When residents of a geographic area, facility, or population group have poor access to basic medical care because too few primary care physicians are serving the area relative to its population size, the setting can be designated a primary care HPSA (health professional shortage area) by the Health Resources and Services Administration (HRSA).  As of December 31, 2022, the HRSA reported that more than 98.5 million Americans lived in designated primary care HPSAs.  The seven-state Great Plains region had 6.1 million residents who lived in a primary care shortage area as of 12/31/22.  This number represented about 6.2% of the U.S. population that was living in primary care shortage areas at that time.  The HRSA estimates that to eliminate the shortage Great Plains region HPSAs would need 1,221 additional primary care physicians.  As such, the region accounted for about 7.2% of the national deficit of primary care physicians.  A closer review of 12/31/22 HRSA data reveals the following state-level details about the Great Plains' primary care shortage:

The Great Plains' Primary Care Shortage

State	(1) HPSAs	(2) Population	(3) Shortage
IA	175	850,095	156
KS	190	823,846	133
MN	219	1,524,235	212
MO	363	2,294,436	600
NE	93	75,705	15
ND	93	229,048	49
SD	104	309,479	56
Region	1,237	6,106,844	1,221
U.S.	8,294	98,537,257	17,065
% of U.S.	14.9%	6.2%	7.2%

(1) Designated Geographic, Population Group, and Facility HPSAs with a primary care shortage

(2) Population of designated HPSAs

(3) Primary Care practitioners needed to remove HPSA Designation

Source:  Designated HPSA Quarterly Summary, 12/31/22 (HRSA)

Of the nearly 697,000 heart disease deaths in the United States in 2020, 382,776 were men.  At 235.9 deaths per 100,000 population, the heart disease death rate for males in the U.S. in 2020 was about 25.5% higher than the female rate and  11.5% greater than the overall national heart disease death rate.  At the regional level, the male heart disease death rate was lowest in the five-state Rocky Mountain region and the highest in the five-state Great Lakes region.  A deeper dive into data from the National Center for Health Statistics details the following about male heart disease rates in the U.S. by region (follow the "region" links below for male heart disease death rate information at the state level within each region):

Male Heart Disease Death Rates in the U.S. by Region

Region	Deaths	Population	Death Rate*
Far West	54,932	28,192,091	194.8
Great Lakes	61,269	23,061,455	265.7
Great Plains	24,559	10,673,839	230.1
Mid-East	61,361	23,747,834	258.4
New England	15,387	7,242,931	212.4
Rocky Mountain	10,593	6,320,743	167.6
Southeast	109,168	41,736,692	261.6
Southwest	45,507	21,280,617	213.8
U.S. Male Only	382,776	162,256,202	235.9
U.S. Female Only	314,186	167,227,921	187.9
U.S. Total	696,962	329,484,123	211.5

(*) number of heart disease deaths per 100,000 population

Report Period: 2020

Source: CDC Wonder. Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2020 on CDC WONDER Online Database, released in 2021. Data are from the Multiple Cause of Death Files, 1999-2020, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed on April 22, 2023

As examined in Dental Assistant Pay in the Top 20 Metropolitan Markets, the biggest metro areas are the major U.S. centers for dental assistant employment. That fact notwithstanding, a closer look into U.S. Bureau of Labor Statistics (BLS) data reveals that smaller metro areas are where dental assistants frequently find better pay, sometimes much better.  Indeed, a review of BLS data from May 2022 shows us that just four of the top 20 U.S. metro areas were among the 20 best metropolitan markets for dental assistant pay:

