Mapping Background and Methodologies


Primary Care Health Professional Shortage Area (HPSA) Maps

A Primary Care Health Professional Shortage Area (HPSA) is a county that has a physician-to-population ratio of less than 1:3,500. This set of state maps illustrates federally designated Primary Care HPSA counties as of December 2002.

Primary Care Health Professional Shortage Area (HPSA) After Withdrawal of Family Physicians Maps

This set of state maps features counties that would become Primary Care HPSAs if family physicians were withdrawn.

Residency Footprint Maps

Family Medicine Residency Footprint Maps

What is a footprint map? These maps depict the historical relationship between a program and its community, state and region. The areas incorporated in the footprint have most consistently attracted program graduates and may not have had as many family physicians if the program had not existed. In this regard, the footprint may indicate an area's measure of dependence on the program for its family physicians. Areas with graduates that are outside the footprint are not unimportant, as many may be underserved areas. Residency programs have used these maps for internal reflection on whether they are fulfilling their mission, and to demonstrate their value to hospital and community leaders.

Footprinting Method: To create a footprint map, we calculate the number of graduates from a program in each county, rank these counties from highest to lowest, and select counties to be shaded that have the highest number of graduates until 70 percent of all graduates are accounted for. For example, if a program has 100 active graduates practicing in the U.S., and 50 are practicing in County A, 15 in County B, five in County C, and three each in Counties D-M, only Counties A, B, and C (which constitute 70 percent of graduates) will be shaded in the residency footprint map. This methodology, which borrows from business industry literature on market service area, is thought to be a reasonable standard for gauging the core service area of a residency program. Find more information on residency footprinting.(

Data Sources: We use physician practice location information from the American Medical Association Physician Masterfile( and graduate medical education information from the American Academy of Family Physicians (AAFP). From a geocoded masterfile, we've extracted practice location (including county) and specialty information for each active physician practicing in the United States, and from the AAFP database the residency program codes for each Family Physician in the United States.

Closing Family Medicine Residency Programs Footprint Maps

These fact sheets with imbedded maps illustrate the impact of family medicine residency programs on communities and regions by where their graduates have chosen to locate and practice. The initial set are for those programs that have closed since 2000. Since rural and other underserved populations primarily rely on family physicians, these maps help us understand how closing programs affect these communities or the local physician workforce.

Closing programs were identified using ACGME and AAFP membership data to determine which physicians graduated from these closing programs. Physician location data from the AMA Physician Masterfile were combined with Health Professional Shortage Area (HPSA) and rurality data to determine where graduates of closing programs are practicing and what types of counties they are serving. These maps show us that the loss of any one of these programs may have a significant impact on a state or region. There are two types of maps: point maps showing the location of each program's graduates and county-level maps showing the footprint of a program (those counties containing 70 percent of a program's graduates).

State Workforce Projections

Primary care physician (PCP) workforce shortages challenge the long-term viability of U.S. primary care. Studies of the future need for primary care providers indicate that demographic and policy trends will only strain a workforce already struggling to meet national needs. Other analyses document geographic maldistribution of PCPs, within states as well as across states. Addressing physician shortages and maldistribution requires analysis and action on the state level.

To this end, the Robert Graham Center expanded the approach used for national projections( to all 50 states. Specifically, using state and national data, we project to 2030 the state PCP workforce necessary to maintain current primary care utilization rates, accounting for increased demand due to aging, population growth, and an increasingly insured population due to the Affordable Care Act.

Learn about the methodology.(8 page PDF)

State Profiles: Potential Variation and Impact of Cuts in Medicare Payment

Since the advent of Sustainable Growth Rate (SGR) legislation in 1997, avoiding negative adjustments to Medicare payment rates has become an annual ritual of Congress and advocates alike, as each seeks to balance fiscal discipline against threats to health care access for millions of Americans. Even against this backdrop, Medicare payments and the access they support faced a unique challenge in the summer of 2008, in which several overlapping cuts were proposed. Most primary care physicians do not fully appreciate the extent to which these cuts could have affected or may again impact payment and access in their states.

You can access a state-specific guide to the Impact of Medicare cuts via the drop-down menu of states on this page. We analyzed the actual and proposed cuts from 2008 at a local level as a way to prepare physicians to understand the many ways in which future changes might affect their practice. The state profiles are associated with the article, “Threats to Medicare Physician Reimbursement and their Geographic Variation, 2008 and 2010” that is pending population.

The state profiles complement the study by providing local projections at-a-glance, but also offer a concise summary and review of the basics of Medicare payment and incentives. We encourage the use of these profiles for distribution to state physicians and leadership and hope that you will find it a useful advocacy tool in the current climate of health care reform.

Learn about the methodology.(2 page PDF)