A Healthy Incentive to Stay

D.C. Program Helps Medical Workers Pay Student Loans, Securing Care for Underserved

The work that Heather Rivasplata does at Bread for the City is exactly what she trained for during years of nursing and graduate school: medical care with layers of nuance and complexity because of her patients' cultural diversity and the many health problems they face.

But Rivasplata was unsure how long she would be able to continue at the organization's clinic on Seventh Street NW, which sees a low-income population and, by necessity, pays its workers accordingly. With $100,000 in student loans hanging over her, she wondered when finances would have to trump desire.

A new city program is helping her stay put at least two more years. Through the D.C. Health Professional Recruitment Program, the 33-year-old nurse practitioner will have more than a quarter of her loans repaid -- and maybe much more -- in exchange for her service in a perennially underserved part of the District.

There's no question, she said, that "it helps a lot."

The initiative began last fall in response to the chronic shortage of doctors, dentists and other providers in neighborhoods where more than 300,000 people live, many of them east of the Anacostia River. The impact of limited access to care can be seen regularly in crowded emergency rooms and higher rates of chronic disease.

But how to draw health workers into these communities? The D.C. Primary Care Association, which represents the groups grappling most with that question, drafted a proposal modeled on the approaches of states across the country, as well as the federal National Health Service Corps. All have found that there are indeed ways to attract and retain talent, especially among men and women just beginning their careers.

Assisting them with their often huge debts from years of schooling is a prime strategy.

"It's going to take a real investment to repopulate our health professionals in underserved areas," said the D.C. Council's health chairman, David A. Catania (I-At Large), who co-sponsored the local legislation and said he believes it has much promise.

Twenty-five nonprofit clinics and city Health Department sites are approved for participation in the program, almost a third of them east of the Anacostia. Physicians and dentists working at those locations can apply to have nearly $53,000 of school loans repaid for the minimum two years of service, or $120,000 for four years. Other health professionals can get up to $66,000, depending on the length of commitment. The money is not taxable income on District returns.

For the program's inaugural year, the council allocated $300,000 for a separate revolving fund. Much of it remains unspent because of a slow start-up. With no funds budgeted for publicity, officials relied on word of mouth and notice through the Primary Care Association and the Health Department's Web site. Carlos Cano, senior deputy director for the department's Community Health Administration, said the resources necessary for a promotional campaign will be found for the second year. "We're all committed to scale it up and make it effective," he said.

And in fiscal 2008, as much as $500,000 more could be available for loan repayment. New legislation already has been drafted to expand worker categories to dental hygienists, clinical psychologists and clinical social workers. Cano expects the measure to be introduced during the 2007-08 council session.

"Now that we have the infrastructure in place . . . what we need to do is increase the number of participants," Cano said.

In addition, District Del. Eleanor Holmes Norton (D) is pushing a bill on Capitol Hill that would allow the city to qualify for a dollar-to-dollar match, as states already do.

"The potential is great," said Jose Aponte, a vice president at Unity Health Care Inc., which serves low-income residents through a network of medical sites, many of them certified for the program. But potential will mean little, he added, if the initiative is not well marketed, especially to medical, dental and nursing schools and societies throughout the Washington region and beyond.

"They may be attracted by the enhancement of loan repayment," Aponte said of providers, "but stay for the mission."

Dentist Jacqueline You, 30, arrived at the So Others Might Eat health clinic in Northwest in January. Only then did she learn about the new benefits, from the other dentist there. The 2006 Boston University graduate applied and became the city program's third recipient. She welcomed the support as she started to tackle $260,000 in student loans.

Working with the clinic's very challenged population was initially shocking, she said. Virtually none of her patients had ever had regular dental care, and it showed the moment the men and women opened their mouths -- revealing broken or missing teeth, legions of cavities, abscesses, all needing major, intense treatment. Or, as You described it last week, "construction."

After almost nine months, however, her days now are more rewarding than frustrating. The clinic gets cards and thank-you notes from its grateful patients. "They really appreciate it," You said. "They really do."