It's Academic

April 2014 

Strong State Funding Boosts Family Medicine Residency Programs

The state’s family medicine residency programs will get $6.4 million in state funding for fiscal year 2015, according to the recently approved budget by the Texas Higher Education Coordinating Board’s (THECB’s) Family Medicine Residency Program Advisory Committee. Starting Sept. 1, Texas will invest $8,737 per capita for an estimated 730 eligible resident positions at 26 programs. The per-capita amount is more than double the amount the Texas Legislature funded for the 2012-13 state budget.

An additional $112,000 will be set aside to pay $2,000 per resident for up to 56 rural rotations, and an additional $6,000 will be available to fund three public health rotations. The Texas Legislature established both of these training options to encourage more family medicine physicians to care for underserved populations. As a reference, 41 residents are expected to participate in the rural rotation program this fiscal year; no residents have pursued the public health rotation to date. 

The Family Medicine Residency Program, which originated in 1977, is the oldest state program that supports primary care training. The 2014-15 funding boost approved by the 2013 legislature — $7.18 million or 128 percent in additional funding for two years — went beyond restoring the cuts made in the 2012-13 budget. Per-resident funding increased from an average of $3,868 for 2012-13 to $8,621 for 2014-15. Funding reached a historic peak of $16,180 per resident in 1992. (Learn more about family medicine training trends in “Record-High 2014 Match Numbers Fall Short.”)

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TMA Weighs In on a Tightening GME Bottleneck

TMA’s Council on Medical Education has concerns about the tightening graduate medical education (GME) bottleneck. Texas continues to fall short of the Texas Higher Education Coordinating Board’s target ratio of 1.1 entry-level residency positions for each medical school graduate.

Estimates from last year indicate the ratio of Texas medical school graduates to entry-level residency positions was 1.02:1, based on 1,611 entry-level residency positions offered in the 2013 residency matches held by the National Resident Matching Program (NRMP) and the American Osteopathic Association for Texas. Last year, Texas had 1,587 medical school graduates. 

To achieve THECB’s 1.1:1 goal, Texas needed a total of 1,746 entry-level residency training positions (an increase of 135) last year. Outcomes for Texas from the 2014 Match will not be available from NRMP for several weeks. 

Three new medical schools are under development in Texas, with a combined 250 new students expected for fall 2016. (See “Dr. Madson Named Dean of New Osteopathic Med School.”) Combined with small growth planned at existing Texas medical schools, TMA data project medical school graduates will peak at 2,007 in 2022, based on a composite class size of 2,075 from 2018-19 and a projected graduation rate of 96.7 percent. 

To achieve the coordinating board’s goal of 1.1:1, TMA calculations project Texas will need an additional 600 entry-level residency program positions by 2022. 

In recent weeks, David P. Wright, MD, chair of TMA’s Council on Medical Education, visited with physician members of the legislature to share the association’s concerns about the growing bottleneck. These visits will continue in preparation for the 2015 legislative session.  

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 Record-High 2014 Match Numbers Fall Short

The 2014 Match Day for allopathic residency programs set new records for residency training in the United States. Match Day, held March 21 by the National Resident Matching Program (NRMP), offered the highest number of positions in the program’s history — 29,671 first- and second-year positions, exactly 500 more than in 2013. 

“In the past five years alone we’ve seen an increase of more than 4,000 positions, and more than half of those are in internal medicine and family medicine,” said Mona M. Signer, NRMP executive director. 

The number of U.S. medical school seniors participating in the Match was slightly smaller than the past year, with 16,399 of them matching to a first-year position. The majority of U.S. seniors matched to their first choice. 

Despite the new records, the Association of American Medical Colleges (AAMC) issued a cautionary message that several hundred U.S. medical students failed to match: “With a serious physician shortage looming closer, we remain concerned that the 17-year cap on federal support of new doctor training will impede the necessary growth in residency positions that must occur to ensure that our growing and aging population will receive the care it needs. According to the most recent AAMC Survey of Medical School Enrollment Plans, U.S. medical school (MD) enrollment will increase to 21,349 students by 2018. Combined with the larger number of graduates from osteopathic schools, which also are expanding to address the shortage, as well as increasing numbers of international graduates entering the Match, there may be too few residency positions for all the newly graduated doctors in the not-too-distant future.” 

Others in medical education express similar views about a “disconnect” between growth in medical student enrollment and the availability of residency positions. The Medical Education Futures Study at George Washington University reported in a February e-newsletter, “Medical student enrollment has been increasing at a rate of 2.7 percent a year, while residency positions are expanding at about 1 percent a year." (See related Texas concerns in “TMA Weighs In on a Tightening GME Bottleneck.”)

