It's Academic: December 2013

 

 State Rolls Out First Two of Five GME Expansion Grant Programs

Grants were awarded on Dec. 13 for two of the five new GME expansion grant programs.  The Texas Higher Education Coordinating Board (THECB) awarded a total of $1.3 million to nine applicants for the state’s new Planning Grant Program and a total of $3.25 million to seven applicants for the new GME Unfilled Position Grant Program. The award listings are available on the THECB website.

During the 2013 legislation session, Texas legislators approved a total of $97 million in state funding for GME in the 2014-15 state budget, an increase of $30 million, or 45 percent more than the previous two years. While a substantial increase, this fell $9 million short of the historic high of $106 million in 2010-11. This total accounts for funding of: 

  • GME formulas,
  • Family medicine residency programs,
  • New GME expansion grant programs, and
  • Trauma fellowship grants. 

GME formula funding (including Baylor College of Medicine) 

  • A 9-percent increase in per-resident base rate, and $880 more in the per-resident amount.
  • In total dollars, the increase was 15 percent or $8.8 million. Growth in residents, an additional 334, accounted for 5.2 percent of the dollar increase. 
  • GME formula funding originated in 2006-07 at $25 million. For the current biennium, that number is $66 million. 

Family Medicine Residency Program  

  • An additional $7.2 million or 128-percent increase over prior biennium. This rescinds the previous funding cuts and provides a total of $13 million for the biennium. 
  • Per-resident amount rose to almost $8,800 from previous $4,000. 
  • Historic peak funding was $13,000 per resident in 2010-11. 

GME Expansion Grant Programs  

  • The legislature established five new GME grant programs with $14.25 million in funding for the biennium.
  • Each of the five programs establishes a new and unique method for incentivizing GME growth.  

These programs reflect a different legislative focus from the formula funding programs: 

  • Funding amounts of $65,000 are significantly higher than the $5,122 used for the annual base rate in the state GME formula funding, which is intended to offset a portion of faculty-related costs. The higher funding amounts acknowledge the need to help cover at least a portion of the hospital side of GME costs.
  • Hospital planning grants signal legislative awareness of the need to identify additional hospital GME partners to increase access to GME for Texas medical school graduates.  

TOTAL POTENTIAL NET OUTCOME FOR GME EXPANSION GRANT PROGRAMS

  • Fiscal Year (FY) 2014: 25 residency positions
  • FY 2015: 164 positions (NET increase of 139 GME positions) 

THECB will administer the new state GME expansion grant programs. Program rules have been adopted for the first three programs listed below. As noted above, grants were issued for the first two programs Dec. 13. Two other programs are expected to be implemented in Fiscal Year 2015 and the remaining program in FY 2016. 

1. “Virgin” Hospital GME Planning Grants 
$1.875 million for up to 12, one-time $150,000 grants in FY 2014-15 with the goal of facilitating development of new hospital GME partners. Seed money to incentivize “virgin” hospitals to conduct feasibility studies on becoming teaching institutions. This is targeted at hospitals that have never offered GME, therefore, they are not under Medicare GME caps, with the goal of gaining future eligibility for Medicare GME funding.

Status: THECB awarded a total of $1.3 million of the possible $1.875 million in grants to the following nine hospitals and educational institutions on Dec. 13. 

The GME planning grantees are: 

  • Baylor College of Medicine Medical Center, Houston;
  • Doctor’s Hospital at Renaissance, Edinburg, and The University of Texas Health Science Center at San Antonio;
  • Hopkins County Memorial Hospital, Sulphur Springs, and The University of Texas Health Science Center at Tyler;
  • Knapp Medical Center, Weslaco, and The University of Texas Health Science Center at San Antonio;
  • Memorial Health System of East Texas, Lufkin, and Texas A&M Health Science Center;
  • Scenic Mountain Medical Center, Big Spring, and Texas Tech University Health Sciences Center;
  • DeTar Healthcare System, Victoria, and Texas A&M Health Science Center;
  • Texoma Medical Center, Denison, and University of North Texas Health Science Center; and
  • Weatherford Regional Medical Center, Weatherford, and University of North Texas Health Science Center 

Expected net outcome in GME growth:
FY 2014: 0
FY 2015 and after: Unknown 

2. Grants for Accredited, Unfilled, and Unfunded GME Positions 
$3.25 million in grants for the biennium for first-year accredited, but unfilled and unfunded, GME slots. Grants of $65,000 per resident for a total of 25 residency positions. The same 25 positions are to be funded again in FY 2015.

