It's Academic

July 2014 

TMA Releases Updated Texas Physician Workforce Numbers

Have you read the latest trends for the state’s physician workforce? TMA’s Committee on Physician Distribution and Health Care Access issued its annual report to the TMA House of Delegates at TexMed 2014 in May with several important new findings, summarized here.  

  • Texas hit another record for the number of state medical license applications: 4,610 in fiscal year 2013. This record will likely be broken this year, with applications projected to exceed 5,000 for the first time.
  • In the past four years, physician supply grew at the fastest and most consistent rate than at any other time during the past two decades. Physician supply has grown faster than the state’s population for seven of the past 10 years, leading to an improved ratio of physicians per capita. 
  • Three out of four newly licensed physicians are graduates of medical schools outside the state. 
  • The number of women in medicine in Texas almost doubled over the past decade. This could have implications for workforce needs given gender differences in specialty and scheduling patterns. 
  • An aggregate of 32,000 newly licensed physicians have been added in Texas since the state's 2003 tort reforms. 
  • Travis County, with Austin as the central city, leads the five largest Texas counties in ratios of patient care physicians and primary care physicians per capita. More specifically, Travis County has better ratios than Harris (Houston), Dallas, Bexar (San Antonio), and Tarrant (Fort Worth) counties. 
  • Although state medical school enrollments are already the highest on record (6,991), projections show the state’s composite medical school class size will increase by 320 from academic years 2013-14 to 2018-19, with the development of three new medical schools and enrollment expansions at two existing schools. This growth will create an even greater demand for residency training positions than seen in recent years. 
  • Texas ranks second in the retention of medical school graduates for medical practice, only behind California. However, this standing is vulnerable absent sufficient growth in residency training positions. 
  • Texas exceeds the ratios of physicians per capita, compared with U.S. totals, for only four specialties: aerospace medicine (206 percent), medical genetics (118 percent), transplant surgery (114 percent), and colon and rectal surgery (102 percent).
  • The lowest Texas ratios of physicians per capita, compared with U.S. totals, are in psychiatry (58 percent), general preventive medicine (65 percent), child/adolescent psychiatry (69 percent), and nuclear medicine (70 percent).
  • U.S. medical school seniors filled less than half (44.9 percent) of the entry-level positions in Texas family medicine residency programs in the 2014 National Resident Matching Program. This was the lowest percentage of U.S. medical school seniors of the five primary care specialties and one of the lowest for all specialties.
  • Family physicians have topped the list as the most heavily recruited specialty in the United States for seven consecutive years, based on recruitment numbers reported in 2013 by Merritt Hawkins, a physician recruitment firm based in Irving. 

The committee recognized that all aspects of the physician workforce in Texas are growing, and the state is making progress in building the physician workforce. 

Despite these improvements, shortages remain. Texas continues to have a low ranking in physicians per capita compared with other states, ranking 43rd among the 50 states and the District of Columbia in 2011 and 2012. There are also increasing concerns the three new medical schools and other enrollment expansions will further drive demand for residency training positions at a time when residency expansions are not keeping pace with medical school enrollment growth. This imbalance remains a high priority for TMA’s Council on Medical Education. 

David Wright, MD, immediate past chair of the council, visited with state legislators about this concern in recent months. This educational effort will continue in preparation for the 2015 legislative session.

The full committee report can be accessed on the TMA website under TMA Physician Workforce Reports.

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Core Activities Address Med School Grads' Readiness for Residency

On May 23, the Association of American Medical Colleges (AAMC) released guidelines for 13 Core Entrustable Professional Activities (EPAs) for Entering Residency. The benchmarks address a concern about the gap between program directors’ expectations and new residents’ performance on day one of residency. A March Journal of Graduate Medical Education article describes the activities as "core units of professional work, tasks or responsibilities to be entrusted to a trainee once sufficient competence has been reached." Entering residents should be able to perform the EPAs without direct supervision. 

“As the nation’s medical school graduates prepare to begin their residency training in July, ensuring they have the confidence to perform these activities is critical for clinical quality and safety,” said AAMC President and Chief Executive Officer Darrell G. Kirch, MD. “These guidelines take medical education from the theoretical to the practical as students think about some of the real-life professional activities they will be performing as physicians.”

Steven Lieberman, MD, senior dean for Administration at The University of Texas Medical Branch at Galveston, served on the panel that developed the guidelines. 

“This initiative from the AAMC comes at an opportune time as medical schools across the country are beginning to question current notions of medical education. The core EPAs help to frame these efforts by providing a foundation for innovative approaches such as the Transformation in Medical Education (TIME) initiative within The University of Texas System and other competency-based medical school programs,” Dr. Lieberman said. 

The publication Core Entrustable Professional Activities (EPAs) for Entering Residency can be downloaded from the AAMC website, including a Curriculum Developers’ Guide and a Faculty and Learners’ Guide.

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AMA Adopts Telemedicine Guidelines

With the support of the Texas delegation, the American Medical Association House of Delegates took a strong stand on behalf of the patient-physician relationship as it adopted new principles on the use of telemedicine at its annual meeting June 7-11 in Chicago.

“A valid patient-physician relationship must be established through a face-to-face physical examination prior to the telemedical encounter, or … the relationship [must be] established through a telemedical encounter where there is a licensed health care provider, acting under the delegation and supervision of the remote physician, present as a clinical observer,” Austin ophthalmologist Michelle Berger, MD, said in testimony to the reference committee.

The house adopted that suggestion and another Texas proposal that a physician providing telemedicine services must meet the licensure requirements and follow the medical practice laws of the state in which the patient receives the services.

