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July/August 2008

Inside This Issue:


From Preparation to Practice
Research Examines Health Care Education Programs and Pipeline to Workforce
While Pennsylvania has an extensive infrastructure for education in health care disciplines, only 36 percent of Pennsylvania medical school graduates are providing care in the state and only 7 percent are providing care in rural areas, according to research recently published by the Center for Rural Pennsylvania.

The research also revealed that only about 4 percent of medical school graduates remain in the state to provide primary care in rural areas and 1 percent or less remain to provide care in underserved areas.

The research, conducted in 2006 by Myron R. Schwartz, Dr. Linda J. Kanzleiter, Dr. John George, and Jeannie Nye of the Penn State College of Medicine, explored how Pennsylvania’s health care degree programs serve the commonwealth’s health care workforce, especially in rural areas.

The research involved an inventory of Pennsylvania’s health care degree programs, a description of their geographic distribution, and an assessment of educational capacity by discipline. It focused particularly on physicians, dentists, and nurses.

Among Pennsylvania dental graduates, 43 percent are providing care in the state and 6 percent provide care in rural areas. And while there are more than 200,000 registered nurse licensees and more than 50,000 practical nurse licensees in Pennsylvania, a considerable number of these licensees are not engaged in patient care.

The research also found that private colleges and universities are responsible for educating the majority of students in most health care disciplines. However, community colleges are responsible for educating the majority of dental hygienists and associate degree nurses; Area Vocational Technical Centers are responsible for educating the majority of licensed practical nurses; and proprietary schools are responsible for educating the majority of dental assistants and are home to a plurality of technology and aides programs.

The number of programs in medicine, pharmacy, and dentistry is limited and are predominately located in larger cities. Because these disciplines generally require residency training, their broad geographic distribution is not critical.

However, very few programs report special efforts to place graduates in Pennsylvania, in rural areas, or in underserved areas.

The research indicated the national educational capacity of dental schools is insufficient to meet the public health demand for dentists in the future. And because of the declining supply of dentists, dental education capacity is a more important issue than capacity in other health care disciplines.

In terms of nursing, expanding educational program capacity is a complex policy issue. According to the researchers, strategies to expand capacity, effectively use that capacity, and maintain an adequate workforce will need to include science education at the elementary-secondary levels, abating premature exits from the workforce, and exploiting the inactive workforce. Meeting Pennsylvania’s nursing workforce needs for the future will be a continual challenge.

From these and other findings, the researchers proposed several policy considerations aimed at the various disciplines. For physicians and dentists, the researchers suggest enhanced focus on the education-to-practice pipeline. For nursing and similar disciplines, the education-to-practice pipeline is naturally strong, so capacity and the geographic distribution of educational programs should receive the most attention.

For a copy of the research results, Health Care Degree Programs: Their Role in Serving Pennsylvania’s Rural Health Care Workforce, call the Center for Rural Pennsylvania at (717) 787-9555, email or visit

Number of Health Care Education Programs by Type of Educational Institution, 2006


Survey Results Provide New Information, Insight into Rural Pennsylvania
The Center for Rural Pennsylvania has updated its database with the results of the 2008 Rural Pennsylvania Current Population Survey (RuralPA-CPS).  Results from this year’s survey include responses from 1,000 rural residents and 500 urban householders about their family, home, income, employment, education, and health insurance. 

The Center for Rural Pennsylvania has been conducting the annual survey of rural households since 2005; in 2006, the survey was expanded to include urban households. This year’s survey was conducted from January to March.

Following is a rural/urban comparison of results from the 2007 and 2008 survey responses. The Center combined the two years’ results to increase validity.

For more results from the 2008 RuralPA-CPS, Rural By The Numbers 2008, call the Center at (717) 787-9555, email, or visit


Chairman’s Message
Summertime is here. School bags are stacked on the closet shelf, parks and pools are open for business, and vacation planning is well underway. Or is it?

The rising costs of gasoline, food, and energy have many families reviewing budgets and trying to cut costs wherever they can. One potential target may be the family vacation. With gasoline prices hovering around $4 per gallon, compared to a national average of $2.87 per gallon just one year ago, many families are considering alternate vacation plans. Just this past July 4th holiday weekend, the American Automobile Association said travel was down by 1.3 percent from last year. 

