The American Recovery and Reinvestment Act (ARRA) recently provided the National Health Service Corps (NHSC) with stimulus money to double the size of its workforce. The National Health Service Corps (NHSC) program has helped improve access to health care providers in rural and inner-city areas since 1972. They offer scholarships and loan repayment programs to recruit primary care medical, dental, and mental health clinicians to serve the 56 million Americans lacking access to primary care. The NHSC Loan Repayment Program addresses one of the barriers to recruiting primary care clinicians to work underserved areas: high student debt load. One of the information specialists for the Health Workforce Information Center, Laura Trude, interviewed Richard J. (Rick) Smith, the director of the NHSC about the impact of the new stimulus funding on the program, the new surgeon general, and the NHSC’s current and future activities on July 21st, 2009.

The National Health Service Corps has a lot of new opportunities related to the American Recovery and Reinvestment Act.  Could you elaborate on those initiatives?
What we have been asked by the Congress to do is to invite as many primary care clinicians that can participate in both the scholarship and loan repayment programs of the National Health Service Corps. And the Congress has given us $300 million to make new awards [for] scholarships and loan repayments. We are anticipating that approximately 4,000 new clinicians will be able to participate in the program. And what I think is interesting is that today the National Health Service Corps is in its 38th year and our current field strength, that is, clinicians working in the field today, is almost 4,000. It has taken us 38 years to get to 4,000 and now in the next 18-20 months we will grow to 8,000.

How many applications have you received so far for the ARRA funding? 
We opened up the opportunity for the Recovery Act funding for the National Health Service Corps on June the 2nd and the last number I had seen, in the first six weeks, we had received 2,200 applications. If that’s in the first six weeks and we have the opportunity to go for the next 18 months… And we [still] have plans for very, very aggressive recruitment efforts. We are going to be working with professionals [and] academic centers. We’re going to work through the professional associations. We’re also extending our reach to conferences so we can go and exhibit and share information. We have updated the National Health Service Corps web site. We have a Frequently Asked Questions [online] and then we also have a call center that on any given year we answer about 45,000 calls. And we’ve beefed that up because of the interest that we’re anticipating in the program.

How do the applications break down by specialty?
Well, we don’t have figures on that yet. The way our application process is working for the Recovery Act is that even though it opened up on June the 2nd, we will go through 6 different cycles. The end of the first cycle just ended on the 15th of July, so it’s just now that we’re starting to look at those, so we don’t have them categorized. What that means is that 2,200 have actually completed the online application. There are a number of additional pieces of documentation that they’ve got to send in, so it’s a little early to know. But, we’re quite honestly expecting that we’re going to see something that parallels our current National Health Service Corps field strength - that the greatest number of applications will come in from primary care medicine and that will be physicians, nurse practitioners, and physician assistants. The second category is actually behavioral and mental health, with about 20-21% of our current field strength, and then the balance in oral health, primarily dentists and also dental hygienists.

What are the barriers to the ARRA funds?  What challenges are the NHSC facing?
That’s a good question, because when we talked to the Congress about the Recovery Act, we told them that it would be a challenge to double the size of the National Health Service Corps in such a short period of time, so they actually have given us three years to spend these dollars. We have established a schedule, and so we’re hoping to do about 40% of the awards in 2009, about 40% of the awards in 2010, and the remaining awards in 2011. And quite honestly, within [the Department of] Health and Human Services, we’re the only program that actually has the use of that money for three years. It’s a first for the National Health Service Corps; generally, appropriations are limited to one fiscal year, but they gave us three years to spend this money. That being said, we put a lot of pressure on ourselves to make these awards as quickly as possible because they are in fact part of the Recovery Act--it is to create new jobs or retain people in service. So we are moving as fast as we can.

The new Surgeon General, Dr. Regina Benjamin, has a background in rural health.  How might that impact NHSC?
Well, you know, it’s a great question. I’m really pleased to able to say that she is a National Health Service Corps Scholar, so she is now an alumnus. She is the first Surgeon General nominee that has ever participated in the National Health Service Corps program. She specifically mentioned the National Health Service Corps in the Rose Garden in her prepared remarks when the President announced her nomination. I believe that she will serve as a tremendous role model for encouraging primary care providers to go and work in underserved communities. She’s received a lot of awards, but she still returned to her small community in Bayou La Batre, Alabama, saying that’s where she wants to practice medicine and I think she will be a role model for primary care providers who may be saying, “Is this something for me?” And quite frankly, we are just thrilled to death that she continues to mention the National Health Service Corps. And it fits so well with the President’s agenda, you know, the importance of health care for all and also that spirit of community service, so we couldn’t have been more pleased with her nomination.

Are there any plans to expand NHSC to other disciplines?  (pharmacy, occupational therapy, etc.) 
We don’t have plans at this time. The definition of primary care and primary care clinicians are in the law and so it would, in fact, take Congressional action to broaden that to disciplines like pharmacy and occupational health.

The NHSC has been holding town hall meetings around the country.  What’s the intention with those?  We believe that they will accomplish a couple of things. We are constantly looking at how we can improve the quality of how we administer this program. And one way to learn more about that is to meet and talk with and listen to the constituents. And those constituents [include] academic faculty that have students who are interested in primary care. It is also valuable to talk to clinicians who have served, who we refer to as our alumni. And it’s also beneficial to talk to our partners, the Primary Care Offices, and the Primary Care Associations within states. And so the main objective is to [determine] how we can effectively and efficiently manage this important program.

We have plans to host somewhere between six and seven additional meetings but right now we are pretty tied up around the Recovery Act and so we’re going to put off for the next one for a couple of months.

The first meeting we had, and it really was a pilot project, pulled in 80 persons from around the region. We had deans of two medical schools, we had scholars, we had clinicians in service, we had some alumni, we had good representation from the PCO and PCA offices. The wonderful thing about it is that the very target groups we wanted to attend, attended, and they all paid their own way.

Is there anything else that you’d like our readership to know about the NHSC or the work of the advisory council?
Most of this discussion has been centered around recruitment into the National Health Service Corps, but the reality is we don’t spent enough time talking about retention of the clinicians we’ve worked so hard to get into the program. So we have been talking to Dr. Mary Wakefield [and] Dr. Marcia Brand [about] what kinds of things we can do to keep clinicians in service. That’s the real success, I think, for the National Health Service Corps, when retention is done well. Then you also get providers who do a better job recruiting other providers to come to your site. If you’re pleased with the environment in which you work, your family enjoys living in the area, you’re going to be more prone to invite other people to come in and become recruiters themselves. So, we have been thinking a lot about what we can do to improve our retention efforts. Part of that is simply the old expression to reach out and touch someone, I think it was a [television] commercial. But do we do a good enough job staying in touch with our clinicians, both scholars and those participating in the loan repayment programs? Do we stay in touch with them? And so we are drafting, over the next couple of weeks, [a] more intensive campaign to say that you are part of something bigger than just your site, but you are part of a national movement that is built around community service and health access to underserved populations, and so that’s the personal touch.

Second, we’re going to work on what would interest that physician or what would interest that behavioral/mental health professional. Can we convey clinical information in a way that would keep them [current]? Because many of the clinical sites are pretty remote and you need to have tools in place to help these practitioners feel connected. So we hope to do that through continuing education efforts and by trying to take advantage of technology. And then, finally, we’re going to be looking at hosting forums where currently serving clinicians and alumni and the Primary Care Offices, and the Primary Care Associations, and the Area Health Education Centers, and the State Offices of Rural Health can come together. We’re hoping to have annual meetings so we can bring all of those constituents together and talk about strengthening the safety net component around workforce.