Article Figures & Data
Tables
- Table 1.
List of State Service Programs by Type of Program With Number of Completed Administrator Questionnaires in Analyses
State Program Name Loan Repayment Programs State Forgivable Loan Programs Solely-State LRP State-NHSC LRP Alaska Alaska SHARP-I Program 39 Alaska SHARP-II Program 38 Delaware Delaware State LRP 10 Iowa Primary Care Recruitment and Retention Endeavor LRP (PRIMECARRE) 13 Missouri Missouri State LRP 60 Primary Care Resource Initiative for Missouri Program (PRIMO) 38 Montana Montana State LRP 2 Nebraska NHSC Nebraska State LRP 23 Nebraska LRP 67 Nebraska Student Loan Program 10 Nevada Nevada Health Service Corps LRP 24 New York New York Primary Care Service Corps 6 North Carolina North Carolina State LRP 14 Community Practitioner Program 55 North Carolina LRP 121 North Dakota North Dakota Federal / State LRP 19 North Dakota Dentist LRP 14 North Dakota LRP 43 Oregon Oregon Behavioral Health LRP 13 Oregon Partnership State LRP 15 Oregon Health Care Provider LRP 8 Oregon Medicaid Primary Care LRP 48 Oregon Primary Care Loan Forgiveness 12 Rhode Island Rhode Island Health Professionals LRP 37 Virginia Virginia State LRP 22 Wyoming Wyoming State LRP 3 Total 413 281 60 Abbreviations: LRP, Loan Repayment Program; NHSC, National Health Service Corps.
- Table 2.
Disciplines, Service Sites and Special Population Groups, by State Service Program
Total
(n = 754)Solely-State LRP
(n = 413)State-NHSC LRP
(n = 281)State Forgivable Loan Programs
(n = 60)P Value for group differences Program clinician disciplines, n (weighted %) Physician 208 (27%) 118 (28%) 60 (22%) 30 (48%) <0.001 Advanced Practice Nurse 140 (18%) 83 (20%) 52 (17%) 5 (7%) Physician Assistant 97 (13%) 62 (15%) 30 (11%) 5 (9%) Dentist 133 (17%) 70 (17%) 51 (17%) 12 (20%) Behavioral health disciplines* 88 (13%) 37 (9%) 46 (19%) 5 (9%) Other disciplines 88 (13%) 43 (12%) 42 (15%) 3 (6%) Types of site, n (weighted %) FQHC, other health centers 228 (29%) 96 (24%) 115 (38%) 17 (28%) <0.001 Rural Health Clinic 93 (12%) 48 (11%) 34 (13%) 11 (19%) Mental health and substance use disorder facility 77 (11%) 47 (11%) 27 (11%) 3 (6%) Health department 30 (4%) 30 (7%) 0 (0%) 0 ( 0%) Pediatric clinic—office or hospital-based 38 (5%) 30 (7%) 7 (2%) 1 (2%) IHS and tribal site 27 (5%) 16 (5%) 11 (7%) 0 (0%) Prison/correctional facility 9 (2%) 2 (1%) 7 (4%) 0 (0%) Other office-based practice 169 (21%) 112 (26%) 38 (13%) 19 (32%) Hospital-based practice 83 (11%) 32 (8%) 42 (13%) 9 (15%) Special patient groups at sites, mean weighted % † Medicaid, IHS insurance, tribal insurance and uninsured 52.8% 55.4% 50.0% 47.4% <0.001 Black, Hispanic and Native, American/Alaskan Native 32.5% 35.5% 31.2% 15.4% <0.001 Abbreviations: LRP, Loan Repayment Program; NHSC, National Health Service Corps; FQHC, Federally Qualified Health Center; CHC, Community Health Center; IHS, Indian Health Service.
↵* Includes Licensed Clinical Social Workers (n = 31), Licensed Professional Counselors (28), Psychologists (17), Licensed Mental Health Practitioners (6), Marriage and Family Therapists (3) and Psychiatric Nurse Practitioners (2).
↵† Percentages among responses with non-missing data. Missing data range from 3.5% to 6.0% across special population groups.
- Table 3.
