BEWARE...Misleading NHSC Issues

[Yosh]

I applied for and recieved the NHSC scholarship this year. My main concern was the autonomy to pick and chose where I fulfill my obligation post residency.
I asked during the interview, and after being accepted and was ASSURED I would have full ability to choose where my duty would be filled.
In January, I received an "update" letter from NHSC asking me to verify my address...year in school and current information. On the "flip side" of the sheet...there was a quote stating that in essence that I am willing to go where ever the NHSC deems the most needy area and serve my time there. Seeing that that was contrary to the scholarship that I signed up for..I contacted the NHSC to inquire.
I was told that it was nothing and that I should just sign the form. I asked for a form that was "correct" and that didn't have this "agreement" The new form was never sent, and so I never signed the old one.
In March, I recieved a certified letter with the form once again, stating that the agreement must be signed...or I would be "suspended" from my stipend and scholarship. I spoke with the NHSC repeatedly...and fought with them over and over, sighting the front page of their website...where it states our abilty to pick where we serve our term.
Needless to say....
I was given the option to leave...with 14 days to payback the NHSC all the money that they had given me....$47,014.00 in cash. I was in the middle of studying for boards, and managed to get the money together and pay them off...

After speaking with other students...I have heard HUGE numbers of horror stories....about people's interactions with this organization....

Bottom line...if you are willing to go wherever they NHSC sends you...it is fine...

if not...carefully think about your decision to apply for and accept this scholarship.....

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[neurobiology]

Yosh,

Thank you very, very much for sharing this information!

I have finished applying for the NHSC and I am waiting to hear from them later this year. I am pretty sure that I will accept the scholarship if I am offered it, but the autonomy to choose where I go after residency (within the postings in the "Scholar list") has been one of the things that I have counted on. I have a family, so the places I would like to go are somewhat limited, but I have taken a look at the postings many times so I (think) I know what I am getting into!

This autonomy issue really concerns me, so when you have some time (like when you are done studying for your boards!) I would really appreciate it if you would quote exactly what they stated on the flip side of the form they sent you that they wanted you to sign.

Without seeing their exact wording, I am wondering if they are covering themselves by having you sign that form, so that in the rare case that you are not able (or unwilling) to match yourself with a position within the "Scholars list" of placements, that they have the contractual ability to place you where they need you most. I have seen on their web site that they boast that they have only had to place one person (which to me means that everyone else found their own placement by the deadline). It also seems to me based on their website that they would much prefer that you place yourself.

Thanks again Yosh for the information that you posted.

 

[Horseradish99]

I just wanted to echo what neurobiology said. I definitely want to have that autonomy. We will be limited enough in where we can choose to go, they shouldn't make it worse and tell you where to go practice. I would really like to read that statement you were supposed to sign. I'm curious as to what it said specifically.

Thanks for the info Yosh!

Scott

 

[Yosh]

Here is the info I was talking about...I had quoted the letter to the NHSC in my e-mails. My interactions with them were quite less than professional..and nightmareish...



The statement says, "I understand that I am obligated to provide full-time clinical primary health care services at a NHSC-approved site in the health professional shortage area(HPSA) to which I am assigned by the NHSC. I further understand that the area to which I am assigned by the NHSC may be located anywhere in the United States.

As stated on the website?

"Directly upon completion of your training, you will choose a practice site in a federally designated health professional shortage area identified as having the greatest need. Period of service is 1 year for each year of support you receive, with a 2-year minimum commitment.


That is what you HAVE to sign....or you are suspended from the program. I understood if you don't chose a place...the NHSC will palce you...but that is NOT AT ALL what the above statement says...and they refused to change, correct or acknowledge it.

I referred several times to the other quote above, which is the front page of their website...but it was NEVER acknowleged.

If you take it...best of luck..and God be with you....

