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Half of doctors in State-sponsored financial support-for- service programs stay in underserved areas over 8 years, most working happily

Many States try to entice young generalist physicians into rural and medically underserved areas with financial support-for-service programs. These include scholarships, service-option loans, loan repayment, direct financial incentives, and resident support programs. It appears these programs are successful in meeting their overall goal, according to a recent study of all 69 State programs operating in 1996 that provided financial support to medical students, residents, and practicing physicians in exchange for a period of service in underserved areas.

The programs as a whole placed physicians in small and needy rural towns and counties, where physicians estimated that nearly half of their patients were insured by State Medicaid programs for the poor or were without health insurance. Doctors who served in these State programs generally were more satisfied with their work and communities and remained in their service sites longer than nonobligated "mainstream" generalists, according to the study which was supported by the Agency for Healthcare Research and Quality (HS09165).

In addition to studying the State programs, Donald E. Pathman, M.D., M.P.H., of the University of North Carolina at Chapel Hill, and his colleagues surveyed 434 generalist physicians who served in 29 of the State programs and a matched comparison group of 723 nonobligated young generalist physicians.

Compared with young nonobligated generalist physicians, those serving obligations to State programs practiced in demonstrably needier areas and cared for more Medicaid and uninsured patients (48.5 vs. 28.5 percent). In addition, State-obligated physicians were more satisfied than nonobligated physicians, and 9 out of 10 indicated that they would enroll in their programs again. Obligated physicians also remained longer in their practices than nonobligated physicians, with respective group retention rates of 71 percent versus 61 percent at 4 years and 55 versus 52 percent at 8 years. Retention rates were highest for loan repayment, direct incentive, and service-option loan programs.

See "Outcomes of States' scholarship, loan repayment, and related programs for physicians," by Dr. Pathman, Thomas R. Konrad, Ph.D., Tonya S. King, Ph.D., and others, in the June 2004 Medical Care 42(6), pp. 560-568.

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