2007 Legislative Compendium: Physician Workforce, Licensure, and Discipline

Graduate medical education (GME) funding was a legislative priority for TMA this session and a focus at each of the four First Tuesdays at the Capitol - TMA-member advocacy days. The TMA Medical Student Section selected GME as its primary legislative issue as well.

Texas medical schools gained $35 million in additional state funding for GME positions for the 2008-09 biennium. Total funding of $86 million met only half of TMA's and Texas medical schools' goal of $16,000 per resident funding for medical schools. The additional funds are essential for allowing the state to respond to a growing physician shortage. When you factor in the additional$12.5 million medical schools received for GME funding through special item budgeting, Texas GME funding reached an unprecedented $99 million in state appropriations.

Recognizing the need for Texas to produce more homegrown physicians, TMA made GME funding a legislative priority this session. Producing our own physicians decreases the state's dependency on other states for our own physician supply; enables the state to have more influence on educational quality; and provides increased educational opportunities for Texans in the state. Given the strong relationship between location of GME training and practice location, the state's investment in GME will produce more physicians for the state's workforce.

The legislature mandated the state workgroup directed by the Texas Health Care Policy Council of the Governor's Office to study the numbers and kinds of additional GME slots needed in the state. The study is to include an action plan for increasing the numbers of GME programs in underserved areas and growing the number of specialists needed most.

One item not accomplished this session was the restoration of the critically important Medicaid GME program, which leaves teaching hospitals without an important funding source. Texas ranks as one of only three states without such a program.

Like GME, state funding for medical students also reached an all-time high. The legislature appropriated $705 million, an increase of 11.6 percent, from increased enrollments. Per-capita spending per medical student was down slightly, 7.9 percent over the previous biennium. The legislature showed a strong willingness to support medical school expansions. It provided $48 million to the Texas Tech University Health Sciences Center in El Paso to continue its conversion to a four-year medical school. Legislators also provided new funding, $34 million, to the Texas A&M Health Science Center for development of a four-year medical school in both Bryan/College Station and Temple.

State Graduate Medical Education Funding

Health-Related Institution and Texas Higher Education Coordinating Board GME Programs
Texas medical schools received their highest-ever state appropriation levels for GME programs, a gain of $35 million, which more than doubled the $25 million allocated for the 2006-07 biennium, for a total of $62.8 million in 2008-09. The House took the lead in the legislature to support GME formula funding expansion, proposing $46 million more dollars ($73 million in total funding). The Senate supported a total of $27 million. A compromise was reached in the final budget, with both sides supporting a total of $63 million for this program.

The Texas Higher Education Coordinating Board received $23 million in state appropriations for primary care GME programs. Special item funding of $12.5 million was awarded to GME programs at four medical schools, bringing the overall total for GME appropriations to a record high of $99 million.

GME Formula Funding
Each of 10 health-related institutions received line-item GME funding on a per-capita basis of $11,268 per GME slot for the biennium, an increase of 134 percent over the 2006-07 base rate of $4,806. Although a welcome increase, it fell below the goal of $32,000 per resident per biennium established by consensus with TMA, Texas medical schools, and state teaching hospital professional associations in a pre-session legislation strategy accord. Appropriations per institution ranged from $270,000 at The University of Texas Health Center at Tyler to $13 million at The University of Texas Southwestern Medical Center at Dallas, as shown below.

State GME Formula Funding for Health-Related Institutions

Health-Related Institution
State Appropriations
 
2006-07
2008-09
Baylor
$5,199,922
$12,834,312
Texas A&M
1,408,112
5,352,324
Texas Tech
2,321,222
5,329,788
UNTHSC
619,954

1,588,796

UT Southwestern
5,815,072
13,239,962
UTHSC-Houston
3,532,296
8,631,328
UTHSC-San Antonio
3,037,294
7,538,326
UTMB
2,537,486
6,794,636
M.D. Anderson
418,108
1,205,682
UT Health Center, Tyler
110,534
270,434
State Total
$25,000,000
$62,785,588

 

 

 

 

 

 

 

 

 

Budget writers specified using the GME formula funding dollars to create new GME slots and faculty costs related to GME. There are some concerns that if the funds do not produce new slots, future legislatures will not be willing to continue the funding. Health-related institutions are to work with the Higher Education Coordinating Board to develop new performance measures relating to increased numbers of GME slots.

