nursing education and training programs, 
including, entry-to-practice nursing programs, graduate nursing 
education programs (including a post-baccalaureate nurse residency), 
and postdoctoral fellowships; 
Targeted health professionals[A]: Nurses; 
Number of trainees supported[B]: 543 paid positions for nurse 
trainees[F]; 
Obligations[C]: $2.331 million. 

Program (Statutory authority): 4. Associated Health Education Programs; 
Purpose and description: Training and stipends for trainees in 
affiliated and VA-sponsored clinical education programs for about 40 
individual health professionals other than physicians, dentists, and 
nurses--referred to as associated health professionals. Fourteen 
clinical professions predominate in receiving a stipend for VA 
training; 
Targeted health professionals[A]: Associated health professionals; 
such as audiologists, occupational and physical therapists, 
pharmacists, physician assistants, psychologists, and social workers; 
Number of trainees supported[B]: 3,789 paid positions for associate 
health trainees[F]; 
Obligations[C]: $91.296 million. 

Program (Statutory authority): 5. Nurse Education Tuition 
Reimbursement Program; 
(38 U.S.C. § 7621); 
Purpose and description: Provides tuition reimbursement for VA 
employees enrolled in a nursing degree granting program and who are 
not otherwise eligible for an occupation-focused tuition support 
program in exchange for a service obligation; 
Targeted health professionals[A]: Nurses; 
Number of trainees supported[B]: Not available; 
Obligations[C]: Not Available[G]. 

Program (Statutory authority): Employee Incentive Scholarship Program 
(EISP); (38 U.S.C. § 7671); 
Purpose and description: VA provides education assistance for their 
health professional employees through the EISP, the VA National 
Education for Employees Program, and two initiatives aimed at nurses--
the National Nursing Education Initiative, and the VA/Department of 
Defense Certified Registered Nurse Anesthetists; 
Targeted health professionals[A]: [Empty]; 
Number of trainees supported[B]: 2,660 VA employees (primarily nurses); 
Obligations[C]: $24.503 million. 

Program (Statutory authority): 6. EISP; 
Purpose and description: Provides scholarships for tuition and related 
expenses for VA employees enrolled in or accepted to accredited 
education programs in certain health care occupations for which 
recruitment and retention is difficult in exchange for a service 
obligation; 
Targeted health professionals[A]: Multiple health professionals. 

Program (Statutory authority): 7. VA National Education for Employees 
Program; 
Purpose and description: Provides scholarships for employees seeking 
first-time licensure/certification in clinical training programs and 
salary replacement dollars to VA medical facilities to allow 
recipients to attend school full time; 
Targeted health professionals[A]: Multiple health professionals. 

Program (Statutory authority): 8. National Nursing Education 
Initiative; 
Purpose and description: Provides scholarships for VA RNs pursuing 
baccalaureate and advanced nursing degrees; 
Targeted health professionals[A]: Nurses. 

Program (Statutory authority): 9. VA/Department of Defense (DOD) 
Certified Registered Nurse Anesthetists; 
Purpose and description: Provides scholarships to VA employees to 
complete certified registered nurse anesthetist training at DOD's 
certified registered nurse anesthetist training program. The program 
is a collaboration with DOD; 
Targeted health professionals[A]: Certified registered nurse 
anesthetists. 

Program (Statutory authority): 10. Education Debt Reduction Program; 
(38 U.S.C. § 7681); 
Purpose and description: Provides education debt reduction 
reimbursements to VA employees with qualifying loans and who are in 
hard-to-recruit health care professional positions providing direct-
patient care services or services incident to direct patient care; 
Targeted health professionals[A]: Multiple health professionals; 
Number of trainees supported[B]: 3,094 VA employees (primarily nurses, 
pharmacists, physicians, physician assistants, and psychologists); 
Obligations[C]: $19.037 million. 

Program (Statutory authority): 11. Accredited Training and Education 
Programs; 
(38 U.S.C. § 7471); 
Purpose and description: Provides VA employees with workforce 
development and accredited continuing education needed to meet state 
requirements and maintain licensure, certification, or both; 
Targeted health professionals[A]: Multiple health professionals; 
Number of trainees supported[B]: 203,000 VA employees received 
continuing education; 
Obligations[C]: $49.635 million. 

