Educational strategies for targeted retention of nonphysician health care providers.

This study examined the impact of a community-based, totally decentralized training program on the likelihood that graduates would establish their first practice within predefined and limited geographic regions. We found that when students in a physician assistant/nurse practitioner program received their preclinical and terminal training (preceptorship) in a region geographically proximate to their home residence, the likelihood that they would establish their first practice in that region was greatly increased. Similar results were found for students who took their preclinical training away from their home region but returned there for terminal training. Three additional training pathways were identified as being associated with markedly lower rates of regionally based graduate retention. Discriminant analysis was used to compare the relative impact of training and personal variables on retention. The educational process itself was found to be the single most important predictor of graduate retention. When structural variables were controlled, personal variables such as marital status, age, or sex had no predictive capabilities. With appropriate attention to the structural components of training--particularly terminal training (preceptorship)--experiences, PAs and NPs can be targeted to specific and relatively focused areas of medical need. These data suggest that several decentralized training strategies exist for physician assistants and nurse practitioners that would contribute to meeting health care delivery needs in chronically underserved areas.