Advancing federal resource allocation: HPSA and the GME impact factor

Abstract

Health Professional Shortage Areas (HPSA) is a new Graduate Medical Education (GME) resource allocation approach by the US Health and Human Services aimed at producing physicians who practice in these areas. We investigated evidence whether HPSA—an ecological index—is associated with closing physician shortage gaps and the added value of a performance-based index. Using linked administrative data from 1) the American Medical Association's Masterfile (2016 and 2021); 2) the Accreditation Council for Graduate Medical Education sponsoring institutions roster (2021–2022), and the primary care geographic HPSA designation (2021), we assembled a prospective cohort and collapsed these data to the organizational level (N = 622). The diagnostic test is the GME Impact Factor, a performance-based index quantifying the proportion of physicians who practice in a HPSA following medical residency. The reference test is HPSA designation of the sponsoring institution. We assessed sensitivity, specificity, and likelihood ratio test of a positive test (LRT) to appraise HPSA utility on outcome, and the Interclass Coefficient (ICC) to assess similarity, where <0.5 indicates considered poor reliability. Sensitivity is 86.2% (95% CI: 81.9–89.7), specificity is 45.1 (95% CI: 39.7–50.5). LRT is 1.57 (95% CI: 1.55–1.59) and ICC is 0.45 (95% CI: 0.37–0.51). Partial evidence that training sites located within HPSAs are associated with producing physicians who will practice in health professional shortage area following residency training. A performance-based approach — the GME Impact Factor—which utilizes historical production, holds added value in distributing fiscal and personnel resources that yields population-level results. ( Fig. 1 ).