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Health Professional Shortages Areas (HPSAs)

Almost 65 million Americans reside in federally designated health professional shortage areas (HPSAs) for primary care. These areas tend to be in remote rural towns and inner city urban areas. This is a crucial issue at this time because even if 32 million uninsured Americans, including 4.2 millions Californians, obtain insurance under Obamacare, millions will still have trouble accessing basic care because there are no primary care providers available in their area.

Over 6 million Californians, including 1.2 million in LA County, reside in such areas without basic access to primary care. Lack of access to basic care remains one of the most enduring and troublesome problems with the American health care system. No matter how many physicians this country educates or imports, these challenges remain because most doctors prefer to live and practice in "green leafy suburbs."

One way to provide medical care to people who lack access is to develop incentives to bring doctors into these areas, such as building community health centers and providing loan repayment programs, etc. To be eligible for such programs, an area must be designated as a HPSA for primary care. Despite more than 20,000 physicians in LA County, several communities, particularly those in South LA and the Northeast San Fernando Valley, have an insufficient supply of primary care providers even though their demographics suggests they should be eligible.  This is because the process required to obtain a the necessary data to submit an application can be arduous. As such, no report has been formally submitted to the government for recognition of these underserved areas.

During this summer fellowship you will work with Dr. Patrick Dowling, MD, MPH Chair of the Department of Family Medicine and Gerardo Moreno MD, MSPH, Assistant Professor of Family Medicine to compile and analyze data concerning the physician workforce supply in both LA County and other underserved areas within the state. This will serve as an excellent scholarly health services research and policy exercise to better understand the challenges in address the primary care physician shortage and the geographic mal-distribution of physicians in LA County and the state. It will also provide you with an introduction to health care policy, research, and strategies to get health care resources into an underserved community.

More information on the HPSA process can be found by searching "state of California shortage designation" and looking at the following sites:

The program consists of the following components:

  1. Collection and analysis of data on the physician workforce in LA County and California comparing it to the demographics of particular Medical Service Study Areas (MSSA). These represent groupings consisting of census tracks of 75,000 to 125,000 people. The state and feds use these datasets to determine physician workforce needs. Next, we will ascertain the ratio of full time equivalent (FTE) primary care doctors to the population and the percentage of time they spend treating patients that are either uninsured or on public insurance—Medicaid which is called Medi-Cal in California. The first part can be done on a laptop anywhere; the second component and the application submission process require a group effort, including a meeting on campus.
  2. Introduction to health services research methodologies to examine large primary care physician workforce research datasets.
  3. Journal club discussions. We will lead a weekly journal discussion group going over some key assigned articles.
  4. Lecture series will involve partnering with other summer project fellows and attending the following weekly Seminar Series:
    • Public Health Lecture Series: Nationally recognized researchers from UCLA and Drew University will discuss current issues we face in addressing health disparities, currently organized by Dr. Gilbert Granados.
    • Health Disparities Research lectures co-led by Dr. Michael Rodriguez in the Department of Family Medicine, which include, but are not limited to: methodology in data collection, analysis and interpretation for health care and community needs, and healthy policy assessment.
  5. Clinical exposure: You will have the opportunity work with Family Medicine residents and faculty in our two teaching family health centers, both of which are in designated shortage areas. Further, you will be introduced to the concept of the Patient Centered Medical Home (PCMH) which is a central tenet of health reform.
  6. The program follows the same guidelines as the Summer Research Fellowships:
    • 8 week commitment (June 09-July 31, 2014)
    • Participate in Josiah Brown Poster Fair on July 31, 2014
    • Application materials due March 21, 2014
    • Send completed aplications and questions/comments to Sun Ito.