Status: THECB awarded a total of $3.25 million in grants for FY 2014/15 to the following seven applicants on Dec. 13: 

  • Plaza Medical Center of Fort Worth. Family Medicine $260,000, 2 positions/year.
  • Texas Tech University Health Sciences Center, Foster School of Medicine, El Paso. Obstetrics/Gynecology $130,000, 1 position/year.
  • University of North Texas Health Science Center, Fort Worth. Internal Medicine $130,000, 1 position/year.
  • The University of Texas Health Science Center-Houston. Internal Medicine, Psychiatry, and Anesthesiology $1,560,000, 12 positions/year.
  • The University of Texas Health Science Center-San Antonio. Internal Medicine $650,000, 5 positions/year.
  • The University of Texas Medical Branch, Galveston. Internal Medicine $260,000, 2 positions/year.
  • The University of Texas Southwestern Medical Center, Dallas. Psychiatry $260,000, 2 positions/year. 

Expected net outcome in GME growth:
FY 2014: 25 first-year residency positions (existing, unfunded and unfilled, but not new positions)
FY 2015: Same 25 

3. Grants for New First-Year GME Slots at Existing OR NEW GME Programs
$4.125 million for 63 NEW first-year GME slots at existing or new GME programs in FY 2015 at $65,000 per resident. NO FUNDING in FY 2014. 

Expected net outcome in GME growth:
FY 2014: 0
FY 2015: 63 new first-year GME positions 

4. Funding of New GME Slots at Hospitals that Previously Received Planning Grants
“Virgin” hospitals that received planning grants in FY 2014 may be eligible for grants that provide $35,000 per newly established residency position, in future years. There is no funding this biennium. An appropriation is anticipated for 2016. 

Expected net outcome in GME growth:
FY 2014: 0
FY 2015: 0
FY 2016 and after: Not yet known, dependent on funding next biennium 

5. Resident Physician Expansion Grant Program With Community Collaboration and Innovative Funding
$5 million for grants for GME expansion through community collaboration and innovative funding.

Anticipated funding will be $65,000 per resident for positions created on/after Jan. 1, 2014, or accredited positions that were unfilled on Jan. 1, 2013. 

Program goals: Creating new positions with an emphasis on first year, maximizing local or federal matching funds, developing programs at “virgin” hospitals, and increasing residency positions with respect to shortage specialties and shortage areas. 

Status: Appropriations for this program could potentially fund an estimated 76 positions at $65,000 each in FY 2015. THECB expects to write program rules in spring 2014. 

Expected net outcome in GME growth
FY 2014: 0 Positions
FY 2015: Estimated 76 GME Positions  

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 Texas a Leader in Physician Retention from Medical School and Residency

Not only is Texas attracting record-high numbers of new physicians to the state each year, but it continues to rank among the leading states in physician retention from medical school and residency, according to new statistics reported by the Association of American Medical Colleges (AAMC). 

In the AAMC’s 2013 update of the State Physician Workforce Data Book released in November, California topped the list with 62 percent and Texas took second place at 59 percent in retention of physicians from medical school and fifth place (58 percent) in retention from residency training. When retention from medical school and residency are combined, Texas ranks third (80 percent), following Hawaii and Arkansas. For this indicator, Texas beat out California, which ranked fourth. 

When the focus is limited only to the top six most-populous states, Texas ranks fourth for ratios of medical students and residents per 100,000 population, edging ahead of Florida and California but falling behind Pennsylvania, New York, and Illinois as shown in the table below. For physician-to-population ratios, however, Texas continues to rank last among the most populous states. The state’s ratios of patient care physicians and primary care physicians per capita have steadily increased for some time but not at a level that allowed Texas to rise in the rankings among the most populous states. 

Pennsylvania led the most-populous states in the ratio of medical students per capita, while New York claimed this title for the other three physician workforce indicators. 

When compared with all 50 states for these indicators, Texas ranks closer to the middle for medical students and residents per capita and remains close to the bottom of the list for ratio of physicians per capita.  

 2013physicians.workforce.indicators

 

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 Triple Growth for U.S.-Citizen IMGs Matching to Texas for GME

A TMA analysis of recent trends for the National Resident Matching Program (NRMP) for Texas found triple growth among U.S. citizen international medical graduates (IMGs) matching to Texas over the past decade. Although the number of non-citizen IMGs consistently outnumbered U.S. citizen IMGs in the Match for this time period, U.S. citizen IMGs saw substantial increases, while non-citizens had a net decline of 3 percent.  

The increase in U.S. citizen IMGs is likely a result of increased numbers and enrollments for off-shore medical schools. In addition, there have been anecdotal reports of visa problems post-Sept. 11, 2001. The combined total of IMGs matching to Texas in the NRMP over the past decade increased 35 percent, as shown in the table below. The proportion of IMGs among those who matched to Texas for postgraduate year one positions was the same in 2003 and 2013, about 20 percent. TMA looked at Match data for 2013, one year ago, five years ago, and 10 years ago.  

