Clinician Recruitment and Service

Authorizing Legislation - Sections 338A, B, I, and L of the Public Health Service Act.

FY 2008 Authorization.........................................................................................................Expired

Statement of the Budget Request - The FY 2008 Budget of $115,959,000 is $9,569,000 below the FY 2007 Continuing Resolution (CR).

Program Description - The National Health Service Corps (NHSC) assists Health Professional Shortage Areas (HPSAs) in every State, Territory, and Possession of the United States to meet their primary care, oral, and mental health services needs. Over its 35-year history, the NHSC has offered recruitment incentives, such as scholarship and loan repayment support to more than 27,000 health professionals committed to service to the underserved. NHSC clinicians have expanded access to high quality health services and improved the health of underserved people.

Currently, approximately 54 percent of the NHSC clinicians serve in Health Centers around the Nation. The NHSC will continue to work with the federally-funded Health Centers to help meet their clinician needs. The NHSC also places clinicians in other community-based systems of care that serve underserved populations targeting HPSAs of greatest need.

Access to primary care services continues to be a problem for underserved populations for a
variety of reasons which include:

• A disproportionate number of health professionals continue to pursue non-primary care training.
• Geographic misdistribution of all health professionals remains a major problem.
• The national health care workforce for the most part does not reflect the racial and ethnic diversity of the population in communities where the lack of access to services and increased health disparities exist.

The NHSC, in partnership with the Health Center Program and other programs targeting areas and populations in need, is a critical part of the safety net infrastructure that assures access to preventive and primary care for vulnerable people. In many cases, the NHSC is the only source of clinicians to care for people of racial and ethnic diversity in communities where lack of access to health care services and increased health disparities exist.

The NHSC Field Program targets:

• recruitment of health professionals, including underrepresented minority and disadvantaged individuals,
• site development efforts and technical assistance to communities for needs assessment and establishing new services,
• support for sites and communities already being served by NHSC clinicians,
• orientation programs for new clinicians,
• State-based efforts to address health professional shortages and to assist in the recruitment and retention of clinicians to serve in underserved areas through active recruitment and placement assistance,
• the development of clinician mentoring and practice enhancement programs,
• programs to expose health professions students to practices in underserved areas to prepare NHSC scholars and attract other students to practices in these areas, and
• a cadre of Ready Responders, PHS Commissioned Officers who serve in HPSAs and are trained to respond to emergencies throughout the nation.

A portion of these developmental efforts will be focused on oral, mental and behavioral health needs.

The NHSC Recruitment Program awards scholarships to health professions students and loan repayment agreements to fully trained clinicians committed to serving underserved communities.

• The NHSC Scholarship Program awards scholarships to health professions students committed to a career in primary care and service in underserved communities of greatest need. Awards are targeted to individuals who demonstrate characteristics that are significantly related to a probable success in a career of service to the underserved. The Scholarship Program provides a predictable supply of clinicians who will be available over the next 1 to 8 years, depending on the length of their training programs. Upon completion of training, NHSC scholars become salaried employees of organized systems of care in underserved communities.
• The NHSC Loan Repayment Program offers fully trained clinicians the opportunity to receive assistance to pay off qualifying educational loans in exchange for service in a HPSA of greatest need. This service commitment is for a minimum of 2 years in an underserved community. The loan repayment program attracts clinicians as they complete training and are immediately available for service, as well as seasoned professionals seeking an opportunity to serve the Nation’s most vulnerable populations.

The combination of these two programs allows flexibility in meeting the future needs (through scholars) and the immediate needs (through loan repayers) of underserved communities.

NHSC Field - FY 2006

• About 212 scholars began service in HPSAs of greatest need.
• Placement of 929 loan repayment clinicians in underserved communities.
• Continued reporting system for NHSC non-grant sites to capture utilization and demographic information on populations served.
• Increased technical assistance to sites to increase the effectiveness, efficiency, and quality of the health care services provided.

NHSC Recruitment - FY 2006

1. AWARDS

• 97 Scholarships were awarded and 37 Scholarships were continued. There were 929 Loan Repayment contracts awarded and 558 amendments processed.

2. PROGRAM

• 46 percent of NHSC Scholars were racial/ethnic minorities and of the total 97 Scholars, 35 were from disadvantaged backgrounds and/or had exceptional financial need.
• 18.5 percent of the 929 NHSC Loan Repayment participants were racial/ethnic minorities.
• The NHSC collects retention information annually, surveying scholars and loan repayers three months after fulfillment of the service commitment. The NHSC is in the process of revising the survey to eliminate ambiguities in the responses in order to more clearly identify retention.
  
  Rationale for the Budget Request - The FY 2008 Budget of $115,959,000 is $9,569,000 below the FY 2007 CR. Funding for NHSC Scholarship and Loan Repayment is held steady.

As a significant source of highly qualified, culturally competent clinicians for the Health Center Program, as well as other safety net providers, the NHSC can build on its success in assuring access to residents of HPSAs, removing barriers to care and improving the quality of care to these underserved populations. The NHSC Program is working with many communities in partnership with State, local, and national organizations to help address their health care needs.

Funding in FY 2008 for the NHSC Field Program will support efforts to work with Health Centers and other community-based systems of care to improve the quality of care provided and reduce the health disparities gap.

Funding levels for The NHSC Program during the last five years reflect this effort and are as follows:

Outputs

1/ The State Loan Repayment Program makes grant awards to States who in turn enter into service contracts. The numbers provided reflect the number of contracts entered into by the 34 States participating in the Program in FY 2006.

Performance Analysis - NHSC Field Strength has increased in recent years, reaching 4,602 in
FY 2005.* The FY 2005 number of 4.4 million persons served through the placement and retention of NHSC clinicians exceeds the target. Funding an increasing number of loan repayment contract amendments over the next several years is projected to reduce the NHSC Field Strength.

The program’s impact goes beyond the number of clinicians in service each year: a great many clinicians placed by the NHSC remain working in high-need areas after their service commitments have been completed. In FY 2003, 78.4 percent of the NHSC clinicians were retained, exceeding the performance target for that year. NHSC’s annual vacancy list also serves as a significant source of employment information for the public, enabling many underserved communities each year to recruit clinicians from other sources because of the awareness that the NHSC list creates. Clearly, the NHSC program has a significant impact on access to care in the Nation’s neediest communities. (See “Details of Performance Analysis.”)

The NHSC had a Program Assessment Rating Tool (PART) review for the 2004 budget cycle and received a rating of Moderately Effective. To enhance the program’s effectiveness, the program will improve recruitment and placement targeting efforts.

* The FY 2006 figures in the waterfall table are estimates. Estimates are not used in the Performance Details from which this summary is drawn.

Table 1. Impact on NHSC Field Strength of FY 2008 Budget Request

* Estimate

Waterfall Assumptions:
1. Funding distribution: 20% Scholarship / 80% Loan Repayment
2.. FED = USPHS Commissioned Corps Ready Responders