Thousands of medical and healthcare students are passionate about providing primary care but are daunted by education debt, which can run $100,000 or more.
At the same time, 50 million Americans live in rural and inner-city communities that the federal government has designated as medically underserved, largely due to a shortage of primary-care providers.
To address this disconnect between disadvantaged patients and the doctors, nurses, mental health professionals, dentists and others needed to treat them, the government established the National Health Service Corps (NHSC) in 1972. The NHSC offers education grants to would-be healthcare providers in exchange for a promise to serve two years or more in a community that needs them.
"The rise in education costs is forcing students to choose higher-paying subspecialties," says Leana Wen, a past president of the American Medical Student Association (AMSA). "The NHSC has been successful in drawing students to primary-care fields."
Providing Care Where It's Needed
Recipients in either of the NHSC's two grant programs -- scholarship and loan repayment -- work in one of the country's 3,000 health professional shortage areas (HPSAs), communities the Department of Health and Human Services has designated as medically underserved.
"This is a service program," says Don Weaver, an administrator with the US Health Resources and Services Administration (HRSA) and a former director of the NHSC. You're committing to go wherever the need is great. You're going where others choose not to go.
Among healthcare professionals eligible for NHSC grants are physicians and other clinicians providing primary care, including nurse practitioners, nurse midwives, social workers, physician assistants, mental and behavioral healthcare providers, dentists and dental hygienists. NHSC grantees can search the HRSA's database for available opportunities.
"I was really drawn to working with clinics," says Jay Bhatt, an NHSC scholar and fourth-year medical student at the Philadelphia College of Osteopathic Medicine. "This became my mission in life, which led me to think about the NHSC." After graduating and completing his residency, Bhatt, also an AMSA past president, hopes to perform his NHSC service in his hometown of Chicago.
Scholarships Pay Tuition and More
Those seeking NHSC scholarships apply early, often during their first year of school. Compared with taking out loans, NHSC scholarships represent a much better financial deal, offering not only full tuition, which can reach tens of thousands of dollars for medical students, but also a monthly stipend of about $1,000 and reimbursement for some educational expenses, such as books.
The scholarship program is competitive, even elite. Only about one in 10 applicants is accepted, for a total of about 300 scholarships per year.
The financial reward lies in avoiding debt, not in high pay early in clinical practice. "They probably get paid a little less than physicians elsewhere," Wen says. But NHSC scholars have the satisfaction of caring for patients who might otherwise go without: "An NHSC physician in a rural area may be the only primary-care provider for thousands of patients for miles around,” she says.
Loan-Repayment Program Eliminates Large Chunks of Debt
The other type of NHSC education grant is loan repayment. For each year grantees serve, they receive up to $25,000 for each of the first two years and up to $35,000 for each additional year.
The grants are easier to win than NHSC scholarships. The NHSC says that between 2003 and 2005, it did not turn down an eligible applicant for the loan-repayment program.
Appropriations for NHSC programs declined from about $125.7 million in fiscal year 2007 to $123.5 million in fiscal year 2008. "Given the appropriations we've received, it's been a very effective program," Weaver says. A $300 million provision for the NHSC is part of the new stimulus package.