12/27/02
Study Findings Indicate NHSC Scholarship Predictive of Commitment to the Underserved

The National Health Service Corps (NHSC) has long known that its Scholarship Program is an important catalyst for launching and sustaining careers in health care for the underserved. However, a statistical study, conducted by Howard K. Rabinowitz, M.D., professor of family medicine at Jefferson Medical College (JMC) of Thomas Jefferson University in Philadelphia, Pennsylvania, demonstrates that this premise is well-founded in fact.

As long-time director of the school’s Physician Shortage Area Program (PSAP) and former director of its third-year family medicine clerkship, Rabinowitz is uniquely qualified to study the characteristics that define an effective clinician-community match for the underserved. In a paper published in the Journal of the American Medical Association (JAMA), Rabinowitz and his colleagues, James J. Diamond, Ph.D.; Fred W. Markham, M.D.; and Nina P. Paynter, B.S.; identified a set of five factors independently predictive of providing primary care to rural populations.

These were:

1. Growing up in a rural setting

2. Being enrolled in the PSAP program

3. Having an NHSC scholarship

4. Planning as an entering medical student to go into family medicine

5. Taking an elective senior practice rural preceptorship

Rabinowitz also found that overall, male gender showed a small predictive tendency but for those students in the PSAP, who entered medial school already committed to rural family practice, there was no gender difference.

The study also demonstrated that the likelihood of physicians choosing rural primary care service increased with the number of predictive factors attached to them. What this indicates is that a physician who had all of the factors was roughly four times more likely to serve in a rural setting that those with no predictors.

"Of particular interest to us," Rabinowitz points out, " was that most of the factors that emerged as significant were identifiable before students were admitted to medical school.

This observation was also borne out in a prior Health Resources and Services Administration (HRSA)-sponsored study conducted on a nationwide sample of physicians who graduated from U.S. medical schools between 1983 and 1984. Here Rabinowitz used a different methodology to look at the predictive factors for generalist physicians’ service in underserved populations, both rural and urban.

In this study, the four self-reported predictive factors for providing care to underserved populations were:

1. Growing up in an underserved area

2. Being a member of an underserved ethic/minority group

3. Having a strong interest in practicing in an underserved area before attending medical school.

4. Having participated in the NHSC

For Rabinowitz, the implications of the findings in both studies for the recruitment and retention of clinicians for rural and underserved areas are wide-ranging.

"What we need are more physicians choosing careers in underserved and rural areas," he says." If we know what predisposes incoming students to this particular career path, why not include these characteristics in our selection criteria at the point of admission?"

Rabinowitz notes that while socioeconomic status did not emerge in either of his studies as a significant determinant of eventual career choice, availability of financial support for students coming from rural settings or underserved populations would always be an important issue.

"Financial support, wherever it comes from, provides the student with freedom to follow a career path based on personal and professional avocation rather than financial and debt considerations." What results, then, according to Rabinowitz, is that the more financial support either in the form of scholarships or a commitment to paying off loans that be offered to medical students with rural and underserved predictive factors, the more likely it will be that they will practice where they are most needed.

1. Howard K. Robinowitz, et al., "Critical factors for designing programs to increase the supply and retention of rural primary care physicians." Journal of the American Medical Association, September 5, 2001, v. 286, no 9, pp. 1041-1048.

2. Howard K. Rabinowitz, et al., "The impact of multiple predictors on generalist physicians’ care of underserved populations." American Journal of Public Health, August 2000, v. 90, no. 8, pop. 1225-1228.