It's Academic

December 2014 

 

U.S. Med School Enrollment Hits Record High and Increased Diversity, Shows Need for More Residency Positions

 In 2014, first-year medical school enrollment reached a new high of 20,343, according to the Association of American Medical Colleges (AAMC). Texas medical school enrollment hit a milestone, too; the Texas Higher Education Coordinating Board reports total Texas medical school enrollment was 6,991 for fall 2013, the highest ever. 

The total number of applicants to medical school increased by 3.1 percent nationally, to a record 49,480. First-time applicants — an important indicator of interest in medicine — increased by 2.7 percent to 36,697.

“In spite of the ongoing partisan debate around the nation’s health care system, it is gratifying to see that increasing numbers of students want to become physicians,” said AAMC President and Chief Executive Officer Darrell G. Kirch, MD. “However, these results show that our nation must act without delay to ensure an adequate number of residency training positions for these aspiring doctors so they will be able to care for our growing and aging population.” 

The diversity of the nation’s medical students showed signs of progress again this year. The number of Hispanic or Latino enrollees increased by 1.8 percent to 1,859 in 2014, with the number of applicants increasing by 9.7 percent to 4,386. African-American enrollees increased 1.1 percent to 1,412, while the number of applicants increased by 3.2 percent to a total of 3,990. 

In addition, American Indian and Alaska Native enrollees showed notable growth, increasing almost 17 percent, from 173 enrollees the previous year to 202 in 2014. The number of applicants from these groups increased by 5.6 percent (from 425 in 2013 to 449 in 2014).

As in prior years, males enrolling in medical school accounted for about 52 percent of students in 2014, while females accounted for nearly 48 percent. Among first-time applicants, the number of females increased by 3.3 percent to 17,625 compared to a 2.1-percent increase in first-time male applicants (19,066).

“Medical schools understand that an effective physician workforce is a diverse workforce,” Dr. Kirch said. “In addition to schools using new, innovative admissions practices that look at attributes and experiences in addition to grades and test scores, they also are working to strengthen the K-12 pipeline. The gains we are seeing show that we are making progress, but there still needs to be more work done to diversify the talent pool.”

Expansion of the nation’s medical school capacity is driving the gains in the numbers of overall applicants and enrollees, which the AAMC called for in 2006 to address the projected physician shortage. Since 2002, enrollment in the nation’s medical schools has increased by 23.4 percent, and 17 new medical schools have been established.  This growth raises questions about the adequacy of the graduate medical education system to accommodate the greater number of students. 

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AMA Adopts Policy Supporting Proposed Interstate Medical Licensure Compact

The American Medical Association House of Delegates adopted new policy at its Interim Meeting last month in support of the proposed interstate medical license compact. Under the new policy, AMA will work with interested medical associations, the Federation of State Medical Boards (FSMB), and other stakeholders to ensure expeditious adoption of the compact and the creation of an Interstate Medical Licensure Commission. TMA does not have formal policy on the compact, but the association will likely consider it in the near future.

The compact proposal, developed by FSMB, is part of its recent focus on expediting multistate licensure, which reinforced that licensure is a state, not a federal, issue. The federation released model legislation in September. At least seven states must adopt the model legislation for the compact to be implemented, and AMA reports this threshold has been met, with recent adoption in 10 states. The Texas Medical Board (TMB) endorsed the concept for the model in May, but implementation requires a change in state legislation. TMA expects a bill to be filed during the 2015 Texas legislative session. 

The compact’s primary goal is to make it easier for qualified physicians to secure medical licensure in more than one state, in an expedited manner. AMA reports 22 percent of U.S. physicians have licenses in more than one state. 

In addition:

  • Adoption of the model legislation by states is voluntary, and participation by individual physicians will likewise be voluntary in states that adopt it. The compact states would be connected through a newly developed commission; however, states do not cede sovereign rights to the commission. 
  • The model legislation sets a high bar for licensure eligibility through the compact pathway and eliminates duplicative primary source verification requirements. An informal estimate from TMB indicates 70 to 75 percent of Texas medical license applicants are expected to qualify. 
  • The basis for the new AMA policy is that the place where the patient receives care, not the physician’s location, defines medicine. The physician would be licensed in the state where the patient is located and be under the jurisdiction of that state’s medical board.
  • Compact licensure pathway would be an add-on to, not a replacement of, the state medical licensing process, which would remain 100-percent intact. 
  • Regulatory authority remains with individual state medical boards. Physicians with licenses in multiple states through the compact would designate one state for their principal license. They would be subject to laws and licensing regulations for each individual state for which they have a license. This includes passage of applicable state jurisprudence exams and completion of mandatory continuing medical education credits. Each state retains its regulatory duties, including enforcement responsibilities. 

