COMMUNITY CLINICS: Federal Loan Cuts Threaten Staffing

      Cutbacks in a federal government program that offers health care workers a $50,000 bonus to practice in poor communities may hamper the recruiting efforts of community health centers that care for the poor and uninsured, the New York Times reports. Enacted in 1989, the National Loan Repayment Program has relied on a $30 million fund to attract health care providers to "remote towns and inner-city neighborhoods." At least 700 doctors, dentists, psychologists and other care providers have committed to two-year positions in urban and rural areas in hopes of repaying their student loans. But because HHS cut its budget "sharply" this year, the program has "exhausted its funds after making only a few dozen grants to new applicants," leaving many program participants without their repayment money. This year's budget shortfall is the "worst in the program's 11-year history," the New York Times reports. Some doctors have begun investigating whether they have legal recourse against the government, but federal officials say that since the providers sign contracts with individual clinics, the federal government has not reneged on any commitments. The program's authorization is set to expire Sept. 30, and prospects for reauthorization appear dim, as "few members of Congress are familiar with the program."

Fewer Doctors?
      The threat of losing authorization for the program has community health centers concerned, since specialist recruitment is already a "daunting task." Stephen Wilhide, chair of the National Rural Health Association committee, which is leading the reauthorization lobbying effort on Capitol Hill, said, "We use loan repayment as our primary recruiting tool. We could simply not get enough doctors without it." Dr. Colleen Wall-Hoeben, who is working in Wyoming as part of the program, said, "It doesn't make much sense to stay [at the rural clinic], earning at that low of a level, with the hope of someday getting the loan repayment. It's a lot of hard work, and there's more money to be made at other places." In the meantime, some clinics have been raising money to make up for the lost federal subsidies, but clinics' "fund-raising capabilities are limited" because many rely on government grants. Lobbying efforts secured a $4 million boost for the program in the House budget, but neither the Clinton administration nor the Senate have promised any funding expansion. While National Association of Community Health Centers officials are confident that the increase will make it into the program's final budget, many have said that it might not be enough to maintain the program (Winter, New York Times, 7/30).