Senate Bill 1095 by Sen. Carl Uresti (D-San Antonio) and coauthored by Sens. Robert Deuell, MD (R-Greenville), Kyle Janek, MD (R-Houston), Jane Nelson (R-Lewisville), Robert Nichols (R-Jacksonville), Eliot Shapleigh (D-El Paso), and Judith Zaffirini (D-Laredo). The bill's companion legislation, House Bill 3065 by Rep. Vicki Truitt (R-Keller), sought a study on the need for expanding GME programs and slots. This did not pass as a separate bill but was added to Senate Bill 10, the Medicaid reform bill, in the final days of the legislative session.

The amendment to SB 10 specifies that the Texas Health Care Policy Council (based in the Governor's Office) is to conduct a study on GME needs in coordination with the Institute of Demographic and Socioeconomic Research at The University of Texas at San Antonio, the Regional Center for Health Workforce Studies at the Center for Health Economics and Policy of The University of Texas Health Science Center at San Antonio, and the Texas Medical Board. The study is to focus on increasing GME programs and slots and physicians practicing medical specialties. The study also will (1) examine the feasibility of using a percentage of physician licensing fees to increase GME programs and slots; (2) put emphasis on and recommend a plan of action for increasing GME programs and slots in medically underserved areas of the state, and physicians practicing specialties underrepresented in the state; and (3) determine the number of medical residents who obtain a license to practice medicine in the state on completion of a GME program in the state.

The Texas Health Care Policy Council is to report study results and make study data available to the governor, lieutenant governor, speaker of the House, House Committee on Public Health, and Senate Committee on Health and Human Services by Dec. 1, 2008.

Texas Higher Education Coordinating Board GME Programs
GME monies allocated to the Texas Higher Education Coordinating Board are dedicated to primary care programs totaling $23 million for the next biennium, reflecting a very modest cut (-$36,804 or less than 1 percent) over the biennium, as shown below.

Texas Higher Education Coordinating Board GME Funding

Program
2006-07 State Approps.
2008-09 State Approps.
Family Medicine Residency
$17,464,310
$17,464,310
Primary Care Residency
4,990,440
4,990,440
GME
3,636,804
600,000
Transferred to GME formula funding
-3,000,000
Total
26,091,554
$23,054,740*

*Note: $3,000,000 was transferred from the Coordinating Board's "GME" program to formula GME funding.  This does not represent a loss to GME overall.

Family Medicine Residency Program : Provides direct support to the state's 25 GME programs in this specialty with the objective of producing family physicians for practice in underserved areas. An estimated $12,400 was allocated for 660 family medicine residents in Fiscal Year 2007.

Primary Care Residency Program : Provides funding to new primary care residency programs with the objective of increasing the primary care physician workforce. An estimated 165 residents were funded at about $16,000 each in Fiscal Year 2007. These funds are targeted toward GME slots filled by residents most likely to remain in the state to practice as identified by GME program directors. Funds may be used for educational enhancements that benefit all residents at a particular program.

Graduate Medical Education Program : Provides funding to medical schools and teaching hospitals to support primary care GME programs. The program was initiated in 1997. Beginning with Fiscal Year 2008, the $600,000 allocation shown in the table above is to be distributed for educational costs incurred by primary care residency programs not affiliated with a medical school. This special provision was made because GME formula dollars are limited to programs affiliated with medical schools. Rider 16 to the Higher Education Coordinating Board budget specifies up to $12,500 per resident may be allocated in each fiscal year; however, the amount of available funds and number of eligible resident slots allows only about $950 to be allocated per slot per year. An estimated 316 resident slots will be funded each year at 12 residency programs. The legislature requires the coordinating board to develop related program rules for equitable distribution of the funds.

