Curious about loan repayment programs- serving in maternity care deserts

FennelCNM, MSN, APRN · Sep 16

It is great that you are starting your research early. There is a lot of paperwork involved when you apply. You apply to a site just like you would any job. HRSA have to verify the site is eligible before it is deemed eligible. MCTA is a score that sits alongside the HPSA score. Generally if the site has a high HSPA score the MCTA will also likely be high as long as they have a women's health department. You can use the connector which I have linked below you will be able to see both the MCTA score and the HPSA score for specific sites. Having a site available doesn't mean they necessarily have a role open for someone to take.

It will also depend on what the LRP is asking for in terms of the score. There are some sites that you won't be able to work for if the score isn't high enough or meets the requirements of your LRP. It changes every year and is in the application booklet you should read before you apply or accept the award.

It is also very hard for a new grad to find a position right now as a CNM. Most health systems want you to have some experience before they are willing to hire you. But once you have experience recruiters and health systems will start to find you and ask if you are interested in a position / invite you to interview. There will also be some health systems depending on who you interview with and the experience they have working with midwives, might request you have prior L&D experience before they are willing to consider you. Good luck to you!

Heathforce Connector

https://connector.HRSA.gov/connector/search

HRSA HPSA Finder

https://data.HRSA.gov/tools/shortage-area/hpsa-find

Richelle Paoli · Sep 16

@FennelCNM thank you so much for your thorough response and resources! Do you happen to know where I can find out what range of MCTA scores are usually required for these programs?

also, that's worrisome about prospects for new grads- reminds me of when I graduated nursing school... unfortunately, I won't be able to do CNM school AND try to get L&D experience.. wonder how new midwives are getting their foot in the door?

FennelCNM, MSN, APRN · Sep 16

If you go to the HRSA website or do a Google search you can download the NHSC or Nurse Corp LRP handbook for this past cycle and see what the MCTA range will be. Just keep in mind the NHSC and Nurse Corp are two seperate programs under HRSA and they will have different HSPA and MCTA requirements. There is also the NHSC and Nurse Corp Scholarship program and they also have different MCTA and HSPA score requirements. These are the federal programs. Each state usually also has their own state LRP programs for healthcare workers. That will be something to look into as well. There are different pros and cons to each program.

You will have to budget enough time post grad to search for and land a job; between 6-12 months depending on where you want to practice and if you are willing to move. The most important thing for most new grads is to be flexible on where you would like to practice if you accept the LRP. Just remember that it is a binding contract and there are penalties for breaking it which are listed in the handbook. I wouldn't recommend accepting the LRP if you have your heart set on staying in a certain geographical location unless you already have a job offer in place or if you have partner who has a job that won't allow you to move or if you have children that don't want to move out of the school that they current love or if you have very specific custody arrangements with an ex-spouse or partner. Generally, this won't be an issue with the LRP but it is more of a consideration with the scholarship program. I have seen all of these things happen to individuals who accepted the LRP or scholarship and couldn't find a site after graduation due to the above listed reasons. There are many more but those are just a few complication that I have seen with people who accept LRP or the scholarship program. I would also recommend that you consider the scholarship program as well. They pay a stipend while you are in school and you won't accrue interest on the loans and have to then pay them back. The LRP is the opposite and you apply for LRP after taking out the loans and you will need to find a site that is LRP eligible and be offered a contract and employment by them by applying and interviewing for the job. Again there are pros and cons to going in either direction.

FullGlass, BSN, MSN, NP · Sep 16

You may also be able to get a full ride scholarship from HRSA in return for working in an underserved area for 2-4 years.

You have to do your own job search and research upon graduation. HRSA does not find you a job. You can use their tool with the HPSA numbers of facilities in specified geographic areas as a starting point, but not every eligible facility is listed. Start looking online to see which areas are advertising for CNMs and then see which of those areas qualifies for HRSA scholarship or loan repayment.

In addition, HRSA has job fairs regularly. You can register for the job fairs and get a list of participating sites that are recruiting. Even if they are not recruiting for CNMs, you can contact the sites if they employ CNMs.

https://bhw.HRSA.gov/job-search/attend-virtual-job-fair

Unfortunately, I'm not sure how much demand there is for CNMs in rural "maternity care deserts" right now. Hospitals in such areas are shutting down their L&D wings due to lack of demand for their services.

Urban areas can also have a high HPSA score. For example, much of Baltimore does and they have a lot of L&D demand.

Many states have scholarships and loan repayment programs similar to HRSA for state residents, so check out those.

Do a lot of online research to determine where there is demand for CNMs. You can also reach out to faculty at CNM programs for information on employment prospects. Look at the school websites, as they will post information on the profession, including demand, provider shortages, etc. ACNM and ACOG are 2 associations in this area. ACNM also has state chapters. Some states have their own midwife associations, so search by state.

https://www.midwife.org/ACOG-and-ACNM-Press-Release

https://www.midwife.org/

https://www.cnma.org/

Go to meetings of nurse midwife associations and start networking. This is chance for you to talk to CNMs and get their take on the job market. Some of my friends got NP jobs just by going to NP association meetings.

Good luck.

Richelle Paoli · Sep 17

@FennelCNM @FullGlass thank you so much for all this helpful information! I'm overwhelmed because there's so much to consider, but also excited. Really appreciate all the resources. It's hard to know what will make the most financial sense when thinking about the future because as of now, I don't have any idea how much financial aid I'll qualify for. I'm going to see if I can get some answers around this, to start 🙏🏼🙏🏼🙏🏼

FullGlass, BSN, MSN, NP · Sep 18

Richelle Paoli said:

@FennelCNM @FullGlass thank you so much for all this helpful information! I'm overwhelmed because there's so much to consider, but also excited. Really appreciate all the resources. It's hard to know what will make the most financial sense when thinking about the future because as of now, I don't have any idea how much financial aid I'll qualify for. I'm going to see if I can get some answers around this, to start 🙏🏼🙏🏼🙏🏼

You are very welcome. I was also thinking that you could research areas with a high birth rate. In developed countries the overall birth rate is dropping, but certain ethnic groups have higher birth rates. You could do some demographic research and target areas where people tend to have more babies. For example, if ethnic or racial Group X has a high birth rate and a lot of them live in area Y, that would probably be an area that needs CNMs and WHNPs.

My first job in primary care was in a rural area. We could not have supported a CNM, but we did have a WHNP. However, even she was not able to work FT in just women's health. She was an FNP that did a post-masters for the WHNP. Have you considered doing something like that? I saw other discussion threads on that in this community: WHNP + CNM, FNP + CNM, etc.

Finally, it is pretty common for students to get job offers as a result of their clinical rotations. Do well in your rotations!

One last thought: that primary care job I had was out in the middle of nowhere. The nearest decent size town was Redding, CA, about 100K people, 50 miles away. Redding has a shortage of all kinds of providers. The Ob Gyns and so forth for the surrounding rural areas were almost all in Redding. Anyway, I was referring women to an Ob Gyn in Redding and that MD made me a job offer! She said it was really hard for her to find providers and she needed help. So you could be in a town or small city that serves nearby "maternity deserts."

Richelle Paoli · Sep 19

@FullGlass more great thoughts! Yes I need to look into how much extra time the FNP or WHNP would take. Tbh, I'm not super intrigued (always been a birth junkie LOL) but it might be worthwhile.

I'm from Northern California! Never been to Redding, but I've heard a lot about it. I love that idea 🙏🏼💖

Red Shirt 6, CNA · Sep 21

I would suggest using 3RNET.org for help with finding employment in a rural area.