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) intro-
duced 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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Ensuring Access to 
General Surgery Act of 2019’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
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(1) According to the Bureau of Health Work-
force, the United States faces a shortage of physi-
cians. 
(2) A 2016 study entitled ‘‘Supply and Demand 
of General Surgeons: Projections From 2014–2030’’, 
prepared by the University of North Carolina at 
Chapel Hill for the American College of Surgeons, 
found that the supply of general surgeons will grow 
slightly by 2030 but will not keep up with overall 
growth in the United States population or demand 
for surgical services. 
(3) A 2018 report released by the American As-
sociation of Medical Colleges projects shortages in 
all surgical specialties of between 20,700 and 30,500 
surgeons by 2030. 
(4) In order to accurately prepare for future 
physician workforce demands, comprehensive, impar-
tial research and high quality data are needed to in-
form dynamic projections of physician workforce 
needs. 
(5) A variety of factors, including health out-
comes, utilization trends, growing and aging popu-
lations, and delivery system changes, influence work-
force needs and should be considered as part of 
flexible projections of workforce needs. 
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(6) Given the particularly acute needs in many 
rural and other surgical workforce shortage areas, 
additional efforts to assess the adequacy of the cur-
rent general surgeon workforce are necessary. 
SEC. 3. STUDY ON DESIGNATION OF GENERAL SURGERY 
SHORTAGE AREAS. 
Part D of title III of the Public Health Service Act 
(42 U.S.C. 254b et seq.) is amended by adding at the end 
the following: 
‘‘Subpart XIII—General Surgery Shortage Areas 
‘‘SEC. 340J. DESIGNATION OF GENERAL SURGERY SHORT-
AGE AREAS. 
‘‘(a) GENERAL SURGERY SHORTAGE AREA DE-
FINED.—For purposes of this section, the term ‘general 
surgery shortage area’ means, with respect to an urban, 
suburban or rural area in the United States, an area that 
has a population that is underserved by general surgeons. 
‘‘(b) STUDY AND REPORT.— 
‘‘(1) STUDY.—The Secretary, acting through 
the Administrator of the Health Resources and Serv-
ices Administration, shall conduct a study on the fol-
lowing matters relating to access by underserved 
populations to general surgeons: 
‘‘(A) Whether current shortage designa-
tions, such as the designation of health profes-
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sional shortage areas under section 332, results 
in accurate assessments of the adequacy of local 
general surgeons to address the needs of under-
served populations in urban, suburban, or rural 
areas. 
‘‘(B) Whether another measure of access 
to general surgeons by underserved populations, 
such as one based on general surgeons prac-
ticing within hospital service areas, would pro-
vide more accurate assessments of shortages in 
the availability of local general surgeons to 
meets the needs of those populations. 
‘‘(C) Potential methodologies for the des-
ignation of general surgery shortage areas, in-
cluding the methodology described in paragraph 
(2). 
‘‘(2) METHODOLOGY FOR THE DESIGNATION OF 
AREAS.—Among the methodologies considered under 
paragraph (1)(C) for the designation of general sur-
gery shortage areas, the Secretary shall analyze the 
effectiveness and accuracy of the following method-
ology: 
‘‘(A) DEVELOPMENT OF SURGERY SERVICE 
AREAS.—Development of surgery service areas 
through the identification of hospitals with sur-
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gery services and the identification of popu-
lations by zip code areas using Medicare patient 
origin data. 
‘‘(B) IDENTIFICATION
OF
SURGEONS.— 
Identification of all actively practicing general 
surgeons. 
‘‘(C) SURGEON TO POPULATION RATIOS.— 
Development of general surgeon-to-population 
ratios for each surgery service area. 
‘‘(D) 
THRESHOLDS.—Determination 
of 
threshold general surgeon-to-population ratios 
for the number of general surgeons necessary to 
treat a population for each of the following lev-
els: 
‘‘(i) Optimal supply of general sur-
geons. 
‘‘(ii) Adequate supply of general sur-
geons. 
‘‘(iii) Shortage of general surgeons. 
‘‘(iv) Critical shortage of general sur-
geons. 
‘‘(3) REPORT.—Not later than one year after 
the date of the enactment of this subpart, the Sec-
retary shall submit to Congress a report on the 
study conducted under this subsection. 
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‘‘(4) CONSULTATION.—In conducting the study 
under paragraph (1), the Secretary shall consult 
with relevant stakeholders, including medical soci-
eties, organizations representing surgical facilities, 
organizations with expertise in general surgery, and 
organizations representing patients. 
‘‘(5) PUBLICATION
OF
DATA.—The Secretary 
shall periodically collect and publish in the Federal 
Register— 
‘‘(A) data comparing the availability and 
need of general surgery services in urban, sub-
urban or rural areas in the United States; and 
‘‘(B) if the Secretary designates one or 
more general surgery shortage areas under sub-
section (c), a list of the areas so designated. 
‘‘(c) DESIGNATION OF GENERAL SURGERY SHORT-
AGE AREAS.— 
‘‘(1) METHODOLOGY
DEVELOPED
THROUGH 
REGULATION.—Not later than 12 months after the 
date of the submission of the report under sub-
section (b)(3), the Secretary may establish, through 
notice and comment rulemaking, a methodology for 
the designation of general surgery shortage areas 
under this section. 
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‘‘(2) REQUIREMENTS.—If the Secretary elects 
to develop methodology under paragraph (1), the fol-
lowing shall apply: 
‘‘(A) Using the methodology established 
under paragraph (1) and taking into consider-
ation the data referred to in subsection (b)(5), 
the Secretary shall— 
‘‘(i) designate general surgery short-
age areas in the United States; 
‘‘(ii) publish a descriptive list of the 
areas; and 
‘‘(iii) review annually, and, as nec-
essary, revise such designations. 
‘‘(B) The Secretary shall follow similar 
procedures with respect to notice to appropriate 
parties, opportunities for comment, dissemina-
tion of information, and reports to Congress in 
designating general surgery shortage areas 
under this section as those that apply to the 
designation of health professional shortage 
areas under section 332. 
‘‘(C) In designating general surgery short-
age areas under this subsection, the Secretary 
shall consult with relevant stakeholders, includ-
ing medical societies, organizations representing 
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surgical facilities, organizations with expertise 
in general surgery, and organizations rep-
resenting patients.’’. 
Æ 
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