Position Summary:
The Clinical Psychiatrist will evaluate, diagnose and treat patients with mental disorders. This role is integrated within the primary care clinic to function as a member of multi-disciplinary and administration teams in the provision of mental health and substance use screening protocols for adult & pediatric patients. This role may prescribe medication or suggest therapy according to their patents’ needs.

Job Responsibilities:
• Helps patients by evaluating medical and psychosocial conditions.
• Develops and implements treatment plans, including prescription of psychotropic medications.
• Monitors and evaluates treatment results.
• Evaluates patients by interviewing patient, family, and other persons; conducting physical examinations; observing behaviors; reviewing medical history and related documents; selecting, administering, and interpreting psychological tests; and ordering laboratory tests and evaluating results.
• Develops treatment plans by determining nature and extent of cognitive, emotional, developmental, social, and behavioral disorders and establishing treatment goals and methodologies.
• Treats patients by utilizing psychotherapeutic methods and medications; discussing progress toward goals with patients; providing instructions; monitoring effect of medications; and supervising staff provision of services.
• Maintains interdisciplinary treatment by reviewing treatment plans and progress, and consulting and collaborating with primary care physicians, mental health therapists, nurses, and other health care providers.
• Assures quality and safe service for patients and staff by enforcing policies, procedures, standards, rules, Joint Commission for Accreditation of Health Care Organizations requirements, and legal regulations; participating in utilization reviews; and remaining available for emergency consultations.
• Improves staff competence by providing training and discussions regarding the interrelationship between psychosocial and physiological problems, psychotropic medications, crisis intervention, and related issues.
• Maintains historical records by documenting symptoms, medications, and treatment events and writing summaries.
• Updates job knowledge by participating in continuing medical educational opportunities, reading professional publications, maintaining personal networks, and participating in professional organizations.
• Enhances department and organization reputation by accepting ownership for accomplishing new and different requests and exploring opportunities to add value to job accomplishments.

Qualifications:
• Strong interpersonal and communication skills
• Strong documentation and monitoring skills
• Proven ability to analyze information and to think critically
• Excellent decision-making and listening skills
• Excellent patient service, care and bedside manner

Preparation and Training:
• Completion of a psychiatric residency or a family medicine/psychiatry residency in an ACGME approved residency program
• Current BC/BE in Psychiatry (American Board of Psychiatry and Neurology in psychiatry)
• Valid state medical license as MD or DO
• Valid DEA certificate
• 2 years’ experience working full-time as a psychiatrist in child/adult psychiatry

Position Summary:
The purpose of the Registered Dietician (RD) position is to provide comprehensive, complex nutrition and health education services to adult and pediatric patients with a variety of medical/nutritional problems. The RD will exercise a thorough knowledge of disease pathophysiology in relation to nutritional theories and practices. The RD will consistently manage acute, chronic, and terminally ill clients/patients who are characterized as medical high risk. The scope of practice will include but not limited to: managing the hypertension program, diabetic program and other quality and patient care initiatives. As a key contributor to the Quality Program the RD will participate in developing and implementing clinic flow, patient referral criteria, operation standards, and procedures. Serves as a technical resource and provides training to other clinical and non-clinical staff and work may include other related assignments as determined by the Chief Medical Officer (CMO).

Overview and Guideline:
The RD will receive complex, critical referrals, requiring independent analysis of clients’ medical condition, researching nutritional requirements of the respective medical problems, and creation of a treatment plan in concert with an interdisciplinary team approach. The RD may provide technical consultation and training to clinicians in developing the nutrition component of the care plan. May interpret medical and laboratory information and discuss hospital referred treatment plans, interpreting their application to the home environment.

Guidelines include standardized assessments, professional reference materials, nutritional program reference manuals, medical reference, and professional standards. Employees must independently apply these guidelines, program goals, and standards or seek advice from either a higher lever nutritionist or the program management team.

Essential Duties:
• Support medical staff in addressing nutrition and weight issues with all patients
• Counsel interested patients/families in healthy food choices and physical activity
• Maintain database of patients counseled
• Plan patient care independently or in concert with an interdisciplinary team.
• Meeting objectives and goals as directed by your supervisors.
• Help program management develop resources (handouts, newsletters, demonstrations and other teaching tools) and forms as assigned and directed.
• Meet with staff to review program and revise process.
• Communicate regularly with providers on all their patients/families enrolled in program
• Provide consultative service to school nurses, fitness program staff and other change agents.
• Assists with special research projects; gathers comprehensive health education data and statistics; and makes proposals as needed based on these and trends in the health education field.
• Provides oversight with the CMO for the Hypertension and Diabetic initiatives at the designated location.
• Participates in TQM (Total Quality Management) at TAPM for children and adults.
• Represents the agency at community organizations; serves as a speaker before public groups, private organizations, and the general public as needed.
• Performs related duties as required.
• Travel as needed.

Confidential Information:
Works with confidential data: patient medical records, insurance, and billing information.

Work Conditions:
Job duties are performed in normal medical office working conditions. There will be exposure to patients with communicable diseases and blood borne pathogens; all necessary protective measures will be provided.

Mental Attention or Visual Demand:
Must be able to communicate via telephone and other automated devices. Mental/visual attention, along with manual coordination is necessary for keyboard operations at least 50% of the time. Normal or corrected hearing is required.

Minimum Qualifications:
Registered Dietitian License
Masters Degree with two year’s work experience.
Proficient in Microsoft Office
Current NC Driver’s License

Position Summary:
Provides direct patient care services by independently and interdependently scheduling, supervising, and/or conducting complex diagnostic and therapeutic procedures. This position independently participates in the delivery of direct patient care within the scope of individual authority granted by the North Carolina State Boards of Medical Examiners and Nursing.

Job Responsibilities:
• Performs complete physical exams, obtains medical history; interprets and records findings.
• Orders/obtains appropriate laboratory and diagnostic studies/tests to assist with patient evaluations, as needed.
• Interprets and integrates data to determine preliminary diagnosis and appropriate therapeutic plan.
• Administers medications, immunizations, and injections in compliance with state law and clinic guidelines.
• Performs direct patient care services, which may include instruction, education, counseling, recommendation of medications and treatments, health and illness prevention, and/or community resources to meet specific needs to patient and family.
• Coordinates and schedules laboratory studies and diagnostic procedures. Explains the necessity, preparation, nature and anticipated effects of scheduled diagnostic and therapeutic procedures to patients.
• Reviews, writes, and renews medication prescriptions, which corresponds to the written standing orders, and/or, to the consultation advice of the supervising physician.
• Documents, updates, and maintains patient records.
• Carries out patient care services under indirect physician supervision, such as suture removal, catheterization, burn and wound debridement, simple head injuries, dressing changes, pelvic exams, removal of foreign bodies from orifice or tissue, etc.
• Collaborates with physician in the management of acute or long-term patient needs: monitors/maintains a record of patient progression, and consults with supervising physician when patient progress does not meet anticipated and/or predetermined criteria.
• Collaborates with the designated Triage Nurse to address phone calls from patient seeking advice, answers to health questions, determination of being seen in the clinic, etc., home health nurses, teachers, inpatient medical team, PT ’s, OT’s, and physicians.
• Collaborates with Community Liaisons and Wraparound staff to coordinate patient complex caie, follow-ups, and continuity of care
• Reviews school reports, psychological evaluations, DEC evaluations, IEP’s, Early Intervention Reports, etc. with regards to patient care plan.
• Summarizes records and prepares referral letters.
• Communicates/confers with various outside agencies and resources regarding medical advice/information of clinic patients, such as dentist, social services, speech and hearing, etc., as needed.
• Refers patients to specialist, such as ENT, Pediatric Surgeon, Dermatologist, Neurologist, Asthma, etc., as needed.
• Participates in clinical research projects and prepares analyses/consensus report, when requested.
• Confers with other health professionals regarding patient condition, if necessary.
• Attends staff meeting once monthly.
• Attends Ground Rounds and continuing education meetings, as required.
• Promotes team, system, and organizational goals; maintains patient confidentiality and provides superior customer service.
• Disposes all disposable, contaminated, and used items into designated waste containers.
• Abides by all company policies regarding safety/health rules and regulations.
• Adapts to various situations and adjusts to shifting priorities.
• Performs other duties as assigned.
Preparation and Training:
Job duties require a broad knowledge of advanced nursing skills and comparable studies not available in undergraduate schools. Requires completion of a master’s degree Nurse Practitioner program and certification as an FNP or PNP. Must have a working knowledge of data processing equipment, computers, telephones, and such typical office machines and equipment. Must maintain effective written and oral communication and English skills. Must maintain current North Carolina RN and NP License, with a letter of approval from the NC Medical Board. CPR certification, and a NC driver’s license are also necessary.

