Outcomes of States' Loan Repayment and Forgiveness Programs From the Perspective of Safety Net Practice Administrators.

BACKGROUND: Nearly every state offers loan repayment (LRP) and some offer loan forgiveness to clinicians who commit to work in safety net practices. The effectiveness of these programs from the perspective of safety net practices is largely unknown. OBJECTIVES: To assess safety net practice administrators' assessments of key outcomes for the 3 principal types of state service programs: LRPs funded by states, LRPs funded jointly by states and National Health Service Corps, and loan forgiveness programs. SUBJECTS: Administrators of safety net sites where primary care, behavioral health and dental health clinicians began serving in 26 state service programs in 14 states from 2011 to 2018. Survey responses were received from 455 administrators reporting on 754 of 1380 clinicians (54.6%). OUTCOME MEASURES: Administrators' ratings of their sites' difficulty recruiting clinicians; relative ease, quickness and cost of recruiting the participating (index) clinician with the service program; program expected effects on participants' retention; participants' job performance. RESULTS: Most administrators (66.1%) reported that recruiting clinicians of the index clinician's discipline is generally difficult but made easier (81.7%) and quicker (65.4%) with the service program, but only sometimes less expensive (34.8%). 78.8% of administrators anticipate that the clinicians will remain longer because of program participation. Participants are perceived to practice good quality care (96.9%) and be positive contributors (92.4%). Administrators' assessments are generally similar for the 3 types of programs. CONCLUSIONS: Administrators of safety net practices generally perceive states' loan repayment and loan forgiveness programs succeed in helping them recruit and retain good clinicians.

Experiences of Safety-Net Practice Clinicians Participating in the National Health Service Corps During the COVID-19 Pandemic.

OBJECTIVES: The impact of the COVID-19 pandemic has been particularly harsh for low-income and racial and ethnic minority communities. It is not known how the pandemic has affected clinicians who provide care to these communities through safety-net practices, including clinicians participating in the National Health Service Corps (NHSC). METHODS: In late 2020, we surveyed clinicians who were serving in the NHSC as of July 1, 2020, in 20 states. Clinicians reported on work and job changes and their current well-being, among other measures. Analyses adjusted for differences in subgroup response rates and clustering of clinicians within practices. RESULTS: Of 4263 surveyed clinicians, 1890 (44.3%) responded. Work for most NHSC clinicians was affected by the pandemic, including 64.5% whose office visit numbers fell by half and 62.5% for whom most visits occurred virtually. Fewer experienced changes in their jobs; for example, only 14.9% had been furloughed. Three-quarters (76.6%) of these NHSC clinicians scored in at-risk levels for their well-being. Compared with primary care and behavioral health clinicians, dental clinicians much more often had been furloughed and had their practices close temporarily. CONCLUSIONS: The pandemic has disrupted the work, jobs, and mental health of NHSC clinicians in ways similar to its reported effects on outpatient clinicians generally. Because clinicians' mental health worsens after a pandemic, which leads to patient disengagement and job turnover, national programs and policies should help safety-net practices build cultures that support and give greater priority to clinicians' work, job, and mental health needs now and before the next pandemic.