Does the National Health Service Corps Improve Physician Supply in Underserved Locations?

In 1970 the National Health Service Corps (NHSC or Corps) was created as part of the Emergency Health Personnel Act. The goal of this agency is to provide health personnel, most often physicians, to communities that are deemed “medically underserved.” The Corps has provided an important subsidy to medical students by providing access to full scholarships covering tuition and fees in exchange for subsequent service in locations designated by the Corps. This paper investigates two issues not examined in previous evaluations of the NHSC. First, although most studies have found that the NHSC physicians are more likely than non-enrollees to leave the community in which they initially locate, the techniques used commonly fail to recognize that the decision to enroll in the NHSC and the decision of where to locate in subsequent years may be endogenous. The results of this study are consistent with previous findings that participation in the Corps decreases the tendency to stay in the original location, even when controlling for self-selection into the program. Second, a broader measure of programmatic success is proposed. If enrollees do not remain in their initial practice locations but subsequently locate in other communities with low access to primary health care, then the program has increased access to health care in medically underserved communities. An accurate measure of the program’s effectiveness should incorporate this benefit. Data obtained from the American Medical Association [1997] allow the geographical positioning of every physician in the United States for 1981, 1986, 1991, and 1996. By comparing locational choices of NHSC enrollees with those of non-enrollees, the extent to which these federal programs decrease inequities through subsequent actions (that is, after the completion of the subsidy) can be determined. Two main questions are pursued in this paper: