Addressing primary care access begins with the workforce

Tags: workforce, legislature, budget, medical school

By now, it’s common knowledge that Texas faces a growing shortage of primary care physicians. We currently have approximately 18,000 primary care physicians to care for more than 25 million Texans, an unfavorable ratio that will worsen as fewer medical students choose to enter primary care fields and as the population continues to balloon at both ends of the age spectrum.

In an op-ed published Feb. 10 in the Houston Chronicle, Sen. Jane Nelson, R-Flower Mound, wrote about this dire need to address primary care access in Texas, acknowledging that the non-emergency medical services and coordinated care primary care physicians provide for their patients has been shown to increase quality and efficiency, and lower costs.

She has worked with TAFP and other stakeholders over the last decade to build the primary care workforce to improve the health of Texans and make health care costs sustainable for our state, and last session authored a comprehensive package of reforms to the state’s health care delivery system that aims to improve quality and efficiency in the health delivery system by testing and implementing various performance-based payment methods that provide incentives for improved patient outcomes.

“Initiatives like these hold great promise. However, realizing the full potential of these reforms will require a strong primary care workforce,” she wrote in the op-ed.

Sen. Nelson identified the need to invest in more primary care residency slots to ensure that more Texas medical school graduates (in which the state has invested taxpayer funds) can remain in the state to complete their graduate medical education and hopefully practice, and she identified the need to examine how payment inequalities between primary care and other specialty physicians impact the primary care workforce.

The Chronicle published a thoughtful response on Feb. 15, agreeing with the senator. “A major concern is that Texas, already ranked 42nd in the number of physicians per capita of population, loses far too many of its medical school graduates. Almost half of them, educated at an average cost to taxpayers of $200,000 per student, leave the state for residency training, and most of them never return — a situation that will be exacerbated this year when steep cuts in already inadequate funding go into effect.”

As you’ll remember, some of the most painful cuts from the 82nd Legislature for family medicine slashed total state funding to graduate medical education, the line item supporting family medicine residency programs, the Statewide Primary Care Preceptorship Program, and the Physician Education Loan Repayment Program. But while the state’s action last session was disheartening, some medical schools and the federal government have announced efforts to address the shortage and the disincentives that discourage medical students from pursing primary care.

The Chronicle highlighted a pilot program being conducted by the University of Texas System that would enable medical students to graduate a year ahead of schedule, presumably similar to Texas Tech Health Science Center’s three-year family medicine accelerated track, or F-MAT.

A news article published Feb. 19 in the LA Times mentions new medical schools opening in Florida, Pennsylvania, and Connecticut that emphasize primary care, others in California changing their curricula to boost the number of primary care graduates, preceptorship programs placing students in community clinics “so they see firsthand what it’s like to practice preventive care and manage chronic diseases,” and efforts to recruit applicants from diverse backgrounds who might be more likely to practice in poor or underserved areas.

And a Feb. 18 CBS News story covered a new loan repayment program from the National Health Service Corps that will award $9.1 million in funding to medical students who commit to practicing primary care in underserved areas. The program will provide up to $120,000 to medical students in their last year of education in exchange for three years of full-time service or six years of half-time service in rural and urban areas of greatest need.

Our state can’t stop our population from growing, but we can promote innovative programs and proper investment of taxpayer funds that support the medical workforce that Texas needs to care for its population. As the Chronicle wrote, “We urge our lawmakers to pay close attention. This is a dire situation that will only grow worse if not addressed.”

– kalfano


  • JEB Johnson said

    Unfortunately organized Family Medicine has become as impotent as the AMA. We embraced quality practice, evidence based medicine, continuing education long ago. What we haven't embraced is full scope practice, taking our own calls, caring for our patients in all settings even when others skills are needed. I know too many FPs whose offices are full but they are full with blood pressure checks, following up cholesterol profiles and taking care of "colds" (which by the way are now called "sinus infections" so that unnecessary antibiotics can be presribed.) This has evolved to increase the number of billable visits and shorten the time spent per patient. Whenever the insurers (or the government) comes up with a way to cut into our income we respond with creative countermeasures. I am tired of it. The public and the physicians need to be retrained and the way the public is trained now is television. My generation flocked to Family Practice to emulate Marcus Welby, MD. We wanted to be loved and respected and the patients were looking for that kind of a doctor. He is dated now but Family Medicine needs a hero.

  • Frau said

    In days past, the view that every patient suolhd have a primary care physician was viable, but in the new math of physician supply, there won't be enough for everyone, so advance practice nurses will be providing much more primary care. And while most physicians went into medicine to care for patients, physician shortages have left many with little time to do so. In a 2002 paper in Health Affairs in which we urged that efforts be made to expand physician supply, we noted that to do nothing invites public discontent and forces the profession of medicine to redefine itself in an ever more narrow scientific and technological sphere while other disciplines evolve to fill important gaps. Nothing was done, and that future is upon us.

Add a Comment