Practice Sights: State Primary Care Development Strategies

Practice Sights was an eight-year, $16.5-million national program to strengthen state efforts to recruit and retain primary care providers, including physicians and midlevel providers, and develop and sustain practice sites in underserved areas. Funded states pursued a number of strategies to improve access to care in underserved areas, including creating recruitment centers to match professionals with open positions and establishing a network of backup practitioners to give professionals a break for vacations or conferences. (See Program Results on Practice Sights.)

Highlights from some of the implemented projects include:

  • In Idaho, 47 physicians and midlevel providers were placed in underserved communities, and vacancies declined from 73 to 15 over a four-year period. (See Program Results on ID# 028754.)
  • In Minnesota, a recruitment service placed 45 practitioners in underserved communities, and reduced vacancies from 95 to 48 over a five-year period. (See Program Results on ID# 030782.)
  • In Nebraska, a scholarship and loan repayment program helped place over 100 new practitioners over a five-year period. The number of federally designated underserved communities declined from 58 to 38 over a three-year period and the number of rural communities actively recruiting physicians declined from 60 to 30. (See Program Results on ID# 028753.)

Southern Rural Access Program

Building on the successes of earlier programs, especially Practice Sights, RWJF funded the Southern Rural Access Program (SRAP) to increase access to health care services in eight underserved states in the south: Georgia, South Carolina, North Carolina, Virginia, West Virginia, Alabama, Mississippi, Louisiana and Arkansas. SRAP was a nine-year, $35-million national program that integrated many of the strategies from earlier efforts in rural areas, plus added a technical assistance component to help existing state efforts. The multipronged effort included a pipeline program to help undergraduates gain admittance to health professional schools and recruitment programs that attracted practitioners to rural communities. The program’s recruitment and retention efforts had a positive effect on the growth of the primary care physician supply in over 100 high-poverty rural counties in the eight states, according to a program evaluation. (See the RWJF Anthology, Volume X chapter and Program Results on the Southern Rural Access Program.)

Recruiting General Practitioners to Rural Areas

The Generalist Physician Initiative, a 10-year, $32-million national program, supported a variety of efforts to increase the number of generalists relative to specialists. (See Program Results on the program.) Some of the efforts focused on rural areas, including:

  • The Pennsylvania State University College of Medicine reoriented its medical education program across the spectrum—from pre-admissions to practice support. Efforts included a scholars program for promising high school students, additional coursework in primary care, a restructured residency experience and a recruitment effort to attract physicians to medically-underserved communities. All of these efforts were intended to improve primary care in Pennsylvania’s large rural areas. During the course of the program, the percentage of medical students choosing primary care residencies increased from 37 percent in 1993 to a peak of 59 percent in 1998 before dropping to 48 percent in 2000. (See Program Results on ID# 031650.)
  • Three Virginia medical schools increased the number of medical students who went into general medicine by 54 percent over a six-year period. Each school developed its own strategy for encouraging more generalists, including increasing generalist representation on admissions committees, creating community-based generalist experiences and creating residency rotations in community settings. (See Program Results on ID# 031653.)
  • East Carolina School of Medicine increased the number of graduates pursuing primary care medicine from 46 percent to 74 percent over a seven-year period. The initiative stepped up recruitment efforts in area colleges, expanded generalist coursework and improved residency education for generalists. (See Program Results on ID# 031644.)

Training Practitioners in Remote Areas

Partnerships for Training: Regional Education Systems for Nurse Practitioners, Certified Nurse-Midwives, and Physician Assistants, a $4-million national program, developed eight regional university-community partnerships to educate nurse practitioner, certified nurse-midwife and physician assistant students who were already practicing in underserved areas. Over a 10-year period, the eight partnerships enrolled over 1,000 rural students in distance-education programs. Some 95 percent of graduates went on to practice in medically underserved areas. An assessment of the program found that 70 percent of the students would not have enrolled in the program had distance education not been available. (See Program Results on Partnerships for Training.)

Highlights included:

  • A coalition of eight colleges and universities in four rural Western states trained over 200 students over a seven-year period. Graduates went on to practice in underserved rural communities that previously had few or no midlevel practitioners. (See Program Results on ID# 030882.)
  • Six universities and four state health departments increased the number of midlevel practitioners in the Mississippi Delta region (including parts of Mississippi, Louisiana, Arkansas and Tennessee). All of the approximately 180 graduates went on to practice in medically underserved areas of the region. (See Program Results on ID# 032601.)