Position Summary

The Clinical Nurse Lead is a key member of the Clinic Management Team, partnering with the Nursing Director, Practice Administrator, and Lead Provider to oversee daily clinical operations, supervise nursing staff, and ensure high-quality patient care. This role provides both clinical and administrative leadership, supports staff development, manages clinic workflows, and serves as a working clinical leader by providing direct patient care as needed.

Key Responsibilities

Provide day-to-day leadership, supervision, scheduling, and performance management for site nursing staff.
Coordinate clinic operations, staffing, and workflows to support quality patient care and efficient clinic operations.
Ensure compliance with nursing protocols, OSHA, infection control, regulatory requirements, and organizational policies.
Participate in hiring, onboarding, training, competency assessments, coaching, and performance evaluations.
Manage clinical supplies, inventory, equipment, and assist with budget oversight.
Collaborate with providers and interdisciplinary teams to improve patient outcomes and continuity of care.
Deliver direct patient care, including triage, medication administration, immunizations, wound care, specimen collection, patient education, and other nursing procedures within scope of practice.
Support chronic disease management, preventive care initiatives, and quality improvement activities.
Maintain accurate clinical documentation and ensure completion of referrals, follow-up care, and patient records.
Serve as a clinical resource for staff and provide coverage for provider clinics, triage, and other nursing functions as needed.
Float to other clinic locations when necessary to meet staffing and patient care needs.
Perform other duties as assigned.

Qualifications

Current North Carolina Registered Nurse (RN) license required; BSN preferred.
Minimum of three (3) years of nursing experience in a leadership or supervisory role.
Current CPR, Venipuncture, and IV certifications required.
Strong leadership, communication, organizational, and problem-solving skills.
Proficient with electronic health records and standard office technology.
Valid North Carolina driver’s license with ability to travel between clinic locations as needed.

Position Summary:
Provides direct patient care services by independently and interdependently scheduling, supervising, and/or conducting complex diagnostic and therapeutic procedures. This position independently participates in the delivery of direct patient care within the scope of individual authority granted by the North Carolina State Boards of Medical Examiners and Nursing.

Essential Functions:
• Performs complete physical exams, obtains medical history; interprets and records findings.
• Orders/obtains appropriate laboratory and diagnostic studies/tests to assist with patient evaluations, as needed.
• Interprets and integrates data to determine preliminary diagnosis and appropriate therapeutic plan.
• Performs direct patient care services, which may include instruction, education, counseling, recommendation of medications and treatments, health and illness prevention, and/or community resources to meet specific needs to patient and family.
• Coordinates and schedules laboratory studies and diagnostic procedures. Explains the necessity, preparation, nature and anticipated effects of scheduled diagnostic and therapeutic procedures to patients.
• Reviews, writes, and renews medication prescriptions, which corresponds to the written standing orders, and/or, to the consultation advice of the supervising physician.
• Documents, updates, and maintains patient records.
• Carries out patient care services under indirect physician supervision, such as suture removal, catherizations, burn and wound debridements, simple head injuries, dressing changes, pelvic exams, removal of foreign bodies from orifice or tissue, etc.
• Collaborates with physician in the management of acute or long-term patient needs: monitors/maintains a record of patient progression, and consults with supervising physician when patient progress does not meet anticipated and/or predetermined criteria.
• Collaborates with the designated Triage Nurse to address phone calls from patient seeking advice, answers to health questions, determination of being seen in the clinic, etc., home health nurses, teachers, inpatient medical team, PT ’s, OT’s, and physicians.
• Collaborates with Community Liaisons and Wraparound staff to coordinate patient complex care, follow-ups, and continuity of care
• Reviews school reports, psychological evaluations, DEC evaluations, IEP’s, Early Intervention Reports, etc. with regards patient care plan.
• Summarizes records and prepares referral letters.
• Communicates/confers with various outside agencies and resources regarding medical advice/information of clinic patients, such as dentist, social services, speech and hearing, etc., as needed.
• Refers patients to specialist, such as ENT, Pediatric Surgeon, Dermatologist, Neurologist, Asthma, etc., as needed.
• Assists in Quality initiative
• Participates in clinic and provider meeting minutes
• Confers with other health professionals regarding patient condition, if necessary.
• Promotes team, system, and organizational goals; maintains patient confidentiality and provides superior customer service.
• Disposes all disposable, contaminated, and used items into designated waste containers.
• Abides by all company policies regarding safety/health rules and regulations.
• Adapts to various situations and adjusts to shifting priorities.
• Performs other duties as assigned.

