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The Mississippi Legislature was influenced by ÂÜÀòÊÓƵresearch to create State-funded education incentives to attract more health care professionals to work in medically underserved areas. When the initial scholarship program did not attract enough workers, the legislature added a loan repayment program as an option and reduced the required years of service under both programs.

Initially, Mississippi law provided only for scholarships. That changed in 2001, when a loan repayment program was added for doctors, dentists, and nurse practitioners. A new law in 2003 also reduced the required years of service for each program to be more in line with scholarships offered by other States.

These enhancements to the program were made after AHRQ-funded research by Donald E. Pathman, MD, MPH, Director of Research, University of North Carolina Department of Family Medicine, demonstrated that establishing a loan repayment program would yield better outcomes from its health care professionals in medically underserved areas, including longer retention. This research was used to show State legislators the benefits of revising the program.

Michael Beachler, MPH, Director of the Rural Health Policy Center in 2003, said Pathman's research was highly influential in persuading the Mississippi Legislature to reduce the required years of service under the scholarship and loan repayment programs. The minimum service requirement was reduced from 10 to 6 years for the scholarship program and from 8 to 6 years for the loan repayment program.

"Dr. Pathman's research was really pivotal in showing the need to reduce the service years required and was presented in a very practical manner that legislators and policymakers could grasp," Beachler says. Pathman's research found that 66 out of 69 State-funded incentive programs for physicians including scholarships and loan repayment had service obligations of 4 years or less. The remaining three programs had a service obligation of 5 years.

Even with the reduction in required service years, the Mississippi physician scholarship and loan repayment programs had little success in attracting health care professionals to medically underserved areas. In 2004, funding for the programs was discontinued.

"The impact of Dr. Pathman's research in changing the service year commitment was a great idea and we had hoped it would translate into a more effective, long-term workforce program for the State of Mississippi," said Robert Pugh, Executive Director of the Mississippi Primary Health Care Association, who helped negotiate the legislature's passage of the change in service years.

Pathman DE, Konrad TR, King TS, Taylor DH Jr, Koch GG. Outcomes of states' scholarship, loan repayment, and related programs for physicians. Med Care 2004;42:560-568.