A program intended to lure and retain high-caliber medical workers to community health centers received a big shot in the arm last month. The Obama administration poured $290 million into a new round of funding for National Health Service Corps, which repays the college loans of doctors, dentists and nurses who sign up to work in underserved neighborhoods — like Dorchester and Mattapan.
The program has been around in different forms for decades and is already a proven tool for local health center directors. This latest boost is intended to triple the federal corps’ ranks and support more than 16,000 new primary care professionals by 2015.
Ed Grimes, who runs the Uphams Corner Health Center, says the federal funds have helped to attract talented staff to his arsenal for almost 20 years. An earlier incarnation of the service corps covered both salary and loan repayment. The current program just repays loans, but it covers up to $60,000 over a two year contract. Plus, the present program is more flexible: Participants get to select their place of employment first — and then seek loan assistance once they are hired in an eligible community.
“It’s a tremendous asset,” said Grimes. “We are in desperate need of physicians and dentists and it’s a meeting of a common need. We have a need to serve residents of our respective communities and they need to get some relief on their debt. It’s a marriage of common interest.”
And the long-term payoff for places like Uphams Corner can be quite dramatic. Grimes estimates that at least 30-40 percent of the staff lured in through the federal loan repayment program stay on after their commitment is complete.
Roberto Beltran, a 32 year-old nurse at the Uphams Corner Health Center, is a good example. Beltran works as the clinical coordinator for Uphams’ Senior Care Options and in the health center’s urgent care department. He grew up in Belmont and was eager to serve in a community like Dorchester, with a heavily immigrant client base.
After working his way through school at Boston University and Regis College as an EMT, he was hired at Uphams in 2007. Beltran contracted with the National Health Service Corps, which repaid $50,000 in his student loans for his first two years of work at Uphams. He then signed onto a third year which has covered an additional $35,000 in loans. He expects to sign a one-year contract extension this year that will completely pay off his school loans.
“The good thing is it helps you through the tough years, that transition from school to a job,” says Beltran. “It gives you an extra foundation and after four or five years into your career you establish yourself at that clinic.”
Beltran says he expects to continue his career at Uphams well into the future.
“I do not see myself leaving,” Beltran told the Reporter. “The clinicians here are amazing. The amount of learning I’ve done with this population, I don’t think I could have learned this much somewhere else.
“I really don’t know how I would have done it without this program,” Beltran says. “It’s a struggle between what you want to do and what you have to do. I’d rather work with people who really need the help than work at a private facility.”
Bill Walczak, the president of Carney Hospital, made heavy use of the service corps during his thirty year stint as executive director of the Codman Square Health Center. He says that some community health centers would not have any medical providers if it were not for the federal corps.
“This is because the health care system’s financial orientation is toward specialty care,” Walczak explains. “As a result, because of the large debt incurred by medical students for medical school, overwhelmingly medical students go toward specialty care. In fact, in one recent study, fewer that 2 percent of medical students indicated that they would pursue careers in primary care.”
This imbalance, Walczak says, is clearly not sustainable, and represents a major flaw in the U.S. system. Most developed countries have a more even split between primary care and specialists. This is why the Obama administration is investing so heavily into the loan repayment plan, he says.
“Unless the medical care system re-orients its financial incentives for physicians, the country will literally run out of primary care doctors,” Walczak said. “Since most health centers serve poor populations, and wages tend to be lower, without the NHSC it would be very difficult to staff health centers with physicians. The loan repayment programs therefore are a godsend, and essential for promoting primary care among medical students and residents.”
The NHSC is not the only avenue that qualified medical professionals can use to ease their debt load. The Massachusetts League of Community Health Centers — or Mass League — manages its own loan repayment program for providers who commit to working at one of the state’s 52 health centers. To date, the Mass League’s loan repayment program has funded 127 professionals, including 78 doctors and 39 nurse practitioners. Each applicant can receive up to $25,000 a year for a maximum of three years through the program. It is funded by private donors, including Neighborhood Health Plan, Blue Cross and Blue Shield Foundation of Massachusetts, Bank of America and Partners HealthCare. The program received a major boost in January when Robert and Myra Kraft, owners of the New England Patriots, committed $20 million to fund loans and grants for providers who go on to work at the state’s health centers.
“We’re hopeful that the Kraft program will enable us to expand into a broader mission,” said Jim Hunt, II, the president and CEO of the Mass League. “It’s a major step forward to helping us recruit and retain talented providers. Rather than being assigned, people are being recruited and it’s a big difference in keeping them committed to a community over the long haul.”