II 

117TH CONGRESS 

2D SESSION S. 4330 

To amend the Public Health Service Act to authorize a loan repayment 

program to encourage specialty medicine physicians to serve in rural 

communities experiencing a shortage of specialty medicine physicians, 

and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

MAY 26, 2022 

Ms. ROSEN (for herself and Mr. WICKER) 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 to authorize a 

loan repayment program to encourage specialty medicine 

physicians to serve in rural communities experiencing 

a shortage of specialty medicine physicians, 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 ‘‘Specialty Physicians 

5 Advancing Rural Care Act’’ or the ‘‘SPARC Act’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 


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1 (1) According to a June 2021 study by the As2 sociation of American Medical Colleges, titled ‘‘The 

3 Complexities of Physician Supply and Demand: Pro4 jections From 2019 to 2034’’, the projected demand 

5 for physicians continues to exceed projected supply, 

6 with a projected shortage of between 37,800 and 

7 124,000 physicians by 2034. Further, the study 

8 projects a shortage of between 21,000 and 77,100 

9 nonprimary care physicians by 2034. 

10 (2) A July 25, 2019, article, titled ‘‘Implica11 tions of an Aging Rural Physician Workforce’’, pub12 lished in the New England Journal of Medicine, esti13 mates that the size of the workforce held relatively 

14 steady at about 12 physicians per 10,000 population 

15 in rural areas from 2000 to 2017, but such work16 force is forecast to decrease by 23 percent by 2030. 

17 (3) According to the report by the Association 

18 of American Medical Colleges, titled ‘‘Medical Stu19 dent Education: Debt, Costs, and Loan Repayment 

20 Fact Card for the Class of 2020’’, the percentage of 

21 medical school graduates with education debt is 73 

22 percent and the average education debt amount for 

23 a medical school graduate is $207,003. Medical 

24 school debt accounts for 70 percent of overall stu25 dent loan debt, and the median stipend for a medical 


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1 graduate’s first year after earning a medical degree 

2 is $58,305. 

3 SEC. 3. SPECIALTY MEDICAL PRACTITIONERS WORKFORCE 

4 IN RURAL COMMUNITIES. 

5 Title VII of the Public Health Service Act (42 U.S.C. 

6 292 et seq.) is amended— 

7 (1) by redesignating part G (42 U.S.C. 795j et 

8 seq.) as part H; and 

9 (2) by inserting after part F (42 U.S.C. 295h) 

10 the following new part: 

11 ‘‘PART G—SPECIALTY MEDICINE WORKFORCE IN 

12 RURAL COMMUNITIES 

13 ‘‘SEC. 782. LOAN REPAYMENT PROGRAM. 

14 ‘‘(a) IN GENERAL.— 

15 ‘‘(1) PROGRAM FOR SPECIALTY MEDICINE PHY16 SICIANS.—The Secretary, acting through the Admin17 istrator of the Health Resources and Services Ad18 ministration, shall carry out a program under 

19 which— 

20 ‘‘(A) the Secretary enters into agreements 

21 with specialty medicine physicians to make pay22 ments in accordance with subsection (b) on the 

23 principal of and interest on any eligible loans 

24 described in subsection (c); and 


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1 ‘‘(B) the specialty medicine physicians 

2 each agree to complete a period of obligated 

3 service described in subsection (d) as a specialty 

4 medicine physician in the United States in a 

5 rural community experiencing a shortage of 

6 specialty medicine physicians. 

7 ‘‘(2) PROGRAM FOR NON-PHYSICIAN SPECIALTY

8 HEALTH CARE PROVIDERS.—The Secretary, acting 

9 through the Administrator of the Health Resources 

10 and Services Administration, may carry out a pro11 gram under which— 

12 ‘‘(A) the Secretary enters into agreements 

13 with non-physician specialty health care pro14 viders to make payments in accordance with 

15 subsection (b) on the principal of and interest 

16 on any eligible loans described in subsection (c); 

17 and 

18 ‘‘(B) the non-physician specialty health 

19 care providers each agree to complete a period 

20 of obligated service described in subsection (d) 

21 as a non-physician specialty health care pro22 vider in the United States in a rural community 

23 experiencing a shortage of such providers. 

24 ‘‘(b) PAYMENTS.—For each year of obligated service 

25 by a specialty medicine physician pursuant to an agreeVerDate Sep 11 2014 15:57 Jun 02, 2022 Jkt 029200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S4330.IS S4330

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1 ment under subsection (a)(1) or by a non-physician spe2 cialty health care provider pursuant to an agreement 

3 under subsection (a)(2), the Secretary shall make a pay4 ment to such physician or provider as follows: 

5 ‘‘(1) SERVICE IN SHORTAGE AREA.—The Sec6 retary shall pay— 

7 ‘‘(A) for each year of obligated service by 

8 a specialty medicine physician or non-physician 

9 specialty health care provider pursuant to an 

10 agreement under paragraph (1) or (2) of subsection (a), 1 11 ⁄6 of the principal of and interest 

12 on each eligible loan of the physician or pro13 vider which is outstanding on the date the phy14 sician or provider began service pursuant to the 

15 agreement; and 

16 ‘‘(B) for completion of the sixth and final 

17 year of such service, the remainder of such 

18 principal and interest. 

19 ‘‘(2) MAXIMUM AMOUNT.—The total amount of 

20 payments under this section to any specialty medi21 cine physician or non-physician specialty health care 

22 provider shall not exceed $250,000. 