 

[alina_s]

I'm sorry to hear that the NHSC turned out so badly for you. Do you know whether the change from a chosen practice site to assigned practice site was a recent change in policy? When you called the office, did they tell you that scholars were all being assigned sites now instead of choosing? That sounds like a very counter-productive idea, since scholars would be a lot more likely to stay beyond their obligations at sites that they had been allowed to select. Never expect wisdom to emerge from a committee, though. The NHSC certainly sounds like a good deal but I am also quite concerned about autonomy and your story makes it a lot less appealing.

 

[KyGrlDr2B]

Yosh, I'm sorry that happened to you. What an ordeal, especially with studying for boards, etc. Glad you made it okay!

 

[Yosh]

I just had HORRIBLE experiences dealing with them...and would hate to see other people get stuck in a bind like I was in...Thank God I was able to stir up $50,000....in 2 weeks time and send it to them..or I would have been stuck dealing with them.
I think it is very misleading..and I said that to them repeatedly...to no avail. I don't think they will necessarliy force you...but I cannot in good conscience sign away my rights to go where I want...reasons like this is why I never joined the military....if you look at my previous posts...I supported this program and advocated for them...

Just beware....they are not how they appear...I spoke with my financial aid office..and other students have had simialr problems with them too....like my advisor said..."If things seem too good or too easy to be true....THEY PROBABLY AREN'T"

The funny thing is...I have several classmates that are in the NHSC also..and when I mentioned the "sheet" to them..they were all like...we didn't read it...we just signed it..and I really think that is EXACTLY what they are counting on....

Just figured I would share my experiences....between that..COMLEX and the USMLE...I have been QUITE the busy boy.....

best of luck to all...

 

[roady]

Hey Yosh,

What is going on here!? How about some help from some of our more senior members who have gone through the NHSC site selection (or is it placement process now?), and what their experiences of site selection was like--and does anyone recall signing the form Yosh is talking about??

Yosh, you never wrote back to me when I PMed you a while back--your perogative, no problem. Wondering if you are still heading to Alaska this summer through NHSC after all? Also, I recall (do I?) hearing that this is not your real picture--is that you...or who?

Somebody in the know about the process--PLEASE HELP OUT!
ThankS a LoT.

 

[roady]

Hey Yosh,

What is going on here!? How about some help from some of our more senior members who have gone through the NHSC site selection (or is it placement process now?), and what their experiences of site selection was like--and does anyone recall signing the form Yosh is talking about??

Yosh, you never wrote back to me when I PMed you a while back--your perogative, no problem. Wondering if you are still heading to Alaska this summer through NHSC after all? Also, I recall (do I?) hearing that this is not your real picture--is that you...or who?

Somebody in the know about the process--PLEASE HELP OUT!
ThankS a LoT.

 

[alina_s]

Roady- I'm not an NHSC scholar (just an applicant) but I am going to do a rotation in Alaska. Maybe it helps to be an NHSC scholar but I applied really early (>12 months) and am going to get to go to my 1st choice site and time. Look at the IHS web site (www.ihs.gov)- there is a page of e-mail/phone numbers to contact for rotations in each service area. I don't think that any site accepts third years and some are open to residents, not students, but there are plenty of choices for 4th years. The Alaska area has rural family medicine options or surgery, ob/gyn, and a few other choices in Anchorage. I believe that the Billings area only offers family medicine. Phoenix, Tuscon, and the Navajo areas also offer rotations in multiple specialties. I think that California contracts out many of their services, so it may not be an option. I don't know anything about the other areas. Good luck.

 

[drpcb]

I am a former NHSC scholar. I entered a Family Practice Residency with a 2 year NHSC obligation. As I decided to pursue Emergency Medicine instead, I left after 1 year, and took a position as a Family Practitioner in Los Angeles.

In CA, we are licensed after one year of training, and hence there is no reason not to take on a full position after 1 year of training, if you are so inclined. This is no different than "moonlighting" full time. Anyway, I had to serve 2 years in a couple of inner city urban clinics in Los Angeles. My pay was $115,500 annually, plus benefits. (My scholarship covered my complete tuition at Tufts, around 30K a year, plus 1000$ or so monthly for a stipend.) My position was a salaried FP along other full fledged FP's.

