National Health Service Corps Research Articles

The Role of the National Health Service Corps Clinicians in Enhancing Staffing and Patient Care Capacity in Community Health Centers.

The National Health Service Corps (NHSC) is a federal program to increase the supply of health professionals in underserved communities, but its role in enhancing the capacity of community health centers (CHCs) has not been investigated. This study examined the role of NHSC clinicians in improving staffing and patient care capacity in primary, dental, and mental health care in CHCs. Using 2013-2016 administrative data from CHCs and the NHSC, we used a generalized estimating equation approach to examine whether NHSC clinicians [staff full-time equivalents (FTEs)] complement non-NHSC clinicians in CHCs and whether their productivity (patient visits per staff FTE) was greater than that of non-NHSC clinicians in primary, dental, and mental health care. Each additional NHSC clinician FTE was associated with a significant gain of 0.72 non-NHSC clinician FTEs in mental health care in CHCs and an increase of 0.04 non-NHSC FTEs in primary care in CHCs with more severe staffing shortages. On average, every additional NHSC clinician was associated with an increase of 2216 primary care visits, 2802 dental care visits, and 1296 mental health care visits per center-year. The adjusted visits per additional staff for NHSC clinicians were significantly greater in dental (difference=992) and mental health (difference=423) care, compared with non-NHSC clinicians. The NHSC clinicians complement non-NHSC clinicians in primary care and mental health care. They help enhance the provision of patient care in CHCs, particularly in dental and mental health services, the 2 major areas of service gaps.

Debt and the Emerging Physician Workforce: The Relationship Between Educational Debt and Family Medicine Residents' Practice and Fellowship Intentions.

Educational debt is increasing and may affect physicians' career choices. High debt may influence family medicine residents' initial practice setting and fellowship training decisions, adversely affecting the distribution of primary care physicians. The purpose of this study was to determine whether debt was associated with graduating family medicine residents' practice and fellowship intentions. The authors completed a cross-sectional secondary analysis of 2014 and 2015 American Board of Family Medicine (ABFM) examination registration questionnaire data and ABFM administrative data. They used multivariate logistic regression to determine whether educational debt was associated with graduating residents' practice (ownership and type) and fellowship intentions. Most residents (89.7%; 3,368) intended to pursue an employed position, but this intention was not associated with their debt. Residents with high debt ($150,000-$249,999) had lower odds of intending to work for a government organization (odds ratio [OR] 0.57; confidence interval [CI] 0.41-0.79). Those with high or very high debt (> $250,000) had lower odds of choosing academic practice (OR 0.55, CI 0.36-0.85 and OR 0.62, CI 0.40-0.96, respectively) or a geriatrics fellowship (OR 0.36, CI 0.20-0.67 and OR 0.29, CI 0.15-0.55, respectively). High educational debt may contribute to national shortages of academic primary care physicians and geriatricians. Existing National Health Service Corps loan repayment opportunities may not offer adequate incentives to primary care physicians with high debt. The medical community should advocate for policies that better align financial incentives with workforce needs.

The Influence of Loan Repayment and Scholarship Programs on Healthcare Provider Retention in Underserved Kansas

Background. In an effort to redistribute healthcare providersto underserved areas, many states have turned to financialincentive programs. Despite substantial research on theseprograms on a national scale, little is known about the successof such programs in Kansas. The purpose of this studywas to provide insight into the relationship between financial incentive programs and provider retention in Kansas.
 Methods. A cross-sectional telephone survey was conducted inApril and May of 2011 with participants who had completedtheir obligations to the Kansas State Loan Repayment Program(SLRP), the National Health Service Corps (NHSC) Loan Repaymentprogram, or the National Health Service Corps Scholar shipprogram in Kansas between January 2006 and January 2011.
 Results. Of the 112 providers included in the study, 54.4% (n = 61)had left their program sites sometime after finishing their commitment,with the mean length of stay after the obligation periodended being 7.3 (median = 3) months. Of the 54 participants whohad left their program sites and whose current locations wereknown, 33.3% (n = 18) were located in new Health ProfessionalShortage Areas (HPSA), 25.9% (n = 14) were in a new non-HPSA,and 40.7% (n = 22) had left the state. Family satisfaction with thecommunity and attending a professional school in Kansas wereassociated statistically with retention of physicians in Kansas.
 Conclusions. Nearly half of all participants had remained attheir sites even after their obligation period ended, with familysatisfaction with the community appearing to be the strongestpredictor for retention among those who had stayed.Efforts to match a provider’s family with the community successfullyand to support the family through networking mayimprove future provider retention. KS J Med 2016;9(1):6-11.

