National Health Service Corps: helping the underserved.
Article Type: Interview
Subject: Psychologists (Interviews)
Author: Roller, Rebecca M.
Pub Date: 12/22/2009
Publication: Name: Annals of the American Psychotherapy Association Publisher: American Psychotherapy Association Audience: Academic; Professional Format: Magazine/Journal Subject: Psychology and mental health Copyright: COPYRIGHT 2009 American Psychotherapy Association ISSN: 1535-4075
Issue: Date: Winter, 2009 Source Volume: 12 Source Issue: 4
Product: Product Code: 8043300 Psychologists NAICS Code: 62133 Offices of Mental Health Practitioners (except Physicians) SIC Code: 8049 Offices of health practitioners, not elsewhere classified
Persons: Named Person: Roller, Rebecca M.
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 216961283

It is estimated that more than 50 million people are still without access to primary health care in the United States. This appears to be the case in Greenfield, Missouri, where I serve as the only full-time psychologist in the entire county. I opened my practice, Sac River Counseling, here in September, 2007, with the help of the National Health Service Corps, a scholarship and loan repayment program that encourages mental health, medical, and dental providers to practice in rural, inner city, and frontier communities across the country.

My first exposure to the National Health Services Corps was while attending graduate school. My initial reaction was excitement about the prospect of being able to repay my student loans. An older student, I was fully

aware of the debt I was incurring, and since my plan from the beginning was to return to work in an already designated shortage area, the program seemed like a perfect fit. But it was not until I was already enrolled in the loan repayment program that I began to truly understand the importance of this dynamic organization. After about a year into my service agreement, I became an ambassador for the program and am excited about any chance I have to tell others about this opportunity.

The National Health Services Corps has been in existence for several years and was created primarily in response to a health care crisis in our nation during the 1950s and 1960s when rural physicians retired or moved to more urban areas. This exodus left many areas of our country without access to basic health care.

The program incentivises individuals to serve in these areas by offering scholarships and loan repayment in exchange for a commitment to live and serve in an underserved area for a specific amount of time. These "underserved areas" are actually locations that have been designated by the Secretary of the Department of Health and Human Services as having a shortage of health professionals. They are referred to as Health Professional Shortage Areas (HPSAs).

The objective of the NHSC program is to recruit and retain medical, dental, and mental health providers within these areas to practice primary health care in underserved communities.

The need for mental health services was clearly evident when my appointment book filled completely soon after opening the practice. Clients were excited about being able to obtain mental health services without driving to the nearest city, which is about a one-hour drive away. In addition, other service providers such as physicians, family support workers, and even clergy were relieved to be able to have a referral source for mental health issues that reached beyond the scope of their practice.

The financial benefits of this program have allowed me to offer services at greatly reduced fees. Enrolling in the program as a private practice can be a tricky balancing act between meeting the requirements to serve those with reduced ability to pay and the need to cover the overhead necessary to keep the practice running. I have, however, been able to afford to take a lower salary for myself since I do not have the burden of the monthly loan repayment on my shoulders.

Of course, there is no such thing as free money. The commitment a clinician makes to serve in these areas in a serious one, and there are significant penalties for not completing the contract. This is not to say that if placed in a site that simply does not work for you that there is no option for change. There is a process that must be followed in order to ensure that every effort is made to assist both the site and clinician to work together. Most individuals, however, complete their service without a problem. Perhaps a fitting testimony to the heart of individuals serving the underserved in this program is the fact that over 50% of NHSC clinicians still serve the underserved in some capacity up to 15 years after completion of the initial service commitment.

Loan repayment amounts vary among professions, but for clinical psychologists there is an award of $50,000 to repay qualifying educational loans in exchange for two years of service. Upon successful completion of this service, the clinician can apply for additional one-year commitments with varying amounts of loan repayment. In exchange, the clinician will agree to serve a minimum number of clients and be physically on site a specific number of hours per week and days per year. Since there is variation among disciplines, it is best to consult the National Health Services Corps about your specific area. They have recently revamped their Web site ( and made it very easy to navigate in order to find information about the program. If you are unable to find the information you need you can always contact them at 800-221-9393.


The American Recovery and Reinvestment Act invested an additional $300 million in the National Health Service Corps, which is expected to double its field strength by 2010. As a result, there is even greater urgency to let others know about ways in which they might be able to assist the underserved and get some much-needed debt relief during this window of opportunity.

Due to the increased funding, the NHSC has made the application process somewhat easier and has also created more opportunities to apply during the year. Applications are being accepted continually until the funds are expended or September 30, 2010--whichever comes first. The first step to begin the process is to review the eligibility requirements. These can be found online in the NHSC Loan Repayment Application Information Bulletin. I would strongly encourage anyone considering applying for the program to thoroughly review this document. If you meet the requirements, you can begin searching for employment using the NHSC's online job opportunities list, a frequently updated, searchable database. Once employed or in negotiations with a qualifying site, you can submit a loan repayment program application.

