,,ii  #aadth ,,congress  #b;d ,session  
,s4 #caff  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,july #ab1     
#bjaf,mr4 ,grassley 7for himself and    
,mr4 ,schatz7 introduced the following  
bill2 which was read twice and referred 
to the ,committee on ,health1           
,education1 ,labor1 and ,pensions  ,a   
,,bill  ,to direct the ,secretary of    
,health and ,human ,services to conduct 
a study on the designation of surgical  
health professional shortage areas4  #a4
 ,short title ,this ,act may be cited as
 the ,ensuring ,access to ,general      
,surgery ,act of #bjaf4  #b4 ,findings  
,congress finds the following3  7#a7    
,according to the ,bureau of ,health    
,workforce1 the ,united ,states faces a 
shortage of physicians4  7#b7 ,in order 
to accurately prepare for future        
physician workforce demands1            
comprehensive1 impartial research and   
high quality data is needed to inform   
dynamic projections of physician        
workforce needs4  7#c7 ,a variety of    

factors1 including health outcomes1     
utilization trends1 growing and aging   
populations1 and delivery system        
changes1 influence workforce needs and  
should be considered as part of flexible
 projections of workforce needs4  7#d7  
,given the particularly acute needs for 
surgeons in many rural areas1 additional
 efforts to assess adequacy of the      
current surgeon workforce are necessary4
  #c4 ,study on designation of surgical 
health professional shortage areas  7a7 
,study ,the ,secretary of ,health and   
,human ,services 7in this section       
referred to as the ,secretary7 shall    
conduct a study on the following matters
 relating to access by underserved      
populations to general surgeons3  7#a7  
,whether the designation of health      
professional shortage areas under       
section #ccb of the ,public ,health     
,service ,act 7#db ,u4,s4,c4 #bed;e7    
results in accurate assessments of the  
adequacy of local general surgeons to   
address the needs of underserved        

populations in urban1 suburban1 or rural
 areas4  7#b7 ,whether another measure  
of access to general surgeons by        
underserved populations1 such as        
hospital service areas1 would provide   
more accurate assessments of shortages  
in the availability of local general    
surgeons to meets the needs of those    
populations4  7#c7 ,the appropriateness 
of establishing the designation under   
such section #ccb of surgical health    
professional shortage areas 7as defined 
in subsection 7b774  7b7 ,surgical      
health professional shortage area       
defined ,for purposes of this section1  
the term surgical health professional   
shortage area means1 with respect to an 
urban1 suburban or rural area in the    
,united ,states1 an area with a         
population that is underserved by       
general surgeons4  7c7 ,designation of  
surgical health professional shortage   
area 7,,shpsa7  7#a7 ,in general ,in    
carrying out the study under this       
section1 the ,secretary shall consider  

potential methodologies for the         
designation of surgical health          
professional shortage areas1 including--
  7,a7 the criteria under which areas   
are designated as health professional   
shortage areas under section #ccb of the
 ,public ,health ,service ,act 7#db     
,u4,s4,c4 #bed;e72 and  7,b7 the        
methodology described in paragraph 7#b74
  7#b7 ,methodology for the designation 
of a ,,shpsa ,among the methodologies   
considered under paragraph 7#a71 the    
,secretary shall analyze the potential  
effectiveness and accuracy of the       
following methodology3  7,a7            
,development of surgery service areas   
,development of surgery service areas   
through the identification of hospitals 
with surgery services and the           
identification of populations by zip    
code areas using ,medicare patient      
origin data4  7,b7 ,identification of   
surgeons ,identification of all actively
 practicing general surgeons4  7,c7     
,surgeon to population ratios           

,development of general                 
surgeon-to-population ratios for each   
surgery service area4  7,d7 ,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 levels3  7i7 ,optimal supply  
of general surgeons4  7ii7 ,adequate    
supply of general surgeons4  7iii7      
,shortage of general surgeons4  7iv7    
,critical shortage of general surgeons4 
7d7 ,consultation ,in conducting the    
study under this section1 the ,secretary
 shall consult with relevant            
stakeholders with appropriate expertise1
 including representatives of           
organizations representing surgeons and 
patients4  7e7 ,report ,not later than  
one year after the date of the enactment
 of this ,act1 the ,secretary shall     
submit to ,congress a report on the     
study conducted under this section1     
including such recommendations for      
legislation or administrative action as 

the ,secretary determines appropriate4