NHSC Clinicians Appear to Attract Non-NHSC Colleagues

Having National Health Service Corps clinicians in rural underserved areas helps persuade non-NHSC physicians to also work there, according to the results of a study, funded by the AAFP's Robert Graham Center, that were published in the fall issue of the Journal of Rural Health.

According to the abstract for "National Health Service Corps Staffing and the Growth of the Local Rural Non-NHSC Primary Care Physician Workforce," "From 1981 to 2001, counties staffed by NHSC clinicians experienced a mean increase of 1.4 non-NHSC primary care physicians per 10,000 population, compared to a smaller, 0.57 mean increase in counties without NHSC clinicians."

In the study's 141 counties with NHSC primary care physicians, the non-NHSC primary care physician workforce increased by an estimated 294 more physicians in 2001, or about two additional physicians for each NHSC-supported county, than would have been expected without the NHSC's involvement, principal investigator Donald Pathman, M.D., M.P.H., said in a recent interview. Pathman is professor and research director in the family medicine department at the University of North Carolina at Chapel Hill.

The Congressional Budget Office and other sources "have at times been concerned that NHSC clinicians might compete with non-NHSC clinicians, particularly physicians, and prevent them from locating nearby," say the authors of the article.

"Over time, non-NHSC physicians have realized the NHSC physicians were working in community centers and taking care of people who didn't have health insurance or had Medicaid. These aren't patients that physicians are competing heavily for," said Pathman.

Communities with NHSC physicians should take reassurance from the study, he added. "If communities are using the NHSC, that's probably not hurting their chances to recruit other physicians."

Congress established the NHSC in 1970, according to the article, and of the 23,000 clinicians who had served in the corps by 2000, more than two-thirds were physicians. The current NHSC clinician workforce "is now larger than ever, numbering over 4,200," according to the article.

The corps began as a scholarship program for medical students, who typically entered the program in their first year of medical school, said Pathman. In 1987, the NHSC added a loan repayment program for clinicians who agreed to work in health professional shortage areas, or HPSAs. The clinicians typically obtain their loan repayment status at about the same time they take a position in an HPSA, so there's no seven-year lag time between making that commitment and starting to fulfill their obligation, said Pathman.

According to the article, non-NHSC physicians began beefing up the workforce in areas with NHSC sites only after 1991, suggesting that ex-NHSC physicians may have stayed at their service sites after completing their years of obligated service. "This might explain why non-NHSC primary care physician growth accelerated in NHSC-supported counties after 1991 when the first of the NHSC's loan repayment program participants were completing their obligations," says the article.

Since 2002, the NHSC has shifted more than 80 percent of its support to participants of its loan repayment program. That's a good thing, said Pathman. "There is a retention advantage" attached to loan repayment programs compared with scholarship programs.