TMA Testimony Against Clerkship Positions for Foreign Medical Schools

TMA Testimony by David Wright, MD

Higher Education Coordinating Board
Board Room
Tues., Dec. 11, 2012
2 to 5 p.m.

My name is David Wright.  I am a family physician in Austin, and I am represent the Texas Medical Association before you today.  I serve as chair of the TMA Council on Medical Education.

I would like to comment on behalf of our membership on the undergraduate medical education (UME) report as well as the doctor of nursing practice (DNP) proposal.

  • First and foremost, I believe it is reasonable to conclude from the UME report that our state does NOT have excess capacity for medical student clerkships.  Although several recommendations in the report shift the focus to graduate medical education (GME), the issue before us is whether the state has excess capacity for medical student clerkships.  Further, hospitals are the primary drivers and payers for GME and it is important to acknowledge this.
  • TMA policy supports the education of more medical students in the state, either through new campuses or class-size expansions.  Our state has done a tremendous job of attracting more doctors, but, even with that accomplishment, we continue to have a low state ranking of doctors per capita.  We need to produce more physicians for at least three significant reasons: 
      1. Our strong population growth,
      2. The need to catch up after long periods when our population grew more quickly than our physician supply, and
      3. In response to the increasingly complex health care needs of our population.

We need highly trained physicians to deliver patient care.  None of us would want anything less for our families, or ourselves.

  • The report shows some variance between core clerkships, and we emphasize the need to preserve a medical education environment that allows for this flexibility. This is characteristic of medical education across the country, not just in our state. All of our schools meet accreditation standards, and all of our graduates must pass the same exams. I believe it would be meaningful to add an acknowledgement of this type to the report.
  • It is far better for medical students to take their time evaluating different specialties to determine the best fit than for a resident to try out different residency programs  a far more costly scenario for the physician, the training program, and the state.
  • TMA’s position has not changed. We believe the state should focus on the needs of Texas medical students those enrolled in our schools. They are the extent of our responsibility. We should ensure that medical students in our state are our priority. We should not have public policies that allow them to be displaced by students from other countries. That is not in the best interest of the state.
  • Twenty additional students is not a significant number if there are 20 extra slots. But, having NO excess capacity means just that.  It is important to note that 35 medical schools in the Caribbean offer instruction in English and more schools are planned.
  • TMA would not support any proposal that may jeopardize the accreditation of our own medical schools.
  • Policies governing the accreditation of U.S. medical schools specify that core clinical training be provided by the parent medical school. Accordingly, TMA has policy that strongly objects to the practice of substituting clerkships in the United States for the core clinical curriculum of foreign medical schools.

The report indicates that meaningful assessments could NOT be made about the cost of clerkships for our medical schools.  I believe the fact that a good portion of our schools do not pay for clerkships is a significant finding. Should all of our schools be forced to pay for clerkships, it can be expected that those costs will be passed on to the students OR monies taken from other areas of medical education. No one would like to see an increase in the cost of medical education.

  • Timing is not right to take on students from foreign countries who were not admitted to U.S. schools.

TMA urges the task force to carefully evaluate whether DNPs should replace master’s-level programs for certified registered nurse anesthetists. The DNP white paper found a void of evidence on a workforce demand for DNPs.  The doctorate level is more expensive for all involved the nurse, the institutions, and the state — at a time when the state is seeking to contain costs, and without a demonstration of  improved patient care outcomes.

Thank you for the opportunity to speak before you today.  I welcome your questions.

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