Like many of my peers, I started medical school with idealistic dreams of providing compassionate care for poor patients. I thought being a physician was a noble profession and even discussing money, much less changing my career choices based on it seemed antithetical to that. A visit to the financial aid office quickly cured me of my naiveté. I was facing over $300,000 in debt and would be forgoing millions of dollars in income by choosing to practice primary care in an underserved setting. My dream suddenly felt like financial suicide.
Desperate for a way to keep my dream alive, I searched for scholarships. Even the most generous scholarships paled in comparison to the staggering cost of medical education. Eventually, I came across the National Health Service Corps (NHSC) Scholarship. The NHSC Scholarship is a federally funded program that covers tuition, living expenses and other academic costs (e.g., USMLE exams) of health professional students committed to primary care in underserved communities. Each year of scholarship funding results in an equivalent time commitment of serving in an underserved community so that a student who receives two years of scholarship funding has a two year commitment and someone who receives four years of funding has a four year commitment. Primary care is defined to include pediatrics, internal medicine, family medicine, psychiatry, and OB/GYN.
I was incredibly excited to learn about this program, but I was worried that the commitment might restrict my career choices in a way that would be a burden on me and my family. I did my research and discovered the following critical information:
1. The NHSC does not restrict choice of residency beyond requiring that the residency be in one of the five designated primary care specialties. Underserved sub-specialties (e.g., child and adolescent psychiatry) are permitted at the discretion of the NHSC.
2. NHSC-approved jobs are available in urban and rural settings. This was very important to me since I plan to practice in an urban setting and was concerned that only rural positions would be available. Eligible jobs are searchable online and I was relieved to see that many positions are available in virtually every major city in the country.
3. The service requirement must be carried out immediately after completion of residency and cannot be delayed for completion of any fellowships. This program is intended to increase the presence of primary care providers in underserved communities so although sub-specializing after completion of the service requirement is legal, it undermines the mission of the NHSC.
4. The scholarship program can be much more generous than the loan repayment program. For medical students, the loan repayment program may pay up to $120,000 in exchange for three years of service. Through the scholarship program, I receive over $80,000 per year; meaning that over a two year period I would receive over $160,000 in scholarship funding in exchange for two years of service.
5. I have a passion for public health, and I am currently pursuing a master of public health degree in health policy. I was ecstatic to discover that the NHSC service requirement may be carried out through the Public Health Service Commissioned Corps which allows opportunities for involvement in crisis response (e.g., Ebola, Zika), health policy and public health leadership in addition to primary care in underserved communities.
The NHSC allowed me to pursue my dreams without the debilitating burden of debt. I have met so many fellow medical students who faced the same situation I faced, but did not know about the NHSC or had misconceptions about it. Lack of visibility and misinformation about the program are serious problems, but lack of funding is clearly the greatest barrier.
In 2016 the NHSC received 2,275 applications to its scholarship program, but only gave out 213 awards; a 9.4 percent acceptance rate. They expect to give out even fewer scholarship awards in 2017. If we truly value the health of our nation’s poorest and most marginalized communities, we must provide a financially sustainable path for passionate health professionals to serve those communities. The NHSC is one of the most effective tools we have to increase access to healthcare for our nation’s underserved communities, and we cannot afford to shortchange it. A serious commitment to serving the underserved means expanding the NHSC and making it more visible so that our nation’s brightest and most dedicated health professionals can pursue their dreams without the threat of crushing debt.
Asaad Traina is a medical student.
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