Form 5 Survey of NHSC Recent Alumni (LRP)

2011 Survey of Recent NHSC Loan Repayment Participants
This questionnaire is intended for clinicians of all disciplines who were serving (providing clinical work) in the National
Health Service Corps during 2004, 2005 or 2006. If you did not serve in the NHSC then, please check the appropriate box
below and mail the questionnaire back to us in the enclosed envelope.
□ I was never in the NHSC—you have the wrong person
□ I served in the NHSC but at no point in 2004, 2005 or 2006
Any explanation/elaboration? __________________________________________________________________
__________________________________________________________________

All others please complete the questionnaire. Thank You!

Use of identifiers and Reporting Burden
The information you provide will not be revealed to the NHSC or others in any way that can be linked to you, your community or
practice. All information provided will be handled anonymously and reported in aggregate. The identification number shown on this page
only allows us to keep track of the questionnaires as they are returned.
Public reporting burden for this collection of information is estimated to average 12 minutes. The OMB control number for this project is
XXX, expiration XX.

I. TRAINING AND EXPERIENCES PRIOR TO NHSC SERVICE
1a. In what state did you live most of your years before college?

State: ____________________

□ or check if
no one place

b. In what type of community was this? (circle one)
1. urban

2. suburban

3. small town or rural

0. N.A., no principal place

c. In which state and year did you graduate professional school (e.g., medical or dental school)?
1. State: ________________________

2. Year of graduation: _______

d. For physicians and others who completed a residency:
In which state and year did you complete your residency? If more than one residency, report the last.
1. State: ________________________

2. Year of graduation: _______

2a. Did you have any formal training experiences with medically underserved populations during your professional
training? (circle number of all that apply)
0. No

 If “no”, skip to 2c

1. Yes, as student
2. Yes, during residency or fellowship
b. How many weeks cumulatively were spent in these experiences?

___________ weeks

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c. Did you participate in the NHSC’s SEARCH Program as a student?

1. Yes

d. During your training, how much exposure did you have to:
(circle one number on each line)
None

0. No

Moderate
Exposure

Extensive
Exposure

1. community and/or migrant health centers?

1

2

3

4

5

2. rural health care?

1

2

3

4

5

3. inner city health care for the poor?

1

2

3

4

5

4. past and/or current NHSC clinicians?

1

2

3

4

5

3. What was your approximate outstanding educational debt when you completed your training? $ _________________

II. JOINING THE NHSC AND SELECTING YOUR FIRST NHSC SERVICE SITE
4a. When did you begin your Loan Repayment Program service? Month: __________________ Year: _________
b. How much do you agree or disagree with the statements below about your reasons for applying to the
NHSC Loan Repayment Program. (circle one response for each question.)
Strongly
Disagree
a. I needed financial assistance to pay off educational
debt.
b. I wanted to provide care to an underserved
population or area.

Neutral

Strongly
Agree

1

2

3

4

5

1

2

3

4

5

5. Where was your first practice/site where you began working as part of the NHSC Loan Repayment Program?
Practice/Organization name:

_____________________________________

City: __________________________ State: _________________________ Zip: _____________

6. When did you begin working in this practice/site? Month: ____________ Year: ______

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7. Were you already working in this practice/site when you applied for NHSC Loan Repayment?
0. No
1. Yes

 If “yes” a. about how many months had you worked
there before applying for loan repayment?

__________ months

b. when you decided to work in this practice, did you
know it be might eligible for NHSC loan repayment?

1. Yes

0. No

8. Where would you likely have worked if you had not participated in the NHSC Loan Repayment Program?
(circle all that apply)
a. in the same practice

d. in an underserved area

b. in a rural practice

e. in a community or migrant health center

c. in an inner city practice

f. other (specify): ___________________________

9. How important to you and your family were each of the following considerations when choosing to work in your
first NHSC practice/site? Did the practice and community you chose meet your needs?
(circle responses for both “importance” and “need met” on each line)
Importance
Not
important
a. Working with a specific socioeconomic or ethnic
population
b. Working at a specific, known site that you
already had in mind
c. Working in a specific area (e.g., near family or
in a particular state)
d. Having ready access to specific activities
like fishing, hiking, fine dining or theater

Was need met at your
first NHSC practice?

