Growth and changes in the National Health Service Corps (NHSC) workforce with the American Recovery and Reinvestment Act.

BACKGROUND From March 2009 through February 2011, the National Health Service Corps (NHSC) received a $300 million supplement through the American Recovery and Reinvestment Act to grant more loan repayment awards to clinicians who agree to work in underserved areas. This study assesses how this unprecedented funding increase affected the size, composition, and location of the NHSC's workforce. METHODS This was a descriptive, time-linked, observational study using NHSC administrative data. Main outcomes were growth and changes in disciplinary composition of the NHSC's workforce and in its rural/urban and state-to-state distribution. RESULTS During the Recovery Act period, the NHSC's workforce increased by 156%, from 3017 to 7713 clinicians. Mental health clinicians grew most numerically (210%) and as a proportion of the NHSC's workforce (from 22.7% to 27.4%). Primary care clinicians grew least and decreased as a proportion of the NHSC's workforce to 58.9%; dental health clinicians remained steady at approximately 13.5%. Among individual disciplines, physicians decreased most as a component of the NHSC's overall workforce, from 38.6% to 26.7%, whereas the proportion of nurse practitioners grew most, from 10.1% to 16.0%. Proportions of the NHSC's workforce serving in rural areas changed only modestly. NHSC clinician numbers grew most in states with the lowest NHSC clinician-to-poverty population ratios before the Recovery Act. CONCLUSIONS With Recovery Act funding, the NHSC's workforce become far larger and more diverse than ever and more evenly distributed across states. The NHSC should now set targets and be more deliberate in managing its growth across disciplines and where its clinicians serve.