I 

111TH CONGRESS 

1ST SESSION H. R. 3648 

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

of physicians who practice in underserved rural communities. 

IN THE HOUSE OF REPRESENTATIVES 

SEPTEMBER 24, 2009 

Mr. SALAZAR (for himself and Ms. MARKEY of Colorado) introduced the 

following bill; which was referred to the Committee on Energy and Commerce 

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— 

9 (1) after the part heading, by inserting the fol10 lowing: 


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

2 and 

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

4 ‘‘Subpart II—Training in Underserved Communities 

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

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

7 the Administrator of the Health Resources and Services 

8 Administration, shall establish a program to make grants 

9 to eligible entities for the purposes of— 

10 ‘‘(1) assisting eligible entities in recruiting stu11 dents most likely to practice medicine in underserved 

12 rural communities; 

13 ‘‘(2) providing rural-focused training and expe14 rience; and 

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

16 and osteopathic medical school graduates who prac17 tice in underserved rural communities. 

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

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

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

21 medicine accredited by a nationally recognized ac22 crediting agency or association approved by the Sec23 retary for this purpose, or any combination or con24 sortium of such schools; and 

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

26 such time, in such form, and containing such inforVerDate Nov 24 2008 23:14 Sep 24, 2009 Jkt 079200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3648.IH H3648

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1 mation as the Secretary may require, including a 

2 certification that such entity— 

3 ‘‘(A) will use amounts provided to the in4 stitution to— 

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

6 Physician Training Program described in 

7 subsection (d); 

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

9 training program to meet the requirements 

10 described in subsection (d) and carry out 

11 such program; or 

12 ‘‘(iii) expand and carry out an exist13 ing rural-focused training program that 

14 meets the requirements described in sub15 section (d); and 

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

17 timeframe sufficient to implement the Program 

18 (as described by a timetable and supporting 

19 documentation in the application of the eligible 

20 entity), faculty with experience or training in 

21 rural medicine or with experience in training 

22 rural physicians. 

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

24 section, the Secretary shall give priority to eligible entities 

25 that— 


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1 ‘‘(1) demonstrate a record of successfully train2 ing students, as determined by the Secretary, who 

3 practice medicine in underserved rural communities; 

4 ‘‘(2) demonstrate that an existing academic 

5 program of the eligible entity produces a high per6 centage, as determined by the Secretary, of grad7 uates from such program who practice medicine in 

8 underserved rural communities; 

9 ‘‘(3) demonstrate rural community institutional 

10 partnerships, though such mechanisms as matching 

11 or contributory funding, documented in-kind services 

12 for implementation, or existence of training partners 

13 with interprofessional expertise (such as dental, vi14 sion, or mental health services) in community health 

15 center training locations or other similar facilities; or 

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

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

18 tracking of where the graduates of such entity are 

19 practicing medicine. 

20 ‘‘(d) USE OF FUNDS.— 

21 ‘‘(1) ESTABLISHMENT.—An eligible entity re22 ceiving a grant under this section shall use the funds 

23 made available under such grant to— 


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1 ‘‘(A) establish and carry out a ‘Rural Phy2 sician Training Program’ (referred to in this 

3 section as the ‘Program’); 

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

5 training program to meet the Program require6 ments described in this subsection and carry 

7 out such program; or 

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

9 rural-focused training program that meets the 

10 Program requirements described in this sub11 section. 

12 ‘‘(2) STRUCTURE OF PROGRAM.—An eligible en13 tity shall— 

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

15 class year into the Program; and 

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

17 Program that gives priority to students— 

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

19 for a period of 2 or more years in an un20 derserved rural community; and 

21 ‘‘(ii) who express a commitment to 

22 practice medicine in an underserved rural 

23 community. 

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

25 students to enroll in didactic coursework and clinical 


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1 experience particularly applicable to medical practice 

2 in underserved rural communities, including— 

3 ‘‘(A) clinical rotations in underserved rural 

4 communities, and in specialties including family 

5 medicine, internal medicine, pediatrics, surgery, 

6 psychiatry, and emergency medicine; 

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

8 additional coursework or training experiences 

9 focused on medical issues prevalent in under10 served rural communities, including in areas 

11 such as trauma, obstetrics, ultrasound, oral 

12 health, and behavioral health; and 

13 ‘‘(C) any coursework or clinical experience 

14 that— 

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

16 the Symposium described in subsection (f); 

17 or 

18 ‘‘(ii) the Secretary finds appropriate. 

19 ‘‘(4) RESIDENCY PLACEMENT ASSISTANCE.— 

20 Where available, the Program shall assist all stu21 dents of the Program in obtaining clinical training 

22 experiences in locations with postgraduate programs 

23 offering residency training opportunities in under24 served rural communities, or in local residency train25 ing programs that support and train physicians to 


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1 practice in underserved rural communities, as well 

2 as assist all students of the Program in obtaining 

3 postgraduate residency training in such programs. 

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

5 The Program shall provide and require all students 

6 of the Program to participate in social, educational, 

7 and other group activities designed to further de8 velop, maintain, and reinforce the original commit9 ment of such students to practice in an underserved 

10 rural community. 

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

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

13 section shall submit a report to the Secretary on— 

14 ‘‘(1) the overall success of the Program estab15 lished by the entity, based on criteria the Secretary 

16 determines appropriate; 

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

18 the Program; 

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

20 participated in the Program; 

21 ‘‘(4) the residency program selection of grad22 uating students who participated in the Program; 

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

24 in the Program who are practicing in underserved 


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1 rural communities not less than one year after com2 pleting residency training; and 

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

4 in the Program who are not practicing in under5 served rural communities not less than one year 

6 after completing residency training. 

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

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

9 Secretary in carrying out the Program and making 

10 grant determinations under this section, the Sec11 retary shall convene a Rural Training Program 

12 Symposium (referred to in this section as the ‘Sym13 posium’) to— 

14 ‘‘(A) develop best practices that may be in15 corporated into consideration of applications 

16 under subsection (b); and 

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

18 osteopathic medical schools that have developed 

19 or will develop rural training programs in ac20 cordance with subsection (d). 

21 ‘‘(2) COMPOSITION.—The Symposium shall in22 clude— 

23 ‘‘(A) representatives from eligible entities 

24 with existing rural training programs; 


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1 ‘‘(B) representatives from all eligible enti2 ties interested in developing the Program; 

3 ‘‘(C) representatives from area health edu4 cation centers; 

5 ‘‘(D) representatives from the Health Re6 sources and Services Administration; and 

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

8 experience in practicing medicine in under9 served rural communities the Secretary deter10 mines appropriate. 

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

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

13 by regulation define ‘underserved rural community’ for 

14 purposes of this section. 

15 ‘‘(h) SUPPLEMENT NOT SUPPLANT.—Any eligible en16 tity receiving funds under this section shall use such funds 

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

18 local funds that would otherwise be expended by such enti19 ty to carry out the activities described in this section. 

20 ‘‘(i) MAINTENANCE OF EFFORT.—With respect to ac21 tivities for which funds awarded under this section are to 

22 be expended, the entity shall agree to maintain expendi23 tures of non-Federal amounts for such activities at a level 

24 that is not less than the level of such expenditures main25 tained by the entity for the fiscal year preceding the fiscal 


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1 year for which the entity receives a grant under this sec2 tion. 

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

4 are authorized to be appropriated— 

5 ‘‘(1) to carry out this section (other than sub6 section (f))— 

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

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

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

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

11 and 

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

13 may be necessary.’’. 

Æ 


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