It's Academic 122013 Chart 1

 

  

As mentioned in the November issue of It’s Academic, IMGs are prominent among newly licensed physicians in Texas. In fact, IMGs outnumbered Texas graduates among the 3,594 newly licensed physicians in Texas in Fiscal Year 2013; 30 percent (1,040) graduated from medical schools in other countries, and 27 percent (946) from Texas medical schools. The remaining 43 percent (1,541) graduated from medical schools in other states in the United States, Puerto Rico, or Canada. (See graphic below.) 

 

It's Academic 122013 Chart 2

 

The increased number and enrollments at offshore medical schools in the Caribbean are reflected among newly licensed physicians as well. For Fiscal Year 2013, 50 of the newly licensed Texas physicians were graduates of St. George’s medical school in Grenada and 44 from Ross medical school in the Dominica. These two schools, combined with schools in Antigua, the Cayman Islands, the Netherland Antilles, Nevis, and St. Maarten, produced 128 of the newly licensed physicians — 12 percent of those who graduated from schools in foreign countries. In comparison, 65 were graduates of Mexico (28 of these from Universidad Autonoma de Guadalajara, which offers instruction in English), 36 graduates of China, and 10 from Canada. As noted in November It’s Academic , India and Pakistan produced the highest numbers among the group of newly licensed, for a combined total of 399. 

There were 56 medical schools in the Caribbean in 2010, 34 with programs in English, and plans for 10 more schools. One-fourth of the IMGs who sought certification from the U.S. Educational Commission for Foreign Medical Graduates (ECFMG) in 2009 were graduates of Caribbean schools ("Medical Education in the Caribbean: A Longitudinal Study of US Medical Licensing Exam Performance, 2000-2009," Academic Medicine, February 2011). IMGs had much lower match rates this year than U.S. allopathic seniors as shown in the following excerpts from NRMP’s “Results and Data 2013 Main Residency Match®:” 

  • 93.7 percent of U.S. allopathic seniors were matched to postgraduate year one positions in 2013;
  • 53.1 percent of U.S. citizens trained in international medical schools were matched; and
  • Match rate for non-U.S. citizens trained in international medical schools was 47.6 percent. 

NRMP reported that matches for foreign-trained physicians were concentrated in a few specialties, with more than half in internal medicine (categorical) and family medicine. Two other specialties with higher match rates for IMGs were pediatrics (categorical) and psychiatry. For U.S. allopathic seniors, there was a greater tendency to match to emergency medicine, anesthesiology, and medicine-preliminary. (Medicine-preliminary refers to one-year programs that begin in postgraduate year one and provide prerequisite training for advanced programs.) 

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 Still Time to Take Our Poll: Should Texas Limit Licensing Exams?

The November issue of It’s Academic  told you how TMA’s Council on Medical Education is examining if TMA should have policy on whether Texas medical licensing laws should continue to set testing limits. As part of this evaluation, the council welcomes your feedback. If you didn’t have a chance to take our poll last month, you encourage to do so: Take our surveyhere.

Such policy would be used whenever TMA is called on to recommend a position on proposed legislation that would alter the current requirements.

The February issue of Texas Medicine will have more on this issue.

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 AMA Delegates Debate Medical Education Issues

Access to training, medical licensure, and maintenance of certification were among the medical education topics the American Medical Association House of Delegates addressed at its interim meeting in November.

The delegates: 

  • Adopted the Council on Medical Education report on expanding access to clinical training sites for medical students. Included in the report is a recommendation that AMA reaffirm its policy that supports the concept that the core curriculum of a foreign medical school should be provided by that school, that U.S. hospitals should not provide substitute core clinical experience for students attending a foreign medical school, and that AMA supports U.S. teaching hospitals and foreign medical educational institutions entering into relationships that provide clinical educational experiences for advanced medical students who have completed the equivalent of U.S. core clinical clerkships. 
  • Directed AMA to continue studying increasing match participants and the stagnant growth of U.S. residency positions. The AMA Council on Medical Education is working on a report on GME funding and will present it at the 2014 annual meeting. 
  • Told AMA to evaluate the consequences of the January 2013 changes to the United States Medical Licensing Examination Step II Clinical Skills exam and their implications for U.S. medical students and IMGs. 
  • Ordered AMA to urge key stakeholders, such as the Accreditation Council for Graduate Medical Education, to explore the feasibility of extending residency programs through a pilot study placing medical graduates in integrated physician-led practices to expand training positions and increase the number of physicians providing health care. 
  • Referred for further study a recommendation that AMA promote development of programs that help physicians provide pre-medical shadowing opportunities.
  • Referred for further study a request that AMA work with the Centers for Medicare & Medicaid Services (CMS) to allow family medicine, general internal medicine, and general pediatric residents to spend one month in the second postgraduate year and one month in the third postgraduate year in the office of a primary care physician who meets the qualifications for adjunct faculty of the sponsoring institution; and work with the Accreditation Council of Graduate Medical Education Residency Review Committee for Family Medicine and other specialties to adjust GME program requirements so that the patient encounters during this time count toward the continuity requirements for the completion of a residency. 
  • Referred for further study a resolution that AMA urge CMS to use the AMA definition of a resident when developing rules and regulations. The reference committee heard testimony that defining physicians in fellowships as “residents” could compromise their ability to bill for services.
  • Reaffirmed AMA policy that, in part, urges every medical school and residency program to teach the legal, political, ethical, and economic issues that will affect physicians. 
  • Reaffirmed AMA policy of working with the American Board of Medical Specialties to streamline Maintenance of Certification (MOC) to reduce the cost, inconvenience, and disruption of practice due to MOC requirements for all of their member boards, including subspecialty requirements.    

