II 

110TH CONGRESS 

1ST SESSION S. 896 

To amend the Public Health Service Act and the Social Security Act to 

increase the number of primary care physicians and medical residents 

serving health professional shortage areas, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

MARCH 15, 2007 

Ms. MURKOWSKI (for herself, Mr. SCHUMER, Mr. STEVENS, and Mr. SANDERS) introduced the following bill; which was read twice and referred to 

the Committee on Health, Education, Labor, and Pensions 

A BILL 

To amend the Public Health Service Act and the Social 

Security Act to increase the number of primary care 

physicians and medical residents serving health professional shortage areas, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Physician Shortage 

5 Elimination Act of 2007’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 


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1 (1) The average life expectancy in the United 

2 States has increased to 80 years of age, causing an 

3 ever-increasing demand for medical care. 

4 (2) Medical school enrollment numbers have 

5 been virtually stagnant for the last 25 years. 

6 (3) During the last 20 years, median tuition 

7 and fees at medical schools have increased by 229 

8 percent (122 percent adjusted for inflation) in pri9 vate schools and by 479 percent (256 percent ad10 justed for inflation) in public schools. 

11 (4) The Association of American Medical Col12 leges, in its Statement on the Physician Workforce, 

13 dated June, 2006, called for an increase of 1,500 

14 National Health Service Corps program awards per 

15 year to help meet the need for physicians caring for 

16 underserved populations and to help address rising 

17 medical student indebtedness. 

18 (5) The National Health Service Corps program 

19 has a proven record of supplying physicians to un20 derserved areas, and has played an important role in 

21 expanding access for underserved populations in 

22 rural and inner city communities. 

23 (6) Continued expansion of the National Health 

24 Service Corps program is strongly recommended. 


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1 (7) The growing debt incurred by graduating 

2 medical students is likely to increase the interest 

3 and willingness of graduates of United States med4 ical schools to apply for National Health Service 

5 Corps program funding and awards. 

6 (8) One-third (250,000) of active physicians are 

7 over the age of 55 and are likely to retire in the next 

8 ten years, while the population will have increased 

9 by 24 percent. These demographic changes will 

10 cause the population-to-physician ratio to peak by 

11 the year 2020. 

12 (9) In 2005, the Council on Graduate Medical 

13 Education stated in a report to Congress that there 

14 will be a shortage of not fewer than 90,000 full-time 

15 physicians by 2020. 

16 (10) A decrease in Federal spending to carry 

17 out programs authorized by title VII of the Public 

18 Health Service Act threatens the viability of pro19 grams used to solve the problem of inadequate ac20 cess to health care. 

21 (11) A continuing decline in the number of pri22 mary care physicians will lead to increased shortages 

23 of health care access in rural America. 

24 (12) There is a declining ability to recruit 

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1 served areas, coupled with greater difficulty on the 

2 part of community health centers and other clinics 

3 to attract adequate personnel. 

4 (13) Individuals in many geographic areas, es5 pecially rural areas, lack adequate access to high 

6 quality preventive, primary and specialty health care, 

7 contributing to significant health disparities that im8 pair America’s public health and economic produc9 tivity. 

10 (14) Barriers to adequate access most acutely 

11 affect community-based health care safety-net pro12 viders, including Community and Migrant Health 

13 Centers, Native American health centers, Rural 

14 Health Clinics, Critical Access Hospitals, public 

15 health departments, and their patients. 

16 (15) Area Health Education Centers and 

17 Health Education Training Centers provide a na18 tional network of community-based and governed en19 tities, linked to community resources and academic 

20 centers, that provide an infrastructure to facilitate 

21 and implement partnerships and programs that suc22 cessfully address each of these barriers, respond to 

23 the health needs of underserved communities and 

24 populations, and use educational interventions to re25 duce health disparities. 


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1 (16) A collaborative process is needed between 

2 hospitals and non-hospital settings to maximize the 

3 potential of non-hospital health care training. 

