Commentary from the front lines: improving the National Health Service Corps' use of nonphysician medical providers.

Migrant and community health centers, funded by the Bureau of Primary Health Care (BPHC), provide a vital service to rural communities by ensuring accessible and affordable medical care. One way the BPHC helps communities staff these centers is through the National Health Service Corps (NHSC). In this program, medical professionals receive scholarships or educational loan repayment in return for practicing in medically underserved regions where migrant and community health centers are located. Nurse practitioners, physician assistants, and nurse midwives (nonphysician providers) are a recent addition to the NHSC, and they offer the advantages of reduced cost and a strong primary care orientation. In this commentary, the authors recount their own experiences as a nonphysician provider NHSC scholarship recipient and spouse, and they identify five underlying problems with the current system, which lead to poor nonphysician provider retention. (1) Too few potential placement sites are made available from the outset. (2) NHSC placement deadlines do not allow enough time for making the best possible placement. (3) Many community health centers are not highly supportive of or invested in the program. (4) NHSC efforts to support the development of local medical providers from within underserved regions are inadequate. (5) NHSC officers working with nonphysician providers do not demonstrate a high degree of commitment to achieving an optimal provider-site match. Changes in the NHSC program based on these five problems are recommended to improve the retention of nonphysician providers in this important program.