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State primary care scholarship programs play a major role in the nation's health care safety net

State-sponsored scholarship, loan forgiveness, and similar programs now support a primary care workforce comparable in size to that fielded by better known Federal programs, such as the National Health Service Corps. Donald Pathman, M.D., M.P.H., and his colleagues at the University of North Carolina at Chapel Hill found that programs receiving only State support have experienced dramatic growth since the 1980s. In fact, the number of such programs doubled between 1990 and 1996 to 82 programs operating in 41 States. In 1996, an estimated 1,306 physicians and 370 nurse practitioners, nurse midwives, and physician assistants provided care under obligation to these State programs, a number roughly equal to those obligated under Federal programs, notes Dr. Pathman.

According to the researchers, these previously unheralded State programs are now a major portion of the U.S. health care system's safety net, and they should no longer be omitted from listings of safety net initiatives. And, they should not be overlooked in future plans to further improve health care access. Dr. Pathman and his colleagues also recommend that a mechanism be established to track, evaluate, and coordinate the efforts of States, local communities, and Federal programs to eliminate duplication of effort and prevent gaps in the health care safety net.

This research was supported by the Agency for Healthcare Research and Quality (HS09165).

Details are in "State scholarship, loan forgiveness, and related programs: The unheralded safety net," by Dr. Pathman, in the October 25, 2000 Journal of the American Medical Association 284, pp. 2084-2092.

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