Hot Specialties in 2014
Which specialties were most competitive in the 2014 Match? The following six (of specialties offering at least 30 first-year positions) filled every available first-year position on Match Day:  

  • Neurological surgery,
  • Otolaryngology,
  • Pediatrics-primary,
  • Physical medicine and rehabilitation,
  • Plastic surgery, and
  • Thoracic surgery.  

Note: All of the numbers presented in this summary are for Match Day only, and many more positions can be expected to be filled prior to the start of the residency year in July. 

For primary care, first-year positions:  

  • Internal medicine offered 6,524 positions, an increase of 247 from 2013; 99.1 percent fill rate, 48.5 percent filled by U.S. seniors.
  • Family medicine offered 3,109 positions, up by 72 from 2013; 95.8 percent fill rate, 45 percent filled by U.S. seniors.
  • Pediatrics offered 2,640 positions, 24 more than 2013; 99.5 percent fill rate, 68.9 percent filled by U.S. seniors.
  • Obstetrics-gynecology offered 1,242 positions, five more than 2013; 99.4 percent fill rate, 76.5 percent filled by U.S. seniors.  

Of the primary care specialties, family medicine had the lowest fill rate — 45 percent — among U.S. seniors. Among all Match participants, family medicine filled 2 percent more positions this year — the fifth year of increases — with an additional 72 filled positions, increasing from 3,037 to 3,109, with a fill rate of 95.8 percent this year. The number of U.S. seniors matching to family medicine went up by 43 from 2013, a 3.2-percent increase. Family physicians have topped the list of the most heavily recruited specialty in the United States for seven consecutive years, based on recruitment requests reported in 2013 by Irving-based Merritt Hawkins, one of the country’s largest physician recruitment firms. 

Surgery-preliminary programs (first-year) had the lowest fill rate at 65 percent (for programs that offered at least 30 positions), and U.S. seniors filled only 38 percent of positions. This is consistent with recent trends for this specialty. 

U.S. Medical School Seniors in the Match
Slightly fewer U.S. medical school seniors participated in this year’s Match — 89 fewer registered, and 113 fewer submitted rank-order lists of programs, compared with 2013. A total of 16,399 U.S. seniors matched to a first-year position, and 1,740 matched to both first- and second-year positions. Fifty-four percent of U.S. seniors who matched received their first residency choice. The number of U.S. medical school seniors matching to primary care continued a modest increase as noted above.  

American Osteopathic Association Match
Results of the 2014 Osteopathic Match show graduates filled 2,064 of 2,988 offered positions this year, a 69-percent fill rate. Two specialties (of programs offering at least 15 positions) filled 100 percent of offered positions: otolaryngology/facial plastic surgery and urological surgery. Other competitive specialties included (of programs offering at least 15 positions):  

  • 99-percent fill rate: emergency medicine, obstetrics/gynecology, and orthopedic surgery, and 
  • 97-percent fill rate: anesthesiology.  

Family medicine filled 519 of 880 positions offered in the Osteopathic Match for a 59-percent fill rate. This was a 10-percent increase over 2013 when 472 positions were filled. Internal medicine filled 439 of 609 offered positions, with a fill rate of 72 percent. This was a 9-percent increase over the prior year. For the other primary care specialties, pediatrics filled 61 of 70 offered positions, an 87-percent fill rate, and obstetrics-gynecology filled at 99 percent. The traditional rotating internship in osteopathic medicine filled 204 of 529 offered positions for a fill rate of 39 percent. 

Texas Match Results Yet to Come
Watch for 2014 Texas Match results in a future issue of It’s Academic

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 Baylor Adds New Pediatric Residency Program at San Antonio Children's Hospital

Children’s Hospital of San Antonio, affiliated with Baylor College of Medicine in Houston, now boasts a new pediatric residency program following approval by the Accreditation Council for Graduate Medical Education. The program will open with 10 slots per year in July 2015. 

Baylor faculty and San Antonio pediatric specialists in private practice will train residents. Patrick Carrier, chief executive officer of the hospital's parent organization, Christus Santa Rosa Health System, said an open-campus policy allows all qualified pediatricians and pediatric specialists to practice at the hospital, which is undergoing a multimillion-dollar expansion and upgrade of its downtown facilities. 

The University of Texas (UT) Health Science Center at San Antonio also operates a longstanding accredited residency program in pediatrics, based at the University Health System. 

