REPORT OF COMMITTEE ON PHYSICIAN DISTRIBUTION AND HEALTH CARE ACCESS
PDHCA Report 2-A-06
Subject: Policy Review
Presented by: Lawrence M. Hanrahan, MD, MBA, Chair
Referred to: Reference Committee on Science and Education
House of Delegates policies included in the association's Policy Compendium are reviewed periodically for relevance and appropriateness. The following policy was reviewed by the Committee on Physician Distribution and Health Care Access on February 3. The committee's analysis and recommendation for retention are summarized below:
The following policy is recommended for retention as it remains current, valid, and relevant:
185.013 Health Professional Shortage and Medically Underserved Areas : Because the use of mid-level practitioners is expanding and the U.S. Department of Health and Human Services (HHS) does not count these practitioners toward calculation of full-time equivalent physician services, the Texas Medical Association supports the American Medical Association working with HHS and other appropriate agencies to revise the calculation so that availability of mid-level practitioners within rural and other underserved areas is appropriately documented and more accurately represents the degree of health care availability or shortage within a community (Amended Res. 28Z, p 217A, A-96).
Background
The federal Health Professional Shortage Area (HPSA) and Medically Underserved Area (MUA) designation programs focus on the ratio of primary care physicians in relation to the population as a measure of the degree of primary care health professional shortages or level of medical "underservice." The benchmarks used to determine shortages, however, have not been updated in 20+ years. At least two different updates have been proposed but were not implemented, leaving the original criteria in place.
HHS has expressed interest for some time in adding advanced practice nurses (APNs) and physician assistants (PAs) to the definition of primary care practitioners used to assess eligibility for HPSA/MUA designation. This probably contributed to initial adoption of TMA policy 185.013. Precedent has been set for this by HPSA criteria for shortages of mental health professionals. This category is defined to include psychiatrists and child psychiatrists, as well as clinical psychologists, clinical social workers, and psychiatric nurse specialists.
The committee supports the addition of APN and PA practitioners to the primary care HPSA/MUA eligibility criteria. In a previous committee study of counties without a full-time physician, it was found that most were served by rural health clinics staffed with APNs and PAs working through established protocols with physicians. The committee recommends retention of the above TMA policy.
Recommendation : Retain.
TMA House of Delegates: TexMed 2006