By Blair Cushing
Fourth-year TCOM student
As a fourth-year medical student, I have spent the past four years highly concerned about what fate would await my classmates and me on Match Day, which is now only a few weeks away. With each passing year, the number of graduating medical students has climbed while the number of available first-year residency positions has remained stagnant. It is anticipated that in 2016, Texas medical schools will graduate 100 more doctors than available residency positions in the state. With three new medical schools expected to matriculate their first classes that fall, this number could easily rise to over 350 by the year 2020 in the absence of any new investment in graduate medical education.
Despite Texas being one of the few states that currently uses state tax dollars to support GME, the dollars have not kept up with the need and more importantly, a flawed funding formula has prevented this money from being used in ways that align with the health care needs of our population. Fortunately, the 84th Texas Legislature affords us a unique opportunity to reform the way GME dollars are allocated in Texas.
The Legislative Budget Board’s Government Effectiveness and Efficiency Report outlines the case for targeting GME dollars toward critical shortage specialties, particularly family medicine and other primary care. One of their recommendations would create a new state program modeled after the federal Teaching Health Centers Program, which was authorized as part of the Patient Protection and Affordable Care Act in 2010. The Teaching Health Centers Program provides GME dollars directly to the residency programs, thereby limiting the indirect expenses paid to hospitals, which have been difficult to account for despite comprising about two-thirds of Medicare GME expenditures.
We know that physicians are likely to settle and practice close to where they complete their residency training, which is why we argue Texas should be investing in new residency training opportunities here in the state. Less often discussed, though perhaps even more important for the needs of our state, is that residents will also go on to practice in the manner in which they were trained. In other words, if one is trained caring for low-income patients in a federally qualified health center, he or she is more likely to continue on to practice in an underserved community.
As a student who specifically sought out family medicine programs that pursue innovative training models, I heard repeatedly from faculty members during my interviews that they were drawn to teaching at such a program because their own experience was one where their primarily hospital-based training did not prepare them adequately to practice primary care in an outpatient setting.
The LBB also recommends that the state provide support for training resident faculty and to encourage collaboration between community health centers, teaching hospitals, and medical schools to help establish new residency programs in the communities where they are most needed.
I cannot state emphatically enough how necessary the GEER recommendations are to begin to address the crisis of health care access in Texas. I applaud Senators Nelson, Seliger, and Hinojosa for further stepping up to the plate as champions of this issue and introducing Senate Bill 18, which would codify the LBB’s recommendations as well as create a permanent fund for GME. The fund would ease some of the struggle we face with ensuring these programs will be financially supported year after year and reduce the risk of one’s training being cut short due to a fiscal shortfall in any given biennium.
It is time that we reverse the trend of exporting one of Texas’ most valuable resources: our highly trained homegrown medical graduates. Many of these students have attended Texas institutions since elementary school and our investment in them extends far beyond the cost of their medical degree. The Texas Legislature must commit to getting them across the finish line and ensuring that we retain as many well-trained physicians as possible to meet the future health care needs of the population. We can and should do more to ensure that GME dollars are working toward a system that will prioritize cost-effective primary care and improve access in underserved communities throughout Texas. The passage of S.B. 18 would be a giant step toward achieving these goals.