Additional State GME Funding
Almost $13 million in GME funding was authorized in response to special item requests made by four health-related institutions as shown in the following table.

Institution 2007-08 Biennial State Appropriations for GME Special Items
Texas Tech University Health Sciences Center

-Medical Residency & Physician Assistant Expansion Program: $3,000,000
-Midland Surgical GME: $268,028
-Midland Cardiology GME: $615,570
-Family/Community Medicine GME: $1,201,830
-Border Health-Resident Support: $775,546
TOTAL: $5,860,974

UT Health Center, Tyler -Family Medicine GME $2,406,068
UT Southwestern Medical Center, Dallas -Primary Care GME $3,115,000
UTHSC-San Antonio -Family Medicine GME $1,130,356
State Total  $12,512,398 million

DSHS is authorized to use funds appropriated to the South Texas Health Care System to help support the Family Medicine Residency Program in McAllen, in collaboration with The University of Texas Health Science Center at San Antonio.

GME Funding Near Miss
As the session began, a recommendation was pending from HHSC to restore the Medicaid GME program. In 2003, the legislature eliminated state matching dollars for Medicaid GME as a cost-saving measure, resulting in a loss of about $127 million each biennium for teaching hospitals. Texas is one of only three states without a Medicaid GME program. The commission recommended restoration of the program and requested $207 million for the 2008-09 biennium. Legislators did not approve the request, though hospital districts may use local dollars for the state match. Parkland is currently doing this, after it sued the state for the privilege. Without Medicaid GME, Texas teaching hospitals have only Medicare GME funding, now capped at 1996 levels, as a direct public funding source for hospital costs related to GME.

Medical School Funding
State funding for medical students has been allocated on a per-capita formula basis since 1999. A modest cut was made to the base unit for medical student funding, slipping 7.9 percent to $10,841 from $10,987. The additional weight of 4.753 per medical student that is applied to the formula was unchanged from previous state budgets. The reduced base unit drops the state appropriation per medical student to $51,527 from $52,221. The highest base funding was achieved in 2002-03 at $11,776, which generated a student per-capita appropriation of $55,971. Study committees appointed by the Texas Higher Education Coordinating Board are to review and recommend formula updates for the 2010-11 budget by June 1, 2008.

The Senate favored higher per-capita funding for medical students with a proposed $11,405 base level compared with the House version at $10,627. The final budget reflected the compromise level of $10,841.

State Medical School
Undergraduate Funding
Health-Related Institution
State Appropriations
 
2006-07
2008-09
Baylor
$73,596,640
$77,596,640
Texas A&M
35,818,222
37,553,643
Expansions
33,000,000
 
70,553,643
Texas Tech
61,390,926
62,589,078
Odessa Med. Ed.
3,199,930
El Paso Faculty/Staff
48,000,000
 
104,789,008
UNTHSC
52,323,902
57,192,678
UT Southwestern
92,324,012
95,836,378
UTHSC-Houston
87,111,362
90,573,826
UTHSC-San Antonio
87,307,722
89,336,620
UTMB
115,916,984
122,291,573
UT Health Center, Tyler*
3,167,500
3,167,501
STATE TOTAL
$608,957,270
705,055,255
Expansions
81,000,000
OVERALL TOTAL
$786,055,255

*Unable to identify medical education separately for Tyler, amount shown also includes infectious disease control and research.

Baylor College of Medicine
Although a private institution, Baylor College of Medicine in Houston receives state funding for 584 Texas resident medical students. This arrangement dates back to 1971 as a means of increasing the number of medical students educated in the state. Baylor receives a state per-capita amount per medical student based on the average for UT Southwestern and UTMB, the two largest public medical schools. This year, the legislature added a requirement through a rider that the Higher Education Coordinating Board report actual and budgeted expenditures for Baylor, which receives distributions from the Permanent Health Fund for Higher Education and a Permanent Endowment Fund.

