The state’s loan remittance program for behavioral health workers who take a gig practicing in a federally designated shortage area is now up and running.
Approved in the 84th Texas legislative session last year, the Loan Repayment Program for Mental Health Professionals sets aside $2.125 million that will pay down student debts if the practitioner agrees to provide five straight years of service in a Mental Health Professional Shortage Area, or MHPSA. The U.S. Department of Health and Human Services defines these as regions where there are 30,000 or more people without a psychiatrist. There are more than 350 of these in Texas, some of which exist in major urban centers. West Dallas is one, for instance. Southeast and southwest San Antonio are two others.
“Without an adequate number of mental health professionals, we will continue to see those experiencing mental illness cycle through our jails and emergency rooms at great expense to the taxpayer,” said state Sen. Charles Schwertner, R-Georgetown, who authored the bill in the senate. Rep. John Zerwas, R-Katy, championed it in the House.
The way it works: Licensed psychiatric physicians could get up to $160,000. In the first year of practice, the state would pay 10 percent. For the next four years, the state adds another 5 percent annually. Psychologists and clinical social workers follow the same pattern for up to $80,000. Registered nurses get $60,000 and social workers up to $40,000. They can spend as much as a quarter of their time providing care via telemedicine each week.
But will this be enough? The problem is a nuanced one. Loan remittance alone isn’t always enough to convince young physicians to start practicing in a rural area, says Phil Miller, a vice president at Irving physician recruitment firm Merritt Hawkins. Some larger hospitals and practices already offer loan payback programs. Too, earning potential may be higher elsewhere; even with the state program, their best option financially may lie in a different, more populated area.
“Even in non-rural areas today a lot of our clients are offering some sort of loan forgiveness program, about a third of them offer that as part of their incentive packages,” he says. “You’re evaluating your overall financial potential and you look at the payer mix out there, the number of and type of patients, and even with loan forgiveness it doesn’t necessarily add up to a real lucrative practice situation.”
Too, there’s the cultural aspect. Some physicians just aren’t going to want to practice in a rural area. The UNT Health Science Center at Fort Worth actually has its own program for students who do. Called Rural Osteopathic Medicine Education, or ROME, the track identifies students that would be interested in eventually practicing in these communities and gets them cycling through them during their time at the school.
“I don’t think you’re going get them there by just taking them out of an urban medical school and plopping them into a residency and say go to a rural area,” Dr. Michael Williams, the university’s president, told me last year. “You have to develop them into a core of what they really do.”
Although, Miller says it’s a step in the right direction. It could be a toe in the water; if it’s successful in driving new practitioners to these underserved areas, maybe the 85th Legislature throws some more money at it. Nevertheless: According to Merritt Hawkins, the state of Texas ranks 30th in the percent of mental health demand needs being met. A total of 184 counties don’t have a psychiatrist.
“I do think this is helpful,” Miller says. “But it certainly won’t be a panacea, I don’t think.”
Interested parties have until May 31 to apply. Head here for more details, straight from the Texas Higher Education Coordinating Board.