Highest Need Primary Care Health Professional Shortage Areas (HPSAs) in Virginia

by James C. Sherlock

Without adequate primary medical, dental and mental health care, people cannot function properly. They often go through life sick and untreated. 

By “sick” in this case I refer to less well than achievable with proper primary care.

Just because there is adequate access to primary care in a particular area does not mean that all people take advantage of it, but lack of access raises significantly the probability of a lifetime of sickness.

Babies are born sick, children go to school while sick, adults work while sick and the elderly suffer and die early.

It is useful to review the areas in Virginia that have profound shortages of primary care providers. Medicaid is a false promise when such shortages exist. Economic development is very unlikely.

Some are where you might guess if you thought about it. Some are not.

A Heath Professional Shortage Area – HPSA – is a federal designation which recognizes that a particular geographical area, population, or institutional facility is experiencing a shortage of primary care services. 

Here is the theory of how HPSA designations are supposed to work:

Once a HPSA designation is achieved, the federal government commits to assist by infusing aid through various programs and incentives, which make the area more attractive to physicians.

As these professionals establish their practices within a HPSA, the shortage of primary caregivers is alleviated, government assistance is eventually withdrawn, and the physicians frequently put down permanent roots within their service area to the mutual benefit of their careers, families, and the community.

HPSA Scores

are developed for use by the National Health Services Corps (NHSC) and Health Resources and Services Administration (HRSA) to prioritize the need of designations. 

Based on the severity of a health professional shortage, scores range from 1 to 25 for primary care and mental health, and 1 to 26 for dental health. The higher the score, the greater the need for additional medical services, which increases an area’s priority for placement of new practitioners (eligibility for acquiring NHSC recruits is typically a score of 14 or higher). 

Several factors go into determining a score, such as providers-to-population ratios, poverty levels, and the incidence of infant mortality or low birth weights.

Federally Qualified Health Centers (FQHCs) are community-based health care providers that receive funds from the HRSA Health Center Program to provide primary care services in underserved areas. They must meet a stringent set of requirements, including providing care on a sliding fee scale based on ability to pay and operating under a governing board that includes patients.

There are three types of HPSA designations: Geographic, Population, and Facility. 

  • Geographic HPSAs have a shortage of providers for the total population within a geographic area; 
  • Population HPSAs have an underserved population group such as those with low incomes or migrant farm workers; 
  • Facility designations are Community Health Centers, Rural Health Clinics, or federal and state correctional facilities whose facility is underserved and in need of a HPSA.


The Health Resources and Services Administration (HRSA) Bureau of Health Workforce keeps track of HPSAs. Follow the link, enter Virginia, select “designated,” check “primary care,” “mental health,” and “dental care,” and submit. 

Dental Health is the biggest healthcare shortage discipline in Virginia. 

The highest need Dental Health HPSA’s in Virginia are very high-need indeed.  They include nine Virginia counties/cities with one or more Federally Qualified Health Center (FQHC) with HPSA scores of 25:

  • Buckingham County
  • Scott County
  • Richmond City (two)
  • Montgomery County
  • Sussex County (two)
  • Lynchburg City (one FQHC and one FQHC look-alike)
  • Roanoke City
  • Martinsville City
  • Lee County

The highest primary medical care needs are seen, with HPSA scores of 21, at a federal correctional facility in Lee County and FQHC’s in

  • Scott County
  • Danville City (two)
  • Portsmouth City
  • Rockbridge County

Primary medical care HPSA Scores of 20 are found in a low income HPSA in Danville and FQHC’s in

  • Richmond City (two)
  • Lee County 
  • Charles City County 

Mental Health HPSA scores of 22 are found at FQHCs in:

  • Harrisonburg City
  • Danville City
  • Rockbridge County

Mental Health HPSA scores of 21 are found at correctional facilities in Lee and Tazewell counties and at FQHCs in:

  • Nelson County 
  • Accomack County
  • Lynchburg City

Immediately across the state border on I-64, Greenbrier County WV FQHC which serves Virginians has critical shortages of dental care, primary medical care and mental health care providers.

Federal healthcare programs associated with HPSA designations can alleviate shortages. For examples, deselect “designated” and select “Proposed for withdrawal” and “Withdrawn” and submit.  

You will see there a lot of success stories since 1979.

However, it remains very hard to get health professionals to establish practices in many areas that most need them not only because of financial, but also lifestyle disincentives. 

For those, the federal programs need state support.

What to do. One of the reasons that I drafted and then-Delegate Jason Miyares, R-Va Beach, carried a Virginia Health Enterprise Zones (HEZ) Act was to focus state efforts to align with those of the federal government. 

In Maryland the state HEZ’s achieved the results that federal efforts had not been able to get. It saved Maryland Medicaid hundreds of millions of dollars because of the reduction of hospital admissions resulting from chronic diseases untreated by primary care at early stages.  

We have yet to establish a HEZ program in Virginia.

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19 responses to “Highest Need Primary Care Health Professional Shortage Areas (HPSAs) in Virginia”

  1. Four years ago Virginia enacted Medicaid expansion. One of the concerns I had at the time was that providing healthcare coverage was not the same as providing access, that Virginia was doing little to address the shortage of healthcare practitioners, especially physicians, and that a lot of people still would have trouble finding care. It appears that nothing has changed, although as a partial excuse for the political class, the COVID pandemic did suck all the oxygen out of the healthcare-policy debate.

