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 under-
served rural communities. 
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 ‘‘Rural Physician Pipe-
line Act of 2009’’. 
SEC. 2. RURAL PHYSICIAN TRAINING GRANTS. 
Part C of title VII of the Public Health Service Act 
(42 U.S.C. 293k et seq.) is amended— 
(1) after the part heading, by inserting the fol-
lowing: 
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‘‘Subpart I—Medical Training Generally’’; 
and 
(2) by inserting at the end the following: 
‘‘Subpart II—Training in Underserved Communities 
‘‘SEC. 749. RURAL PHYSICIAN TRAINING GRANTS. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Administrator of the Health Resources and Services 
Administration, shall establish a program to make grants 
to eligible entities for the purposes of— 
‘‘(1) assisting eligible entities in recruiting stu-
dents most likely to practice medicine in underserved 
rural communities; 
‘‘(2) providing rural-focused training and expe-
rience; and 
‘‘(3) increasing the number of recent allopathic 
and osteopathic medical school graduates who prac-
tice in underserved rural communities. 
‘‘(b) ELIGIBLE ENTITIES.—In order to be eligible to 
receive a grant under this section, an entity shall— 
‘‘(1) be a school of allopathic or osteopathic 
medicine accredited by a nationally recognized ac-
crediting agency or association approved by the Sec-
retary for this purpose, or any combination or con-
sortium of such schools; and 
‘‘(2) submit an application to the Secretary at 
such time, in such form, and containing such infor-
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mation as the Secretary may require, including a 
certification that such entity— 
‘‘(A) will use amounts provided to the in-
stitution to— 
‘‘(i) establish and carry out a Rural 
Physician Training Program described in 
subsection (d); 
‘‘(ii) improve an existing rural-focused 
training program to meet the requirements 
described in subsection (d) and carry out 
such program; or 
‘‘(iii) expand and carry out an exist-
ing rural-focused training program that 
meets the requirements described in sub-
section (d); and 
‘‘(B) employs, or will employ within a 
timeframe sufficient to implement the Program 
(as described by a timetable and supporting 
documentation in the application of the eligible 
entity), faculty with experience or training in 
rural medicine or with experience in training 
rural physicians. 
‘‘(c) PRIORITY.—In awarding grant funds under this 
section, the Secretary shall give priority to eligible entities 
that— 
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‘‘(1) demonstrate a record of successfully train-
ing students, as determined by the Secretary, who 
practice medicine in underserved rural communities; 
‘‘(2) demonstrate that an existing academic 
program of the eligible entity produces a high per-
centage, as determined by the Secretary, of grad-
uates from such program who practice medicine in 
underserved rural communities; 
‘‘(3) demonstrate rural community institutional 
partnerships, though such mechanisms as matching 
or contributory funding, documented in-kind services 
for implementation, or existence of training partners 
with interprofessional expertise (such as dental, vi-
sion, or mental health services) in community health 
center training locations or other similar facilities; or 
‘‘(4) submit, as part of the application of the 
entity under subsection (b), a plan for the long-term 
tracking of where the graduates of such entity are 
practicing medicine. 
‘‘(d) USE OF FUNDS.— 
‘‘(1) ESTABLISHMENT.—An eligible entity re-
ceiving a grant under this section shall use the funds 
made available under such grant to— 
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‘‘(A) establish and carry out a ‘Rural Phy-
sician Training Program’ (referred to in this 
section as the ‘Program’); 
‘‘(B) improve an existing rural-focused 
training program to meet the Program require-
ments described in this subsection and carry 
out such program; or 
‘‘(C) expand and carry out an existing 
rural-focused training program that meets the 
Program requirements described in this sub-
section. 
‘‘(2) STRUCTURE OF PROGRAM.—An eligible en-
tity shall— 
‘‘(A) enroll no fewer than 10 students per 
class year into the Program; and 
‘‘(B) develop criteria for admission to the 
Program that gives priority to students— 
‘‘(i) who have originated from or lived 
for a period of 2 or more years in an un-
derserved rural community; and 
‘‘(ii) who express a commitment to 
practice medicine in an underserved rural 
community. 
