Changing Health Professional Shortage Area Boundaries

FOR IMMEDIATE RELEASE: Thursday, May 1, 2014

Leslie Champlin
Senior Public Relations Strategist
(800) 274-2237, Ext. 5224 

WASHINGTON — The volatility of primary care Health Professional Shortage Area (HPSA) designations may be another variable that is hampering efforts to attract physicians to underserved areas, according to research by the Robert Graham Center for Policy Studies in Family Medicine and Primary Care.

The research, summarized in a one-pager, “The Changing Landscape of Primary Care Health Professional Shortage Areas and Their Influence on Physician Practice Location,” is published in the May 1 issue of American Family Physician.

Robert Graham Center researcher Sean Finnegan, MS, and his colleagues examined the HPSA status of primary care physicians whose practice locations remained the same between 2008 and 2013. They found that, of the 16,442 physicians who did not move their medical offices, 4,580, or nearly 28 percent, lost their designation as practicing in a primary care HPSA by 2013. Meanwhile, 3,232 physicians, or 21 percent, who had not been practicing in a HPSA in 2008 had gained a designation by 2013.

Medicare provides financial incentives to physicians who practice in underserved areas. Loss of designation as a HPSA means the loss of a 10 percent bonus payment for Medicare patients — a sometimes serious cut in underserved rural areas where family physicians are the only doctors in many communities and where Medicare patients comprise up to 80 percent of their patient population. 

“While HPSAs should be dynamic enough to acknowledge when physician movement has corrected a shortage, policymakers should also recognize and address how volatility in HPSA geographies may undermine physician incentives to practice in these locations and render such incentives ineffective,” Finnegan and his colleagues write. 

Most physicians practice in the same location for extended periods, sometimes for life. The study shows that those who specifically want to care for the underserved may not have a lifelong practice location, given the fluent nature of HPSA designations. 

“There’s been concern that HPSAs aren’t doing enough to encourage physicians to practice in designated areas,” Finnegan said. “We’re pointing out a reason why: HPSA designations are revisited every three years and therefore have the potential to change quite a bit. Physicians whose goal is to serve underserved populations and practice in designated HPSAs may have move frequently, and this is most likely not feasible.”


About the Robert Graham Center

The Robert Graham Center for Policy Studies in Family Medicine and Primary Care works to improve individual and population health by enhancing the delivery of primary care. The Center staff generates and analyzes evidence that brings a family medicine and primary care perspective to health policy deliberations at local, state, and national levels.

Founded in 1999, the Robert Graham Center is an independent research unit affiliated with the American Academy of Family Physicians (AAFP). The information and opinions contained in research from the Center do not necessarily reflect the views or policy of the AAFP.