HRSA
DC FLI Presentation
Michelle Simon ND PhD
May 4, 2012
Health Resources and Services
Administration (HRSA)
– HRSA is an agency of the US Department of Health and Human
Services (HHS).
– There are 6 bureaus and 10 regional districts that distribute funds to
states.
– HRSA is the primary Federal agency for improving access to health
care services for people who are uninsured, isolated, or medically
vulnerable.
– More than 1,100 health center grantees operate more than 7,900
community-based clinics in every state and territory, giving
geographically isolated or economically distressed people access to
preventive and primary health care.
– One of every 18 people living in the U.S. now relies on a HRSA-funded
clinic for primary care.
– Determine what the term “primary care” constitutes.
– Designate Health Professional Shortage Areas (HPSAs) for eligibility for
loan repayment programs.
Bureau of Clinician
Recruitment and Service (BCRS)
• The BCRS is the agency
responsible for most loan
repayment programs.
• BCRS coordinates the recruitment
and retention of health
professionals to work in medically
underserved communities.
• The NHSC falls within HRSA’s
Bureau of Clinician Recruitment
and Service (BCRS)
Department of Health
and Human Services
(HHS)
Health Resources and
Services Administration
(HRSA)
Bureau of Clinician
Recruitment and
Service (BCRS)
Native Hawaiian Health
Scholarship Program
NHHSP
Nursing
Scholarship
Program
Nursing
Education
Loan
Repayment
Program
NELRP
Faculty Loan
Repayment
Program
NHSC
SP
NSP
BCRS
FLRP
NHSC
SLRP
National Health
Service Corps
SCHOLARSHIP
PROGRAM
NHSC
LRP
NHSC
S2S
State Loan
Repayment
Program
National Health
Service Corps
LOAN REPAYMENT
PROGRAM
National Health
Service Corps
STUDENTS TO SERVICE
LOAN REPAYMENT
PROGRAM (PILOT)
HRSA Eligible Professions
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–
–
–
–
–
–
–
–
–
–
Primary Care Physician (MD or DO)
Dentist (DDS or DMD)
Primary Care Certified Nurse Practitioner (NP)
Certified Nurse-Midwife (CNM)
Primary Care Physician Assistant (PA)
Registered Dental Hygienist (RDH)
Health Service Psychologist (HSP)
Licensed Clinical Social Worker (LCSW)
Psychiatric Nurse Specialist (PNS)
Marriage and Family Therapist (MFT)
Licensed Professional Counselor (LPC)
Health Professional Shortage Areas
(HPSAs)
– HPSA’s: Originally created in 1978 to identify areas
in need of physicians and other health care
providers from HHS’s National Health Service
Corps (NHSC) programs, HPSA designation is now
used by a variety of federal programs—including
programs that provide grants for health
professions.
– HRSA’s Office of Shortage Designation (OSD)
develops shortage designation criteria and uses
them to decide whether or not a geographic area,
population group or institution is a HPSA.
Federal Loan Repayment Programs
• Function at three levels
– Federal:
• HRSA
•
•
•
•
Primary Care Loan Program (PCL)
Student to Service Program (NHSC S2S LRP)
State Loan Repayment Program (NHSC SLRP)
Loan Repayment Program (NHSC LRP)
• Indian Health Services Administration
• NIH and NCCAM
– Regional:
• HRSA distributes funds to 10 regional areas of the US.
– State:
• 2 existing programs, Washington and Oregon. Both receive
federal (HRSA) SLRP $, States provide matching $
ND’s and HPSA’s in the USA
The Geography and Distribution of Naturopathic Physicians in
the United States A Rising Profession Donald Albert, PhD, and Ferry
Butar PhD. . The Edwin Mellon Press. Lewiston. Queenstown. Lampter. 2006.
University of Texas
Analysis of ND geographic presence and diffusion trends;
impact of inclusion of ND’s in HPSA designations would
decrease total number of national HPSA’s.
Predicts diffusion from urban centered to rural areas as
profession grows to saturation
Rural retention
The potential impact of selecting medical students of rural origin was quantified by
Rabinowitz in a longitudinal study that evaluated the impact of the Physician Shortage
Area Program (PSAP) in the USA. Rural origin was the single variable most strongly
associated with rural practice (OR 4.2, 95% confidence interval [CI] 2.8–6.3)
Rabinowitz HK, Diamond JJ, Hojat M, Hazelwood CE. Demographic, educational
and economic factors and retention of physicians in rural Pennsylvania. Journal of
Rural Health 1999; 15: 212-218.
Rural origin is especially linked to the decision to choose a rural community as one’s
first practice location
Bowman RC. Continuing family medicine's unique contribution to rural health
care. American Family Physician 1996; 54(2): 471-4,479,483.
Rourke JT. Politics of rural health care: recruitment and retention of physicians.
Canadian Medical Association Journal 1993; 148(8): 1281-1284.
Barer ML, Stoddart GL. Toward integrated medical resource policies for Canada: 8.
Geographic distribution of physicians. Canadian Medical Association Journal 1992;
147(5): 617-623.
Strong evidence from various countries that ‘rural origin’ (or rural
background) is associated with rural practice
• Playford D, Larson A, Wheatland B. Going country: rural student
placement factors associated with future rural employment in nursing and
allied health. Australian Journal of Rural Health 2006; 14(1): 14-19
• De Vries E, Reid S. Do South African medical students of rural origin return
to rural practice? South African Medical Journal 2003; 93: 789-793.
• Laven G, Wilkinson D. Rural doctors and rural backgrounds: how strong is
the evidence? A systematic review. Australian Journal of Rural Health
2003; 11: 277-284.
• Easterbrook M, Godwin M, Wilson R, Hodgetts G, Brown G, Pong R et al.
Rural background and clinical rural rotations during medical training:
effect on practice location. Canadian Medical Association Journal 1999;
160(8): 1159-1156.
• Rabinowitz HK. Recruitment, retention, and follow-up of graduates of a
program to increase the number of family physicians in rural and
underserved areas. New England Journal of Medicine 1993; 328(13): 934939.
Rural and Urban Underserved Health Care
Survey
94% of Bastyr University naturopathic students answered yes
when asked if they would relocated to a rural or urban
underserved communities to practice in exchange for medical
school loan repayment.
Almost 60% of Bastyr students identified themselves as being
from rural communities, an indicator of potential retention rates
for ND providers maintaining practices in rural environments
after their scheduled service is complete.
Student Rural Interest Survey. Simon, M., Snider, P., et al. 2007. Bastyr University, Seattle, Wa.
Corresponding author Michelle Simon, ND, PhD. Seattle , Wa
206-399-5451. dr.michelle@earthlink.net . Survey conducted at Bastyr University
ND’s providing Primary Care to Underserved
Highlights
• Over 60 community, neighborhood and rural clinics for
underserved health care employ ND’s in USA
• WA: King County’s Health Point (2009): 160,000 patient
visits, estimated 50% were by ND’s
• OR: NCNM (Portland) 16,220 visits at community health
clinics, FQHC (9077 ND, 7146 LAc)
• AZ: Hamilton Elementary School Clinic, (low income)San
Carlos Apache Tribal Clinic Diabetes Prevention, Care
and Management
The way forward
• Pilot projects
– NHSC pilot project
– CMS pilot project
– Bureau of Health Professions (PCL)
• Coordinated campaign
– Congressional
– Agencies