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  • The Lack of Long-Term Funding for the National Health Service Corps Limits the Ability to Address Health Care Workforce Shortages
  • Jordan Marshall, MPH (bio), Amanda Pears Kelly, BA (bio), and Rick Brown, MA (bio)

Founded by alumni and members of the National Health Service Corps (NHSC) in 1996, the Association of Clinicians for the Underserved (ACU) is committed to educating, encouraging, and enabling health care providers of all backgrounds to practice in underserved communities nationwide. The organization engages providers early in their clinical careers, helping to support placement in safety-net organizations that provide guidance and experience while simultaneously serving those communities in need.

For more than a decade, ACU has been the leading advocate for the NHSC, specifically leading efforts to secure increased funding and resources for the growth and expansion of this federal program. The NHSC has a 50-year legacy of national impact, supporting clinicians who are caring for medically underserved patients in health centers and other safety-net practices across the country by offering these health professionals loan repayment or scholarships in return for service in federally designated Health Professional Shortage Areas (HPSAs). Approximately 75,000 clinicians have served in the Corps since its inception, and in 2023 alone, 18,335 clinicians provided 19 million individuals with a range of clinical services that would often otherwise have been out of reach.1

Current NHSC Funding Realities—What's at Stake

The NHSC is presently seeking loan repayment applications from health professionals in training to become NHSC Scholars. Much is imminently at stake for the NHSC's long-term viability because of the Corps' funding cycle and timing of awards, which directly affects students making decisions about where they will train and practice medicine. If the Corps is underfunded, they will go elsewhere. To make matters worse, research shows that clinicians often stay in the communities where they are trained. Overall, 54.2% of the individuals who completed residency training from 2008 through [End Page xi] 2017 are practicing in the state of their residency training, with retention rates varying but reaching as high as 77.7% in California.2 As it relates to the Corps, if someone opts not to go to a HPSA because there is a lack of funding to support NHSC scholarships or loan repayments, the likelihood of attracting them to practice in an underserved community further along in their career is minute. The impacts of the funding choices being made now will have severe implications not just in the immediate future (six to 12 months), but for years to come.

Nationally, the workforce of primary care clinicians diminished by more than 107,000 providers or 13% between 2022 and 2023. The situation is even more dire in underserved and rural communities,3 and the supply of primary care providers has decreased by as much as 25% in certain communities.4 Given that health centers have limited capacity to recruit and retain providers because of their financial structure (health centers cannot adjust their rates for inflation or increased cost, and that directly affects their ability to adjust salaries and benefits), the NHSC is usually one of their only tools to help get clinicians into their communities and retain them. When these resources diminish, that leads directly to decreased ability to reach adequate staffing levels and ensure access for those most in need, especially in rural areas. In general, health centers are losing clinicians to other private entities because they cannot compete both with respect to salary, but now with respect to their ability to guarantee loan repayment/scholarship opportunities, too. They are also seeing new providers choose other opportunities to begin their careers because of uncertainty around benefits such as loan repayment. Ultimately, if a health center cannot rely on the NHSC being funded to access dollars for their providers, they will be left with few, if any, resources to recruit and retain those providers.

Funding Levels Directly Affect the Success of the NHSC

The Corps' clinical field strength—18,335 providers as of 2023—has already decreased by 2,000 providers from its peak of approximately 20,000 in 2022. At a time when the health center workforce is already understaffed...

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