It was a bit difficult working full time as an FP after only one year of training, but ultimately an incredible experience. I got no help from the NHSC to find my FP position when I "bailed" from my FP residency early, after one year, although after I found myself an eligible position, they completed the essential paperwork to fulfill my obligation. Often, "GP's" (i.e. MD with only 1 year of training) get stuck in IHS or worse yet Prison clinics. PLEASE don't get stuck in one of those unless you know what you are getting yourself into. I am just cringing when I think about my Jail ER rotations, and can't imagine doing it full time.

With respect to dealing with the NHSC, I would offer the following observations:

1) I am currently a county Emergency MEdicine resident and the NHSC is no different than any other federal/state/county run program.

2)With respect to the commitment, I was grilled HARD about the fact that I was THEIRS when my training was complete. This was reinforced repeatedly (this was 1996, don't know if its different now) While there is a list to choose from, it was crystal clear that nothing is a sure thing. You can not guarantee that you will not end up in Guam, or Rosebud South Dakota. You are really at their disposal.
3)If you are going into primary care, and dedicated to the underserved it may be a good deal. Of course you could work at any of these positions on your own without the NHSC obligation if you are so inclined. These are regular old clinics and hospitals, desperate for physicians. You may be able to negotiate a significantly higher salary if you are NOT an NHSC scholar. You need to take a hard look at the finances, with compounded interest, to see where your "break even point" is.
4)DON'T DO IT if you think there is ANY CHANCE that you may not want to go into primary care as defined by the NHSC (OB, peds, FP, general IM, psych) If you change your mind, you will be doing your specialty residency AFTER your commitment.

 

[roady]

Hey drpcb,

Thank you very much for sharing your thought provoking experiences and reflections on the NHSC. As one of those who has actually been through the process, you bring much to bear to this discussion. Thanks again!

Calling out now for any other NHSC grads--please, could you share your experiences here, specifically in regard to your ability to choose your practice site?

THANK YOU TO ALL!

 

[jhug]

i thought i'd let you know that i'm going to talk with a local doc that somewhat represents the nhsc here as well as a doc in the middle of her payback time to see what they think of all this. i'll fill you in as soon as i have something worth while to post.

 

[jhug]

i havn't had the time to meet with the two docs yet but found this on the nhsc web site. I hope it is able to shed some light on this. I'll fill you in when i talk with the other two.....

http://nhsc.bhpr.hrsa.gov/applications/psab_phys/iii.cfm

it sounds like they are just trying to cover their backs and make sure we'll do what we have promised.

 

[Yosh]

I agree 100%....I have no problem with what the website says...and agree full heartedly....if you don't match/pick somewhere, and have no where to go...I understand them selecting an area for you to do your repayment in.
My letter stated nothing about this...it was just to the fact that I acknowledge that they can send me where they want....not under any specific stipulations...just that they can send me where they want...

I tried to have them "correct" the document..to no avail...so I left...and paid them back all the money...in cash in the allotted 14 day slot.

They were HORRIBLE to deal with, and I hope my experience was the exception....more than the rule

 

[andrea]

Yosh,

I'm surprised that you took the scholarship and were not aware that the NHSC would assign you. In my opinion, the two quotes that you listed above say the exact same thing, so I'm having trouble understanding why you were so upset. Regardless of whether or not you CHOOSE the location, the NHSC would still have to ASSIGN it to you. Everyone gets "assigned." See what I mean? And as someone previously mentioned, just about everyone IS able to choose. It sounded to me as though you were uninformed when you made your decision, so I would look again to see who the "horrible" person was to work with. Sorry, just my opinion.

-Andrea

 

[Horseradish99]

I kinda sorta agree with andrea, here. I talked to an NHSC field consultant last week about this letter, and he said it is entirely true...they reserve the right to place you and that's that. However, it's in writing other places (like this website) that we have X amount of days to places ourselves.

