In 1996, states fielded an obligated primary care workforce comparable in size to the better-known federal programs. These state programs constitute a major portion of the US health care safety net, and their activities should be monitored, coordinated, and evaluated. State programs should not be omitted from listings of safety-net initiatives or overlooked in future plans to further improve health care access. JAMA. 2000;284:2084-2092.
The RHSP is meeting some interim objectives conducive to its long-term goal of developing physicians who will practice primary care medicine in rural, underserved areas of North Carolina.
Data from a 1975 and a follow-up 1979 survey of 44 rural, satellite health centers staffed by new health practitioners (NHPs)are compared to determine what changes have taken place in these centers during this period when the number of physicians in the United States has markedly increased. Of the surveyed clinics, 8 closed and 12 converted to having physicians on their staffs by 1979. The remaining 24 NHP-staffed centers realized growth in staff size and budget, patient utilization, and proportion of budget generated by revenues from patients. (Despite these positive changes, most of these 24 clinics expressed concern about their financial situations-a reflection of the considerable room for further improvement.) The general growth of the 24 NHP-staffed satellites, however, was not as substantial as that achieved by the 12 clinics staffed by physicians in 1979. The rapidly increasing supply of physicians in the United States and the potential effects of this trend on NHP-staffed rural satellite centers are discussed. Possible reasons why these satellites may continue to be of value in making primary care available in rural areas are enumerated.
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