Physician Shortage Area Program (PSAP)
About the Program
The Physician Shortage Area Program (PSAP) is an admissions and educational program designed to increase the supply and retention of physicians in rural areas and small towns, especially in Pennsylvania and Delaware. The program is designed to recruit and educate medical students who:
- Grew up in a rural area or small town, or spent a substantial portion of their life in a similar area; and also
- Intend to practice in a rural area or small town (with priority for those planning to practice the specialty of family medicine).
The shortage of physicians, especially primary care physicians, in rural areas of the US represents one of the most intractable health policy problems of the past century. With 20% of the population living in rural areas but only 9% of physicians practicing there, rural areas represent one of the largest physician underserved populations in the country. This physician shortage has serious implications for access to care, the quality of care, and the health of those individuals living in rural areas.
Rural Physician Shortages in Pennsylvania & Delaware
This is a particularly serious problem in the states of Pennsylvania and Delaware, where more than one of every five persons lives in a rural area. Pennsylvania has the third largest rural population of any state. In addition, Pennsylvania has a severe maldistribution of physicians, with almost one-half of the doctors in the state practicing in only three counties (Philadelphia County, its suburban Montgomery County, and Pittsburgh's Allegheny County), even though the remaining 64 counties have almost three-quarters of the population. Overall, 55 of the 67 Pennsylvania 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.
It is unlikely that this shortage of rural physicians will improve in the near future, since one-quarter of primary care physicians in these states are 55 years or older, and nationally, only 3% of recent medical school students indicate that they plan to practice in a rural area or small town.
In order to address this serious problem, Jefferson Medical College of Thomas Jefferson University developed the Physician Shortage Area Program (PSAP) in 1974. The PSAP is a unique admissions and educational program designed to increase the number of rural physicians, especially family physicians. Since that time, the PSAP has been highly successful in increasing the number of rural family physicians. Outcomes of the PSAP, published in the New England Journal of Medicine and the Journal of the American Medical Association (JAMA), have shown that PSAP graduates:
- Are more than 8 times as likely as their peers to become rural family physicians;
- Have a retention rate of 79% after 11-16 years in practice, and;
- Account for 21% of family physicians practicing in rural Pennsylvania who graduated from one of the state's 7 medical schools, even though they represent only 1% of graduates from those schools.