Posts Tagged ‘National Health Service Corps’

National Health Service Corps Caring for More Medically Underserved Americans

Wednesday, October 19th, 2011

In the last three years, membership in the National Health Service Corps (NHSC) has tripled, according to Kathleen Sebelius, Secretary of Health and Human Services (HHS).  The NHSC is a national network of 10,000 primary-care providers and 17,000 sites in underserved communities with limited access to healthcare.

“When you don’t have access to primary care, small health problems grow into big ones,” Sebelius said.  “Way too many Americans have gone without check-ups, preventive screenings, vaccines, routine dental work and other care simply because there was no one to see,” Sebelius said.  The agency estimates that its providers care for approximately 10.5 million patients, compared with just 3,600 providers who cared for roughly 3.7 million patients three years ago.

The program, which is almost 40 years old — is administered by HHS’ Health Resources and Services Administration (HRSA) — and provides financial, educational and professional resources to medical, dental and behavioral healthcare providers.  According to HRSA the NHSC has awarded approximately $900 million in scholarships and loan repayment to healthcare professionals since 2008 to expand the agency’s primary-care workforce. That funding has come from the Patient Protection and Affordable Care Act (ACA), the American Recovery and Reinvestment Act (ARRA) and base appropriations.  “Eighty-two percent of NHSC clinicians continue to serve in high-need areas after they fulfill their service commitment,” HRSA Administrator Mary Wakefield said.  “These awards help ensure that underserved communities across the country have access to quality healthcare both today and in the future.”

“When you don’t have access to primary care, small health problems grow into big ones,” Sebelius said. “Most of these providers graduate with tens or even hundreds of thousands of dollars in loans, and it is very difficult to pay off while doing this important work.”

The Association of American Medical Colleges estimates that the nation will have a shortage of 91,500 physicians across all specialties just nine years from now. 

Despite the program’s recent significant growth, Wakefield said there are underserved areas of the country that qualify for National Health Service Corps members, but there is not enough money to fund providers there.  “It is a significant challenge,” Wakefield said.  “We have more sites that are designated or eligible than we have clinicians.  We also have, on the flip side, more students applying to National Health Service Corps than we have availability” to fund.

In Minnesota, for example, a state with vast wilderness areas, the federal government is providing $6.6 million in incentive dollars to doctors and nurses to increase the state’s number of primary-care providers.  According to Minnesota Public Radio, “Minnesota’s rural healthcare system is feeling new pressure.  National healthcare reform is forcing expensive record-keeping changes.  Greater reliance on Medicare and Medicaid reimbursement makes rural providers vulnerable.  Rural people tend to be older and poorer, are less likely to have insurance and suffer more chronic illness.  And the doctor shortage has gotten harder to deal with.  In response, care is changing.  Services like mental health counseling are delivered via teleconference.  Clinics and hospitals are consolidating.  ‘Mid-level’ practitioners like paramedics and dental therapists are starting to play new roles.”

Why Aren’t Physicians Paid For Talking To Their Patients?

Tuesday, July 5th, 2011

One possible reason that more physicians do not choose family practice as their specialty could be the fact that an essential part of the job is spent talking with patients – an activity that pays less than does performing procedures.   According to a recent study published by the Journal of the American Medical Association, just two percent of medical students plan a career in general internal medicine, pediatrics or ob/gyn.

Writing on the KevinMD.com website, Jennifer Adaeze Anyaegbunam says that “Family doctors spend more time talking to patients than performing procedures, but these doctors don’t get paid much to chat.  According to Dr. Sameer Badlani, a professor at the University of Chicago School of Medicine, when physicians are paid on a fee-for-service basis, specialists have the opportunity to make four to five times as much as a family physician.  Given the increasing debt of medical students, it is no surprise that the overwhelming majority choose to specialize.  In order to increase the supply of primary-care providers and meet the anticipated demand, family physicians need to be reimbursed more for their services.  Congress is looking into legislation that includes provisions for loan forgiveness and increased Medicare/Medicaid payments to primary-care providers.  Additionally, there have been talks of expanding the National Health Service Corps, program that utilizes scholarships and loan repayment to recruit primary care professionals to work in underserved areas.”