The University of Texas M.D. Anderson Cancer Center and Health Center at Tyler
The University of Texas M.D. Anderson Cancer Center and Health Center at Tyler has distinct funding processes. For 2008-09, the legislature is establishing a pilot program for M.D. Anderson for funding tied to the number of Texas cancer patients served at the institution. About $220 million in general revenue funds were appropriated for cancer center operations based on a formula tied to the number of Texas cancer patients served in 2004, at a rate of $2,900 per patient. The average growth in formula funding for this institution cannot exceed the average growth for the other state health-related institutions. The Higher Education Coordinating Board is to monitor and report the validity of this funding process by Dec. 1, 2008. If the new funding pilot is inappropriate, the funding process will revert to the previous methodology.

State funding for The University of Texas Health Center at Tyler is based on the number of new primary chest disease diagnoses made each year in Texas. Participating Texas hospitals in the Texas Hospital Association Patient Data System program report these diagnoses. Similar to M.D. Anderson above, Tyler's funding for 2008 will be case-specific based on the number of new primary chest disease diagnoses reported in 2004 at a rate of $6.68 per case. Funding for 2009 is based on 2005 cases at a rate of $6.18 per case.

Medical School Expansions

Texas Tech University Health Sciences Center in El Paso
Long-awaited funding was authorized to allow the Texas Tech University System to move forward in hiring faculty and staff for the Texas Tech El Paso Medical School. Texas Tech gained legislative approval in 2003 to convert the two-year El Paso regional academic health center for third- and fourth-year medical students) to a separate four-year school.

Approved funding includes $48 million to hire faculty over the next biennium; and a rider for $1,812,456 to cover infrastructure support, faculty salaries, maintenance and operation, and library resources. The rider requires Texas Tech to file a report with the Legislative Budget Board and governor on use of the funds in relation to intended purposes by Dec. 1, 2008. The first four-year class scheduled to matriculate is in fall 2009.

Early in the session, a rider was included in HB 1, the appropriations bill, which proposed $31 million in funding for the El Paso medical school in 2008, and an additional $17 million in 2009 contingent on the ability of the school to demonstrate the need for the additional dollars. This contingency was removed on the Senate side of the legislature in April at the urging of Sen. Robert Duncan (R-Lubbock), chair, Senate Finance Committee Health-Related Institutions Workgroup, and was not part of the final budget.

Texas A&M Health Science Center
Plans to create two four-year medical schools within the Texas A&M University System were aided by a special items appropriation totaling $23 million and a line-item appropriation of $10 million, for a total of $33 million in new funding. Currently, A&M students spend the first two years of medical school in College Station and the third and fourth clinical training years at Scott & White Hospital System in Temple. Land has been secured in Bryan near College Station for construction of a new health science center with a four-year medical school. The program at Temple expands to a four-year medical school. Funding levels are:

  • $14 million, for expanding the Temple clinical training program;
  • $10 million for medical school expansions at both College Station and Temple; and
  • $9 million to build and support clinical facilities for the Round Rock campus.    

Lower Rio Grande Valley Regional Academic Health Center, Harlingen, and McAllen
House Bill 2386 by Rep. Eddie Lucio III (D-Brownsville) and Senate Bill 420 by Senator Lucio unsuccessfully sought expansion of the Lower Rio Grande Valley Regional Academic Health Center (RAHC) to a four-year medical school. The school is located in Harlingen and McAllen. This is the third consecutive legislative session for this effort. The center remains an extension campus with clinical training programs for third- and fourth-year medical students from UT Health Science Center-San Antonio. The RAHC received $24,084,819 for the next biennium, an increase of $7 million or 34 percent over the current budget. House Bill 1375 by Rep. Aaron Pena (D-Edinburg) requested $5 million additional dollars for the facility, but the bill did not make it out of committee. The House recommended $24 million in comparison to $19 million by the Senate, with the House prevailing in the end.