Satisfaction of the Primary Care, Mental Health, and Dental Health Clinicians of the National Health Service Corps Loan Repayment Program.

The National Health Service Corps (NHSC) aims to foster a positive service experience for its clinicians to promote long-term retention. We assess the satisfaction of primary care, dental, and mental health clinicians in the NHSC's Loan Repayment Program (LRP). Survey data are from 1,193 clinicians (72.4% response) who completed NHSC LRP contracts in 16 states from July 2015 through December 2016. Eighty-one percent reported overall satisfaction with their work and practice, without differences across disciplines. Nearly 95% were satisfied with the mission and patients of their practices. Fewer clinicians were satisfied with compensation (51%) and time demands of work (36%). Ninety-four percent reported the NHSC experience met or exceeded their expectations, and 94% recommend the NHSC LRP to others. In summary, the NHSC LRP experience is generally positive for clinicians of all disciplines. Clinicians' issues with their incomes and with the time demands of their work deserve attention from the NHSC.

The 2019 ACU Annual Meeting Wrap-Up.

The 2019 ACU Annual Meeting Wrap-Up Douglas Olson, MD (bio) and Craig Kennedy, MPH (bio) The 2019 Annual Meeting of The Association of Clinicians for the Underserved (www.clinicians.org) theme was Stronger Teams, Healthier Communities. Held in July in Washington, D.C., the theme recognized the importance of developing the health care team through support, trainings, and new ideas to create healthier individuals, families, neighborhoods, and communities. This JHCPU column highlights some of the exciting opportunities and presentations available to attendees. The three-day, three-track meeting highlighted many of the most pressing topics in underserved and community health care today: Policy, Practice, and Workforce. Gary Puckrein, PhD President and CEO, National Minority Quality Forum (www.nmqf.org), gave the opening keynote address. The NMQF addresses the critical need for strengthening national and local efforts to use evidence-based, data-driven initiatives to guide programs to eliminate the disproportionate burden of premature death and preventable illness for racial and ethnic minorities and other populations. This underscores much of ACU's historical and ongoing work towards eliminating health disparities and inequities, and started the meeting on an energetic note. In partnership with the NMQF and others, ACU has worked tirelessly for policy changes aimed at positively impacting underserved communities. Recognizing the need for collaboration at the federal level to address this as well, Senator Roy Blunt of Missouri was chosen as ACU's 2019 Congressional Champion. Senator Blunt has taken a leadership role in the U.S. Senate to highlight the importance of the National Health Service Corps (NHSC), and rally his colleagues in support of the program. His leadership specifically resulted in the inclusion of direct funding for the NHSC in FY 2019 appropriations process, and he recognizes that an increased, mission-driven workforce is one critical solution to promote health equity in the United States. The Practice Track of the meeting recognized the pressing issue of clinician stress and burnout, and Mr. Paul Huschilt (Twitter@PaulHuschilt)—Professional Speaker, Humor and Wellness Expert—shared his techniques on how to get the most out of life, deal with change, and laugh at just about anything! The ACU also had the opportunity to honor those health care professionals who serve as an inspiration for us all: Debbie Lupeika, MD of Shasta Community Health (www.shastahealth.org) received the 2019 Clinician of the Year award for her years of dedicated service developing physician [End Page 1249] leaders as well as her work with the California Primary Care Association (www.cpca.org) to position community health centers at the forefront of Graduate Medical Education. Jessica Adkins, a medical student at the University of Kentucky College of Medicine joined an illustrious group of previous winners with her award of the 2019 Health Professional in Training award for her commitment and dedication to helping underserved communities. As the Chair of the American Medical Association–Medical Student Section Community Service Committee (Twitter@AMSANational), she and her committee educated communities in overdose recognition and naloxone administration. These efforts of Ms. Adkins and her colleagues do not exist in a vacuum within Kentucky! The 2019 Award for Organizational Excellence was awarded to the Zero Overdose Initiative, started in New York City. The Zero Overdose initiative and its staff have demonstrated a high level of commitment and dedication to underserved populations through development of an overdose care pathway that ensures effective treatment across the continuum of care, as well as the training and resources needed for the clinicians serving those in most need. Zero Overdose has also worked in tribal health settings that have limited resources and experience disproportionate rates of drug overdose. Thomas McCarry, LMHC, of The Institute for Family Health (www.institute.org) accepted the award. Implementing policy and improving practice of course requires workforce, and ACU's long advocacy for and commitment to the National Health Service Corps was again front and center at this meeting. Torey Mack, MD, FAAP from HRSA's Bureau of Health Workforce (www.bhw.hrsa.gov) provided an overview and update of federal workforce policies. Margaret Flinter, PhD, APRN, Senior Vice President and Clinical Director of CHC, Inc. (www.chc1.com) spoke about creating a workforce team and the initiatives...

