Physician Shortage Area 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 or spent a substantial portion of their life in a rural area or small town and intend to practice in a similar area (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 U.S. 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.
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
Rural Physician Shortages in Pennsylvania & Delaware
Physician shortage is a particularly serious problem in the states of Pennsylvania and Delaware, where more than 20% of people live 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. 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.
Priority for our PSAP Program is therefore given to Pennsylvania and Delaware residents, and to students from the seven undergraduate institutions in Pennsylvania and Delaware that are part of the PSAP Cooperative Program:
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 sophomore medical student from the PSAP, to help guide them through the Program.
Rural Area Medicinal Experience
PSAP students take at least one of their required 3rd year clerkships in a smaller community outside the Philadelphia metropolitan area (currently the family medicine clerkship at Latrobe Area Hospital, or one of the family medicine, internal medicine, general surgery or obstetrics/gynecology clerkships at York Hospital).
Students are also encouraged to take at least one of their senior rotations or electives in a rural area or small town, and are given priority to take their senior-year outpatient subinternship in family medicine at a preceptorship in a rural location.
Robert J. Motley, MD, MHCDS
Fred W. Markham, MD
Associate Director, PSAP
Howard K. Rabinowitz, MD
Director Emeritus, PSAP
Frequently Asked Questions
Who should apply to PSAP?
Applicants who have grown up in (or spent a substantial part of their life in) a rural area or small town, AND who are committed to practice in a rural area or small town (not necessarily their home town), should apply to the PSAP. Highest priority will be given to those planning a career in family medicine.
What is family practice?
Family practice continues to be one of the more popular medical specialties, with almost 10% of national medical school graduates entering the field. Family physicians provide comprehensive and continuing care for people of all ages, caring for most types of medical problems. Family medicine is a specialty that emphasizes forming long-term relationships with patients and their families, and providing high-quality personal care.
What if I plan to practice another specialty, or am unsure of my future specialty?
Although applicants planning family medicine are given the highest priority for the PSAP, many rural communities also have a shortage of other physicians, especially other general physicians (e.g., general internal medicine, general pediatrics, obstetrics and gynecology, general surgery, emergency medicine). As a result, applicants planning any specialty, or who are unsure of their future specialty, will also be given consideration for the PSAP.
What are the benefits, requirements & expectations of the PSAP?
Students who matriculate into Thomas Jefferson University's PSAP are required to take the PSAP curriculum during medical school.
They receive mentorship from:
- A medical school faculty advisor
- A 'Big Sib' (sophomore medical student) from PSAP
- A family physician advisor to serve as their clinical mentor during their first year longitudinal clinical experience (optional)
- Do paid summer research in family medicine during the summer after their first year of medical school
- Take at least one of their 3rd year required clinical clerkships at an affiliated hospital in a smaller community located outside of the Philadelphia metropolitan area
- Take their 4th year four-week Outpatient Subinternship in family medicine at a private office preceptorship in a rural area
- Take at least one of their four-week senior rotations or electives in a rural area or small town (e.g., on an American Indian reservation)
- Take a residency of their choice after medical school
After graduation, students are expected to practice in a rural area or small town, preferably in Pennsylvania or Delaware, for their professional career.
How can I apply to the PSAP?
Applicants who want to participate in PSAP should indicate so on the PSAP question of the SKMC Secondary Application Form. The PSAP application form (PDF) should also be completed by November 15th. This application form includes a list of Pennsylvania and Delaware counties that contain underserved rural areas and small towns, although students from similar areas in other Pennsylvania and Delaware counties or other states are also invited to apply to the Program.