General Medical School Provisions

Minimum Medical School Enrollments (Budget Rider)
The legislature established the minimum medical school enrollments for state institutions as these:

Texas Tech University Health Sciences Center School of Medicine 100
University of North Texas Health Science Center at Fort Worth 100
The University of Texas Medical Branch School of Medicine 200
The University of Texas Southwestern Medical School 200
The University of Texas Medical School at Houston 200
The University of Texas School of Medicine at San Antonio 200

Should a medical school fall more than 5 percent below the defined minimum, the school is required to file a report with LBB on the reasons for failing to meet the minimum enrollment number.

A 10-Percent Cap in Non-Texas Resident Medical School Enrollments (Budget Rider)
Public medical schools (excludes Baylor College of Medicine) are barred once again from using state appropriations if they limit admissions and accept nonresident students beyond a 10-percent cap if doing so denies admission to a qualified Texas applicant.

Special Enrollment Provisions (Budget Riders)
UT Southwestern Medical Center at Dallas may admit up to 25 competitively recruited medical students for a specialized six-year program of clinical and research training designed to lead to an MD and/or PhD. The students do not have to be Texas residents.

Texas medical schools may enroll up to six competitively recruited medical students, who already have a DDS, in each second-year medical school class for a specialized six-year program in oral and maxillofacial surgery, composed of the last three years of medical school and a three year-GME program, irrespective of whether those students are Texas residents.

Efforts to Increase Medical School Diversity

Joint Admission Medical Program
Senate Bill 1601 by Sen. Royce West (D-Dallas) and sponsored by Rep. Fred Brown (R-Bryan) contains cleanup and refinement language for the Joint Admission Medical Program (JAMP). This program designates 10 percent of its medical school positions for economically disadvantaged students. JAMP has proven to be a model of collaboration among medical schools and universities in the state. Students enter the program in their sophomore year of college and receive extensive tutoring and mentoring throughout college and medical school. The bill expands the participation of private and independent undergraduate institutions through a designated slot in each JAMP class, with a cap of 30 percent of overall JAMP enrollment. Public universities have two designated slots per institution per year, with a provision for adjustments if needed. SB 1601 removed original references to nontraditional students. The bill also authorizes JAMP administrative staff to work with affiliated nonprofit organizations to raise funds and provide services. 

Prairie View A&M Undergraduate Medical Academy
Prairie View A&M University is authorized to support the undergraduate medical academy out of $15 million appropriated for the Academic Development Initiative. The goal of the academy, created in 2003, was to expand the minority medical school applicant pool.

Scholarships
Once again, a budget rider (Sec. 11 Method of Financing Scholarships of the special provisions for state agencies of higher education) directs health science centers to use funds for need-based student scholarships regardless of race, color, or ethnicity of the student recipient. This prevents medical schools from using these state scholarship funds to recruit underrepresented minority students directly.

Other Programs

Collaborative Research on Acute Neurological Injuries (Budget Rider)
Texas A&M Health Science Center has authority to spend $2 million to conduct joint research endeavors with other scientists from Baylor College of Medicine, The University of Texas Health Science Center at Houston, and The University of Texas Medical Branch School of Medicine in Galveston to develop treatments to repair acute neurological injuries such as those caused by trauma and strokes.

Creation of the Rare and Aggressive Breast Cancer Research Program (Budget Rider)
The University of Texas M.D. Anderson Cancer Center received $4 million for development of a research program focused on rare and aggressive breast cancer to improve the diagnostics in patients with breast cancer.

Texas Cancer Registry (Budget Rider)
The Senate Finance Committee Workgroup on Health-Related Institutions expressed a willingness to provide relief to medical schools from the obligation to fund the Texas Cancer Registry. Unfortunately, an alternate funding source was not found, and the obligation remains. The Higher Education Coordinating Board is directed to collect $1,875,000 from health-related institutions, including Baylor College of Medicine, and general academic institutions involved in cancer research. Once again, the coordinating board is to use a methodology that assesses a proportional cost for each institution. The funds are to be used by DSHS to enhance the infrastructure of the registry and to fund a staff person to monitor contract compliance and quality assurance.