In Case You Haven't Heard

The money is flowing. On Sept. 18, the Senate passed a funding bill that includes $5.7 billion for the Substance Abuse and Mental Health Services Administration, which is $584 million more than fiscal year 2018. This includes $1.5 billion for State Opioid Response Grants, an increase of $50 million for Certified Community Behavioral Health Clinics and $105 million for the National Health Service Corps. It also expands loan repayment eligibility requirements to include substance use disorder counselors, which will support recruitment and retention of health professionals needed in underserved and rural areas.

Is the National Health Service Corps the Answer? (for Placing Family Doctors in Underserved Areas).

Paying for college and medical school is expensive in the United States, often leaving recent graduates with large educational loan debt.[1][1] This can influence the specialty medical students choose and where they practice. Analyzing a survey of board-certified family physicians who were 3 years

Bipartisan Budget Deal Includes Wins for Health, MH Priorities

Back to table of contents Previous article Next article Government NewsFull AccessBipartisan Budget Deal Includes Wins for Health, MH PrioritiesLinda M. RichmondLinda M. RichmondSearch for more papers by this authorPublished Online:22 Feb 2018https://doi.org/10.1176/appi.pn.2018.3a5AbstractThe budget deal includes funds to combat the opioid crisis, support mental health programs, and increase NIH spending.The bipartisan budget agreement Congress passed last month provides funding for important mental health initiatives for which APA lobbied hard, including earmarking $6 billion to confront the opioid epidemic as well as extending the state Children’s Health Insurance Program (CHIP). The Bipartisan Budget Agreement of 2018 extends CHIP through 2028, marking the longest reauthorization in the program’s history. This decade-long renewal ends the recent uncertainty felt by families and state officials, as the program had technically expired and was relying on a temporary spending allotment for several months, with several states running critically low on funds. CHIP is a federal-state partnership that provides comprehensive health insurance coverage for children whose families earn too much to qualify for Medicaid, but not enough to afford private insurance. CHIP insures 9 million children, including 850,000 children with serious behavioral or emotional disorders. The agreement contains a new requirement for states to report pediatric health quality measures starting in 2024 and a continuation of CHIP’s “express lane eligibility,” which permits new participants based on their eligibility for other state welfare programs.The CHIP extension became more politically palatable after a scoring by the nonpartisan Congressional Budget Office (CBO) showed that a 10-year extension would reduce the federal deficit by $6 billion. However, a sizeable portion of the cost savings comes from a reduction in the average federal match rate: 70 percent in 2021 and beyond, down from 93 percent in 2019. This will force states to shoulder more of the costs of the program.The budget agreement, passed February 9, scraps the spending “caps” imposed during the Obama administration and increases government spending by $320 billion over two years, according to the CBO. The agreement keeps the federal government in operation through March 23, giving Congress time to refine the details of its plan in an omnibus spending package. Meanwhile, a White House tax and spending plan issued February 12 calls for $3 trillion in spending cuts to Medicare, Medicaid, food stamps, and other social programs.APA applauded the Congressional budget agreement’s provision of $6 billion to help fight the nation’s opioid epidemic, primarily through state grants aimed at fighting drug abuse and expanding treatment for mental illness and substance use. Another $2 billion over the next two years will support research at the National Institutes of Health, including its study of nonopioid pain therapies.“We are pleased that the budget deal includes $6 billion to fight opioid abuse, one of the most critical public health issues facing our nation today,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “The opioid crisis has taken a heavy toll on millions of families in America. Our members stand ready to provide our expertise in treating this epidemic.” Additional mental health care provisions in the budget agreement include the following:Critical health-related resources to vulnerable communities, namely two-year reauthorizations of funding for community health centers; the Teaching Health Center Graduate Medical Education program; and the National Health Service Corps, which provides student loan forgiveness to health professionals who work in rural or underserved areas.Technical corrections related to the Medicare Access and CHIP Reauthorization Act (MACRA), which will help ease regulatory burdens faced by physicians.Additional funding for Department of Veterans Affairs hospitals and clinics.Funding that will improve access to telehealth services by Medicare Advantage enrollees.Levin sent a letter to congressional leaders to acknowledge their efforts to facilitate funding for mental health–related programs. “We recognize that Congress faces difficult decisions in funding myriad priorities with increasingly limited resources and appreciate your efforts to prioritize funding for mental health-related programs,” he wrote. “Through enhanced federal commitment to programs—stimulating the mental health workforce, furthering evidence-based practices, and advancing medical research—we can ensure the next generation of mental health professionals are well prepared to combat current and future health-related challenges.” ■APA’s press statement on the budget legislation can be accessed here. Levin’s letter to congressional leaders can be read here. ISSUES NewArchived

