Last week, HHS Secretary Sylvia Mathews Burwell announced that the Health Resources and Services Administration awarded $283 million in ACA funding through the NHSC program for fiscal 2014 to increase access to primary-care services. According to HHS, in fiscal 2014 the program provided more than 5,100 loan repayment and scholarship awards to clinicians and students, and 38 states received grants to support state loan repayment programs.
Despite loan repayments and other incentives to encourage medical school graduates to pursue primary-care careers in underserved communities, some experts worry the program is not enough to head off a primary-care shortage. They say lower pay for primary-care doctors remains a big problem, though the NHSC's loan repayment program helps.
“This is a piece of a larger puzzle about helping our country learn how to value primary care,” said Dr. Reid Blackwelder, president of the American Academy of Family Physicians. A medical student entering the workforce, often burdened with nearly a quarter-million dollars in educational debt, may see more opportunity in subspecialty areas offering higher payments. “Money isn't the main thing, but money is a big thing,” he said.
In April, more than 30 organizations including the AAFP, the American College of Physicians, the American Nurses Association, and the Association of American Medical Colleges, wrote a letter to congressional leaders (PDF) expressing concern that mandatory funding for the NHSC could expire at the end of fiscal 2015.
The groups said that with a field strength of 8,899 NHSC professionals in fiscal 2013, the program fell far short of fulfilling the healthcare needs of all federally designated shortage areas. Even with the potential 15,000-plus practitioners envisioned in Obama's proposed 2015 budget, a number of underserved areas still would lack access to primary care. The current shortage of healthcare professionals, they wrote, could result in 59.4 million unserved primary-care patients, 46.7 million unserved dental patients, and 94.9 million unserved mental health patients.
As of Jan. 1, 2014, the Health Resources and Service Administration estimated that 17,653 additional practitioners are required to eliminate all current primary care, dental and mental health shortage areas. A more conservative ratio of 1 primary-care physician to 2,000 population would increase the need to 25,700 additional practitioners.
The stakeholder groups said they endorse Obama's overall funding level of $810 million for the NHSC in his proposed 2015 budget, and that they support his proposed five-year mandatory funding investment of $710 million for each of fiscal years 2016-2021. They urged Congress to work together before current mandatory funding for the NHSC expires at the end of fiscal 2015.
“It's one thing to say, 'This is what we want to do,' but it's another to support it with funding,” Blackwelder said. “We have a very inadequate primary-care base. There's no question that more is needed.”
Applications for the newest round of NHSC applications are due by November. Blackwelder said one of his students has been funded, which means she has a four-year commitment to NHSC service in a medically underserved area. But if mandatory funding expires, his student may only receive two years of funding. That would mean after two years she would have to look for another job and find another way to pay off her medical education loans.