Outcomes of States’ Scholarship, Loan Repayment, and Related Programs for Physicians

Pathman, Donald E.; Konrad, Thomas R.; King, Tonya S.; Taylor, Donald H.; Koch, Gary G.

doi:10.1097/01.mlr.0000128003.81622.ef

Cited by 118 publications

(107 citation statements)

References 13 publications

(12 reference statements)

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“…In addition, several states have programs aimed at retaining homegrown physicians through scholarships and grants. 22 Some have tried efforts to discourage physicians from establishing practices in oversubscribed markets. The single-payer system in Ontario, Canada, conducted a trial of reduced reimbursements to new physicians in the saturated market of Toronto.…”

Section: Resultsmentioning

confidence: 99%

Geographic Maldistribution of Primary Care for Children

et al. 2011

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OBJECTIVES: This study examines growth in the primary care physician workforce for children and examines the geographic distribution of the workforce. METHODS: National data were used to calculate the local per-capita supply of clinically active general pediatricians and family physicians, measured at the level of primary care service areas. RESULTS: Between 1996 and 2006, the general pediatrician and family physician workforces expanded by 51% and 35%, respectively, whereas the child population increased by only 9%. The 2006 per-capita supply varied by >600% across local primary care markets. Nearly 15 million children (20% of the US child population) lived in local markets with <710 children per child physician (average of 141 child physicians per 100 000 children), whereas another 15 million lived in areas with >4400 children per child physician (average of 22 child physicians per 100 000 children). In addition, almost 1 million children lived in areas with no local child physician. Nearly all 50 states had evidence of similar extremes of physician maldistribution. CONCLUSIONS: Undirected growth of the aggregate child physician workforce has resulted in profound maldistribution of physician resources. Accountability for public funding of physician training should include efforts to develop, to use, and to evaluate policies aimed at reducing disparities in geographic access to primary care physicians for children.

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Section: Resultsmentioning

confidence: 99%

Geographic Maldistribution of Primary Care for Children

et al. 2011

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“…15,16 In contrast, a study of 69 US state-run programs reported that physicians who were obligated (by return-of-service commitments) to practice in rural or underserviced areas were slightly more likely than non-obligated physicians to stay longer (55% of obligated physicians stayed over 8 years compared with 52% of non-obligated physicians). 17 This study reported that programs that provided incentives to physicians entering practice and to residents were more successful than for programs aimed at medical students. The increasing costs of medical education and student debt may decrease physicians' interest in rural practice, leading them to chose a more lucrative urban specialty.…”

Section: Personal Factorsmentioning

confidence: 94%

Increasing the number of rural physicians

Rourke¹

2007

Canadian Medical Association Journal

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3 32 22 2 M any rural communities are desperate to recruit and retain physicians. Although there are important shortages of family physicians and specialists in all areas of Canada, physicians in rural areas are far fewer in number and fulfill a wider range of roles. The loss of a single physician from a rural community can change how the entire health care system is organized and run.One might ask whether there is a maldistribution of physicians favouring urban centres. Indeed, a detailed analysis of the practice locations of Canadian physicians in 2004 showed that 9.4% of physicians (15.7% of family physicians and 2.4% of specialists) were located in rural areas. In contrast, 21.4% of the general population resided in rural areas.1 This is slightly worse than in 1998, when 9.8% of physicians and 22.2% of the population lived in rural areas.1 The United States and Australia are experiencing similar shortages (Figure 1, Figure 2). The shortage of rural physicians, however, is not limited to large or developed countries.It is estimated that in 2004, an additional 1308 family physicians would have been needed in rural areas to equalize the family physician-population ratio between rural and urban areas of Canada. This would have required more than a 25% increase in the number of rural family physicians. And yet, even this probably wouldn't have been enough. Rural family physicians spend substantially more time than urban physicians providing hospital-based patient care (including treating patients in the emergency department, acting as the primary physician for hospital inpatients, providing intrapartum obstetrics care and, occasionally, working as an anesthesiologist 4 ), which leaves rural family physicians less time to provide office-based primary care.The supply pool for Canadian rural physicians consists of Canadian medical graduates and international medical graduates. In 2004, 26.3% of physicians in rural Canada were international medical graduates, compared with 21.9% of physicians in urban areas.1 However, the proportion of international medical graduates practising in rural areas is unlikely to increase. The traditional recruitment of international medical graduates from developing countries is in part responsible for the high cost of training and the devastating loss of physicians in the developing world, particularly Africa.5 Increasing the number of Canadian medical graduates interested in rural practice will be essential to developing a stable and sufficient rural physician workforce.Although some urban physicians relocate to rural areas, rural physicians are more likely to move to urban areas. Each year from [2001][2002][2003][2004][2005], an average of 368 (almost 8%) physicians moved from rural to urban areas, compared with 241 (about 0.5%) physicians who moved from urban to rural areas (Tara S. Chauhan, Canadian Medical Association, Ottawa, Ontario: personal communication, 2007).There are a number of solutions to address the dire need for physicians in remote areas. Like career choice, the select...

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“…Programs, like the state-level initiatives studied, continue to be an important source of financial support for those willing to make service commitments in underserved areas. Furthermore, previous research indicates these programs are not only successful at attracting students to primary care, but that state obligated physicians are more satisfied and remain longer in their practice than non-obligated physicians [11] [30] [31]. Health care advocates and policy makers must not overlook the state role in providing loan and scholarship opportunities to meet their unique and growing needs to expand access to quality health care.…”

Section: Discussionmentioning

confidence: 99%

State Scholarship and Loan Forgiveness Programs in the United States: Forgotten Driver of Access to Health Care in Underserved Areas

Geletko¹,

Brooks²,

Hunt³

et al. 2014

Health

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State-supported programs providing loans and scholarships in exchange for service in underserved areas provide an important source of financial support for medical students while encouraging them to select careers in primary care. The purpose of this research was to seek a better understanding of these often unheralded but important state sources of support, and learn if they have continued to grow in the twenty-first century. Administrative data were obtained on statesupported programs operating in 2008 that provided financial support to students, resident or practicing physicians, physician assistants, nurse practitioners, certified nurse midwives, dentists, and licensed mental healthcare providers in exchange for service in an underserved area. The authors identified numbers, types of state-supported programs, program workforce strength, and features of state programs. In 2008, 75 state programs, operating in 37 states, collectively had 5113 program participants under contract. Loan repayment programs (n = 42, 56%) were the most common type of state-supported programs. Practitioners signed initial contracts in 2008 totaled 1173, with more non-physicians (n = 681, 58%) signing initial contracts than physicians (n = 492, 42%). Additionally, 2803 practitioners were serving in programs in 2008. Field placement was also slightly greater among non-physicians in 2008 (n = 1433, 51%) than physicians (n = 1370, 49%). State support-for-service programs remains an important source of financial assistance for those willing to make service commitments in underserved areas. Moreover, these programs continue to increase in size, even amidst the economic malaise, and provide an obligated primary care workforce in underserved areas. K. W. Geletko et al.1995

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Outcomes of States’ Scholarship, Loan Repayment, and Related Programs for Physicians

Abstract: States' support-for-service programs bring physicians to needy communities where a strong majority work happily and with at-risk patient populations; half stay over 8 years. Loan repayment and direct financial incentive programs demonstrate the broadest successes.

Cited by 118 publications

References 13 publications

Geographic Maldistribution of Primary Care for Children

Geographic Maldistribution of Primary Care for Children

Increasing the number of rural physicians

State Scholarship and Loan Forgiveness Programs in the United States: Forgotten Driver of Access to Health Care in Underserved Areas

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