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
|
|
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
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Health Information Technology
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Prescription Drugs
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Long-Term Care
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Workers' Compensation
|
Abortion
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Franchise Tax Reform