U.S. and Texas medical schools are expanding enrollment to address the growing physician shortage. Nationally, they’re on track to increase medical school enrollment 30 percent by 2016, a goal called for by the Association of American Medical Colleges.
However, association president Darrell Kirch bluntly states, “This won’t amount to a single new doctor in practice without an expansion of residency positions.”
Those training to be physicians attend four years of medical school. Upon graduation, they receive their M.D. or D.O. degrees and finish their preparation as residents, also called graduate medical education (GME). GME residents treat patients, usually in hospitals, and are mentored by more seasoned physicians. Physicians typically spend four years in GME training, although those in highly specialized fields may require several more years.
There are about 115,000 physicians in U.S. residency programs. Federal financial support translates is about $100,000 per resident per year. That, combined with state Medicaid payments and the length of time in training, the public GME investment can be $500,000 or more.
The 2011 Texas legislature took a meat cleaver to its GME support. State lawmakers cut state GME funding by nearly 40 percent. That included an 80 percent cut to programs designed to increase and train primary-care physicians. The state has about 18,000 PCPs to treat a growing population of more than 26 million—well below the national ratio.
About two-thirds of Texas counties are designated as whole or partial Primary Care Health Professional Shortage areas.The Dallas-Fort Worth Hospital Council estimates there will be a 50 percent shortage of PCPs in the nine-county metropolitan region by 2016.
The Family Practice Residency Program was cut by 72 percent, from more than $20 million in 2010-11 to $5.6 million in 2012-13. In 2000, Texas had 247 first-year family medicine residency positions. By 2011, that number dropped to 211.
- The Primary Care Residency Program was eliminated in 2011. The program trained more than 120 primary-care residents.
- The state’s physician education loan repayment program, created during the 2009 legislature, was cut from $23.2 million in 2010-2011 to $5.6 million in 2012-2013. The budget cut could affect healthcare access for 1.1 million Texans in underserved areas, according to the Texas Primary Care Office at the Department of State Health Services.
There is a national shortage of medical residencies nationally as well. In 2010, there were about 30,500 medical students competing for about 25,500 residencies.
Nearly 45 percent of Texas medical-school students leave the state for residency training. According to a Texas Medical Association (TMA) survey, 38 percent of those students would have preferred to do that training in Texas. Most medical residents set up their practices within 100 miles of their residency location, so the $168,000 the state of Texas invested in their education is lost to another state.
Those who stay for their residencies, however, are likely to practice in the state afterward. In fact, Texas trails only Hawaii and California in retention of physicians who go to medical school in-state and remain here to complete their residency training.
Robert Earley, president and chief executive officer of JPS Health Network in Fort Worth, confirms that ranking. He said that nearly three out of four of his hospital’s 202 recent GME graduates stayed in Dallas-Fort Worth to practice.
Texas has about one residency position for every medical school graduate, compared with a ratio of 1.7-1 in California and more than 3-1 in New York. The Texas Higher Education Coordinating Board recommends a ratio of 1.1. To meet this goal, Texas would need 1,590, or about 114 more positions. It estimates the state will have 180 fewer GME slots than medical-school graduates by 2016.
New Med Schools Planned
Ironically, Texas universities are forging ahead with plans to create new medical schools, despite the lack of state GME slots. The University of Texas system is planning to open schools in Austin and the Rio Grande Valley. The University of North Texas Health Science Center is attempting to add an allopathic medical school to its campus.
Darren Whitehurst, TMA vice president of advocacy, said, “We need to make sure there are GME opportunities for these students as well. Otherwise, the state will have spent a lot of new money educating these students only to lose them to other states that provide the needed GME programs and we potentially lose these students forever, “he said.
Dan Stultz, president and chief executive officer of Texas Hospitals Association, said, ” If we get 100 or more (GME) slots created (in the next legislative session), that’s a win. Anything less is a token.”
The interim charges for the Texas House Committee on Public Health prior to the 2013 legislative session include examining the impact of state and federal funding reductions to GME and physician loan repayment programs.
Although the report is not due until this fall, the findings should be obvious: GME and physician loan repayment funding cuts will mean Texas will force its medical school graduates to train—and likely settle —elsewhere, and lose the state’s investment in their education.
Steve Jacob is editor of D Healthcare Daily and author of the new book Health Care in 2020: Where Uncertain Reform, Bad Habits, Too Few Doctors and Skyrocketing Costs Are Taking Us. He can be reached at email@example.com.