H.  Full-Time Clinical Practice

Every participant is required to engage in the full-time outpatient clinical practice of the profession for which he or she was awarded an NHSC LRP contract. 

A full-time practice is defined as a minimum of 40 hours per week.  The 40 hours per week may be compressed into no less than 4 days per week, with no more than 12 hours of work to be performed in any 24-hour period.  Time spent in "on-call" status will not count toward the 40-hour week.  Hours worked over the required 40 hours per week will not be applied to any other workweek.

No more than 7 weeks (35 workdays) per service year can be spent away from the practice for vacation, holidays, continuing professional education, illness, or any other reason.  For absences of greater than 7 weeks in an NHSC LRP service year, the participant should request a suspension.  See Section K of the Bulletin.  A break in service will extend the service commitment end date.

A full-time clinical practice is defined as follows:

For all health professionals, except obstetrician/gynecologist (OB/GYN) physicians, family medicine physicians who practice obstetrics on a regular basis, certified nurse midwives, and behavioral and mental health providers, at least 32 of the minimum 40 hours per week must be spent providing direct outpatient care. These services must be conducted during normally scheduled clinic hours in an ambulatory care setting in the office(s) specified in the PPA or PPO Agreement.  The remaining hours must be spent providing inpatient care to patients of that clinic (as appropriate to meet the needs of the patients and to assure continuity of care) and/or in practice-related administrative activities.

For OB/GYN physicians, family medicine physicians who practice obstetrics on a regular basis, and certified nurse midwives, at least 21 of the minimum 40 hours per week must be spent providing direct outpatient care.  These services must be conducted during normally scheduled clinic hours in an ambulatory outpatient care setting in the office(s) specified in the PPA or PPO Agreement.  The remaining hours must be spent providing inpatient care to patients of that clinic and/or performing practice-related administrative activities, with administrative activities not to exceed 8 hours per week.

For behavioral and mental health providers, at least 32 hours of the minimum 40 hours per week must be spent providing direct clinical services.  Of the 32 clinical hours, 21 hours of the 32 clinical hours per week must be spent providing direct patient counseling during normally scheduled office hours in an ambulatory outpatient care setting in the office(s) specified in the PPA or PPO Agreement.  The remaining hours must be spent providing direct clinical services, or performing practice-related administrative activities, with administrative activities not to exceed 8 hours per week.

Practice-related administrative activities include teaching, attending staff meetings, supervision of other clinicians, court appearances, and other non-treatment related activities pertaining to the clinician’s approved NHSC practice. Supervision of other clinicians is defined as an administrative activity if the clinician being supervised is treating the patient and billing for such treatment in his or her name.  If the supervising clinician is treating the patient and billing for such treatment under his or her name, this activity would be counted as direct clinical services for the supervising clinician. 

Every NHSC LRP participant must complete and submit a verification form for each 6 months of service.  The form, which is signed by the participant and an appropriate official at the NHSC community site, will verify the participant's compliance/noncompliance with the full-time clinical practice requirement during that 6-month period.  The form will also record the participant's time spent away from the practice site during that 6-month period.   Failure to submit 6 month verification forms may jeopardize participants from receiving future amendment awards.

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