While vacations may be a target for cost cutting, it doesn’t mean they need to be eliminated from a family’s summer plans altogether; especially when there is such a wealth of travel and tourism opportunities in our own backyard.

If it wasn’t already on your agenda, perhaps it’s time to consider a rural Pennsylvania destination for your family’s summer vacation. Whether you want a relaxing reprieve from your traditional weekly schedule or prefer non-stop activity, rural Pennsylvania has something for just about every taste.

How about getting a little rest and relaxation in one of the many bed and breakfasts or luxurious resorts in the mountains of the northeast? Or have you considered visiting the quaint towns and enjoying the beautiful scenery along Pennsylvania’s northern tier by touring nationally acclaimed Route 6?

If you’re a pushover for funnel cakes and shoofly pie, then check out the fairs and festivals throughout central Pennsylvania and throw in some antiquing while you’re there.

If you’re a thrill-seeker who’s in the mood for biking, rafting, fishing, and a host of other outdoor fun, visit southwestern Pennsylvania and take in all it has to offer.

And let’s not forget northwestern Pennsylvania, where you can enjoy hiking, camping and nature-watching in the breathtaking Allegheny National Forest.

As you can see from the article on Page 6, tourism means a great deal to our state. Domestic visitors to Pennsylvania spent an estimated $25.7 billion in 2005, ranking Pennsylvania seventh in the nation with domestic travel visits and expenditures. For rural Pennsylvania, its share was $6.4 billion.

Spending time in rural Pennsylvania this summer can help the family budget, support our local economies, and give us a better appreciation for Pennsylvania’s natural beauty, its history, and its people.  

While you’re on vacation and looking for some good reading, take along a copy of Rural Perspectives, or one of the Center’s recent research reports featured in this issue. They might not make this summer’s bestseller’s list, but I’m sure you’ll find them full of useful information and data on issues affecting us all. Happy reading, and, no matter what your plans, have a safe and restful summer.

Senator John Gordner


KOZ/KOEZ Encourages Local Investment
The Keystone Opportunity Zone (KOZ) and Keystone Opportunity Expansion Zone (KOEZ) programs have encouraged local investment in housing, downtowns and brownfield sites, but have also resulted in inter-zone competition between greenfield properties and abandoned industrial sites, according to research sponsored by the Center for Rural Pennsylvania. The research was conducted in 2005 by Dr. Paula A. Holoviak and Damian Carabello of Kutztown University of Pennsylvania to learn if the KOZ/KOEZ program was meeting the legislative goals of increased employment, capital investment and use of brownfields, particularly in rural zones.

The results of the research were mixed as the researchers found both positive and negative outcomes associated with the program.

The research evaluated the program’s economic impact in rural KOZs, and the satisfaction of program participants including local governments, school districts, economic development organizations and private businesses.

The research included an analysis of changes in employment, per capita income, and state and local tax expenditures and revenues. Surveys were conducted of program participants and supplemented with case studies of three communities.

The research results showed that economic development professionals use the program for marketing, especially for brownfields or other less desirable industrial and commercial sites. The results showed that KOZ/KOEZ has limited negative impact on the tax revenues and service expenditures of local government. KOZ/KOEZ also has relatively few administrative costs at the state level, and relies primarily on existing economic development organizations for implementation. Businesses do not have any substantial complaints about the program’s implementation or reporting requirements. The research results indicated that the program encourages local investment in housing, downtowns and brownfield sites.

The findings also suggested that there are program inequities due to administration challenges and professional promotion. These issues have resulted in some properties having zero activity and some businesses not taking advantage of other programs available in the zones that could increase the KOZ/KOEZ impact. Inter-zone competition between greenfield properties and abandoned industrial sites, which was not the legislative intent of the program, has also occurred. 

From the results, the researchers offered policy considerations that include the following: centralize the administration of the program in the Pennsylvania Department of Community and Economic Development rather than having the Department of Revenue determine tax abatement eligibility; require more rigorous reporting for businesses and zones; and focus resources on small business development, business incubators and locally owned and operated companies rather than the recruitment of larger out-of-state, out-of-region firms. Finally, the researchers recommended that tax abatement be phased-in by end-loading as much as possible: this could include rewarding firms with increased tax abatements after one or more years, rather than giving total abatement upfront and phasing in taxes slowly.

