State-sponsored scholarship, loan forgiveness, and similar programs now support a primary care
workforce comparable in size to that fielded by better known federal programs such as National Health
Service Corps. Donald Pathman, M.D., M.P.H., and his colleagues at the University of North Carolina
at Chapel Hill found that solely state-supported programs have experienced dramatic growth since the
1980s. In particular, the number of programs doubled between 1990 and 1996 to 82 programs operating
in 41 states. In 1996, an estimated 1,306 physicians and 370 nurse practitioners, nurse midwives, and
physician assistants provided care under obligation to these state programs, a number roughly equal to
those obligated under federal programs.
According to researchers, these previously unheralded state programs are now a major portion of
the U.S. health care system's safety net, and they should no longer be omitted from listings of safety net
initiatives, nor overlooked in future plans to further improve health care access. In addition, Dr.
Pathman and his colleagues recommend that a mechanism be established to track, evaluate, and
coordinate the efforts of states, local communities, and federal programs to eliminate duplication of
efforts and to prevent gaps in the health care safety net.