A call to promote healthcare justice: A summary of integrated outpatient clinics exemplifying principles of Catholic social teaching.

There is an urgent need to promote healthcare justice for patients as well as members of the healthcare team including physicians. In this article, we explain how principles of Catholic social teaching (i.e., dignity of the individual, common good, destination of goods, solidarity, and subsidiarity) are applied to health care, by featuring various types of outpatient clinics including free, charitable-direct primary care, hybrid, federally qualified health center, and rural health clinic. We describe how attempts have been made to improve the quality and access of health care by creating new medical schools (i.e., Marian University College of Osteopathic Medicine) and training programs as well as allocating government funding to alleviate the cost of training new healthcare providers through the National Health Service Corps. Finally, we suggest a few approaches (i.e., adopting new clinic models to include volunteer healthcare professionals and cross-training members of the healthcare team) to fill in current gaps in health care. Summary : There is a need to promote justice in healthcare. In this article, we explain how principles of Catholic social teaching are applied to health care. To illustrate this, we feature various types of outpatient clinics. We also describe how attempts have been made to improve the quality and access of health care. Finally, we suggest further ways to improve healthcare reform based upon Catholic social teaching.

Borrow or Serve? An Economic Analysis of Options for Financing a Medical School Education.

To understand the long-term economic implications of key pathways for financing a medical school education. The authors calculated the net present value (NPV) of cash flow over a 30-year career for a 2013 matriculant associated with (1) self-financing, (2) federally guaranteed loans, (3) the Public Service Loan Forgiveness program, (4) the National Health Service Corps, (5) the Armed Forces Health Professions Scholarship Program, and (6) matriculation at the Uniformed Services University of the Health Sciences. They calculated the NPV for students pursuing one of four specialties in two cities with divergent tax policies. Borrowers were assumed to have a median level of debt ($180,000), and conservative projections of inflation, discount rates, and income growth were employed. Sensitivity analyses examined different discount and income growth rates, alternative repayment strategies, and various lengths of public-sector service by scholarship recipients. For those wealthy enough to pay cash or fortunate enough to secure a no-strings scholarship, self-financing produced the highest NPV in almost every scenario. Borrowers start practice $300,000 to $400,000 behind their peers who secure a national service scholarship, but those who enter a highly paid specialty, such as orthopedic surgery, overtake their national service counterparts 4 to 11 years after residency. Those in lower-paid specialties take much longer. Borrowers who enter primary care never close the gap. Over time, the value of a medical degree offsets the high up-front cost. Debt avoidance confers substantial economic benefits, particularly for students interested in primary care.

