Govt. Hopes Loan Repayments Lure Psychiatrists to Rural Areas

Stimulus and response worked for Pavlov. Can it work as well for the U.S. government as it tries to place psychiatrists and mental health professionals where they are needed?

The Health Resources and Services Administration (HRSA) hopes that more psychiatrists will respond to offers of stimulus money and practice for two years in medically underserved areas, anywhere from Bethel, Alaska, to Brooklyn, N.Y.

The Obama administration's economic stimulus package—formally known as the American Recovery and Reinvestment Act—allots $300 million for the National Health Service Corps (NHSC), including $200 million to cover loan repayments for primary care clinicians who agree to work for two years in health professional shortage areas.

Psychiatry is considered an “approved primary care specialty” in the eyes of the NHSC.

The HRSA program does not pay salaries but offers up to $50,000 toward repayment of qualifying loans. The loan-repayments funds are exempt from income and employment taxes.

Wider Choice of Eligible Service Sites

New applicants to the program will have a wider choice of eligible service sites than before and a greater number of vacancies from which to choose, according to an agency statement. There are more than 7,000 health care jobs of all types currently listed by the agency.

Kofi Abadio, M.D., completed his NHSC service in 2008 after graduating from the University of Oklahoma Medical School and finishing residency in Norman, Okla. He worked for two years in private practice in Salina, Kan., a designated underserved area.

“I felt like I was helping in an area where help was needed,” Abadio told Psychiatric News. “Psychiatry is psychiatry, wherever you go.”

Private practice is just one alternative for psychiatrists taking part in the program. About half of NHSC clinicians fulfill their commitment at federally supported health centers. Others serve in rural health clinics, Indian Health Service clinics, public health department clinics, hospital-affiliated primary care practices, managed care networks, prisons, and U.S. Immigration, Customs, and Enforcement sites.

Health Professional Shortage Areas are designated by HRSA as having shortages of primary medical care, dental, or mental health providers and may be defined by geographic, demographic, or institutional criteria.

Abadio felt welcomed into the overall medical community in Salina once he began practice there. He noted that the NHSC does not pay a salary, so his compensation was the same as any other psychiatrist would receive in the same setting. The advantage was the reduction in medical-school debt, he said.

“If there was any drawback, it was the paperwork involved in documenting the numbers of patients you see, how many are on Medicare or Medicaid, and so on,” he said.

Abadio enjoyed working in a rural area. He still lives in Salina, even after taking a full-time job as a civilian psychiatrist with the U.S. Army 40 miles away at Fort Riley.

Must Practice General Psychiatry

Psychiatrists in the NHSC must meet the same qualifications as other physicians but must serve in areas specifically designated as having mental health professional shortages. They must also agree to practice as general psychiatrists during their period of service, even if they have completed fellowships in subspecialties such as child or geriatric psychiatry.

They must be board certified in psychiatry or have completed a residency program in psychiatry and have a full, permanent medical license from the state where they intend to serve.

At least 21 hours of the 40-hour work-week must be spent providing direct patient counseling during normally scheduled office hours in an ambulatory outpatient care setting, according to agency information. The remaining hours must be spent providing clinical services in alternative settings or performing practice-related administrative activities.

More information on the National Health Service Corps is posted at<http://nhsc.hrsa.gov/index.htm>.▪