Remarks to the National Advisory Council
of the National Health Service Corps

Prepared Remarks of Elizabeth M. Duke, Ph.D.
Administrator, Health Resources and Services Administration

Rockville, Md. 
March 8, 2002

Good morning. It’s my pleasure to welcome you and thank you for your contribution to the work of the Department and HRSA. 

I am delighted that Dr. Susan Fleishman has agreed to serve as Acting Chair of this Committee. She is Director of Medical Services at the Venice Family Clinic in Venice, California.  And this clinic is the recipient of a HRSA Health Care for the Homeless grant. I know that each of you represents a part of the broad spectrum of the health care community.  This is the kind of collaboration we need to be successful – many interests and resources coming together to tackle health care access issues.

The work that you do has a profound impact on the way that HRSA and the Department do business.  Advisory councils allow us to receive information from the perspective of professionals -- people in the field -- on the front lines of our public health concern.  You provide us with insight and suggestions that we might otherwise miss.

As you know, HRSA’s mission is to improve the nation's health by ensuring access to comprehensive, culturally competent, quality health care for some of the country’s most vulnerable families and individuals. Your commitment helps us in this mission and complements President Bush and Secretary Thompson’s goal to ensure greater access to quality health care for all Americans.

The good news for us is that the President and Secretary are both passionate about the work of the National Health Service Corps and are determined to do all they can to give the Corps the resources needed to expand its outstanding service to the Nation. In fact, the National Health Service Corps and our Community Health Centers program are key parts of HHS' strategy to expand access to health-care for those most in need -- especially those in rural and inner-city communities.

To demonstrate this commitment, Secretary Thompson recently announced that the National Health Service Corps will offer a record $89.4 million in scholarship and loan repayments to doctors and other health professionals who serve in rural and inner-city areas that lack adequate access to care.

The increased resources -- almost $19 million more than last year -- will support 900 new and continuing loan repayment awards and 400 new and continuing scholarship awards. Awardees must agree to provide health care services for a minimum of two to four years in areas of the country with the greatest shortage of medical professionals. Applications must be postmarked by March 29.

The loan repayment program is open to a long list of medical professionals, among them physicians, nurses and dentists. The scholarship program is open to students enrolled or accepted for enrollment in accredited medical schools, family nurse practitioner programs, certified nurse-midwifery programs, physician assistant programs and dental schools.

Last year, the National Health Service Corps awarded a total of $70.8 million, including 677 new and continuing loan repayment awards and 363 new and continuing scholarships. Of the loan repayment award recipients, 60 percent work as primary health care providers, 21 percent work in behavioral health and 19 percent work in oral care. More than half the scholarship recipients were students studying to be physicians.

For fiscal year 2003, President Bush has proposed an additional 32 percent increase in the budget for the National Health Service Corps for a total of $192 million, an increase of $44 million. The additional resources will result in awards to about 1,800 physicians, dentists and other clinicians who practice in underserved areas.

The President's budget also requests $1.5 billion for community-based health centers, a $114 million increase that would continue the Bush administration's long-term strategy to add 1,200 new and expanded health center sites over five years and ultimately double the number of patients treated at them.

Early in his tenure, Secretary Thompson identified the nursing shortage as a critical national priority. We are pursuing several strategies to increase the number of professional nurses in America.  We must make this vocation attractive. It is a public service and a public need.

In  September, Secretary Thompson announced a new series of grants and contracts totaling more than $27.4 million to increase the number of qualified nurses and the quality of nursing services across the country.  The awards will help ease the emerging shortage of qualified nurses available to provide essential health care services in many communities nationwide.

In addition, President Bush’s fiscal year 2003 budget proposes a total of $15 million, nearly a 50 percent increase above last year’s funding, to expand the Nursing Education Loan Repayment program to help address the nation’s growing need for nursing professionals.  The increase will support 800 new nursing education loan repayment agreements.  The program repays a substantial portion of the education loans of nurses who agree to work for two years in designated public or nonprofit health facilities.

To highlight the critical need for more nurses, Secretary Thompson and Education Secretary Rod Paige recently visited a junior high school in Washington, D.C. to launch a national campaign to encourage school children to consider careers in nursing and other health professions.

