By Tom Banning
TAFP CEO/EVP

There is not a self-respecting health policy analyst here or anywhere in the country who will say otherwise – we need to invest in and produce more primary care physicians.

The conventional economic wisdom, backed by common sense and an abundance of evidence drawn from the real world, is that patients with ready access to primary care receive more timely and optimal health care services with better outcomes. Primary care physicians provide preventive, coordinated, and continuous care which results in less invasive and costly medical intervention and reduces the probability of redundant or unnecessary services.

A new report reveals a severe problem in addressing the Texas physician workforce shortage: Though more medical students are graduating from Texas medical schools, our state won’t have enough first-year residency slots to keep them in the state to complete their training.

The Texas Higher Education Coordinating Board finds that while Texas medical schools have increased their enrollment by 31 percent from fall 2002 to fall 2011, at least 63 graduates will not be able to enter a Texas residency program in 2014. Without action, this shortfall will reach 180 by 2016.

According to THECB and reported by the Texas Tribune, Texas had more than 550 residency programs in 2011 that offered a total of 6,788 residency slots. By 2014, Texas will need 220 more residency positions to achieve the 1.1 to 1 ratio of first-year residency positions to Texas medical school graduates. 

By Jason Hill
RRNeT network coordinator

The Research Residency Network of Texas, or RRNeT, is a collaboration of 10 Texas family medicine residency programs across the state, representing 100 family physician faculty and 300 family medicine residents who see approximately 300,000 outpatient visits per year. The program is comprised of physicians and researchers who meet bi-monthly to discuss research projects. RRNET is united by a single goal: to generate medical research that meets the needs of our diverse patient population. RRNeT’s patients are comprised of Latinos (55 percent), African Americans (12 percent), Caucasians (27 percent), and Asians (4 percent).

To begin a study, physicians discuss reoccurring medical issues and concerns arising in their day-to-day clinical work. “What patient issues are most puzzling or worrisome?” A consensus answer to this question often determines the research agenda for the upcoming year. Each year, one or two large research studies are implemented. Research topics to date have included alternative medicine use, medication compliance, teen preventive care, cost-efficient care, low back pain, and obesity. After selecting a research topic, RRNeT members derive specific research aims to shed light on underlying causes, further describe the topic, and  test linkages between the causes and associated health outcomes.  Then study design, sampling, procedures, and data collection processes are determined. At this point, RRNeT members acquire permission to conduct the study with their respective institutional review boards.

By Kathy McCarthy, TAFP COO

In recognition of the 15th anniversary of my time at TAFP, I’d like to take a moment to reflect. In these tough economic times, most feel lucky just to have a job. I am especially blessed to have one that I enjoy, that challenges me, and that rewards me in so many ways. I began working for TAFP in 1996 as a secretary and left after about nine months to get certified to teach grade school. After a few months of substitute teaching, I knew that I was not well suited to teaching. I returned to Austin and found myself back with TAFP on April 7, 1997, as “special projects coordinator.”

I’ve seen lots of changes in those years, many driven by revolutionary technology. When I started working in membership, we still had a microfiche machine to view member records and speakers would show up for our CME event with slide carousels!

After 12 years of planning, Texas leaders unveiled a Capitol grounds monument on March 29 honoring Tejanos, the first Spanish and Mexican descendants who introduced many of our state’s proud traditions and culture.

This is el sueño (the dream) of McAllen family physician and TAFP member Cayetano E. Barrera III, M.D., as event emcee State Rep. Richard Peña Raymond said at the unveiling ceremony. Back in 2000, Barrera and his wife were walking the grounds of the Texas Capitol when they noticed that none of the statues or monuments recognized Hispanic contributions to the state. With his love of history and respect for genealogy, Barrera knew that the Tejano contribution was too important in the formation of Texas culture to ignore. And over the next decade, he worked as president of the Tejano Monument Committee to meet with sponsors, architects, engineers, historians, board members, legislators, and all other necessary contacts to raise support and funding for the monument.

The final product is a grand tribute to the Tejano contribution. It features 11 life-size bronzed statues mounted on slabs of pink granite: a vaquero on horseback corralling two longhorns, a Tejano couple with a baby, a young girl, a boy leading a goat, and an explorer gazing over the whole scene.

By David W. Bauer, M.D.

When is a patient-centered medical home not a patient-centered medical home? In my practice, the answer is “every day.” In 2009 we received NCQA’s designation as a Level 3 PCMH. To achieve this, our physicians had to document ways in which our patients had enhanced access to our practice, provide examples of how we use evidence-based guidelines to provide quality care, demonstrate the means by which we coordinated care across time and space, and a number of other measures. We do, in fact, do those things every day. What we don’t do, is do all of them for every single patient, every single day.

Consider the analogy of a patient with diabetes whose hemoglobin A1c is 6.9. We would say that the patient’s diabetes is well controlled and congratulate the patient. But there are many ways that a patient could achieve this value. One would be to have very little fluctuation of her glucose from hour to hour. Another would be for the patient to drop into the 40s overnight, and climb to 200 immediately after meals. The hemoglobin A1c is an average, and doesn’t factor in variation. For years, decreasing variation has been the mantra of those working to improve quality, increase efficiency, and decrease medical errors in the hospital setting. As we migrate toward a new model of health care in this country—the PCMH—it would be valuable to embrace this concept in our offices as well.

By I. L. Balkcom IV, M.D.
TAFP President 2012-2013

Her name was not important. This little 6-year-old girl I had been called to examine in the emergency room now sat silently, flanked by her mother and mother’s boyfriend.

I was in my third year of residency and was summoned to evaluate this patient who I’d been told had fallen in the bathtub at home. She had a large bruise around her left eye.

By John K. Frederick, M.D.

If your clinic is anything like ours, we are being deluged with obesity and its downstream effects of diabetes, hypertension, obstructive sleep apnea, and heart disease.  New evidence surfaces almost daily in the medical literature describing some new correlation between obesity and negative health consequences. This situation is also discouraging because there aren’t many good community resources that are both easy to access and effective. The inertia of poor diet and lack of exercise is overwhelming. Repeated advice and encouragement often seem useless, and eventually it feels as if there is no point. Even the employees in our own clinic seem to be disproportionately affected with this condition.

Several factors contributed to our recent action. Perhaps it was seeing how fast the box of doughnuts emptied in our break room. Or, maybe it was the Medscape article pointing out that overweight doctors tend to spend less effort on recognizing and treating obesity. That hit close to home!