Health corps helps doctors serve areas with needs: Program growing
==================================================================

* Charlotte Tucker

Jamie Bell, MD, has a job she loves, working with a poor population in a Birmingham, Ala., hospital. Most of her patients have serious, chronic medical conditions.

“The healthy ones have diabetes, high blood pressure and high cholesterol,” she said. Many are much sicker.

It is a population that badly needs a caring physician, and Bell is able to serve them, despite being nearly $250,000 in debt from medical school, thanks to a program run by the Health Resources and Services Administration.

The program, the National Health Service Corps, provides loan repayment and scholarships to clinicians who agree to work in underserved areas for at least two years. They can earn up to $60,000 in loan repayment and have the option to extend their service to earn more.

The corps is a 40-year-old program, but it has undergone a resurgence as a result of increased funding from both the stimulus program in 2009 and the Affordable Care Act. In 2008, about 3,600 people had a service obligation to the program, but by the end of 2011 it had grown to more than 10,000 physicians, dentists, nurse practitioners, physician assistants, dental hygienists and mental and behavioral health providers.

The corps benefits both clinicians, who might struggle to repay their loans, as well as communities, many of which lack enough medical personnel to meet their needs. In some communities, it can take years to recruit a physician who will both want to live in a community and will be able to afford to live there.

“Most of the awards we make will be in very high-need areas,” said Rebecca Spitzgo, associate administrator of HRSA and director of the National Health Service Corps. Such areas generally have fewer than one provider for every 3,500 people.

Bell went to school in Kentucky but said she always knew she wanted to return to her hometown of Birmingham. She said she was not sure how she could manage to pay her loans while doing the work she wanted to do.

“Medical school is very costly,” she said. “It takes time for you to become financially established. I always tell people, ‘If you want to make a lot of money, don’t go into medicine.’”

According to the American Medical Association, the average educational debt of medical school graduates in the class of 2010 who owed money for their educations was nearly $158,000. Nearly 80 percent of graduates have at least $100,000 in debt, and 42 percent have at least $150,000.

Debt among health workers is climbing ever higher, and it has the potential to harm both patients and physicians. Studies have shown that students with high debt may be less likely to pursue family practice and primary care in favor of specialties with higher salaries. The cost of tuition can also prevent students from low-income or minority backgrounds from attending medical school for fear of never being able to pay off their debt, the studies found.

That inability to ever get out of debt was one of Bell’s concerns when she was in school, which was an incentive for her to consider the National Health Service Corps program.

The program is competitive, Spitzgo said. In the most recent application process, 5,700 applied for help repaying their loans, and the corps made about 1,800 awards, she said. Repayment is made directly to the loan, and the provider receives the same salary as others working in the same facility who are not part of the repayment program.

The corps has also just begun a scholarship program that provides loan repayment assistance to students in their last year of school in return for a commitment to provide care in underserved areas after graduation.

Before being accepted into the corps, Everol Ennis said paying the bills “was like robbing Peter to pay Paul.”

Ennis, a nurse practitioner working in Hartford, Conn., had about $100,000 in debt after school. He said the program gives him the ability to “have a better work-life balance,” while also doing important work.

When asked to describe his job in the adult medicine department in a nonprofit health center, Ennis was momentarily at a loss for words.

“What doesn’t it consist of is probably a better question,” he said. “On any given day, I can see urgent care walk-in visits ranging from something as simple as a sinus infection to broken bones. I also keep office visits where I’m managing a lot of chronic health conditions. There is never a shortage of patients.”

Ennis said he likes his job because he gets to see results.

“I just like watching the natural progression of people going from sick to less sick,” he said. “Just feeling better in mind, body and spirit and having a hand in that.”

Spitzgo said one of the hallmarks of the National Health Service Corps is that many practitioners stay in their jobs even after their term of service is up. About 80 percent of participants continue to work in underserved areas in the year or two after their terms, and 10 years out, 50 percent of those clinicians are still serving the same populations.

Part of the reason for that loyalty, Spitzgo said, is that the National Health Service Corps chooses carefully when making awards.

![Figure1](http://www.thenationshealth.org/https://www.thenationshealth.org/content/nathealth/42/6/1.2/F1.medium.gif)

[Figure1](http://www.thenationshealth.org/content/42/6/1.2/F1)

Patricia Neis, center, an advanced registered nurse practitioner, examines Lori Walker at a clinic in Lawrence, Kan., in 2011. Neis received an award from the National Health Service Corps.

Photo by Kevin Anderson, courtesy Lawrence Journal World

“We really do look for folks who identify with the mission of working in underserved areas,” she said. “We’re looking for folks who have done a lot of volunteer work. They’re mission-driven folks that we find come in and apply, folks who grew up in rural areas and want to give back to those areas, that’s what helps drive our retention.”

That spirit of wanting to give back to the community makes participants in the corps an even better bet, Spitzgo said, because the jobs are often not easy and participants tend to give back outside of work as well.

“Not only do they work eight or 10 hours a day, they’re often leaders in their communities, too,” she said. “Our health care providers are very trusted individuals.”

Members of the corps have seen specific problems, such as diabetes or childhood obesity, in their communities and have created programs to help.

For her part, Bell says she has no plans to leave her community hospital in Birmingham.

“Unless my facility closes down, I don’t plan on leaving,” she said. “I tell my patients, ‘I’m not looking for another job.’ This is our mission and what we set out to do.”

For more information on the National Health Service Corps, visit [www.nhsc.hrsa.gov](http://www.nhsc.hrsa.gov).

*   Copyright The Nation’s Health, American Public Health Association