I 

116TH CONGRESS 

1ST SESSION H. R. 1841 

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

of general surgery shortage areas, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 21, 2019 

Mr. BERA (for himself, Mr. BUCSHON, Mr. PETERS, and Mr. MULLIN) introduced the following bill; which was referred to the Committee on Energy 

and Commerce 

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 2019’’. 

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 2018 report released by the American As13 sociation of Medical Colleges projects shortages in 

14 all surgical specialties of between 20,700 and 30,500 

15 surgeons by 2030. 

16 (4) In order to accurately prepare for future 

17 physician workforce demands, comprehensive, impar18 tial research and high quality data are needed to in19 form dynamic projections of physician workforce 

20 needs. 

21 (5) A variety of factors, including health out22 comes, utilization trends, growing and aging popu23 lations, and delivery system changes, influence work24 force needs and should be considered as part of 

25 flexible projections of workforce needs. 


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1 (6) Given the particularly acute needs in many 

2 rural and other surgical workforce shortage areas, 

3 additional efforts to assess the adequacy of the cur4 rent general surgeon workforce are necessary. 

5 SEC. 3. STUDY ON DESIGNATION OF GENERAL SURGERY 

6 SHORTAGE AREAS. 

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

8 (42 U.S.C. 254b et seq.) is amended by adding at the end 

9 the following: 

10 ‘‘Subpart XIII—General Surgery Shortage Areas 

11 ‘‘SEC. 340J. DESIGNATION OF GENERAL SURGERY SHORT12 AGE AREAS. 

13 ‘‘(a) GENERAL SURGERY SHORTAGE AREA DE14 FINED.—For purposes of this section, the term ‘general 

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

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

17 has a population that is underserved by general surgeons. 

18 ‘‘(b) STUDY AND REPORT.— 

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

20 the Administrator of the Health Resources and Serv21 ices Administration, shall conduct a study on the fol22 lowing matters relating to access by underserved 

23 populations to general surgeons: 

24 ‘‘(A) Whether current shortage designa25 tions, such as the designation of health profesVerDate Sep 11 2014 22:32 Apr 01, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1841.IH H1841

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1 sional shortage areas under section 332, results 

2 in accurate assessments of the adequacy of local 

3 general surgeons to address the needs of under4 served populations in urban, suburban, or rural 

5 areas. 

6 ‘‘(B) Whether another measure of access 

7 to general surgeons by underserved populations, 

8 such as one based on general surgeons prac9 ticing within hospital service areas, would pro10 vide more accurate assessments of shortages in 

11 the availability of local general surgeons to 

12 meets the needs of those populations. 

13 ‘‘(C) Potential methodologies for the des14 ignation of general surgery shortage areas, in15 cluding the methodology described in paragraph 

16 (2). 

17 ‘‘(2) METHODOLOGY FOR THE DESIGNATION OF

18 AREAS.—Among the methodologies considered under 

19 paragraph (1)(C) for the designation of general sur20 gery shortage areas, the Secretary shall analyze the 

21 effectiveness and accuracy of the following method22 ology: 

23 ‘‘(A) DEVELOPMENT OF SURGERY SERVICE

24 AREAS.—Development of surgery service areas 

25 through the identification of hospitals with surVerDate Sep 11 2014 22:32 Apr 01, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1841.IH H1841

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1 gery services and the identification of popu2 lations by zip code areas using Medicare patient 

3 origin data. 

4 ‘‘(B) IDENTIFICATION OF SURGEONS.— 

5 Identification of all actively practicing general 

6 surgeons. 

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

8 Development of general surgeon-to-population 

9 ratios for each surgery service area. 

10 ‘‘(D) THRESHOLDS.—Determination of 

11 threshold general surgeon-to-population ratios 

12 for the number of general surgeons necessary to 

13 treat a population for each of the following lev14 els: 

15 ‘‘(i) Optimal supply of general sur16 geons. 

17 ‘‘(ii) Adequate supply of general sur18 geons. 

19 ‘‘(iii) Shortage of general surgeons. 

20 ‘‘(iv) Critical shortage of general sur21 geons. 

22 ‘‘(3) REPORT.—Not later than one year after 

23 the date of the enactment of this subpart, the Sec24 retary shall submit to Congress a report on the 

25 study conducted under this subsection. 


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

2 under paragraph (1), the Secretary shall consult 

3 with relevant stakeholders, including medical soci4 eties, organizations representing surgical facilities, 

5 organizations with expertise in general surgery, and 

6 organizations representing patients. 

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

8 shall periodically collect and publish in the Federal 

9 Register— 

10 ‘‘(A) data comparing the availability and 

11 need of general surgery services in urban, sub12 urban or rural areas in the United States; and 

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

14 more general surgery shortage areas under sub15 section (c), a list of the areas so designated. 

16 ‘‘(c) DESIGNATION OF GENERAL SURGERY SHORT17 AGE AREAS.— 

18 ‘‘(1) METHODOLOGY DEVELOPED THROUGH

19 REGULATION.—Not later than 12 months after the 

20 date of the submission of the report under sub21 section (b)(3), the Secretary may establish, through 

22 notice and comment rulemaking, a methodology for 

23 the designation of general surgery shortage areas 

24 under this section. 


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

2 to develop methodology under paragraph (1), the fol3 lowing shall apply: 

4 ‘‘(A) Using the methodology established 

5 under paragraph (1) and taking into consider6 ation the data referred to in subsection (b)(5), 

7 the Secretary shall— 

8 ‘‘(i) designate general surgery short9 age areas in the United States; 

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

11 areas; and 

12 ‘‘(iii) review annually, and, as nec13 essary, revise such designations. 

14 ‘‘(B) The Secretary shall follow similar 

15 procedures with respect to notice to appropriate 

16 parties, opportunities for comment, dissemina17 tion of information, and reports to Congress in 

18 designating general surgery shortage areas 

19 under this section as those that apply to the 

20 designation of health professional shortage 

21 areas under section 332. 

22 ‘‘(C) In designating general surgery short23 age areas under this subsection, the Secretary 

24 shall consult with relevant stakeholders, includ25 ing medical societies, organizations representing 


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1 surgical facilities, organizations with expertise 

2 in general surgery, and organizations rep3 resenting patients.’’. 

Æ 


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