Tuition assistance programs, service scholarships, and student loan repayment programs are useful tools in recruiting and retaining public health professionals. These programs help grab the attention of potential candidates and can help make health departments more attractive to employees. They also help public health workers control and manage their debt burden.

Such programs can also play a critical role in shaping how public health services are provided. Take Rhode Island, for example. Its Health Professional Loan Repayment Program (HPLRP) supports the recruitment and retention of community-centered healthcare professionals who serve in federally designated Health Professional Shortage Areas (HPSAs) throughout the state. The program’s 2024 cohort, the largest in its history, included 58 health professionals who pledged to work in underserved areas for a minimum of two years. These professionals included physicians, dentists, nurses, and behavioral healthcare providers.

It’s an investment that’s paying off. More than 100,000 Rhode Islanders receive health care from current or former program participants each year.

“We’ve seen that 91% of awardees over the last decade are either actively licensed in Rhode Island or still working in the state,” said Manuel Ortiz, MPA, chief in the Office of Primary Care and Rural Health at the Rhode Island Department of Health (RIDOH). “This program has been instrumental in retaining clinicians in the areas of highest need — communities that, due to socioeconomic or other barriers, might not otherwise have access to care. It plays a critical role in ensuring that vulnerable populations across the state are not left behind.”

The Rhode Island legislature established the HPLRP in state statute in 1993. The program provides incentives, in the form of loan repayment, to healthcare professionals who choose to serve in the state’s medically underserved communities.

Rhode Island first received funding from the Health Resources and Services Administration (HRSA) in September 1994, and the first official cohort of loan repayment recipients enrolled in 1995. RIDOH administers the program, which is overseen by the Rhode Island Health Professional Loan Repayment Board. The Board reviews applications and selects awardees.

Flexibility leads to funding — and impact

Historically, the HRSA grant has required a one-to-one match. “In order to use the federal dollars that came in, the state had to come up with matching dollars,” Ortiz said.

At the program’s inception, a state appropriation provided the required matching dollars. But around 2007, the state’s budgetary priorities shifted to meet other pressing needs, such as housing. “We didn’t apply for the grant again because we didn’t know if we’d have the resources to fund it,” he said.

That’s when Rhode Island got creative. The Board approached potential philanthropic partners in the state about funding the one-to-one match. By 2013, the HPLRP once again had HRSA grant funding and a new cohort of recipients.

“The Board really became the driving force behind engaging donors and building the program into what it is today,” Ortiz said, noting that state employees are limited in their ability to solicit donations. “That’s why having the Board steward those philanthropic relationships has been so critical to the program’s success. With each grant cycle, we’ve seen funding grow, largely thanks to this donor engagement. As contributions increased, so did the program’s capacity and impact. We’ve been able to award more recipients because private donations unlocked more federal dollars.”

In 2024, HPLRP donors include Blue Cross & Blue Shield of Rhode Island, Delta Dental of Rhode Island, Care New England, Neighborhood Health Plan of Rhode Island, Prospect CharterCARE, the Rhode Island Foundation, the Rhode Island Medical Society, the Rhode Island Health Center Association, and UnitedHealthcare Community Plan.

Support for the program has been so strong that Rhode Island continued to bring in matching donations even when ARPA funding allowed a three-year reprieve from the match requirement. “That was done intentionally because we knew the cycle would return,” Ortiz said. “The Board made sure our donors knew that, and they have kept donating. Every year, this program has grown.”

Applying an equity lens

Currently, Rhode Island’s HPLRP is designed to recruit and retain critical public health professionals in three areas — licensed clinicians in the areas of primary care, dental health, and behavioral health. The program aims to reduce health disparities faced by those who live in underserved areas.

Applicants to the HPLRP must meet eligibility requirements. They must:

  • Be a U.S. citizen or national.
  • Have completed an accredited health education.
  • Hold a valid unrestricted Rhode Island license.
  • Be employed at, or have accepted employment with, an approved site in a designated HPSA.

Rebeca Vasquez, chief of program development, manages program operations and supports applicants, including managing the application process and verification of applicant eligibility.

“It’s a highly competitive process, and we work hard to make sure it’s fair, efficient, and accessible,” Vasquez said. “Our goal is to ensure applicants understand the requirements and are supported throughout the process.”

Once the RIDOH team verifies eligibility, applications go before the Board for review and decision. The Board uses a formula to rank applicants and determine individual award amounts. This formula considers student loan debt and applicant income, along with applicant essays.

“The Board applies an equity lens to every application,” Ortiz said. “When two applicants have similar scores, how do you decide who has greater need? That’s where the debt-to-income ratio comes in — it helps the Board prioritize applicants who are carrying a heavier financial burden. It’s a way to make awards as equitable as possible. To my knowledge, we’re the only state that factors individual debt levels into the decision-making process.”

Awards are made until the program depletes its funding for the year. “On average, within six months, we make a payment directly to the awardee’s lender,” Ortiz said. “The award does not go to the individual.”

Strings attached: Awardee expectations

Awardees receive a set payment for a two-year initial commitment. After two years, they can reapply annually for a continuation contract with a new award amount. Awardees can participate in the program for a maximum of six years.

The HPLRP has two tracks — full time (40 hours) and half time (under 39 hours). In both tracks, a minimum number of weekly hours must be devoted to direct patient care, while the remaining time may be administrative.

The Board has placed restrictions on how much awardees can earn, according to Ortiz. But the benefits of the program may outweigh those restrictions. “If a person owes $100,000, they could get that paid off by the program in four to five years,” he said. 

“Awardees are required to work at an eligible site for the duration of their service term,” Ortiz said. “But we recognize that life happens — you might change employers, move, or start a family during your service. Our role is to help participants understand their commitment and any potential penalties. We want awardees to benefit from the program, so we’re very upfront about what’s required and what happens if those terms aren’t met.”

Ortiz and Vasquez manage site staff communications throughout the award period. “We certify every six months,” Vasquez said. “Site administrators must attest to the hours awardees have worked within those six months.”

They must also report days missed. There are limits to the number of days awardees can miss during their service commitment. “Those limits are set by the federal grant,” Ortiz said.

Incentive to stay

Ortiz noted that many health professionals could work in other nearby states and earn more money than they can in Rhode Island. That’s why he tries to maintain as much flexibility as possible within the program’s rules. “One of the biggest strengths of our program and one of the reasons why it’s grown is that we remember the human touch,” he said. “If you really want to recruit and retain talent — if you want them to stay — you have to be as flexible as you’re able to be.”

Rhode Island’s diverse population is best served by a diverse workforce. “We’ve made the program as wide-ranging as possible to attract different types of professionals interested in public health,” he said. “If you’re willing to work in a high-need area, we want to support you by helping pay down your student loans. This is our way of saying we value your service, and we want you to stay.”

Key Actions

Wondering if a loan repayment program or tuition assistance program is right for your health department? Here’s what to consider:

  • Create a vision. Define your goals to design a program that aligns with public health needs and department capacity.
  • Explore funding sources. Federal, state, and municipal funds may provide needed dollars. Other potential funding sources include private foundations, associations, academic institutions, insurers, and philanthropic organizations.
  • Ensure adequate personnel. Some funding comes with complex requirements. Ensure you have staff resources to support the program’s administration.
  • Track data. Collecting and sharing metrics on the program’s impact on recruitment and retention can help bring in additional funding.