A nurse demonstrates how blood pressure is taken at Turning Point Center in Jeffersonville. The center is a substance abuse and mental illness inpatient facility run by LifeSpring Health Systems. Provided image
A map showing Indiana’s primary care health professional shortage areas and populations. Most rural counties are considered a shortage area, as well as areas of Indianapolis and Fort Wayne. Indiana Department of Health
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Rob Ryan wanted to work in Indiana after earning his degrees in school psychology and community counseling. But with over $100,000 in student debt, it seemed unlikely he’d find a job in the state that paid enough to keep up on his loans.
That all changed when he learned about the National Health Service Corps. Since 1972, the federal program has enticed health professionals to underserved areas by offering to pay off student loans. Today, the program promises to pay $50,000 for every two years served working in rural, urban or poor areas.
Around 2005, Ryan applied to the program and was placed at the Bowen Center in Warsaw, which today provides mental-health services, primary care and life-skills coaching in 31 counties.
In around six years, his student debt was gone. But Ryan never left the Bowen Center. Today, he serves as its CEO and president.
“I came here because this was someplace to get my loans paid,” Ryan said. “By the time that happened, I was invested in the culture of Bowen Center, I was invested in the community and my reputation was built here.”
The National Health Service Corps has steadily grown over the decades to attract and retain more and more doctors, nurses, dentists, counselors and other professionals to medical deserts across the country in desperate need of services.
The largest expansion came during the pandemic, when the federal government poured $800 million in COVID relief money into the program. In Indiana, the funding was a shot in the arm to community health facilities that provide care to patients regardless of insurance coverage or their ability to pay.
But now, the funding that Hoosier clinics say has bolstered their services in the face of a national shortage of healthcare workers is set to expire in September.
With a split Congress that’s just weeks away from allowing the U.S. to default on its debts, the program’s future is hanging in the balance. That’s despite the fact the program has found rare bipartisan support from lawmakers who say they’re grateful for the void corps members fill in rural and needy communities.
In Indiana, federal funding in 2019 allowed 78 workers to enroll in the program. With the extra money, that number jumped to 220 in 2021 and 185 in 2022. Nationwide, just over 20,000 people were corps members last year — up more than 50% from 13,000 people in 2019.
At LifeSpring Health Systems, a Jeffersonville-based provider with over 20 facilities across southern Indiana, the extra funding has allowed 16 health care workers to receive loan repayments. Almost half of those are nurse practitioners or physicians. The others are licensed clinical social workers.
Before the COVID relief money, the health system usually only qualified for six or seven corps members, according to Mary Roby, vice president of human resources.
Although the program does sometimes attract new workers, she explained, the biggest perk is retaining health professionals who want to help underserved patients but can’t afford a low-paying job due to crushing student debt.
“I do think it helps,” Roby said. “I think some of the people we have would not be here if they didn’t have the loan repayment.”
That’s the case for Eric Yazel, the chief medical officer at LifeSpring. He’s worked at the health system for years, but has never been able to put a dent in his $160,000 student debt.
The 47-year-old doctor explained he has a heart for working with underserved populations, but his looming loans have always forced him to consider moving to a private, higher-paying position out of state.
That all changed when he qualified for the National Health Service Corps last year and received his first loanrepayment check.
“It allows me the freedom to take care of the populations that need me the most and who can benefit the most from my services without worrying about that debt now,” Yazel said.
At the Maple City Health Care Center in Goshen, the program has helped retain a midwife, dental hygienist and nurse practitioner. Nearly three-fourths of the clinic’s patients are Hispanic. Many are immigrants with no access to insurance or other healthcare options, according to Rocio Diaz, communication outreach coordinator.
The clinic has its own loan repayment program to help staff, but the expansion of the National Health Service Corps has allowed it to spend less out-of-pocket, which means more money to provide services, Diaz explained. Those services will take a hit if the extra funding goes away.
“It definitely would be more money that we would have to pay out in the long run, as opposed to having the program cover the majority of that,” she said.
Bowen Center CEO Ryan urged federal lawmakers to continue the expansion of the service corps, which has been a lifeline when attracting and retaining counselors, behavioral health specialists and others to his clinics.
The increased funding will be even more crucial in the coming years as the nation’s dearth of healthcare workers is projected to worsen. That will leave the hundreds of thousands of Hoosiers in underserved areas with few options for basic healthcare unless more providers are enticed to Indiana by the program, Ryan explained.
“By not funding this $800 million, the government is essentially saying, ‘You know what? You have enough people,’” he said. “We all know in our gut that we need more. That’s what’s going to get cut with the increased funding going away.”
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