Doctor Shortages and the ACA

This NY Times piece got folks talking about physician shortages and whether/how the ACA would make them worse. The ACA also contains many provisions related to addressing health workforce issues.

One such provision was contained in section 5602 that created a negotiated rulemaking committee to update the decades-old approach to identifying and responding to areas that are Health Professional Shortage Areas (HPSA) and Medically Underserved Areas (MUA). I served as a member of this committee that approved a recommendation for a revised method of identifying–and therefore allocating federal resources to address these issues–21-2. However, under the Negotiated Rulemaking Act of 1990 such committee recommendations have to be unanimous for their plans to be granted automatic status as an interim final rule.

Because our committee did not reach unanimous agreement, the Sec. of HHS is able to modify our recommendations in any way she sees fit and the federal rulemaking process is then followed. The point of negotiated rulemaking is to get parties that might disagree about contentious issues to hash out their differences, and if they can do so unanimously, then their agreement stands a very good chance of becoming the law of the land. Both the Clinton administration and the Bush II administrations attempted to change how HPSAs and MUAs are designated, but their plans ran aground during the rulemaking process, hence the attempt for negotiated rulemaking.

These designation methods make areas eligible for resources such as the National Health Service Corps and Medicare physician bonus payments (HPSA) and Community Health Centers (MUA/P).

The final report (10/31/11) of the committee contains a great deal of information about the definition and measurement of physician shortage and underservice. A new paper in HSR by Bob Phillips (also a member of the committee) and others gives more detail on some of the conceptual and analytical issues related to measuring these concepts in a definable unit of geography (the key is that a given supply has to be compared with needs of an area/population). Here is a 2007 paper that I did with colleagues at UNC that proposed a MUA designation method that is derivative of my dissertation research.

I am unsure when or if the Sec. of HHS will move ahead with this effort (I would guess the week after the election). While I think unanimity is an absurd standard for consensus, that was the standard, and our committees’ failure to reach a unanimous agreement is one the most disappointing professional experiences of my life, especially given that we met for over 30 days across 14 months.

About Don Taylor
Professor of Public Policy (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute), and Chair of the Academic Council at Duke University . I am one of the founding faculty of the Margolis Center for Health Policy. My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

One Response to Doctor Shortages and the ACA

  1. Pingback: Nurses, Primary Care & Shortage Designation « freeforall

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