NHSC at 50: New Investments for a New Workforce
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As the National Health Service Corps (NHSC) turns 50 years old, the need for a national program designed to care for the U.S.'s underserved is more apparent than ever. In addition to developing a health care workforce that is diverse and culturally responsive throughout the nation, the NHSC is the U.S.'s best, most efficient and most data-proven clinical care delivery system to ensure well-trained clinicians are paired with communities in need.
The NHSC has national impact—clinicians who are caring for the needy serve in every single state in the country as well as on Indian reservations and in correctional facilities. This is not surprising given the need for physical, mental, and oral health care services in both rural and urban locations in communities throughout the United States. The NHSC is funded by a combination of mandatory and discretionary dollars annually, and despite temporary increases in funding, the NHSC is only able to fund approximately 40% of all applications it receives.1 This persistent deficit in NHSC funding has resulted in a perpetual shortfall in filled clinician vacancies in underserved communities across the nation.
This situation could be remedied by Congress: allocate—consistently—enough money to fund the Corps for its mission now and for the next 50 years. Not only would such an investment help deliver a more robust workforce to the underserved at a time of tremendous need in the U.S.; it would help accelerate the necessary and long overdue transformation of the health care workforce, ensuring not only cultural competency but the racial and ethnic diversity that is a reflection of the peoples of the U.S. and embodies many community and public health principles.
The Association of Clinicians for the Underserved, marking its 25-year anniversary this year, has a five-pillar plan to connect funding to function. The broad plan is built on perennial key considerations of a strategic plan to enhance the impact of the NHSC.
1. Enable the Corps to fund the providers needed to eliminate all health professional shortages
The NHSC has a diverse workforce with a long history of service to areas in need due to deep and longstanding disparities along geographic and demographic lines. There has [End Page xii] never been sufficient funding for NHSC to meet the need. This is so despite the double impact that the NHSC could have in mitigating disparities while providing clinical care to our nation's most impoverished and disadvantaged communities. For example, in the last quarter of 2020, more than 32,000 clinicians were needed to address all regions designated as health professional shortage areas (HPSAs), in the face of shortages in primary care, dental, and mental health.2 Long-term, stable funding to address the full scope of need across disciplines would help to ensure millions of Americans would not suffer an inequitable lack of access to care, and correspondingly inequitably high rates of morbidity and mortality, as a result of clinician shortages.
2. Expand NHSC eligibility for behavioral health professionals
Nearly 6,450 mental health providers were needed to address HPSA designees at the end of 2020.2 Expanded eligibility for behavioral health professionals could help address the immediate need in serving the more than 121 million individuals currently living in mental health HPSAs and help to stem the heightened need being seen as a result of the COVID-19 pandemic.2 This could also address structural barriers to success for underserved communities by eliminating the need to have a master's-level behavioral health or counseling degree to provide mental health and counseling services to these communities. This would afford opportunities to highly intelligent and motivated community members who face significant barriers to obtaining master's degrees. An investment in this area, as well as scholarships for these providers, would address the structural racism and classism inherent in currently legislated programs.