Expanding the National Health Service Corps Scholarship Program to General Surgery

Expanding the National Health Service Corps Scholarship Program to General Surgery

Improving Primary Care Retention in Medically Underserved Areas: What's a Clinic to Do?

To reduce health professional shortage areas, the National Health Service Corps has attempted to increase the number of primary care providers in underserved communities through scholarships and loan repayment. Program evaluations assessed Loan Repayment Program (LRP) propensity to work in underserved communities. The National Health Service Corps LRPs were asked about preferences for particular retention strategies and which strategies were utilized by their clinical sites. Loan Repayment Programs were asked to rank retention strategies. Loan Repayment Program top choices were competitive salary, 88%; professional development, 70%; knowledgeable/competent support staff, 59%, and professional support, 58%. Loan Repayment Programs were also asked to rank retention strategies provided by their clinical sites: professional development, 74.2%; competitive salary, 71.2%; policies that prohibit abusive behavior, 63.6%, and knowledgeable/competent support staff, 60.6%. Loan Repayment Programs indicated professional support was an important retention element. However, when asked if professional support opportunities were offered, LRP indicated that these were not in the strategies offered by sites.

Feasibility assessment for using telehealth technology to improve access to dental care for rural and underserved populations

ObjectiveSouth Carolina Dental Association members were surveyed on telehealth knowledge, need, and interest in using it for access to care improvements. MethodsDependent variables were Medicaid patient population size (less than or greater than 10%), career stage (early to middle and advanced), and National Health Service Corps participation (yes or no). Practice and provider characteristics were screener questions. Data were collected electronically and analyzed with SAS. Descriptive and bivariate analyses were conducted. ResultsMost (69.3%) reported some or no teledentistry knowledge. Distribution of needing consults was: endodontics (40.2%), oral-maxillofacial surgery (37.9%), orthodontia (30.7%), periodontics (28.4%), and pediatrics (12.5%). Consultations for diagnosis (72.9%), emergencies (56.7%), and continuing education (53.3%) were most frequently identified telehealth uses. Medicaid patient population size was the only dependent measure with statistical significance. Compared to <10% Medicaid, >10% was more likely to (1) frequently need consults for orthodontics (25.5% vs 43.4%, P = .0043) and pediatrics (5.9% vs 29.0%, P < .0001); (2) use telehealth for children with special health care needs (44.1% vs 65.8%, P = .0017), complex health conditions (54.3% vs 78.1%, P = .0004), conditions exacerbated by unmet dental needs (44.6% vs 65.8%, P = .0022); and (3) use telehealth for extending practice to underserved populations (14.6% vs 33.8%, P = .0004). ConclusionsDespite need for telehealth knowledge improvement, sufficient interest exists. Further study will determine if demand for teledentistry is in balance with consultant availability. It has been suggested that access to care improvements require capacity expansions in private practices. States will need to engage dental communities determine if teledentistry is an effective solution.

