Remarks to the National Health Service Corps’ Ambassadors Conference

by HRSA Administrator Elizabeth M. Duke

July 25, 2008
Phoenix, Arizona

Yes, you heard that right: 20 million!

I don’t know how we would have done it without you. As we raced to complete the biggest expansion in our community health center system in its 40-year history, it must have seemed that our unofficial motto at the Health Resources and Services Administration had become, “More! More! More!”

More doctors, more nurses, more dentists, more mental health professionals – more support staff -- and it was you, our Ambassadors, who came through for us.

Were it not for your recruitment efforts, your on-campus testimonials to young students and recent graduates, and your success at convincing them that public health is a noble calling, this modern miracle called the Health Center Expansion Initiative would have been difficult to move beyond an ideal.

But we did move it, together. Oh, did we move it!

In a minute, I’ll tell you how far we’ve come – and where we’re going. But first, I want to thank a few people whom some of you have known for a long time from your years in the National Health Service Corps Ambassador Program.

I also see a lot of new faces in the room today – as 255 new Ambassadors joined us this year, bringing our compliment of volunteer healthcare recruiters and mentors to almost 1,100 for the first time in the history of the program.

So introductions are in order all the way around. If I don’t get to meet each of you individually today, let me say now—Thank you!

Here are a few more folks you’ll want to get to know…

Rick Smith is the Director of the National Health Service Corps, and the Associate Administrator of our newest HRSA bureau – the Bureau of Clinician Recruitment and Services. For the first time, we now have a freestanding shop within the agency to oversee our six major scholarship and loan repayment programs. Think of this as HRSA’s employment agency and placement firm. I’ll be telling you more about Rick and the great work his people do in a moment.

Mark Pincus is the Director of the Division of Site and Clinician Recruitment. We stole him from a successful tenure leading one of our programs.

CDR Jeanean Willis-Marsh is our new Director of State and Community Initiatives – which includes 3 efforts that are near and dear to my heart: the Ambassadors, Ready Responders and J-1 Visa Waiver Programs. So Jeanean is coming along at an especially exciting time.

Diane Culkin is our new Ambassador Program Manager, and she knows her business. She has been with the NHSC for the past seven years as an analyst working full-time with our scholarship program. Diane will be your main point-of-contact, we hope for many years to come.

I want to thank Rick, Mark, Jeanean and Diane for getting us all together, and for organizing the great slate of speakers we have for you in the next couple of days.

We have seven different bureaus at HRSA and 14 different offices, performing a variety of different functions in support of public health. But at the beginning and end of every day, one of our main tasks is to put doctors, dentists and nurses where they are needed most.

In the past 36 years, HRSA has placed more than 28,000 clinicians in some of the nation’s poorest and most geographically isolated communities. And a lot of those fine people were guided to us by Ambassadors. Many of them are still with us today. You’ll be hearing a lot more from some of these people in our breakout sessions and panels.

Some of the first questions I hear from new Ambassadors are, “Well, Dr. Duke, what’s it like? What do you want me to do? How can I make a difference?”

In the room with us today are Ambassadors who can answer those questions best. I want to take a moment to introduce you to a just a couple of them:

Dr. Joseph Zanga is an Asst. Dean at East Carolina University Brody School of Medicine who joined us in 2004 – and the things he has done to get out the word about the National Health Service Corps among his students are just amazing. We love it when our Ambassadors take the hands-on approach, and Dr. Zanga does just that. He sets up clinical rotations for his students in local HRSA-funded health centers, and links them with practicing doctors and nurses so they can “shadow” the on-site professionals as they interact with patients in some of the most medically underserved communities in the state.

You’ll hear us “talk” a lot about how personally fulfilling it is to work among the millions of people in this country who do not have access to even basic health care. But seeing the gratitude on the faces of those patients is often a life-changing experience for a young intern trying to decide on a career course. Thank you, Joe!

Mary Amundson is an Assistant Professor at the University of North Dakota Center For Rural Health. She has been a relentless organizer and advocate for rural health services for more than 30 years. She has served on advisory panels across the western frontier, acting as a consultant to HRSA and HHS, and regularly convenes group information sessions for students interested in ways of financing their educations. Mary has made it a point to know our loan programs inside and out, and has testified before Congress on the J-1 Visa Program.

More to the point, Mary Amundson walks her talk.

