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April 21, 1993

Improving Access to Primary Care

Author Affiliations

Bellingham, Wash

JAMA. 1993;269(15):1943-1944. doi:10.1001/jama.1993.03500150051024

To the Editor.  —I hope that the excellent historical perspective and solutions to access and cost concerns through physician training and recruitment in academic community health centers presented by Ginzberg1 will be heeded by politicians, their policy-making consultants, and particularly the medical academic community.To some extent, this approach for rural areas was explored by the Washington-Alaska Regional Medical Program in the early 1970s, implemented by the University of Washington School of Medicine and persisting today as the Washington-Alaska-Montana-Idaho program. Support from the involved states has varied and some of the problems with achieving the desired migration of medical practitioners to rural areas have been identified.One factor not addressed by Ginzberg is the "spousal factor," involving educational and employment opportunities and so-called cultural amenities that impact to a greater extent on spouses and families than the health care provider.Another factor is the use of nurse practitioners to increase