Physician Shortage Area Program

For more than 100 years, the shortage of physicians in rural areas of the United States has been a major health policy problem. Approximately one-fifth (20%) of the nation’s population lives in a rural area, but only about 10 percent of the nation’s physicians are located there. This is considered to be one reason rural Americans have higher rates of death, disability and chronic disease than their urban counterparts.

PSAP has been highly successful in increasing the number of rural family physicians. Since the Program began in 1974, we have trained more than 300 PSAP physicians. The outcomes, published in the New England Journal of Medicine and the Journal of the American Medical Association, have shown that PSAP graduates:

• Are more than eight times as likely as their peers to become rural family physicians
• Have a retention rate of 79% after 11-16 years in practice
• Account for 21% of family physicians practicing in rural Pennsylvania who graduated from one of the state's seven medical schools, even though they represent only 1% of graduates from those schools

The rural physician workforce shortage is a particularly serious problem in the states of Pennsylvania and Delaware, where more than 20% of people live in rural areas.

Pennsylvania has the third largest rural population of any state. In addition, Pennsylvania’s physicians are poorly distributed across the state. Almost one-half of the doctors practice in 3 counties (Philadelphia, Montgomery, and Allegheny near Pittsburgh), while almost three quarters (75%) of the population live in the other 64 counties. Fifty-five of Pennsylvania’s 67 counties contain federally designated Health Profession Shortage Areas (HPSAs) or Medically Underserved Areas (MUAs).

The state of Delaware also has a critical shortage of physicians, with two of its three counties (Sussex and Kent Counties in southern Delaware) designated as rural HPSAs.

There is reason for hope. While the shortage of rural physicians is not likely to be totally resolved in the near future, the emergence of health system networks in Pennsylvania and Delaware means better professional and financial support for those committing to practice in rural locations.

The Physician Shortage Area Program (PSAP) provides for up to 24 places in Sidney Kimmel Medical College’s (SKMC’s) first-year class. Priority is given to applicants enrolled in one of the seven colleges & universities that are members of the PSAP Cooperative:

• Allegheny College
• Bucknell University
• Franklin & Marshall College
• Indiana University of Pennsylvania
• Juniata College
• Pennsylvania State University
• University of Delaware
• University of Scranton

Students from other schools are also welcome to apply.

To summarize, successful applicants to the PSAP:

• Have grown up in a rural or small town.
• Are interested in returning to a similar community to practice after they finish their medical training.
• Are otherwise competitive candidates for medical school. Special consideration is given to residents of Pennsylvania and Delaware and to graduates of the seven PSAP Cooperative undergraduate schools. Applicants from other states and other undergraduate schools are also encouraged to apply.

All incoming PSAP students are provided with an advisor in the Department of Family & Community Medicine at the beginning of medical school. These advisors provide curricular and career guidance, and are available as mentors throughout all four years.

PSAP students also get a “Big Sib", a second year medical student from the PSAP, to help orient them to medical school life and to guide them through the Program.

PSAP students are required to take at least one of their required Phase 2 clinical clerkships in a smaller community. Current sites include Excela Latrobe Hospital (for Family Medicine) and Wellspan York Hospital (for Internal Medicine, General Surgery or Obstetrics/Gynecology). PSAP is also piloting a longitudinal curriculum for the six Phase 2 clinical rotations in affiliation with Atlantic Health System. This option features sites in rural and suburban communities in New Jersey.

Students are also encouraged to take at least one of their Phase 3 clinical rotations in a rural/small town setting. PSAP students are given schedule priority for outpatient clinical rotations with family physicians in smaller community settings. Many of these doctors are graduates of PSAP, SKMC or its residency programs and enjoy having students in their practices.