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.

NHSC at 50: New Investments for a New Workforce

Expand NHSC eligibility for behavioral health professionals Nearly 6,450 mental health providers were needed to address HPSA designees at the end of 2020.2 Expanded eligibility for behavioral health professionals could help address the immediate need in serving the more than 121 million individuals currently living in mental health HPSAs and help to stem the heightened need being seen as a result of the COVID-19 pandemic.2 This could also address structural barriers to success for underserved communities by eliminating the need to have a master's-level behavioral health or counseling degree to provide mental health and counseling services to these communities. Provide grants to states to engage their K–12 systems, Workforce Investment Councils, and AHEC programs to better engage the interest of underrepresented students of color to enter the health care career fields and to enable more diversification of the health care workforce in the future Refocusing the health care workforce lens on pipeline initiatives starting as early as K–12 can help address persistent access disparities, but more centrally, help cultivate the diverse clinical workforce of the future. Historically and currently, many racial and ethnic and minority groups are under-represented within the health profession workforce, a situation that has exacerbated disparities in access and quality of care in these communities.3,4,5 African Americans make up 13% of the U.S. population but constitute only 6.9% of U.S. advanced practice nurses (nurse practitioners and nurse midwives) and 4% of U.S. physicians.1 Of actively practicing advanced practice nurses in the U.S. in 2018, 81.8% were White, 7.9% were Asian, and 0.2% were American Indian or Alaska Native.1 The disparities among groups are most glaring in states such as California where the Latinx population constitutes 40% of the population, yet only 5% of the physician workforce.6 These statistics stand in contrast to statistics on the workforce of clinicians that represents the NHSC: 13% are African American, 10% are Latinx, 7% are Asian or Pacific Islander, and 2% are American Indian or Alaska Native. "7 This perpetuation of a teaching hospital-based training model further undermines the opportunity to attract physicians to practice settings in underserved communities.8 This could be examined to align with NHSC/underserved area workforce needs and re-invest monies to reflect the changing workforce needs among medical clinicians (nurse practitioners and physician assistants) as well as behavioral health providers, all of whom are in high demand but are not historically part of traditional graduate medical education (GME) funding.