Provider Surveys for Medical, Dental, and Mental Health Professionals

The federal Shortage Designation Branch requires specific data to be submitted in applications requesting designation of an area or population group as a Health Professional Shortage Area (HPSA) or Medically Underserved Area/Population (MUA/P). The required information consists largely of primary care providers names, specialties, office locations, hours per week in patient care activities, information on the provider's patient population, and information on other activities the provider might be engaged in outside of patient care. 

In reviewing the designation status of areas within Michigan, the Michigan Department of Health and Human Services collects data primarily through phone surveys of provider offices and a combination of supplemental data sources such as online resources and available data sets (i.e. Medicaid Claims). The document below is the current version of the survey used to collect shortage designation data. Reviewing this survey should assist in familiarizing you with the information required for evaluating shortage designations. Interested providers and offices may also feel free to proactively complete surveys and return them to the Michigan Department of Health and Human Services.

For primary medical care, mental health, and dental health HPSAs and for MUA/P designations, the following survey is used:

HPSA Physician Questionnaire Form


Which Providers Count for the Ratios of Population to Providers?

  • For primary medical care: Includes Doctors of Medicine (MD) and Doctors of Osteopathy (DO) who provide services in the following specialties – Family Practice, Internal Medicine, Obstetrics and Gynecology, and Pediatrics.
  • For mental health: Includes Psychiatrists, and may include other Core Mental Health providers, such as Clinical Psychologists, Clinical Social Workers, Psychiatric Nurse Specialists, and Marriage and Family Therapists.
  • For dental health: Includes Dentists and considers the number of Dental Auxiliaries. Dental Auxiliaries are defined as any non-dentist staff employed by the dentist to assist in the operation of the practice.

Please note that Nurse Practitioners (NPs) and Physician Assistants (PAs) are not counted for shortage designations. Also, providers solely engaged in administration, research and training should be identified as they are excluded from the population to provider ratios.


Please return completed surveys to:

Miguelina Carela-Garcia
Fax: (517) 284-4993