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
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.
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.
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>.▪