If I had to do it over again, I would have just worked in private practice and paid off the amount myself. Of course if you want them to pay off more than 50K, then you must sign up for more punishment after your time is up.

The job choices are very poor, usually extremely rural locations or poor urban environments. When interviewing for the selected jobs, you are at an disadvantage because absolutely no one interviews at these jobs unless they are NHSC and they offer you low salary, little to no benefits and a punishing work load. They think you are their slave for two years and treat you accordingly.

As a physician, you are responsible for everything but have no authority. All the staff report to the non-clinical CEO/CFO and feel they don’t have to listen to you. Many of the staff’s attitude is ….I’m not here to work. You find yourself doing your job and everyone’s as well. You have liitle to no support from “upper level” supervisor(s) and many of them relish in being above the phyisician and putting the doctor in their place.

Those two years were the most stressful and demoralizing time thus far in my career. Everyday you fight a battle. After my 2 years, I had to take a mental break, and I also needed time to remove all the knives that were embedded my back. My salary was never 125K, no where near.

While I enjoyed the patients and felt like I was doing something significant, the price was too high mentally and emotionally. I changed sites (hard to do in NHS contract) to find a better working environment, but it was worse.

Every patient is a “train wreck” and all have significant social issues that you must help them with before even thinking about treating their medical problems. There are very few specialist that will take them on so as a primary doc you are managing complicated problems you would normally refer.

The problem with recruiting at many of these sites is the extremely poor treatment of physicians. Why work a site where you make less money than your peers, work much harder and get treated poorly.

I made a decision during the two years to live like a hermit and pay off the rest of my loans myself. Never again will I be “owned” and work somewhere that was so unhealthy. The sad thing is I enjoyed the patients and what I was doing and would have stayed in that line of work. Unfortunately, the environment for phyisicans is so toxic at many of these places, you can not stay.

But if you would be turned off by working in an incredibly inefficient environment that managed primarily by non-clinicians who care most about maximizing patient visits in order to boost revenue and who care little about and have no clue how to assess/measure quality of care, then you might want to consider other options.

These FQCHCs are having money pumped into them to provide incredibly inefficient care, and they end up having a tremendous competitive advantage (due to enhanced Medicaid reimbursement/FTCA) over private practitioners practicing in the same communities.

I pity the NHSC scholars who have no choice but to work in these settings.

But that is not what it is really like working in a public clinic serving the poor for most people. Some people can just get their cookies from the grateful and needful patients with out having their soul slowly killed by the equally large troops of manipulative drug addicts, disability malingerers, hostile, distrustful, non-compliant, and entitled.

The marketplace will tell us what the job is really worth when we see what salary they have to pay to fill the positions. Maybe it is less than average because of the emotional rewards. Maybe it is more than average because of the emotional drain.

In my community private school teachers make a lot less than public school teachers–yet they get great teachers doing a great job because it is not just about money. Compliant students, friendly parents,a safe working environment, and freedom from silly rules and bureacracy are all worth something.

if they can’t fill the position, isn’t it simple enough? just keep raising the bar until someone bites (duh!)

for those who think it’s a very good living, they can go out and invest 12 yrs of their life & $300k, come out and take those jobs (assuming they are competitive enough academically). Undoubtedly they will still be available, as these kinds of salaried jobs typically have a very high turnover rate, attracting those right out of residency for a couple of years max.

As far as “getting more people interested in providing care to the underserved,” what a ridiculous statement. I remember just starting private practice, and meeting with the Cigna field rep for a “site visit” as part of the credentialling process. I chatted w/her about the low reimbursements nowadays, and her take on it was “this is really going to attract the right kind of people into medicine now, those that want to help people”!!!

I guess what she meant is “stupid people with no economic sense”.