Weighted Percentages* of Administrators’ Perceptions of the Impact of the State Service Program on Their Site’s Ability to Recruit and Retain Clinicians of the Participating Clinician’s Discipline, by the Three Program Types
Perceived Effects Total Solely-State LRPs State-NHSC LRPs Forgivable Loan Programs P Value for Group Differences (n = 735) (n = 396) (n = 279) (n = 60) Recruitment In general, how easy or difficult is it for this clinic to recruit this discipline? % difficult 66.1% 63.8% 71.8% 52.8% 0.019 % easy 14.5% 16.4% 11.1% 18.9% 0.137 How much easier or more difficult was it to recruit this clinician because of the state service program? % easier 81.7% 82.2% 82.3% 75.0% 0.53 % more difficult 3.1% 3.2% 3.2% 2.3% 0.89 How much quicker or longer did it take to fill this position because of the state service program % quicker 65.4% 67.3% 64.3% 58.3% 0.53 % longer 1.1% 1.5% 0.8% 0.0% 0.31 How much less or more expensive was it to fill this position because of the state service program? % less expensive 34.8% 34.9% 35.6% 29.8% 0.80 % more expensive 9.6% 6.3% 15.8% 0.0% 0.002 Retention Do you anticipate that this specific clinician’s participation in the state service program will help her/him remain longer at this practice? % longer 78.8% 78.2% 82.6% 62.3% 0.008 % shorter 3.0% 2.3% 3.5% 5.7% 0.47 In general, do you anticipate that clinicians of this discipline remain longer or shorter in your practice if they participate in this state service program? % longer 83.0% 83.2% 85.5% 67.9% 0.015 % shorter 1.8% 1.5% 2.4% 0.0% 0.41 Abbreviations: NHSC, National Health Service Corps; LRP, Loan Repayment Program.
↵* Results from Likert-scaled questionnaire items with 5 response options and a neutral middle value. Weighted percentage figures (e.g., “% easier”) represent the combined weighted percent of subjects reporting the two values at the relevant end of the scale (e.g., weighted % “much easier” combined with weighted % “somewhat easier”).
- Table 4.
Weighted Percentages of Administrators’ Perceptions of the Job Performance of Participating Clinicians and the Site’s Involvement with Service Programs, by the Three Service Program Types
Ratings Total Solely-State LRPs State-NHSC LRPs Forgivable Loan Programs P Value for Group Differences (n = 735) (n = 396) (n = 279) (n = 60) Clinician Provides good quality care % well or very well * 96.9% 96.7% 96.8% 98.1% 0.82 Is a positive contributor within the practice % well or very well 92.4% 91.9% 92.6% 94.3% 0.69 Overall performance on the job % well or very well 93.8% 93.5% 94.0% 94.3% 0.88 Site Involvement/Interaction With Service Program While looking to hire or qualify clinicians for the program % very good or excellent † 67.4% 65.2% 71.6% 60.4% 0.21 % fair or poor ‡ 7.6% 7.1% 6.7% 15.1% 0.14 As clinicians participate in the program % very good or excellent 70.3% 69.7% 73.5% 58.35 0.19 % fair or poor 5.2% 5.3% 3.5% 13.2% 0.036 Overall participation with the program % very good or excellent 69.3% 67.7% 72.9% 62.3% 0.29 % fair or poor 6.0% 6.9% 3.5% 13.2% 0.09 - Table 5.
Adjusting Outcome Differences† Found across the Three Types of State Service Programs in Bivariate Analyses for Differences in Their Participants’ Disciplines, Types of Practice Sites, and Patient Race-Ethnicity
It is generally difficult for this practice to recruit clinicians of this discipline It was more expensive to fill a position because of this service program Participation in this service program will help this clinician remain longer Participation in this service program generally yields longer retention for clinicians of this discipline Variable Odds Ratio Odds Ratio Odds Ratio Odds Ratio State-NHSC LRP
(vs Solely-State LRP)1.64 * 3.25 *** 1.19 1.21 Forgivable Loan Program
(vs Solely-State LRP)0.59 0.00 0.52 * 0.44 * Physician discipline 1.55 * 0.53 0.85 0.99 Behavioral health discipline 0.98 0.89 1.34 0.97 FQHC or CHC 0.62 0.38 ** 0.95 0.77 “Other” office-based practice 0.50 ** 0.68 0.53 0.58 Combined % Black, Hispanic and Native American patients 0.99 1.00 1.014 ** 1.01 Model P value <0.001 <0.001 <0.001 0.02 Model Nagelkerke R2 0.062 0.112 0.079 0.046
