Bill Overview
Title: Physicians for Underserved Areas Act
Description: This bill modifies how a hospital's residency positions are redistributed after it closes for purposes of graduate medical education payments under Medicare. Under current law, if a hospital with an approved medical residency program closes, the Centers for Medicare & Medicaid Services (CMS) must redistribute the hospital's residency positions to other hospitals in the following order: (1) hospitals in the same core-based statistical area as the closed hospital, (2) hospitals in the same state as the closed hospital, (3) hospitals in the same region of the country as the closed hospital, and (4) other remaining hospitals. In order to receive the additional positions, hospitals must demonstrate a likelihood of filling the positions within three years. The bill removes the requirement that the CMS prioritize hospitals in the same region of the country as the closed hospital. It also requires hospitals to demonstrate a likelihood of (1) starting to use the positions within two years, and (2) filling the positions within five years.
Sponsors: Rep. Lee, Susie [D-NV-3]
Target Audience
Population: People dependent on healthcare services in underserved areas
Estimated Size: 60000000
- Medical residents will be directly affected as the redistribution of residency slots impacts their placement opportunities.
- Hospitals in underserved areas might be able to gain new residents, impacting medical service availability in those areas.
- Patients in underserved areas will be indirectly impacted as increased medical residency positions might improve healthcare access.
- Healthcare systems and administrators in both urban and rural areas will need to adapt to changes in residency allocations.
- Existing physicians and medical staff in rural hospitals will interact with more residents, potentially reducing their workloads and enhancing service delivery.
Reasoning
- Medical residents will be directly affected as the redistribution of residency slots impacts their placement opportunities.
- Residents' selection of hospitals will impact both urban and rural hospitals differently depending on changes in policy.
- Hospitals in underserved areas might be able to gain new residents, impacting medical service availability in those areas.
- Patients in underserved areas will indirectly benefit as medical residency positions increase, improving healthcare access.
- Healthcare systems and administrators across these areas will need to adapt to changes in residency allocations.
- Existing physicians and medical staff in rural hospitals interacting with more residents could see reduced workloads, enhancing service delivery.
Simulated Interviews
Medical Resident (Rural Missouri)
Age: 26 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 5.0 years
Commonness: 10/20
Statement of Opinion:
- The policy could provide more opportunities in rural settings which I am very much interested in.
- I feel it may make my residency journey smoother with more available slots closer to home.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 7 | 5 |
Physician (Southern Indiana)
Age: 40 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 8/20
Statement of Opinion:
- An increase in residency slots could help distribute workload better.
- More residents can significantly enhance our service capabilities.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 8 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 9 | 6 |
| Year 20 | 8 | 6 |
Hospital Administrator (Upstate New York)
Age: 52 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 5/20
Statement of Opinion:
- This policy could improve our staffing levels, aiding in patient service coverage.
- Concerns remain about meeting the benchmarks of the policy.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 8 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 6 | 5 |
Nurse (Central Idaho)
Age: 60 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 8.0 years
Commonness: 7/20
Statement of Opinion:
- Additional residents would support our team significantly.
- I am hopeful this policy will alleviate some of the work pressures we face.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 6 | 4 |
| Year 5 | 7 | 4 |
| Year 10 | 6 | 4 |
| Year 20 | 6 | 4 |
Medical Resident (New Mexico)
Age: 35 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 3.0 years
Commonness: 9/20
Statement of Opinion:
- This policy increases my prospects in terms of where I can train and serve.
- Provides hope for better placement options in underserved areas.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 7 | 6 |
| Year 10 | 7 | 6 |
| Year 20 | 6 | 6 |
Family Physician (Appalachian Ohio)
Age: 45 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 15.0 years
Commonness: 5/20
Statement of Opinion:
- Potentially having more residents could balance the patient load.
- Concerned about the practical integration of residents quickly and effectively.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 7 | 4 |
| Year 5 | 6 | 4 |
| Year 10 | 6 | 4 |
| Year 20 | 5 | 4 |
Patient (Rural Mississippi)
Age: 50 | Gender: female
Wellbeing Before Policy: 3
Duration of Impact: 10.0 years
Commonness: 12/20
Statement of Opinion:
- I hope more doctors will be available with this policy to improve my access to health services.
- Increased presence of medical residents might mean less travel to find specialized care.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 4 | 3 |
| Year 2 | 5 | 3 |
| Year 3 | 6 | 3 |
| Year 5 | 6 | 3 |
| Year 10 | 5 | 3 |
| Year 20 | 4 | 3 |
Medical Resident (Urban Alaska)
Age: 38 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 3.0 years
Commonness: 15/20
Statement of Opinion:
- Increasing opportunities in remote areas aligns with my career goals.
- It may facilitate better choices of placement for my remaining residency.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 5 | 5 |
| Year 10 | 5 | 5 |
| Year 20 | 5 | 5 |
Healthcare Policy Expert (Central Georgia)
Age: 47 | Gender: other
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 3/20
Statement of Opinion:
- This policy is a significant movement toward addressing regional healthcare disparities.
- Effective implementation depends on administrative coordination and resource support.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 8 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 7 | 6 |
Medical Student (South Texas)
Age: 24 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 5.0 years
Commonness: 10/20
Statement of Opinion:
- The policy will probably ease some competitive pressure around residency spots.
- Provides more options for me to consider areas I would love to serve in.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 8 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 7 | 6 |
| Year 10 | 7 | 6 |
| Year 20 | 7 | 6 |
Cost Estimates
Year 1: $8000000 (Low: $5000000, High: $12000000)
Year 2: $8000000 (Low: $5000000, High: $12000000)
Year 3: $8500000 (Low: $6000000, High: $13000000)
Year 5: $9000000 (Low: $7000000, High: $14000000)
Year 10: $10000000 (Low: $8000000, High: $16000000)
Year 100: $0 (Low: $0, High: $0)
Key Considerations
- Potential administrative burden on CMS with redistributing residency positions.
- The ability of hospitals to quickly integrate new residents into their systems and provide necessary training.
- Impact on rural and underserved communities that may experience improved healthcare services.
- Measuring the policy's effectiveness in filling medical residency slots quickly compared to previous requirements.