Mississippi has a scholarship to encourage doctors and dentists to move to rural areas, and it’s working. But despite the fact that the scholarship has helped 86 healthcare providers move to a rural area in the last 16 years, the program can be improved.
Here’s a little more background: The state’s Rural Physician and Dentist program was designed to place doctors and dentists in rural Mississippi by paying for their medical/dental school in return for serving in a rural location.
At least 83 percent of Mississippians live in counties without proper access to primary care and 85 percent without proper access to dental care. This is an alarming problem, so I tasked my office with reviewing the scholarship program to determine how effective the program has been. After a couple of months of review and meeting with the program administrators, we determined the program was doing well, but there were some accounting issues and vague program guidelines that could be changed to make the program even more effective.
To begin, many Mississippi doctors and dentists—along with the communities they serve — have benefited from the program. And every new doctor moving into an area means more patients have access to care, more jobs for nurses and support staff, and a healthier Mississippi.
Despite this, nearly 25 percent of doctors and 14 percent of dentists in the program have breached their contracts. This happens when someone takes the scholarship money but doesn’t move to a rural area in Mississippi to work. When that happens, the scholarship program is supposed to make the doctor or dentist pay the money back, with interest. My team found instances where the program had either failed to make someone pay it back or had miscalculated interest payments.
Also, every single scholarship winner is required to submit documentation showing they have kept their promise and moved to a rural area. The administrators could not provide an accurate list of those who had breached their contracts.
Program administrators have to buckle down on those who breach their contracts. Some individuals have yet to repay their loans, and this is costing taxpayers thousands a year for no healthcare benefit.
Another problem we identified was a vague definition of “rural.” For example, if a scholarship recipient chose to practice in Flowood, Mississippi (which is just outside of Jackson), the recipient could claim the city was rural because it has a population under 15,000. Flowood is probably not the kind of city that was intended to benefit from the scholarship. Due to this definition of rural areas, the scholarship program has allowed approximately 10 percent of participants to practice in areas that the federal government does not consider rural. Program administrators and legislators should work together to tighten the definition of “rural.”
If all this changes, the program will get stronger. And if we get this right, Mississippians stand to benefit. Since 2013, the Legislature has spent $33.5 million on the program. The federal government has determined that 80 of 82 counties in Mississippi are medically underserved, so we need every penny of that $33.5 million to create a new doctor or dentist in a needy area.
In short, our report aimed to help an important rural scholarship program maximize every dollar. With small improvements in record keeping and a better definition of “rural,” this program will help meet a critical need in our state. We can keep talented healthcare professionals in state and give residents of our rural areas more access to care.
Shad White is the 42nd State Auditor of Mississippi.