Family Planning Services at Federally Qualified Health Centers (Budget Rider)
Once again, up to $20 million in state funding for family planning services is to be set aside for Federally Qualified Health Centers (FQHC), and up to $2 million may be allocated to clinics for core family planning services provided under the auspices of Baylor College of Medicine in Houston. Funds not applied for and granted to FQHCs will be made available to other providers.

Tobacco Endowment Funds
In addition to state appropriations noted above, all health-related institutions, including Baylor College of Medicine and the Lower Rio Grande Valley Regional Academic Health Center in Harlingen/McAllen, will receive funding from the tobacco permanent endowment fund.

Feasibility Study on Joint Health Science Courses for Health Professional Students (NEW)
Senate Bill 141 by Senator Nelson allows but does not require the Higher Education Coordinating Board to conduct a study on feasibility of public and private institutions of higher education offering joint courses in basic sciences to students pursuing various health science or health professions degrees. The board is to be assisted in conducting the study by each state agency named to the Health Professions Council, including licensing boards for physicians, chiropractors, dentists, nurses, occupational therapists, optometrists, pharmacists, physical therapists, podiatrists, psychologists, and veterinarians. Professions licensed by DSHS and Texas Funeral Service Commission are to be included as well as the Governor's Office. Representatives of higher education institutions also are to be included among the study group. Recommendations are to be submitted on feasibility of providing joint courses, courses to be offered, institutions to offer courses, and relevant issues. The study is due by Sept. 30, 2008, if conducted. (Note: original version of bill would have required the study but it was changed to permissive language by a floor amendment from Sen. Diane Patrick (R-Arlington) in the House session on May 23, 2007.) 

Study of Potential for Joint Partnership Agreement Between Institutions of Higher Education (NEW)
Similar to SB 141 above, Senate Bill 649 by Sen. Eliot Shapleigh (D-El Paso) allows but does not direct the Higher Education Coordinating Board to conduct a feasibility study. In this case, the board is asked to consider studying if joint partnership agreements can be entered into by higher education institutions. The study is to assess whether institutions could develop joint degree and research programs, joint faculty appointments, and joint facilities. If conducted, study is to be completed by Jan. 1, 2009, with existing resources.

The original version of the bill authorized a joint-partnership between Texas Tech Health Sciences Center in El Paso and The University of Texas at El Paso to develop joint degree and research programs and to allow for joint faculty appointments. Senator Shapleigh filed the same bill last session but was unsuccessful. The bill was reworked to allow for a study of the potential for joint-partnerships among higher education institutions in general, without mention of specific institutions.

Physician Workforce

Texas Liaison to National Health Service Corps Ambassador Program
Senate Calendar Resolution 1 by Senator Nelson designates the Texas Primary Care Office of DSHS as liaison with the federal National Health Service Corps Ambassador Program. The program matches university and community-based volunteers with health professions students to encourage students to select careers in medically underserved areas. Prior to the bill, there was no official state liaison for this national program. The Texas Primary Care Office assists communities in recruiting physicians.

Funding for Primary Care Preceptorship Programs
State allocations to the primary care preceptorship programs, including family medicine, general internal medicine, and general pediatrics, remained stable: $452,144 per year ($904,289 for the biennium). The programs seek to engender interest in primary care careers among medical students by offering a one-month optional preceptorship with primary care physicians in community practice. The Texas Higher Education Coordinating Board administers the program and sought $1,941,437 in total funding for the 2008-09 biennium, an amount that would have come close to restoring funding levels to the peak level of 2003. All other funding proposals called for retention of current funding levels, including those by the LBB, House, and Senate.

Family Practice Rural and Public Health Rotations (Budget Rider)
Of the $17 million per year appropriated for the Texas Higher Education Coordinating Board's Family Medicine Residency Program, $363,000 each year is to be designated for one-month rural or public health rotations for family medicine residents. Funds for the rotation were unchanged from the previous biennium.