    1. LarrytheG Avatar

      the question is – is no one on Medicaid getting care?

      And the answer is obvious. That’s not true.

      So what is true?

      That perhaps SOME (how many, what percent?) are not?

      and without Medicaid – how many who do get care now would not?

      1. James C. Sherlock Avatar
        James C. Sherlock

        Not germane. I supported Medicaid expansion. But access is not the same as insurance. Which is the point of the article. I am pointing out that poor people, Medicaid beneficiaries all, in parts of Virginia have no providers for their primary care needs.

        1. LarrytheG Avatar

          access is not the same as insurance, I AGREE.

          But out of how many Medicaid recipients are not getting care as opposed to those that are – compared to how many would get car without Medicaid at all?

          We’re playing half glass here again.

          A hell of a lot people ARE getting care now that they do have Medicaid – at the same time some percent are not and should be addressed.

          As you answered above, the shortage of primary care in some places is really not directly related to Medicaid. No one , regular insured, Medicare, and Medicaid have access… because of the geographic shortage of primary care.

    2. James C. Sherlock Avatar
      James C. Sherlock

      No one likes to talk about it, but the absolute bane of healthcare providers to Medicaid patients are no-shows. Lots of reasons for that, but it is true. Virginia hires insurance companies to “manage” Medicaid patients, but they don’t manage that.

      1. LarrytheG Avatar

        I don’t doubt that is true. IMHO Those in the lower economic tiers tend to not be as dependable for all manner of things from work to keeping their kids in school. One can call it a “culture” thing but it has nothing to do with race and everything to do with poor education and lower economic status. It’s IMHO, I do disclose that I really have no real data or research to back this up. Perhaps others who make such similar claims, do.

  2. LarrytheG Avatar

    So why do SOME parts of Virginia not have providers? What is the main reason?

    And what exactly would HEZs do to remedy that?

    1. James C. Sherlock Avatar
      James C. Sherlock

      A. Because doctors, dentists and psychologists don’t want to work and live there.
      B. HEZ’s raise treatment reimbursements, provide cost-free facilities and law enforcement support to office security and increase tuition debt repayment support.

      1. LarrytheG Avatar

        A – good answer – bigger issue than just Medicaid.
        B. – not sure the things named will bring more customers or incentivize a doc to move there.

        At one time the Feds would classify these places as “underserved’ and would provide incentives to new doctor to locate there for some period of time in exchange for paying some of their loans.

        Is that no longer true. Would you offer that in your HEZ? Does Maryland?

        1. Stephen Haner Avatar
          Stephen Haner

          The question nobody addresses: Is anybody on Medicaid getting healthier? Just like the schools. They don’t want to know. How dare we expect results!

          1. LarrytheG Avatar

            I think that’s a legitimate question but why would we expect folks who are on Medicaid and who DO see a doctor, not benefit from doing that like others who also go to a doctor but have other insurance?

            Is there an implication that folks with Medicaid don’t get the same level of care if they do get to the Doctor?

            is there a feeling that those who have Medicaid (and can get to a doctor) don’t get the same standard of care?

        2. James C. Sherlock Avatar
          James C. Sherlock

          Feds do offer limited loan forgiveness support. A state HEZ would expand the limits of that forgiveness.

          1. LarrytheG Avatar

            And a good thing, agree.

            I remember a few years back , West Va having mobile clinics that provided primary care, drugs, dentist, etc.
            not sure how follow-up worked.

            Does Va do that? Would that be a HEZ thing?

          2. James C. Sherlock Avatar
            James C. Sherlock

            The private mobile charitable clinics operate regularly. HEZs in Maryland are, as the term indicates, geographic zones. There is no reason, however, that if Virginia found mobile clinics more adaptable to market conditions in certain areas it could not support their operation, probably most efficiently with support to existing charitable operations.

    2. LG, here is the answer, and thank you, JS, for the observation: “it remains very hard to get health professionals to establish practices in many areas that most need them not only because of financial, but also lifestyle disincentives.” Like, book burning and anti-science attitudes.

      1. LarrytheG Avatar

        Yes. But still think younger guys/gals right out of Medical school could be “incentivized” to spend a few years there…. I notice that organizations like UVA now are deploying satellite sites out in the hinterlands – and the docs are not there all days – they commute.

        Nothing to do with Medicaid… There are others on Medicare and state/fed health plans also but they are dispersed. There’s just not enough density of patients to make it worthwhile for a doc to be there permanently.

        In Fredericksburg, we have the Lloyd Moss ‘free’ Clinic but it’s fees are structured per income level and insurance and it’s staffed by volunteer Docs.

      2. James C. Sherlock Avatar
        James C. Sherlock

        Like bad schools.

        1. LarrytheG Avatar

          I’d sign up for every single voucher school that served only at-risk kids and provided full transparency on results and if they’re successful – put them everywhere a public school was failing at teaching at-risk.

  3. Matt Adams Avatar
    Matt Adams

    PPACA (Obamacare) conflated the lines of having healthcare and access to it. Just because you have “insurance” doesn’t mean you have healthcare. Everyone has always been entitled to healthcare regardless of your ability to pay.

    Government intervention is never the solution, especially when they let insurance companies write the damn law.

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