Q&A with Dr. Roller What inspired you to enter the field of psychology?

My undergraduate degree was actually in sociology, and I had plans to enter social work after college. Plans changed as they sometimes do, and I ended up spending the next several years in education and the computer software industry. I continued to work with people through volunteer work with my church and other organizations, always seeming to gravitate toward projects that involved helping others grow and reach their full potential. But I believe the transitional moment that led me back to the field of psychology happened when I found myself with three foster children who needed therapy. Living in a rural area, we were very limited in our options, and I found myself thinking how great the need was for therapists who were integrated into the community and able to coordinate efforts with other providers in a meaningful way.

How has the NHSC helped you achieve your career goals? Are there things you have achieved that you wouldn't have without the help of NHSC?

The National Health Services Corps has been instrumental in my being able to open a private practice in a rural area. Had it not been for the loan repayment program, I would have had the burden of a great deal of student loan debt to repay. That overhead alone would have inhibited my ability to afford the most basic essentials such as office space, equipment, etc. It also provides me the ability to add more therapists in the future through their assistance in recruiting practitioners for underserved areas. In addition, I have grown to appreciate their ongoing support in providing information and encouragement.

How would you describe the scope of your work day to day?

Working in a rural and underserved area, I have a broad scope of practice. In any given day, I will see clients who vary widely in age, diagnosis, and level of care. I have found that having a good source of specialists to whom I can refer people is critical in my situation to ensure my clients get the best possible care when their issues fall out of my expertise. I am also licensed as a marriage and family therapist and have found this particular specialty to be very helpful in a rural community because it adds a systemic way of thinking that I believe serves my clients well.

In a small town where everyone knows your name, how do you balance your professional and personal life?

Very carefully. I have found one of the best ways to guard against dual relationships that would be harmful to my clients is to be very proactive in regard to communication about such issues. It serves everyone well to have a very clear discussion about what might happen should we see each other in the grocery store next week. In addition, I have had to make some difficult choices with regard to joining organizations or other groups where I might have too much contact with clients.

In your opinion, what are the greatest benefits of building a practice in an underserved area? Any drawbacks?

One of the greatest benefits for me is the sense of fulfillment in providing a much needed and appreciated service. I also love the variety of things I get to do from day to day, as well as the ability to coordinate my efforts with physicians, school personnel, family services workers, and others. One of the most significant drawbacks is the possibility of isolation. I make a lot of effort to work collaboratively for this reason. In addition, my site is also a practicum site for training therapy students from a local university. I have found that having other professionals around sharpens my abilities and broadens my perspective. The NHSC has also been very helpful in working with practitioners to reduce this isolation by providing a network of individuals who share a somewhat common experience. Another drawback is that because the area is underserved, I am frequently challenged in finding other professionals to whom we can refer our clients for things such as medication. We are, however, encouraged by the stimulus money that has been earmarked for such efforts, and as an ambassador for the program, I would encourage them to contact the NHSC for more information on how they might be able to participate.


How do you like working in Greenfield, Missouri?

I was raised in a small town in the Ozarks, and although I spent some time in other areas of the country, my heart has never really left its home. Returning to serve those individuals who once lacked access to mental health care is one of the most gratifying ways to give back to an area that was so instrumental in developing my own set of values. There is no comparison to the feeling of community and the ability to provide a quality network of care with other professionals in the same area. I am extremely grateful to the National Health Services Corps for allowing me the privilege of this experience.

How to Get Involved

The NHSC Scholarship Program is open to U.S. citizens who are full-time students enrolled or accepted for enrollment at fully accredited U.S. health professional schools. NHSC pays tuition, required fees, and some other education costs--tax free--for up to four years. Recipients also receive a monthly living stipend ($1,269 in 2009-2010). The stipend is taxable.

The National Health Service Corps Loan Repayment Program provides $50,000 (or the outstanding balance of qualifying student loans if it is less than $50,000)--tax free--to primary care medical, dental, and mental health clinicians in exchange for two years of service at an approved site in a Health Professional Shortage Area.

For behavioral and mental health providers, at least 21 hours of the 40 hours per week must be spent providing direct patient counseling during normally scheduled office hours in an ambulatory outpatient care setting in the office(s) specified in the Community Site Information Form or on the Practice Agreement. The remaining hours must be spent providing clinical services in alternative settings, or performing practice-related administrative activities. Administrative activities may not exceed eight hours per week.


For more information about the programs and opportunities available, and more detailed information about eligibility requirements, log on to

Rebecca M. Roller, PsyD, LIFT, is a clinical psychologist and licensed marital and family therapist. She received her doctorate in clinical psychology and post-graduate certificate in marriage and family therapy from the School of Clinical Psychology at Forest Institute During her time there, she served as development director for Ozarks Marriage Matters, a non-profit Organization dedicated to sit strengthening marriages in the Ozarks.
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