[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 1140 Introduced in Senate (IS)]
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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 Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Ensuring Access to General Surgery
Act of 2023''.
SEC. 2. FINDINGS.
Congress finds the following:
(1) According to the Bureau of Health Workforce, the United
States faces a shortage of physicians.
(2) A 2016 study entitled ``Supply and Demand of General
Surgeons: Projections From 2014-2030'', prepared by the
University of North Carolina at Chapel Hill for the American
College of Surgeons, found that the supply of general surgeons
will grow slightly by 2030 but will not keep up with overall
growth in the United States population or demand for surgical
services.
(3) A 2021 report released by the Association of American
Medical Colleges projects shortages in all surgical specialties
of between 15,800 and 30,200 surgeons by 2034.
(4) A 2020 report prepared by the Health Resources and
Services Administration for the Committee on Appropriations of
the Senate found a maldistribution of general surgeons
nationwide, with rural areas having only 69 percent of the
general surgeons needed to meet demand for care.
(5) In order to accurately prepare for future physician
workforce demands, comprehensive, impartial research and high-
quality data are needed to inform dynamic projections of
physician workforce needs.
(6) A variety of factors, including health outcomes,
utilization trends, growing and aging populations, and delivery
system changes, influence workforce needs and should be
considered as part of flexible projections of workforce needs.
(7) Given the particularly acute needs in many rural and
other surgical workforce shortage areas, additional efforts to
assess the adequacy of the current general surgeon workforce
are necessary.
SEC. 3. STUDY ON DESIGNATION OF GENERAL SURGICAL HEALTH PROFESSIONAL
SHORTAGE AREAS.
Part D of title III of the Public Health Service Act (42 U.S.C.
254b et seq.) is amended by adding at the end the following:
``Subpart XIII--General Surgery Shortage Areas
``SEC. 340J. DESIGNATION OF GENERAL SURGERY SHORTAGE AREAS.
``(a) General Surgery Shortage Area Defined.--For purposes of this
section, the term `general surgery shortage area' means, with respect
to an urban, suburban, or rural area in the United States, an area that
has a population that is underserved by general surgeons.
``(b) Study and Report.--
``(1) Study.--The Secretary, acting through the
Administrator of the Health Resources and Services
Administration, shall conduct a study on the following matters
relating to access by underserved populations to general
surgeons:
``(A) Whether current shortage designations, such
as the designation of health professional shortage
areas under section 332, results in accurate
assessments of the adequacy of local general surgeons
to address the needs of underserved populations in
urban, suburban, or rural areas.
``(B) Whether another measure of access to general
surgeons by underserved populations, such as one based
on general surgeons practicing within hospital service
areas, would provide more accurate assessments of
shortages in the availability of local general surgeons
to meets the needs of those populations.
``(C) Potential methodologies for the designation
of general surgery shortage areas, including the
methodology described in paragraph (2).
``(2) Methodology for the designation of areas.--Among the
methodologies considered under paragraph (1)(C) for the
designation of general surgery shortage areas, the Secretary
shall analyze the effectiveness and accuracy of the following
methodology:
``(A) Development of surgery service areas.--
Development of surgery service areas through the
identification of hospitals with surgery services and
the identification of populations by ZIP Code areas
using Medicare patient origin data.
``(B) Identification of surgeons.--Identification
of all actively practicing general surgeons.
``(C) Surgeon to population ratios.--Development of
general surgeon-to-population ratios for each surgery
service area.
``(D) Thresholds.--
``(i) In general.--Determination of
threshold general surgeon-to-population ratios
for the number of general surgeons necessary to
treat a population for each of the following
levels:
``(I) Optimal supply of general
surgeons.
``(II) Adequate supply of general
surgeons.
``(III) Shortage of general
surgeons.
``(IV) Critical shortage of general
surgeons.
``(ii) Considerations.--In determining the
thresholds under clause (i), the Secretary
shall not assume that the current supply of
general surgeons nationwide is the optimal or
adequate level and shall consider additional
factors such as wait times, health outcomes,
ground transportation time to the nearest
health care center with a general surgeon,
critical access hospitals with surgical
capabilities but lacking a general surgeon, and
patient experience.
``(3) Report.--Not later than 1 year after the date of the
enactment of this subpart, the Secretary shall submit to
Congress a report on the study conducted under this subsection.
``(4) Consultation.--In conducting the study under
paragraph (1), the Secretary shall consult with relevant
stakeholders, including medical societies, organizations
representing surgical facilities, organizations with expertise
in general surgery, and organizations representing patients.
``(5) Publication of data.--The Secretary shall
periodically collect and publish in the Federal Register--
``(A) data comparing the availability and need of
general surgery services in urban, suburban, or rural
areas in the United States; and
``(B) if the Secretary designates one or more
general surgery shortage areas under subsection (c), a
list of the areas so designated.
``(c) Designation of General Surgery Shortage Areas.--
``(1) Methodology developed through regulation.--Based on
the findings of the report under subsection (b)(3), the
Secretary may establish, through notice and comment rulemaking,
a methodology for the designation of general surgery shortage
areas under this section.
``(2) Requirements.--If the Secretary elects to develop a
methodology under paragraph (1), the following shall apply:
``(A) Using the methodology established under
paragraph (1) and taking into consideration the data
referred to in subsection (b)(5), the Secretary shall--
``(i) designate general surgery shortage
areas in the United States;
``(ii) publish a descriptive list of the
areas; and
``(iii) review annually, and, as necessary,
revise such designations.
``(B) The Secretary shall follow similar procedures
with respect to notice to appropriate parties,
opportunities for comment, dissemination of
information, and reports to Congress in designating
general surgery shortage areas under this section as
those that apply to the designation of health
professional shortage areas under section 332.
``(C) In designating general surgery shortage areas
under this subsection, the Secretary shall consult with
relevant stakeholders, including medical societies,
organizations representing surgical facilities,
organizations with expertise in general surgery, and
organizations representing patients.''.
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