‘‘(3) CURRICULA.—The Program shall require 
students to enroll in didactic coursework and clinical 
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experience particularly applicable to medical practice 
in underserved rural communities, including— 
‘‘(A) clinical rotations in underserved rural 
communities, and in specialties including family 
medicine, internal medicine, pediatrics, surgery, 
psychiatry, and emergency medicine; 
‘‘(B) in addition to core school curricula, 
additional coursework or training experiences 
focused on medical issues prevalent in under-
served rural communities, including in areas 
such as trauma, obstetrics, ultrasound, oral 
health, and behavioral health; and 
‘‘(C) any coursework or clinical experience 
that— 
‘‘(i) may be developed as a result of 
the Symposium described in subsection (f); 
or 
‘‘(ii) the Secretary finds appropriate. 
‘‘(4) RESIDENCY
PLACEMENT
ASSISTANCE.— 
Where available, the Program shall assist all stu-
dents of the Program in obtaining clinical training 
experiences in locations with postgraduate programs 
offering residency training opportunities in under-
served rural communities, or in local residency train-
ing programs that support and train physicians to 
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practice in underserved rural communities, as well 
as assist all students of the Program in obtaining 
postgraduate residency training in such programs. 
‘‘(5) PROGRAM STUDENT COHORT SUPPORT.— 
The Program shall provide and require all students 
of the Program to participate in social, educational, 
and other group activities designed to further de-
velop, maintain, and reinforce the original commit-
ment of such students to practice in an underserved 
rural community. 
‘‘(e) ANNUAL REPORTING REQUIREMENT.—On an 
annual basis, an eligible entity receiving a grant under this 
section shall submit a report to the Secretary on— 
‘‘(1) the overall success of the Program estab-
lished by the entity, based on criteria the Secretary 
determines appropriate; 
‘‘(2) the number of students participating in 
the Program; 
‘‘(3) the number of graduating students who 
participated in the Program; 
‘‘(4) the residency program selection of grad-
uating students who participated in the Program; 
‘‘(5) the number of graduates who participated 
in the Program who are practicing in underserved 
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rural communities not less than one year after com-
pleting residency training; and 
‘‘(6) the number of graduates who participated 
in the Program who are not practicing in under-
served rural communities not less than one year 
after completing residency training. 
‘‘(f) RURAL TRAINING PROGRAM SYMPOSIUM.— 
‘‘(1) PURPOSES OF SYMPOSIUM.—To assist the 
Secretary in carrying out the Program and making 
grant determinations under this section, the Sec-
retary shall convene a Rural Training Program 
Symposium (referred to in this section as the ‘Sym-
posium’) to— 
‘‘(A) develop best practices that may be in-
corporated into consideration of applications 
under subsection (b); and 
‘‘(B) establish a network of allopathic and 
osteopathic medical schools that have developed 
or will develop rural training programs in ac-
cordance with subsection (d). 
‘‘(2) COMPOSITION.—The Symposium shall in-
clude— 
‘‘(A) representatives from eligible entities 
with existing rural training programs; 
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‘‘(B) representatives from all eligible enti-
ties interested in developing the Program; 
‘‘(C) representatives from area health edu-
cation centers; 
‘‘(D) representatives from the Health Re-
sources and Services Administration; and 
‘‘(E) any other experts or individuals with 
experience in practicing medicine in under-
served rural communities the Secretary deter-
mines appropriate. 
‘‘(g) REGULATIONS.—Not later than 60 days after 
the date of enactment of this section, the Secretary shall 
by regulation define ‘underserved rural community’ for 
purposes of this section. 
‘‘(h) SUPPLEMENT NOT SUPPLANT.—Any eligible en-
tity receiving funds under this section shall use such funds 
to supplement, not supplant, any other Federal, State, and 
local funds that would otherwise be expended by such enti-
ty to carry out the activities described in this section. 
‘‘(i) MAINTENANCE OF EFFORT.—With respect to ac-
tivities for which funds awarded under this section are to 
be expended, the entity shall agree to maintain expendi-
tures of non-Federal amounts for such activities at a level 
that is not less than the level of such expenditures main-
tained by the entity for the fiscal year preceding the fiscal 
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