Uneven distribution of primary care physicians, as well as inadequate use of mid-level providers — physicians' assistants, nurse practitioners, and nurse midwives — creates barriers to access for many rural and inner city residents.

The Robert Wood Johnson Foundation (RWJF) launched Practice Sights: State Primary Care Development Strategies in 1991 to strengthen state efforts to recruit and retain primary care providers, including physicians and mid-level providers, and develop and sustain practice sites in underserved areas.

The North Carolina Foundation for Alternative Health programs, a not-for-profit adjunct of the North Carolina Office of Rural Health, Raleigh, N.C. served as the national program office.

Key Results
States pursued strategies to help improve access in underserved areas in the following ways:

• Creation of recruitment centers helped to publicize openings and matched providers with practice sites.
• Provision of technical assistance helped practice sites in underserved areas improve their financial viability.
• Adoption of financial incentives such as loan repayment programs encouraged providers to practice in underserved areas.
• Establishment of locum tenens programs, which provided temporary backup for practitioners in underserved areas, giving them the opportunity to attend conferences or take vacations.
• Expansion of the scope of practice for mid-level practitioners — physician assistants, nurse practitioners, and nurse midwives — increased the services these providers could offer. Click here for list of project sites.
• During the program, recruitment centers in the 10 implementation states placed 867 providers in underserved areas; not all of these placements can be attributed to Practice Sights, however.

Site Selection
Fifteen states received planning grants:

• Arizona
• Arkansas
• Idaho
• Kentucky
• Maine
• Minnesota
• Nebraska
• New Hampshire
• New Mexico
• New York
• Pennsylvania
• South Dakota
• Texas
• Virginia
• Wisconsin

Ten of these states continued with three-year implementation grants:

• Idaho
• Kentucky
• Minnesota
• Nebraska
• New Hampshire
• New Mexico
• New York
• Pennsylvania
• South Dakota
• Virginia

Four of these states (Idaho, Minnesota, Nebraska and Virginia) also received program-related investments (PRIs) allowing them to create loan funds totaling $19.7 million for capital projects to increase the availability of health care in underserved areas.

Funding
In October 1991, the RWJF Board of Trustees authorized up to $16.5 million for the national program.