Improving Recruitment and Retention of Medical Scholarship Recipients in Rural Georgia

Brief communication 135 IMPROVING RECRUITMENT AND RETENTION OF MEDICAL SCHOLARSHIP RECIPIENTS IN RURAL GEORGIA A variety of strategies have been employed to recruit physicians to rural areas. At the national and state levels, these include financial incentives to enter practice in rural areas (including service-linked scholarships and loan repayment programs)1 and special rural training programs for medical students and/or residents,2"4 including Area Health Education Centers programs .5"7 Individual rural communities have also developed a variety of approaches to recruitment, and community factors, such as the creation of opportunities for spouses and children, may be very important.8,9 This paper describes and evaluates an annual medical fair, a program of negotiation, collaboration , education and incentives. The medical fair is designed to introduce medical students and residents who anticipate a rural practice to representatives of rural communities. It provides the future practitioners and the communities the opportunity to learn about each other and to begin to negotiate the conditions of a medical practice. Most of the medical students and residents attending the medical fair are recipients of scholarships that require a period of rural service after the completion of training. Originally implemented in Georgia, the medical fair has since been emulated in several other states. This evaluation of the program is intended to provide policy makers in Georgia and in other states with an assessment of the utility of this approach in the recruitment and retention of rural physicians, and strengthen service -linked scholarship programs. Background The Georgia Medical Fair was originally developed with the intent of improving the performance of the state service-linked scholarship program in recruiting physicians for rural communities. Beginning in 1952, the state of Georgia awarded scholarships initially in an amount of $1,250; this figure has increased to the present value (since 1995) of $10,000 per year for up to four years. The awards were made each year to medical students who would promise to practice in a town with a population of less than 15,000 following the completion of their training. Repaying by practice originally required a total of five years. Today, one year of practice is required for each year of scholarship support. The scholarships were (and continue to be) administered by Journal of Health Care for the Poor and Underserved · Vol. 11, No. 2 · 2000 136 Recruiting and Retaining Medical Scholarship Recipients the State Medical Education Board of Georgia (SMEB). Currently, the board awards approximately 25 scholarships annually. Four criteria are used for the selection of scholarship recipients: (1) residence in the state of Georgia, (2) attendance at a four-year U.S. medical school, (3) financial need, and (4) a willingness to accept the scholarship's service requirement. Until 1985, graduates of the scholarship program were strongly encouraged to repay by service. However, many recipients repaid in cash with accrued interest, which ranged from 4 to 15 percent. Consequently, fewer than half of scholarship recipients actually entered practice in a rural area. More than half repaid in cash. In 1985, the state initiated a triple-indemnity incentive provision under which graduates who do not fulfill their practice obligation are required to pay back three times the amount of the scholarship. The first scholarship recipients to enter practice under this provision did so in 1990. The State Medical Education Board, the Medical College of Georgia, and the University of Georgia Cooperative Extension Service established the Georgia Medical Fair in 1979 as a community approach to achieving the goal of recruiting scholarship recipients (and other physicians) to rural communities . The fair provides a setting in which scholarship recipients can meet representatives of potential practice sites. A comparison of the three different periods in the history of the scholarship program (scholarship alone 1952-79; scholarship plus medical fair 1980-89; scholarship plus medical fair plus triple-indemnity provision 1990-92) provides an opportunity to evaluate the success of the medical fair. The Georgia Medical Fair The development and implementation of the medical fair has been described previously.10'13 Briefly, in 1977 and 1978, the Medical Association of Georgia and the Southeastern Institute for Community Health (a private rural health care research and advocacy organization in...