Practice Sights: State Primary Care Development Strategies

An RWJF National Program

Dates of Program: October 1991 to December 2000

Field of Work: Recruiting and retaining primary care providers in medically underserved areas.

Problem Synopsis: In 1990, the federal government designated 1,956 mostly rural and inner-city communities as Health Professional Shortage Areas, the same number as in 1980. According to federal estimates in the late 1980's, an additional 4,200 primary care physicians were needed to address the nationwide shortage in Health Professional Shortage Areas. Many of these communities also have had difficulty recruiting and retaining mid-level providers—nurse midwives, nurse practitioners, and physician assistants—despite the steady growth in these fields.

Synopsis of the Work: Practice Sights: State Primary Care Development Strategies strengthened state efforts to recruit and retain primary care providers, including physicians and mid-level providers, and developed and sustained practice sites in underserved areas. The program developed new clinics, provided financial and technical assistance to improve the profitability of established practices and expanded the use of mid-level practitioners.

Key Results

  • The ten states participating in the program pursued strategies to help improve access in underserved areas in the following ways:

    • Created recruitment centers helped to publicize openings and matched providers with practice sites.
    • Provided technical assistance that helped practice sites in underserved areas improve their financial viability.
    • Adopted financial incentives such as loan repayment programs that encouraged providers to practice in underserved areas.
    • Established locum tenens programs, which provided temporary backup for practitioners in underserved areas, giving them the opportunity to attend conferences or take vacations.
    • Expanded the scope of practice for mid-level practitioners, thus increasing the services these providers could offer.
    • Recruitment centers in the implementation states placed 867 providers in underserved areas; not all of these placements can be attributed to Practice Sights, however.