I applaud you, Yosh, for being willing to stick up for yourself and other NHSC scholars by trying to get the wording better, but to go to such lengths as to cut yourself off from the scholarship is pretty bold. Is it possible that after a year of med school, you were starting to decide that primary care or working in a rural/inner city area wasn't for you?

Or are you still thinking of going that route, just without the NHSC involved?

Don't mean to be overly critical-- I just find it unfathomable to pass up on such an opportunity of some wording that you didn't like and some people who didn't take you seriously because of it.

Scott

 

[jhug]

i am pretty dang impressed yosh was able to round up enough funds to pay that off.....that says a lot about your resorcefulness and ability to accomplish a huge task in a short amount of time!
i wish you the best in all you do in the future and thank you for what i feel has been a very sincere expression of a concern to us all.

 

[Yosh]

Just to clarify what I am saying...

Andrea, I am really trying not to take this as a personal attack...but then again, as I RETHINK who the HORRIBLE person to work with is...I find it quite difficult. I am amazed that you see fit to throw stones and judge me. Was there really a need to be so caustic..when you don't even know me?

I was going by EXACTLY what I was told by the NHSC opening page on their website, and during my interview. I picked this scholarship beacuse I had the ability to decide where I want to serve. When that ability was withdrawn or compromised....I fought to have it re-instated. They refused to do that, so I left.

To me...there is a HUGE difference to my being able to CHOOSE where I can serve...vs NHSC TELLING me where I am going to serve. I clarified this before during and after my interview....and was assured repeatedly that the autonomy was a key element in the offerings of this scholarship.

I made it a point to be informed about my scholarship, as I was leary of doing this in the first place for the above stated reasons, which is what I said during my interview as well.

I understand that from past people...many can choose..many isn't all...not to get into semantics...but I worked like hell to get into med school..and will not be told where I am going to have to serve.

I was mislead, and when people try to twist my arm...they would have better luck breaking it than getting me to do something that I don't agree with.

I understand money is important and people can't see how I would "throw away" all that money...but bigger picture..money is NOT happiness...and to compromise myself and what I believe is right....and in essence being manipulated and misled..I cannot tolerate that.

Granted I had the financial resources to acquire the money in the 14 day period...again which is another way they try to screw you. How many medical students can come up with that much money in cash in 14 days? Its like being dangled by a rope...

I have nothing to gain by any of this..I am just trying to share my experiences...so people can make educated decisions about what they do..and make sure they full understand exactly what they are getting themselves into.

As usual on SDN...there are always people that like to argue and stir the pot.....my post was to inform people about what I have gone through....bottom line.

If I would have heard a story like this when I was applying...I definately would have looked at things much closer and perhaps spared myself some of the grief and aggravation.

...and I am still going the same route..even without the NHSC...I am possibly still doing the Alaska Exposure too...just paying my own way. This experience has not changed what I want to do...

but growing up as a New Yorker...I have always fought for what I believe in...and when I feel liek things are misrepresented....I address them. I just thank God I had the means to close out my contract and go my own way...

I encourage people to post all expericences both good and bad...the more info we have...the better we can judge what programs are suited to our individual needs and plans....

For those of you who appreciated it....I am glad..

..for those of you who didn't....that is fine too...

 

[jhug]

ok.....i spoke with the "ambassador" for the nhsc at my school today. He is great and gave me straight-forward answers!

