109 HR 5770 IH: United States Physician Shortage
U.S. House of Representatives
2006-07-12
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
1.This Act may be cited as the
United States Physician Shortage
Elimination Act of 2006
.
2.Congress finds the following:
(1)The average life
expectancy in the United States has increased to 80 years of age, causing an
ever-increasing demand for medical care.
(2)In 1975, United
States medical schools graduated approximately 12,716 physicians. Half of these
physicians entered programs of medical studies as graduates of United States
colleges and universities. The other half consisted of graduates of foreign
institutions admitted to United States medical schools under the J–1 Visa
Program.
(3)Presently, the
number of applicants, foreign and domestic, seeking admission to United States
medical schools has decreased to approximately 37,364.
(4)During the last 20
years, median tuition and fees at medical schools have increased by 745 percent
(270 percent adjusted for inflation) in private schools and by 876 percent (318
percent adjusted for inflation) in public schools.
(5)Physicians who
graduated from medical schools in the 1970’s will be leaving the profession
within the next 10 years, causing a decrease of 30 percent in the supply of
physicians, while the population will have increased by 24 percent.
(6)The Indiana State
Medical Licensing Board has estimated that in 20 years there will be 200,000
fewer physicians available to deliver medical services.
(7)In 2005, the
Council on Graduate Medical Education stated in a report to Congress that there
will be a shortage of not fewer than 90,000 full-time physicians by
2020.
(8)A
decrease in Federal spending to carry out programs authorized by title VII of
the Public Health Service Act threatens the viability of programs used to solve
the problem of inadequate access to health care.
(9)A
continuing decline in the number of family physicians may lead to renewed
shortages of safety net and rural physicians.
(10)There is a
declining ability to recruit qualified medical students from rural and
underserved areas, coupled with greater difficulty on the part of community
health centers and other clinics to attract adequate personnel.
3.National Health
Service Corps Medical School Scholarship Program
(a)Subpart III of
part D of title III of the Public Health Service Act (42 U.S.C. 254l et seq.)
is amended—
(1)in the heading by
inserting , Medical School
Scholarship Program,
after Scholarship Program
; and
(2)by inserting after
section 338A the following:
338A–1.National
Health Service Corps Medical School Scholarship Program
(a)
(1)The Secretary shall establish a program to be known as
the National Health Service Corps Medical School Scholarship Program (in this
subpart referred to as the Medical School Scholarship Program
to
ensure, with respect to the provision of primary health services, including
primary care, psychiatric care, and emergency medical services, pursuant to
section 331(a)(2), an adequate supply of physicians. The purpose of the program
is to train an additional 5000 medical students each year.
(2)Relationship to
National Health Service Corps Scholarship ProgramScholarships
provided under this section are intended to complement, and not take the place
of, scholarships provided to students enrolled in courses of study leading to a
degree in medicine or osteopathic medicine under the National Health Service
Corps Scholarship Program authorized by section 338A.
(b)To
be eligible to participate in the Medical School Scholarship Program, an
individual must—
(1)be accepted for
enrollment as a full-time student—
(A)in an accredited
(as determined by the Secretary) educational institution in a State; and
(B)in a course of
study, or program, offered by such institution leading to a degree in medicine
or osteopathic medicine;
(2)be eligible for,
or hold, an appointment as a commissioned officer in the Regular or Reserve
Corps of the Service or be eligible for selection for civilian service in the
Corps;
(3)submit an
application to participate in the Medical School Scholarship Program;
and
(4)sign and submit to
the Secretary, at the time of submittal of such application, a written contract
(described in subsection (f)) to accept payment of a scholarship and to serve
(in accordance with this subpart) for the applicable period of obligated
service in a health professional shortage area.
(c)Application,
contract, and information requirements
(1)In disseminating
application forms and contract forms to individuals desiring to participate in
the Medical School Scholarship Program, the Secretary shall include with such
forms—
(A)a fair summary of the rights and
liabilities of an individual whose application is approved (and whose contract
is accepted) by the Secretary, including in the summary a clear explanation of
the damages to which the United States is entitled under section 338E in the
case of the individual's breach of the contract; and
(B)information respecting meeting a service
obligation through private practice under an agreement under section 338D and
such other information as may be necessary for the individual to understand the
individual's prospective participation in the Medical School Scholarship
Program and service in the Corps, including a statement of all factors
considered in approving applications for participation in the Program and in
making assignments for participants in the Program.