Program (Statutory authority): 12. Simulation Learning, Education, and 
Research Network; 
(38 U.S.C. § 7471); 
Purpose and description: Provides simulation-based learning curricula, 
including continuing education, for clinical and nonclinical VA 
employees; 
Targeted health professionals[A]: Multiple health professionals; 
Number of trainees supported[B]: [Empty]; 
Obligations[C]: $13.330 million. 

Source: GAO summary of statutes and VA information, including budget 
justifications, summary information from the VA website, and 
information provided by agency officials. 

Notes: 

[A] Targeted health professionals are the direct care health 
professionals that are eligible for the program. We provide the health 
professional (e.g. physicians) rather than the field (e.g. medicine). 
Some programs target multiple health professionals. "Physicians" 
refers to doctors of allopathic or osteopathic medicine and includes 
all medical specialties unless specified. "Nurses" refers generally to 
any degree level unless specified (RN = registered nurse, APRN = 
advanced practice registered nurse--including NP = nurse practitioner, 
certified registered nurse anesthetist, certified nurse midwife.) 
"Behavioral health professionals" includes professionals such as 
psychologists and clinical social workers. 

[B] Programs provided different levels of assistance to direct care 
health professional trainees. The number of trainees supported refers 
to the agency-reported number of trainees who completed a training 
carried out by the program; received financial support from the 
program in the form of scholarships, loans, loan repayment, or 
stipend; were in grantee programs who received support for training; 
or received a combination of these types of program services. When 
known, we specified the number of trainees who received financial 
assistance or continuing education. We did not determine the amount of 
funding provided per trainee because of the range of services that 
programs provided. 

[C] Obligations are as reported by VA and include obligations for 
which expenditures were made in FY 2012 unless otherwise noted. The 
term obligation refers to a definite commitment by a federal agency 
that creates a legal liability to make payments immediately or in the 
future. Agencies incur obligations, for example, when they award 
grants or contracts. An expenditure is the actual spending of money by 
the issuance of checks, disbursement of cash, or electronic transfer 
of funds made to liquidate a federal obligation. GAO, A Glossary of 
Terms Used in the Federal Budget Process, GAO-05-734SP (Washington, 
D.C.: September 2005). 

[D] VA's clinical health professions training is organized into four 
service lines, which we categorized as separate programs for the 
purposes of this report--graduate medical and dental education, VA 
advanced fellowships, nursing education, and associated health 
education. Most VA clinical training is provided through affiliations 
with academic institutions that sponsor accredited training programs. 

[E] VA supports trainees in paid and unpaid positions who rotate 
through VA medical facilities during their clinical training. 

[F] The number of trainees supported includes only the number of paid 
positions. Paid trainee positions are per academic year and may 
support more than one trainee. 

[G] The Nurse Education Tuition Reimbursement Program is administered 
by local VA medical facilities and the number of trainees and funding 
is not available according to agency officials. 

[End of table] 

[End of Enclosure II] 

Enclosure III: 

Department of Defense (DOD) Health Care Workforce Training Programs 
Funded in Fiscal Year (FY) 2012: 

DOD reported obligating about $0.89 billion for programs that 
specifically supported postsecondary training or education for direct 
care health professionals in FY 2012. Table 4 describes each of DOD's 
seven health care workforce training programs and provides information 
on the number of trainees supported by each program and related 
funding obligations in FY 2012.[Footnote 20] 

Table 4: Department of Defense (DOD) Health Care Workforce Training 
Programs That Received Funding in Fiscal Year (FY) 2012: 

Program (Statutory authority): 1. Uniformed Services University of 
Health Sciences; (10 U.S.C. § 2112); 
Purpose and description: DOD-funded graduate school that awards 
masters or doctoral degrees in medicine, advanced practice nursing, 
and other health-related disciplines in order to support the Military 
Health System, the national security and national defense strategies 
of the United States, and the readiness of our armed forces. Students 
do not pay tuition and receive a salary and benefits as commissioned 
officers in exchange for a service obligation; 
Targeted health professionals[A]: Dentists, APRNs, physicians, 
psychologists, and others; 
Number of trainees supported[B]: 1,708 students; 
Obligations[C]: $130.614 million. 

