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Health Professional Shortages Areas (HPSAs)

Are you a medical student hoping to:

  • Conduct high quality research on physician healthcare workforce and health disparities?
  • Gain exposure to community-based participatory research methods?
  • Work with UCLA physicians addressing workforce and health care disparities?
  • Collaborate on innovative, "real world," cutting-edge research to improve minority health?
  • Receive a stipend for you work?

Background:

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 million 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. Research project in one of the following areas       
  •  Characterization of HPSAs:  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.
  • Characterization of the relationships and associations between the primary care physician workforce and health care utilization, clinical outcomes, practice-based outcomes, and quality of care. Research that focuses on determining the predictors or factors that improve workforce outcomes as they relate to underserved areas are also exposed.
  • Other research topics related to physician workforce and health care equity or dispartilies are considered.

     2. Journal club discussions. We will lead a weekly journal discussion group going over key assigned articles.

     3. Lecture series co-led by Drs. Dowling and Moreno in the Department of Family Medicine.

  • Include an introduction to health services research methodologies commonly used to examine large primary care physician workforce research datasets.
  • Introduction to the collection and analysis of primary physician workforce data.
  • Discussion of healthcare equity and and disparities as they relate to physician workforce.
  • Implicators of workforce shortages and misdistribution on healthcare policy.

     4. Clinical exposure: You will Shadow 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.

     5. Community Volunteer experience: You will have the opportunity to participate in community service projects located in underserved communities in the San Fernando Valley.