20 Best Metropolitan Markets for Dental Assistant Pay

	Metropolitan Area		# Employed	Annual Mean Wages
1	San Francisco-Oakland-Hayward (#)		5,550	$62,830
2	San Jose-Sunnyvale-Santa Clara, CA		3,700	$61,130
3	Minneapolis-St. Paul-Bloomington (#)		3,930	$61,020
4	Santa Rosa, CA		680	$56,750
5	Rochester, MN		350	$56,510
6	Mankato-North Mankato, MN		110	$55,470
7	Santa Maria-Santa Barbara, CA		530	$54,850
8	St. Cloud, MN		240	$54,710
9	Bismarck, ND		190	$54,170
10	Burlington-South Burlington, VT		250	$54,050
11	Portland-Vancouver-Hillsboro, OR-WA		3,270	$53,350
12	Seattle-Tacoma-Bellevue, WA (#)		6,050	$53,330
13	Napa, CA		230	$53,280
14	Boston-Cambridge-Nashua, MA-NH (#)		7,330	$53,060
15	Vallejo-Fairfield, CA		540	$52,560
16	Salem, OR		550	$52,550
17	Fairbanks, AK		140	$52,500
18	Duluth, MN-WI		250	$52,360
19	Durham-Chapel Hill, NC		730	$52,160
20	El Centro, CA		120	$51,880
	National		363,880	$44,710

(#) a top 20 U.S metro population area

Source: U.S. Bureau of Labor Statistics OES. Data extracted on April 26, 2023

According to data from the Health Resources and Services Administration (HRSA), as of December 31, 2022, almost 69.8 million Americans lived in a dental health professional shortage area (HPSA).  A dental health HPSA is a geographic area, population group, or facility where access to dental care is impaired because too few dentists work in the area relative to the size of the population.  In the four-state Southwest, as of December 31, 2022, over 8.4 million residents lived in dental care shortage areas, representing about 12% of all Americans who lived in a dental health HPSA.  The HRSA estimates that HPSAs in the Southwest would need 1,363 more dentists to eliminate the dental care shortage in the region.  This deficit represented about 11.4% of the national shortage of dentists.  Here is a summary look at the Southwest's dental care shortage:

The Southwest's Dental Care Shortage

State	(1) HPSAs	(2) Population	(3) Shortage
AZ	249	2,984,483	485
NM	112	1,187,842	223
OK	176	1,073,200	180
TX	320	3,157,537	475
Region	857	8,403,062	1,363
U.S.	7,313	69,766,605	11,909
% of U.S.	11.7%	12.0%	11.4%

(1) Designated Geographic, Population Group, and Facility HPSAs with a dental care shortage

(2) Population of designated HPSAs

(3) Dental Care practitioners needed to remove HPSA Designation

Source:  Designated HPSA Quarterly Summary, 12/31/22 (HRSA)

According to data released recently by the U.S. Bureau of Labor Statistics (BLS), there were just under 363,900 dental assistants employed in the U.S. as of May 2022. The overwhelming majority of dental assistants work in dental offices, with small numbers found employed by employment agencies, physician offices, and outpatient care centers. While dental assistants must possess some technical understanding, many of their duties can be administrative in nature and don't require the kind of advanced skills or training required by many other healthcare occupations. Dental assistants, on average, earn lower salaries than workers in most other occupations. As of May 2022, the BLS estimated that the national mean salary for dental assistants was $44,710 per year. Pay for the profession varies considerably depending upon the region in which a practitioner works, with dental assistants in some regions making materially more than what their professional peers made elsewhere. As of May 2022, BLS data reveals the following about dental assistant pay in the top 20 metropolitan markets in the United States:

Dental Assistant Pay in the Top 20 Metropolitan Markets

	Metropolitan Area		# Employed	Mean Annual Wage
1	New York-Newark-Jersey City		20,750	$48,570
2	Los Angeles-Long Beach-Anaheim		20,160	$44,020
3	Chicago-Naperville-Elgin		10,220	$42,320
4	Dallas-Fort Worth-Arlington		10,550	$41,270
5	Houston-The Woodlands-Sugar Land		7,720	$39,080
6	Washington-Arlington-Alexandria		6,520	$48,430
7	Philadelphia-Camden-Wilmington		5,830	$48,040
8	Miami-Fort Lauderdale-Pompano Beach		8,080	$41,020
9	Atlanta-Sandy Springs-Alpharetta		6,760	$42,630
10	Boston-Cambridge-Newton		7,330	$53,060
11	Phoenix-Mesa-Chandler		6,610	$45,620
12	San Francisco-Oakland-Berkeley		5,550	$62,830
13	Riverside-San Bernardino-Ontario		5,120	$45,440
14	Detroit-Warren-Dearborn		5,540	$41,580
15	Seattle-Tacoma-Bellevue		6,050	$53,330
16	Minneapolis-St. Paul-Bloomington		3,930	$61,020
17	San Diego-Chula Vista-Carlsbad		5,050	$48,110
18	Tampa-St. Petersburg-Clearwater		3,010	$45,950
19	Denver-Aurora-Lakewood		3,420	$48,470
20	Baltimore-Columbia-Towson		1,860	$45,430
	National		363,880	$44,710

Report Period:  May 2022
Top 20 U.S. Metro Areas from the 2020 Census
Source: U.S. Bureau of Labor Occupational Statistics
Data extracted on April 26, 2023

The Health Resources and Services Administration (HRSA) designates a geographic area, population group, or facility where access to mental health care is substandard as a mental health HPSA (health professional shortage area). This designation can be based on the size of the HPSA's population relative to either (a) the number of psychiatrists that service the area, or (b) the combined number of psychiatrists and certain other types of mental health care providers that serve the community. Currently, most mental health HPSA designations are based on population size relative to the number of psychiatrists serving the community.

As of December 31, 2022, mental health care HPSAs in the six-state Far West region had 23.6 million residents, accounting for about 14.9% of the U.S. population who lived in mental health care shortage areas.  To eliminate the shortage, the HRSA estimates that Far West HPSAs would need 1,225 additional mental health care providers.  Further examination of HRSA data reveals the following state-level details about the Far West's mental health care shortage:

The Far West's Mental Health Care Shortage

State	(1) HPSAs	(2) Population	(3) Shortage
AK	322	419,792	21
CA	608	13,121,872	673
HI	32	496,429	28
NV	62	4,012,818	235
OR	141	2,392,363	114
WA	187	3,206,169	154
Region	1,352	23,649,443	1,225
U.S.	6,599	158,413,168	7,957
% of U.S.	20.5%	14.9%	15.4%

(1) Designated Geographic, Population Group, and Facility HPSAs with a mental health care shortage

(2) Population of designated HPSAs

(3) Mental Health Care practitioners needed to remove HPSA Designation

Source:  Designated HPSA Quarterly Summary, 12/31/22 (HRSA)

As designated by the Health Resources and Services Administration (HRSA), a primary care health professional shortage area (HPSA) is a geographic area, population group, or facility where residents have inadequate access to basic medical care because too few primary care physicians service that population.  As of December 31, 2022, more than 98.5 million Americans lived in HRSA-designated primary care HPSAs.  With over 32.8 million residents living in primary care shortage areas, the twelve-state Southeast accounted for one-third of the U.S. population who lived in primary care HPSAs as of 12/31/22.  The HRSA estimates that to eliminate this shortage, Southeast region HPSAs would need nearly 5,300 additional primary care physicians.  A deeper examination of 12/31/22 HRSA data reveals the following state-level view of the Southeast's primary care shortage:

The Southeast's Primary Care Shortage

State	(1) HPSAs	(2) Population	(3) Shortage
AL	129	2,863,772	354
AR	127	1,105,866	144
FL	306	7,688,768	1,745
GA	247	3,369,911	683
KY	253	2,043,331	319
LA	183	2,590,723	298
MS	181	2,035,170	330
NC	222	3,216,821	498
SC	106	1,989,936	209
TN	148	2,582,889	304
VA	149	2,536,647	261
WV	120	787,032	138
Region	2,171	32,810,866	5,283
U.S.	8,294	98,537,257	17,065
% of U.S.	26.2%	33.3%	31.0%

(1) Designated Geographic, Population Group, and Facility HPSAs with a primary care shortage

