Clinician Recruitment and Service
National Health Service Corps
Legislation: Sections 338A, B, and I of the Public
Health Service Act
Awards to Individuals
Description and Accomplishments
The National Health Service Corps (NHSC) assists Health
Professional Shortage Areas (HPSAs) in every State,
Territory, and Possession of the United States to
meet their primary care, oral, and mental health services
needs. Over its 37-year history, the NHSC has offered
recruitment incentives, in the form of scholarship
and loan repayment support to more than 28,000 health
professionals committed to service to the underserved.
NHSC clinicians have expanded access to high quality
health services and improved the health of underserved
The NHSC has, since its inception in 1972, worked
closely with the federally-funded Health Centers to
help meet their clinician needs. Currently, approximately
50 percent of the NHSC clinicians serve in Health
Centers around the Nation. The NHSC also places clinicians
in other community-based systems of care that serve
underserved populations, targeting HPSAs of greatest
The NHSC Scholarship Program awards scholarships to
health professions students committed to a career
in primary care and service in underserved communities
of greatest need. Awards are targeted to individuals
who demonstrate characteristics that are significantly
related to a probable success in a career of service
to the underserved. The Scholarship Program provides
a predictable supply of clinicians who will be available
over the next 1 to 8 years, depending on the length
of their training programs. Upon completion of training,
NHSC scholars become salaried employees of organized
systems of care in underserved communities.
The NHSC Loan Repayment Program offers fully trained
primary care clinicians the opportunity to receive
assistance to pay off qualifying educational loans
in exchange for service in a HPSA of greatest need.
This service commitment is for a minimum of two years
in an underserved community. The loan repayment program
recruits clinicians as they complete training and
are immediately available for service, as well as
seasoned professionals seeking an opportunity to serve
the Nation’s most vulnerable populations.
The combination of these two programs allows flexibility
in meeting the future needs (through scholars) and
the immediate needs (through loan repayers) of underserved
communities in the following ways:
In FY 2006:
NHSC Field Strength By Program / by Discipline
(as of 09/30/06)
= Scholarship Program participants
LRP = Loan Repayment Program participants
RR = Ready Responders
SLRP = State Loan Repayment participants
CSP = Community Scholarship participants (demonstration
project defunded in FY 1999)
MD/DO = Allopathic/Osteopathic physicians
DD = Dentists
DH = Dental Hygienists
NP = Nurse Practitioners
PA = Physician Assistants
NM = Nurse Midwives
M&BH = Mental and Behavioral Health professionals
DC = Doctors of Chiropractic (Demonstration Project)
The NHSC had 4,109 clinicians in service to the
underserved, which was 99 percent of the target
NHSC clinicians provided primary care services to
approximately 4.47 million people, exceeding the
target of 4.1 million by 9 percent.
percent of clinicians retained in service was 76
percent, which was 96 percent of the target. (Retention
is measured at one year after fulfillment of service
NHSC Jobs Opportunity List showed a total of 8,032
vacancies nationwide; of these, 1,141 were filled
by NHSC clinicians, and 1,525 were filled by other,
non-NHSC clinicians, totaling 2,662, exceeding the
target of 2,200 by 21 percent.
In FY 2007:
NHSC Scholarship Program made 113 new awards; 225
scholars were placed in service.
The NHSC Loan Repayment Program placed 899 clinicians
in service through new loan repayment contracts.
In FY 2008:
The NHSC Jobs Opportunity List showed a total of
4,888 vacancies nationwide; of these, 2,704 (55
percent) are located in health centers.
NHSC Scholarship Program is projected to make 84
new awards; there are 878 scholars in school or
NHSC Loan Repayment Program is projected to make 646
new awards. The NHSC had a Program Assessment Rating
Tool (PART) review in 2002, and received a Moderately
Effective rating. This assessment found that the NHSC
had a clear purpose and was designed to have a unique
and significant impact; that the program ensures clinicians
honor their service agreements, uses information to
improve outcomes, and had shown some efficiency improvements.
The review noted that efficiency could be improved
with greater flexibility in allocating funds between
scholarships and loan repayments.
In response to this review, the NHSC has in recent
years better targeted NHSC placements in HPSAs of
greatest need: in 2006 placing 1,141 NHSC clinicians
in sites with an average HPSA score of 13.7, a score
which improved on the previous year and exceeded the
target. (The HPSA score is a proxy for the degree
of need for health professionals in an area. Scores
range from 1 to 25, with 25 representing the greatest
need.) The program has recruited increasing numbers
of minorities: 42 new scholars and 245 new loan repayers
in 2007 identified themselves as racial/ethnic minorities.
The program has been as flexible as possible under
the current law to allocate more funds to loan repayers
to meet more of the immediate need in underserved
communities, and is endeavoring to replace its legacy
information system to further increase management
Funding includes costs associated with grant reviews,
processing of grants through the Grants Administration
Tracking and Evaluation System (GATES) and HRSA’s
electronic handbook, and follow-up performance reviews.