Program (Statutory authority): 2. Armed Forces Health Professions 
Scholarship Program; 
(10 U.S.C. §§2120-2128, 16201-16204); 
Purpose and description: Provides scholarships for tuition expenses 
and a stipend for health professional students enrolled in an 
accredited training program in exchange for an active duty or reserve 
military service obligation upon completion of a professional degree 
in order to obtain active duty commissioned officers trained in 
various health professions identified by each military service. 
Military services may also provide a signing bonus to obtain 
physicians and dentists; 
Targeted health professionals[A]: Multiple health professionals, such 
as dentists, nurses, optometrists, physicians, psychologists, and 
pharmacists as determined by each military service; 
Number of trainees supported[B]: 4,449 students; 
Obligations[C]: $372.310 million[D]. 

Program (Statutory authority): 3. Financial Assistance Program; 
(10 U.S.C. §§ 2120-2128); 
Purpose and description: Provides annual grants and stipends for 
physicians and dentists accepted or enrolled in a residency program in 
exchange for an active duty military service obligation in order to 
recruit and train military health care providers to fill medical 
specialty positions; 
Targeted health professionals[A]: Physicians and dentists; 
Number of trainees supported[B]: 104 physician and dentist residents; 
Obligations[C]: $5.652 million[D]. 

Program (Statutory authority): 4. Health Professions Loan Repayment 
Program; (10 U.S.C. § 2173); 
Purpose and description: Provides repayment of educational loans for 
licensed health professionals in exchange for an active duty or 
reserve service obligation in order to obtain and retain adequate 
numbers of commissioned officers in qualified health professions 
identified by each military service; 
Targeted health professionals[A]: Multiple health professionals, such 
as dentists, nurses, physicians, psychologists as determined by each 
military service; 
Number of trainees supported[B]: 771 professionals; 
Obligations[C]: $28.357 million[D]. 

Program (Statutory authority): 5. Nurse Officer Candidate Program; 
(10 U.S.C. § 2130a); 
Purpose and description: Pays a stipend and signing bonus for students 
enrolled in an accredited nursing degree program in exchange for an 
active duty and reserve service obligation as a commissioned officer; 
Targeted health professionals[A]: Nurses; 
Number of trainees supported[B]: 79 students; 
Obligations[C]: $2.129 million[D]. 

Program (Statutory authority): Training and Education for Military 
Medical Personnel[E]; (10 U.S.C. §§ 2004a-2004b, 2016); 
Purpose and description: In order to develop, train, and educate 
highly skilled U.S. military medical personnel and leaders, DOD funds 
undergraduate, graduate, post-graduate, and professional development 
health professional education programs for the range of medical 
professions for its officer, enlisted, and civilian medical personnel. 

Program (Statutory authority): 6. Graduate Medical Education; 
Purpose and description: Provides resources required to administer 
DOD's GME programs, including certain local operating expenses for 
accredited DOD residency programs and expenses to support residents in 
civilian-sponsored residency programs, and to support a Joint Service 
Graduate Medical Education Selection Board; 
Targeted health professionals[A]: Physicians; 
Number of trainees supported[B]: 2,706 physician residents and fellows; 
Obligations[C]: $16.519 million[F]. 

Program (Statutory authority): 7. Other Education and Training for 
Military Medical Personnel; 
Purpose and description: Provides all resources required for 
instruction in more than 300 undergraduate, graduate, and professional 
development and clinical skill continuing education programs provided 
at the U.S. Army Medical Department Center and School; Academy of 
Health Sciences; Navy Bureau of Medicine and Surgery-sponsored schools; 
and Air Force medical professions education and training programs; the 
Medical Education and Training Campus; as well as formal educational 
programs at civilian academic institutions, civilian medical 
facilities, and facilities of non-DOD governmental agencies. Personnel 
participating in longer-term health education programs may incur a 
service obligation; 
Targeted health professionals[A]: Multiple health professionals; 
Number of trainees supported[B]: 113,273 entered training programs 
106,113 graduated from training programs; 
Obligations[C]: $333.504 million[F]. 

Source: GAO summary of statutes and DOD information, including, budget 
justifications, summary information from DOD Web sites and information 
provided by agency officials. 

