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AAMC Reporter: October 2004
A Word From the President:
"America's Healthcare Heroes"
 Medicine offers countless opportunities for idealistic healthcare professionals to care for the underserved, all the way from those who venture into far off African villages and South American jungles to those who pursue the abundant, if somewhat less romantic, opportunities much closer to home.
The National Health Service Corps (NHSC), a federally funded program that matches primary healthcare professionals with communities in need, offers many of those ‘closer to home’ opportunities. Since its inception more than three decades ago, the NHSC as enlisted nearly 25,000 clinicians in its various programs. What is not well known is that at least 50 percent of these professionals remain working in underserved communities for at least a period of time after they complete their service commitments. According to the Department of Health and Human Services, the NHSC’s current field strength totals nearly 4,000 individuals, including physicians, physician assistants, dentists, mental health professionals, nurse practitioners and nurse midwives. NHSC clinicians have been aptly dubbed “America’s healthcare heroes.”
Inducements for individuals to consider serving in the NHSC come in two forms, a scholarship while still in school and loan repayment after completion of formal training. Medical students who opt to compete for an NHSC scholarship must agree to pursue post-graduate training in a primary care discipline and, hence, must make a decision about their future career earlier than many of their peers. This option has obvious appeal for those who begin their education having made a firm decision about a primary care career. But many students, probably the majority, are reluctant to commit themselves to an early choice before sampling other possibilities. For this reason, and perhaps others, the NHSC’s loan repayment program has become the more popular of the two options available for medical students.
The loan repayment program works this way: for physicians, applications are generally filed midway through residency for a position on completion of training. In return for working full-time at an NHSC approved site, the individual receives (a) a base salary and routine benefits, (b) up to $25,000 for each of the first two years of service to repay student loans and (c) an additional 39 percent of the loan repayment amount to offset the taxes due on (b).
In fiscal year 2004, Congress appropriated $170 million for the NHSC, which included $46 million for its field budget and $124 million for its recruitment budget (i.e., for scholarships and loan repayments). The President’s fiscal year 2005 budget proposal calls for $205 million for the NHSC, a 20.6 percent increase over the last year.
Last month’s issue of the AAMC Reporter outlined the types of clinicians who compose the Corps and described the widely varying communities to which they are assigned. Dr. Malcolm Butler, a former NHSC doctor who still works in an underserved community in rural Washington State, treats mostly Spanish-speaking patients. Dr. Celia Lloyd-Turney, another former NHSC physician, works on the other side of the country, in a predominantly African-American community in Alabama. Both of these doctors expressed undiminished satisfaction with their experiences with the NHSC and with their choice to dedicate their careers to its mission of service to the underserved. If you peruse the NHSC Web site, you will find similar stories of healthcare workers who joined the NHSC several years ago and are still serving our country’s rural and inner-city communities.
In addition to contributing mightily to easing America’s burden of the medically underserved, the NHSC has been a godsend for many students who are only too willing to ease their own burden of educational debt by joining the effort. In the process the NHSC has awakened interest in primary care careers among many students, including many from underrepresented minority backgrounds, who might not have entertained the possibility otherwise. Indeed, to fulfill its own programmatic needs, the NHSC actively recruits students from diverse racial and ethnic backgrounds. As a consequence, the NHSC is aiding in the effort to increase the diversity of the country’s primary care workforce and, in so doing, helping to eliminate health care disparities.
I am pleased that so many medical school faculty members have recognized the value of the NHSC and have actively promoted the program among interested students. In my estimation, the NHSC is one of the true jewels in the crown of federal health programs and deserves all the support we can give it. Not only has it (1) been successful in its primary mission of bringing needed services to millions of people with limited or no access to healthcare, it has (2) eased the financial burden of a health professions education for thousands of students, has (3) contributed to closing medicine’s racial and ethnic diversity gap, and has (4) worked to reduce health care disparities among our country’s minority populations.
How often do we get a “four-fer” like this for our tax dollars?
Jordan J. Cohen, M.D.
AAMC President
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