By Clare Hawkins, M.D.
With another legislative session underway, our Academy is poised to make great gains for family medicine and recoup budget losses from 2011. We’re building on a decade of work educating legislators and the public about the value of family medicine, but it’s evident that our work particularly since the last session has led to a deeper understanding of the current and coming crisis in the primary care workforce.
This summer TAFP held a legislative training seminar in Austin and attendees of that conference formed the core of a new Key Contacts program. These leaders actively share resources provided by the Academy with their state representative and senator, which include not only our own policy briefs and legislative magazine features, but editorials and news stories from the major daily newspapers. People are “getting it.”
In early October, I attended a stimulating meeting of stakeholders presenting to the Texas Higher Education Coordinating Board’s Graduate Health Professions Subcommittee. I represented TAFP and the San Jacinto Methodist Family Medicine Residency. Also at the table were representatives from other large academic institutions—Texas A&M College of Medicine, the University of Texas Southwestern Medical School in Dallas and Austin, the University of Texas Health Science Center in Houston, Texas Tech University Health Sciences Center School of Medicine, the University of North Texas Health Science Center, and Baylor College of Medicine—plus the Texas Medical Association, the Texas Hospital Association, the Department of State Health Services, and, of course, THECB staff.
The coordinating board presented a report they released in April that assessed the adequacy of opportunities for graduates of Texas medical schools to enter residency training in the state. They also presented the ill-fated success story of the Physician Education Loan Repayment Program, which began to address health care access in the neediest areas in Texas before its funding was drastically slashed last session.
As TAFP reported in a recent issue of Texas Family Physician, “The Right Kind of Doctors for Texas,” THECB found in the report that while enrollment in Texas medical schools jumped 31 percent from fall 2002 to fall 2011, the number of first-year Texas residency positions remained flat. If no action is taken, at least 63 graduates of Texas medical schools will not have an opportunity to enter a Texas residency program in 2014 and 180 will not have this opportunity by 2016.
To expand the number of GME positions and restore part of the funding to the loan repayment program, the coordinating board has included two exceptional item requests in their budget to present to the Legislature. But because many funding streams pay for the cost of residency training—estimated to be around $150,000 per year per physician—physician members of the board asked if the state should focus on primary care.
There was resounding support for not just primary care, but for family medicine. Even internists were clear in their testimony that internal medicine does not have many residency graduates who stay in primary care and that family medicine provides the bulk of true primary care.
A committee member asked if the state should provide funds to academic institutions without stipulation and allow them to expand GME positions for any of the specialties experiencing shortages in Texas; he said of 40 specialties we’re only at the national average for three of them.
The answer: no. The stakeholders pointed out that fourth- and fifth-year GME positions have a return on investment for institutions and these positions would be more likely to be created than primary care positions. They explained that THECB should continue with their emphasis on first-year positions, with dominant sentiment that the funds should be disproportionately directed toward family medicine, general pediatrics, and psychiatry.
This meeting is just one example of the momentum driving lawmakers’ understanding that we need to invest in more family medicine residency positions for the benefit of Texans’ health and our economic stability. The coordinating board is on the right path and the Legislature will be well served with their expert direction. We in the Academy’s leadership encourage all TAFP members to continue talking about the value of family medicine to strengthen our message into the current session and beyond.