According to a recent study conducted by Yale University, a federal program designed to attract physicians to medically underserved areas in the United States has fallen short of its intended goals. Not only has the program failed to reduce mortality rates in these regions, but it has also not succeeded in attracting enough physicians to address the healthcare disparities across the country. As a result, the researchers suggest that alternative approaches need to be explored to bridge the gap in healthcare access and improve outcomes for underserved communities.
The findings were published Nov. 6 in the journal Health Affairs.
Studies have consistently revealed that individuals have a tendency to seek medical care within their own communities. This can be attributed to the fact that the farther people have to travel to access healthcare, the less likely they are to actually do so. Consequently, the shortage of physicians – a problem that affects over 40 million Americans – exacerbates disparities in healthcare access. It has been observed that regions with a dearth of healthcare professionals generally exhibit higher mortality rates compared to areas that do not face this issue.
To tackle this issue, the U.S. government initiated the Health Professional Shortage Area (HPSA) program in 1965, aiming to entice physicians to work in regions that lack adequate healthcare providers. The program offers various incentives, including student loan forgiveness and higher Medicare reimbursement, to encourage doctors to practice in these underserved areas.
Though the HPSA program has existed for nearly 60 years, there is limited research on whether it has achieved its intended effect.
For the study, researchers compared health data from U.S. counties designated as HPSAs with similar counties that met the qualifications for HPSA status but, for a variety of reasons, were never classified as such.
“The way this program works is that state-level actors need to petition federal officials for the HPSA designation, which was an approach that made sense in 1965 when technology was different and local officials were in a better position to know what areas were in need,” said lead author Justin Markowski, a Ph.D. candidate at Yale School of Public Health. “However, because states engage with the HPSA process differently, there are counties that could be designated as HPSA but are not.”
This approach allowed the researchers to compare underserved counties that did and did not receive HPSA benefits and assess whether HPSA incentives were effective.
Their findings revealed that the program has not had much of an impact.
“Our study showed that the program has had little effect on underserved areas, yielding no significant changes in physician density or county-level mortality rates,” said Chima Ndumele, an associate professor of public health at Yale School of Public Health and faculty advisor on the project.
In fact, 73% of counties designated as HPSAs continued to experience physician shortages in the 10 years after their initial designation.
“The HPSA program has been great at identifying in-need counties, but not great at ameliorating that need,” said Markowski. “We’ve really not moved the needle on this.”
Additionally, the research indicates that enhancing the current incentives may not be the solution. Despite the government’s efforts to increase incentives for physicians to work in medically underserved areas, the study did not find any evidence of improvement in mortality rates or the number of physicians in these regions throughout the program’s duration.
As the researchers delve into potential solutions for the shortcomings of the current HPSA program, they put forward two innovative strategies. One of these strategies involves redirecting incentives towards fresh medical school graduates.
“We know that physicians and health care practitioners in general don’t really want to move once they’ve established their care. And when they do, they typically move out of HPSAs if they were originally in one,” said Markowski. “Attracting young providers before they establish practices somewhere else is one potential solution. We don’t know what goes into that decision-making process for young physicians, and that’s an avenue for new research.”
The other potential solution is for the United States to provide nurse practitioners and physician associates in underserved areas with a broader range of responsibilities and increased independence. This would empower these healthcare professionals to play a more significant role in addressing the healthcare disparities faced by these communities. By expanding their scope of practice and granting them more autonomy, we can leverage their skills and expertise to improve access to quality healthcare in areas that are currently underserved.
Ultimately, it’s about thinking outside the box, said Markowski.
“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.”