The National Health Service Corps (NHSC) was created in 1972 with the purpose to bring primary healthcare to those in rural and underserved areas. The reason it exists is because health care provider jobs in inner-city, rural, and frontier areas were frequently passed over due to a variety of different issues including low income and geographical preference. The corps increases the number of primary care physicians by helping with loan repayment in return for service in specialties such as family medicine, general pediatrics and general psychiatry. Ensuring Children’s Access to Specialty Care (H.R. 1859) would expand the NHSC to include pediatric subspecialists and child psychiatrists who are currently ineligible for participation in this federal program.
As my colleague Dr. Abraham wrote in “The Pediatric Subspecialty Shortage” in February 2015, the shortage of health care professionals in rural areas is not limited to primary care. When a rural-based primary care physician discovers a condition beyond the scope of practice, s/he often has to refer the patient to a big academic center which may be 4 to 5 hours away or even in another state. In Dallas we oftentimes have patients tell us that they live 4 hours away and sometimes even farther. They can receive the specialty care in Dallas when they are here, but the patients often have medical problems that require frequent follow-up outside of the hospital.
Many pediatricians decide that a subspecialty career is not appropriate for them because of the additional time in training (3-4 years) without corresponding added income. This is highlighted in comparing pediatricians to internal medicine colleagues. For example, the average adult hematologist/oncologist earns $321,000 a year or almost 50% more than their pediatric colleagues for the exact same time spent in training and with the same loan burden.
Thus, helping to alleviate some loan burden would increase the incentive and support pediatricians who want to pursue additional training. The increase in pediatric specialists would improve access to care for medically complex and fragile children in rural areas.. The AAP has formally endorsed this bill so contact your local U.S. Representative to do so as well.
Pratik Patel, M.D.