Somewhat
important

Very
important

Yes

No

1

2

3

4

5

Y

N

1

2

3

4

5

Y

N

1

2

3

4

5

Y

N

1

2

3

4

5

Y

N

III. ABOUT YOUR FIRST NHSC SERVICE SITE
10. Which one of the following best describes your first NHSC practice/site? (circle one letter)
a.
b.
c.
d.
e.
f.
g.

community or migrant health center
rural health center
other primary care practice
Indian Health Service (IHS) site
tribal site
prison
city or county health department

h. dental practice—group or private
i. mental health or substance abuse facility
j. nursing home
k. university-based clinic or service
l. hospital-based clinic or service
m. Other (specify): ________________________

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11. How many patient/client visits or encounters did you have on
a typical day in all settings (e.g., office & hospital)?

__________ total visits per day

12. How many weekday evenings and weekend days on average per week
were you on call (apart from scheduled clinic hours)?
(respond “0” if you did not take call)

__________ days and nights
(maximum = 7)

13. How much do you agree or disagree with the following statements about your work in your first NHSC practice/site
while you were serving in the NHSC? (circle one number on each line)
Strongly
Disagree
a.

Neither Agree
nor Disagree

Strongly
Agree

I had good clinical back-up from more senior and/or
supervising clinicians at my practice.

1

2

3

4

5

I was able to provide the full range of services for which
I was trained and wished to perform.

1

2

3

4

5

c.

The practice had an effective administrator.

1

2

3

4

5

d.

Work rarely encroached upon my personal time.

1

2

3

4

5

e.

I felt a strong personal connection to my patients.

1

2

3

4

5

f.

I felt I was doing important work in this practice.

1

2

3

4

5

g.

I felt a sense of belonging in the community where I worked. 1

2

3

4

5

h.

I felt appreciated by NHSC staff for my work.

1

2

3

4

5

i.

Overall, I was pleased with my work.

1

2

3

4

5

j.

Overall, I was satisfied with my practice.

1

2

3

4

5

b.

14. How satisfied were you with the following aspects of your first NHSC practice/site during the years you
were serving in the NHSC?
(circle one number on each line)
Very
Dissatisfied

Very
Satisfied

Neutral

a. your relationship with the practice administrator

1

2

3

4

5

b. financial stability of the site / practice organization

1

2

3

4

5

c. physical condition of the healthcare facility

1

2

3

4

5

d. your salary or income from your practice

1

2

3

4

5

e. availability of cross coverage to allow you to leave town

1

2

3

4

5

f. mission and goals of the practice

1

2

3

4

5

g. your access to specialist consultations for your patients

1

2

3

4

5

h. support by other clinicians working at the site

1

2

3

4

5

i. the contacts and other support you received from NHSC staff 1

2

3

4

5

4

15. a. What was your annual salary or income when you began working in your first NHSC practice/site? $___________
b. What was your most recent or last annual salary or income in this practice?

$ ___________

16. Did you teach students or other learners at your first NHSC practice/site when you were serving in the NHSC?
1. Yes  If yes, about how many half-days per month did you teach?

___________ half-days

0. No
17. How much do you agree or disagree with each of the following statements about the community where you lived
while working in your first NHSC practice/site and serving in the NHSC?
(circle one number on each line or “NA” if you did not have a spouse or partner or didn’t have children)
Strongly
Disagree

Strongly
Agree

Neutral

Not
Applicable

a. My spouse/partner was happy in the community.

1

2

3

4

5

N/A

b. Satisfactory professional opportunities for my spouse/partner
were available in the community.

1

2

3

4

5

N/A

c. My children were happy in the community.

1

2

3

4

5

N/A

d. Satisfactory educational opportunities for my children were
available in the community.

1

2

3

4

5

N/A

e. My family was concerned about personal safety in the
community.

1

2

3

4

5

N/A

IV. JOB CHANGES AND YOUR FUTURE
18. Did you complete your initial two-year NHSC Loan Repayment Program contract/term with service?
(circle 1 or 2 below)
1. Yes  If yes, when did you complete that initial two-year contract?

