2002
Primary Health Care Policy Fellows

Establishing a National Medical Corps

Brent Beasley, MD
American College of Physicians

Darwin Brown, PA-C
American Academy of Physician Assistants

Jennifer Burks, RN
Health Resources and Services Administration

Mary Knudtson, NP
American College of Nurse Practitioners

Ivan Lugo, DMD, MBA
American Dental Education Associations

Ana Núñez, MD
Association of American Medical Colleges

John Ryan, DrPH
North American Primary Care Research Group

Workforce: National Medical Corps: Improving the Workforce for Primary Care Health Professionals and Trainees

Goal: Create a national network of front-line clinicians prepared for national health emergencies including delivering care in medically underserved areas and responding to urgent health events.

Problem: There continues to be growing health care disparities, growing primary care health professional shortages and temporal instability with regard to students choosing primary care careers. Current programs (NHSC and planned Medical Reserve Corps) should be modified to address:

• Decreasing health care professional student enrollment coupled with a decreasing interest in primary care careers
• Decreasing student interest in health care educator careers coupled with an aging faculty health educator workforce
• Challenges in recruiting and retaining students, residents and providers to underserved areas

Even with increased resources allocated to the National Health Service Corps (NHSC), multiple points on the training continuum have reached or will reach a shortfall that will result in the need exceeding the supply of primary care health clinicians. This problem is worsened by potential health threats from internal sources, such as worsening health disparities or external sources such as bioterrorism.

Solutions and Outcomes:

• Address pipeline issues by expanding student exposure programs by funding service learning experiences that include grades middle school to college.
• Modify National Health Service Corps by allowing part-time service and implementing a Health Emergency Readiness curriculum.
• Enhance the proposed Medical Reserve Corps to include pay incentives for primary care service in underserved areas.

Recommended Actions:

1. Enhancing Kids Into Health Careers - Appropriate funding for early exposure programs with service learning components to encourage students to consider careers in the health professional and create a cadre of student (middle school age to college) trained in a service-learning format.
   • Fund Kids Into Health Careers
   • Expand Program from Middle-School to College
   • Require a Service Learning Component
2. Modify National Health Service Corps
   • Support authorizing legislation to allow part time service
   • Provide an option for NHSC clinicians to train for emergency preparedness using the Health Emergency Readiness curriculum
3. Enhance Medical Reserve Corps
   • Develop incentives for full time employed clinicians to participate
   • Ensure parity of the MRC with other Corps
   • Ensure equivalency of training by using the Health Emergency Readiness Curriculum
   • Use MRC to address health disparities in community focused service methods and in direct clinical care.

Create the National Medical Corps

Implemented as a branch of the National Health Service Corps, a National Medical Corps is created by blending the models used by the National Guard and the National Health Service Corps. The National Medical Corps would be an inter-disciplinary workforce. These professionals will be recruited to serve in underserved areas or may serve as reservists.

1. Develop Pipeline and Recruit
   1. STUDENT READINESS SCHOLARS - Appropriate funding and training for Kids Into Health Careers program to encourage students to consider careers in the health professions and create a cadre of student (middle school age to college) trained in a service-learning format.
2. Recruit and Train
   1. Individuals who are recruited into the National Medical Corps (NMC) will receive scholarships and loan repayment similar to the current National Health Service Corps. They will also receive public health training on bioterrorism, health readiness in case of chemical, biological or nuclear attacks, infection control training from the CDC, Public Health officials and others. Existing and entering National Health Service Corps members can opt to train as Readiness officers, but are not mandated to do so. Incentives to opt for training may include loan repayment, scholarships or tax credits.
   2. TRAINING - These individuals will be trained with a focus on being Sentinel Clinicians who will be vigilant for health trends and bioterrorism response as they care for their patients – they will not be recruited to function as epidemiologist or as CDC analysts. They will also function as pivotal collaborators with local, state and national agencies (e.g. Health Departments, HHS, CDC, etc.) In times of peace they can work within their community on health promotion, disease prevention and on reducing health disparities.

      Best Practices Grant Program to create Health Emergency Readiness Curriculum - Develop a grant program to solicit best practices from community/academic partnerships to recruit, train and retain primary health care clinicians in underserved sites. This grant program can serve as the nidus for the curriculum needed for the NMC clinicians. Educational models, suited to local needs (rural, urban, community needs, state needs), especially those using distance learning or early placement of trainee in supervised clinical settings would be solicited as models for replication.

   3. SERVICE - Each National Medical Corps clinicians will serve full- or part-time commensurate to his or her loan repayment, scholarship and tax credits. During peacetime, these individuals would work towards reducing health disparities in their local communities.
   4. UNIQUE FEATURES - This program differs from existing programs in that it will: a. Follow a national curriculum, b. Allow interdisciplinary training, c. Involve private, public, and academic collaborations, d. Enable flexibility in responsiveness to community needs, e. Generate a large front-line, trained health workforce needed for responsiveness to local and national emergencies.

3. Reserve Corps

Enhance Proposed Medical Reserve Corps - Individuals who serve their time can leave the National Medical Corps but stay in reservist duty by maintaining CME and serving a set number of weekends per year (similar to the National Guard) in order to maintain their skills, update them with new technology and changes to biological warfare drills in order to be responsive to a bioterrorism threat. Professionals who have not been a part of the Corps during their training could also enter as a reservist.

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