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In bad economy, more docs and nurses trade debt for service

Sarah Baker drives 130 miles round-trip every weekday from her home in Bismarck, N.D., to her job as the sole provider of primary health care in McClusky, N.D. -- population 500.

“I’m it,” says the 49-year-old family nurse practitioner, whose duties have ranged from an office visit for a 2-day-old newborn to a surgical session with a 75-year-old man who nearly lost an ear in a fall down an elevator shaft.

“I give them their flu shots, I give them their shingles shots,” she said. “I know I’ve kept some of them out of the hospital.”

Baker has held her position at the Northland Community Health Center for three years, thanks in large part to a growing federal program that will pay off some $34,000 in nursing school debt in exchange for her rural work.

She’s a member of the National Health Service Corps, which has more than tripled its numbers in the past three recession-stricken years, U.S. Health and Human Services department officials announced Thursday. The program helps would-be primary care doctors, nurses, dentists and other health care providers pay for training -- and repay medical debt -- in exchange for working in rural and medically under-served areas.

Since 2008, the number of NHSC members has climbed from about 3,600 providers serving some 3.7 million patients to more than 10,000 clinicians serving some 10.5 million patients, HHS officials reported.

“Thanks to the National Health Service Corps, more Americans can see a doctor and get the health care that they need,” said Health and Human Services Secretary Kathleen Sebelius.

At the same time, health professionals themselves have gotten a helping hand with the high costs of medical training.

That’s an important boost, especially for would-be primary care providers in a down economy, said Dr. Amy McIntyre, 29, who was a NHSC scholar while attending the Alpert Medical School at Brown University in Providence, R.I., and is now in her third year of residency at the Family Medicine Health Center in Boise, Idaho.

Students of all kinds, even medical students, have needed extra assistance with rising tuition. And the downturn has made it even more difficult for rural and under-served areas to attract health care providers to their clinics and hospitals, health experts say.

Next year, with NHSC help, McIntyre hopes to find her first job as a primary care doctor at a community health center in the rural Northwest.

She estimates the program paid for about $100,000 in medical school tuition, a huge boon in a country where the average med student graduates with median debt of about $160,000, according to the American Association of Medical Colleges.

The program essentially allows primary care doctors, who are paid less than specialists, to work in places that need them most, McIntyre said. In 2010, for instance, family care doctors were paid a median salary of $208,861, compared with a median salary of $402,000 for cardiologists and $500,672 for orthopedic surgeons, according to the American Medical Group Association.

Health workers in the program receive full salaries, but they're working in places that otherwise have a difficult time attracting primary care providers for a variety of reasons ranging from remote locations and scarce resources to very disadvantaged patients.

Idaho, for instance, where McIntyre works, ranks last in the U.S. with only 76 primary care doctors per 100,000 population, according to the United Health Foundation. That compares with Massachusetts, which has 191 primary care providers per 100,000 population.

“Programs like National Health Service Corps match dedicated primary care providers with communities in need, when otherwise forces in our health care system often drive providers away from our communities,” said McIntyre.

The program helps place health care providers at some 17,000 under-served and rural sites across the U.S. Though they’re free to leave after their required service is complete, some 82 percent of NHSC clinicians stay in the high-need areas where they start, HHS officials said.

This year’s NHSC program includes some 5,418 awards totaling $253 million for loan repayments through the Obama Administration’s Affordable Care Act, the American Recovery and Reinvestment Act and annual appropriations. About 62 percent of eligible applicants were accepted.

In addition, some 247 scholarship awards totaling $46 million were paid for through the Affordable Care Act. Only about 20 percent of eligible applicants were accepted.

Still, demand for the program is even higher. Applications have jumped 500 percent for the loan repayment program and 600 percent for the scholarship program since 2008, HHS officials said.