NHSC Timeline

1970: National Health Service Corps established

• Dr. Larry J. Platt, a Public Health Service physician, in 1969, wrote a proposal to develop a National Health Service Corps (NHSC) (PDF - 1 MB)*. The proposal becomes the basis for the Emergency Health Personnel Act of 1970.
• Congress passes the Emergency Health Personnel Act Amendments establishing the NHSC and authorizing scholarships for health professionals in return for a minimum of two years of service in designated health professional shortage areas.

1972: The work begins

• Hubert McDonald Rimple is appointed first director of the NHSC.
• The NHSC sends its first clinicians to 20 communities in 13 states. The first group includes physicians, dentists, and nurses who were also federal employees. Dr. Joseph Viglotti and wife Monique (a registered nurse) serve in Jackman, Maine, as the first placements of 16 NHSC teams.
• Within six months of operation, the NHSC places 180 clinicians (U.S. Public Health Service Commissioned Corps Officers or civil servants) in more than 100 communities.
• Through 1979, NHSC uses a short-term health professional loan repayment program to attract current providers as volunteers who agreed to serve in shortage areas in return for repayment of a portion of their federal educational loans.

1976: The National Advisory Council of the NHSC established

1979: Provider and budget growth

• NHSC grows from 181 providers to over 1,800.
• The first scholarship participants graduate and are available for service.
• Budget increases ten-fold by decade’s end and significantly increases the number of scholarships awarded.

1981: Nearly 6,700 scholarships awarded by the Corps

1983: New model

• Community-based nonprofit organizations, state correctional and mental health institutions, and county health-related programs begin hiring NHSC practitioners directly. This means that NHSC members are no longer federal employees.

1986: Scholarship program reaches a high of 1,600 scholars in residency or school preparing to serve

1987: New programs added

• Amendments to the Public Health Service Act expands the National Health Service Corps to include the NHSC Loan Repayment Program and State Loan Repayment Program.

1989: Pipeline declines; State Loan Repayment Program grantees make awards

• A lack of physicians and other health professionals in the pipeline due to reduced NHSC funding results in vacancies in community and migrant health centers as well as Indian Health Service and Bureau of Prisons facilities. The number of physicians and other health professionals available annually from the NHSC scholarship program declines from a high of 1,600 in 1986 to about 215 in 1989.
• Seven State Loan Repayment Program grantees place their first 74 health professionals, including 67 physicians, in medically underserved areas.

1990: Overcoming challenges

• NHSC Revitalization Act of 1990 expands funding for the scholarship and loan repayment programs. Congress reauthorizes NHSC funding for an unprecedented ten years. Prior to that, it was reauthorized every year.
• The Disadvantaged Minority Health Improvement Act of 1990 funds the Community Scholarship Program, which awards grants to 12 states to increase the availability of primary health care in urban and rural health professional shortage areas.

1991: Field strength numbers decline to only 1,000 providers

1995: NHSC makes first mental and behavioral health loan repayment awards

1997: 25 years of NHSC

• National Health Service Corps observes its 25th anniversary with more than 22,000 alumni.
• More than 2,200 clinicians make up the year’s field strength.

1999: More than 2,500 providers serving by the end of the decade

2002: 30 years of NHSC

• In its first 30 years, the NHSC places 13,915 health professionals in 1,911 rural counties.
• Health Care Safety Net Amendments, 2002, creates automatic HPSAs (Auto-HPSAs) - facilities automatically designated as a HPSA by statute or regulation. 

2009: Physicians make up the largest discipline in the NHSC

2010: NHSC is made permanent

• Patient Protection and Affordable Care Act of 2010 permanently reauthorizes the NHSC and creates a mandatory funding stream, as well as adding a part-time service option for members.
• The NHSC establishes the Division of Regional Operations (DRO) to further outreach, support, and engagement efforts in the ten U.S. Department of Health and Human Services (HHS) regional offices. Up to that point this work was managed by dedicated HHS regional staff members.
• HRSA establishes the Students to Service Loan Repayment Program aimed at health professional students in their final year of school

2011: Division of Regional Operations develops the first site reference guide and site visit tool for new site approval/recertification

2016: New paths

• With an increased need in providers, behavioral health becomes the top discipline among NHSC clinicians.
• Students to Service (S2S) Loan Repayment Program adds dentistry discipline.
• NHSC adds 27 Indian Health Service and tribal hospitals as eligible sites in both their outpatient and inpatient settings. There had previously only been 12 such sites.
• The 21st Century Cures Act clarifies that adolescent and child psychiatrists can participate in the NHSC loan repayment program.
• Zika Response and Preparedness Appropriations Act funds establish the Zika Response and Preparedness Act Loan Repayment Program to address public health crisis, especially targeting recruitment efforts toward clinicians in the territories and other high-risk areas of the country.

2018: Addressing the opioid crisis and expanding telehealth

• The Consolidated Appropriations Act, 2018, expands eligibility for the NHSC loan repayment program to substance use disorder counselors; the law also increases NHSC funding and specifies that this funding be used to support substance use disorder providers.
• Substance Use Disorder (SUD) Loan Repayment Program and Rural Community Loan Repayment Programs begin recruiting SUD providers to combat the opioid crisis in urban and hard-hit rural areas. Added disciplines include SUD counselors, registered nurses, pharmacists, and, in the case of the Rural Community LRP, certified registered nurse anesthetists.
• Substance Use Disorder treatment facilities become eligible site types for NHSC approval.
• NHSC revises its telehealth policy to increase rural healthcare access.

2020: NHSC responds to COVID-19; site approvals soar

• NHSC providers support efforts to help people with COVID-19 or to help them prevent infection through telehealth visits, testing, and vaccinations.
• Between 2012 and 2020, the Division of Regional Operations approves a record 21,518 new site applications resulting in 27,230 clinicians being recruited and 17,773 clinicians retained.

2021: Continued growth

• Record field strength—nearly 20,000 participants—due to historic increase in funding through the American Rescue Plan.
• Students to Service Loan Repayment Program adds nurse practitioner and certified nurse midwife disciplines.

2022: 50 years of NHSC

• Students to Service Loan Repayment Program further expands its eligible disciplines and adds physician assistants for the FY 2022 application cycle.
• More than 19,000 active NHSC sites across the U.S. and its territories.
• Current alumni data shows that as many as 80% of NHSC members continue to serve in an underserved community after completing their service.
• FY 2022 saw another record-setting year of participants with 20,215 clinicians currently serving and more than 3,500 scholars in the pipeline preparing to serve.