(2) Population of designated HPSAs

(3) Primary Care practitioners needed to remove HPSA Designation

Source:  Designated HPSA Quarterly Summary, 12/31/22 (HRSA)

Women accounted for 314,186 of the nearly 697,000 heart disease deaths in the United States in 2020.  At 187.9 deaths per 100,000 population, the heart disease death rate for females in the U.S. in 2020 was about 20% lower than the male rate and  11.1% lower than the overall national heart disease death rate.  At the regional level, the female heart disease death rate was lowest in the five-state Rocky Mountain region and the highest in the Mid-Eastern U.S., a region that includes the District of Columbia and five states.  A closer examination of data from the CDC's National Center for Health Statistics provides the following details about female heart disease rates in the U.S. by region (follow the "region" links below for female heart disease death rate information at the state level within each region):

Female Heart Disease Death Rates in the U.S. by Region

Region	Deaths	Population	Death Rate*
Far West	54,932	28,192,091	194.8
Great Lakes	51,675	23,773,455	217.4
Great Plains	20,501	10,807,995	189.7
Mid-East	56,010	25,009,994	224.0
New England	13,193	7,604,537	173.5
Rocky Mountain	8,470	6,226,673	136.0
Southeast	87,506	43,829,093	199.7
Southwest	34,947	21,588,645	161.9
U.S. Female Only	314,186	167,227,921	187.9
U.S. Male Only	382,776	162,256,202	235.9
U.S. Total	696,962	329,484,123	211.5

(*) number of heart disease deaths per 100,000 population

Report Period: 2020

Source: CDC Wonder. Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2020 on CDC WONDER Online Database, released in 2021. Data are from the Multiple Cause of Death Files, 1999-2020, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed on April 22, 2023

December 31, 2022, data from the HRSA (Health Resources and Services Administration) indicated that nearly 69.8 million Americans lived in a dental health HPSA (health professional shortage area).  A dental health HPSA is a population group, geographic area, or facility where residents have substandard dental care access because too few dentists serve the area relative to the population living in the HPSA.  HPSAs in the six-state New England region of the country were home to almost 1.4 million residents, or about 2% of the U.S. population, who lived in dental care shortage areas.  The HRSA estimates that New England HPSAs would need 224 more dentists in order to eliminate the dental care shortage in the region.  This shortfall represented about 1.9% of the nation's dental care shortage.  Further examination of the HRSA's 12/31/22 data provides the following details about New England's dental care shortage:

New England's Dental Care Shortage

State	(1) HPSAs	(2) Population	(3) Shortage
CT	40	481,721	110
ME	96	380,414	59
MA	61	327,538	21
NH	23	35,002	9
RI	13	140,648	23
VT	15	29,428	2
Region	248	1,394,751	224
U.S.	7,313	69,766,605	11,909
% of U.S.	3.4%	2.0%	1.9%

(1) Designated Geographic, Population Group, and Facility HPSAs with a dental care shortage

(2) Population of designated HPSAs

(3) Dental Care practitioners needed to remove HPSA Designation

Source:  Designated HPSA Quarterly Summary, 12/31/22 (HRSA)

A facility, geographic area, or population group where individuals have subpar access to mental health care services can be designated by the Health Resources and Services Administration (HRSA) as a health professional shortage area (HPSA).  A healthcare shortage designation from the HRSA is based on population size relative to the number of providers who service that population. In the case of mental health care, that designation can be based on either (a) the size of the HPSA population relative to the number of psychiatrists that serve the community or (b) the size of the HPSA population relative to the combined number of psychiatrists and certain other mental health practitioners (clinical social workers, clinical psychologists, etc.) who service the HPSA. According to the HRSA, most mental health care shortage designations are currently based on the number of psychiatrists that serve the HPSA setting or community.  As of December 31, 2022, the HRSA reports that more than 158.4 million Americans lived in mental health HPSAs.