(2)Understandability
and clarityThe application form, contract form, and all other
information furnished by the Secretary under this subpart shall be written in a
manner calculated to be understood by the average individual applying to
participate in the Medical School Scholarship Program.
(3)The
Secretary shall make such application forms, contract forms, and other
information available to individuals desiring to participate in the Medical
School Scholarship Program on a date sufficiently early to ensure that such
individuals have adequate time to carefully review and evaluate such forms and
information.
(4)Recruitment and
retention
(A)Distribution of
materialsThe Secretary shall
distribute to schools of medicine, schools of osteopathic medicine, and medical
organizations participating in a medical pipeline program described in section
749 materials providing information on the Medical School Scholarship Program
and shall encourage the schools and organizations to disseminate the materials
to students of the schools and students being recruited through the medical
pipeline program.
(B)Retention of
health professionals in shortage areas
(i)Health
professionals nearing completion of obligated serviceIn the case
of any health professional whose period of obligated service under the Medical
School Scholarship Program is nearing completion, the Secretary shall encourage
the individual to remain in a health professional shortage area and to continue
providing primary health services.
(ii)Health
professionals making a transition to private practiceDuring the
period in which a health professional is planning and making the transition to
private practice from obligated service under the Medical School Scholarship
Program, the Secretary may provide assistance to the professional regarding
such transition if the professional is remaining in a health professional
shortage area and is continuing to provide primary health services.
(C)Options to
encourage health professionals to remain in health professional shortage
areasIn the case of entities to which participants in the
Medical School Scholarship Program are assigned under section 333, the
Secretary shall encourage the entities to provide options with respect to
assisting the participants in remaining in the health professional shortage
areas involved, and in continuing to provide primary health services, after the
period of obligated service under the Medical School Scholarship Program is
completed. The options with respect to which the Secretary provides such
encouragement may include options regarding the sharing of a single employment
position in the health professions by 2 or more health professionals, and
options regarding the recruitment of couples where both of the individuals are
health professionals.
(d)Considerations
in providing contracts
(1)Subject to section 333A, in providing
contracts under the Medical School Scholarship Program, the Secretary—
(A)shall consider—
(i)the extent of the
demonstrated interest of the applicants for the contracts in providing primary
health services; and
(ii)the extent of the
demonstrated interest of the applicants for the contracts in working with
underserved communities; and
(B)may consider such other factors regarding
the applicants as the Secretary determines to be relevant to selecting
qualified individuals to participate in such Program.
(2)In providing contracts under the Medical School
Scholarship Program, the Secretary shall give highest priority to any
application for such a contract submitted by an individual who has been
recruited and admitted to a medical school through a medical pipeline program
described in section 749.
(3)In providing
contracts under the Medical School Scholarship Program, the Secretary shall
give second-highest priority—
(A)to any application for such a contract
submitted by an individual who has (and whose spouse, if any, has)
characteristics that increase the probability that the individual will continue
to serve in a health professional shortage area after the period of obligated
service pursuant to subsection (f) is completed; and
(B)subject to
subparagraph (A), to any application for such a contract submitted by an
individual who is from a disadvantaged background and who would otherwise be
unable to afford a medical school education.
(e)
(1)Approval of
participationAn individual becomes a participant in the Medical
School Scholarship Program only upon the Secretary’s approval of the
individual’s application submitted under subsection (b)(3) and the Secretary’s
acceptance of the contract submitted by the individual under subsection
(b)(4).
(2)The Secretary shall provide written notice to an
individual promptly upon the Secretary’s approving, under paragraph (1), of the
individual’s participation in the Medical School Scholarship Program.