For a copy of the research results, An Evaluation of the Keystone Opportunity Zone (KOZ) and the Keystone Opportunity Expansion Zone (KOEZ) Programs in Rural Pennsylvania, call the Center for Rural Pennsylvania at (717) 787-9555, email, or visit


Research Explores Movement of Urban Families to Rural Pennsylvania Counties
A recently published report by the Center for Rural Pennsylvania presents the results of an ethnographic study that examined the movement of low-income families from urban areas to rural Pennsylvania to find available, affordable quality housing. The year-long study involved interviews with migrant families to understand why they moved and what their perceptions of their new community were. It also involved interviews with long-term community members to examine their perceptions of community change and with local government/community organization representatives to ascertain what, if any, changes to social services were being attributed to low-income families migrating to the area.

A key finding from the study showed that, contrary to much of the migration literature, respondents did not relocate for labor opportunities but for housing opportunities.

The research was conducted by Dr. Sherri Lawson Clark, formerly of Pennsylvania State University and now with Duke University, after an on-going study called the Family Life Project (FLP). The FLP showed that low-income individuals and families who were migrating to three research counties in Pennsylvania were driven by public housing availability and the prison economy.

The Center-sponsored research allowed a small team of researchers from the FLP to explore these findings more systematically in the three rural counties of Huntingdon, Blair and Cambria, where the FLP data were collected.

The research, conducted in 2005, explored the lived experiences of 15 families that chose to leave high poverty urban neighborhoods and move into a central Pennsylvania rural county. Over seven months of interviews and observations, the project elicited factors that respondents say contributed to their mobility, and the processes of relocation that included how respondents discovered information, obtained services, built upon opportunities and reacted to challenges.

To understand how agencies and local long-term residents responded to demographic shifts occurring in these communities, the researchers attended meetings, and interviewed organization officials and residents who had spent their lifetimes in the area and lived in the same neighborhood as the migrant families participating in the study.

In addition to finding that respondents relocated for housing opportunities rather than labor opportunities, the research also shed light on how U.S. public housing policy made at the federal level may be playing out at the local level, and how the federal program expectations may be presenting challenges for local policymakers and small communities and their residents.

For a copy of the research results, Migration for Housing: Urban Families in Rural Living, call the Center for Rural Pennsylvania at (717) 787-9555, email, or visit

The Family Life Project, which was funded by the National Institute of Child Health and Human Development and began data collection in 2002, was a five-year study conducted by researchers at Penn State and the University of North Carolina at Chapel Hill. The goal of the project was to understand the development of young children by following them from infancy through their first three years of life. The communities of study in Pennsylvania were Huntingdon, Blair and Cambria counties


Projections Show Declining School Enrollment
A majority of Pennsylvania schools are experiencing decreases in enrollment, and these decreases are projected to continue through 2017, according to data from the Pennsylvania Department of Education (PDE). While some Pennsylvania schools are experiencing increases in enrollment, they typically are experiencing only low to moderate increases and are largely concentrated in the southeastern portion of the state.

In 2002-2003, total public school enrollment (K-12) throughout the commonwealth was 1.8 million students. In 2007-2008, this number dropped to 1.7 million students, for an overall decrease of more than 94,800 students (5 percent) over a five-year period. According to PDE projections, this number is expected to continue to decrease in the upcoming years. Excluding Bryn-Athyn School District in Montgomery County, which has no students enrolled, of Pennsylvania’s remaining 500 school districts, 202 are projected to have an enrollment decline of 10 percent or greater, and 115 are projected to have an enrollment decline of between 1 percent and 9 percent. The remaining 183 schools are projected to have enrollment increases of more than 1 percent.

Regionally, the biggest decrease in enrollment is projected to occur in western Pennsylvania. From 2007 to 2017, elementary school enrollment is projected to decrease 10 percent and secondary school enrollment is projected to decrease 15 percent. Total enrollment in western Pennsylvania schools is expected to decrease by 13 percent from 2007 to 2017. In eastern Pennsylvania, elementary school enrollment is projected to increase 7 percent and secondary school enrollment is projected to decrease 1 percent. Total enrollment in eastern Pennsylvania schools is projected to increase 3 percent from 2007 to 2017.

Among Pennsylvania rural and urban schools, rural schools are projected to experience the largest enrollment declines. Rural school enrollment is projected to decrease 8 percent from 2003 to 2017 and urban school enrollment is projected to decrease 2 percent.

