Map of HPSA Scores sourced from Rural Health Information Hub.
This work was developed by the CPI Center for Healthcare Disparities, led by Associates of the University of Louisville Chapter, consultation with research faculty in the Commonwealth Institute of Kentucky, and in considering feedback from the Kentucky Rural Hospital Association.
Years before the COVID-19 pandemic brought on a health care shortage in America, its rural areas were already struggling to obtain and attract primary care medical practitioners. Even though the number of medical school graduates in the U.S. has steadily increased throughout the years, there is a general disinterest in rural or small-town practice, and experts project that this shortage will only be exacerbated in the future by the country’s recent population shift from rural to urban areas. In Kentucky currently, there are 191 Health Resources and Services Administration designated Primary Care Health Professional Shortage Areas (HPSAs), meaning that approximately 43% of the state does not have their primary care needs met. Physicians, advanced practice registered nurses (APRNs) and physician assistants (PAs) are considered to be the core disciplines in primary care. Because those that live in rural areas are already more likely to die from heart disease, cancer, chronic lower respiratory disease, and stroke than their urban counterparts, lack of access to this preventative primary care only perpetuates the health crisis in rural areas.
Each of these primary care disciplines (physicians, APRNs, and PAs) require significant clinical training during medical school that must be provided in community-based settings by community-based preceptors who are not employed by educational institutions. A preceptor is an experienced medical practitioner who voluntarily provides supervision during clinical practice. In Kentucky, these primary care preceptors are not currently compensated for taking on students to train; the ones that do so do it out of commitment to the betterment of the healthcare sector.
Thus, CPI formulated a policy to provide nonrefundable income tax credits to be claimed by any non-compensated, community-based, Kentucky-licensed medical preceptor located in one of Kentucky’s 191 HRSA-designated Primary Care Health Professional Shortage Areas (HPSAs) supervising 3rd and 4th year medical/osteopathic students, physician assistant students, and advanced practice registered nurse students. In forming the text of the bill, noting that similar to Kentucky prior legislation without geographic tailoring had not passed in the Georgia assembly in years prior, CPI Associates consulted with bill sponsors in the Georgia State Legislature to consider translation to the Kentucky General Assembly.
The goals of such an approach is to enhance necessary state investment in educational programs seeking to provide the next generations of primary care providers, though decrease the cost by tailoring the investment to highest scoring rural HPSA areas. This is intended to decrease the number of Primary Care Health Professional Shortage Areas (HPSAs) in Kentucky, increase the number of primary care preceptors in the state, and ultimately combat health inequity in the state’s rural and underserved areas.
This proposal has resulted in the sponsorship of HB 718 in the 2022 Kentucky General Assembly legislative session with an amendment informed by CPI's policy reccomendation.
See our briefs for more:
To read the full policy short brief, click here: A Geographically Targeted Approach for a Preceptor Tax Incentive Using Primary Care Health Professional Shortage Areas (HPSAs) - The Commonwealth Policy Papers
To read the draft state legislation developed by CPI, click here: Draft State Legislation: A Geographically Targeted Approach for a Preceptor Tax Incentive Using Primary Care Health Professional Shortage Areas (HPSAs)