II 

111TH CONGRESS 

1ST SESSION S. 1628 

To amend title VII of the Public Health Service Act to increase the number 

of physicians who practice in underserved rural communities. 

IN THE SENATE OF THE UNITED STATES 

AUGUST 6, 2009 

Mr. UDALL of Colorado (for himself and Mrs. HAGAN) introduced the following bill; which was read twice and referred to the Committee on 

Health, Education, Labor, and Pensions 

A BILL 

To amend title VII of the Public Health Service Act to 

increase the number of physicians who practice in underserved rural communities. 

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 ‘‘Rural Physician Pipe5 line Act of 2009’’. 

6 SEC. 2. RURAL PHYSICIAN TRAINING GRANTS. 

7 Part C of title VII of the Public Health Service Act 

8 (42 U.S.C. 293k et seq.) is amended— 


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1 (1) after the part heading, by inserting the fol2 lowing: 

3 ‘‘Subpart I—Medical Training Generally’’; 

4 and 

5 (2) by inserting at the end the following: 

6 ‘‘Subpart II—Training in Underserved Communities 

7 ‘‘SEC. 749. RURAL PHYSICIAN TRAINING GRANTS. 

8 ‘‘(a) IN GENERAL.—The Secretary, acting through 

9 the Administrator of the Health Resources and Services 

10 Administration, shall establish a program to make grants 

11 to eligible entities for the purposes of— 

12 ‘‘(1) assisting eligible entities in recruiting stu13 dents most likely to practice medicine in underserved 

14 rural communities; 

15 ‘‘(2) providing rural-focused training and expe16 rience; and 

17 ‘‘(3) increasing the number of recent allopathic 

18 and osteopathic medical school graduates who prac19 tice in underserved rural communities. 

20 ‘‘(b) ELIGIBLE ENTITIES.—In order to be eligible to 

21 receive a grant under this section, an entity shall— 

22 ‘‘(1) be a school of allopathic or osteopathic 

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1 retary for this purpose, or any combination or con2 sortium of such schools; and 

3 ‘‘(2) submit an application to the Secretary at 

4 such time, in such form, and containing such infor5 mation as the Secretary may require, including a 

6 certification that such entity— 

7 ‘‘(A) will use amounts provided to the in8 stitution to— 

9 ‘‘(i) establish and carry out a Rural 

10 Physician Training Program described in 

11 subsection (d); 

12 ‘‘(ii) improve an existing rural-focused 

13 training program to meet the requirements 

14 described in subsection (d) and carry out 

15 such program; or 

16 ‘‘(iii) expand and carry out an exist17 ing rural-focused training program that 

18 meets the requirements described in sub19 section (d); and 

20 ‘‘(B) employs, or will employ within a 

21 timeframe sufficient to implement the Program 

22 (as described by a timetable and supporting 

23 documentation in the application of the eligible 

24 entity), faculty with experience or training in 


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1 rural medicine or with experience in training 

2 rural physicians. 

3 ‘‘(c) PRIORITY.—In awarding grant funds under this 

4 section, the Secretary shall give priority to eligible entities 

5 that— 

6 ‘‘(1) demonstrate a record of successfully train7 ing students, as determined by the Secretary, who 

8 practice medicine in underserved rural communities; 

9 ‘‘(2) demonstrate that an existing academic 

10 program of the eligible entity produces a high per11 centage, as determined by the Secretary, of grad12 uates from such program who practice medicine in 

13 underserved rural communities; 

14 ‘‘(3) demonstrate rural community institutional 

15 partnerships, through such mechanisms as matching 

16 or contributory funding, documented in-kind services 

17 for implementation, or existence of training partners 

18 with interprofessional expertise (such as dental, vi19 sion, or mental health services) in community health 

20 center training locations or other similar facilities; or 

21 ‘‘(4) submit, as part of the application of the 

22 entity under subsection (b), a plan for the long-term 

23 tracking of where the graduates of such entity are 

24 practicing medicine. 

25 ‘‘(d) USE OF FUNDS.— 


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1 ‘‘(1) ESTABLISHMENT.—An eligible entity re2 ceiving a grant under this section shall use the funds 

3 made available under such grant to— 

4 ‘‘(A) establish and carry out a ‘Rural Phy5 sician Training Program’ (referred to in this 

6 section as the ‘Program’); 

7 ‘‘(B) improve an existing rural-focused 

8 training program to meet the Program require9 ments described in this subsection and carry 

10 out such program; or 

11 ‘‘(C) expand and carry out an existing 

12 rural-focused training program that meets the 

13 Program requirements described in this sub14 section. 

15 ‘‘(2) STRUCTURE OF PROGRAM.—An eligible en16 tity shall— 

17 ‘‘(A) enroll no fewer than 10 students per 

18 class year into the Program; and 

19 ‘‘(B) develop criteria for admission to the 

20 Program that gives priority to students— 

21 ‘‘(i) who have originated from or lived 

22 for a period of 2 or more years in an un23 derserved rural community; and 


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1 ‘‘(ii) who express a commitment to 

2 practice medicine in an underserved rural 

3 community. 