Preparation and Training:
Job duties require a broad knowledge of advanced clinical/Physician Assistant Program skills and comparable studies not available in undergraduate schools. Requires completion of certification as an Physician Assistant. Must have a working knowledge of data processing equipment, computers, telephones, and such typical office machines and equipment. Must maintain effective written and oral communication and English skills. Must maintain current North Carolina PA License, with a letter of approval from the NC Medical Board. CPR certification, and a NC driver’s license are also necessary. (Every 2 years)

Position Summary:

We are seeking a dedicated and detail-oriented Dental Assistant (I and II) to join our team. The ideal candidate will assist the dental team in providing high-quality pediatric patient care and ensure the smooth operation of the dental office.

Key Responsibilities
• Ensure that all operatories are ready for patients prior to clinic hours/end of day
• Proficiency in 4-handed dentistry, prioritizing patient comfort
• Prepare and sterilize instruments and dental equipment.
• Take and process dental X-rays (with proper certification).
• Perform basic lab tasks, such as pouring and trimming dental models.
• Take impressions of patients’ teeth for study models or orthodontic appliances.
• Apply fluoride treatments and sealants (if qualified and permitted).
• Perform coronal polishing (if qualified and permitted)
• Accurately record all medical/dental findings, results and outcomes in the EHR (Epic Wisdom) in accordance with HIPAA guidelines
• Sequence and appoint comprehensive treatment plans in Wisdom
• Provide post-operative care instructions to patients.
• Ensure infection control by following OSHA and CDC guidelines.
Administrative Responsibilities
• Schedule and confirm patient appointments in Wisdom according to effective scheduling policies.
• Maintain and update patient records.
• Assist with billing, insurance claims, and payment processing.
• Order and manage dental supplies and inventory.
• Greet and check in patients, ensuring a smooth office workflow.

POSITION REQUIRMENTS

Education
• High school diploma or equivalent.
• Successful completion of a dental assistant licensing or registration program as may be
required by the state.
• Radiation safety certification or successful completion of a radiation safety course.
• Certification in office practice or enrollment in such a program is desired.
Experience
• 3 years chairside pediatric experience preferred

Position Summary:
Under the supervision of a licensed Dentist in a clinical setting and using established dental hygiene protocols and procedures, the Dental Hygienist provides professional, high-quality dental care and education to a broad range of patients. Diagnoses and treats diseases, injuries, and malformations of teeth and gums, and related oral structures: Examines patient to determine nature of condition, utilizing x rays, dental instruments, and other diagnostic procedures. Cleans, fills, extracts, and replaces teeth, using rotary and hand instruments, dental appliances, medications, and surgical implements. Provides preventive dental services to patient, such as applications of fluoride and sealants to teeth, and education in oral and dental hygiene.

Job Responsibilities:

• Institutes and supervises oral hygiene practices; determines that aseptic techniques of treatment are followed; acquires and supervises maintenance of supplies and equipment necessary to perform all types of dental treatment.
• Coordinates local dental health projects; directs and participates in dental examinations of school age children; promotes dental health programs in public schools.
• Serves as an area consultant in promoting dental health education with local health departments; conducts state-wide program with local agencies and assists in establishing and maintaining an effective program on the local level.
• Examines and determines need for dental treatment of patients entering institution or clinic; participates in dental treatment by performing all procedures required to establish and maintain proper dental health for the patients.
• Serves as a consultant in dental problems to other medical and para-medical services in the institution, clinic, or other health facilities.
• Assists in promoting and maintaining good public relations among community groups and professional health organizations such as the North Carolina Dental Society.
• Determines that patients’ charts and dental records are correctly maintained through accurate recording of all dental procedures performed on patient during period of confinement.
• Performs related duties as required.
• Provides high-quality dental hygiene care within the scope of service consistent with accepted standards of care.
• Evaluates patients and implements treatment regimens under the supervision of the Dentist.
• Provides complete documentation of all findings, treatments and outcomes;
• Initiates oral health education and prevention activities;
• Reviews and interprets patient dental records;
• Works cooperatively with other Dental Program staff;
• Helps out where needed to ensure smooth, efficient running of Dental Program; and
• Participates in the ongoing evaluation of Dental Program operations to assure the delivery of high-quality services that support the financial sustainability of the program.

