Health Professional Shortage Areas

Healthcare access is key to health outcomes. When people must travel far to visit a healthcare provider (a structural barrier to healthcare access), they are more likely to delay treatment and forgo preventative care and screenings.[1]
The Health Resources & Services Administration (HRSA) designates and scores Health Professional Shortage Areas (HPSAs), geographic areas that do not have enough healthcare providers.[2] The Bureau of Health Workforce designates HPSAs according to the type of health professional: primary care, mental health,[3] and dental healthcare. The HPSA label can go on a geographic area for a certain population, like Medicare-eligible residents or low-income residents; on a geographic area for the entire population of that area; or on facilities, like Federally Qualified Health Centers or correctional institutions.[4] However, HPSA designations associated with facilities and designations withdrawn or proposed for withdrawal were not considered for this report.
Each type of score is based on the same foundational criteria―population-to-provider ratio, poverty, and travel time―and includes some additional criteria specific to the type of designation. Primary care HPSA scores range from 0-25 and take infant mortality and low birthweight rates into account. Dental HPSA scores range from 0-26 and include water fluoridation status. Mental health HPSA scores range from 0-25 and include the proportion of people over 65, under 18, and dealing with alcohol or substance abuse. Higher HPSA scores indicate a worse shortage and greater priority; in this report, any score greater than zero is considered a HPSA.[5] For geographies, the HPSA designation is assigned to 2010 census tracts for 2021 (census tracts were redefined for the 2020 decennial census but were not yet in use by the HRSA).
Census tracts in San Diego County with a population or geographic HPSA as of December 31, 2021, were identified. For primary care, there were 39 total census tracts in central and southeast San Diego County where the HPSA designation applied to the Medicaid-eligible population (Figure 1). For dental healthcare, there were 43 census tracts in north county where the HPSA designation applied to the Medicaid-eligible population (Figure 2). For mental health, there were 152 census tracts in south and central San Diego County where the shortage designation applied to the low-income population of those areas and one census tract along the southern border where the shortage designation applied to the whole population of the census tract (Figure 3). In total, 177 of 628 (28.2%) census tracts in San Diego County experienced at least one type of health professional shortage; 18 census tracts had all three types of HPSA and 21 census tracts had two types of HPSA (all were mental health and primary care) (data not shown).
Limitations of these data include how the HPSA scores are calculated. HPSA scores are based on the federal poverty level and are not adjusted for cost of living. This may artificially reduce the HPSA scores throughout San Diego County, where wages are higher than in many other areas of the country. Although this means the scores may not capture all areas with a health professional shortage, these data are still helpful for identifying areas with the most extreme need.

Data Information
Data Source: Health Resources & Services Administration, 2021.
  • HPSA designations are based on 2010 Census Tracts.
References
  1. Carrillo, J., Carrillo, V., Perez, H., Salas-Lopez, D., Natale-Pereira, A., & Alex, B. (2011). Defining and targeting health care access barriers. Journal of Health Care for the Poor and Underserved, 22, 562–575. https://doi.org/10.1353/hpu.2011.0037
  2. HPSA Find (hrsa.gov) Retrieved August 22, 2023.
  3. Mental health care shortage areas can either be defined by the number of psychiatrists, other mental health practitioners, or both; the publicly available data do not clarify which definition was used for mental health care. It is also not clear from the data nor the documentation whether behavioral health providers, including providers of substance use services, are included in the mental health HPSA designation.
  4. Bureau of Health Workforce. (n.d.). What is Shortage Designation? Retrieved September 8, 2022, from https://bhw.hrsa.gov/workforce-shortage-areas/shortage-designation
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Updated February 7, 2024