Symposium on Medical Education -- August 2002
By Abelardo Rodriguez, MD
Medical education has undergone tremendous changes in the last 10 years. The primary mission of medical schools in Texas -- teaching, research, and patient care -- has been affected by political, economic, demographic, legal, social, and technological factors. A decrease in state and federal funding sources -- coupled with increased managed care, which doesn't pay for any medical education expense -- has resulted in medical school faculties having to generate more money from patient care revenue. This means less time to spend teaching.
Medical schools and academic medical centers are increasingly dependent on income generated by clinical practice. A high priority of the Texas Medical Association and its Council on Medical Education has been to support both graduate and undergraduate education funding.
Many leaders in medical education view educating physicians as a public good and believe training costs need to be borne by people, corporations, and the government
An important issue related to access to health care and medical centers is the physician workforce. Trying to achieve the right number of physicians with a balance of primary care doctors and specialists is challenging. Medical education is expensive, and increasing medical school class sizes or creating new medical schools needs to be evaluated carefully. Factors to consider include population growth, especially in certain regions of the state, and the migration of physicians to Texas.
The Texas population is growing and changing, gaining 3.4 million residents in the last decade, second only to California. Texas is becoming more racially diverse, with the Hispanic population increasing much faster than any other ethnic group.
Texas is a major importer of physicians. More than half of the new physicians licensed by the Texas State Board of Medical Examiners attended school in another state or country. Distribution of the physician workforce continues to be a problem, and economists urge that assuring an adequate physician supply be left to the marketplace rather than to government policymaking.
A standing agenda item for TMA's Council on Medical Education has been the "town-gown" issue. In general, this problem usually involves an academic health center that receives some funding from state and federal governments to expand its services into an area already served by private physicians who receive no outside funding.
TMA has a very clear policy on this issue: "The Texas Medical Association opposes the solicitation of private patients by state-supported and tax-funded medical schools."
An understanding of medical education and a personal relationship between community and academic physicians can go a long way to alleviate the town-gown problems. Community physicians involved in medical education also may lessen the issue. But, community-based educational programs in certain parts of Texas are needed to train students and residents.
A widely accepted definition of community-based education is academic programs that use existing community resources. Texas medical schools could combine training at academic centers and teaching hospitals with training experiences in the community. Academic physicians involved in both their county medical societies and TMA and community physicians serving on the clinical faculty can be the basis for strong partnerships.
As we plan for the 2003 legislative session, this relationship becomes increasingly important. We anticipate that medical education-related bills will include expanding medical school class sizes, establishing new medical schools, scope-of-practice issues, and new methods of financing undergraduate medical education. Legislation related to tort reform and prompt pay will affect all physicians.
The Texas Legislature will focus also on issues of medical errors and patient safety. Medical education in its broadest sense and system operations will be the basis of increased patient safety. Licensure based on board certification and meaningful medical education requirements also will be addressed.
Medical education involves all of us. The excellence in patient care and research begins with excellence in medical education. Medical students and residents who are our future leaders need to see the community of physicians -- whether they are academic, private, public health, or military -- working together. We have similar interests and goals. I hope you enjoy this symposium issue of Texas Medicine .
Dr. Rodriguez is a family practice physician in San Antonio and the immediate past chair of the TMA Council on Medical Education.
For Web sites dealing with medical education, see MedBytes.
August 2002 Texas Medicine Contents
Texas Medicine Back Issues