(f)The written
contract (referred to in this subpart) between the Secretary and an individual
shall contain—
(1)an agreement
that—
(A)subject to paragraph (2), the Secretary
agrees—
(i)to
provide the individual with a scholarship (described in subsection (g)) during
the entire period in which the individual is pursuing a course of study
described in subsection (b)(1)(B), with such period not to exceed 5 years;
and
(ii)to accept
(subject to the availability of appropriated funds for carrying out sections
331 through 335 and section 337) the individual into the Corps (or for
equivalent service as otherwise provided in this subpart); and
(B)subject to
paragraph (2), the individual agrees—
(i)to accept provision of such a scholarship
to the individual;
(ii)to maintain enrollment in a course of study
described in subsection (b)(1)(B) until the individual completes the course of
study;
(iii)while enrolled
in such course of study, to maintain an acceptable level of academic standing
(as determined under regulations of the Secretary by the educational
institution offering such course of study);
(iv)to complete a residency in a specialty that
the Secretary determines is consistent with the needs of the Corps, except that
the Secretary shall not determine the location of the residency training;
and
(v)to serve for a time period (hereinafter in
the subpart referred to as the period of obligated service
)
equal to 6 years, as a provider of primary health services in a health
professional shortage area (designated under section 332) to which the
individual is assigned by the Secretary as a member of the Corps, or as
otherwise provided in this subpart;
(2)a provision that any financial obligation
of the United States arising out of a contract entered into under this subpart
and any obligation of the individual which is conditioned thereon, is
contingent upon funds being appropriated for scholarships under this subpart
and to carry out the purposes of sections 331 through 335 and sections 337 and
338;
(3)a statement of the damages to which the
United States is entitled, under section 338E for the individual's breach of
the contract; and
(4)such other statements of the rights and
liabilities of the Secretary and of the individual, not inconsistent with the
provisions of this subpart.
(g)
(1)A scholarship
provided to a student for a school year under a written contract under the
Medical School Scholarship Program shall consist of—
(A)payment to, or (in accordance with
paragraph (2)) on behalf of, the student of the amount (except as provided in
section 711) of—
(i)the tuition of the student in such school
year; and
(ii)all other reasonable educational expenses,
including fees, books, and laboratory expenses, incurred by the student in such
school year; and
(B)payment to the
student of a stipend of—
(i)$2500 per month
(adjusted in accordance with paragraph (3)) for each of the 12 consecutive
months beginning with the first month of such school year during the first and
second school years of the program of study leading to a degree in medicine or
osteopathic medicine; and
(ii)$3000 per month
(adjusted in accordance with paragraph (3)) for each of the 12 consecutive
months beginning with the first month of such school year during each
subsequent school year of the program of study leading to a degree in medicine
or osteopathic medicine.
(2)Contracts with
schools of medicine and schools of osteopathic medicineThe Secretary may contract with a school of
medicine or school of osteopathic medicine, in which a participant in the
Medical School Scholarship Program is enrolled, for the payment to the school
of the amounts of tuition and other reasonable educational expenses described
in paragraph (1)(A). Payment to such a school may be made without regard to
section 3648 of the Revised Statutes (31 U.S.C. 529).
(3)Adjustment of
monthly stipendThe amount of
the monthly stipend, specified in paragraph (1)(B) and as previously adjusted
(if at all) in accordance with this paragraph, shall be increased by the
Secretary for each school year ending in a fiscal year beginning after
September 30, 2010, by an amount (rounded to the next highest multiple of $1)
equal to the amount of such stipend multiplied by the overall percentage (under
section 5303 of title 5, United States Code) of the adjustment (if such
adjustment is an increase) in the rates of pay under the General Schedule made
effective in the fiscal year in which such school year ends.
(h)Notwithstanding any
other provision of law, individuals who have entered into written contracts
with the Secretary under this section, while undergoing academic training,
shall not be counted against any employment ceiling affecting the
Department.
(i)Authorization of
appropriationsThere is authorized to be appropriated
$425,000,000 for fiscal year 2007 and such sums as may be necessary in each
fiscal year thereafter to carry out this
section.
.
(b)Section 338C of such Act (42 U.S.C. 254m) is
amended—
(1)in subsection (a)
by striking 338A
and inserting 338A,
338A–1,
;
(2)in subsection
(b)(1) by striking 338A(f)(1)(B)(v)
and inserting
338A(f)(1)(B)(v), 338A–1(f)(1)(B)(v),
; and
(3)in
subsection (b)(5)(A) by striking the Scholarship Program
and
inserting the Scholarship Program and the Medical School Scholarship
Program
.
(c)Section 338D of such Act (42 U.S.C. 254n) is
amended—
(1)in subsection
(a)(1) by striking the Scholarship Program
and inserting
the Scholarship Program or the Medical School Scholarship
Program
; and
(2)in subsection (c)
by striking 338A
and inserting 338A,
338A–1,
.
