Satisfaction of the Primary Care, Mental Health, and Dental Health Clinicians of the National Health Service Corps Loan Repayment Program

Pathman, Donald E.; Konrad, Thomas R.; Sewell, Robert G.; Fannell, Jackie; Rauner, Thomas

doi:10.1353/hpu.2019.0082

Cited by 8 publications

(4 citation statements)

References 25 publications

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“…We presented findings for clinicians in 3 broad fields, which may overlook important differences among disciplines within each field. 77 Twenty-five clinicians (1.3% of all respondents) completed NHSC service contracts before the survey and had since relocated and reported on their experiences in new practices, which may be better than where they worked in the NHSC and which they had elected to promptly leave.…”

Section: Discussionmentioning

confidence: 99%

Experiences of Safety-Net Practice Clinicians Participating in the National Health Service Corps During the COVID-19 Pandemic

et al. 2021

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Objectives The impact of the COVID-19 pandemic has been particularly harsh for low-income and racial and ethnic minority communities. It is not known how the pandemic has affected clinicians who provide care to these communities through safety-net practices, including clinicians participating in the National Health Service Corps (NHSC). Methods In late 2020, we surveyed clinicians who were serving in the NHSC as of July 1, 2020, in 20 states. Clinicians reported on work and job changes and their current well-being, among other measures. Analyses adjusted for differences in subgroup response rates and clustering of clinicians within practices. Results Of 4263 surveyed clinicians, 1890 (44.3%) responded. Work for most NHSC clinicians was affected by the pandemic, including 64.5% whose office visit numbers fell by half and 62.5% for whom most visits occurred virtually. Fewer experienced changes in their jobs; for example, only 14.9% had been furloughed. Three-quarters (76.6%) of these NHSC clinicians scored in at-risk levels for their well-being. Compared with primary care and behavioral health clinicians, dental clinicians much more often had been furloughed and had their practices close temporarily. Conclusions The pandemic has disrupted the work, jobs, and mental health of NHSC clinicians in ways similar to its reported effects on outpatient clinicians generally. Because clinicians’ mental health worsens after a pandemic, which leads to patient disengagement and job turnover, national programs and policies should help safety-net practices build cultures that support and give greater priority to clinicians’ work, job, and mental health needs now and before the next pandemic.

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Section: Discussionmentioning

confidence: 99%

Experiences of Safety-Net Practice Clinicians Participating in the National Health Service Corps During the COVID-19 Pandemic

et al. 2021

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“…Two publications described providers' perceptions of and experiences with the NHSC and found that behavioral health providers reported being satisfied with most facets of the NHSC program but few reported being satisfied with their wages and workloads. One 2019 study revealed that over 85% of surveyed behavioral health providers indicated that they applied to the NHSC LRP for educational debt assistance and over 70% indicated they did so to help the underserved (35). The vast majority of behavioral health providers reported being satisfied with their NHSC LRP experiences, work, practices, and communities and these findings were comparable to responses by other non-behavioral health NHSC LRP participants (35).…”

Section: Providers' Perceptions Of and Experiences With The Nhsc (K=2)mentioning

confidence: 99%

“…One 2019 study revealed that over 85% of surveyed behavioral health providers indicated that they applied to the NHSC LRP for educational debt assistance and over 70% indicated they did so to help the underserved (35). The vast majority of behavioral health providers reported being satisfied with their NHSC LRP experiences, work, practices, and communities and these findings were comparable to responses by other non-behavioral health NHSC LRP participants (35). However, fewer than half of behavioral health providers were satisfied with their compensation or time demands at work.…”

Section: Providers' Perceptions Of and Experiences With The Nhsc (K=2)mentioning

confidence: 99%

The Impact of U.S. Federal Loan Repayment Programs on the Behavioral Health Workforce: A Scoping Review

Last¹,

Crable²,

Khazanov³

et al. 2023

Preprint

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Objective: Federal loan repayment programs are one strategy to address the U.S.’s shortage of behavioral health providers. This scoping review aims to identify and characterize the evidence of federal loan repayment programs’ impact on the behavioral health workforce in the U.S. Methods: We conducted a systematic scoping review in accordance with the Joanna Briggs Institute’s methodology for scoping reviews. Databases searched were Ovid Medline, Web of Science, PsycInfo, EconLit, PAIS Index, and Embase, and grey literature was reviewed. Two coders screened each abstract and full-text and extracted study data. Findings were narratively synthesized and conceptually organized. Results: After full-text screening, the search yielded 17 articles that met eligibility criteria. Of these, 8 were peer-reviewed publications, and all but one article evaluated the National Health Service Corps (NHSC) loan repayment program. Findings were conceptually organized into six categories: 1) descriptive studies of NHSC behavioral health needs and the NHSC workforce (k=4); 2) providers’ perceptions of and experiences with the NHSC (k=2); 3) associations between NHSC funding and the number of behavioral health providers (k=4); 4) NHSC behavioral health workforce capacity and productivity (k=3); and 5) federal loan repayment program recruitment and retention (k=4). Conclusions: The scientific literature on federal loan repayment programs and their impact on the behavioral health workforce is relatively limited. Though federal loan repayment programs are an important and effective tool to address the workforce shortage, additional federal policy strategies are needed to attract and retain behavioral health providers and to diversify the behavioral health workforce.

