TMA Testifies Before Senate Finance Committee on Article III

Testimony: Article III by Travis Bias, DO

Senate Finance Committee
Higher Education Appropriations

Jan. 29, 2013 

Good afternoon, my name is Travis Bias, DO.  I’m a family physician in private practice in Pflugerville, and I’m proud to say I was educated and trained fully in Texas. I am here today to on behalf of the Texas Medical Association, which consists of 47,000 physicians and medical students to discuss programs needed to shore up Texas’ workforce. 

A sound health care system depends on the solid foundation of physicians and other health care providers. For our state to have a robust and solid foundation, it must continue to hone its ability to attract and keep medical students in Texas, especially in those areas of our state where physicians are needed most. 

When I was in medical school, I had a required four-day preceptorship with a solo practicing family physician in Fort Worth.  At that time, “Family Medicine” was at the bottom of my list of specialties I wanted to pursue. However, after spending four days observing his practice, I started to re-think my area of specialization. 

Dr. Richwine had an excellent electronic medical record system; he managed coronary risk factors such as, diabetes, hypertension, and high cholesterol; he diagnosed sleep apnea and did skin biopsies.  He treated depression and anxiety and cared for those with dementia.  I learned primary care was not just coughs, colds, and referrals. 

Texas’s Primary Care Preceptorship program could have the same impact on other medical students. With a very small investment, Texas can help medical students to have a four-week experience with a practicing physician, where they can learn firsthand “real life” family medicine.

Texas needs more primary care physicians and more physicians in shortage specialties, such as adult and child psychiatry.  To accomplish this it is critical to restore and grow Graduate Medical Education (GME), or residency positions funding.  Right now, GME formula funding is flat in the proposed base budget bills.  At the federal level, Medicare GME funding has been frozen at 1997 levels.

Residency is that last step needed to produce a fully board-certified physician.  Texas has fewer GME slots per capita than New York, Pennsylvania, and Illinois. Residency funding is critical because roughly 80 percent of residents end up practicing within a 100-mile radius of where they complete their residency. This is because many young doctors lay down roots or establish a referral network in the community they do their residency training. 

The bulk of the funding occurs through the GME formula funding line item, which is given to medical schools, but there are also other line items that have been zeroed-out in recent legislatures such as the two primary care GME programs at the Coordinating Board where monies are given directly to the residency program itself.  There are excellent community-based residency programs that have no formal ties with a health-related institution. These programs, without these primary care GME programs, are then forced to rely on local foundations or governments, which are rare, or to make painful decisions, such as cutting faculty positions.  This is exactly what happened at my well-known program at Memorial Hermann Southwest in the last biennium.

According to the Association of American Medical Colleges, the average medical student graduates with $167,000 in debt.  After attending a private undergraduate university and public medical school, I graduated with more debt than that.  Debt plays a major role in young doctors decisions – it influences the specialty we choose, where we practice, whether to enter into an employed arrangement agreement so we can start paying off loans immediately, large physician practice, or start a solo practice. I can tell you from my experience it is extremely rare now for someone to have the ability to start a solo practice immediately after completing residency training. 

The Physician Education Loan Repayment Program, which was cut by 78 percent last session, is arguably the best incentive our state has to encourage physicians to work in underserved communities. If this program was fully funded it will give more underserved areas a valuable tool to attract physicians to their communities.

In closing, I want to thank you for your time. We hope in the days to come, you can prioritize spending on vital programs, that if funded can help shore up Texas’ workforce. We urge you to fund medical education, Texas’s Primary Care Preceptorship program, GME formula funding, and Texas’ Physician Loan Repayment program. These programs are important to the physicians of Texas because they are essential for the health of Texans.  Thank you for your time.

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