title: Outcomes of states' scholarship, loan repayment, and related programs for physicians.
abstract: BACKGROUND
  Many states attempt to entice young generalist physicians into rural and medically underserved areas with financial support-for-service programs-scholarships, service-option loans, loan repayment, direct financial incentives, and resident support programs-with little documentation of their effectiveness.
  
  
  OBJECTIVE
  The objective of this study was to assess outcomes of states' support-for-service programs as a group and to compare outcomes of the 5 program types.
  
  
  METHODS
  We conducted a cross-sectional, primarily descriptive study.
  
  
  METHODS
  We studied 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; federally funded initiatives were excluded. We also surveyed 434 generalist physicians who served in 29 of these state programs and a matched comparison group of 723 nonobligated young generalist physicians.
  
  
  METHODS
  Information on eligible programs was collected by telephone, mail questionnaires, and from secondary sources. Obligated and nonobligated physicians were surveyed, with 80.3% and 72.8% response rates, respectively.
  
  
  METHODS
  Levels of socioeconomic need of communities and patients served by physicians, programs' participant service completion and retention rates, and physicians' satisfaction levels.
  
  
  RESULTS
  Compared with young nonobligated generalists, physicians serving obligations to state programs practiced in demonstrably needier areas and cared for more patients insured under Medicaid and uninsured (48.5% vs. 28.5%, P <0.001). Service completion rates were uniformly high for loan repayment, direct incentive, and resident-support programs (93% combined) but lower for student-targeting service-option loan (mean, 44.7%) and scholarship (mean, 66.5%) programs. State-obligated physicians were more satisfied than nonobligated physicians, and 9 of 10 indicated that they would enroll in their programs again. Obligated physicians also remained longer in their practices than nonobligated physicians (P = 0.03), with respective group retention rates of 71% versus 61% at 4 years and 55% versus 52% at 8 years. Retention rates were highest for loan repayment, direct incentive, and loan programs.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Cecil G. Sheps Center for Health Services Research, UNC-Chapel Hill, Chapel Hill, North Carolina 27599, USA. don_pathman@unc.edu
authors.forename: Donald E
authors.initials: DE
authors.lastname: Pathman
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Konrad
authors.forename: Tonya S
authors.initials: TS
authors.lastname: King
authors.forename: Donald H
authors.initials: DH
authors.lastname: Taylor
authors.forename: Gary G
authors.initials: GG
authors.lastname: Koch
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D003430:Cross-Sectional Studies; D005257:Fellowships and Scholarships; D005260:Female; D006801:Humans; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D010816:Physician Incentive Plans / Q000331:legislation & jurisprudence*; D010821:Physicians, Family / Q000191:economics / Q000600:supply & distribution*; D011320:Primary Health Care; D011365:Professional Practice Location / Q000191:economics*; D019035:Rural Health Services / Q000191:economics; D013219:State Government; D011795:Surveys and Questionnaires; D014146:Training Support / Q000331:legislation & jurisprudence*; D014481:United States; D000078329:Workforce