Outcomes of States’ Loan Repayment and Forgiveness Programs From the Perspective of Safety Net Practice Administrators

Background: Nearly every state offers loan repayment (LRP) and some offer loan forgiveness to clinicians who commit to work in safety net practices. The effectiveness of these programs from the perspective of safety net practices is largely unknown.

Objectives: To assess safety net practice administrators’ assessments of key outcomes for the 3 principal types of state service programs: LRPs funded by states, LRPs funded jointly by states and National Health Service Corps, and loan forgiveness programs.

Subjects: Administrators of safety net sites where primary care, behavioral health and dental health clinicians began serving in 26 state service programs in 14 states from 2011 to 2018. Survey responses were received from 455 administrators reporting on 754 of 1380 clinicians (54.6%).

Outcome Measures: Administrators’ ratings of their sites’ difficulty recruiting clinicians; relative ease, quickness and cost of recruiting the participating (index) clinician with the service program; program expected effects on participants’ retention; participants’ job performance.

Results: Most administrators (66.1%) reported that recruiting clinicians of the index clinician’s discipline is generally difficult but made easier (81.7%) and quicker (65.4%) with the service program, but only sometimes less expensive (34.8%). 78.8% of administrators anticipate that the clinicians will remain longer because of program participation. Participants are perceived to practice good quality care (96.9%) and be positive contributors (92.4%). Administrators’ assessments are generally similar for the 3 types of programs.

Conclusions: Administrators of safety net practices generally perceive states’ loan repayment and loan forgiveness programs succeed in helping them recruit and retain good clinicians.