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“…14 Other factors such as lifestyle, family considerations, financial incentives, practice characteristics, availability of loan forgiveness, and personal characteristics also influence the decision to practice in rural areas. 15 These factors are multifaceted, nuanced, and interrelated, and studies investigating the relative influence of these various factors on rural practice are lacking.…”

Section: Introductionmentioning

confidence: 99%

Factors Associated With Health Care Professionals’ Choice to Practice in Rural Minnesota

et al. 2023

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ImportanceRural health inequities are due in part to a shortage of health care professionals in these areas.ObjectiveTo determine the factors associated with health care professionals’ decisions about where to practice.Design, Setting, and ParticipantsThis prospective, cross-sectional survey study of health care professionals in Minnesota was administered by the Minnesota Department of Health from October 18, 2021, to July 25, 2022. Advanced practice registered nurses (APRNs), physicians, physician assistants (PAs), and registered nurses (RNs) renewing their professional licenses were eligible.ExposuresIndividuals’ ratings on survey items related to their choice of practice location.Main Outcomes and MeasuresRural or urban practice location as defined by the US Department of Agriculture’s Rural-Urban Commuting Area typology.ResultsA total of 32 086 respondents were included in the analysis (mean [SD] age, 44.4 [12.2] years; 22 728 identified as female [70.8%]). Response rates were 60.2% for APRNs (n = 2174), 97.7% for PAs (n = 2210), 95.1% for physicians (n = 11 019), and 61.6% for RNs (n = 16 663). The mean (SD) age of APRNs was 45.0 (10.3) years (1833 [84.3%] female); PAs, 39.0 (9.4) years (1648 [74.6%] female); physicians, 48.0 (11.9) years (4455 [40.4%] female); and RNs, 42.6 (12.3) years (14 792 [88.8%] female). Most respondents worked in urban (29 456 [91.8%]) vs rural (2630 [8.2%]) areas. Bivariate analysis suggested that family considerations are the most important determinant of practice location. Multivariate analysis revealed that having grown up in a rural area was the strongest factor associated with rural practice (odds ratio [OR] for APRNs, 3.44 [95% CI, 2.68-4.42]; OR for PAs, 3.75 [95% CI, 2.81-5.00]; OR for physicians, 2.44 [95% CI, 2.18-2.73]; OR for RNs, 3.77 [95% CI, 3.44-4.15]). When controlling for rural background, other associated factors included the availability of loan forgiveness (OR for APRNs, 1.42 [95% CI, 1.19-1.69]; OR for PAs, 1.60 [95% CI, 1.31-1.94]; OR for physicians, 1.54 [95% CI, 1.38-1.71]; OR for RNs, 1.20 [95% CI, 1.12-1.28]) and an educational program that prepared for rural practice (OR for APRNs, 1.44 [95% CI, 1.18-1.76]; OR for PAs. 1.70 [95% CI, 1.34-2.15]; OR for physicians, 1.31 [95% CI, 1.17-1.47]; OR for RNs, 1.23 [95% CI, 1.15-1.31]). Autonomy in one’s work (OR for APRNs, 1.42 [95% CI, 1.08-1.86]; OR for PAs, 1.18 [95% CI, 0.89-1.58]; OR for physicians, 1.53 [95% CI, 1.31-1.78]; OR for RNs, 1.16 [95% CI, 1.07-1.25]) and a broad scope of practice (OR for APRNs, 1.46 [95% CI, 1.15-1.86]; OR for PAs, 0.96 [95% CI, 0.74-1.24]; OR for physicians, 1.62 [95% CI, 1.40-1.87]; OR for RNs, 0.96 [95% CI, 0.89-1.03]) were important factors associated with rural practice. Lifestyle and area considerations were not associated with rural practice; family considerations were associated with rural practice for RNs only (OR for APRNs, 0.97 [95% CI, 0.90-1.06]; OR for PAs, 0.95 [95% CI, 0.87-1.04]; OR for physicians, 0.92 [95% CI, 0.88-0.96]; OR for RNs, 1.05 [95% CI, 1.02-1.07]).Conclusions and RelevanceUnderstanding the interconnected factors involved in rural practice requires modeling relevant factors. The findings of this survey study suggest that loan forgiveness, rural training, autonomy, and a broad scope of practice are factors associated with rural practice for most health care professionals. Other factors associated with rural practice vary by profession, suggesting that there may not be a one-size-fits-all approach to recruitment of rural health care professionals.

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Satisfaction of the Primary Care, Mental Health, and Dental Health Clinicians of the National Health Service Corps Loan Repayment Program

Cited by 8 publications

References 25 publications

Experiences of Safety-Net Practice Clinicians Participating in the National Health Service Corps During the COVID-19 Pandemic

Experiences of Safety-Net Practice Clinicians Participating in the National Health Service Corps During the COVID-19 Pandemic

The Impact of U.S. Federal Loan Repayment Programs on the Behavioral Health Workforce: A Scoping Review

Factors Associated With Health Care Professionals’ Choice to Practice in Rural Minnesota

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