Obligations: The Oklahoma Physician Manpower Training Commission has placed physicians for over 25 years. OPMTC physicians have served for 3100 physician FTE years. The cost to the state was 100 million for GME and 18 million for scholarships and 11 million for administrative/other. These physicians have returned $3.6 billion dollars of direct and indirect impact on an investment of 130 million dollars with 2.7 billion in impact in rural areas. This is just the dollar contribution. Obviously some physicians would have made these choices anyway. The commission has estimated that 15% of the physicians that they have placed would not have been there without the state investment, this has meant 445 million dollars going to the communities most in need in the state for only 130 million in tax dollars. By the numbers
The key to obligations is the numbers that actually do go to rural communities. Osteopathic physicians went to rural Oklahoma locations 77% of the time. Allopathic family medicine graduates honored their commitment 50% of the time. Allopathic internal medicine docs made it to small towns only 20% of the time.
Only changing the mix made the program viable. This is something that the National Health Service Corps has learned, the hard way. Additional resources had to be expended to interview applicants, orient them, train them, etc., far beyond the loan repayments and scholarships. In addition much is expended to attempt to keep them at locations where they never anticipated.
Such students desire to go to rural locations. Only changes in education and admissions have kept them from this desire Admissions Package. The costs involve extra admissions committee time in training and in evaluating candidates with less emphasis on scores and more on personal characteristics. Admissions Committee Efforts. There is also a cost for outreach programs getting students and others out to rural schools for presentations. There is some cost to work with students and advisors at feeder colleges, the usual sources of rural background candidates. The cost of this is a coordinator or two to help students and faculty with organization and materials and scheduling.
The major controversy with this approach is whether growing your own leads to
better retention. Rabinowitz PSAP program grads and Duluth grads in Minnesota
have had much greater retention. Pathman's studies demonstrated no benefit for
rural background or spouse rural background for retention, with about 6 years
stay in rural areas for rurals or for urbans. This may have to do with the
numbers of suitable candidates. When the bulk of the rural candidates presented
for admissions are marginal, it is difficult to choose according to motivation
and psychosocial factors. When there are greater numbers of acceptable
candidates, superselection can occur. Working with 5 small colleges, their
health career advisors, and a larger state with the greatest rural population
may give Rabinowitz an advantage in this area. Admissions in Kentucky can be a
more challenging process where acceptable rural candidates are soon depleted.
Looney SW; Blondell RD; Gagel JR;
Pentecost MW J Ky Med Assoc, 96(5):189-93 1998 May Which Medical School
Applicants Will Become Generalists or Rural-Based Physicians?