Oquendo Urges Senate Passage of Mental Health Reform Bill

Back to table of contents Previous article Next article Government NewsFull AccessOquendo Urges Senate Passage of Mental Health Reform BillAaron LevinAaron LevinSearch for more papers by this authorPublished Online:9 Jun 2016https://doi.org/10.1176/appi.pn.2016.6b23AbstractThe bill will benefit patients and their families for generations to come, say senators and psychiatrists.APA President Maria A. Oquendo, M.D., and other mental health experts went to Capitol Hill in late May to generate support for passage of the bipartisan Mental Health Reform Act of 2016 (S 2680).“As a nation, we have failed to meet the needs of Americans with mental illness,” Oquendo told senators and advocates gathered for the event in the Hart Senate Office Building. “We have a fragmented delivery and reimbursement system, we deal with workforce shortages and obsolete regulations, and we face the enduring stigma surrounding mental illness. We must do better, and we can do better.”The Mental Health Reform Act would improve access to care by increasing the number of providers, disseminating the best scientific research, integrating physical and mental health care, and bolstering coordination among federal mental health agencies, said bill coauthor Sen. Bill Cassidy, M.D. (R-La.).His colleague and coauthor from across the aisle, Sen. Chris Murphy (D-Conn.), described the step-by-step process of gathering support among fellow senators, including eight Democratic and eight Republican cosponsors, to move the bill closer to passage.“The act is the first attempt in the House and the Senate to take a holistic look at a broken system,” said Murphy. “We assessed the problem as being threefold: a lack of resources, a lack of coordination, and a lack of focus on continuing stigma.”Spending in Medicare, Medicaid, and private insurance is highly concentrated, and all citizens pay for it, directly or indirectly, said Ashish Jha, M.D., M.P.H., director of the Harvard Global Health Institute and a professor of medicine at Harvard Medical School and the Harvard T. H. Chan School of Public Health.“About 21 percent of the Medicare population had a mental health diagnosis, but 49 percent of the high-cost patients had such a diagnosis, primarily depression, anxiety, or schizophrenia,” said Jha. “However, we can’t point to any one mental health diagnosis as the problem.”Five critical components were needed for meaningful mental health reform, said Oquendo.First, all federal mental health initiatives must be overseen by physicians with expertise in psychiatric conditions, she said. “Because psychiatric and substance use disorders are fundamentally brain disorders, leadership with the appropriate biological training is key.”She also called for more research support at the National Institute of Mental Health, National Institute on Drug Abuse, and National Institute on Alcohol Abuse and Alcoholism, as well as more resources for training psychiatrists and other mental health clinicians. Greater emphasis on preventing mental illness is also essential, she said, along with stronger federal enforcement of the Mental Health Parity and Addiction Equity Act.In thanking the senators for their efforts, Oquendo said, “APA is very encouraged that the components of meaningful mental health reform are addressed in the bill.”Child and adolescent psychiatrists face additional problems as they seek to help solve the problems addressed by the bill, said Gregory Fritz, M.D., a professor of psychiatry at Brown University School of Medicine and president of the American Academy of Child and Adolescent Psychiatry.Medical school loan repayment plans don’t include child and adolescent psychiatrists, an oversight rendering them ineligible for such programs, said Fritz. Also, National Health Service Corps loan relief is available only within two years of completion of a “primary residency,” again leaving out child psychiatrists, who must complete a two-year fellowship. Amendments covering changes to eliminate these restrictions have been proposed, he noted. “Let’s not leave the children out,” said Fritz. “We need to get the details right.”“Ignoring mental health is hugely costly to our health system, our treasury, and our own pockets,” said Jha. “If we get it right, we will be fiscally more prudent and provide better care for our patients.”Cassidy and Murphy emphasized the importance of grassroots support of mental health reform in the months ahead.“Even in this election year, we can still pass the Mental Health Reform Act and get it signed by the president,” said Cassidy. ■In a blog post on APA’s website, Oquendo urged her fellow psychiatrists to contact their representatives in Congress and ask them to support comprehensive mental health reform. ISSUES NewArchived

Overcoming Opioid Abuse in Rural U.S. Requires Varied Approach

Overcoming Opioid Abuse in Rural U.S. Requires Varied Approach

Dr. Virgilio Licona-A Crusader for Health and Social Justice.