Delegates also called for a study of the issues associated with the state-based licensure and the portability of state licensure for telemedicine services.

In addition, a new Federation of State Medical Boards (FSMB) model policy aims to create a roadmap for the safe and appropriate practice of telemedicine. One provision that has sparked extensive debate says a telephone call or online visit alone won't suffice for newly established patient relationships. Read "Digital Doctor" in the July issue of Texas Medicine for more on the evolution of telemedicine, FSMB's policy, and licensure and credentialing concerns. 

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Preceptorship Program Connects Med Students With Internists

The General Internal Medicine Statewide Preceptorship Program (GIMSPP) is placing 56 students this summer to work with 48 internal medicine physicians across the state of Texas. The physician preceptors are all volunteers, recruited each year specifically to get new medical students interested in pursuing primary care after medical school. A total of 2,543 students have been matched through GIMSPP since its inception in 1995.

The GIMSPP places medical students with general internists across the state for two-, three-, or four-week preceptorships during the students' summer break. Students from Texas medical schools who are in their first or second year of medical school participate in the program. They receive one-on-one experience in the clinical, administrative, and patient communication realms of practicing medicine.  

“My preceptorship was more rewarding than I could ever imagine. Many things I learned during my first year were reinforced during the last four weeks,” said one student of the program. “I am now convinced that I will be pursuing general internal medicine after leaving medical school.” 

The program, funded in previous years by a grant administered by the Texas Higher Education Coordinating Board (THECB), is now curated by the nonprofit Texas Chapter of the American College of Physicians (TXACP). The program's purpose is to support educational and scientific activities. Donations for the program are being accepted through the TXACP Foundation and new grant opportunities are also being pursued.

Even without the ability to offer stipends to cover students’ cost of living for the preceptorship, the program has continued to hold steady enrollment numbers over the past three years, reaching the goal of matching at least 50 students each year. 

“This program works,” said Eugene Stokes, MD, cochair of the Medical Student Committee and GIMSPP Advisory Council for TXACP. “The percentage of students pursuing internal medicine because of their experience in the GIMSPP is around 36 percent, which is higher than the national average. The numbers don’t lie, and neither do the students who offer consistently positive feedback.”

For more information about the preceptorship program, contact Laura Tolin, GIMSPP program coordinator, at (512) 370-1539, or visit www.gimspp.org

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AACOM Joins DC Graduate Medical Education Summit

The American Association of Colleges of Osteopathic Medicine (AACOM) joined national and regional health care leaders in a Capitol Hill briefing last month to highlight the essential need to explore innovative models of graduate medical education (GME) to strengthen the primary care physician workforce. The AACOM represents the 30 accredited colleges of osteopathic medicine in the United States.

AACOM supports the expansion of GME positions, particularly in primary care. The association says sustainable funding for GME is critical to address an aging physician workforce and to meet the health care demands of the aging and growing U.S. patient population, as well as to accommodate an increasing number of medical school graduates.

“Sufficient funding for GME is necessary to properly address the severe shortage of primary care physicians and ensure patients have access to critical health services,” said AACOM President and Chief Executive Officer Stephen C. Shannon, DO. “With less than 50 percent of new doctors choosing to pursue primary care, this shortage will only worsen in coming years unless we invest in innovative models of GME.”

AACOM says colleges of osteopathic medicine across the nation play an important role in training the future primary care workforce. Fifty-six percent of the osteopathic physicians who have completed their medical residency training now practice in family medicine and general practice, pediatrics and adolescent medicine, and general internal medicine, according to the association.

The Association of American Medical Colleges, which represents the 141 accredited allopathic medical schools in the United States, also has policies in strong support of GME expansions. 

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TexMed 2014 House of Delegates Wrap-up

Ratifying a position TMA has pushed in Congress and at AMA, the House of Delegates at its annual meeting last month adopted a resolution directing TMA to “work to permanently delay the implementation of ICD-10.” One delegate tweeted, “If they want our data, then they should pay us for it.” Delegates also:  

  • Called for changes in the ACA to prevent recoupment of payments to physicians made during the ACA grace period when physicians have not received adequate notice that patients has not paid their health insurance premiums;
  • Adopted resolutions to fight air pollution and improve immunization rates;
  • Said Congress should permanently adopt Medicare payment parity for Medicaid services provided by primary care physicians and extend that parity to all other specialties;
  • Directed TMA to work with other organizations to “aggressively pursue the reduction or elimination of as much of the documentation burden as possible”;
  • Called for insurance companies to provide real-time adjudication of claims; and
  • Rejected a proposal to eliminate TMA’s International Medical Graduate Section. 

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We Could Use Your Help and Encourage Your Participation

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. 

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 for you and your patients. 

Join or renew today, 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. 

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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 from out of state?

TMA’s Welcome to Texas webpage can help new or returning Texans get their practices up and running. The page provides links 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 setups, 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 July issue of Texas Medicine examines the evolution of telemedicine and addresses a new Federation of State Medical Boards model policy aiming to create a roadmap for the safe, appropriate practice of telemedicine. It also informs physicians about cyber liability insurance, policymakers' price transparency efforts, an initiative to improve health literacy in the state, and the status of e-prescribing controlled substances. Check out our digital edition.

Also, you can subscribe to RSS feeds for TMA Practice E-Tips, TMA news releases, Blogged Arteries, and Texas Medicine. More

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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    The State legislature is unable to support the existing medical schools adequately. Another institution, no matter where it is located, would put more unnecessary strain on already stretched finances. Find the money to treat the ones you have better before straining draining resources.
    William E. Powell, M.D.

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