II 

118TH CONGRESS 

1ST SESSION S. 1140 

To amend the Public Health Service Act with respect to the designation 

of general surgery shortage areas, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

MARCH 30, 2023 

Mr. SCHATZ (for himself, Mr. BARRASSO, Ms. CANTWELL, Mr. MARSHALL, 

and Ms. SINEMA) 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 with respect to 

the designation of general surgery 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 ‘‘Ensuring Access to 

5 General Surgery Act of 2023’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 


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1 (1) According to the Bureau of Health Work2 force, the United States faces a shortage of physi3 cians. 

4 (2) A 2016 study entitled ‘‘Supply and Demand 

5 of General Surgeons: Projections From 2014–2030’’, 

6 prepared by the University of North Carolina at 

7 Chapel Hill for the American College of Surgeons, 

8 found that the supply of general surgeons will grow 

9 slightly by 2030 but will not keep up with overall 

10 growth in the United States population or demand 

11 for surgical services. 

12 (3) A 2021 report released by the Association 

13 of American Medical Colleges projects shortages in 

14 all surgical specialties of between 15,800 and 30,200 

15 surgeons by 2034. 

16 (4) A 2020 report prepared by the Health Re17 sources and Services Administration for the Com18 mittee on Appropriations of the Senate found a mal19 distribution of general surgeons nationwide, with 

20 rural areas having only 69 percent of the general 

21 surgeons needed to meet demand for care. 

22 (5) In order to accurately prepare for future 

23 physician workforce demands, comprehensive, impar24 tial research and high-quality data are needed to inVerDate Sep 11 2014 00:45 Apr 13, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1140.IS S1140

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1 form dynamic projections of physician workforce 

2 needs. 

3 (6) A variety of factors, including health out4 comes, utilization trends, growing and aging popu5 lations, and delivery system changes, influence work6 force needs and should be considered as part of 

7 flexible projections of workforce needs. 

8 (7) Given the particularly acute needs in many 

9 rural and other surgical workforce shortage areas, 

10 additional efforts to assess the adequacy of the cur11 rent general surgeon workforce are necessary. 

12 SEC. 3. STUDY ON DESIGNATION OF GENERAL SURGICAL 

13 HEALTH PROFESSIONAL SHORTAGE AREAS. 

14 Part D of title III of the Public Health Service Act 

15 (42 U.S.C. 254b et seq.) is amended by adding at the end 

16 the following: 

17 ‘‘Subpart XIII—General Surgery Shortage Areas 

18 ‘‘SEC. 340J. DESIGNATION OF GENERAL SURGERY SHORT19 AGE AREAS. 

20 ‘‘(a) GENERAL SURGERY SHORTAGE AREA DE21 FINED.—For purposes of this section, the term ‘general 

22 surgery shortage area’ means, with respect to an urban, 

23 suburban, or rural area in the United States, an area that 

24 has a population that is underserved by general surgeons. 

25 ‘‘(b) STUDY AND REPORT.— 


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1 ‘‘(1) STUDY.—The Secretary, acting through 

2 the Administrator of the Health Resources and Serv3 ices Administration, shall conduct a study on the fol4 lowing matters relating to access by underserved 

5 populations to general surgeons: 

6 ‘‘(A) Whether current shortage designa7 tions, such as the designation of health profes8 sional shortage areas under section 332, results 

9 in accurate assessments of the adequacy of local 

10 general surgeons to address the needs of under11 served populations in urban, suburban, or rural 

12 areas. 

13 ‘‘(B) Whether another measure of access 

14 to general surgeons by underserved populations, 

15 such as one based on general surgeons prac16 ticing within hospital service areas, would pro17 vide more accurate assessments of shortages in 

18 the availability of local general surgeons to 

19 meets the needs of those populations. 

20 ‘‘(C) Potential methodologies for the des21 ignation of general surgery shortage areas, in22 cluding the methodology described in paragraph 

23 (2). 

24 ‘‘(2) METHODOLOGY FOR THE DESIGNATION OF

25 AREAS.—Among the methodologies considered under 


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1 paragraph (1)(C) for the designation of general sur2 gery shortage areas, the Secretary shall analyze the 

3 effectiveness and accuracy of the following method4 ology: 

5 ‘‘(A) DEVELOPMENT OF SURGERY SERVICE

6 AREAS.—Development of surgery service areas 

7 through the identification of hospitals with sur8 gery services and the identification of popu9 lations by ZIP Code areas using Medicare pa10 tient origin data. 

