News Release: Faculty Experts

May 13,  2009

Expert: Grow the U.S. National Health Service Corps

From Woodruff Health Sciences Center News

A commentary written by Michael M. E. Johns, MD, chancellor of Emory University, and Jonathan F. Saxton, JD, in the May 13, 2009, Journal of the American Medical Association suggests the National Health Service Corps (NHSC) mission could be recast to play a more central role in modeling a team approach to wellness, prevention and chronic care programs.

“After all,” say the authors, “the NHSC represents decades of accumulated experience in managing known issues in structuring and delivering preventive, primary and chronic care.”Pointing to President Barack Obama’s call for renewal and expansion of volunteerism, Johns and Saxton say the initiative presents the health professions with an extraordinary opportunity to renew health professions' basis in charity while modeling service, wellness and chronic care programs essential to health care reform. “The NHSC could be the best place to start,” they say.

The authors note in the commentary that the NHSC knows how to identify communities in need that can leverage community resources to support care teams and programs; knows how to identify and recruit primary care team members, including physicians, nurse practitioners, dentists, mental and behavioral health professionals, physician assistants, certified nurse-midwives and dental hygienists; knows how to train individuals to help provide quality, culturally competent care to those most in need; has deep experience in quality care delivered by teams of clinicians working together to treat patients through health promotion, disease prevention and continuity of care factoring in medical, dental, mental and behavioral, and cultural aspects; and has important experience in providing services with salaried caregivers as well as through traditional fee-for-service mechanisms.

Since 1972, the NHSC, part of the Health Resources and Services Administration, has been providing scholarships and student loan repayments to physicians and other clinicians who agree to practice for a period in underserved communities in the United States. The NHSC enables invaluable service opportunities and financial support for primary care clinicians, while providing underserved communities with access to essential health care services. Yet there is both the opportunity and imperative to do more.

“President Obama's commitment to a reformed health care system appears to be as strong as his commitment to renewing voluntarism and service,” say Johns and Saxton. “His agenda for reform reflects a convergence of thought leadership over the last decade on the need for universal coverage (however that might be achieved) and the need for "value-driven" systems of care. This commitment to reform and responsibility means that there are many pressing issues to address and questions to answer.”

Chronic diseases are the major cause of death and disability worldwide, responsible for 59 percent of deaths and 46 percent of the global burden of disease. How to practice good chronic care management is just beginning to be understood, according to the authors.

“Despite advances in the effectiveness of prevention and treatment for many diseases, patients frequently do not receive the care they want or need,” report Johns and Saxton. “The NHSC could innovate in structuring rural practice environments, appropriate technologies, and other factors for improving compliance with evidence-based care standards.”

The authors suggest that the NHSC program and its budget should be expanded so that it can offer significantly more placement opportunities and longer placements, and enhance its capacity to evaluate and share the results and innovations in its clinical and related programmatic initiatives.

Additional resources, they say, would enable a far larger number of health professionals the opportunity to perform national service, to serve underserved communities, and to deepen the opportunities for the NHSC to be a prime learning laboratory for the reform and improvement of health care.

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