Notes: 

[A] Targeted health professionals are the direct care health 
professionals that are eligible for the program. We provide the health 
professional (e.g. physician) rather than the field (e.g. medicine). 
Some programs target multiple health professionals. "Physicians" 
refers to doctors of allopathic or osteopathic medicine and includes 
all medical specialties unless specified. "Nurses" refers generally to 
any degree level unless specified (APRN = advanced practice registered 
nurse--including NP = nurse practitioner, certified registered nurse 
anesthetist, certified nurse midwife.) "Behavioral health 
professionals" include, for example, clinical psychologists and 
clinical social workers. "Allied health professionals" include, for 
example, audiologists, dental hygienists, and physical therapists. 

[B] Programs provided different levels of assistance to direct care 
health professional trainees. The number of trainees supported refers 
to the agency-reported number of trainees who completed a training 
carried out by the program; received financial support from the 
program in the form of scholarships, loans, loan repayment, or 
stipend; were in grantee programs who received support for training; 
or received a combination of these types of program services. When 
known, we specified the number of trainees that received financial 
assistance or continuing education. We did not determine the amount of 
funding provided per trainee because of the range of services that 
programs provided. 

[C] Obligations are as reported by DOD and include obligations for 
which expenditures were made in FY 2012 unless otherwise noted. The 
term obligation refers to a definite commitment by a federal agency 
that creates a legal liability to make payments immediately or in the 
future. Agencies incur obligations, for example, when they award 
grants or contracts. An expenditure is the actual spending of money by 
the issuance of checks, disbursement of cash, or electronic transfer 
of funds made to liquidate a federal obligation. GAO, A Glossary of 
Terms Used in the Federal Budget Process, GAO-05-734SP (Washington, 
D.C.: September 2005). 

[D] Each military department, including the Army, Air Force, and Navy, 
operate the Armed Forces Health Professions Scholarship Program, the 
Financial Assistance Program, the Nurse Officer Candidate Program, and 
the Health Professions Loan Repayment Program separately. 
Scholarships, grants, and loan repayment for the Armed Forces Health 
Professions Scholarship Program, the Financial Assistance Program, and 
the Health Professions Loan Repayment Program, are paid out of the DOD 
Defense Health Program Education and Training budget activity that is 
distributed to each military service. Stipends and certain other 
expenses for the Armed Forces Health Professions Scholarship Program, 
the Financial Assistance Program, and the Nurse Officer Candidate 
Program are paid out of separate service personnel accounts. 

[E] For the purposes of this review we characterized DOD's multiple 
clinical training and education programs for military medical 
personnel into two programs according to DOD's Defense Health Program 
training and education budget--graduate medical education (GME) and 
other education and training for military medical personnel--because 
the department could not provide consistent program level information. 
DOD reported obligations for the other education and training programs 
in total, but could not provide funding for each program separately. 

[F] Trainees in GME programs receive salaries while completing 
training; however, reported funding does not include salaries. 

[End of table] 

[End of Enclosure III] 

Enclosure IV: 

Department of Education's (Education) Workforce Training Programs: 

Funded in Fiscal Year (FY) 2012 and Examples of Additional Programs 
That Support Education for, but Do Not Specifically Target, Direct 
Care Health Professionals: 

Education reported obligating about $2 million for three programs in 
FY 2012 that supported postsecondary training or education 
specifically for direct care health professionals (see table 5). In 
addition, Education administers programs that support postsecondary 
training or education but do not specifically target health 
professionals, and for which the number and types of health 
professionals in the programs could not be determined (see table 6). 
[Footnote 21] 

Table 5: Department of Education (Education) Health Care Workforce 
Training Programs That Received Funding in Fiscal Year (FY) 2012: 

Program (Statutory authority): 1. Master's Degree Programs at 
Historically Black Colleges and Universities (HBCUs); (20 U.S.C. § 
1136a); 
Purpose and description: Grants to HBCUs to improve graduate education 
opportunities in scientific disciplines where African American 
students are underrepresented, including nursing and allied health 
professions. Grantee services can include providing scholarships, 
fellowships, and other financial assistance to African American 
students pursuing master's level graduate education in various 
scientific fields such as nursing and allied health; 
Targeted health professionals[A]: Nurses and allied health 
professionals[D]; 
Number of trainees supported[B]: 357 graduate students received 
financial assistance; 
Obligations[C]: $1.228 million. 

