State Scholarship, Loan Forgiveness, and Related Programs

Abstract

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.

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

“…In order to record and compare trends in state support-for-health service programs over time we reviewed and utilized where possible the methodology previously reported by Pathman et al [19]. This previous study of state loan and scholarship programs identified five different program categories (scholarship, loan, resident support, loan repayment, and direct financial support), and we have done likewise.…”

“…Compendia included online sources and other available documents; previous studies; lists of state primary care office directors and administrators; lists of state loan repayment program contacts; officials in state offices of rural health and primary care, state public health offices and state higher education financial aid authorities, and other online sources, printed materials and documents available to the public. Our eligibility criteria for programs were determined using similar methods established by Pathman et al [19]. Eligible programs were designated as those that 1) provided financial support to students, resident or practicing physicians (MD or DO), physician assistants (PA), nurse practitioners (ARNP), certified nurse midwives, dentists, and licensed mental healthcare providers (e.g.…”

“…registered or licensed psychologists, marriage/family therapists or clinical social workers); 2) had a service requirement or option in a defined medically underserved setting across a given state rather than solely in one region or community within a state; 3) supported practitioners with state public dollars, community funds, recurring program dollars, or funds from private nonprofit sources but do not have majority direct federal support; 4) delivered financial support directly to practitioners or to an educational or financial entity on their behalf, such as a medical school or commercial lender; 5) and were operating in the calendar year 2008. Our criteria differed from Pathman et al [19] in that we included dentists and licensed mental health providers in the list of eligible programs. Similar to Pathman, et al [19], we excluded service-requiring programs for registered nurses, pharmacists, and other health care workers if physicians and mid-level practitioners did not comprise the majority of obligated participants.…”

“…Our criteria differed from Pathman et al [19] in that we included dentists and licensed mental health providers in the list of eligible programs. Similar to Pathman, et al [19], we excluded service-requiring programs for registered nurses, pharmacists, and other health care workers if physicians and mid-level practitioners did not comprise the majority of obligated participants.…”

“…This program, in existence for 40 years, matches students and residents to areas of need in exchange for scholarship and loan repayment incentives. NHSC has been recognized as an important program in the quest to realign physician maldistribution in the US [19]. Less well known as part of the solution for steering more recent graduates to primary care and underserved areas, are the programs which have been set up in many states to provide scholarships and loans in exchange for practice in underserved areas.…”