State Physician Education Loan Repayment Program
Approximately $3.8 million is expected to be available for the State Physician Education Loan Repayment Program. This program has been one of the state's most successful initiatives for recruiting and retaining primary care physicians in underserved areas. Interest in the program has exceeded available resources in recent years. The program is funded via state appropriations ($2.1 million) and by a 2 percent set-aside from medical school tuition ($1.7 million) that is collected by medical schools and transferred to the Higher Education Coordinating Board for loan repayment. The combined total is approximately $1.3 million higher than the previous biennium.

Rural Physician Relief Program
The Office of Rural Community Affairs (ORCA) received $332,352 in continued funding for the Rural Physician Relief Program. Rural physicians seeking coverage of their practices during a brief absence for vacation, medical care, or continuing medical education (CME) can receive assistance in finding a physician to provide locum tenens services. ORCA provides a forum for physicians to specify their locum tenens needs, register their willingness to provide locum tenens, as well as payment for the locums' coverage, all in the interest of recruiting and retaining physicians to rural practices. ORCA also received $6.6 million for programs that increase access to health care in rural areas, including the Texas Health Service Corps and Medically Underserved Community/State Matching Incentive Program.

Improvements to Physician Licensure
House Bill 1973 by Rep. Diane Delisi (R-Temple) and Sen. Jane Nelson (R-Lewisville) responds to the Texas Medical Board's (TMB's) unprecedented increase in medical license applications during past year, and recent delays in licensure processing. The bill requires an annual evaluation of the policy and procedures used to issue licenses. It requires the board to perform an annual needs assessment to determine performance goals for reducing any unnecessary delays in timely completion of licensing process. Not later than Aug. 1 of even-numbered years, the executive director is to issue a report to the governor, Legislative Budget Board, and relevant committees of the Senate and House on the status of the board's licensing process.

The report is to include a projected yearly budget for board staffs and technology improvements to facilitate licensure processing in a reasonable time period. Information on applicants, including specialty certification, location of intended practice, felony and misdemeanor convictions, and deferred adjudications, is to be reported. By Aug. 31, 2008, the board is to ensure that the average license processing time does not exceed 51 days. Priority is to be given to applicants who inform the board of their intention to practice in an underserved area. More specifically, the board is to adopt rules for expediting applications for those who submit an affidavit stating that the applicant intends to practice in a rural or medically underserved area or health professional shortage area with a shortage of physicians.

Budget writers increased funding to the TMB by $3.9 million to expedite physician licensure. A portion of the money is to be used to hire six new staff. The budget specifies, however, that $267,000 in Fiscal Year 2008 and $198,000 in Fiscal Year 2009, as well as the six new staff, are contingent upon TMB prioritizing licensure of physicians who treat Medicare and Medicaid patients. The board is to issue a report to the LBB, state comptroller, House Appropriations Committee, and Senate Finance Committee no later than Dec. 1 of each year verifying implementation of this requirement.

The board's performance target has also been increased 56 percent from 4,500 new medical licenses a year to 7,038, a net increase of about 2,500 licenses per year.

Senate Bill 36 by Senator Nelson and Rep. Craig Eiland (D-Galveston) adds new provisions that allow additional attempts for passage of the U.S. Medical Licensure Exam (USMLE) beyond the previous cap of three attempts. Prior to 2005, state law contained a provision that allowed a physician under certain circumstances six attempts at passage of one of the three exams of the USMLE. That provision was removed by the 79th Texas Legislature during the board's sunset review. SB 36 allows physicians who fail a USMLE step exam more than three times to qualify for medical licensure in Texas if they meet one of the following sets of requirements:

  • Residents with physician-in-training permits or those with pending permit applications on Sept. 1, 2005, are allowed four rather than three attempts on one of the three USMLE step exams. (Note: this provision was previously in place by means of an emergency rule by the Texas Medical Board that has since expired. This is expected to affect few physicians.).
  • Physicians are allowed six attempts if they are board certified (by an American Board of Medical Specialties board or American Osteopathic Association) and have completed an additional two years of GME in the state beyond minimum licensure requirements.
  • Physicians with unrestricted licenses in good standing at least five years in another state are allowed four attempts  or six attempts if they are board certified and have completed an additional two years of GME beyond the minimum licensing requirement .

