Memo From the Editor

What about the underserved physician?

By Jeff Forster, Editor

It's a simple enough concept: Certain parts of this great land don't have enough doctors, nurses, dentists, and other health professionals. So it's a matter of public interest, and public health, to encourage them to practice in the areas of greatest need, and a matter of public policy to offer a financial incentive to do so. In fact, since 1987 the National Health Service Corps has offered a loan-repayment program to health professionals who agree to devote at least two years of their lives to a designated area of "health professional shortage."

The match seems made in heaven—doctors saddled with education debt, communities in dire need of care. But this match wasn't made in heaven, it was made in Washington. And that's where things have gone terribly wrong.

Budget cuts by Congress, and budget shifts within HHS, have run this worthy program dry. In fiscal year 2000, a total of 715 health professionals who were newly eligible for loan repayment applied to the program. More than half of them—378—got nothing. The other 337 received awards, and another 263, who were already in the program, were given extension grants.

Many of those who took jobs in underserved areas with the hope—and expectation—that they'd be rewarded for their commitment were simply out of luck. The rewards they'd counted on are not insignificant: For a doctor whose application is approved, the government will make student-loan repayments of up to $25,000 a year for the required two-year stay. A one-year extension can be worth as much as $35,000.

The professionals who took Uncle Sam up on his offer—most of them young people at the beginning of their careers, suffused with energy and idealism—have kept their word. Ready to make a difference, they've gone to inner cities and remote rural outposts, where many of their brethren choose not to tread. You'll meet some of them in the excellent article Senior Editor Wayne Guglielmo has written about their plight (see "Treating the underserved: You call this an incentive?").

Many of them wouldn't have done so—couldn't have afforded to do so—had it not been for the tangible incentive their government offered. But what Uncle Sam really offered the unlucky "unfunded applicants" turned out to be nothing less than a bait-and-switch—and an incentive to leave rather than stay.

The bureaucrats insist that, technically, the money was never actually promised to all eligible applicants. Demand has simply exceeded the supply of loan relief money, they say, and we have to do a better job of "managing expectations." On its Web site, the NHSC apologizes: "We deeply regret that there will be unmet needs."

Well, what we deeply regret is that the government so often is unable to put its money where its mouth is. To make matters worse, budget authorization for the entire NHSC program expired on Sept. 30. In their rush to hit the campaign trail, our elected representatives never got around to renewing it.

That makes it a major item of unfinished business as we start all over again with a new administration and Congress. It's a no-brainer: Fund the program in such a way that promises can be made and promises can be kept. The last thing this country needs is to launch a generation of young doctors on a sea of hope, only to dash them against the rocks. Our health professionals—and the communities who so desperately need them—deserve much better than that.

 

Jeff Forster. Memo From the Editor: What about the underserved physician?. Medical Economics 2001;2:7.