TMA will be watching for and monitoring bills on the compact in the 2015 legislative session.

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Texas A&M KSTAR, UTMB Announce New Reentry Education Program

The Texas A&M Health Science Center KSTAR Physician Assessment Program is partnering with The University of Texas Medical Branch at Galveston (UTMB) to create the KSTAR/UTMB Health Mini-Residency Program. The program’s first trainees begin in February 2015. The mini-residency provides three-month, residency-based reentry education for physicians who want to return to medical practice after an interruption in their careers. 

The components of this model of reentry education are:  

  • All training occurs within residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME).
  • Faculty represent seasoned clinicians and educators familiar with and supportive of physician reintegration into medical practice.
  • Reentry physicians work as part of a health care team and get hands-on experience, including access to performing procedures.
  • Physicians in the mini-residency interact with many specialties and subspecialties while they train.
  • The curriculum addresses aspects of all six core competencies, and the evaluation process focuses on achievement of curricular milestones.
  • Physicians trained in the program have access to educational experiences, such as lectures, presentations, and grand rounds, while they are getting clinical experience.
  • Most training occurs in medical settings.  

KSTAR has experience with residency-based reentry education, and UTMB has experience in reentry education within its post-graduate programs. KSTAR and UTMB have significant simulation resources available to enhance the program’s assessment and education components. TMB has the authority to grant KSTAR/UTMB trainees Visiting Physician Temporary Permits for out-of-state physicians or for those who do not currently hold an active medical license.

Liability coverage has been secured at a reasonable rate for KSTAR/UTMB trainees. 

For more information, visit www.rchitexas.org

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AMA Fights Back Against Patient Care Intrusions

Physicians won't stand for technology mandates or other regulations that interfere with patient care, the American Medical Association House of Delegates said in a broad series of new policy positions adopted at its 2014 Interim Meeting in Dallas.

About 75 Texas physicians and medical students representing the Texas Medical Association and various sections and national specialty societies participated in the Nov. 7-10 meeting at the Hilton Anatole Hotel. The Texas delegation geared up for former TMA President Sue Bailey, MD’s, race for speaker of the AMA house next June. Dr. Bailey is currently vice speaker of the house.

“Your Texas delegation is working hard to represent Texas physicians at the AMA, but with your help, we could do even more,” said Delegation Chair David Henkes, MD, of San Antonio. “The number of delegates we have, the number of votes we have, is determined by how many Texas physicians belong to the AMA. At last count, we needed just 519 more AMA members in Texas to pick up an additional delegate, an additional voice for you.” 

No more “meaningless use”

Meaningful use regulations, maintenance of certification (MOC) exams, and the mandatory switch to the ICD-10 coding system all caught the wrath of the delegates. 

With new government figures showing that only 2 percent of physicians have demonstrated Stage 2 meaningful use so far this year, the house took aim at the Medicare payment penalties (1 percent in 2015, 2 percent in 2016, capped at 3 percent in 2017 and beyond) that come with noncompliance. Delegates took to the meeting room microphone to condemn the program as “meaningless use” and “meaningless abuse.”

The house voted overwhelmingly to ask the Centers for Medicare & Medicaid Services (CMS) to suspend penalties to physicians and health care facilities that fail to meet meaningful use criteria.

“The whole point of the meaningful use incentive program was to allow for the secure exchange of information across settings and providers, and right now, that type of sharing and coordination is not happening on a wide scale for reasons outside physicians’ control,” AMA President-Elect Steven Stack, MD, said.

Delegates also expressed their ongoing irritation at the MOC process and sent a clear message to the specialty boards that administer the MOC exams. Per newly adopted AMA policy, MOC: 

  • Should be evidence-based and relevant to clinical practice;
  • Must not be a “mandated requirement for licensure, credentialing, payment, network participation or employment”; and
  • Should include actively practicing physicians on the boards that develop it.  

While official AMA policy calls on the association to stop the government-imposed implementation of ICD-10, delegates continued to push fallback plans to help physicians should the mandate eventually come to pass. The house adopted a proposal for AMA to work toward having insurance companies and government payers reimburse physicians for the extra cost of the “increasingly complex and mandatory changes in coding.”

Medicaid: Pay more, cover more

Although many parts of the Affordable Care Act (ACA) remain unpopular among physicians, the House of Delegates voted to continue and expand one provision that many physicians see as a success. That piece of the law, which makes Medicaid payments equal to Medicare rates for certain primary care services provided by certain primary care physicians, was scheduled to expire at the end of 2014.

