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The effects of an industrywide physician shortage are never evenly distributed. A large hospital or clinic in an affluent suburban neighborhood, for example, may have to spend a few more dollars recruiting and retaining physicians, but rarely will it bear the brunt of the shortage. The direct fallout is often reserved for rural areas and other regions that have already less than ideal physician-to-patient ratios and trouble attracting new doctors. But help is available for these hard-hit regions in the form of the health professional shortage area (HPSA) designation.