(d)Breach of
scholarship contractSection 338E of such Act (42 U.S.C. 254o) is
amended—
(1)by striking
338A
each place it appears and inserting 338A or
338A–1
;
(2)by
striking the Scholarship Program
each place it appears and
inserting the Scholarship Program or the Medical School Scholarship
Program
;
(3)in subsection
(b)(1)(A) by striking 338A(f)(1)(B)(iv)
and inserting
338A(f)(1)(B)(iv) or 338A–1(f)(1)(B)(iv)
;
(4)in subsection
(b)(3)(B) by striking 338A(g)
and inserting 338A(g) or
338A–1(g)
; and
(5)in subsection
(d)(3)(B)(i) by striking the Scholarship or Loan Repayment Program (or
contract thereunder)
and inserting the Scholarship Program, the
Medical School Scholarship Program, or the Loan Repayment Program (or a
contract under any of such programs)
.
(e)Fund regarding
use of amounts recovered for contract breach to replace services lost as result
of breachSection 338F of such Act (42 U.S.C. 254o–1) is amended
by striking 338A
each place it appears and inserting
338A, 338A–1,
.
4.Grants to
increase the number of available slots for newly admitted medical students and
to increase participation in the National Health Service Corps Medical School
Scholarship ProgramPart C of
title VII of the Public Health Service Act (42 U.S.C. 293k et seq.) is amended
by adding at the end the following:
749.Grants to
increase the number of available slots for newly admitted medical students and
to increase participation in the National Health Service Corps Medical School
Scholarship Program
(a)Grants to medical
schools
(1)The Secretary may make grants to medical schools for
the following purposes:
(A)To increase the
capacity of the recipient medical school to accept additional medical students
each year.
(B)To develop
curriculum.
(C)To acquire
equipment.
(D)To recruit, train,
and retain faculty.
(E)To provide
assistance to students who have completed a course of study at the recipient
medical school during the period in which such students are completing a
residency program affiliated with the recipient medical school.
(2)A
medical school seeking a grant under this subsection shall submit an
application to the Secretary at such time, in such manner, and containing such
information as the Secretary may require.
(3)Priority for
additional slotsPriority for additional slots made available
using funds from a grant awarded under this subsection shall be given to
students who have been recruited by the recipient medical school through a
medical school pipeline program described in subsection (b)(2).
(b)Grants to
medical organizations
(1)The Secretary may make grants to eligible medical
organizations for the following purposes:
(A)To recruit
students to participate in the National Health Service Corps Medical School
Scholarship Program authorized by section 338A–1 (in this section referred to
as the Medical School Scholarship Program
).
(B)To participate in
a medical school pipeline program described in paragraph (2).
(2)Medical school
pipeline programA medical school pipeline program is a program
to target minority students to increase the number of minority health
professionals serving medically underserved communities through activities
including tutoring, course development, and other student support designed to
recruit students from middle schools, high schools, and universities to
participate in the Medical School Scholarship Program.
(3)The Secretary shall determine the amount of a grant based
on factors including the cost of living and health care needs of the State for
which students are recruited.
(4)A
medical organization seeking a grant under this subsection shall submit an
application to the Secretary at such time, in such manner, and containing such
information as the Secretary may require, including—
(A)a description of
how the organization will carry out the purposes described in subsection
(b)(1);
(B)a description of
goals and objectives with respect to—
(i)the intended
number of students to be accepted and graduated from medical schools each year
under the grant program established under this subsection;
(ii)the intended
number of newly graduated students who will serve in medically underserved
communities; and
(iii)the intended
number of individuals in medically underserved communities who will have access
to primary care physicians as a result of the increase in graduating physicians
under the grant program; and
(C)information
regarding the anticipated number of Medical School Scholarship students the
organization seeks to recruit.
(5)
(A)A recipient of a grant under this subsection shall
submit to the Secretary at the end of each fiscal year in which a grant is
received, a report containing the following:
(i)The amount of the
grant received under this subsection.
(ii)An expense report
detailing the use of amounts from a grant under this subsection.
(iii)A description of
the results of the use of amounts from a grant under this subsection.
(B)At
the end of each fiscal year in which grants under this subsection are made, the
Secretary shall compile and submit to Congress the information received under
paragraph (5)(A).
(c)In
this section, the following definitions apply:
(1)The term medical school means a school of
medicine or a school of osteopathic medicine.
(2)Medical School
Scholarship studentThe term
Medical School Scholarship Student means a student who is a
recipient of a scholarship under the Health Service Corps Medical School
Scholarship Program authorized by section 338A–1.
