TMA Testimony: Dr. Wright Asks Lawmakers to Support GME Funding

TMA Testimony by David Wright, MD

House Appropriations Committee, Article III
Friday, Feb. 15, 2013

Good afternoon, chair and members of the committee. I’m Dr. David Wright, a family physician from Austin and chair of the Texas Medical Association’s (TMA) Council on Medical Education. I’m also director of a family medicine clerkship program —This is one of six core rotations every medical student must do during his or her third year in medical school. I trained in Austin and have practiced medicine for 29 years. Today I am testifying on behalf of the TMA, representing our membership of 47,000 physicians and medical students.

I know there was some discussion Monday in reference to the Texas Higher Education Coordinating Board about funding for graduate medical education (GME), the Physician Education Loan Repayment Program, and the Primary Care Preceptorship Program.  Today I want to focus my remarks on these programs as well.

Texas has a shortage of doctors. Texas is not waiting for the problem to resolve on its own. Instead, our state is working to educate and train more physicians. The number of new physicians licensed by the Texas Medical Board in the last fiscal year was the largest in TMB’s history — 3,630. 

We are doing many things right to attract new doctors. Three-out-of-four of the newly licensed physicians in the past fiscal year graduated from medical schools outside of Texas.

Our state also is educating and training the highest-ever number of medical students and residents.

Yet our state continues to fall behind in the ratio of physicians per capita than all the other most-populous states.  The U.S. ratio of patient care physicians per 100,000 population is 240. Texas only has 193 patient care physicians per 100,000 people.  There has been steady improvement of the ratio but the primary reason it has not grown more quickly is because of our state’s population growth over the past two decades. Had that level of growth not occurred, our ratio of physicians per capita would have seen a considerable increase.

Texas has too few physicians in primary care AND in many other specialties. The greatest shortages are in adult and child psychiatry and general/preventive medicine. The only four specialties Texas has more physicians per capita than the US are aerospace medicine, transplant surgery, medical genetics, and colon/rectal surgery. 

We must educate and train enough new physicians to take care of our citizens.  One major hurdle standing in our way is the growing bottleneck in GME positions—not enough GME positions in relation to the growing number of medical school graduates. If this is not fixed, our graduates will have no choice but to leave for residency training outside Texas.

There are two major factors contributing to the GME bottleneck:

  1. Medicare funds most of the GME.  However, if a hospital received money from Medicare for GME in 1996 they are frozen at that same level today — 17 years later. This is a result of federal payment policies. 
  2. State support of GME formula funding at $4,700 a year, per resident is about one-fourth of the $18,000 in estimated faculty costs per resident. The full cost of GME is not included in state formula funding. What is left out of this equation are these items: $50,000 for the annual resident stipends on average, and facility costs that total, all together, including the stipend, an estimated $120,000 to 150,000 a year per resident. 

All together, the state’s support for GME was reduced by 41 percent in the current budget over the prior biennium.

In addition to training and research, residents also provide a significant amount of patient care in their training — often to the sickest and poorest patients.  Medical school graduates for Texas’ nine schools are projected to peak at around 1,700 in 2015. In comparison, about 1,500 entry-level GME positions were offered in 2012. The bottom line: More GME slots are needed to break the bottleneck.

TMA strongly supports the Physician Education Loan Repayment Program. It has been one of our most valuable and successful tools for recruiting and retaining physicians in our most underserved areas of the state. Approximately 5.5 million Texans live in these areas and need access to care. The average debt for a young physician completing residency training is over $160,000.Without these important funds, young doctors simply could not afford to go to areas of the state where 80 to 90 percent of their patient mix is funded by the government, such as Medicaid and Medicare. This program was among the hardest hit during the last session, with a loss of 78 percent of funding.
In closing.

In closing, I would like to stress that TMA supports restoration of the $900,000 for two years for the primary care preceptorship program, which encourages medical students to shadow a primary care physician and learn first-hand about primary care. Thank you for allowing me to speak before you today.

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