Dr. Virgilio Licona—A Crusader for Health and Social Justice Jennifer Anderson, MPH (bio) and Julie Hulstein, MNM (bio) Dr. Virgilio Licona is a national treasure. He was a pioneer in the early days of the movement to create health equity through community health centers and he has dedicated his life to caring for the medically underserved and serving as the voice for those who are often not heard. He recently retired, after serving as Vice President of Medical Services at Salud Family Health Centers in Fort Lupton, Colorado since 2000. Salud is committed to providing an affordable, high quality medical home to families and individuals in the nine northern Colorado communities they serve. A gifted speaker, Dr. Licona can motivate and inspire those around him with words that so succinctly paint a picture that his listener cannot help but take up his cause. With this skill he has treated those most in need, administered health centers, impacted public policy, and changed the overall landscape of community health. “We were still burning on fumes from the sixties.” Born as the son of farmworkers in California, Licona came to Colorado in the early 1970s as a community organizer and political activist. After earning a degree from Colorado State University, he founded and served as director of La Clinica del Valle in Rocky Ford, Colorado largely to serve the needs of migrant and seasonal farmworkers. Licona and the countless others who were working for social justice intended to change the country. These defenders of the underserved were fueled by the efforts of the 1960s and President Johnson’s War on Poverty. He fully believed that through programs like Head Start, Medicaid, and job training through the Office of Economic Opportunity, that they could eliminate poverty. He believed that one day everyone could compete on a level playing field. Dr. Licona’s place in this movement would unfold over 40 years of dedicated service to community health centers. As director of La Clinica del Valle, Licona struggled to find a Physician Assistant (PA-C) to work in his clinic. Undeterred, he enrolled in school to become a PA-C. After graduation, he began his clinical career at Pueblo Community Health Center [End Page x] providing high quality, culturally competent health care. Not long after, the health center was unsuccessful in finding a physician to serve their rural community. Perhaps unsurprisingly, Licona enrolled in medical school at the Autonomous University of Hidalgo. Not one to waste an opportunity to build new partnerships, Dr. Licona was among the first residents to participate in a new collaboration between medical schools in Mexico and rural residencies in the United States. After completing his residency in family medicine he returned to Pueblo Community Health Center as a physician to serve those most in need. “Healthcare is for people and not for profit.” Dr. Licona doesn’t only provide care as a family physician. He has long been an ardent advocate for the medically underserved. He testified before the Colorado state legislature for the first time in 1975 on behalf of the community health center movement. In the late 1990s, he returned to the state capitol to successfully lead the advocacy efforts for a bill that would provide prenatal care for undocumented women. Dr. Licona also served on the National Advisory Council of the National Health Service Corps as well as on the National Rural Health Advisory Committee. He contributed as a member of the Legislative Policy Committee before being elected to the board of directors of the American Academy of Family Physicians. In his home state, he served as president of the Colorado Academy of Family Physicians and on the Board of The Colorado Health Foundation as well as Colorado Community Health Network and Community Health Association of Mountain/Plains States. Dr. Licona used these leadership positions to champion higher quality healthcare and increased access to care for those who need it the most. “We’re helping move the health care status of the country forward.” Dr. Licona has been recognized by his peers throughout his illustrious career. In 2000, he was the recipient of the Colorado Minority Health Forum’s “Outstanding Contributor to Minority Health Care in...

Developing a Pipeline for the Community-Based Primary Care Workforce and Its Leadership: The Kraft Center for Community Health Leadership's Fellowship and Practitioner Programs.

Community health centers (CHCs) face challenges recruiting and retaining primary care clinicians. Providing advanced training that enhances clinical skills within a public health framework, teaches leadership, protects time for scholarly activities, and focuses on the social mission may be a successful career development strategy. In July 2012, the Kraft Center for Community Health Leadership developed and implemented two 2-year programs to develop physician and nursing leaders with blended academic-community career paths and identities. The fellowship program for physicians and the practitioner program for early-career physicians and advanced practice nurses include mentored practice in a CHC; monthly learning days; completion of a community-based research project; and, for fellows, matriculation in an MPH program and engagement in a bimonthly leadership seminar. The first classes of 5 fellows and 14 practitioners graduated in June 2014. All 5 fellowship graduates were offered full-time positions at the CHCs where they practiced, and 2 have accepted leadership positions at their CHCs. All 14 practitioner graduates remain in community health, 5 have accepted leadership positions, and 2 have obtained grants to support ongoing projects. The authors are tracking graduates' career paths and the programs' impact on CHCs while modifying the programs on the basis of feedback; identifying elements of the programs that may be amenable to more cost-effective delivery; and exploring the potential for federal funding to support expansion of the practitioner program, and for the practitioner program to increase the return on investment provided by the National Health Service Corps.

Aging in rural America.

