North Carolina Rural Health Research and Policy Analysis Center, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill 27599-7590, USA.
J Rural Health. 2012 Fall;28(4):408-15. doi: 10.1111/j.1748-0361.2012.00409.x. Epub 2012 May 1.
The landscape of education loan repayment programs for health care professionals has been turbulent in recent years, with doubling of the funding for the National Health Service Corps (NHSC) and cuts in funding for some states' programs. We sought to understand how this turbulence is being felt within the state offices involved in recruiting clinicians to rural and urban underserved communities.
We conducted key informant telephone interviews with staff of state offices of rural health, primary care organizations, and/or related organizations within 28 diverse states to answer questions about perceived changes and interplay among solely state-funded loan repayment programs, joint state-federal programs, and the NHSC federal program. Interviews were transcribed, formally analyzed, and key issues summarized.
Informants reported that solely state-funded and joint state-federal loan repayment programs are greatly valued for their ability to target a state's particular needs and to complement the NHSC federal program. However, budgets for state programs have been threatened, reduced, or eliminated entirely in many cases. All informants positively perceived the NHSC's recent growth and changes, which they feel are helping fill important workforce needs for their states. Nevertheless, the much larger NHSC federal program now competes with some states' programs for clinicians and service sites; states' programs are pushed to adjust their operations to maintain a unique "niche".
States' key recruiters lament reductions in funding for states' loan repayment programs, and welcome the NHSC's recent growth and changes. Better coordination is needed to minimize competition and maximize complementarity between state and federal programs.
近年来，医疗保健专业人员教育贷款偿还计划的格局一直动荡不安，国家卫生服务团（NHSC）的资金增加了一倍，而一些州的计划资金减少。我们试图了解参与招募临床医生到农村和城市服务不足社区的州办事处如何感受到这种动荡。
我们对 28 个不同州的农村卫生、初级保健组织和/或相关组织的州办事处工作人员进行了关键知情人电话访谈，以回答有关仅由州资助的贷款偿还计划、州-联邦联合计划以及 NHSC 联邦计划之间感知变化和相互作用的问题。对访谈进行了转录、正式分析，并总结了主要问题。
受访者报告说，仅由州资助和州-联邦联合贷款偿还计划因其能够针对一个州的特定需求并补充 NHSC 联邦计划而受到高度重视。然而，在许多情况下，州计划的预算受到了威胁、减少或完全取消。所有受访者都对 NHSC 的近期增长和变化持积极态度，他们认为这有助于满足各州对劳动力的重要需求。然而，规模更大的 NHSC 联邦计划现在与一些州的计划竞争临床医生和服务地点；各州的计划被迫调整其运营以保持独特的“利基”。
各州的主要招聘人员对州贷款偿还计划资金减少表示遗憾，并欢迎 NHSC 的近期增长和变化。需要更好的协调，以最大限度地减少州和联邦计划之间的竞争并最大限度地发挥互补性。