I asked him about the selecting vs. assigning issue and his general answer is that whether you are "assigned" through your own contacting, applying, and receiving a job on the hspa list, or whether you are "assigned" a spot through the nhsc doing it for you is up to you as an individual. In short, where ever you end up, and whether it be on your own accord or through placement, you are "assigned" a place to work.
He explained the two part process and how it is in our best interest to find a site between the beginning of july (start of last year of residency) and feb. (when the deadline is for finding a site). The nhsc gives us a good 8 months to find a site, anywhere in the US and it's territories, where we can be "assigned" to work. If we are unable to find a site to be "assigned" to, the nhsc will try and work with us to find a site that conforms to what we are hoping for and "assign" us to it. At that point we are obligated to take the site or be in forfeit of the scholarship and required to payback it's money at a hefty price. I have spoken with two that have done the scholarship and both were able to find a site, interview, and offered positions. Seeing that the corps. goal was met and that the site was on the list of hspa's, the nhsc "assigned" them that site.

so when the nhsc says we are obligated to provied full-time clinical primary car services at a nhsc-approved site in the hpsa to which we are "assigned" by the nhsc, and that the site may be anywhere in the us.......they are pretty much saying we are obligated to pay them back with our services in an area they "assign" us, either through
1.)our selecting a site and being "assigned" there before feb.
or
2.)the nhsc selecting a site for us and "assigning" us to work there.

i hope i exlained that clearly.....seemed awfully long-winded!

 

[PACtoDOC]

First of all, can anyone enlighten me as to why some people have been contacting by NHSC "Field Consultants" and why some have not? I called and asked them but I was transfered an inordinate number of times and finally hung up! That is the norm when you try to call NHSC. But to address what Yosh stated:

First, having served what seemed a lifetime in the military, it is true that the government usually tries to paint a worst case scenario for any situation, because they don't want you to be surprised if something happens that is not customary. In my years of military service, there was never a time I did not receive my first choice of duty stations throughout the world. But if you had to read the contract I had to sign for the military, it basically guaranteed me 3 meals a day for 4 years, with time off and duty location at "their discretion". But this was not how military life actually was!! What purpose would it serve to have a bunch of pissed of soldiers running around the world who were forced to go places they did not wish.

Now the NHSC is exactly the same way, but even more accomodating. Trust me, I have investigated this deal to no end (with the exception of the "Field Consultant" thing I cannot figure out!!). I even talked by phone with the woman who is in charge of "assigning" FP docs to scholar payback sites, and what I got was very useful information.

Hold onto your hats everyone, because this is great info. She told me in confidence that only one FP this year had to actually be "assigned" to a place that was not of their choosing, and it was because this doc dragged their feet and could not make up their mind by the deadline. She stated that ALL OTHER FP DOCS found, interviewed, and accepted positions at scholar sites of their own choosing. I mean come on guys, if you see the list of sites, and how often new ones are added, you will see that there are tons more jobs than there are scholars. You will have excellent opportunities to fulfill your contract and it serves no purpose for the NHSC to try and force a doc into a place they don't want to be. If this were the case, you would hear many more of these so called "NIGHTMARE SCENARIOS" on this forum and elsewhere.

And in response to the FP turned EM doc who was a former scholar, things have changed since this person went through. No longer are you allowed to simply get a license and practice after doing one year of internship and expect to pay back your obligation. All NHSC docs now have to be board certified before starting payback, so you really better decide if primary care is truly right for you from the beginning!!!

Overall, if you don't want to accumulate debt in school, the NHSC is the absolute best option around. It is even better than the military with even better overall benefits. Some of you may squable over a few governmental forms that you have to sign, but that is typical government. Just think of inconsistencies as loopholes that can help you get out of the obligation of things ever got rough, because that is all they are. I had friends get out of even military obligations over less ambiguous wording in a contract, so keep those inconsistencies in your wallet as the trump card if something bad ever happens.

But for the most part, just relax, and let the money come in!! NHSC is not just about you, but also about the people who will benefit from your service.

 

[jhug]

pactodoc....you reminded me that that ambassador also told me that it is a rule that the nhsc have three spots to every graduating/applying position. 100 FP physicians would have 300 sites to choose from-- just as 50 NP's or PA's will have 150 sites to get. That way they can try and keep everyone happy. He did say though, that he didn't know if this rule would still be in effect by the time we roll around (about 7-8 years)