4 SEC. 3. AMENDMENTS TO THE PUBLIC HEALTH SERVICE 

5 ACT. 

6 (a) REAUTHORIZATION OF NATIONAL HEALTH

7 SERVICE CORPS SCHOLARSHIP PROGRAM AND LOAN RE8 PAYMENT PROGRAM.— 

9 (1) REAUTHORIZATION OF APPROPRIATIONS.— 

10 Section 338H(a) of the Public Health Service Act 

11 (42 U.S.C. 254q(a)) is amended by striking 

12 ‘‘$146,250,000’’ and all that follows through the pe13 riod and inserting ‘‘$300,000,000 for each of fiscal 

14 years 2008 through 2012.’’. 

15 (2) SCHOLARSHIPS FOR MEDICAL STUDENTS.— 

16 Section 338H of such Act is further amended by 

17 adding at the end the following: 

18 ‘‘(d) SCHOLARSHIPS FOR MEDICAL STUDENTS.—For 

19 contracts for scholarships under this subpart to individ20 uals who are accepted for enrollment, or enrolled, in a 

21 course of study or program described in section 

22 338A(b)(1)(B) that leads to a degree in medicine or osteo23 pathic medicine, the Secretary shall, of the amounts ap24 propriated under subsection (a) for a fiscal year, obligate 


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1 the greater of 10 percent or such amount as necessary 

2 to fund ongoing activities related to such contracts.’’. 

3 (b) REAUTHORIZATION OF CERTAIN PROGRAMS PRO4 VIDING GRANTS FOR HEALTH PROFESSIONS TRAINING

5 FOR DIVERSITY.— 

6 (1) GRANTS FOR CENTERS OF EXCELLENCE.— 

7 Section 736(h)(1) of the Public Health Service Act 

8 (42 U.S.C. 293(h)(1)) is amended by striking 

9 ‘‘$26,000,000’’ and all that follows through ‘‘2002’’ 

10 and inserting ‘‘$33,610,000 for each of fiscal years 

11 2008 through 2012’’. 

12 (2) EDUCATIONAL ASSISTANCE FOR INDIVID13 UALS FROM DISADVANTAGED BACKGROUNDS.—Sec14 tion 740(c) of such Act (42 U.S.C. 293d(c)) is 

15 amended by striking ‘‘$29,400,000’’ and all that fol16 lows through the period and inserting ‘‘$35,650,000 

17 for each of fiscal years 2008 through 2012.’’. 

18 (c) EXPANSION OF RESIDENCY TRAINING PROGRAMS

19 AND PRIMARY CARE SERVICES OFFERED BY COMMUNITY

20 HEALTH CENTERS.—Part C of title VII of the Public 

21 Health Service Act (42 U.S.C. 293k et seq.) is amended— 

22 (1) by adding before section 747 the following: 

23 ‘‘Subpart I—In General’’; and 

24 (2) by adding after section 748 the following: 


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1 ‘‘Subpart II—Additional Programs 

2 ‘‘SEC. 749. GRANTS TO EXPAND MEDICAL RESIDENCY 

3 TRAINING PROGRAMS AT COMMUNITY 

4 HEALTH CENTERS. 

5 ‘‘(a) PROGRAM AUTHORIZED.—The Secretary may 

6 make grants to community health centers— 

7 ‘‘(1) to establish, at the centers, new or alter8 native-campus accredited medical residency training 

9 programs affiliated with a hospital or other health 

10 care facility; or 

11 ‘‘(2) to fund new residency positions within ex12 isting accredited medical residency training pro13 grams at the centers and their affiliated partners. 

14 ‘‘(b) USE OF FUNDS.—Amounts from a grant under 

15 this section shall be used to cover the costs of establishing 

16 or expanding a medical residency training program de17 scribed in subsection (a), including costs associated with— 

18 ‘‘(1) curriculum development; 

19 ‘‘(2) equipment acquisition; 

20 ‘‘(3) recruitment, training, and retention of 

21 residents and faculty; and 

22 ‘‘(4) residency stipends. 

23 ‘‘(c) APPLICATIONS.—A community health center 

24 seeking a grant under this section shall submit an applica25 tion to the Secretary at such time, in such manner, and 

26 containing such information as the Secretary may require. 