4 ‘‘(3) CURRICULA.—The Program shall require 

5 students to enroll in didactic coursework and clinical 

6 experience particularly applicable to medical practice 

7 in underserved rural communities, including— 

8 ‘‘(A) clinical rotations in underserved rural 

9 communities, and in specialties including family 

10 medicine, internal medicine, pediatrics, surgery, 

11 psychiatry, and emergency medicine; 

12 ‘‘(B) in addition to core school curricula, 

13 additional coursework or training experiences 

14 focused on medical issues prevalent in under15 served rural communities, including in areas 

16 such as trauma, obstetrics, ultrasound, oral 

17 health, and behavioral health; and 

18 ‘‘(C) any coursework or clinical experience 

19 that— 

20 ‘‘(i) may be developed as a result of 

21 the Symposium described in subsection (f); 

22 or 

23 ‘‘(ii) the Secretary finds appropriate. 

24 ‘‘(4) RESIDENCY PLACEMENT ASSISTANCE.— 

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1 dents of the Program in obtaining clinical training 

2 experiences in locations with postgraduate programs 

3 offering residency training opportunities in under4 served rural communities, or in local residency train5 ing programs that support and train physicians to 

6 practice in underserved rural communities, as well 

7 as assist all students of the Program in obtaining 

8 postgraduate residency training in such programs. 

9 ‘‘(5) PROGRAM STUDENT COHORT SUPPORT.— 

10 The Program shall provide and require all students 

11 of the Program to participate in social, educational, 

12 and other group activities designed to further de13 velop, maintain, and reinforce the original commit14 ment of such students to practice in an underserved 

15 rural community. 

16 ‘‘(e) ANNUAL REPORTING REQUIREMENT.—On an 

17 annual basis, an eligible entity receiving a grant under this 

18 section shall submit a report to the Secretary on— 

19 ‘‘(1) the overall success of the Program estab20 lished by the entity, based on criteria the Secretary 

21 determines appropriate; 

22 ‘‘(2) the number of students participating in 

23 the Program; 

24 ‘‘(3) the number of graduating students who 

25 participated in the Program; 


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1 ‘‘(4) the residency program selection of grad2 uating students who participated in the Program; 

3 ‘‘(5) the number of graduates who participated 

4 in the Program who are practicing in underserved 

5 rural communities not less than one year after com6 pleting residency training; and 

7 ‘‘(6) the number of graduates who participated 

8 in the Program who are not practicing in under9 served rural communities not less than one year 

10 after completing residency training. 

11 ‘‘(f) RURAL TRAINING PROGRAM SYMPOSIUM.— 

12 ‘‘(1) PURPOSES OF SYMPOSIUM.—To assist the 

13 Secretary in carrying out the Program and making 

14 grant determinations under this section, the Sec15 retary shall convene a Rural Training Program 

16 Symposium (referred to in this section as the ‘Sym17 posium’) to— 

18 ‘‘(A) develop best practices that may be in19 corporated into consideration of applications 

20 under subsection (b); and 

21 ‘‘(B) establish a network of allopathic and 

22 osteopathic medical schools that have developed 

23 or will develop rural training programs in ac24 cordance with subsection (d). 


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1 ‘‘(2) COMPOSITION.—The Symposium shall in2 clude— 

3 ‘‘(A) representatives from eligible entities 

4 with existing rural training programs; 

5 ‘‘(B) representatives from all eligible enti6 ties interested in developing the Program; 

7 ‘‘(C) representatives from area health edu8 cation centers; 

9 ‘‘(D) representatives from the Health Re10 sources and Services Administration; and 

11 ‘‘(E) any other experts or individuals with 

12 experience in practicing medicine in under13 served rural communities the Secretary deter14 mines appropriate. 

15 ‘‘(g) REGULATIONS.—Not later than 60 days after 

16 the date of enactment of this section, the Secretary shall 

17 by regulation define ‘underserved rural community’ for 

18 purposes of this section. 

19 ‘‘(h) SUPPLEMENT NOT SUPPLANT.—Any eligible en20 tity receiving funds under this section shall use such funds 

21 to supplement, not supplant, any other Federal, State, and 

22 local funds that would otherwise be expended by such enti23 ty to carry out the activities described in this section. 

24 ‘‘(i) MAINTENANCE OF EFFORT.—With respect to ac25 tivities for which funds awarded under this section are to 


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1 be expended, the entity shall agree to maintain expendi2 tures of non-Federal amounts for such activities at a level 

3 that is not less than the level of such expenditures main4 tained by the entity for the fiscal year preceding the fiscal 

5 year for which the entity receives a grant under this sec6 tion. 

7 ‘‘(j) AUTHORIZATION OF APPROPRIATIONS.—There 

8 are authorized to be appropriated— 

9 ‘‘(1) to carry out this section (other than sub10 section (f))— 

11 ‘‘(A) $4,000,000 for fiscal year 2010; 

12 ‘‘(B) $8,000,000 for fiscal year 2011; 

13 ‘‘(C) $12,000,000 for fiscal year 2012; 

14 ‘‘(D) $16,000,000 for fiscal year 2013; 

15 and 

16 ‘‘(2) to carry out subsection (f), such sums as 

17 may be necessary.’’. 

Æ 


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