Slashing Loan Debt May Attract Primary Care Workers

Legislation aiming to restore "decimated" student loan funding could help incentivize nurses and healthcare professionals to practice in rural and underserved areas of Washington State.

APRNs and other highly trained nurses are among the health providers that Washington State is trying to recruit with loan-quashing legislation introduced in December.

The bill, SB 5010 introduced by Senator David Frockt (D), aims to alleviate the state's primary care shortage by helping to ease the financial burden of massive student loan debt that healthcare providers are saddled with when they leave college.

Such debt leads to a vicious cycle that affects everyone from the providers themselves to the patients that get left behind. When faced with massive debt, new grads have no choice but to work in settings that can pay them higher salaries, leaving community health settings and underserved areas such as rural Washington State unable to recruit desperately needed providers.

"If they add on all this debt, they need to know they're going to have a way to pay [it down]," says Molly Belozer Firth, director of public policy for the Community Health Network of Washington, one of the organizations working in coalition to support the legislation. Also supporting it are the Washington State Nurses Association, Washington State Hospital Association, Washington State Medical Association, Washington State Dental Association, and Washington Association of Community & Migrant Health Centers.

SB 5010 would allocate $8 million in the 2015–2017 biennium for Washington's Health Professional Loan Repayment and Scholarship Fund, which encourages healthcare students and healthcare professionals to practice in underserved areas by helping pay down their student loans. The program has been in existence for years, but it was, as Firth says, "decimated" in 2011, when it was cut by 87%.

The program's current funding are "not enough to be able to support the number of providers that are out there that are looking to work in community health settings," Firth says. For example, in 2008 the program issued 84 loan repayment awards. In the most recent cycle, it only issued 25, she says.

The coalition believes that restoring funding to the program would allow it to fund 118 additional loan repayment awards, which could translate into 36,000 more medical patients being served.

Recruiting nurses, especially ARNPs, can go an extremely long way in alleviating Washington State's—or any state's—primary care shortage, especially when they're allowed to practice independently.

In Washington State, "Advanced Registered Nurse Practitioners (ARNPs) are independent in their scope of practice including full prescriptive authority. No collaborative agreements are required," states the Washington State Department of Health website.

"[Supplementing] with nurses is very important to increasing access to care," Firth says. There's also an emphasis on recruiting nurses of all kinds, especially since Firth says the state's community health centers believe strongly in team-based care.

Moreover, she says Washington State is a leader in trying to address the needs of nurses and trying to make sure they're present in healthcare decision making. "For the state overall… we've been a longtime supporter of nurses," Firth says.

She notes that although the Medicaid expansion in Washington State is good news for patients, it can only go so far; health coverage doesn't mean much if there aren't health professionals to provide care.

"This is a really smart investment that Washington State could make," Firth says. "It could really help ensure that we could help meet the needs of tens of thousands additional patients."

Restoring funding to the loan repayment program is a great way to address the primary care shortage without trying to solve longer-term pipeline issues, she adds.

"We can dramatically increase the number of providers in these rural and underserved areas with this investment, and it's an immediate investment. You see results pretty fast. This is an immediate solution."