Provider Retention in High Need Areas. Post-training programs


  1. Loan repayment programs which commit students near the end of their residency training to provide a period of service in exchange for assistance in repaying traditional education loans

  2. Direct financial incentive programs, which commit students near the end of their residency to provide a period of service in exchange for unrestricted funds

Most medical students fund their education with traditional loans that do not carry service obligations. However, past research has indicated that given the chance, a large proportion of students would change to a primary care specialty if adjustments in income, hours worked, or loan repayment availability occurred (Rosenthal et al., 1994). This is relevant because participants in financial incentive programs are more likely to serve in underserved areas than non-participants (Holmes, 2005).

Overall, the literature suggests loan repayment programs and direct financial incentive programs are more successful than scholarship programs, loan programs, and resident-support programs in affecting clinician supply (NHSC, 1995; Pathman et al., 2004). These programs are also the most prevalent nationwide, and make up the largest share of aggregate funding in the NHSC program.

Pre-service programs often suffer from lower enrollment completion rates because student interest often changes over the several years of training. Post-training programs have been shown to be much more important for students with more than $50,000 in debt than for students with less debt (Rosenthal et al., 1994).

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