As of December 31, 2022, the five-state Rocky Mountain region was home to more than 9.6 million residents who lived in mental health care shortage areas.  The HRSA estimates that Rocky Mountain region HPSAs would need 372 additional mental health care providers to eliminate the shortage in the region.  As such, HPSAs in the Rocky Mountain region accounted for about 6.1% of the U.S. population who lived in mental health care shortage areas and approximately 4.7% of the national deficit of mental health care providers.  A closer examination of HRSA data reveals the following state-level details about the Rocky Mountain region's mental health care shortage:

The Rocky Mountain Region's Mental Health Care Shortage

State	(1) HPSAs	(2) Population	(3) Shortage
CO	73	2,831,663	114
ID	72	2,209,556	82
MT	122	986,301	70
UT	50	2,921,191	78
WY	26	699,712	28
Region	343	9,648,423	372
U.S.	6,599	158,413,168	7,957
% of U.S.	5.2%	6.1%	4.7%

(1) Designated Geographic, Population Group, and Facility HPSAs with a mental health care shortage

(2) Population of designated HPSAs

(3) Mental Health Care practitioners needed to remove HPSA Designation

Source:  Designated HPSA Quarterly Summary, 12/31/22 (HRSA)

A geographic area, population group, or facility where residents have substandard access to basic medical care due to a lack of primary care physicians can be designated a primary care HPSA (health professional shortage area) by the Health Resources and Services Administration (HRSA).  As of December 31, 2022, more than 98.5 million Americans lived in primary care HPSAs as designated by the HRSA.  More than 9.6 million residents of the MidEast region of the U.S., which includes the District of Columbia and five states, lived in a primary care HPSA.  The MidEast region thus accounted for just about 9.7% of the U.S. population who lived in primary care shortage areas.  The HRSA estimates that to eliminate the region's primary care shortage, MidEast HPSAs would need more than 2,000 additional primary care physicians.  A closer examination of 12/31/22 HRSA data reveals the following about the MidEast region's primary care shortage:

The MidEast Region's Primary Care Shortage

State	(1) HPSAs	(2) Population	(3) Shortage
DC	19	545,480	122
DE	11	253,696	75
MD	76	1,748,349	354
NJ	38	29,048	21
NY	194	6,449,663	1,348
PA	153	580,050	109
Region	491	9,606,286	2,029
U.S.	8,294	98,537,257	17,065
% of U.S.	5.9%	9.7%	11.9%

(1) Designated Geographic, Population Group, and Facility HPSAs with a primary care shortage

(2) Population of designated HPSAs

(3) Primary Care practitioners needed to remove HPSA Designation

Source:  Designated HPSA Quarterly Summary, 12/31/22 (HRSA)

The U.S. recorded over 696,900 deaths in 2020 that were attributable to heart disease.  The seven-state Great Plains region accounted for 45,060 of those heart disease deaths in 2020.   At  209.8 heart disease deaths per 100,000 population, the region had the fourth-highest regional heart disease death rate in 2020.  As seen throughout the U.S., the heart disease death rate for women in the Great Plains region was notably lower than the male rate.  The heart disease death rate for men in the region was slightly better than it was for males nationally, whereas the death rate for women in the region was slightly worse than for females nationally. Further examination of data from the National Center for Health Statistics yields the following details about male vs. female heart disease death rates in the Great Plains region:

Male vs. Female Heart Disease Death Rates in the Great Plains Region

	Deaths	Population	Death Rate*
Regionwide	45,060	21,481,834	209.8
Male	24,559	10,673,839	230.1
Female	20,501	10,807,995	189.7
Nationwide	696,962	329,484,123	211.5
Male	382,776	162,256,202	235.9
Female	314,186	167,227,921	187.9

(*) number of heart disease deaths per 100,000 population

Report Period: 2020

States in Region:  Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, and South Dakota

Source: CDC Wonder. Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2020 on CDC WONDER Online Database, released in 2021. Data are from the Multiple Cause of Death Files, 1999-2020, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed on April 15, 2023