Update on National Health Service Corps and Community Health Centers: Opportunities for Psychologists to Work in Underserved Areas

The National Health Service Corps (NHSC) was created due to the health care crises that emerged in the U.S. in the 1950’s and 1960’s. Rural areas and inner-city neighborhoods competed unsuccessfully with affluent medical practices that offered higher compensation, more interaction with other professionals, and job opportunities for spouses. Rural communities lacked resources to provide the technologically sophisticated facilities that many physicians desired. Rural states appealed to Congress for help thus establishing what is now known as the National Health Service Corps. The National Health Service Corps (NHSC) provides financial assistance to psychologists (and other health professionals) in exchange for providing health care services in designated underserved areas known has Health Professional Shortage Areas (HPSAs). There are three categories of health professional shortage areas: medical, dental and mental health. Psychologists are listed in the mental health category.

Federally funded Community Health Centers (CHCs) were created because of the millions of Americans, living in inner-city neighborhoods and rural areas throughout the country that suffered from deep poverty and a desperate need for health care. CHCs, which are in underserved areas, also have HPSA designations. Both of these federal programs hold promising employment prospects for psychologists willing to work in our nation’s underserved communities in rural and urban areas.

Education Directorate Initiatives

The APA Education Directorate has long been involved in efforts to gain inclusion of psychologists and other mental/behavioral health professionals in the NHSC and CHC since 1994 through successful initiatives that targeted authorizing legislation, appropriations, federal and state agency policies. These advocacy initiatives included: $1 million in 2000 for regional Mental Health Summits on integrated health care for underserved populations that included mental and behavioral health; the Safety Net Amendments of 2002, which authorized the eligibility of psychologists and other mental/behavioral health professionals in the NHSC Loan Repayment & Scholarship Programs and mental health services as an allowable use of funds in the CHC program; efforts with the U.S. Department of Health and Human Services’ Health Resources and Services Administration (HRSA) and particularly with the NHSC to increase the focus on matching psychologists and other mental/behavioral health professionals to Mental Health HPSAs and to update the way in which Mental Health HPSAs are determined; and efforts with state based Primary Care Associations on hiring psychologists and utilizing services of psychology interns.

Proposed FY 2008 Appropriations

The President's FY 2008 budget proposed $116 million for the National Health Service Corps, a $9 million (7.2 percent) decrease below FY 2007. The House and Senate have completed work on their FY 2008 Labor-HHS appropriations bills. For the NHSC, the House bill provides $131.5 million, a $5.8 million (4.6 percent) increase over FY 2007. The Senate bill level funds the NHSC at the FY 2007 level ($125.6 million), rejecting the proposed $9 million (7.2 percent) cut in the President's budget. The President’s FY 2008 budget proposed a $25 million increase for Community Health Centers, representing only a modest increase as compared to his previous yearly increases of close to $200 million. The House proposed an increase of $200 million in its FY 2008 appropriations bill and the Senate proposed a $250 million increase.

NHSC Loan Repayment for Early Career Psychologists

The NHSC Loan Repayment Program continually seeks clinicians dedicated to working with our nation’s underserved. In fact, the need for psychologists currently exceeds the number of applicants. As of October 2007, there are over 227 vacancies listed for clinical psychologists across the country. In order to participate in the NHSC Loan Repayment Program, psychologists must find a facility or site that is 1) designated as a mental health professional shortage area and 2) willing to hire them.

The NHSC (and over thirty other federal agencies) use a list compiled by the Office of Shortage Designation to determine health professional shortage areas. Like the NHSC, the Office of Shortage Designation is administered by the U.S. Department of Health and Human Services’ Health Resources and Services Administration (HRSA). [Note: The Community Health Center Program is administered by the Bureau of Primary Health Care which is also within HRSA.]

Another Option for Participating in the NHSC Loan Repayment

Besides finding a facility or site, which has already been designated as a mental health HPSA, a psychologist who wants to participate in the NHSC Loan Repayment program may seek out a public facility or site in an underserved area that is willing to become designated as a Mental Health HPSA. The facility may apply for the designation, which is a simple process, and then hire the psychologist. Getting a designation is not difficult. Filling out the application only requires some time and effort to gather the appropriate information. Further, the Office of Shortage Designation is available to provide technical assistance (1-800-400-2742 or sdb@hrsa.gov). Along with the Office of Shortage Designation your state’s Primary Care Office (PCO) can also assist with the data collection. The purpose of a state PCO is to increase access to primary and preventative health care and to improve the health status of underserved and vulnerable populations. The types of data required include: provider to population ratio, access to primary health care (distance and time), and poverty levels.