(3)The term
medical organization
means a national, State, local, or
community-based public or nonprofit private organization having as its mission
the goal of identifying and recruiting minority students for health
professions.
(d)Authorization of
appropriationsThere is authorized to be appropriated—
(1)$500,000,000 for
fiscal year 2007 and such sums as may be necessary in each fiscal year
thereafter to carry out subsection (a); and
(2)$35,000,000 for
fiscal year 2007 and such sums as may be necessary in each fiscal year
thereafter to carry out subsection
(b).
.
5.Expansion of
residency programs and primary care services offered by community health
centersPart C of title VII of
the Public Health Service Act (42 U.S.C. 293k et seq.) is amended by adding
after section 749 the following:
749A.Grants to
establish medical residency programs at community health centers
(a)The Secretary may make grants to community health
centers to establish, at the centers, new or alternative-campus accredited
medical residency programs affiliated with accredited medical programs.
(b)Amounts from a grant under this section shall be used to
cover the costs of establishing the medical residency program described in
subsection (a), including costs associated with—
(1)curriculum
development;
(2)equipment
acquisition; and
(3)recruitment,
training, and retention of residents and faculty.
(c)A
community health center seeking a grant under this section shall submit an
application to the Secretary at such time, in such manner, and containing such
information as the Secretary may require.
(d)In reviewing applications submitted under subsection
(c), and in selecting recipients for a grant under this section, the Secretary
shall give preference to funding medical residency programs focusing on
providing training in primary care, psychiatric care, and emergency care
medicine.
(e)In
this section, the following definitions apply:
(1)The term accredited, as
applied to a new or alternative-campus medical residency program, means a
program that is accredited by a recognized body or bodies approved for such
purpose by the Accreditation Council for Graduate Medical Education, except
that a new medical residency program that, by reason of an insufficient period
of operation, is not eligible for accreditation on or before the date of
submission of an application under subsection (c) shall be deemed accredited if
the Accreditation Council for Graduate Medical Education finds, after
consultation with the appropriate accreditation body or bodies, that there is
reasonable assurance that the program will meet the accreditation standards of
such body or bodies prior to the date of graduation of the first entering class
in that program.
(2)The term community health center means a
health center as defined in section 330.
(3)The term medical program means a program in
medicine or a program in osteopathic medicine.
749B.Grants to
improve delivery of primary care services in community health centers
(a)Primary care
access grants
(1)The Secretary, acting through the Administrator of the
Health Resources and Services Administration, may make grants to community
health centers for the purpose of increasing the number of medical service
providers associated with such centers.
(2)A
recipient of a grant under this subsection shall be eligible to receive such
grants for five fiscal years.
(3)A recipient of a grant under this subsection shall use
amounts from the grant for one or more of the following activities:
(A)To recruit
residents for medical residency programs at community health centers from among
students who are recipients of a scholarship under the National Health Service
Corps Medical School Scholarship Program authorized by section 338A–1.
(B)To establish a
multi-community physician mentoring program to encourage upper level residents
to remain in the State in which the community health center and medical
residency program are located.
(C)To enter into
contracts for technical assistance for the purpose of recruiting or retaining
primary care staff.
(D)To enter into
contracts for technical assistance in preparing contracts with local providers
of primary health care to provide services for medically underserved
communities.
(4)A
community health center seeking a grant under this subsection shall submit an
application to the Secretary at such time, in such manner, and containing such
information as the Secretary may require.
(b)Grants for
primary care facility capital expenditures
(1)The Secretary, acting through the Administrator, may
make grants to community health centers for the purpose of increasing primary
care capabilities through the construction, expansion, or renovation of
facilities.
(2)A
recipient of a grant under this subsection shall be eligible to receive such
grants for 5 fiscal years.
(3)A recipient of a grant under this subsection shall use
amounts from the grant for one or more of the following activities:
(A)To acquire or
lease facilities.
(B)To construct new
facilities.
(C)To repair or
modernize existing facilities.
(D)To purchase or
lease medical equipment.
(c)In
this section, the following definitions apply:
(1)The term community health center means a
health center as defined in section 330.
(2)The term medical school means a school of
medicine or a school of osteopathic medicine.
749C.Authorization
of appropriations to assist community health centersThere is authorized to be appropriated
$200,000,000 for fiscal year 2007 and such sums as may be necessary for each
fiscal year thereafter to carry out sections 749A and
749B.
.