By Judy E. Hall, PhD

Integrated Healthcare in the Community

Approximately 7,500 healthcare professionals work in 10,000 community health center sites in underserved areas across the US. Only a small portion of these professionals are psychologists. Many more are needed to serve the rural population due to the higher proportion of people who are at risk for mental and behavioral problems. These community health center sites provide a primary care safety net for people in underserved areas through an integrated healthcare delivery system. Properly staffed, they offer a solution to the healthcare crisis in areas where healthcare is most needed and where many of the 38 million additional lives under healthcare reform will be served.

Two things have occurred to promote psychologists’ involvement: the title health service psychologist was created to define the type of psychologist needed in the National Health Service Corps (NHSC); and an educational loan repayment program (LRP) was extended to qualified psychologists who worked in the NHSC. As of July 7, 2010, there were 679 psychologists taking advantage of the LRP, which offers $60,000 for a two year commitment and up to $170,000 for a five year commitment in any of the many locations across the US. One additional benefit: the LRP is exempt from federal income tax.

More recently, the Affordable Care Act (ACA) extended the support for rural Americans by providing an additional $11B over the next five years for these community health centers to offer comprehensive primary health care to medically underserved communities and vulnerable populations. The ACA also offers up to $1.5B over the same time period for the NHSC. While members of other professions (physicians, dentists, family nurse practitioners, nurse midwives and physician assistants) have access to scholarships as well as the LRP, currently psychologists only have access to the LRP.

All health service psychologists are eligible for the NHSC. Previously the program was restricted to only clinical or counseling psychologists working in CHCs; it now includes clinical and counseling psychologists who work in schools and specialize in serving the health care of older adults. Also new is an option for part-time employment (20-39 hours weekly for at least 45 weeks annually). NHSC approved sites include urban, rural, frontier communities, Indian reservations, tribal sites, Federal prisons or with the Division of Immigration Health Services, as long as the location meets the criteria for a health provider shortage area (HPSA). In addition, a solo or group partnership or practice, a hospital-affiliated primary care practice or a managed care network now may qualify if it can document adherence to the HPSA criteria.

The NHSC projects a field strength of 10,683 clinicians is needed in health service shortage areas by FY 2012, if Congress funds the program at the President’s request.  This means that more psychologists should be encouraged to apply for these opportunities, especially if they are trained in integrated primary care.  We asked Kristi Van Sickle, PsyD, who is chair of the APA Committee on Rural Health and a Registrant, to emphasize this opportunity.