Loan forgiveness, visas offered to fill rural health care positions in region

NORTH CANAAN — The Northwest Corner was designated a Health Professional Shortage Area (HPSA) by the Health Resources and Services Agency in late August, following two years of efforts on the part of local health care organizations.

The federally awarded designation grants medical providers in the region—including such entities as Nuvance Health’s Sharon Hospital and North Canaan’s forthcoming Federally Qualified Health Center—incentives to attract crucial primary care providers to the area. 

The two principle incentives are loan forgiveness, for practitioners who took out federal loans to complete medical school, and visa sponsorship, for foreign practitioners who want to continue to work in, or attend school for, health care professions in the U.S.

To benefit the health care organizations operating in designated areas, the federal government increases Medicaid reimbursements for appointments with doctors and nurses who qualify as general practitioners.

Concerned by the lack of primary care services in the Northwest Corner—a nationwide trend in rural areas—the Torrington-based Community Health and Wellness Center (CHWC) first applied to the state Primary Care Office (PCO), a part of the state Department of Public Health, which in turn applied to the federal Health Resources and Service Administration (HRSA) a full two years ago.

However, the Primary Care Office based its assessment on outdated information on the number of primary care providers operating in the region—the numbers complicated by COVID-19, among other things. For example, HRSA’s data showed that in Canaan there were two general practitioners, when in fact, one had retired. 

Across the country, the primary care workforce is aging, a trend that particularly affects rural areas, said a spokesman for the Primary Care Office.

CHWC also had difficulty proving that the region included a high level of low-income or poverty-level households, the designation’s other principle criterion.

“North Canaan and surrounding towns have somenaffluence and pockets of wealth,” said Joanne Borduas, chief executive officer of CHWC, who spearheaded the effort. Because of the area’s small population, she said, providing evidence of a qualifying percentage of low-income patients in the service region was difficult.

After the first application was denied, CHWC worked with the Office of Rural Health Care, Sharon Hospital and other local organizations to revise their data, and after several months of work, the application went to HRSA again.

The “new” designation is technically an expansion of Torrington’s HPSA designation, which has been in place for over 20 years, said Borduas.

The primary care providers incentivized by the designation include GPs and other practitioners of family medicine and internal medicine, including advanced nurse practitioners, nurses and even—on a case-by-case basis— licensed clinical social workers.

The incentives do not extend to specialists like OB-GYNs or gastroenterologists—other health care providers sorely needed in a region characterized by an aging population and a lack of reliable access to transport.

Asked if the program works, Borduas was unequivocal. “Absolutely, it works,” she said. “I’ve hired maybe a dozen or so providers who have come looking for sponsorships for visas” since she began working at CHWC, she said.

She has also seen many providers come through the loan repayment program. It’s “a big draw for those who are just coming out of medical school,” she said, which is “a really big plus” for local health care “because [recent graduates’] skills are usually very high.”

“The HPSA designation is one more tool in our recruitment toolbox to help attract and retain top talent from a larger pool of clinical candidates,” said Sharon Hospital president Christina McCulloch in a statement. “We are actively building the needed infrastructure to take advantage of this opportunity.”

Andrea Rynn, spokesperson for Nuvance Health at Sharon Hospital, said that the designation is primarily directed towards physicians and not nurses, so she doesn’t expect the incentives to help Sharon Hospital attract and retain staff in their Labor and Delivery Unit, which Nuvance is trying to close.

“But we will be exploring all opportunities,” she said.

Improving rural healthcare is also necessary for keeping people in the area and attracting new full-time residents, or for people to return to the communities that they worked in and grew up in, said Borduas. “This could be a promising step in that direction—to get folks to stay locally, and to get health care services where they are very much needed.”

The new designation includes Salisbury, North Canaan, Canaan, Norfolk, Colebrook, Sharon, Cornwall, Goshen, Kent, Warren, Litchfield, and Morris.