Studies demonstrate that there are mixed benefits for obligated physicians from this nation and from other nations. States and nations compete with one another to steal tax dollars and other investments made in education and training. The long term impact can be significant for additional physicians who may serve for a short time in shortage areas, and then add their costs to the nation's health bill in places not necessarily needed. The best solution is to grow our own, from underserved areas, from underserved populations, etc. Temporary solutions may be more costly and may keep underserved areas underserved.
When loan forgiveness programs have been instituted without any other strategies, the results have been dismal. But when they have been combined with other efforts, such as careful selection of candidates who are motivated to work in the areas of need, specially designed teaching experiences, and counseling and placement services, they have been quite successful. Southern Regional Education Board 1983
We have known that individual and late interventions were doomed to failure.
We began to realize very recently that we have been doing something which ……may be destined to failure. As far as physicians, we have had limited success… What can we do that maintains that person there? … what can you do to change the pattern of isolation, low status, and lack of consultation that occurs in most of the places we are talking about? We feel that the present time, that without changing those three things, one will not retain a physician, or any other health professional, beyond that 5 or 7 year limit when most of the statistics say they leave. Particularly the young ones. Robert Shannon, M.D. National Health Service Corps: Overview and New Directions. Report of Regional Workshops on Health Manpower Distribution, National Health Council, New York, 1975
The problems with obligated physicians are legendary and continuing. The cost of replacing temporary physicians is enormous (over $200000) and has the worst impacts on the shortage areas that can least bear the burden of turnover costs.
The problems of obligated physicians and the greater potential of Programs to Grow Your Own have long been known:
Dr. La Flesche commenced her studies of English at the school on the Indian reservation. Coming East, she continued them for awhile at a boarding-school, and later at the excellent school for her people at Hampton, Va., where she graduated in 1886, and came at once to Philadelphia to study medicine. The impulse to a professional career was not of recent growth nor from friendly suggestions from those who had watched her course. It came as an inspiration when at home with her people and was born of a desire to see them independent, so far as she could make them, of the too frequently unskilled and oftener indifferent attention of the reservation doctor. Picotte Graduation
Even with major improvements in training and higher standards, there are still problems with obligated physicians beyond mismatches of training, personalities, and specialities: the problem of communication, lack of continuity, differences in culture, support services, family situation, and poor coordination with existing local health services.
Character, Color, Admissions, and Physicians
State Scholarship and Loan Repayment Programs
Strengthening the US Health Care Safety Net Nicole Lurie
Why Doctor's Don't Go Where They Are Needed
Role of Black and Hispanic Physicians Volume 334
Federal Policy Legislation Needs to Focus on Rural Underserved Areas
By the numbers: Rural Doctors and Rural Economies: see Oklahoma summary
National Health Service Corps Links, Quotes, and History
Rural Health and Economics Senate Testimony