Program (Statutory authority): 2. Master's Degree Programs at 
Predominantly Black Institutions; 
(20 U.S.C. § 1136b); 
Purpose and description: Grants to specified predominantly black 
institutions to improve graduate education opportunities in scientific 
disciplines where African American students are underrepresented, 
including nursing and allied health professions. Grantee services can 
include providing scholarships, fellowships, and other financial 
assistance to African American students pursuing master's level 
graduate education in various scientific fields such as nursing and 
allied health; 
Targeted health professionals[A]: Nurses and allied health 
professionals[D]; 
Number of trainees supported[B]: 10 graduate students received 
financial assistance; 
Obligations[C]: $0.110 million. 

Program (Statutory authority): 3. Graduate Assistance in Areas of 
National Need; (20 U.S.C. § 1135); 
Purpose and description: Grants to academic departments and programs 
of institutions of higher education to provide fellowships to assist 
graduate students in areas of national need, including nursing, with 
excellent academic records and who demonstrate financial need and plan 
to pursue the highest degree available in their course of study at the 
institution. Nursing program grantees focus on preparing nurse 
scholars for educational leadership roles and to become teachers 
preparing students for careers in nursing; 
Targeted health professionals[A]: APRNs[D]; 
Number of trainees supported[B]: 15 fellowships; 
Obligations[C]: $0.666 million. 

Source: GAO summary of statutes and Education information, including 
grant announcements, summary information from Education Web sites, and 
information provided by agency officials. 

Notes: 

[A] Targeted health professionals are the direct care health 
professionals that are eligible for the program. We provide the health 
professional (e.g. physician) rather than the field (e.g. medicine). 
Some programs target multiple health professionals. "Physicians" 
refers to doctors of allopathic or osteopathic medicine and includes 
all medical specialties unless specified. "Nurses" refers generally to 
any degree level unless specified (APRN = advanced practice registered 
nurse--including NP = nurse practitioner, certified registered nurse 
anesthetist, certified nurse midwife.) "Behavioral health 
professionals" include, for example, clinical psychologists and 
clinical social workers. "Allied health professionals" include, for 
example, audiologists, dental hygienists, and physical therapists. 

[B] Programs provided different levels of assistance to direct care 
health professional trainees. The number of trainees supported refers 
to the agency-reported number of trainees who completed a training 
carried out by the program; received financial support from the 
program in the form of scholarships, loans, loan repayment, or 
stipend; were in grantee programs that received support for training; 
or received a combination of these types of program services. When 
known, we specified the number of trainees who received financial 
assistance or continuing education. We did not determine the amount of 
funding provided per trainee because of the range of services that 
programs provided. 

[C] Obligations are as reported by Education and include obligations 
for which expenditures were made in FY 2012 unless otherwise noted. 
The term obligation refers to a definite commitment by a federal 
agency that creates a legal liability to make payments immediately or 
in the future. Agencies incur obligations, for example, when they 
award grants or contracts. An expenditure is the actual spending of 
money by the issuance of checks, disbursement of cash, or electronic 
transfer of funds made to liquidate a federal obligation. GAO, A 
Glossary of Terms Used in the Federal Budget Process, GAO-05-734SP 
(Washington, D.C.: September 2005). 

[D] Programs are targeted toward multiple science-related 
professionals and are not limited to the listed health professionals. 

[End of table] 

Table 6: Examples of Additional Department of Education (Education) 
Programs That Support Education for Direct Care Health Professionals: 

Program: Subsidized Direct Stafford Loans[A]; 
Description: Loans are made on the basis of financial need to 
undergraduate, students who are enrolled at least half-time. The 
federal government pays the interest on subsidized loans while the 
student is in school, for a grace period of 6 months after the student 
leaves school, and during subsequent periods if needed. However, 
borrowers with new loans made in academic years 2012-2013 and 2013-
2014 are responsible for paying interest during the grace period. 

Program: Unsubsidized Direct Stafford Loans[A,B]; 
Description: Loans are made to undergraduate, graduate, and 
professional students who are enrolled at least half-time. Students 
are responsible for interest costs throughout the life of the loan. 

