NHSC accounted for a total of $171 million of HRSA’s FY 2003 budget. Field operations amounted to nearly $46 million and NHSC recruitment to slightly more than $125 million.
While NHSC’s main purpose is to expand access to health services to persons most in need (especially in rural and inner city settings), the organization offers service opportunities to providers. HRSA reserves some of its funding to target recruitment of “URMs and other students and professionals from disadvantaged backgrounds into the program” (Duke, 2003). In its 2001 annual report, HRSA indicated that 25 percent of NHSC scholarship and loan repayment awards had gone to URMs (HRSA, 2001a).
An evaluation of the NHSC program in 2000 by researchers at the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill and at Mathematica Policy Research, Inc., did not address the topic of URM inclusion and retention in NHSC. However, it did look at affirmation of cultural competence and cultural concordance in NHSC practice:
Over the years, NHSC clinicians have come to accept the affirmation of cultural competence as an important element in health care practice. On the other hand, they have been less receptive to the notion of cultural concordance through the matching of clinicians to communities. Nonetheless, cultural concordance finds greater support among members of racial and ethnic minority groups that have been historically underrepresented in the health professions. Moreover, women (compared with men) are also more likely to affirm the importance of cultural concordance and cultural competence (Konrad et al., 2000).
Some other HRSA programs affecting the four professions also take into account disadvantaged/minority funding factors in their grant processes. For example, the Geriatric Education Centers program grants 10 points if an applicant’s project has the potential to recruit and retain minority faculty members and trainees and improve access to a diverse and culturally competent workforce, according to HRSA’s FY 2003 application kit for the program. The Primary Care Medicine and Dentistry Grant Program grants 20 points for diversity, in terms of an applicant’s racial and socioeconomic makeup of trainees and faculty and its goal of increasing the proportions of both in the health professions workforce, according to that program’s application kit.
The Children’s Hospitals Graduate Medical Education (CHGME) program is a recently enacted initiative given to HRSA to administer. Congress authorized the program in 1999 in response to complaints that children’s hospitals received “$374 per resident in Medicare funds versus an average of $87,034 per resident for a non-children’s hospital” because of their low proportion of Medicare patients. CHGME provides funds to children’s