The FY 2009 Request of $120,959,000 is a decrease
of $2,518,000 below the FY 2008 Enacted level. The
$11,489,000 increase in the Recruitment Line, which
supports the NHSC Scholarship and Loan Repayment Programs,
and the State Loan Repayment Program,* will focus
on the recruitment of dentists into the NHSC: $1,000,000
of this additional funding will support four new dental
student scholars who will be available to serve in
future years as they complete their training. This
is in addition to the 84 scholars projected to be
supported by the baseline funding. The remaining $10,489,000
will support new loan repayment contracts for 210
dentists over and above the 716 new loan repayment
contracts that are projected to be made in this year.
This will add a total of 926 clinicians to the NHSC
Field Strength immediately. The $14,007,000 decrease
in the Field Line, which funds the salaries of the
NHSC staff and Ready Responders, as well as the grants
and contracts that support the programs’ recruitment
and retention efforts and the administrative costs
of the NHSC, is a reflection of the increased efficiencies
and economies of scale experienced by the Bureau of
Clinician Recruitment and Service (BCRS) as the procedures
of the NHSC Scholarship and Loan Repayment Programs
are integrated with the other scholarship and loan
repayment programs within BCRS.
The NHSC will increase its recruitment activities
to disseminate awareness of the program’s new
focus on oral health in order to increase the number
of dentists interested in participating in the NHSC
Loan Repayment Program. Additionally, the NHSC will
increase its outreach to underserved communities and
offer technical assistance to enable them to complete
the process of becoming designated as dental HPSAs
and to post dental vacancies with the NHSC.
This focus on oral health is an effort to address
a well-documented need. According to a 2000 Surgeon
General Report, dental caries is the single most common
childhood chronic disease. Every year 30,000 elderly
Americans are diagnosed with oral cancer; lower income
populations are disproportionately affected and less
likely to receive treatment. As of March 2007 more
than 9,000 dentists would be needed to reach the target
ratio of one dentist for every 3,000 people in dental
HPSAs nationwide. In 2006, the NHSC filled 340 of
782 dental vacancies; in 2007 the NHSC posted 500
As a significant source of highly qualified, culturally
competent clinicians for the Health Center Program,
as well as other safety net providers, the NHSC can
build on its success in assuring access to residents
of HPSAs, removing barriers to care and improving
the quality of care to these underserved populations.
The NHSC Program is working with many communities
in partnership with State, local, and national organizations
to help address their health care needs.
* The State Loan Repayment Program is a dollar-for-dollar
match between the NHSC and the State to provide loan
repayment to clinicians to work in that State. The
program is administered by the Bureau of Clinician
Recruitment & Service (BCRS).
Funding in FY 2009 for the NHSC Programs will support
efforts to work with Health Centers and other community-based
systems of care to improve the quality of care provided
and reduce the health disparities gap. As measurement
of these efforts:
In FY 2009:
The NHSC Field Strength is projected to be 3,466.
number of individuals served is expected to meet
the target of 3.39 million people.
The number of vacancies filled by all sources is
expected to exceed the 2,200 target.
average HPSA score of 13.6 for sites receiving NHSC
clinicians is expected to be met.
The decrease in the NHSC Field Strength from 4,109
in FY 2006 to 3,466 in FY 2009 is the result of two
separate but interrelated factors. The first is that
the NHSC awarded more than 3,000 new two-year loan
repayment contracts in the years 2003 – 2005.
The second is that as many of these clinicians apply
for amendments for their 3rd, 4th, and 5th year of
service, there is less funding for new contracts.
While the clinicians with amendments remain in the
Field Strength, the number of new clinicians starting
service is smaller than the number of clinicians who
fulfill the service commitment and are no longer counted
in the Field Strength, causing the projected decrease.
With the additional funding requested, it is anticipated
that the NHSC Field Strength will stabilize around
the FY 2009 number.
Objective: Improve the distribution of health
professionals in underserved areas
the number of individuals served through the placement
and retention of NHSC (Baseline-2001: 4.44 M)
20% over baseline
the number of individuals served in all communities
seeking NHSC assistance through NHSC placement,
retention and other sources (Baseline: 5.9 M)
the field strength of the NHSC through scholarship
and loan repayment agreements
the percent of NHSC clinicians retained in service
to the underserved
2008 Target/ Est.
2009 Target/ Est.
Target / Est. Out-
Objective: Improve the distribution of health
professionals in underserved areas
the number of NHSC-list vacancies filled through
the average HPSA score of the sites receiving
NHSC clinicians, as a proxy for service to communities
of greatest need.
or decrease the average cost to the NHSC program
of a patient encounter
Amount ($ Million)
targeted field strength for FY 2007 may differ
from that shown in the NHSC waterfall table. Whereas
the waterfall table is continually updated, the
performance reporting guidelines do no permit
changing a previously established target for the
FY 2008 target differs from that shown in the
FY 2008 Congressional Justification, as this is
an updated estimate consistent with the NHSC waterfall
data was not available in FY 2004 and 2005 due
to incomplete data collection. The program has
reformatted the survey to reduce ambiguity, and
the retention figures for FY 2006 are expected
to be available in November 2007.
target is lower than latest result reported (2006),
reflecting an anticipated decrease in the number
of new loan repayment contracts, due to increased
amendments to previously awarded loan contracts.
1. Impact on NHSC Field Strength of FY 2009 Budget
1. Funding Distribution: 20% Scholarship/80% Loan
2. FED = USPHS Commissioned Corps Ready Responders