FEATURING: Tim Starkey, MBA, FACHE, Great Salt Plains Health Center, Cherokee, Oklahoma



Primary care is the cornerstone of effective and efficient health care that meets the needs of patients, families, and communities. People who receive regular care from primary care providers are generally healthier than people only receive episodic care.i The federal National Health Service Corps (NHSC) program is focused on improving access to primary care providers for the nation’s underserved populations. The NHSC was created to “improve the delivery of health services to persons living in communities and areas of the United States where health personnel and services are inadequate.”ii

Today the NHSC offers loan repayment to new providers who agree to practice in a federally-designated shortage area and scholarships to medical students who agree to serve in a shortage area after their residency program. By the end of 2013, 42 years after its founding, the NHSC had placed more than 44,000 health professionals in shortage areas. NHSC clinicians have expanded access to high-quality health services and improved the health of millions of underserved people.iii

The NHSC is funded by the Health Resources and Services Administration (HRSA) within the U.S. Department of Health and Human Services. HRSA places NHSC personnel based on a scoring system that ranks areas by need – including physician to population ratios, infant mortality and other key health indicators.


The need for these primary care physicians is particularly high in both densely populated cities and rural areas. One state with a particularly strong need for services provided by the NHSC is Oklahoma. Oklahoma has the second highest rate of death due to heart disease in the nation and is ranked seventh in the nation for cancer deaths.iv,v,vi,vii Despite the significant health needs, Oklahoma has shortages of both primary care physicians and public funds.viii

Tim Starkey is the CEO of the Great Salt Plains Health Center in Cherokee and relies on the NHSC to recruit primary care providers to his center in rural Oklahoma. “This funding helps increase access to high quality health care,” said Tim. “With the NHSC, more people will be able to get the affordable care they need in their local communities.”

Unfortunately, federal sequestration cut federal funding of the NHSC by $15 million, or 5.1 percent in 2014. This cut negatively affected hundreds of providers that had applied to work in a shortage area with the promise of loan
ix As a result of sequestration, NHSC awards were denied in areas that had once been able to count on the program. Health centers, like Great Salt Plains, that had relied on the NHSC to recruit primary care providers to underserved communities suddenly saw their primary recruitment tool eliminated.x Tim and his health center were among those directly affected by budget cuts. As Tim explained:

Our health profession shortage area (HPSA) score is 14; this score has allowed the clinic to use the NHSC loan repayment program several times in the past five years alone to recruit providers. This time, Great Salt Plains Health Center was not one of the funded facilities. We simply provide as much
care as our system can handle. Anything that takes financial resources away impacts the level of access to care we
can provide.xi


Should sequestration continue, Tim isn’t sure how his center will absorb the cuts. He explained the impossible choices the organization is grappling with now:

One of our physicians had asked Great Salt Plains Health Center to recruit a doctor to work as a partner here in Cherokee. After a year of looking, there was no doctor available to work in Medford. At that point, I decided to look for a Nurse Practitioner instead. Both the physician and practitioner were assured that they could apply and receive loan repayment through the NHSC; both providers were denied due to our HPSA score after the sequestration cut.
Rather than rein in costs, sequestration payment cuts to health care providers will reduce access to needed care, increase the risk that preventable health conditions will develop or worsen, and increase the chance that patients will ultimately require more intensive and expensive care.
I simply want to express the impact on rural health care in Northern Oklahoma. Future recruiting efforts will be much more difficult, if not impossible, without the availability of NHSC loan repayment. I urge Congress to do everything within its power to provide adequate funding for loan repayment programs through the NHSC.

Association of Clinicians for the Underserved

i. “Key Facts: Poverty and Poor Health.”Health Poverty Action. N.p., n.d. Web. 27 Mar. 2014.

ii. “Mission and History.” Mission and History. U.S. Department of Health and Human Services - National Health Service Corps, n.d. Web. 22 Apr. 2014.

iii. “Health Resources and Services Administration.” Department of Health and Human Health Services . N.p., n.d. Web. 25 Mar. 2014.

iv. American Cancer Society. Cancer Facts & Figures 2010. Atlanta: American Cancer Society; 2010.

iv. Centers for Disease Control and Prevention, National Center for Health Statistics. Compressed Mortality File 1979-1998. CDC WONDER Online Database, compiled from Compressed Mortality File (CMF) 1968-1988 Series 20 No. 2A, 2000 and CMF 1989-1998 Series 20 No. 2E, 2003

vi. Centers for Disease Control and Prevention, National Center for Health Statistics. Compressed Mortality File 1999-2007. CDC WONDER Online Database, compiled from Compressed Mortality File 1999-2007 Series 20 No. 2M, 2010.

vii. Newschaffer, C.J., Longjian, L., and Sim, A. (2010). Cardiovascular Disease. Remington, P., Brownson, R., and Wegner, M. Chronic Disease Epidemiology and Control (pp.383-428). Washington, DC: American Public Health Association.

viii. “Oklahoma health insurance.” Health Insurance Resource Center. (accessed March 21, 2014).

ix. For a comprehensive description of community health centers see the Kaiser Family Foundation, Community Health Centers: The Challenge of Growing to Meet the Need for Primary Care in Medically Underserved Communities, March 2012

x. Redhead, C. Stephen . “Appropriations and Fund Transfers in the Patient Protection and Affordable Care Act.”Congressional Research Service. N.p., n.d. Web. 25 Mar. 2014.

xi. “Recruit Providers.” Recruit Providers. N.p., n.d. Web. 24 Mar. 2014.