The National Health Service Corps at 50: A Legacy of Impact in Partnership with The Association of Clinicians for the Underserved

The year 2020 marks the 50th anniversary of the legislation that created the National Health Service Corps (NHSC). Congress created the National Health Service Corps with passage of the Emergency Health Personnel Act of 1970 (P.L. 91-623) on December 31, 1970¹ and in 1972 the first NHSC-sponsored clinicians provided ser-vices in the field.

The Association of Clinicians for the Underserved (ACU)—formed by current and former NHSC recipients—has served as an important advocacy, policy, and clinicallyoriented professional organization since 1996. Shared membership, commitment to the underserved, and a sense of a common mission have inextricably linked the NHSC and ACU for nearly 25 years.

The original intent of the NHSC legislation was "to authorize the assignment of commissioned officers of the Public Health Service to areas with critical medical manpower shortages [and] to encourage health personnel to practice in areas where shortages of such personnel exist…" Initial funding for years 1, 2 and 3 was set at 10, 20 and 30 million dollars, respectively.¹

Dr. James Hotz, an internal medicine physician who is on the ACU Board of Directors, joined the ranks of the Commissioned Corps in 1978 after being sent to help Albany Area Primary Health Care, a community health center that now cares for over 40,000 underserved people in rural Southwest Georgia. That initial two-year commitment has turned into a 41-year career; Albany Area Primary Health Care just celebrated its four

Figure 1.

NHSC field strength, 1927–2016.²

Figure shows increases in NHSC field strength from 1972 to 2016, with significant growth since 2009.

millionth patient visit, and over half of these visits have been provided by clinicians recruited through the NHSC.

Jim's story and his work in southeast Georgia reflects the impact the NHSC has on communities, with greater than 50% of NHSC clinicians serving in underserved communities for over 10 years after completing their service requirement.²

Patient stories and clinical care have been the bedrock of the Corps since inception, but the NHSC does much more—so much more—than just provide clinical care ser-vices to the areas of the country that need them most. In addition to this, the NHSC:

• • Helps to increase health equity

• • Creates a more diverse workforce

• • Supports the creation of local economic growth

As can be seen in Figure 1, the NHSC has expanded not only in numbers of clinicians but also in types of clinicians since its inception. Notably, the Corps—which initially counted physicians as its dominant workforce—now counts behavioral health clinicians as its largest workforce component. In 2009, a majority of the Corps was physicians (35%); in 2017, behavioral health providers now make up the majority of clinicians in the NHSC (30%), with nurse practitioners taking second place (at 23%) and physician participation down to (20%).³ The NHSC continues to adapt to the needs of the United States and reflects that in its workforce.

Over the past several years the program has expanded to respond to national crises such as the Zika outbreak (in 2017), the substance use disorder crisis (in 2019), and the present COVID-19 pandemic. What began as one program—a scholarship program—now encompasses six complementary but distinct opportunities to serve under the NHSC: The scholarship program and multiple loan repayment programs including the students to service program.

Reduction of Health Inequities

Health equity and health care equality are key components of federal health policy.⁴ The NHSC is an important way that these measures are achieved, both by delivering services to underserved areas, and by the workforce that delivers these services. A study by the Robert Graham Center documenting the impact that the NHSC has had on health equality during its first 30 years showed that the NHSC...