Program: Direct PLUS Loans[A]; 
Description: Loans are made to parents of dependent undergraduates and 
to graduate and professional students who are enrolled at least half-
time. 

Program: Federal Perkins Loans[C]; 
Description: Low-interest (5 percent) loans made to undergraduate, 
graduate, and professional students, with priority given to those with 
exceptional financial need. Schools administer funds composed of 
federal capital contributions and school matching funds (at least one-
third of federal contributions). 

Program: Pell Grants; 
Description: Grant amounts are based on the student's enrollment 
status and the difference between the expected family contribution and 
the cost of attendance. 

Program: Federal Supplemental Educational Opportunity Grants; 
Description: Schools administer grant funds to undergraduate students 
with exceptional financial need; 
schools are generally required to match at least 25 percent of the 
federal funds allocated. 

Program: Federal Work Study; 
Description: Schools administer federal funds and make part-time 
employment available to undergraduate, graduate, and professional 
students with federally defined financial need. Participating schools 
or nonprofit employers generally contribute at least 25 percent of a 
student's earnings. 

Source: GAO summary of Education information. 

Notes: 

[A] Reduced monthly payments through the Income Based Repayment (IBR) 
plan and Pay as You Earn Repayment plan are available to Direct 
Subsidized and Unsubsidized Loan borrowers and student borrowers of 
Direct PLUS Loans who have a partial financial hardship. IBR also 
provides cancellation of remaining loans after 25 years if certain 
conditions are met. Pay as You Earn Repayment also provides 
cancellation of remaining Direct Loans after 20 years if certain 
conditions are met. In addition, cancellation of a portion of a 
borrower's Direct Loan is available through the Public Health Service 
Loan Forgiveness Program to borrowers who have made consistent 
payments for a 10 year period while employed full-time in a public or 
private non-profit organization, including private non-profit 
organizations that provide public health services. 

[B] Education provides higher Unsubsidized Direct Loan borrowing 
limits specifically for certain health professionals. 

[C] Cancellation of a portion of a borrower's Federal Perkins Loan is 
available to borrowers employed full-time in certain professions, 
including but not limited to health professions, based on the number 
of years of service in eligible professions. 

[End of table] 

[End of Enclosure IV] 

Footnotes: 

[1] For the purposes of this review, direct care health professionals 
are those who deliver clinical or rehabilitative care to patients, 
such as allopathic and osteopathic physicians, nurses, dentists, 
pharmacists, physician assistants, podiatrists, psychologists, and 
physical or occupational therapists. 

[2] 42 U.S.C. §§ 292 - 298d. 

[3] Pub. L. No. 111-148, 124 Stat. 119, as amended by the Health Care 
and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 
Stat. 1029. 

[4] Specifically, we reviewed reports by the Congressional Research 
Service, the Institute of Medicine, and the Medicare Payment Advisory 
Commission. 

[5] The CFDA is a government-wide compendium of federal programs that 
provide assistance or benefits to the American public. 

[6] Programs supported health professional trainees through a range of 
services with differing costs; we therefore did not think it 
appropriate to determine or compare the funding programs provided per 
trainee. 

[7] We included programs that agencies developed as directed in 
statute or initiated under the agencies' authorizing legislation. A 
program is an organized set of activities directed toward a common 
purpose or goal that an agency undertakes to carry out its 
responsibilities. GAO, A Glossary of Terms Used in the Federal Budget 
Process, [hyperlink, http://www.gao.gov/products/GAO-05-734SP] 
(Washington, D.C.: September 2005). For the purposes of this report to 
more completely describe health care workforce training efforts, we 
counted separate activities that were funded within an authorized 
program as individual programs when possible. Exceptions are noted in 
the report. 

[8] We excluded programs with a primary focus on training researchers, 
health administrators, or public health-related professions because 
they do not provide direct care to patients; programs that did not 
specifically target benefits toward direct care health professionals; 
and programs focused on health care workforce analysis. 

[9] We excluded programs if they supported continuing education in 
addition to other services that were otherwise unrelated to health 
care workforce training because it was difficult to separate 
continuing education services and funding from other program services. 
Continuing education is formal or informal training for established 
health professionals in a specific skill (e.g., a specific procedure). 
Some continuing education courses award continuing education credits 
needed for certain health professionals to maintain licensure. 