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1 ‘‘(d) PREFERENCE.—In selecting recipients for a 

2 grant under this section, the Secretary shall give pref3 erence to funding medical residency training programs fo4 cusing on primary health care. 

5 ‘‘(e) DEFINITION.—In this section: 

6 ‘‘(1) The term ‘accredited’, as applied to a new 

7 or alternative-campus medical residency training 

8 program, means a program that is accredited by a 

9 recognized body or bodies approved for such purpose 

10 by the Accreditation Council for Graduate Medical 

11 Education, except that a new medical residency 

12 training program that, by reason of an insufficient 

13 period of operation, is not eligible for accreditation 

14 on or before the date of submission of an application 

15 under subsection (c) shall be deemed accredited if 

16 the Accreditation Council for Graduate Medical 

17 Education finds, after consultation with the appro18 priate accreditation body or bodies, that there is rea19 sonable assurance that the program will meet the ac20 creditation standards of such body or bodies prior to 

21 the date of graduation of the first entering class in 

22 that program. 

23 ‘‘(2) The term ‘community health center’ means 

24 a health center as defined in section 330. 


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1 ‘‘SEC. 749A. GRANTS TO IMPROVE DELIVERY OF PRIMARY 

2 CARE SERVICES IN COMMUNITY HEALTH 

3 CENTERS. 

4 ‘‘(a) PRIMARY CARE ACCESS GRANTS.— 

5 ‘‘(1) PROGRAM AUTHORIZED.—The Secretary, 

6 acting through the Administrator of the Health Re7 sources and Services Administration, may make 

8 grants to community health centers for the purpose 

9 of increasing the number of medical service pro10 viders associated with such centers. 

11 ‘‘(2) GRANTS.—A recipient of a grant under 

12 this subsection shall be eligible to receive such 

13 grants for a total of 5 fiscal years. 

14 ‘‘(3) USE OF FUNDS.—A recipient of a grant 

15 under this subsection shall use amounts from the 

16 grant for one or more of the following activities: 

17 ‘‘(A) To recruit residents for medical resi18 dency training programs at the community 

19 health center. 

20 ‘‘(B) To establish a multi-community phy21 sician mentoring program to encourage upper 

22 level residents to remain in the State in which 

23 the community health center and medical resi24 dency training program are located. 


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1 ‘‘(C) To enter into contracts for technical 

2 assistance for the purpose of recruiting or re3 taining primary health care staff. 

4 ‘‘(D) To enter into contracts for technical 

5 assistance in preparing contracts with local pro6 viders of primary health care to provide services 

7 for medically underserved communities. 

8 ‘‘(4) APPLICATION.—A community health cen9 ter seeking a grant under this subsection shall sub10 mit an application to the Secretary at such time, in 

11 such manner, and containing such information as 

12 the Secretary may require. 

13 ‘‘(b) GRANTS FOR PRIMARY CARE FACILITY CAPITAL

14 EXPENDITURES.— 

15 ‘‘(1) PROGRAM AUTHORIZED.—The Secretary, 

16 acting through the Administrator of the Health Re17 sources and Services Administration, may make 

18 grants to community health centers for the purpose 

19 of increasing primary health care capabilities 

20 through the construction, expansion, or renovation 

21 of facilities. 

22 ‘‘(2) GRANTS.—A recipient of a grant under 

23 this subsection shall be eligible to receive such 

24 grants for a total of 5 fiscal years. 


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1 ‘‘(3) USE OF FUNDS.—A recipient of a grant 

2 under this subsection shall use amounts from the 

3 grant for one or more of the following activities: 

4 ‘‘(A) To acquire or lease facilities. 

5 ‘‘(B) To construct new facilities. 

6 ‘‘(C) To repair or modernize existing facili7 ties. 

8 ‘‘(D) To purchase or lease medical equip9 ment. 

10 ‘‘(c) DEFINITION.—The term ‘community health cen11 ter’ means a health center as defined in section 330. 

12 ‘‘SEC. 749B. AUTHORIZATION OF APPROPRIATIONS. 

