NHSC - FT direct care requirements realistic?

[flora77]

Hi y'all,

I'm posting on this forum because this seems to be the most active place I can find on the internet to talk about NHSC. Please forgive me that I'm not a student or a doctor.

I'm an LCSW applying to the NHSC loan repayment program. I have a full time position at an eligible site, and I'm applying for the full-time contract. FT to NHSC means 32 hours direct patient care per week, leaving no more than 8 hours to be doing admin. My main question: is this realistic for behavioral health providers? If so, please help me understand how!

I've been at this position for 6 months. I'm the sole mental health professional at my integrated health clinic. My number of direct practice hours has gone up steadily but has not yet reached 32 hours per week, and honestly I can't fathom managing 32 hours of direct practice per week. I schedule 7x 45 minute individual sessions per day = 26.25 direct patient hours per week. Of these 7 appointments, I generally have 1-3 no shows per day, which gets me even further away from 32 hours per week.

I have colleagues in private practice who consider a full caseload 15-25 clients per week.
I love my patients, and I love my job. I show up around 9:30am, and I am busy all the way until 8pm, even with no shows. I care about treatment planning and thorough documentation, and although I am getting speedier at these tasks, they do take time. I also can't control my no show rate, and I am afraid to schedule more than 7 clients per day because that sounds exhausting if they all show up.

Am I being a wimp? Is it normal to be able to see 32+ patients per week for individual psychotherapy? (Or 43!! if 45 minute sessions.) How do people meet the 32 hr/wk rule, especially considering no show rates?

I do not want to sign a contract that I cannot fulfill. Should I apply for the PT contract instead? I have $45K in student loan debt, and I would obviously prefer to get the $50K in loan forgiveness rather than just the $30K for PT.

If there is a way to get 32 direct care hours per week and keep my sanity and fulfill a FT contract, I want to do it. Please provide any tips you have for getting to 32 hrs/wk while remaining effective for your clients.

---

Members don't see this ad.

 

[smalltownpsych]

As long as you are working in a clinic and scheduling patients then it counts as direct care. No shows and 15 minute breaks between patients doesn’t count against you as far as I can tell from my reading of the rules of NHSC. If it did, then it would be almost impossible as you rightly saw.

 

[AcronymAllergy]

32 hours/week of direct patient care isn't unusual as a requirement; technically, that's 90% of a full-time week. Although are you sure that a 45-minute session doesn't count as an hour of patient care, given that you're going to be billing with a 60-minute CPT code most likely?

My clinic, when it went by clinic utilization, required 90% of providers' time devoted to patient care. But for an hour-long session block, providers typically spent anywhere from 45-50 mins in session and the other ~10 mins completing notes.

 

[smq123]

As long as you are working in a clinic and scheduling patients then it counts as direct care. No shows and 15 minute breaks between patients doesn’t count against you as far as I can tell from my reading of the rules of NHSC. If it did, then it would be almost impossible as you rightly saw.

As an NHSC scholar, this is correct.

The time that the NHSC calculates is the time that you were required to be at work. If the patient shows up or doesn't show up is not relevant. Breaks between patients are not relevant either. Lunch breaks aren't calculated either. As long as the clinic schedules you to see patients for at least 32 hours a week, then that is all that matters.

For my first 3 months during my service repayment, I think I saw about 10 patients a day. And this is family medicine primary care, so those were 15 minute visits. If the NHSC calculated it by time actually spent with a patient, I'd still be paying back my service obligation!