[10] Postsecondary education is education or training beyond the high 
school level. 

[11] GAO asked department and agency officials to provide obligations, 
including those for which expenditures have been made, for each 
program in fiscal year 2012. The term obligation refers to a definite 
commitment by a federal agency that creates a legal liability to make 
payments immediately or in the future. Agencies incur obligations, for 
example, when they award grants or contracts to private entities. An 
expenditure is the actual spending of money by the issuance of checks, 
disbursement of cash, or electronic transfer of funds made to 
liquidate a federal obligation. See [hyperlink, 
http://www.gao.gov/products/GAO-05-734SP]. Generally, the total 
reported obligations do not include amounts obligated in prior years 
that were expended by grantees in fiscal year 2012. 

[12] One of DOD's seven programs represents multiple clinical and 
instructional health professions education programs. For the purposes 
of this report, we characterized them as a single program because DOD 
could not provide consistent program level information. 

[13] For the purposes of this review, we considered Medicare DGME 
payments and Medicare IME payments to be separate programs. Medicare 
DGME payments cover the teaching costs of training residents, such as 
resident stipends, administrative overhead, and supervisory physician 
salaries. Medicare IME payments support the higher patient care costs 
associated with training residents, such as the ordering of more tests 
and increased use of emerging technologies. 

[14] Medicaid payments for GME and the two HRSA programs--the 
Children's Hospitals GME Payment program and the Teaching Health 
Center GME Payment program--provided funding for both direct costs of 
resident training, such as resident salaries and benefits, and 
indirect funding to reflect the higher patient care costs associated 
with resident education. 

[15] Programs that supported continuing education are identified in 
the program purpose and description in enclosures I through IV, if 
applicable. 

[16] We included both programs that solely targeted direct care health 
professionals and programs that targeted direct care health 
professionals among other professionals if the program purpose or 
objectives specifically identified direct care health professionals. 

[17] Generally, the total reported obligations do not include amounts 
obligated in prior years that were expended by grantees in FY 2012. 
For example, HHS's Health Resources and Services Administration 
(HRSA), obligated funds in FY 2010 for a three year budget period for 
the Nurse Managed Health Clinics program created by the Patient 
Protection and Affordable Care Act of 2010 (PPACA). 

[18] For the purposes of this report, we considered separate 
activities funded within an authorized program to be individual 
programs unless otherwise noted in the table. Table 2 does not include 
programs that were authorized for but that did not receive 
appropriations to provide training services in FY 2012. For example, 
the Centers for Medicare & Medicaid Services (CMS) administered a 
Graduate Nurse Education Demonstration, aimed at increasing the 
provision of training to advanced practice registered nursing 
students; however, funds for the training aspects of the program were 
not available until FY 2013. In addition to the programs in Table 2, 
the Centers for Medicare & Medicaid Services (CMS), HRSA, and the 
Substance Abuse and Mental Health Services Administration (SAMHSA) 
identified other programs for which obligations were made in FY 2012 
but that were outside the scope of this report. For example, HRSA 
administered programs aimed at public health workforce development, 
which targeted health professionals or provided training in skills not 
directly related to patient care. 

[19] Table 3 does not include programs that were authorized, but that 
did not receive appropriations to provide training services in FY 
2012.In addition to the 12 programs specifically targeted to provide 
or support training for health care professionals, VA's Veterans 
Benefit Association administered several programs that supported 
education for veterans, but did not specifically target direct care 
health professionals--the Post-9/11 GI Bill, the Montgomery GI Bill, 
and the Reserve Educational Assistance Program. 

[20] For the purposes of this review we characterized DOD's multiple 
clinical training and education programs for military medical 
personnel into two programs according to DOD's Defense Health Program 
training and education budget--graduate medical education (GME), and 
other education and training for military medical personnel. Military 
departments also fund programs not included in this table, such as 
reserve officer training programs. 

[21] In addition, the Job Corps, administered by the Department of 
Labor, provides free vocational and academic training, including 
health related training, to young people that qualify as low income. 
The Department of Veterans Affairs also administers several programs 
that provide financial support to veterans, but do not specifically 
target direct care health care professionals. 

[End of section] 

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