13 ‘‘There is authorized to be appropriated 

14 $200,000,000 for fiscal year 2008 and such sums as may 

15 be necessary for each fiscal year thereafter to carry out 

16 this subpart.’’. 

17 (d) INTERDISCIPLINARY, COMMUNITY-BASED PRO18 GRAMS.— 

19 (1) AREA HEALTH EDUCATION CENTERS.—Sec20 tion 751(a) of the Public Health Service Act (42 

21 U.S.C. 294a(a)) is amended— 

22 (A) in paragraph (1)(A)— 

23 (i) in clause (i), by inserting at the 

24 end before the semicolon the following: ‘‘, 


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1 with an emphasis on such personnel who 

2 focus on primary care’’; 

3 (ii) by redesignating clauses (ii) 

4 through (vii) as clauses (iii) through (viii), 

5 respectively; and 

6 (iii) by inserting after clause (i) the 

7 following: 

8 ‘‘(ii) foster and provide community9 based training and education for health 

10 professions students in underserved com11 munities and among underserved popu12 lations, including but not limited to the 

13 National Health Service Corps, community 

14 and migrant health centers, rural health 

15 clinics, critical access hospitals, tribal 

16 health clinics, and public health depart17 ments;’’; and 

18 (B) by adding at the end the following: 

19 ‘‘(3) POINT OF SERVICE ENHANCEMENT

20 GRANTS.— 

21 ‘‘(A) IN GENERAL.—The Secretary may 

22 award grants to entities receiving an award 

23 under paragraph (1) or (2) to improve the ef24 fectiveness of the programs operated by such 

25 entities or to enable the entities to respond to 


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1 changes affecting such entities arising since the 

2 date of the receipt of the award under para3 graph (1) or (2). 

4 ‘‘(B) APPLICATION.—To receive an award 

5 under this paragraph, an entity described under 

6 subparagraph (A) shall submit to the Secretary 

7 an application at such time, in such manner, 

8 and containing such information as the Sec9 retary may require, including an explanation of 

10 the changes affecting such entity arising since 

11 the date of the receipt by the entity of the 

12 award under paragraph (1) or (2), such as 

13 changes in the demographics of the area served, 

14 the needs of the population served, and the sit15 uations encountered by such population and 

16 such entity.’’. 

17 (2) AUTHORIZATION OF APPROPRIATIONS.— 

18 Section 757 of the Public Health Service Act (42 

19 U.S.C. 294g) is amended— 

20 (A) in subsection (a), by striking 

21 ‘‘$55,600,000’’ and all that follows through 

22 ‘‘2002’’ and inserting ‘‘$125,000,000 for fiscal 

23 year 2008 and such sums as may be necessary 

24 for each of fiscal years 2009 through 2012’’; 


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1 (B) by striking subsection (b) and insert2 ing the following: 

3 ‘‘(b) ALLOCATION.— 

4 ‘‘(1) IN GENERAL.—Of the amounts appro5 priated under subsection (a) that the Secretary 

6 makes available for each fiscal year to carry out sec7 tion 751, the Secretary shall obligate— 

8 ‘‘(A) for awards under paragraph (1) of 

9 section 751(a), not more than 25 percent of 

10 such amounts in each fiscal year; and 

11 ‘‘(B) for awards under paragraphs (2) and 

12 (3) of section 751(a), not less than 60 percent 

13 of such amounts in each fiscal year.’’; and 

14 (C) in subsection (c), by— 

15 (i) striking the subsection designation 

16 and heading and inserting the following: 

17 ‘‘(c) SENSE OF THE CONGRESS.—It is the sense of 

18 the Congress that—’’. 

19 (ii) striking paragraph (1); and 

20 (iii) in paragraph (2), by— 

21 (I) striking the paragraph des22 ignation and all that follows through 

23 ‘‘Congress that—’’; and 


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1 (II) redesignating subparagraphs 

2 (A) and (B) as paragraphs (1) and 

3 (2) and indenting appropriately. 

