Congress Hasn't Renewed A Program That Helps With Nevada's Primary Care Shortage

Feb 4, 2018

 

Dr. Eithne Barton is a primary care doctor with Community Health Alliance.
Credit Anh Gray

The National Health Service Corps is a more than 40-year-old federal program that helps medical professionals defray the cost of education. It also recruits providers to underserved areas. But, Congress hasn’t renewed the program and funding runs out in March. Reno Public Radio’s Anh Gray explores how that program impacts Nevada.

Community Health Alliance, is a Federally Qualified Health Center and serves low-income families.

At the end of a busy day, a nurse at the center chases Dr. Eithne Barton down a hallway.

A Midwesterner, Barton moved to Reno to take a job as a primary care doctor at the facility. She has served with the National Health Service Corps. Since the government helped pay for her education, she committed to work in an underserved community, in return.

 

“It allowed me to do the work that I knew wanted to do and not worry about being able to pay back my loans,” Barton explains, “which is a huge part of what I think affects what people choose to do when they’re coming out of medical school these days.”

 

Dr. Eithne Barton moved to Reno to work with Community Health Alliance. About a third of the healthcare professionals at the center are with the National Health Service Corps.
Credit Anh Gray

Barton’s husband is also a physician, and like many of their colleagues, he graduated with a quarter of a million dollars in debt. The Association of American Medical Colleges reports that the average tab to attend a four-year public medical school exceeds $240,000. Going to a private school would add about 100 grand more.

“You know, it’s a mortgage for education. You kind of have to look at it that way, Barton says. “But if you’re also paying a mortgage, and you’re paying back your loans—it’s huge.”

 

Nearly 15% of med school grads owe more than $300,000 even before their residency training begins.

Chuck Duarte heads up Community Health Alliance, which has about six facilities in the Reno-Sparks area. A third of the 40 providers there—including doctors, nurses and dentists—are with the National Health Service Corps. 

“That’s a very high percentage,” Duarte explains, “but it’s not uncommon to find those kinds of numbers across community health centers across here, in Nevada, and across the nation.”

The program places providers in what the federal government designates as Health Professional Shortage Areas, or HPSAs. These are the rural and urban communities in need of healthcare workers.

 

Community Health Alliance is a Federally Qualified Health Center. They center has six facilities in the Reno-Sparks area.
Credit Anh Gray

“It is a vital part of our recruitment efforts because as a nonprofit serving underserved populations,” Duarte explains,” we’re unable to compete with the like of for-profit entities or large not for profit organizations.”

Scott Jones manages the Nevada Primary Care Office. Getting more providers out to those areas, he says, benefits both other doctors and patients.

“The shortages can cause burnout for these providers; it can cause also for the residents limitations in their access to care,” Jones explains. “So if a resident has to wait weeks or months to get access to care, then some of the chronic conditions can be worsened by that.”

There were 54 National Health Service Corps providers scattered throughout Nevada in 2017. In just that year, loan repayments for the state’s participants reached more than a million dollars.

Programs that help with recruitment are important in Nevada because the state ranks near the bottom nationally for its number of primary care doctors per capita. Jones says one reason for the shortage is the need for more in-state residencies.

“Because a lot of times the residency locations are where doctors get settled and then connects with the local medical community, and then sets up a practice,” Jones says. “And so our hope in Nevada is to have more of these residency slots that will support the doctors staying in Nevada, getting fully trained and finishing their training in the state.”

Even with loan repayment programs, there are still not enough doctors going into primary care. 

 “We see that there’s a lot of doctors going towards specialties,” Jones says, “and not as many going towards primary care.”

 

Scott Jones, seated, heads up the Nevada Primary Care Office. He's looking at a map of the Health Professional Shortage Areas in Nevada with his team. Veronica Sheldon, far left, with Joseph Tucker and Margot Chappel works with programs that recruits providers to underserved communities.
Credit Anh Gray

Dr. Melissa Piasecki is the Executive Associate Dean at the University of Nevada, Reno School of Medicine. She says that while the National Health Service Corps can help defray costs.“But I don’t think it would make or break someone’s decision to go to medical school,” Piasecki says.

If the program isn’t renewed, what bothers her is losing the pipeline of healthcare workers the program provides.

 “I think that all the states that rely on loan repayment programs will be very concerned,” Piasecki explains, “about how they’re going to recruit and retain their professionals.”

In Nevada, figuring out how to provide healthcare access to the state’s most vulnerable people is an ongoing dilemma. And this program has been one way to address it.