05.24.24

Durbin, Rubio Urge Health Resources And Services Administration To Revise NHSC Application Process To Address Health Care Workforce Shortages

In the letter, the Senators ask for flexibility in the National Health Service Corps application timeline, to encourage more doctors, dentists & other health providers to serve in rural & urban communities in need

CHICAGO – U.S. Senate Majority Whip Dick Durbin (D-IL) and U.S. Senator Marco Rubio (R-FL) today sent a letter to Health Resources and Services Administration (HRSA) urging a revision to the National Health Service Corps (NHSC) application process to make it more accessible and attractive to all stakeholders as the United States faces a health care workforce shortage.  More than 21,000 primary care, oral health, and behavioral health practitioners across the United States participate in this program and treat more than 20 million patients each year, many of whom are low-income or uninsured. 

The Senators wrote, “Currently, the application cycle opens annually in the spring, with awards issued in the fall.  This once per year window, coupled with the requirements of the application, does not adequately reflect the sequencing of graduation cycles—and limits the incentive that NHSC could offer. Those who graduate in late May or June and have a job offer pending would have to wait more than a year to apply and ultimately receive NHSC loan repayment—effectively meaning they could be working three years to receive two years of loan repayment.”

In the letter, the Senators encourage HRSA to revise its application process to provide additional flexibilities that would help make the NHSC more accessible and attractive to all stakeholders.  HRSA has experience previously offering a rolling application cycle for the NHSC, and in the letter, the Senators encourage the agency to consider reinstating this process, or allowing for multiple application cycles in a given year.  If that flexibility is not feasible, the Senators write that HRSA should consider alternative options, such as allowing for provisional applications to be submitted with awards only made contingent upon proof of valid licensure—as is already done on a limited basis for clinicians who are in residency programs. 

The Senators concluded, “The NHSC is one of the most effective federal tools to encourage desperately needed health care providers to serve in rural and urban areas facing shortages of doctors, nurses, dentists, and behavioral health providers.  But the current structure of the application cycle risks missing new graduates each year who may be interested in serving in the NHSC but cannot wait for the once-a-year cycle to open and practice elsewhere instead.”

Durbin and Rubio previously introduced bipartisan legislation to provide historic investments in the NHSC scholarship and loan repayment program to address health workforce shortages throughout our country.  The Restoring America’s Health Care Workforce and Readiness Act includes a three-year reauthorization that would more than double the mandatory funding, which will expire on December 31, from the current annualized rate of $364 million up to $825 million in Fiscal Year 2026 (FY26). 

Durbin secured a historic $1 billion in scholarship and loan repayment funding for NHSC and Nurse Corps in the American Rescue Plan to recruit more doctors, nurses, dentists, and behavioral health providers to underserved rural and urban areas.  The NHSC addresses these workforce shortages and health disparities by enticing promising students from diverse backgrounds into health careers in underserved communities by providing scholarship and loan repayment funding in exchange for a service commitment in an urban or rural area.  Across Illinois, more than 935 clinicians with the NHSC serve in community health centers, hospitals, and other high-need care settings. 

Durbin and Rubio previously introduced the Strengthening America’s Health Care Readiness Act, legislation that provides a historic investment in the NHSC, Nurse Corps, and National Disaster Medical System (NDMS) programs to bolster health emergency surge capacity and restore the pipeline of physicians, nurses, and other health professionals.

The Restoring America’s Health Care Workforce and Readiness Act is endorsed by the: Association of Clinicians for the Underserved, National Association of Community Health Centers, American Medical Association, American Hospital Association, American Dental Association, American Academy of Family Physicians, PA Education Association, Council on Social Work Education, Illinois Health & Hospital Association.

Full text of the letter can be found here and below:

May 24, 2024

Dear Administrator Johnson:

We write to draw your attention to an aspect of the National Health Service Corps (NHSC) application process that may pose challenges for prospective participants, current clinicians, and eligible health care sites seeking to recruit these providers. 

We are strong supporters of the NHSC scholarship and loan repayment programs, and recognize its meaningful impact and success in increasing the health care workforce and recruiting health care clinicians to health professional shortage areas to care for underserved populations.  More than 21,000 primary care, oral health, and behavioral health practitioners across the United States participate in this program and treat more than 20 million patients each year, many of whom are low-income or uninsured.  Congress has increased funding in recent years for the NHSC, recognizing the significant health workforce shortages facing our country.

Currently, the application cycle opens annually in the spring, with awards issued in the fall.  This once per year window, coupled with the requirements of the application, does not adequately reflect the sequencing of graduation cycles—and limits the incentive that NHSC could offer.  Those who graduate in late May or June and have a job offer pending would have to wait more than a year to apply and ultimately receive NHSC loan repayment—effectively meaning they could be working three years to receive two years of loan repayment.  This rigid, singular application window is exacerbated by the requirement to have a valid state license at the time of application, meaning new graduates who have a conditional offer of employment and anticipate receiving such licensure miss an opportunity to apply. 

The specifics of this timing pose challenges to prospective clinicians and health care facilities, because—despite the NHSC’s intent and success in enticing providers to shortage areas—there remains a relative incentive to practice elsewhere that can offer more favorable compensation without such strict timing parameters.  In many circumstances, clinicians effectively are asked to take a leap of faith, and work in an eligible site in hopes of obtaining loan repayment more than a year later.  But for many, that risk is too great to pursue service via the NHSC. 

We encourage HRSA to revise its application process to provide additional flexibilities that would help make the NHSC more accessible and attractive to all stakeholders.  HRSA has experience previously offering a rolling application cycle for the NHSC, and we strongly encourage the agency to consider reinstating this process, or allowing for multiple application cycles in a given year.  If that flexibility is not feasible, then HRSA should consider alternative options, such as allowing for provisional applications to be submitted with awards only made contingent upon proof of valid licensure—as is already done on a limited basis for clinicians who are in residency programs. 

The NHSC is one of the most effective federal tools to encourage desperately needed health care providers to serve in rural and urban areas facing shortages of doctors, nurses, dentists, and behavioral health providers.  But the current structure of the application cycle risks missing new graduates each year who may be interested in serving in the NHSC but cannot wait for the once-a-year cycle to open and practice elsewhere instead. 

Thank you for your consideration of this request.  We look forward to your response.

Sincerely,

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