Minimum Training and Experience Requirements:
Graduation from an approved school of dentistry and two years of experience in the general practice of dentistry.

Position Summary:
Under the general supervision of the Clinical Nurse Lead and in collaboration with the Director of Nursing, the Licensed Practical Triage Nurse provides care coordination and performs professional nursing functions to assess the severity of patients’ health concerns, using TAPM-established Adult and Pediatric telephone protocols and clinical algorithms in collaboration with the RN and provider. The Licensed Practical Nurse (LPN) practices under the supervision of a Registered Nurse (RN) or licensed provider (physician, nurse practitioner, or physician assistant), in accordance with the North Carolina Nursing Practice Act (N.C. Gen. Stat. § 90-171.20 et seq.) and the North Carolina Board of Nursing (NCBON) rules and guidelines.
Job Responsibilities:
• Triage Nurses manage nurse-directed patient telephone calls and from walk-in patients requesting health care services
• Evaluate and assesses patient’s health care needs based on patient’s signs and symptoms
• Obtain appropriate input and direction from the provider as needed to determine best clinical course of action and recommendations for specific patient health care needs
• Coordinate and schedule same-day and walk-in appointments on the provider schedule
• Maintain a nurse only schedule
• Assist providers with special procedures as needed
• Manage prescription refills per protocol
• Provides clinical support on the floor as needed to ensure adequate coverage and continuity of patient care.
• Serve as a clinical resource and professional role model for other nursing staff.
• Prioritize work tasks and services to ensure timely and efficient completion.
• Maintains accurate, clear, and concise documentation, including progress notes, problem lists, and medication lists, in accordance with clinical and organizational standards.
• Communicates appropriately and tactfully with staff, consultants, patients, significant others, and community.
• Participate in staff planning, in-service, and other meetings as needed.
• Administers medications and performs medical and nursing procedures as ordered within the scope of practice.

Administrative Responsibilities:
• Document symptoms/complaints, nursing assessment, advice provided and patient/caller response. Follows policies, procedures, and protocols to ensure consistency and departmental effectiveness as well as improve health care outcomes of patients/callers and their access to appropriate health care.
• Completes all patient-related documentation, including but not limited to prior authorizations, home health forms, and other required medical paperwork in a timely and accurate manner.
• Provide patient education: e.g. chronic disease, preventive and family
• Participate in quality improvement programs
• Assure that pertinent medical information is forwarded to proper departments as needed for continuity of patient care
• Document in electronic health record (EHR), triage assessment, plan, implementation, and evaluation, follow-up
• Must have knowledge of disease processes, normal growth and development of all age groups
• Must possess community health knowledge and theory
• Must operate with culturally sensitivity with respect to working with persons and groups of diverse racial, ethnic, economic and social backgrounds

Clinical Responsibilities:
• Administer certain medications, injections, immunizations, and family planning options as ordered by a provider and within LPN scope of practice.
• Under the direction of the Clinical Nurse Lead (RN), DON, or provider, assist with monitoring patient flow in the clinic to ensure that patients receive all recommended services in a timely manner.

The LPN MAY NOT perform the following (outside LPN scope of practice):
• Independently assess, diagnose, or develop a nursing care plan without RN or provider oversight.
• Perform the initial nursing assessment for new patients independently (must be completed or supervised by an RN).
• Independently determine final patient disposition for complex or high-acuity triage calls without RN or provider consultation.
• Supervise or direct Registered Nurses (RNs).
• Administer IV push medications or initiate IV therapy without appropriate certification and provider order
• Perform any procedure or task not covered by a current, approved TAPM protocol or provider order.
• Practice beyond the current North Carolina LPN scope of practice as defined by the NCBON.

Minimum Qualifications
• Must hold a current, valid North Carolina LPN license.
• Currently CPR certified.
• At least one 2-3 years of triage or clinical nursing experience is preferred.
• High school diploma or GED required; completion of an accredited LPN program required.
• Associate’s Degree or further education preferred.

