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States continue to place clinicians where they are in short supply, despite recession

UNC News Release

For immediate use: Wednesday, Nov. 13, 2013

States continue to place clinicians where they are in short supply, despite recession

Despite the recent recession, states increased the overall number of loan repayment programs designed to recruit health care professionals to live and practice in underserved communities, according to research at the University of North Carolina at Chapel Hill.

“This is good news for our country’s health care system and people’s access to care,” said Donald Pathman, a physician and professor of family medicine who led the study. “The study shows that states recognized the importance of loan repayment and other incentives and were willing to create more programs even during the early, toughest years of the recent recession when states’ budgets were stretched thin.”

The work, published as a research letter in the Nov. 13 issue of JAMA, not only highlights states’ activities in placing clinicians where they are needed most, but also comes at a time when the Affordable Care Act puts a focus on primary care and preventative care.

The most popular of these incentive programs offer young physicians, dentists, mental health providers and other health professionals the opportunity to have their student loans repaid while serving in communities with limited access to care. These loan repayment programs from states help practitioners pay off their debt and simultaneously help states’ neediest communities attract clinicians.

Pathman and his colleagues at UNC’s Cecil G. Sheps Center for Health Services Research and School of Medicine took inventory of all incentive programs offered by states from 2007-2010. They found that in 2010, there were 93 programs for health professionals of all types across the United States – an increase from 87 programs in 2007. During the study period, 47 states offered at least one incentive program for clinicians, compared to 37 in 1996, the last time an official tally of these programs had been made.

One quarter of programs in 2010 were sponsored jointly by states and the National Health Service Corps, which offers its own, entirely federally supported loan repayment program which also increased in size during the recession to help assure access for the many unemployed who lost health insurance.

As of 2010, a total of 3,325 clinicians were serving in these state programs across the nation. Of these clinicians, 1,395 were primary care clinicians (physicians, physician assistants, nurse practitioners and midwives) who were serving in solely state-funded loan repayment and direct incentive programs – double the number from 1996.

The states with the highest clinician counts serving in these programs include California (488), Texas (267), North Carolina (235), Wyoming (214) and New Mexico (153).

“Research tells us that an important way to improve health, lower costs and increase people’s satisfaction with their care is through a relationship with a primary care provider,” said Pathman. “States are doing a lot of the heavy lifting in attracting clinicians into these rural and underserved areas – and that’s what many areas need if people are going to get quality care.”

School of Medicine contact: Donna Parker, (919) 843-4760,

News Services contact: Thania Benios, (919) 962-8596,