The bill was amended in a House/Senate conference committee in late May to allow up to four attempts if a physician had an unrestricted license for at least five years in another state. SB 36 took effect June 15, 2007.

Health Professionals Data Collection
Senate Bill 29 by Senator Nelson and Rep. Vicki Truitt (R-Keller) sets into statute a requirement for the collection and reporting of basic practice information for health professionals via a defined minimum dataset. Data is to be collected and processed by DSHS with a role for the Health Professions Council in promoting the reporting of required and encouraging collection of voluntary (demographic and practice information) data elements. This will have little impact on TMB with the exception that the board is now directed to encourage physicians to provide their high school of graduation, a question not previously asked by the board. The change will necessitate revisions to the medical license application online form, with related costs.

Workforce/Medical Education Near Misses
Senate Bill 30 by Senator Nelson would have required all non-U.S. citizen international medical graduates (IMGs) seeking medical licensure in the state to show proof of employment or a contract for employment in a health professional shortage area (HPSA) or medically underserved area (MUA) for three years as an additional requirement for licensure. The apparent objective was to require IMGs with H1-B Visas (employment visas) to be obligated to practice in an underserved area for three years similar to the requirement placed on IMGS with J-1 Visas. There were concerns the bill may have served as a disincentive for IMG physicians to seek practice in Texas at a time when the state is experiencing a growing physician shortage. The bill came very close to passage but failed to achieve a majority vote by the House in the final days of the session.

Senate Bill 31 by Senator Nelson started out as a bill to incentivize medical schools to create rural medicine training tracks similar to the Rural Osteopathic Medical Education (ROME) program at the University of North Texas Health Science Center. The bill was reworked twice: once as a rural medical school scholarship program, the second time as a physician and dentist education loan-repayment program (50/year) and Medicaid provider fee bonus (10 percent) program. The program would be funded using Frew settlement dollars totaling $10.3 million. Eligibility was limited to physicians or dentists who practiced in rural underserved areas for a minimum of three years and provided services to children enrolled in Medicaid. The use of Frew lawsuit dollars to fund this bill was problematic, and ultimately the bill did not pass. In the last days of session, supporters of the bill added it to House Bill 2667. The bill focused on health insurance for volunteer firefighters, police force members, and emergency services districts, but the amendment was struck before HB 2667 passed.

House Bill 38 by Rep. Burt Solomons (R- Carrolton) would have required TMB to verify employment eligibility for applicants for medical licensure, including citizenship or legal immigration status. The bill did not pass the full House.

Senate Bill 1055 by Sen. Judith Zaffirini (D-Laredo) would have established a commission under direction of the Higher Education Coordinating Board to study the need for faculty at public and private higher education institutions, including medical schools, through academic year 2026-27. TMA Council on Medical Education was in favor of the bill as a means of determining future staffing needs at medical schools, particularly in consideration of recent and planned enrollment increases. The bill was favorably voted out of committee but was not passed by the full Senate.

Physician Workforce, Licensure, and Discipline TMA Staff Team:

Legislative: Dan Finch (licensure) and  Michelle Romero (workforce/funding)
Policy: Marcia Collins and  Karen Batory
Legal: C.J. Francisco

Overview  |  Managed Care/Insurance Reform | Scope of Practice  | Retail Health Clinics | Responsible Ownership | Corporate Practice of Medicine | Health Care Funding  |  Medicaid, CHIP, and the Uninsured  | Public Health  | Border Health  | Mental Health | Emergency Medical Services and Trauma Care | Rural Health | Medical Science and Quality  | Health Information Technology | Prescription Drugs | Long-Term Care | Workers' Compensation | Abortion  | Franchise Tax Reform


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