SENDING A POLICY SIGNAL - STATE LEGISLATURES, MEDICAL-SCHOOLS, AND PRIMARY-CARE MANDATES

In the past few years, eleven states have directed medical schools in their states to produce more primary care practitioners or to change t he training of physicians to make careers in primary care more attract ive to medical students. This article outlines the progress and politi cs of the states' desire to hold medical schools accountable for produ cing more primary care practitioners. It analyzes the coerciveness and scope of the laws, including the provisions for implementation and ac countability. Interviews with legislative staff, legislators, and univ ersity and medical school lobbyists provide information on the measure s' political rationale and expectations. Most striking was the signali ng nature of the provisions. The laws were not strident or especially onerous; they contained many loopholes and no real sanctions. They wer e important, however, in the message they conveyed. in state after sta te, legislatures sent a message to the medical schools that they were part of the solution to distributional problems of health care deliver y and must be responsive to legislative desires for action. State legi slators sent a policy signal, and most medical schools apparently unde rstood its significance.