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Federal program does little in 60 years to increase doctor numbers in underserved areas, says study

by John R. Fischer, Senior Reporter | November 17, 2023
A nearly 60-year-old federal program has done little to increase the number of physicians in areas dealing with shortages in medical professionals.
After nearly 60 years, a federal program designed to populate medically underserved areas with more care providers has failed to make much progress on this front.

Researchers at Yale University found that the Health Professional Shortage Area (HPSA) program, launched in 1965, did not significantly increase physician numbers in these counties or reduce mortality rates, with 73% of these regions continuing to lack an adequate number of providers ten years after being designated an HPSA.

“The HPSA program has been great at identifying in-need counties, but not great at ameliorating that need. We’ve really not moved the needle on this,” said lead author Justin Markowski, a Ph.D. candidate at Yale School of Public Health, in a statement.

In 1965, the government began offering student loan forgiveness and higher Medicare reimbursements to entice physicians to move out to HPSAs. For their study, the researchers compared underserved counties that did and did not receive these incentives and assessed whether they effectively attracted physicians, but found little change.

Markowski and his colleagues say that the program's approach is outdated, relying on state-level actors to petition federal officials to designate areas as HPSAs. They say that it may have made sense in 1965 when technology was different and local officials were better able to determine which areas required more physicians. But because states today abide by different processes for HPSA designation, there is a greater risk for not identifying counties that tick all the boxes to be HPSAs.

They also say that extending incentives does not work, with previous examples not making a dent in mortality rates or attracting more physicians. Here are their recommendations for the government:

  • Offer incentives to medical school graduates rather than healthcare practitioners who are less likely to move away from where they already have set up care practices.

  • Provide a wider scope of practice and more autonomy as incentives to nurse practitioners and physician associates who are willing to work in underserved areas.

“The federal government just released a significant amount of new funds for HPSA programs, but our findings underpin the idea that we need to think carefully about how we use those dollars,” said Markowski. “We need to do better about getting physicians to these areas, and we need to try other approaches.”

Their findings were published in Health Affairs.

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