4 SEC. 4. AMENDMENTS TO THE SOCIAL SECURITY ACT. 

5 (a) CLARIFICATION OF CONGRESSIONAL INTENT RE6 GARDING THE COUNTING OF RESIDENTS IN A NONHOS7 PITAL SETTING.— 

8 (1) D–GME.—Section 1886(h)(4)(E) of the So9 cial Security Act (42 U.S.C. 1395ww(h)(4)(E)) is 

10 amended by adding at the end the following new 

11 sentences: ‘‘For purposes of the preceding sentence, 

12 the term ‘all, or substantially all, of the costs for the 

13 training program’ means the stipends and benefits 

14 provided to the resident and other amounts, if any, 

15 as determined by the hospital and the entity oper16 ating the nonhospital setting. The hospital is not re17 quired to pay the entity any amounts other than 

18 those determined by the hospital and the entity in 

19 order for the hospital to be considered to have in20 curred all, or substantially all, of the costs for the 

21 training program in that setting.’’. 

22 (2) IME.—Section 1886(d)(5)(B)(iv) of the So23 cial Security Act (42 U.S.C. 1395ww(d)(5)(B)(iv)) is 

24 amended by adding at the end the following new 

25 sentences: ‘‘For purposes of the preceding sentence, 


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1 the term ‘all, or substantially all, of the costs for the 

2 training program’ means the stipends and benefits 

3 provided to the resident and other amounts, if any, 

4 as determined by the hospital and the entity oper5 ating the nonhospital setting. The hospital is not re6 quired to pay the entity any amounts other than 

7 those determined by the hospital and the entity in 

8 order for the hospital to be considered to have in9 curred all, or substantially all, of the costs for the 

10 training program in that setting.’’. 

11 (3) EFFECTIVE DATE.—The amendments made 

12 by this subsection shall take effect on January 1, 

13 2008. 

14 (b) CLARIFICATION OF ELIGIBILITY OF A NONRURAL

15 HOSPITAL THAT HASA TRAINING PROGRAM WITH AN

16 INTEGRATED RURAL TRACK.— 

17 (1) IN GENERAL.—Section 1886(h)(4)(H) of 

18 the Social Security Act (42 U.S.C. 

19 1395ww(h)(4)(H)) is amended— 

20 (A) in clause (iv), by inserting ‘‘(as defined 

21 in clause (v))’’ after ‘‘an integrated rural 

22 track’’; and 

23 (B) by adding at the end the following new 

24 clause: 


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1 ‘‘(v) DEFINITION OF ACCREDITED

2 TRAINING PROGRAM WITH AN INTEGRATED

3 RURAL TRACK.—For purposes of clause 

4 (iv), the term ‘accredited training program 

5 with an integrated rural track’ means an 

6 accredited medical residency training pro7 gram located in an urban area which offers 

8 a curriculum for all residents in the pro9 gram that includes the following character10 istics: 

11 ‘‘(I) A minimum of 3 block 

12 months of rural rotations. During 

13 such 3 block months, the resident is 

14 in a rural area for 4 weeks or a 

15 month. 

16 ‘‘(II) A stated mission for train17 ing rural physicians. 

18 ‘‘(III) A minimum of 3 months of 

19 obstetrical training, or an equivalent 

20 longitudinal experience. 

21 ‘‘(IV) A minimum of 4 months of 

22 pediatric training that includes neo23 natal, ambulatory, inpatient, and 

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1 tions, or an equivalent longitudinal ex2 perience. 

3 ‘‘(V) A minimum of 2 months of 

4 emergency medicine rotations, or an 

5 equivalent longitudinal experience.’’. 

6 (2) EFFECTIVE DATE.—The amendments made 

7 by this subsection apply with respect to— 

8 (A) payments to hospitals under section 

9 1886(h) of the Social Security Act (42 U.S.C. 

10 1395ww(h)) for cost reporting periods begin11 ning on or after January 1, 2008; and 

12 (B) payments to hospitals under section 

13 1886(d)(5)(B)(v) of such Act (42 U.S.C. 

14 1395ww(d)(5)(B)(v)) for discharges occurring 

15 on or after January 1, 2008. 

Æ 


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