States' experiences with loan repayment programs for health care professionals in a time of state budget cuts and NHSC expansion.
OBJECTIVE
The landscape of education loan repayment programs for health care professionals has been turbulent in recent years, with doubling of the funding for the National Health Service Corps (NHSC) and cuts in funding for some states' programs. We sought to understand how this turbulence is being felt within the state offices involved in recruiting clinicians to rural and urban underserved communities.


METHODS
We conducted key informant telephone interviews with staff of state offices of rural health, primary care organizations, and/or related organizations within 28 diverse states to answer questions about perceived changes and interplay among solely state-funded loan repayment programs, joint state-federal programs, and the NHSC federal program. Interviews were transcribed, formally analyzed, and key issues summarized.


RESULTS
Informants reported that solely state-funded and joint state-federal loan repayment programs are greatly valued for their ability to target a state's particular needs and to complement the NHSC federal program. However, budgets for state programs have been threatened, reduced, or eliminated entirely in many cases. All informants positively perceived the NHSC's recent growth and changes, which they feel are helping fill important workforce needs for their states. Nevertheless, the much larger NHSC federal program now competes with some states' programs for clinicians and service sites; states' programs are pushed to adjust their operations to maintain a unique "niche".


CONCLUSIONS
States' key recruiters lament reductions in funding for states' loan repayment programs, and welcome the NHSC's recent growth and changes. Better coordination is needed to minimize competition and maximize complementarity between state and federal programs.
North Carolina Rural Health Research and Policy Analysis Center, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill 27599-7590, USA. don_pathman@unc.edu
Donald E
DE
Pathman
Jennifer Craft
JC
Morgan
Thomas R
TR
Konrad
Lynda
L
Goldberg
D002017:Budgets; D005380:Financing, Government / Q000191:economics / Q000706:statistics & numerical data; D006282:Health Personnel / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008507:Medically Underserved Area; D013219:State Government; D014146:Training Support / Q000191:economics* / Q000706:statistics & numerical data; D014481:United States