Clinician Recruitment and Service

National Health Service Corps

Notes:
*   This long-term measure does not have annual targets.
a   DNA = Data Not Available.  Retention data was not available in FY 2004 and FY 2005 due to incomplete data collection.  The program has reformatted the survey to reduce ambiguity.
b   DNA = Data Not Available.  Retention data will not be available for FY 2007 due to incomplete data collection by contractor and contract expiration.

INTRODUCTION

The statutory purpose of the National Health Service Corps (NHSC) is to eliminate “…health manpower shortages in health professional shortage areas,” (Section 331(a)(1) of the Public Health Service Act [42 USC 254d]).  The performance measures gauge the NHSC’s contribution to the HRSA strategic goals of improving access to health care and improving the health care systems through the recruitment and retention of NHSC clinicians.

Most of these measures are dependent on the size of the Field Strength (4.I.C.2.).  The larger the Field Strength, the greater number of people served, and the pool of clinicians who fulfill the service commitment to be potentially retained increases.  Also, as the NHSC has been able to shift more funding to the NHSC Loan Repayment Program (LRP), the cost per patient encounter decreases.  In managing performance, the NHSC uses these data to inform policy decisions regarding distribution of Recruitment Line funding between the Scholarship and Loan repayment Programs.  Another strategy used by the program is to target sites that need recruitment and retention technical assistance.  The NHSC constantly evaluates its options regarding distribution of funds between the programs and the size and/or duration of awards and contracts.

DISCUSSION OF RESULTS AND TARGETS

Long-Term Objective:  Improve the distribution of health professionals in underserved areas.

4.I.C.1.  Number of individuals served through the placement and retention of NHSC clinicians.

The FY 2001 baseline of individuals served is 4.44 million.  The FY 2006 estimate was 4.47 million, and the FY 2007 estimate of 3.88 million exceeds the target by 2 percent, and is a function of an increased number of clinicians retained out of the increased number of loan repayers recruited in previous years, as well as a larger-than-expected Field Strength.  These encounters are adjusted for both type of site and by primary care, dental, and mental and behavioral health disciplines, and include patients seen by NHSC alumni in their first year post completion of the service commitment.  The projected decreases through the FY 2009 target of 3.39 million reflect the decreasing number of vacancies filled by new NHSC loan repayers as the number of loan repayment amendments (extensions on existing loan repayment contracts for an additional year) is projected to increase, leading to the decline in the Field Strength described below.

4.1.  Number of individuals served in all communities seeking NHSC assistance through NHSC placement, retention and other sources.
(Baseline - 5.9 M)

4.I.C.2.  Field strength of the National Health Service Corps through scholarship and loan repayment agreements.

In FY 2007, NHSC Field Strength was 3,820, which is 3 percent over the target.  This decrease from the FY 2005 level (4,602, the largest Field Strength in the history of the NHSC) was anticipated, due to large numbers of loan repayers have fulfilled the service commitment and are no longer counted in the Field Strength.  This trend is expected to continue through FY 2009 for the reason noted in 4.I.C.1 above, at which point the number of new loan repayment contracts and amendments will achieve a balance, and the Field Strength will stabilize at the FY 2009 target of 3,466. 

4.I.C.4.  Percent of NHSC clinicians retained in service to the underserved.

Retention of NHSC clinicians preserves access to care for the underserved beyond the period of service commitment.  The NHSC measures retention at one year after fulfillment of the service commitment.  Retention data was not available in FY 2004 and 05 due to incomplete data collection, resulting in too small a sample to be considered representative.  Retention data was not available in FY 2007 due to incomplete data collection, the Recruitment, Training, and Support Center (RTSC) contract expiration, and a six month gap before a new contract was finalized with a new contractor.  Collection of retention data is required under the new contract and mechanisms are in place to monitor performance more closely.

4.I.C.3.  Number of NHSC-list vacancies filled through all sources.

In FY 2007, 1,376 vacancies were filled, which is 21 percent below the target.  This is due to a decrease in the number of vacancies filled by non-NHSC clinicians. (See section below on “Targets Substantially Exceeded or Not Met.”)  In 2003, the program shifted the proportion of recruitment line budget to loan repayment.  As a result, an unusually large number of new loan repayment awards were made that year.  The rise and fall in the target numbers from FY 2005 through FY 2009 reflect the cyclical nature of the NHSC Loan Repayment Program: as the number of loan repayment amendments (extensions on existing contracts) increases, the number of new contracts falls, resulting in fewer total vacancies filled from all sources.  The target for FY 2009 is 2,200.

4.I.C.5.  Average HPSA score of the sites receiving NHSC clinicians, as a proxy for service to communities of greatest need.

The HPSA score is a proxy measure for the degree of need for health professionals in an area.  Scores range from 1 to 25, with 25 representing the greatest need.  Increasing the average HPSA score of site vacancies filled through NHSC assistance indicates success in targeting vacancies of greatest need.  The FY 2007 actual average score was 13.7, which equaled the average score of FY 2006 and exceeded the target by 3 percent.  This is a function of the fact that the program did not award all qualified loan repayment applications in 2007 (as was the case in FY 2006):  no loan repayment contracts were awarded to a clinician working at a facility with a HPSA score below 8, resulting in a higher average score.  The FY 2009 target is 13.8 which represents the projection of a relatively stable Field Strength.

4.E.  Maintain or decrease the average cost to the NHSC program of a patient encounter.

This average cost of patient encounter is the benchmark of management efficiency which the NHSC will track over time.  The measure tracks how well the Program can maintain or even lower this cost regardless of changes in annual appropriations and the resulting fluctuation of the Field Strength from year to year.  The estimated cost of an encounter in FY 2007 is 8 percent below the target and reflects a significant decrease from the previous year’s actuals (FY 2006 and 2005).  This may be due to the increased percentage of NHSC loan repayers and state loan repayers (vs. scholars) in the field strength who serve at a lower annual cost to the program than scholars.  As the program continues to gather data to track this measure and gain more experience, it is believed that future targets will be estimated more accurately.  The FY 2009 target is $4.15.

TARGETS SUBSTANTIALLY EXCEEDED OR NOT MET

Measure:  Increase the number of NHSC-list vacancies filled through all sources.

FY 2007 Target:  1,746
FY 2007 Actual:  1,376

In FY 2007, 1,376 vacancies were filled, which is 21 percent below the target.  This is due to a decrease in the number of vacancies filled by non-NHSC clinicians.  Targets are based on the number of projected new loan repayment awards, the number of new scholars beginning service, and the assumption that an equal number of non-NHSC clinicians will fill NHSC-listed vacancies.  This last assumption proved to be incorrect in 2007, for reasons that are not clear, as the program has no direct contact with the non-obligated clinicians who fill these positions.  This could a result of the fact that the NHSC Jobs Opportunity List website was not available.  The NHSC temporarily replaced the list with an Excel spreadsheet, which some may have found less user-friendly.  NHSC has since replaced the list with a searchable web-based portal.