11 ‘‘(B) IDENTIFICATION OF SURGEONS.— 

12 Identification of all actively practicing general 

13 surgeons. 

14 ‘‘(C) SURGEON TO POPULATION RATIOS.— 

15 Development of general surgeon-to-population 

16 ratios for each surgery service area. 

17 ‘‘(D) THRESHOLDS.— 

18 ‘‘(i) IN GENERAL.—Determination of 

19 threshold general surgeon-to-population ra20 tios for the number of general surgeons 

21 necessary to treat a population for each of 

22 the following levels: 

23 ‘‘(I) Optimal supply of general 

24 surgeons. 


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1 ‘‘(II) Adequate supply of general 

2 surgeons. 

3 ‘‘(III) Shortage of general sur4 geons. 

5 ‘‘(IV) Critical shortage of general 

6 surgeons. 

7 ‘‘(ii) CONSIDERATIONS.—In deter8 mining the thresholds under clause (i), the 

9 Secretary shall not assume that the cur10 rent supply of general surgeons nationwide 

11 is the optimal or adequate level and shall 

12 consider additional factors such as wait 

13 times, health outcomes, ground transpor14 tation time to the nearest health care cen15 ter with a general surgeon, critical access 

16 hospitals with surgical capabilities but 

17 lacking a general surgeon, and patient ex18 perience. 

19 ‘‘(3) REPORT.—Not later than 1 year after the 

20 date of the enactment of this subpart, the Secretary 

21 shall submit to Congress a report on the study con22 ducted under this subsection. 

23 ‘‘(4) CONSULTATION.—In conducting the study 

24 under paragraph (1), the Secretary shall consult 

25 with relevant stakeholders, including medical sociVerDate Sep 11 2014 00:45 Apr 13, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1140.IS S1140

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1 eties, organizations representing surgical facilities, 

2 organizations with expertise in general surgery, and 

3 organizations representing patients. 

4 ‘‘(5) PUBLICATION OF DATA.—The Secretary 

5 shall periodically collect and publish in the Federal 

6 Register— 

7 ‘‘(A) data comparing the availability and 

8 need of general surgery services in urban, sub9 urban, or rural areas in the United States; and 

10 ‘‘(B) if the Secretary designates one or 

11 more general surgery shortage areas under sub12 section (c), a list of the areas so designated. 

13 ‘‘(c) DESIGNATION OF GENERAL SURGERY SHORT14 AGE AREAS.— 

15 ‘‘(1) METHODOLOGY DEVELOPED THROUGH

16 REGULATION.—Based on the findings of the report 

17 under subsection (b)(3), the Secretary may establish, 

18 through notice and comment rulemaking, a method19 ology for the designation of general surgery shortage 

20 areas under this section. 

21 ‘‘(2) REQUIREMENTS.—If the Secretary elects 

22 to develop a methodology under paragraph (1), the 

23 following shall apply: 

24 ‘‘(A) Using the methodology established 

25 under paragraph (1) and taking into considerVerDate Sep 11 2014 00:45 Apr 13, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1140.IS S1140

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1 ation the data referred to in subsection (b)(5), 

2 the Secretary shall— 

3 ‘‘(i) designate general surgery short4 age areas in the United States; 

5 ‘‘(ii) publish a descriptive list of the 

6 areas; and 

7 ‘‘(iii) review annually, and, as nec8 essary, revise such designations. 

9 ‘‘(B) The Secretary shall follow similar 

10 procedures with respect to notice to appropriate 

11 parties, opportunities for comment, dissemina12 tion of information, and reports to Congress in 

13 designating general surgery shortage areas 

14 under this section as those that apply to the 

15 designation of health professional shortage 

16 areas under section 332. 

17 ‘‘(C) In designating general surgery short18 age areas under this subsection, the Secretary 

19 shall consult with relevant stakeholders, includ20 ing medical societies, organizations representing 

21 surgical facilities, organizations with expertise 

22 in general surgery, and organizations rep23 resenting patients.’’. 

Æ 


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