Researchers from Michigan State University in East Lansing, Mich., examined the actions taken by state legislatures to hold their medical schools accountable for producing more primary care practitioners.

The project was part of the Robert Wood Johnson Foundation (RWJF) national program Generalist Provider Research Initiative.

Key Findings
The researchers reported these and other findings in the Journal of Health Politics, Policy and Law and the Journal of Public Administration Research and Theory:

• The laws were generally not highly coercive. None stipulate penalties for failure to meet mandated targets.
• The laws tended to be broad in scope, involving public and private institutions and covering admission policies, curriculum changes, clerkships, and other aspects of training.
• The laws were generally politically popular, especially among those with rural interests.
• The laws were important in the message they conveyed that medical schools were part of the solution to the distributional problems of health care delivery.
• For several states, the mandate proved to be an impetus for additional legislation, additional resources, and an increased awareness of the importance of medical school-legislature relations.
• The bills provided a mechanism whereby medical school deans could move in the direction they saw most useful — that is, toward more primary care.
• Not all medical schools responded in the same way. Even within the same state, some schools were more enthusiastic — and more compliant — than others.
• The laws led to greater interest and, in several states, greater cooperation in tracking students to find out both where students are trained and what type of practice they choose to enter.
• A number of schools set up rural health tracks and residency programs in answer to legislative directives, but there was little or no reporting on their outcomes.
• The presence of a state-level entity that holds medical schools accountable was important in successful implementation of changes at schools.
• Availability of additional resources from the state legislature or from outside sources also was a key success factor.
• Schools that were especially responsive to state directives tended to have a strong and supportive medical leadership and to be willing to join coalitions and work more closely with legislators.
• In state medical schools' implementation of primary care mandates, two predictions were important: incentives and the preferences of implementers.

The principal investigator published articles in the Journal of Health Politics, Policy and Law and in Academic Medicine. (See the Bibliography for details.)

Funding
RWJF provided $112,378 in funding from July 1995 to August 1998 to support the project.