For additional information on the AMA house actions on medical education, log on to http://www.ama-assn.org/assets/meeting/2013i/i13-reference-committee-reports.pdf,and click on Report of Reference Committee K. 

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Join the Houston Conference for Medical Educators  

Texas Children’s Hospital and Baylor College of Medicine are cosponsoring a conference for medical educators, Moving Up the Educational Ladder: Improving Your Skills and Building Your Career in Medical Education, Feb. 6-9 at the Pavilion for Women at Texas Children’s Hospital in Houston.  

In addition to presentations by world-renowned speakers, there will be a poster session to showcase educational research and educational innovations and a "Hot Topics" lunch.  

Contact Baylor staff at faced@bcm.edu for more information.

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Help the NBME Celebrate Its 100th Birthday  

The National Board of Medical Examiners (NBME) is accepting entries until Jan. 17 for its Centennial Prize Competition. NBME will observe its 100th anniversary on May 15, 2015.  

NBME Centennial Prize Competition objectives include identifying innovative ideas that address future assessment needs for individual health professionals, health professions institutions/programs, licensing and certification bodies, and other areas of education and practice.  

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 Join or Renew TMA Today: We Could Use Your Help!

TMA has been a longtime advocate for academic faculty and medical schools — monitoring legislation, determining the potential impact on patients, and lobbying for your interests.

The results of the 2013 legislative session were outstanding for academic medicine. Our efforts in this session, including public testimony provided by TMA leadership at every applicable legislative committee hearing and personal visits with legislative members and staff, paid off. For example, lawmakers restored graduate medical education formula funding, which took a 31-percent hit in 2011, with a 15-percent, or $8.8 million, increase this budget cycle. Lawmakers also restored the Family Medicine Residency and State Physician Loan Repayment programs, which were almost eliminated in the past budget. Undergraduate medical education also received a boost of 7 percent in per-student funding. TMA helped stop off-shore medical schools from buying up clerkship spots in Texas hospitals and repealed a 2011 law that forced IMGs to spend three years working in only medically underserved areas.  

TMA is extremely successful in Texas — for one reason only. TMA speaks with one strong, firm, and consistent voice, the voice of its members. Only with grassroots support … only with your support … can we continue to be successful. 

Join or renew today at www.texmed.org/join and see what a difference TMA membership can make. Within your department and/or academic institution, funds may be available to cover the cost of your membership. Please check with your department administrator or chair to see if applicable. 

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New-to-Texas Physicians Can Start Here

Are you a new Texas physician? Have you recruited a physician for your school, your practice, or your community from out of state?

 TMA's New to Texas webpage can help new or returning Texans get their practices up and running. The page provides links that doctors need to obtain a Texas license, plus contact information for relevant state and federal agencies, and links to resources such as practice consulting for set-ups, health insurance plan contacts, and employee salary data.

TMA members can email the TMA Knowledge Center or call (800) 880-7955 for fast answers to questions about membership, TMA member benefits and services, practice management or legal information, and more.

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This Month in Texas Medicine

The December issue of Texas Medicine tells you what Texas medical schools are doing to speed up training of primary care physicians, explains what you need to know about how the new health insurance exchange will affect your practice, and reports on an emergency physician’s fight with a hospital over peer review. It also explains why 2014 is a big year for electronic health records, and how Medicaid is trying to base payments on quality.

It's Academic is for physicians in academic settings. For more information about TMA’s efforts on behalf of medical education and academic physicians, visit the TMA Council on Medical Education’s Subcommittee for Academic Physicians page on the TMA website.

Please share with your colleagues who are not TMA members and ask them to join.

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