What This Bill Does
This bill asks the federal government to study how to identify areas where not enough general surgeons are available to serve the population. The bill then allows the government to create a system to officially designate these areas as "general surgery shortage areas." The goal is to better understand and address problems with surgeon availability, especially in rural parts of the country.
Who It Affects
The Health Resources and Services Administration (a federal agency that works on health workforce issues). Medical societies and organizations representing surgeons and surgical facilities. Patients living in areas with few available surgeons. Hospital systems and surgical facilities.
Key Provisions
* The federal government must conduct a study comparing current methods for identifying surgeon shortages and test whether measuring access through hospital service areas would work better (Sec. 340J(b)(1)).
* The study must examine a specific methodology that identifies hospitals offering surgery, uses Medicare patient data organized by ZIP Code areas, counts practicing surgeons, and creates surgeon-to-population ratios (Sec. 340J(b)(2)).
* The government must set threshold ratios to define four levels: optimal supply, adequate supply, shortage, and critical shortage of general surgeons (Sec. 340J(b)(2)(D)).
* The government must submit a report to Congress within one year of the law taking effect (Sec. 340J(b)(3)).
* The government may create official regulations designating general surgery shortage areas based on the study findings and must review these designations annually (Sec. 340J(c)).
What Changes
If this bill becomes law, the federal government will study how to better identify areas where there are not enough general surgeons. The government will regularly collect and publish data comparing surgeon availability across different areas. The government may then officially designate certain areas as "general surgery shortage areas." The government will consult with medical groups, surgeon organizations, surgical facilities, and patient groups throughout this process.
Important Definitions
General surgery shortage area: An urban, suburban, or rural area in the United States where the population does not have enough general surgeons to meet its needs (Sec. 340J(a)).
II
118TH CONGRESS
1ST SESSION
S. 1140
To amend the Public Health Service Act with respect to the designation
of general surgery shortage areas, and for other purposes.
IN THE SENATE OF THE UNITED STATES
MARCH 30, 2023
Mr. SCHATZ (for himself, Mr. BARRASSO, Ms. CANTWELL, Mr. MARSHALL,
and Ms. SINEMA) introduced the following bill; which was read twice and
referred to the Committee on Health, Education, Labor, and Pensions
A BILL
To amend the Public Health Service Act with respect to
the designation of general surgery shortage areas, and
for other purposes.
Be it enacted by the Senate and House of Representa-
1
tives of the United States of America in Congress assembled,
2
SECTION 1. SHORT TITLE.
3
This Act may be cited as the ‘‘Ensuring Access to
4
General Surgery Act of 2023’’.
5
SEC. 2. FINDINGS.
6
Congress finds the following:
7
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•S 1140 IS
(1) According to the Bureau of Health Work-
1
force, the United States faces a shortage of physi-
2
cians.
3
(2) A 2016 study entitled ‘‘Supply and Demand
4
of General Surgeons: Projections From 2014–2030’’,
5
prepared by the University of North Carolina at
6
Chapel Hill for the American College of Surgeons,
7
found that the supply of general surgeons will grow
8
slightly by 2030 but will not keep up with overall
9
growth in the United States population or demand
10
for surgical services.
11
(3) A 2021 report released by the Association
12
of American Medical Colleges projects shortages in
13
all surgical specialties of between 15,800 and 30,200
14
surgeons by 2034.
15
(4) A 2020 report prepared by the Health Re-
16
sources and Services Administration for the Com-
17
mittee on Appropriations of the Senate found a mal-
18
distribution of general surgeons nationwide, with
19
rural areas having only 69 percent of the general
20
surgeons needed to meet demand for care.
21
(5) In order to accurately prepare for future
22
physician workforce demands, comprehensive, impar-
23
tial research and high-quality data are needed to in-
24
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•S 1140 IS
form dynamic projections of physician workforce
1
needs.
2
(6) A variety of factors, including health out-
3
comes, utilization trends, growing and aging popu-
4
lations, and delivery system changes, influence work-
5
force needs and should be considered as part of
6
flexible projections of workforce needs.
7
(7) Given the particularly acute needs in many
8
rural and other surgical workforce shortage areas,
9
additional efforts to assess the adequacy of the cur-
10
rent general surgeon workforce are necessary.
11
SEC. 3. STUDY ON DESIGNATION OF GENERAL SURGICAL
12
HEALTH PROFESSIONAL SHORTAGE AREAS.
13
Part D of title III of the Public Health Service Act
14
(42 U.S.C. 254b et seq.) is amended by adding at the end
15
the following:
16
‘‘Subpart XIII—General Surgery Shortage Areas
17
‘‘SEC. 340J. DESIGNATION OF GENERAL SURGERY SHORT-
18
AGE AREAS.
19
‘‘(a) GENERAL SURGERY SHORTAGE AREA DE-
20
FINED.—For purposes of this section, the term ‘general
21
surgery shortage area’ means, with respect to an urban,
22
suburban, or rural area in the United States, an area that
23
has a population that is underserved by general surgeons.
