The National Health Service Corps: a partner in rural medical education

Within the United States Public Health Service, the programs of the Bureau of Health Care Delivery and Assistance have played an important role in improving access to primary care services in rural America. In part, this has been accomplished through the administration of grants to assist in establishing systems of care and the assignment of National Health Service Corps (NHSC) health professionals. From a peak of over 1,600 NHSC-obligated scholarship recipients available for service in 1985, the number of available obligated practitioners has decreased to around 120 in 1990. A main focus of the NHSC has, therefore, necessarily changed from the placement of obligated health professionals to the recruitment of volunteers and increased emphasis on the retention of current providers. The systems of care that have been most successful in their retention efforts have been: group practices, composed of a nucleus of individuals who had been at the site for three to five years; community-oriented, utilizing non-physician providers as part of the delivery team; and those committed to continued provider education. The NHSC has initiated programs to help increase the likelihood that medical students will choose a primary care career and spend all or part of that career serving those most in need. These programs include the National Medical Association Minority Mentor Network, the American Medical Student Association Health Promotion/Disease Prevention Program, the Commissioned Officer Student Training and Externship Program, and the American Academy of Family Physicians Residency Advocate Program. To meet the future needs for access to care in rural America, partnerships with academic centers must be enhanced and expanded.