A major emphasis for us at HRSA is identifying scholarship candidates and graduate repayors who actually grew up in and around medically underserved communities. We know these are the people most likely to continue to practice in those areas after their loan obligations have been satisfied. Mary not only is a lifelong North Dakotan, she grew up on a farm and still tends a flock of 120 sheep with her husband, Bob. She began her career in social services in Larimore decades ago and has continued to serve the people of her home state ever since. Talk about a role model! Thanks, Mary!

You meet the most interesting people in the Ambassador Program, don’t you?

That’s really what being an Ambassador is all about. It’s a community of committed and accomplished professionals who know their own hearts and minds. Ambassadors are people of conscience reaching out to the next generation of frontline health professionals and bringing them into the HRSA family.

But we shouldn’t kid ourselves about the enormity of the task before us, which is why we are so happy (relieved might be a better word) that so many of you answered our call in Memphis last year when we set out to expand the Ambassador corps by 20 percent. Where, we wondered, would we find 250 new Ambassadors? Well, 255 of you found us, helping us get well beyond our goal.

Words can barely express how grateful we are for your help and caring.

I’m going to talk now for a few minutes about the distance we’ve come since 2002, when the President announced his Health Center Expansion Initiative, and the distance we have yet to travel.

Just six short years after the President charged us with carrying out one of the most ambitious experiments in the recent history of American Public Health, we have extended our reach with some 6,000 delivery sites and almost 250 mobile clinics. We are, literally, beating the bushes to bring medical services to people who had all but given up hope of ever seeing a doctor.

With the expansion in the number of HRSA-funded clinics, we are reaching more economically vulnerable and geographically isolated Americans than ever before – up from 10 million patients in 2001 to 16 million today!

By last year, we had vastly increased the number of dental patients served in our clinics to 2.8 million. Think about that for a moment. Think about what it might mean to a child growing up on a farm or a ranch in a frontier state – where we know only 1 person in 11 has ever seen a dentist in their lifetime. I’ll be talking more about this in a moment.

We also increased the number of patients who received mental health or substance abuse counseling to 613,000 since the President’s Initiative took hold. And with telemedicine hub sites sprouting up all over now, more patients than ever can finally get to tell their story to a mental health professional.

Finally – and here’s the real miracle – our Bureau of Primary Health Care now reports that HRSA-supported grantees added 3,200 physicians to their staffs and more than 2,000 nurse practitioners, physician assistants and certified nurse-midwives. Our CHCs now support a total full-time work force of nearly 13,000 frontline primary care professionals.

This initiative has been a triumph for all of us, and it’s about to get even bigger.

In the days ahead, you’re going to be hearing a lot more about the President’s latest round of funding increases to continue the expansion of the community health system. We’re going to be adding 40 more primary care clinics next year, for example.

Nearest and dearest to my heart, we are hopeful that we’ll be receiving an additional $11 million to leverage the student loans of 200 more dentists and hygienists – on top of the 700-plus we already have. The President has already requested it, and we are getting positive responses so far from the Congressional budget staffs, so it seems far more likely than not that we’ll be getting those oral health dollars.

This has not just been a policy goal of ours at HRSA, it has been a personal crusade of mine for the past several years to address the historic absence of dental care in our Health Professional Shortage Areas.

We hear a lot of statistics in our line of work, and I have to admit that they often fly past my eyes in a blur. But some of them just make me so heartsick I can’t get them out of my head.

Think about this one, folks: a recently completed study of young recruits to our nation’s armed forces found that four out of 10 had untreated childhood dental conditions so severe that they couldn’t serve until they got their teeth fixed. Among these soldiers and sailors in basic training, 15 percent had four or more teeth in urgent need of repair, extraction or other treatment.

It doesn’t take much to imagine what their lives must have been like for all those years without access to a dentist – and I believe we have a moral duty to do something about that.

Today, nearly 3 out of 4 HRSA-funded clinics offer dental care -- and we’ve moved way beyond basic “drill-and-fill” work over the past six years. The young dentist who comes to us today will find 750 clinics fully equipped for restoration and emergency dentistry. And we’ve more than doubled the number that can perform rehabilitative work.

So behind all of these impressive expansion numbers, you can see that we’ve also added practice incentives for our oral health professionals.

Put simply, we’ve made it possible for them to do more stuff. And I can’t think of too many other things we’ve done at HRSA that have had a more immediate and lasting affect on peoples’ lives – because it’s hard to enjoy life much at all when your teeth hurt.