23 ‘‘(c) ELIGIBLE LOANS.—The loans eligible for repay24 ment under this section are each of the following: 


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1 ‘‘(1) Any loan for education in specialty medi2 cine or specialty health care. 

3 ‘‘(2) Any Federal Direct Stafford Loan, Fed4 eral Direct PLUS Loan, Federal Direct Unsub5 sidized Stafford Loan, or Federal Direct Consolida6 tion Loan (as such terms are used in section 455 of 

7 the Higher Education Act of 1965). 

8 ‘‘(3) Any Federal Perkins Loan under part E 

9 of title I of the Higher Education Act of 1965. 

10 ‘‘(4) Any other Federal loan as determined ap11 propriate by the Secretary. 

12 ‘‘(d) PERIOD OF OBLIGATED SERVICE.—Any spe13 cialty medicine physician or non-physician specialty health 

14 care provider receiving payments under this section as re15 quired by an agreement under paragraph (1) or (2) of sub16 section (a) shall agree to a 6-year commitment to full-time 

17 employment, with no more than 1 year passing between 

18 any 2 years of covered employment, as a specialty medi19 cine physician or non-physician specialty health care pro20 vider, as applicable, in the United States in a rural com21 munity experiencing a shortage of specialty medicine phy22 sicians or non-physician specialty health care providers, as 

23 applicable. 


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1 ‘‘(e) INELIGIBILITY FOR DOUBLE BENEFITS.—No 

2 borrower may, for the same service, receive a reduction 

3 of loan obligations or a loan repayment under both— 

4 ‘‘(1) this section; and 

5 ‘‘(2) any federally supported loan forgiveness 

6 program, including under section 338B, 338I, or 

7 846 of this Act, or section 428J, 428L, 455(m), or 

8 460 of the Higher Education Act of 1965. 

9 ‘‘(f) BREACH.— 

10 ‘‘(1) LIQUIDATED DAMAGES FORMULA.—The 

11 Secretary may establish a liquidated damages for12 mula to be used in the event of a breach of an 

13 agreement entered into under paragraph (1) or (2) 

14 of subsection (a). 

15 ‘‘(2) LIMITATION.—The failure by a specialty 

16 medicine physician or a non-physician specialty 

17 health care provider to complete the full period of 

18 service obligated pursuant to such an agreement, 

19 taken alone, shall not constitute a breach of the 

20 agreement, so long as the physician or provider com21 pleted in good faith the years of service for which 

22 payments were made to the physician or provider 

23 under this section. 

24 ‘‘(g) SPECIAL RULES FOR NON-PHYSICIAN SPE25 CIALTY HEALTH CARE PROVIDERS.—Non-physician speVerDate Sep 11 2014 15:57 Jun 02, 2022 Jkt 029200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S4330.IS S4330

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1 cialty health care providers participating in the program 

2 under this section are not eligible for other Federal loan 

3 forgiveness programs specific to health care providers. Not 

4 more than 15 percent of amounts made available to carry 

5 out this section for a fiscal year may be allocated to 

6 awards to non-physician specialty health care providers. 

7 ‘‘(h) REPORTS TO CONGRESS.—Not later than 5 

8 years after the date of enactment of this section, and not 

9 less than every other year thereafter through fiscal year 

10 2030, the Secretary shall report to Congress on— 

11 ‘‘(1) the practice location of special medicine 

12 physicians and non-physician specialty health care 

13 providers participating, or who have participated, in 

14 the loan repayment program under this section; and 

15 ‘‘(2) the impact of the loan repayment program 

16 under this section on the availability of specialty 

17 medicine or specialty health care services in the 

18 United States in rural communities experiencing a 

19 shortage of specialty medicine physicians or non20 physician specialty health care providers. 

21 ‘‘(i) DATA UPDATES.—The Administrator of the 

22 Health Resources and Services Administration shall up23 date publicly available data on the supply of specialty med24 icine physicians and non-physician specialty health care 

25 providers, as appropriate. 


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1 ‘‘(j) DEFINITIONS.—In this section: 

2 ‘‘(1) NON-PHYSICIAN SPECIALTY HEALTH CARE

3 PROVIDER.—The term ‘non-physician specialty 

4 health care provider’ means a health professional 

5 other than a physician who is licensed to provide pa6 tient care other than primary care services. 

7 ‘‘(2) SPECIALTY MEDICINE PHYSICIAN.—The 

8 term ‘specialty medicine physician’ means a physi9 cian practicing in— 

10 ‘‘(A) a specialty identified in the report of 

11 the Health Resources and Services Administra12 tion, titled ‘Projecting the Supply of Non-Pri13 mary Care Specialty and Subspecialty Clini14 cians: 2010–2025’; 

15 ‘‘(B) hospice and palliative medicine; 

16 ‘‘(C) geriatric medicine; or 

17 ‘‘(D) another medical specialty, if the Sec18 retary determines that there is evidence dem19 onstrating a significant shortage of providers in 

20 the medical specialty and limited patient access 

21 to care. 

22 ‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—To 

23 carry out this section, there are authorized to be approVerDate Sep 11 2014 15:57 Jun 02, 2022 Jkt 029200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S4330.IS S4330

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1 priated such sums as may be necessary for fiscal years 

2 2022 through 2031.’’. 

Æ 


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