Assessing the Effect of Physician Scarcity Area on Physician Movement

Context: The U.S. federal government established many programs such as Health Professional Shortage Areas (HPSAs), Medically Underserved Area/Population (MUA/P), and Physician Scarcity Area (PSA) to ameliorate the geographic maldistribution of physician workforce and improve the public's access to quality health care. PSA was established in 2005 and died out in June 2008. It was created to induce physicians to practice in areas with the worst Medicare-to-physician ratios by paying a 5% Medicare payment bonus. There is a lack of study on the effect of PSA on physician choice of practice location.

Objective: This study examines the effect of PSA on physician movement pattern in the U.S.

Methods: Non-federal direct-patient care physicians practice locations are geocoded from American Medical Association (AMA) Master Files (2000 to 2008). Their locations are then linked to primary care PSA (data obtained from CMS, June, 2008), HPSA, MUA/P, and GPCI carrier localities. We track primary care physician (PCP) movement patterns into and out of PSAs over the years and compare the patterns before and after PSA establishment. We also examine the interaction effect between PSA and other factors such as HPSA, MUA/P, Geographic Practice Cost Index (GPCI), and rurality on physician movement pattern.

Results: Preliminary results show that on average 47% of PSA PCPs are located in rural areas; 60% of PSA PCPs are located in either HPSA or MUAP; and 91% of PSA PCPs are subject to GPCI floor. PSA PCPs over total PCPs increased from 8.93% in 2004 to 9.48% in 2008, which translates to a net gain of 2903 primary care physicians, with most increase occurred in 2008. Percent of rural PSA PCPs increased steadily from 47.13% in 2004 to 48.49% in 2008.

Conclusion: PSAs show small short term effect on physician movement to these areas. Further research is necessary to determine the long term effect of this incentive program. Federal policies tailored to create incentives for physician movements to underserved areas need better coordination.