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The government keeps a map of where healthcare is missing(4 min read)

Written by

Deepesh Arora

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This is post 3 of 10 in the series “FabrixMed learnings”

  1. The referral is where healthcare goes to die
  2. The ED doesn’t just need more hands. It needs faster answers.
  3. The government keeps a map of where healthcare is missing(4 min read)
  4. Who the ED calls, and how long the answer takes
  5. We ration specialists by zip code
  6. Screening is a logistics problem, not a medicine problem
  7. Stop selling the device, sell the outcome
  8. Independence needs shared support Scheduled for November 7, 2026
  9. Pay for the answer, not the appointment Scheduled for November 14, 2026
  10. Healthcare’s last mile runs on fax machines Scheduled for November 21, 2026

I spent some time this week on the Bureau of Health Workforce’s website, reading about how the federal government officially labels the places and people that don’t have enough healthcare. I didn’t know this machinery existed. Now I can’t stop thinking about it.

Here’s the plain-English version.

The government gives shortage labels to places, groups of people, or buildings that don’t have enough healthcare. The count of geographic shortage areas alone is just over 1,000 — and that’s only one kind of label. There are five, and they stack like this:

1. Not enough doctors here. The official name is a Health Professional Shortage Area. It comes in three flavors: a whole area (a county, a neighborhood), a specific group of people (low-income families, homeless people, migrant farmworkers), or a specific building (a prison, a mental hospital). And it covers three kinds of care: basic primary care, dental, and mental health.

2. Not enough maternity care, specifically. Inside the areas above, some places are short on the people who deliver babies and care for mothers. Those get their own sub-label: Maternity Care Target Areas.

3. Underserved — the area or the people. Medically Underserved Areas are whole geographies (a county, a cluster of counties, city blocks) that lack basic care. Medically Underserved Populations are specific groups inside a geography — people facing money, language, or cultural barriers to care. These labels are what let community health centers get built.

4. Doesn’t fit the boxes, but still can’t get care. The Exceptional Medically Underserved Population — for groups whose situation is unusual enough that the standard definitions miss them.

5. The governor can just say so. A state governor can flag an area as short on providers, and that flag is what lets a Rural Health Clinic get established there.

These labels aren’t just statistics. They unlock real things: loan repayment for clinicians who go work in these places, bonus payments, even visa waivers for foreign-trained doctors. The labels are the system formally admitting: care is missing here.

And here’s the part I’m chewing on. Every program attached to these labels tries to move the doctor to the pin on the map. Loan forgiveness, bonuses, visas — all of them are trying to relocate a human being. But doctors are people with lives, and they mostly don’t relocate on command. That’s not a criticism; it’s just how humans work.

What if the geometry is wrong? What if the doctor doesn’t need to move — only the doctor’s answer needs to travel? A question from a clinic in a shortage county, answered by a specialist two states away, in hours instead of months. The specialist stays where she is. The patient stays where he is. Only the consult moves.

And the answer really is the slow part. A 2026 study of roughly 35,000 emergency department consults at the University of Virginia found the median wait from consult order to an actionable answer was 108 minutes — nearly two hours. For psychiatry, it was 196 minutes. Over three hours. Meanwhile, three out of four ED directors say their specialist on-call coverage is inadequate. The bed isn’t always the bottleneck. Sometimes it’s the answer.

That’s the shape of what I’m building with FabrixMed — digital infrastructure that carries specialist answers into the places the map says are missing them. No relocation required.

I’m still learning how these designations work in practice. If you know this world — a state primary care office, a rural clinic, an FQHC — I’d love to hear what the map gets right and what it misses.

References

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