Month: ________ Year: _________

2. No  If no, what happened with your initial NHSC Loan Repayment contract obligation?
(circle one number)
0. I am now serving my initial NHSC Loan Repayment contract
1. I am now in deferment for my initial NHSC contract
2. I paid the required amounts to buy out of part or all of my initial NHSC contract
3. The NHSC now considers me in default
4. Other Specify: _____________________________________________

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19. Did you apply for one or more renewal (“amendment”) Loan Repayment contracts to extend your NHSC service?
(circle one number)
0. No
1. Yes, I applied, but I wasn’t granted a renewal
2. Yes, I applied and was offered a renewal contract but decided not to take the renewal offer
3. Yes, I signed a renewal contract
 If you signed a renewal contract, when did or will
you complete your last renewal contract?
Month: ______________ Year: ___________

20. Are you still working in the same practice where you first served in the NHSC?
1. Yes  Skip to question 22 below.
0. No

 If no, when did you leave your first NHSC site? Month ______________ Year ___________

21a. Please list all positions where you have worked for six months or longer since leaving your first NHSC practice site.
Include periods of clinical and non-clinical work, as well as periods of training and when you did not work.
List current position first, then others going backward in time.

1.
2.
3.
4.

Start Date
Year
Month

End Date
Month
Year

___
___
___
___

___
___
___
___

___
___
___
___

___
___
___
___

Position
Clinical Other Specify*

□
□
□
□

□
□
□
□






_
_
_
_

City/Town

State

Zip
(if known)

_______
_______
_______
_______

_______
_______
_______
_______

______
______
______
______

This organization
focuses on care for
underserved?

Yes

No

Yes

No

Yes

No

Yes

No

*If responded Other, please note appropriate number above:

1.
2.
3.
4.
5.

non-clinical work
in training
teaching
other work
not working

b. If you are now in clinical practice, what proportions of the patients are covered under: (Numbers may not total to
100%)
1. Medicaid _________%

3. IHS or tribal coverage _________%

2. Medicare _________%

4. uninsured

__________%

6

22. The following questions are about your current career plans. Respond on each line with a single year estimate if able,
otherwise a range of years. Check “NA” when not applicable.
Looking ahead, how many more years do you think you will:
Single year estimate

Range of years estimate

a. remain in your current practice/site?

_____________

OR

_____ to _____

b. remain practicing in your current community?

_____________

OR

_____ to _____

c. remain in rural practice?

_____________

OR

_____ to _____

□ NA

d. continue practicing with a medically underserved
population?
_____________

OR

_____ to _____

□ NA

V. YOUR BACKGROUND AND FAMILY
23. Year of birth:__________________
24. Your gender:

1. Male

2. Female

25. Are you of Hispanic origin?

1. Yes

2. No

26. Race:

(circle all that apply)
1. White

4. Asian

2. Black or African American

5. Native Hawaiian or other Pacific Islander

3. American Indian or Alaska Native

6. Other: ________________________

27. Were you married or did you have a partner at any point while working in your first NHSC practice site?
0. No  If no, skip to question 28 below.
1. Yes
b. In what state did your spouse/partner live growing up?

State: _______________________

□ or check if no
principal state
□ or check if outside
the U.S.

c. In what type of community did your spouse/partner grow up? (circle one)
1. urban

2. suburban

3. small town or rural

0. Not applicable, no principal place

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VI. YOUR EVALUATIONS AND RECOMMENDATIONS
28. Considering all of the experiences you have had with the NHSC Loan Repayment program, how satisfied were you
with this Program? (circle number)
1

2

3

4

5

Very Dissatisfied

|

6

7

8

9

Neutral

10
Very Satisfied

b. To what extent did the NHSC Loan Repayment Program fall short of or exceed your expectations?
1
Fell Well Short

2

3

4

5

|

6

7

8

9

Met My Expectations

10
Far Exceeded
My Expectations

29. What can the NHSC leadership and staff do to make the NHSC a better program for its clinicians?
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________

30. What can the NHSC do to make it more likely that its alumni would continue to serve needy populations?
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________

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