24
‘‘(b) STUDY AND REPORT.—
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•S 1140 IS
‘‘(1) STUDY.—The Secretary, acting through
1
the Administrator of the Health Resources and Serv-
2
ices Administration, shall conduct a study on the fol-
3
lowing matters relating to access by underserved
4
populations to general surgeons:
5
‘‘(A) Whether current shortage designa-
6
tions, such as the designation of health profes-
7
sional shortage areas under section 332, results
8
in accurate assessments of the adequacy of local
9
general surgeons to address the needs of under-
10
served populations in urban, suburban, or rural
11
areas.
12
‘‘(B) Whether another measure of access
13
to general surgeons by underserved populations,
14
such as one based on general surgeons prac-
15
ticing within hospital service areas, would pro-
16
vide more accurate assessments of shortages in
17
the availability of local general surgeons to
18
meets the needs of those populations.
19
‘‘(C) Potential methodologies for the des-
20
ignation of general surgery shortage areas, in-
21
cluding the methodology described in paragraph
22
(2).
23
‘‘(2) METHODOLOGY FOR THE DESIGNATION OF
24
AREAS.—Among the methodologies considered under
25
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•S 1140 IS
paragraph (1)(C) for the designation of general sur-
1
gery shortage areas, the Secretary shall analyze the
2
effectiveness and accuracy of the following method-
3
ology:
4
‘‘(A) DEVELOPMENT OF SURGERY SERVICE
5
AREAS.—Development of surgery service areas
6
through the identification of hospitals with sur-
7
gery services and the identification of popu-
8
lations by ZIP Code areas using Medicare pa-
9
tient origin data.
10
‘‘(B) IDENTIFICATION
OF
SURGEONS.—
11
Identification of all actively practicing general
12
surgeons.
13
‘‘(C) SURGEON TO POPULATION RATIOS.—
14
Development of general surgeon-to-population
15
ratios for each surgery service area.
16
‘‘(D) THRESHOLDS.—
17
‘‘(i) IN GENERAL.—Determination of
18
threshold general surgeon-to-population ra-
19
tios for the number of general surgeons
20
necessary to treat a population for each of
21
the following levels:
22
‘‘(I) Optimal supply of general
23
surgeons.
24
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•S 1140 IS
‘‘(II) Adequate supply of general
1
surgeons.
2
‘‘(III) Shortage of general sur-
3
geons.
4
‘‘(IV) Critical shortage of general
5
surgeons.
6
‘‘(ii)
CONSIDERATIONS.—In
deter-
7
mining the thresholds under clause (i), the
8
Secretary shall not assume that the cur-
9
rent supply of general surgeons nationwide
10
is the optimal or adequate level and shall
11
consider additional factors such as wait
12
times, health outcomes, ground transpor-
13
tation time to the nearest health care cen-
14
ter with a general surgeon, critical access
15
hospitals with surgical capabilities but
16
lacking a general surgeon, and patient ex-
17
perience.
18
‘‘(3) REPORT.—Not later than 1 year after the
19
date of the enactment of this subpart, the Secretary
20
shall submit to Congress a report on the study con-
21
ducted under this subsection.
22
‘‘(4) CONSULTATION.—In conducting the study
23
under paragraph (1), the Secretary shall consult
24
with relevant stakeholders, including medical soci-
25
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•S 1140 IS
eties, organizations representing surgical facilities,
1
organizations with expertise in general surgery, and
2
organizations representing patients.
3
‘‘(5) PUBLICATION
OF
DATA.—The Secretary
4
shall periodically collect and publish in the Federal
5
Register—
6
‘‘(A) data comparing the availability and
7
need of general surgery services in urban, sub-
8
urban, or rural areas in the United States; and
9
‘‘(B) if the Secretary designates one or
10
more general surgery shortage areas under sub-
11
section (c), a list of the areas so designated.
12
‘‘(c) DESIGNATION OF GENERAL SURGERY SHORT-
13
AGE AREAS.—
14
‘‘(1) METHODOLOGY
DEVELOPED
THROUGH
15
REGULATION.—Based on the findings of the report
16
under subsection (b)(3), the Secretary may establish,
17
through notice and comment rulemaking, a method-
18
ology for the designation of general surgery shortage
19
areas under this section.
20
‘‘(2) REQUIREMENTS.—If the Secretary elects
21
to develop a methodology under paragraph (1), the
22
following shall apply:
23
‘‘(A) Using the methodology established
24
under paragraph (1) and taking into consider-
25
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•S 1140 IS
ation the data referred to in subsection (b)(5),
1
the Secretary shall—
2
‘‘(i) designate general surgery short-
3
age areas in the United States;
4
‘‘(ii) publish a descriptive list of the
5
areas; and
6
‘‘(iii) review annually, and, as nec-
7
essary, revise such designations.
8
‘‘(B) The Secretary shall follow similar
9
procedures with respect to notice to appropriate
10
parties, opportunities for comment, dissemina-
11
tion of information, and reports to Congress in
12
designating general surgery shortage areas
13
under this section as those that apply to the
14
designation of health professional shortage
15
areas under section 332.
16
‘‘(C) In designating general surgery short-
17
age areas under this subsection, the Secretary
18
shall consult with relevant stakeholders, includ-
19
ing medical societies, organizations representing
20
surgical facilities, organizations with expertise
21
in general surgery, and organizations rep-
22
resenting patients.’’.
23
Æ
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