Growth and Changes in the National Health Service Corps (NHSC) Workforce with the American Recovery and Reinvestment Act

Abstract

Background: From March 2009 through February 2011, the National Health Service Corps (NHSC) received a $300 million supplement through the American Recovery and Reinvestment Act to grant more loan repayment awards to clinicians who agree to work in underserved areas. This study assesses how this unprecedented funding increase affected the size, composition, and location of the NHSC's workforce.Methods: This was a descriptive, time-linked, observational study using NHSC administrative data. Main outcomes were growth and changes in disciplinary composition of the NHSC's workforce and in its rural/urban and state-to-state distribution.Results: During the Recovery Act period, the NHSC's workforce increased by 156%, from 3017 to 7713 clinicians. Mental health clinicians grew most numerically (210%) and as a proportion of the NHSC's workforce (from 22.7% to 27.4%). Primary care clinicians grew least and decreased as a proportion of the NHSC's workforce to 58.9%; dental health clinicians remained steady at approximately 13.5%. Among individual disciplines, physicians decreased most as a component of the NHSC's overall workforce, from 38.6% to 26.7%, whereas the proportion of nurse practitioners grew most, from 10.1% to 16.0%. Proportions of the NHSC's workforce serving in rural areas changed only modestly. NHSC clinician numbers grew most in states with the lowest NHSC clinician-to-poverty population ratios before the Recovery Act.Conclusions: With Recovery Act funding, the NHSC's workforce become far larger and more diverse than ever and more evenly distributed across states. The NHSC should now set targets and be more deliberate in managing its growth across disciplines and where its clinicians serve. (J Am Board Fam Med 2012;25:723-733.)

Building The Mental Health Workforce Capacity Needed To Treat Adults With Serious Mental Illnesses

“…By 2011, 27 percent (n ¼ 2; 111) of the total NHSC workforce consisted of mental health clinicians, excluding psychiatrists. 23 The NHSC is expected to continue to grow with additional appropriations through the ACA.…”

Barriers and Potential Solutions to Providing Optimal Guideline-Driven Care to Patients With Diabetes in the U.S.

“…Such programs, similar to the National Health Service Corps and state-supported programs, could be implemented by state or federal agencies, private sector organizations, and educational institutions through funding from nonprofit foundations and trusts (39–41). This could counteract the reputation of diabetes care as an underpaid professional endeavor that dissuades providers from seeking to enter it as they face looming debt repayment.…”

US Federal Policies Should Better Support the Primary Care Physician Workforce

“…13 Unfortunately, many communities that would benefit from NHSC sponsorship have not been able to obtain it-funds are limited and the demand for physicians is still great. 12 There is little evidence that the opportunity for NHSC loan repayment influences students to choose primary care, although it probably has some effect. Unfortunately, students often perceive the available amount of loan repayment as small relative to their debt levels.…”

“…As of 2011, more than 2,000 NHSC primary care physicians were caring for underserved communities in the United States. 12 Most states have similar loan repayment programs. 13 Unfortunately, many communities that would benefit from NHSC sponsorship have not been able to obtain it-funds are limited and the demand for physicians is still great.…”