At that time we released the “Kids into Health Careers” tool kit which has information on more than 270 health careers, including nurses, physical therapists, x-ray technicians, and emergency medical technicians. We are very excited about this innovative program and today each of you will receive one of these kits.

Secretary Thompson has also directed HRSA to play a leading role in his effort to expand health care services to rural America. This is a topic that he feels deeply about, as the son of a small town in rural Wisconsin and an ex-governor.  Last July, he named Department-wide task force to look at how HHS programs serve rural communities and explore ways to improve our service to rural America.  A draft report from the task force currently is being reviewed by staff in the Secretary’s office.

One of the goals included in the report is to improve access to health and social services in rural America.  We know from public comments we received that transportation is a critical issue in determining access to rural health care.  We know, too, that multiple program application and evaluation processes make it hard for rural organizations with limited resources and staff to take full advantage of funding opportunities.  And we realize there is great demand in rural areas for more oral and mental health care.  These issues and many more will be addressed by the task force and Secretary Thompson in coming weeks. 

Our telehealth program is also a vital and growing part of HRSA’s outreach efforts. The Secretary and I intend to ensure that telehealth consultation and distance-learning are not just innovative grant programs in their own right, but that they rapidly become vital parts of all HRSA services.  We want to ensure that the best care is available even in the most remote and difficult sites.

As you can see, President Bush and Secretary Thompson are determined to get as much of our money as they can into direct medical services for the people we serve.  To that end, I have been directed to take a number of internal changes to make sure we save money, streamline operations, and increase our efficient delivery of services. So I want to spend a little time this morning going over what we’ve done and why – and explain how these changes fit in with President Bush’s design for our future.

Last July we announced the transfer of the National Health Service Corps, the Division of Scholarship and Loan Repayment, and the Division of Shortage Designation from the Bureau of Primary Health Care to its sister entity within HRSA, the Bureau of Health Professions.  We made the change to improve internal efficiency and streamline duplicative operations, which are good reasons by themselves.  But we also made the change with an eye to the future.  As I said earlier, Community Health Centers and the Corps are at the heart of President Bush’s multi-year plan to expand health care services to America’s neediest citizens. To make the plan work, we need to make sure these programs are operating at peak performance.

We had two Presidential Initiatives in one Bureau---both very important programs designed to make a big difference for our vulnerable populations. We made the transfer to allow each to be a central focus of one bureau -- yet still linked together through one HRSA.

Moving the National Health Service Corps to the Bureau of Health Professions also makes sense because it puts in a single bureau the entire spectrum of HRSA’s recruitment, training, loan, scholarship and placement programs for health professionals.  Consolidating responsibility for health professions programs in one HRSA bureau increases the internal coordination needed to ensure that the right number of health care professionals serve in the right places.

And by streamlining operations at the Bureau of Primary Health Care, we’ll be better able to focus staff and resources on the President’s push to expand the health center system.  This expansion will be a top priority for HRSA for many years, and it will be a very visible task of great importance to the nation.  BPHC’s leadership in building and maintaining the health center network is widely respected.   Now, with the restructuring, they can turn their full attention toward making the expansion a success. And BHPr can focus on the Presidential Initiative to revitalize the National Health Service Corps.

We made other changes too. We centralized our legislation and communication shops. By doing so, we were able to redeploy, in each case, 30 FTE’s from those staff functions into direct program service work.  Further, we moved the telehealth group out of the Office of the Administrator to a Bureau site to ensure quality grant making expertise, and to put it under a management leadership which is committed to helping the Secretary and I weave telehealth into all of our programs.

We’ve made a lot other changes, too, but all have one goal: to further HRSA’s mission to expand access to quality health care for all Americans who need it.  Our goal remains the same: to bring high quality health care to people no matter what their circumstance or where they live.

In closing, let me say that I believe the NHSC is one of the best tools the federal government has to extend quality health care to Americans who need it most. President Bush recognizes this and so does Secretary Thompson. In the weeks and months ahead, there is much that we can accomplish together to keep the Corps strong.

I wish you much success on your work these next few days. You have before you an ambitious and worthwhile agenda.  I urge you to continue to let us know what we can do to make your work easier and what barriers need to be overcome. 

At HRSA, our pledge to you is this: when you talk, we will listen and respond.