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 Dr. Madson Named Dean of New Osteopathic Med School

The new University of the Incarnate Word (UIW) School of Osteopathic Medicine hired Robyn Phillips-Madson, DO, as founding dean of the San Antonio school.  

Dr. Madson, board certified in family medicine, most recently served as dean and chief academic officer at the Pacific Northwest University College of Osteopathic Medicine in Yakima, Wash. 

Dr. Madson has a master’s degree in public health from Nova Southeastern University in Florida and completed the American Osteopathic Association’s Health Policy Fellowship Certificate program. 

“It is the belief and hope of the university administration that Dr. Madson will lead the effort to inspire a new generation of doctors to serve with the same enthusiasm and dedication that has motivated Dr. Robyn Madson throughout her medical career. We welcome her to our community and to San Antonio and commit to supporting her in the enormous task of creating a distinctive and quality osteopathic medical school for South Texas,” said UIW Chancellor and Search Committee Chair Denise Doyle. 

Last fall, the City of San Antonio voted to approve a $7.7 million funding agreement for infrastructure improvements and job incentives to help UIW build a new, private, downtown osteopathic medical school with an estimated $50 million price tag. 

The new osteopathic medical school, in addition to the two new University of Texas System medical schools — The University of Texas at Austin Dell Medical School and the South Texas School of Medicine in McAllen and Harlingen — will bring the total number of medical schools in Texas to 12. The combined class size for the two new UT schools will be 100 (50 per school). The class size for the new osteopathic school will be 150, for a combined total of 250 for the three new schools, which anticipate accepting their first classes in fall 2016.  

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 Attend the Choosing Wisely CME Track at TexMed

 TMA will offer a continuing medical education (CME) track titled Choosing Wisely®: Quality and Patient Safety Saturday, May 3, from 10 am to 2 pm at the Fort Worth Convention Center during TexMed 2014. The program will include several physician speakers from throughout the state. Each speaker’s presentation will highlight the benefits of Choosing Wisely for different practice settings and specialties. 

The keynote speaker is David H. Johnson, MD, chair of the American Board of Internal Medicine Board of Directors, and chair and professor of the Department of Internal Medicine at The University of Texas Southwestern Medical Center. Lisa L. Ehrlich, MD, chair of the TMA Health Quality Council, and Frank Villamaria, MD, will cochair the CME program. Take advantage of the opportunity to ask your questions by participating in a Choosing Wisely in-depth panel discussion. 

To plan your day at TexMed, visit CME Programming or search the full CME database. TexMed and the CME are free to TMA members. 

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 Share Your Choosing Wisely Story

 TMA is looking for physicians who have used the Choosing Wisely lists of recommendations to engage in important conversations with patients to do the right thing at the right time. We want to share with other physicians how this program works for you and your patients. Please contact Hella Wagner at TMA by email or by calling (800) 880-1300, ext. 1403, or (512) 370-1403 to help us tell your Choosing Wisely story.

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 Disguise Yourself at TMAF's 21st Annual Benefit Gala

Join your colleagues and gala cochairs Joe Todd, MD, and Susan Todd of Fort Worth at the TMA Foundation (TMAF) 21st annual gala, A Masqued Ball, Friday, May 2, at the Omni Fort Worth, held in conjunction with TexMed 2014. You’ll enjoy an evening of revelry fit for a carnival of incognito party goers, with two guest receptions, a silent auction, special entertainment, and dinner.

Purchase your tickets or table now. VIP tickets (greater recognition and early entrance) are $225, and regular tickets are $175 through April 30. 

Proceeds benefit TMA health promotion programs, including Be Wise ─ ImmunizeSM, Hard Hats for Little Heads, the Ernest and Sarah Butler Excellence in Science Teaching Awards, Choosing Wisely, and the Minority Scholarship Program

Proceeds also help fund TMA’s Award for Excellence in Academic Medicine Platinum Award and TMAF’s Healthy Now, Healthy Future initiatives, including the Champion of Health Award and Medical Community Grants Program, which unite medicine, business, and community in a shared vision of a healthier Texas. 

Visit the TMAF website to purchase tickets. For more information, email Sean Dunham, or call (800) 880-1300, ext. 1664, or (512) 370-1664.

Be Wise ─ Immunize is a service mark of the Texas Medical Association.

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This Month in Texas Medicine

The April issue of Texas Medicine examines new rules that overhaul residency training accreditation, how Texas practices are coping with challenges brought about by the Affordable Care Act; the impact of patient noncompliance on quality outcomes and physician ratings; the challenges physicians face in giving the HPV vaccine; new DocbookMD features; and a profile of the TexMed 2014 General Session speaker, Zubin Damania, MD. 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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