Rural Health Group, Inc., a thriving multi-location Community Health Center located in scenic northeastern North Carolina, is seeking FM/IM/Med-Ped physicians to provide excellent quality patient-centered health care in an outpatient-only setting. No hospital call. Flexible scheduling options. Residents are welcome to apply. Practicing providers must be BC/BE.

RHG is a well-established primary medical care practice founded in 1974. We are searching for individuals committed to a rural practice with the desire to establish roots in the community. Our positions qualify for NHSC Scholars, Loan Repayment Program (LRP), and Students to Service (S2S). No outstanding medical student loans? Ask us about a potential state high needs bonus option.

As a Community Health Center, we see everyone – those with NC Medicaid, NC Health Choice, Medicare, private insurance, and the uninsured. RHG is a Federally Qualified Health Center and Patient Centered Medical Home dedicated to serving our region’s underserved through:

18 FM/IM offices, pediatrics office, OB/GYN office, school based health center program
3 dental offices
4 in-house pharmacies and 340b pharmacy services
Integrated Behavioral Health – Psychiatrists and LCSWs
Case Management, RN ACO Care Managers, Community Health Workers
Community-Based Outreach Department, including Migrant/Seasonal Farm Worker, Infectious Disease, Cancer, Diabetes, etc.
Our Providers include: Family Physicians, Internists, Physician Assistants, Nurse Practitioners, Pediatricians, OB/GYNs, Dentists, Clinical Pharmacists, and Licensed Clinical Social Workers.

In addition to competitive salary & benefits, we offer:

Signing bonus and (if applicable) relocation allowance
Quality and Production incentives
Annual CME allowance of up to $3000 & up to 40 hours
Malpractice insurance covered through Federal Tort Claims Act (FTCA) coverage
Paid Time Off (PTO)
Closed on major holidays
403(b) retirement plan (employer contribution starts after 2 years)
Professional fees and dues are reimbursed
FQHC Benefits:
Primary care/medical HPSA score of 22
National Health Service Corps (NHSC) Loan Repayment Program
North Carolina has a High Needs Service Bonus program for physicians with no loans

Rural Health Group, Inc., a thriving multi-location Community Health Center located in scenic northeastern North Carolina, is seeking FM/IM/Med-Ped physicians to provide excellent quality patient-centered health care in an outpatient-only setting. No hospital call. Flexible scheduling options. Residents are welcome to apply. Practicing providers must be BC/BE.

RHG is a well-established primary medical care practice founded in 1974. We are searching for individuals committed to a rural practice with the desire to establish roots in the community. Our positions qualify for NHSC Scholars, Loan Repayment Program (LRP), and Students to Service (S2S). No outstanding medical student loans? Ask us about a potential state high needs bonus option.

As a Community Health Center, we see everyone – those with NC Medicaid, NC Health Choice, Medicare, private insurance, and the uninsured. RHG is a Federally Qualified Health Center and Patient Centered Medical Home dedicated to serving our region’s underserved through:

18 FM/IM offices, pediatrics office, OB/GYN office, school based health center program
3 dental offices
4 in-house pharmacies and 340b pharmacy services
Integrated Behavioral Health – Psychiatrists and LCSWs
Case Management, RN ACO Care Managers, Community Health Workers
Community-Based Outreach Department, including Migrant/Seasonal Farm Worker, Infectious Disease, Cancer, Diabetes, etc.
Our Providers include: Family Physicians, Internists, Physician Assistants, Nurse Practitioners, Pediatricians, OB/GYNs, Dentists, Clinical Pharmacists, and Licensed Clinical Social Workers.

In addition to competitive salary & benefits, we offer:

Signing bonus and (if applicable) relocation allowance
Quality and Production incentives
Annual CME allowance of up to $3000 & up to 40 hours
Malpractice insurance covered through Federal Tort Claims Act (FTCA) coverage
Paid Time Off (PTO)
Closed on major holidays
403(b) retirement plan (employer contribution starts after 2 years)
Professional fees and dues are reimbursed
FQHC Benefits:
Primary care/medical HPSA score of 22
National Health Service Corps (NHSC) Loan Repayment Program
North Carolina has a High Needs Service Bonus program for physicians with no loans