A report from the AMA Council on Medical Service pointed out that most other Medicaid rates — and the rates to which primary care payments would revert — average about two-thirds of Medicare rates. That is “insufficient to ensure access to care for Medicaid patients and adequate payment to physicians providing care to these patients,” the report states.

Delegates directed AMA to continue to advocate that the Medicare-parity provision be continued “in a manner that does not negatively impact payment for any other physicians.” They also said obstetricians and gynecologists should be eligible for the higher rates for evaluation and management codes and for vaccine administration codes.

A more politically divisive question is the issue of states’ expanding Medicaid under the ACA to cover low-income adults. As of press time, 21 states, including Texas, had declined Medicaid expansion, an ACA provision made optional by a U.S. Supreme Court ruling in 2012. Delegates in Dallas voted to encourage those states “to develop waivers that support expansion plans that best meet the needs and priorities of their low-income adult populations.”

“The AMA is sensitive to state concerns about expanding Medicaid in a traditional manner, but we believe they must find ways to expand health insurance coverage to their uninsured populations, especially as coverage disparities continue to grow between expansion and non-expansion states,” said AMA Immediate Past Board Chair David O. Barbe, MD. “We encourage states that would otherwise reject the opportunity to expand their Medicaid programs to develop expansion waivers that help increase coverage options for their low-income residents.”

Other issues meriting action

Delegates addressed various other legislative, economic, public health, and medical education topics. The house: 

  • Directed AMA to fight insurance company policies that require advance notice of or prior authorization for outpatient laboratory testing, and to study how much time physicians and office staff spend on such nonclinical paperwork.
  • Stated that the states need to continue to be the enforcers of inadequate network rules for health insurance plans; called for legislation to outlaw false advertising regarding patient choice of physicians in plans with limited networks; and said plans with inadequate networks should treat patient visits to out-of-network physicians the same as in-network visits.
  • Backed FSMB’s plan for interstate compacts to make it easier for physicians to obtain licenses in multiple states. (See “AMA Adopts Policy Supporting Proposed Interstate Medical Licensure Compact” in this issue.)
  • Called for strong regulation of electronic cigarettes, specifically prohibiting people under age 18 from buying them.
  • Said AMA should push legislation requiring insurers who pay physicians via virtual credit cards to be responsible for paying any associated bank charges or transaction fees.
  • Voted to encourage states to delay legalizing marijuana pending further research “on the public health, medical, economic, and social consequences of chronic use of cannabis.”
  • Asked for further study of a proposal that AMA support giving competent, pregnant women the same rights as nonpregnant women to use advance directives to refuse treatment.  

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Valley Gains Initial Approval of New Surgery Residency

A new general surgery residency program will open next summer in the Lower Rio Grande Valley. ACGME granted provisional approval to The University of Texas (UT) Health Science Center at San Antonio and Doctors Hospital at Renaissance for this program. There will be four surgical residency slots in the first year. This will be part of the UT South Texas medical school currently under development. The school plans to accept its first medical school class in fall 2016.   

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TMA: A Physician's Strongest Advocate

The 2015 congressional and state legislative sessions are right around the corner. TMA’s Healthy Vision 2020, Second Edition, articulates in detail what we are asking of the Texas Legislature, the U.S. Congress, and state and federal regulators. 

TMA has been a longtime advocate for academic faculty and medical schools, monitoring legislation, determining the potential impact to patients, and actively lobbying for your interests. Only with grassroots support can we make sure Texas remains a premier state in the education of future physicians, in research, and in quality patient care. 

Join or renew today, pay 2015 membership dues, and receive membership for the remainder of 2014 free of charge. That’s 13 months for the price of 12. Within your department 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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Have You Recruited a Physician From out of State?

TMA’s Welcome to Texas webpage can help new or returning Texansphysicians. 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 employee salary data.

You can also contact the TMA Knowledge Center at (800) 880-7955 for fast answers to questions about membership, TMA member benefits and services, and help navigating the complex laws and regulations unique to Texas medicine, and more. 

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This Month in Texas Medicine

The December issue of Texas Medicine features a cover story on volunteer physicians who answered the call over the summer to care for Central American immigrants crossing the border from Mexico into Texas. In the latest issue, you’ll also find a profile of the new head of the Texas Workers’ Compensation Program, results of the latest survey by The Physicians Foundation, a look at improvements in patient safety efforts, a court case that upholds a statute for lawsuits involving minors, and potential renewal of the 1115 Medicaid Waiver.

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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