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.
Beyond the physician shortage, this issue has economic implications. Texas taxpayers spend more than $168,000 to educate each medical student, and research shows that the location of residency training is highly predictive of where physicians ultimately decide to practice. The reality is that if Texas continues to graduate more medical students than we have first-year residency training slots, we are subsidizing other states’ physician workforces.
The report recommends that the Texas Legislature provide an additional $11.7 million in funding in the 2014-2015 biennium to support 10 percent of the cost for new first-year entering residency training positions, “if funding is available.” This would support the addition of 220 first-year entering residency positions that would be needed beginning in 2014.
What the study does not address is whether Texas’ medical schools and GME programs are producing the appropriate specialty mix to care for Texas’ growing population. It is widely acknowledged that patients with ready access to primary care receive more timely and optimal health care services with better outcomes. And primary care physicians provide preventive, coordinated, and continuous care that results in less invasive and costly medical intervention and reduces the probability of redundant or unnecessary services. Unfortunately, though primary care specialties are the most in demand, they also face the greatest shortages.
This begs the question: Should policymakers require some accountability for the type of physicians we are producing? Can Texas provide incentives to produce more family physicians and other primary care specialists?