Primary Health Care doesn’t get anymore “primary” than the smiles on our children’s faces.

Now, as you no doubt have been expecting, here’s the hard part – the place where you come in. The mission, should you decide to accept it, is daunting.

I hope nobody told you that being an Ambassador would be easy!

On the one hand, we have succeeded over the past six years in pulling off one of the largest expansions of the nation’s frontline public health system in history. In the year the community health centers were first launched, Lyndon Johnson was the president, the Sound of Music was playing in theaters and Frank Sinatra was still on the pop charts.

In other words, this expansion was a looooong time coming.

It was 36 years before the program finally received the sustained support of both the President and Congress. All of the stars had to align to get us where we are today -- and we are about to take another important step forward in the coming year.

The challenge we face, friends, is that we desperately need people to staff these clinics if we are going to make these gains a permanent legacy for future generations.

But we’ll be searching for those new doctors, dentists, nurses, technicians, assistants and allied health professionals in one of the tightest labor markets in modern memory. Further, when you consider that upwards of a third of the workforce in many medical specialties is now over 50 years of age, you can see that time is not on our side.

The NHSC job opportunities list currently has nearly 6,000 clinical vacancies nationwide. These are immediate openings that they have not been able to fill.

Lately, you’ve been hearing a lot about the nursing shortage. This is truly worrisome.

Not only are we projecting a shortage of one million nurses by 2020, the average age of the current nursing workforce (46.8) is at its highest level since we started keeping track of it way back in 1980. As these people start approaching retirement, we’ll be losing not only senior clinical managers, but also our most experienced nursing instructors.

In other words, we’re getting hit at both ends.

There is no lack of qualified nursing candidates in this country. Last year at HRSA, we had 32 applicants for every available academic contract we were able to award. The President just authorized a 30 percent increase in those funds, but there is an acute admissions logjam at the nation’s nursing schools because of insufficient numbers of faculty.

So, you see, the challenge is enormous -- all the more so when you consider the skyrocketing cost of tuition.

For example, a typical dental student today graduates with about as much academic debt as an M.D. And these young men and women are being heavily recruited by private providers offering salary and incentive packages worth twice what most of our community health centers can hope to pay.

Thus, we have a dilemma – and an historic opportunity.

The people we are most interested in attracting and supporting with scholarships and loan repayments are people just like you. We need people who are moved to civic involvement as clinicians, educators and community-based administrators because they heard a larger calling at some point in their professional lives. As National Health Service Corps Ambassadors, you are uniquely positioned as mentors, advisors and teachers to convey that noble calling to the altruistic young people you come into contact with.

I have asked Associate Administrators Marcia Brand, Jim Macrae and Rick Smith to work together for the next few months on setting an agenda for a Health Care Workforce Summit later this year. We hope to see some of you there.

Over the next few days, Rick and his people will be telling you in much greater detail about how we’re tailoring our scholarship and loan payback programs to make them easier to access and more attractive. But I want to highlight one pilot program we’ll be launching soon that we think has tremendous promise – and we want your advice on it.

As we are seeing, all of the best evidence now suggests that the very culture of health care professionals is changing – and we need to change with it.

There are more women in the field, for one thing, and they simply are not willing to give up completely on having stable family lives while they pursue their careers. There are also more middle-aged doctors looking to wind down their practices and enjoy the fruits of their labors. And there is less tolerance among the next generation of specialists for the all-consuming workstyle that once prevailed in medicine.

In other words, they want to have lives…Imagine that!

One answer would be to let these doctors and dentists work less than full-time hours in a community health center, while paying down any lingering education debt they may have through a HRSA grant. We think this makes sense, and we’ll be exploring the establishment of a demonstration project for Part-Time Service in the coming year.

Please do help us spread the word about this project among your friends and colleagues.

We are living in interesting times in public health, folks, with the ability to literally shape the future and set new precedents. The needs are critical, which has brought us the full attention of the President and the Congress. So this is one of those rare moments that we prepare for all our lives -- when we get to hold tomorrow in the palm of our hands.

With your help, Ambassadors, we are confident we can make it better for the millions of Americans living on the fringes of the mainstream health care system.

With your help, we hope to make this “ideal” a permanent reality.

Thank you.

Go to:  News Room | HRSA | HHS | Privacy Policy | Disclaimers | Accessibility | FOIA | Search | Questions?