American Recovery and Reinvestment Act and the expansion and streamlining of the National Health Service Corps: a great opportunity for service-minded family physicians.

President Obama has challenged Americans to improve their communities and country through service to others. There are many ways one can serve others but few ways one can do this and benefit financially from one’s service. The National Health Service Corps (NHSC) offers physicians and others in health care a way to do exactly this. With a $300 million expansion from the American Recovery and Reinvestment Act and an updating of its programs, the NHSC now offers more and better opportunities than ever for rewarding and well-compensated service. The NHSC has long been the premier federal initiative directly supporting the primary health care practitioner needs of underserved communities. The 40-year-old NHSC’s Scholarship Program, its longest running program, pays tuition and other education expenses for health professions students who contract to serve in designated high-need communities after their training. The NHSC’s predominant current initiative is its Loan Repayment Program, which offers a $50,000 education loan repayment enticement to practitioners who have completed their training and serve for 2 years in eligible underserved areas. The full value of this enticement, which practitioners receive on top of their regular salary from the clinics where they work, is closer to $65,000, because NHSC funds are exempt from federal income taxes and participants would otherwise have to repay their education loans with personal, after-tax earnings. This improves the starting annual salary for work in a health center from, for example, $110,000 to a value of approximately $142,000, making the option of work in an underserved area financially attractive for those carrying education loans. And the option to extend the loan repayment agreement for a third and fourth year and beyond for a $35,000 loan repayment amount for each extended year makes the deal even more attractive. With loan repayment, service does not demand financial sacrifice of practitioners. As of this past spring, 2950 NHSC clinicians were working in underserved communities, including 2394 who were receiving loan repayment support and 556 who had received scholarship support when they were students. In its early days, the NHSC limited its awards to the primary care disciplines and principally physicians. Now, its workforce has diversified to include mental health and dental health workers. However, primary care remains the NHSC’s focus, and family physicians have always constituted the core of the NHSC’s primary care and physician workforce. During its history, 5620 family physicians have served in the NHSC, including 703 who currently serve. The NHSC’s annual appropriation and, consequently, the size of its workforce have risen and fallen over the decades with Congress’s fluctuating This article was externally peer reviewed. Submitted 16 June 2009; revised 16 June 2009; accepted 23 June 2009. From the Department of Family Medicine and Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill (DEP); the Department of Family Medicine, University of Wisconsin, Madison (BJC); the Upper Cardozo Community Health Center, Unity Health Care, Inc, Washington, D.C. (LFP); the Physician Assistant Program, Hofstra University, Hempstead, NY (TVH); and Family Medicine Residency, San Joaquin General Hospital, Stockton, CA (TTN). Funding: none. Conflict of interest: All authors serve on the National Advisory Council of the National Health Service Corps. Corresponding author: Donald Pathman, MD, MPH, Department of Family Medicine, UNC CB# 7595, University of North Carolina, Chapel Hill, NC 27599-7595 (E-mail: [email protected]).