Health> Vol.6 No.15, August 2014

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

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ABSTRACT

State-supported programs providing loans and scholarships in exchange for service in under-served 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 state-supported 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.

Cite this paper

Geletko, K. , Brooks, R. , Hunt, A. and Beitsch, L. (2014) State Scholarship and Loan Forgiveness Programs in the United States: Forgotten Driver of Access to Health Care in Underserved Areas. Health, 6, 1994-2003. doi: 10.4236/health.2014.615234.

References

[1] Bodenheimer, T. and Pham, H.H. (2010) Primary Care: Current Problems and Proposed Solutions. Health Affairs (Millwood), 29, 799-805.
http://dx.doi.org/10.1377/hlthaff.2010.0026
[2] Bodenheimer, T. (2006) Primary Care—Will It Survive? The New England Journal of Medicine, 355, 861-864.
http://dx.doi.org/10.1056/NEJMp068155
[3] Council on Graduate Medical Education (2009) Patient Care Physician Supply and Requirements: Testing COGME Recommendations; Summary of Eighth Report [Internet]. Executive Summary. Rockville (MD): COGME.
http://www.cogme.gov/rpt8.htm
[4] Bodenheimer, T. and Grumbach, K. (2009) Understanding Health Policy: A Clinical Approach. 5th Edition, McGraw-Hill, New York.
[5] Phillips Jr., R.L. and Bazemore, A.W. (2010) Primary Care and Why It Matters for US Health System Reform. Health Affairs (Millwood), 29, 806-810.
http://dx.doi.org/10.1377/hlthaff.2010.0020
[6] Colwill, J.M., Cultice, J.M. and Kruse, R.L. (2008) Will Generalist Physician Supply Meet Demands of an Increasing and Aging Population? Health Affairs (Millwood), 27, 232-241.
http://dx.doi.org/10.1377/hlthaff.27.3.w232
[7] Pugno, P.A., Schmittling, G.T., Fetter Jr., G.T. and Kahn Jr., N.B. (2005) Results of the 2005 National Resident Matching Program: Family Medicine. Family Medicine, 37, 555-564.
[8] Force, A.G.P.T. (1993) AAMC Policy on the Generalist Physician. Academic Medicine, 68, 1-6.
http://dx.doi.org/10.1097/00001888-199301000-00001
[9] Abrams, M.K., Nuzum, R., Mika, S. and Lawlor, G. (2011) How the Affordable Care Act Will Strengthen Primary Care and Benefit Patients, Providers, and Payers. Issue Brief (Commonw Fund), 1, 1-28.
[10] American College of Physicians (2008) How Is a Shortage of Primary Care Physicians Affecting the Quality and Cost of Medical Care? American College of Physicians, Philadelphia.
[11] Woodworth, P.A., Chang, F.C. and Helmer, S.D. (2000) Debt and Other Influences on Career Choices among Surgical and Primary Care Residents in a Community-Based Hospital System. American Journal of Surgery, 180, 570-575.
http://dx.doi.org/10.1016/S0002-9610(00)00543-2
[12] Marci, C.D. and Roberts, T.G. (1998) The Increasing Debt of Medical Students: How Much Is Too Much? JAMA, 280, 1879-1880.
[13] Levinsky, N.G. (1993) Recruiting for Primary Care. New England Journal of Medicine, 328, 656-660.
http://dx.doi.org/10.1056/NEJM199303043280913
[14] Schwartz, R.W., Jarecky, R.K., Strodel, W.E., Haley, J.V., Young, B. and Griffen Jr., W.O. (1989) Controllable Lifestyle: A New Factor in Career Choice by Medical Students. Academic Medicine, 64, 606-609.
[15] Naradzay, J.F. (1998) Into the Deep Well: The Evolution of Medical School Loan Debt. JAMA, 280, 1881, 1883.
[16] Jolly, P. (2005) Medical School Tuition and Young Physicians’ Indebtedness. Health Affairs (Millwood), 24, 527-535. http://dx.doi.org/10.1377/hlthaff.24.2.527
[17] American Medical Association (1997) The Financing of Medical School—Student Loan/Higher Education Act. Chicago.
[18] Association of American Medical Colleges (2012) Medical Student Education: Costs, Debt, and Loan Repayment Facts. Washington DC.
[19] Pathman, D.E., Taylor Jr., D.H., Konrad, T.R., King, T.S., Harris, T., Henderson, T.M., et al. (2000) State Scholarship, Loan Forgiveness, and Related Programs: The Unheralded Safety Net. JAMA, 284, 2084-2092.
http://dx.doi.org/10.1001/jama.284.16.2084
[20] Youngclaus, J.A., Koehler, P.A., Kotlikoff, L.J. and Wiecha, J.M. (2013) Can Medical Students Afford to Choose Primary Care? An Economic Analysis of Physician Education Debt Repayment. Academic Medicine, 88, 16-25.
[21] Banning, T. (2011) Texas Health Bill Provides Building Blocks for Reform. Houston Chronicle.
[22] Oregon Rural Health Association (2010) Oregon Rural Health Association Holds Rural Health Policy Summit.
http://www.orha.org/PolicySummit.htm
[23] Virginia Office of the Governor (2010) Governor’s Recommendations. Virginia Office of the Governor, Richmond.
[24] United States General Accounting Office (1995) National Health Service Corps Opportunities to Stretch Scarce Dollars and Improve Provider Placement: Report to the Chairman, Committee on Labor and Human Resources, US Senate. Washington DC.
[25] Pathman, D.E., Morgan, J.C., Konrad, T.R. and Goldberg, L. (2012) States’ Experiences with Loan Repayment Programs for Health Care Professionals in a Time of State Budget Cuts and NHSC Expansion. Journal of Rural Health, 28, 408-415.
http://dx.doi.org/10.1111/j.1748-0361.2012.00409.x
[26] US Department of Health and Human Services (2011) Affordable Care Act Bolsters the Primary Care Workforce in Medically Underserved Communities. US Department of Health and Human Services, Washington DC.
[27] US Department of Health and Human Services (2013) National Health Service Corps Expands the Primary Care Workforce. US Department of Health and Human Services, Washington DC.
[28] Pathman, D.E., Konrad, T.R., King, T.S., Spaulding, C. and Taylor, D.H. (2000) Medical Training Debt and Service Commitments: The Rural Consequences. Journal of Rural Health, 16, 264-272.
http://dx.doi.org/10.1111/j.1748-0361.2000.tb00471.x
[29] Rosenblatt, R.A. and Andrilla, C.H. (2005) The Impact of US Medical Students’ Debt on Their Choice of Primary Care Careers: An Analysis of Data from the 2002 Medical School Graduation Questionnaire. Academic Medicine, 80, 815-819.
http://dx.doi.org/10.1097/00001888-200509000-00006
[30] Miller, J.B. and Crittenden, R.A. (2001) The Effects of Payback and Loan Repayment Programs on Medical Student Career Plans. Journal of Rural Health, 17, 160-164.
http://dx.doi.org/10.1111/j.1748-0361.2001.tb00952.x
[31] Pathman, D.E., Konrad, T.R., King, T.S., Taylor Jr., D.H. and Koch, G.G. (2004) Outcomes of States’ Scholarship, Loan Repayment, and Related Programs for Physicians. Medical Care, 42, 560-568.
http://dx.doi.org/10.1097/01.mlr.0000128003.81622.ef

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