Nationally, from 2000 to 2005, the United States had a 4 percent gain in school enrollment. However, this increase was largely concentrated in five states: Arizona, Nevada, Texas, Georgia, and Florida. Each of these states had a 10 percent or greater enrollment increase. Nineteen states had a decline in enrollment. The largest declines occurred in North Dakota and Louisiana, each with a 10 percent decline. Pennsylvania ranked 26th in school enrollment change during this period.

In Pennsylvania, one reason for the decline in school enrollment may be attributed to the decline in the total number of births. From 1986 to 2006, the total number of births in the state declined 8 percent. The total number of births in rural areas decreased 10 percent, and in urban areas, it decreased 7 percent.


Rural Captures $6.4 Billion in Tourism Dollars
According to the Pennsylvania Tourism Office, domestic visitors to Pennsylvania spent an estimated $25.7 billion in 2005, helping Pennsylvania rank seventh in the nation in domestic travel visits and expenditures. Travelers to rural Pennsylvania counties spent an estimated $6.4 billion in 2005, while travelers to urban counties spent about $19.3 billion.

Regionally, travel expenditures were lowest in northwestern Pennsylvania ($1.8 billion) and highest in the southeastern region ($6.9 billion). At the county level, 48 cents out of each travel dollar were spent in just seven counties: Allegheny, Bucks, Dauphin, Philadelphia, Lancaster, Montgomery and York. In each of these counties, travelers spent more than $1 billion.

Within rural Pennsylvania, tourists spent the most in Monroe, Centre and Franklin counties, where tourism expenditures totaled more than $350 million in 2005. Tourists spent the least in Cameron and Sullivan counties. Each had less than $10 million in domestic travel expenditures.

Among both rural and urban Pennsylvania counties, tourists spent the most in Allegheny and Philadelphia counties, where expenditures totaled more than $2.5 billion in each of these counties in 2005.

Tourism expenditures are a calculation of total domestic spending by tourists on transportation, food and beverages, lodging and temporary housing, shopping, and entertainment.

When travelers visit rural areas, they spend proportionally more for food and beverages than they do in urban areas. In 2005, 30 percent of rural travel expenditures were spent on food and beverages compared to 24 percent in urban areas. However, the opposite was true for transportation expenditures. Travelers to urban areas spent 25 percent of their expenditures for transportation, compared to 20 percent in rural areas. Proportionally, travelers to rural and urban areas spent the same on lodging, shopping, and other related expenses.

As the data show, tourism is an important industry in Pennsylvania. While total domestic tourism expenditures in urban counties were 66 percent greater than in rural counties, tourism is an important industry in rural Pennsylvania. Each year, domestic tourism brings millions of dollars to the rural economy. Overall, in 2005, traveler spending contributed $23.9 billion to Pennsylvania’s Gross Domestic Product and generated more than $2.6 billion in state and local tax revenues.


Just the Facts: High School Seniors and Military Service After Graduation
From 2005 to 2007, the percentage of rural high school seniors planning to join the military after graduation remained steady at about 4 percent. However, a more long-term view shows a decline, according to data collected by the Pennsylvania Department of Education. From 1999 to 2007, the number of rural high school seniors planning to join the military after graduation declined 20 percent. Among urban seniors, there was a 28 percent decline.

As a percentage of all graduating seniors, in 2007, 4 percent of rural seniors and 2 percent of urban seniors planned to join the military. From 1999 to 2007, there was a nearly identical 1 percentage point decline in rural and urban seniors planning to join the military. 

The reason for the decline is not readily apparent from the data. The decline, however, is not attributed to a decrease in the number of graduating seniors. From 1999 to 2007, the number of graduating seniors in rural schools increased 5 percent and the number in urban schools increased 14 percent.

From a gender perspective, in 2007, rural male seniors were more likely to consider military service (83 percent) than rural female seniors (17 percent). There was a similar pattern among urban male and female seniors.

Statistically, the percent of rural seniors planning to enter the military was significantly correlated with the Free and Reduced School Lunch program. That is, in 2007, the higher the percentage of students who were eligible for the school lunch program, the higher the percentage of seniors who planned to join the military. 

Military service is important to rural and urban Pennsylvania families. According to data from the U.S. Department of Veterans Affairs, in 2005, Pennsylvania had more than 1 million veterans—the fifth highest number of veterans in the United States.

Percent of Rural and Urban High School Seniors Planning to Join the Military After Graduation, 1999 to 2007