Primary-care physicians spend more time talking to patients and helping them avoid health crises to cope with chronic and incurable diseases than they spend performing tests and procedures. These doctors ask relevant questions, about health and life circumstances, and listen carefully to their patients.  These are physicians who know their patients and the circumstances and beliefs that can make health problems worse or hamper effective treatment.  The problem is that reimbursements are dictated by Medicare and other insurers.  As a result, physicians are not compensated well for taking the time to talk to patients.  They are primarily paid for procedures – such as blood tests and surgery — and for the number of patients they see.  Most spend long hours doing paperwork and negotiating treatment options with insurers.  The payments they receive have not increased along with increases in the costs of running a modern medical practice.  To earn a reasonable income of $150,000 a year, many primary-care doctors squeeze more and more patients into the workday.  “If you have only six to eight minutes per patient, which is the average under managed care, you’re forced to concentrate on the acute problem and ignore all the rest,” said Dr. Byron M. Thomashow, medical director of the Center for Chest Diseases at New York-Presbyterian Columbia Medical Center.  In a study of more than 3,000 patients with chronic obstructive pulmonary disease, 50 to 60 percent had one or more other illnesses, and 20 percent had more than 11 other conditions that required medical attention.  “There just isn’t the time to address them all,” Thomashow said.

Dr. Alan J. Stein, an infectious disease specialist in private practice in Brooklyn who treats many patients with HIV, described his practice as “heavily cognitive.  I spend a lot of time talking to patients — listening to them, examining them, interpreting tests and figuring out what’s wrong,” he said.  “I don’t do procedures in the office.  Over the last 10 or 15 years, the income of procedure-based physicians like cardiologists has increased significantly, whereas for those in primary care it has remained the same.”

Despite this, many physicians are reluctant to talk to their patients via e-mail.  Suzanne Kreuziger, a Milwaukee registered nurse, said.  “It makes sense to me to have the words laid out, to be able to re-read, to go back to it at a convenient time,  If I were able to ask my physician questions this way, it would make my own health care much easier.”  Her experience is shared by the majority of Americans: They want the convenience of e-mail for non-urgent medical issues, but fewer than 33 percent of doctors use e-mail to communicate with patients, according to surveys.

“People are able to file their taxes online, buy and sell household goods, and manage their financial accounts,” said Susannah Fox of the Pew Internet & American Life Project.  “The health care industry seems to be lagging behind other industries.”  Physicians have good reasons for avoiding e-mail exchanges with their patients.  Some are concerned that it will increase their workload.  Others worry about hackers compromising patient privacy.

Stimulus Bill Boosts Healthcare for the Uninsured and Underserved

Thursday, July 2nd, 2009

Tucked into the Obama Administration’s stimulus bill is $200 million to support student loan repayments for primary-care physicians, dentists and mental health specialists who devote two years to working at National Health Service Corps sites.  Approximately 3,300 awards are being made to individuals serving in health centers, rural health clinics and healthcare facilities that treat the uninsured and people living in under served areas.23285

Department of Health and Human Services Secretary Kathleen Sebelius, notes that the American Recovery and Reinvestment Act “has laid the foundation for health reform and is supporting our effort to give more people access to the quality, affordable healthcare they need.  National Health Service Corps has helped protect the health and well-being of millions of Americans.  Now, we are doubling the Corps and putting doctors and clinicians in the communities where they are desperately needed.”

The additional funding should double the number of corps members “and the number of patients they care for, and spark economic growth in communities hard hit by the economic turndown,” according to Mary Wakefield, administrator of the Health Resources and Services Administration, which manages the corps.