Tess Stack Kuenning: Increase funding for State Loan Repayment Program

For the Monitor
Saturday, March 10, 2018

‘Attaining a strong health care workforce and encouraging young professionals to remain in New Hampshire is vital to the state’s economic growth,” Gov. Chris Sununu remarked during a recent roundtable to address our state’s infamous workforce shortage. “How do we not only get the best people here, but how do you retain them?”

The N.H. State Loan Repayment Program, or SLRP, is the New Hampshire solution to a workforce deficiency dilemma, and the most effective tool for practices in rural and underserved areas of the state to attract and retain providers. It allows primary care, dental and behavioral health clinicians to repay their student loans in exchange for a three-year commitment (two-year, for part-time clinicians) to work at an approved site in a high-need, underserved area. The program is a critical resource for practices in rural and underserved areas because it is more difficult to attract and retain clinicians in these areas of our state. The State Loan Repayment Program is a way for practices to incentivize primary care physicians to stay at their practices and reduce turnover, which in turn enables Granite Staters to establish medical “homes,” where they can receive consistent care from health care teams they know and trust.

Health care reform is driving practices to provide “integrated care,” which means integrating mental health, substance abuse and primary care services under one roof. This reform is supported by research recognizing the effects mental illness and substance use disorders have on physical health and the rising awareness to reduce stigma around mental illness. Studies show that 20 percent of primary care office visits are mental health related, and almost 70 percent of adults with behavioral health disorders do not get behavioral health treatment. Behavioral health and primary care workforce challenges go hand-in-hand. The type of clinicians who provide behavioral health and substance use disorder treatment in primary care settings are often the same. Therefore, solutions to workforce challenges should address the full continuum of the health care workforce to meet the needs of the Granite State.

Organizations have reported almost 200 provider vacancies to Bi-State Primary Care Association’s Recruitment Center; approximately 70 percent of vacancies reported in New Hampshire are for behavioral health and substance use disorder treatment. Filling these vacancies is more important now than ever, when New Hampshire has the second highest number of drug overdose deaths per capita in the nation and the second lowest rate of spending on substance use disorder treatment and prevention. Every vacancy is a valuable resource we cannot afford to lose, especially amidst an opioid epidemic that is devastating families and communities throughout the Granite State.

The State Loan Repayment Program is currently at a standstill: All the funds have been allocated, so there is no money to cover more providers without additional funding. As the wait list grows, so does the likelihood that these providers will seek work at out-of-state practices (for example, in the greater Boston area), where they can receive higher wages and private loan repayment. When qualified candidates lose interest, New Hampshire loses its ability to retain a robust pool of providers to choose from, who want to work in New Hampshire. This, in turn, leads to many common struggles for Granite Staters who need care, including long wait times at the doctor’s office, driving long distances to access care and inability to find doctors who are accepting new patients.

Advocacy for the SLRP is strong among New Hampshire leadership: Sen. Jeb Bradley and others in the New Hampshire Legislature have introduced Senate Bill 590, which adds $1.1 million a year to the SLRP for two years; and Gov. Sununu is working tirelessly on a long-term solution to New Hampshire’s behavioral health workforce shortage, publicly emphasizing the SLRP’s role. We respectfully ask you to join us in supporting the passage of Senate Bill 590: It benefits all of us by attracting health care providers to New Hampshire and encouraging them to stay.

(Tess Stack Kuenning, CNS, MS, RN, is president and chief executive officer of Bi-State Primary Care Association.)