SDN Article: National Health Service Corps Explained

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Erin Wildermuth

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Though most doctors will be able to pay their medical school loans, being weighed down by debt is not ideal. If you’re a practicing physician or entering medicine with dreams of being a primary care provider, consider applying to the National Health Service Corps. This organization provides incentives for doctors to give back to communities in need around the United States.

What is the National Health Service Corps?​

The National Health Service Corps (NHSC) is a federal organization mandated to improve access to healthcare across the United States. Toward this aim, the NHSC designates Health Professional Shortage Areas (HPSA). Areas can be chosen based on geography, population, or facility. NHSC rates sites on a scale from 0-25 according to need. NHSC provides incentives to healthcare professions who commit to work at these sites. Though this article centers on physicians, many of the incentives discussed are also available for dentists, psychologists, pharmacists, nurse practitioners, certified nurse-midwives and physician assistants. The details and logistics, however, will differ between medical professionals.

Physician Programs Supported by the National Health Service Corps

Federal Scholarship Program​

Medical students (MD/DO) committed to primary care are eligible to receive tuition, reasonable school-related expenses and a stipend from NHSC. The stipend is the only part of this package that is taxable and amounted to $1383/month during the 2019-2020 school year. For each year of scholarship, students complete a year of service working as a physician at a designated Health Progression Shortage Area. Scholars serve a minimum of two years full-time (or four years part-time) and can only receive four years of scholarship.

Medical students must be US citizens, in school full-time, and complete a primary care residency to be eligible for this program. The process is competitive, with around ten percent of applicants receiving scholarship. For the most detailed information about this program, read their latest application and program guidance pamphlet.

Federal Loan Repayment Program​

Licensed primary care physicians can also apply for loan repayment of qualifying debt if employed by NHSC-approved sites. Qualifying debt includes principle and interest accrued via private and public loans. Tuition and living expenses associated with both undergraduate and medical school are eligible. This program allots repayment amounts based on the HPSA rating of a site. Physicians can work-part time, though their repayment amount will reflect this. A full-time physician at a site rated 14+ can expect to receive about $50,000 in loan repayment funds.

There are three variations of this program for loan repayment: general, substance abuse workforce, and rural community. All three programs use the same application, but applicants may only apply to a single program.

In addition to the flagship program above, NHSC supports the Federal Students to Service (S2S) Loan Repayment Program. The S2S Program offers up to $120,000 in repayment to medical students in their fourth year of study. In return, these students commit to a primary care residency and either three years full-time work or six years part-time work at an HPSA with the greatest need.

State Loan Repayment Program​

The State Loan Repayment Program allows states to tailor the NHSC repayment program to better suit state needs. States can modify who is eligible for the program or endorse different service requirements. The program operates as a matching grant between the state and NHSC.

Life as an NHSC Doctor​

I caught up with Natalie Spicyn, a participant of loan repayment program recipient. Here’s what she had to say:

Which NHSC repayment program did you participate in and where was your site?​

I participated in the loan repayment program. I applied after accepting a position at an FQHC (federally qualified community health center) in Baltimore, where I completed my medical residency. I actually changed jobs towards the end of my 2-year contract, to another NHSC-eligible FQHC in Baltimore, where I then ended up applying for a 1 year extension, for a total of 3 years of service. I completed my commitment in November 2018 and have continued in my position since the end of that contract.

What is the best thing about participating in the NHSC repayment program? The worst thing?​

The best thing about participating in the NHSC repayment program was… the money!
It’s nice to get a tax-free lump sum to help pay down loans early in one’s career.

When I made the difficult decision to leave my initial site before my NHSC commitment was up, having the service commitment did limit my job search. While it ultimately led me to an opportunity I might not otherwise have found and that I’ve been very happy with, there are other opportunities that I had to pass up because I could not afford to break my contract.

Was it challenging to find a designated site?​

Not for me, no. This varies geographically and by discipline, but as a med-peds trained physician in an urban area, I felt I had adequate options without having to leave Baltimore City.

What has been your experience working at a designated site?​

FQHCs have their ups and downs, but the bottom line is that every day, I get to do the work that I went into medicine to do, and it is a true privilege.

Did you consider the scholarship program? If so, why did you decide on the repayment program instead?​

I did consider the scholarship program, but I was afraid to be locked into a specialty (and there was a period of my life that I thought I’d become a pediatric oncologist) and afraid to be forced to move someplace rural. Even after I completed a primary care residency program, I wasn’t fully committed to NHSC. I wanted my first job search to be about finding the right job; as it happened, the right job was at a Federally Qualified Community Health Center, so I decided to apply for the repayment program after making the decision about the position. It was the right pathway for me.

Considering the National Health Service Corps: Pros and Cons

There is invariably a loss of freedom for medical students that become NHSC scholars. The primary care requirement locks students into these specialties, even if they prefer a different field after completing clinical rotations. Fellowships within primary care are also limited. Child psychiatry, addiction medicine, an obstetrics/gynecology fellowship following family medicine residency, or geriatrics fellowship may be considered on a case-by-case basis. Other specialties would need to be completed after service.

It doesn’t end there. Though participants are technically able to choose their own program-approved job after residency, one will be assigned if you haven’t secured a hire within six-months. NHSC is also very clear that participants should be open to relocating anywhere in the United States and that NHSC has final say over placements.

The consequences for not following through on your scholarship agreement are dire. If you breach your contract by choosing a different residency or not completing your service requirement you will owe the government three times the amount they have invested, plus interest. If you don’t graduate, for any reason, you have three years to pay back the amount originally given.

The loan repayment programs are much less restrictive, but also offer less in return. A scholar at an expensive private medical school can expect full tuition and a stipend of around $16,000 each year. This adds up to much more than the $50,000 offered for a two-year commitment after residency. Medical school tuition at Johns Hopkins University is over $50,000/year. An NHSC scholar attending this school would see a scholarship package of $132,000 over the first two years.

Is it worth the loss of freedom? It depends. Once you’re a physician there will be many opportunities to pay off your debt – you can choose a better paid position or find one that offers loan repayment. How committed are you to public service? To primary care? How expensive is your medical school? Like many programs with financial incentives, it is important to believe in the mission before you sign the dotted line.

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