S. 4582

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 4582 Introduced in Senate (IS)]

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119th CONGRESS
2d Session
S. 4582

To amend the Public Health Service Act with respect to the designation 
of general surgery shortage areas, and for other purposes.

_______________________________________________________________________

IN THE SENATE OF THE UNITED STATES

May 20, 2026

Mr. Schatz (for himself, Mr. Barrasso, Ms. Cantwell, Mr. Marshall, and 
Ms. Klobuchar) introduced the following bill; which was read twice and 
referred to the Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

A BILL

To amend the Public Health Service Act with respect to the designation 
of general surgery shortage areas, and for other purposes.

Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Ensuring Access to General Surgery 
Act of 2026''.

SEC. 2. FINDINGS.

Congress finds the following:
(1) According to the Bureau of Health Workforce, the United 
States faces a shortage of physicians.
(2) A 2016 study entitled ``Supply and Demand of General 
Surgeons: Projections From 2014-2030'', prepared by the 
University of North Carolina at Chapel Hill for the American 
College of Surgeons, found that the supply of general surgeons 
will grow slightly by 2030 but will not keep up with overall 
growth in the United States population or demand for surgical 
services.
(3) A 2021 report released by the Association of American 
Medical Colleges projects shortages in all surgical specialties 
of between 15,800 and 30,200 surgeons by 2034.
(4) A 2020 report prepared by the Health Resources and 
Services Administration for the Committee on Appropriations of 
the Senate found a maldistribution of general surgeons 
nationwide, with rural areas having only 69 percent of the 
general surgeons needed to meet demand for care.
(5) In order to accurately prepare for future physician 
workforce demands, comprehensive, impartial research and high-
quality data are needed to inform dynamic projections of 
physician workforce needs.
(6) A variety of factors, including health outcomes, 
utilization trends, growing and aging populations, and delivery 
system changes, influence workforce needs and should be 
considered as part of flexible projections of workforce needs.
(7) Given the particularly acute needs in many rural and 
other surgical workforce shortage areas, additional efforts to 
assess the adequacy of the current general surgeon workforce 
are necessary.

SEC. 3. STUDY ON DESIGNATION OF GENERAL SURGICAL HEALTH PROFESSIONAL 
SHORTAGE AREAS.

Part D of title III of the Public Health Service Act (42 U.S.C. 
254b et seq.) is amended by adding at the end the following:

``Subpart XIII--General Surgery Shortage Areas

``SEC. 340J. DESIGNATION OF GENERAL SURGERY SHORTAGE AREAS.

``(a) General Surgery Shortage Area Defined.--For purposes of this 
section, the term `general surgery shortage area' means, with respect 
to an urban, suburban, or rural area in the United States, an area that 
has a population that is underserved by general surgeons.
``(b) Study and Report.--
``(1) Study.--The Secretary, acting through the 
Administrator of the Health Resources and Services 
Administration, shall conduct a study on the following matters 
relating to access by underserved populations to general 
surgeons:
``(A) Whether current shortage designations, such 
as the designation of health professional shortage 
areas under section 332, results in accurate 
assessments of the adequacy of local general surgeons 
to address the needs of underserved populations in 
urban, suburban, or rural areas.
``(B) Whether another measure of access to general 
surgeons by underserved populations, such as one based 
on general surgeons practicing within hospital service 
areas, would provide more accurate assessments of 
shortages in the availability of local general surgeons 
to meet the needs of those populations.
``(C) Potential methodologies for the designation 
of general surgery shortage areas, including the 
methodology described in paragraph (2).
``(2) Methodology for the designation of areas.--Among the 
methodologies considered under paragraph (1)(C) for the 
designation of general surgery shortage areas, the Secretary 
shall analyze the effectiveness and accuracy of the following 
methodology:
``(A) Development of surgery service areas.--
Development of surgery service areas through the 
identification of hospitals with surgery services and 
the identification of populations by ZIP Code areas 
using Medicare patient origin data.
``(B) Identification of surgeons.--Identification 
of all actively practicing general surgeons.
``(C) Surgeon to population ratios.--Development of 
general surgeon-to-population ratios for each surgery 
service area.
``(D) Thresholds.--
``(i) In general.--Determination of 
threshold general surgeon-to-population ratios 
for the number of general surgeons necessary to 
treat a population for each of the following 
levels:
``(I) Optimal supply of general 
surgeons.
``(II) Adequate supply of general 
surgeons.
``(III) Shortage of general 
surgeons.
``(IV) Critical shortage of general 
surgeons.
``(ii) Considerations.--In determining the 
thresholds under clause (i), the Secretary 
shall not assume that the current supply of 
general surgeons nationwide is the optimal or 
adequate level and shall consider additional 
factors such as wait times, health outcomes, 
ground transportation time to the nearest 
health care center with a general surgeon, 
critical access hospitals with surgical 
capabilities but lacking a general surgeon, and 
patient experience.
``(3) Report.--Not later than 1 year after the date of the 
enactment of this subpart, the Secretary shall submit to 
Congress a report on the study conducted under this subsection.
``(4) Consultation.--In conducting the study under 
paragraph (1), the Secretary shall consult with relevant 
stakeholders, including medical societies, organizations 
representing surgical facilities, organizations with expertise 
in general surgery, and organizations representing patients.
``(5) Publication of data.--The Secretary shall 
periodically collect and publish in the Federal Register--
``(A) data comparing the availability and need of 
general surgery services in urban, suburban, or rural 
areas in the United States; and
``(B) if the Secretary designates one or more 
general surgery shortage areas under subsection (c), a 
list of the areas so designated.
``(c) Designation of General Surgery Shortage Areas.--
``(1) Methodology developed through regulation.--Based on 
the findings of the report under subsection (b)(3), the 
Secretary may establish, through notice and comment rulemaking, 
a methodology for the designation of general surgery shortage 
areas under this section.
``(2) Requirements.--If the Secretary elects to develop a 
methodology under paragraph (1), the following shall apply:
``(A) Using the methodology established under 
paragraph (1) and taking into consideration the data 
referred to in subsection (b)(5), the Secretary shall--
``(i) designate general surgery shortage 
areas in the United States;
``(ii) publish a descriptive list of the 
areas; and
``(iii) review annually, and, as necessary, 
revise such designations.
``(B) The Secretary shall follow similar procedures 
with respect to notice to appropriate parties, 
opportunities for comment, dissemination of 
information, and reports to Congress in designating 
general surgery shortage areas under this section as 
those that apply to the designation of health 
professional shortage areas under section 332.
``(C) In designating general surgery shortage areas 
under this subsection, the Secretary shall consult with 
relevant stakeholders, including medical societies, 
organizations representing surgical facilities, 
organizations with expertise in general surgery, and 
organizations representing patients.''.
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