For older Americans, accessing high-quality care can be a challenge. For those in rural communities, it's even harder.

Physician assistants and nurse practitioners in the National Health Service Corps.

This study describes the experiences of physician assistants (PAs) and nurse practitioners (NPs) in the National Health Service Corps' (NHSC) loan repayment program in 2010. In 2011, a stratified random sample of NHSC clinicians was surveyed. Data from the 148 PA and 137 NP respondents were analyzed (52.4% response rate). PAs were younger than NPs (mean age 31 versus 35 years), less often female (68% versus 91%), and more often carried educational debt over $100,000 (56% versus 24%). Both groups were serving in states familiar to them and within communities where they felt accepted. The groups were generally satisfied on most measures of work, with PAs more satisfied than NPs on some measures. The NHSC's PAs and NPs are well matched to communities and satisfied with their work. Maximizing their NHSC experiences and retention requires recognizing their differences in demographics, debt, and areas of job satisfaction.

Obama 2015 Budget Would Extend Medicaid Pay Bump

Many physicians would continue to see higher payments through 2015 for treating Medicaid ­patients under President Obama's proposed budget for the upcoming fiscal year. The budget request submitted to Congress March 4 includes $5.4 ­billion to extend the Affordable Care Act (ACA) provisions that pay physicians at Medicare levels for certain primary care services to Medicaid patients. Otherwise, the increase will end this year. Under the budget proposal, nurse practitioners and physician assistants also would be eligible for the higher payment rates. “Allowing [the higher rates] to expire would result in a deep, across-the-board cut to primary care physicians who are taking care of the most vulnerable populations, at a time when millions more are becoming eligible for Medicaid,” Molly Cooke, MD, president of the American College of Physicians (ACP), said in a statement. The budget proposes $77.1 billion in discretionary spending for Health and Human Services (HHS), down $1.3 billion from 2014. This includes investments in the primary care workforce, expanded mental health services, and continued implementation of the ACA insurance marketplaces. The president's budget also calls for Medicare cuts of more than $400 billion over 10 years. Proposed in previous budgets, these include payment cuts for inpatient rehabilitation facilities, long-term care hospitals, and home health agencies; reduction in Medicare coverage of hospitals’ bad debts; reductions to indirect graduate medical education payments; and payment cuts to critical-access hospitals. In addition, the budget would introduce readmission penalties for skilled nursing facilities and strengthen the controversial Independent Payment Advisory Board (IPAB). The proposal would require the IPAB to recommend cost-cutting targets to Congress if the Medicare growth rate exceeds gross domestic product plus 0.5 percentage points. Current law sets that level at GDP plus 1 percentage point. The 2015 budget proposal would increase investment in the primary care workforce. It requests more than $5 billion over the next decade to train 13,000 new residents as part of a new competitive grant program available to teaching hospitals, children's hospitals, and community-based consortia of teaching hospitals or other health care institutions. The budget also beefs up funding for the National Health Service Corps. It includes nearly $4 billion in new funding over 6 years to increase the number of health providers in rural areas and federally funded health centers to 15,000. And it would invest $4.6 billion in community health centers in 2015 and another $8.1 billion for the next 3 years. For mental health services, the budget includes $55 million for Project AWARE, which encourages community and school officials to work together to keep schools safe, refer students to mental health services, and provide mental health “first aid” training so that teachers can detect early signs of mental illness. The budget request includes $50 million to train about 5,000 new mental health professionals, $20 million to help young adults aged 16-25 years navigate behavioral health services, and $5 million to change attitudes about people who have behavioral health needs in the workplace. The budget also provides funding for a demonstration project in Medicaid to help reduce the use of psychotropic medications prescribed to children in foster care by improving access to other mental health services. The release of the president's budget request came just weeks before the end of open enrollment in private health plans through the ACA's marketplaces. The budget includes $1.8 billion in funding for 2015 to cover the cost of running the federally facilitated marketplace. However, most of the funding – $1.2 billion – would be covered by user fees from health plans in the marketplaces. If Congress fails to provide the remaining funds, HHS officials said they could transfer monies from other agency accounts to cover marketplace costs.