Health Professional Shortage Area (HPSA)

Key facts

Legal basis

Section 332 of the Public Health Service Act; 42 CFR Part 5

Disciplines

Primary care, dental health and mental health

Designation types

Geographic, population and facility

Primary care threshold

Generally 3,500 people per FTE physician (3,000 with unusually high need)

Applications from

State Primary Care Offices, reviewed by HRSA

What is a Health Professional Shortage Area?

A Health Professional Shortage Area is a federal designation made by the Health Resources and Services Administration (HRSA) under Section 332 of the Public Health Service Act. Each designation applies to one discipline: primary care, dental health or mental health. A county can be a dental HPSA without being a primary care HPSA.

Designations rest mainly on a population-to-provider ratio measured in full-time-equivalent (FTE) clinicians, adjusted for high need. For primary care, the providers counted are physicians (MDs and DOs) in family or general practice, general internal medicine, pediatrics, and obstetrics and gynecology.

Types of HPSA designations

Every HPSA falls into one of three types:

• Geographic HPSA: a whole service area, such as a county or group of census tracts, is short of providers for everyone who lives there.
• Population HPSA: a specific group within an area is underserved, such as low-income, Medicaid-eligible, migrant farmworker or homeless residents.
• Facility HPSA: a specific facility, such as a state mental hospital or a correctional facility, is short of providers.
• Automatic facility HPSA: Health Center Program awardees, look-alikes, tribal health facilities and Rural Health Clinics that meet NHSC site requirements receive a facility designation by law.

How HPSAs are designated and updated

State Primary Care Offices gather data and submit designation requests through HRSA's Shortage Designation Management System. HRSA reviews each request, assigns a HPSA score and publishes the designation. Designations are reviewed and updated as the underlying data changes, so an area can lose or gain HPSA status over time.

Why HPSAs matter

HPSA status unlocks money and staffing programs, which makes it a useful targeting signal:

• The National Health Service Corps places clinicians only at approved sites in HPSAs.
• Medicare pays a 10 percent bonus on physician services furnished in geographic primary care HPSAs, and to psychiatrists in mental health HPSAs.
• Conrad 30 physicians must serve in or treat patients from shortage areas.
• Recruiters, device and pharma field teams and network planners use HPSA maps to find places where patients have few local options.