TMA Testimony: GME Funding

TMA Testimony by Rodney Young, MD

House Appropriation Subcommittee on Article III
Friday, Feb. 22, 2013

Texas Higher Education Coordinating Board 

My name is Rodney Young. I am a family physician in Amarillo. I completed my medical degree and residency training at Texas Tech in Lubbock. I have been the regional chair of a family and community medicine program for the past 10 years. I am before you today representing the 47,000 physicians and medical students of the Texas Medical Association (TMA). 

There may be some confusion about why our state has multiple programs to fund graduate medical education (GME). Perhaps talking about when and why the Texas Higher Education Coordinating Board (THECB) developed GME programs will be helpful. 

When: The coordinating board developed three GME programs in the 1990s to support to primary care resident slots:

  • The Family Medicine GME program began in 1979,
  • The Primary Care Residency program began in 1995, and
  • The program simply titled “GME” began in 1997.  

Why: The Texas Legislature recognized the need to address a primary care physician shortage and to chip away at the primary care disadvantage in Medicare GME funding policies. Medicare — a federal program — pays for resident slots through hospital claims for inpatient services to Medicare patients. But residents don’t always train in a hospital. Many primary care residents train in ambulatory clinics, often in a community setting, not in hospital surgical suites or in radiology or pathology labs. Medicare GME payment policies generally don’t extend to community-based clinics. The Patient Protection and Affordable Care Act (PPACA) took a small step to address this situation.

  • It’s equally important to emphasize THECB’s GME dollars are, or have been, allocated differently from Medicare GME dollars. State dollars go directly to the residency programs.  Medicare GME pays the hospitals, and the state GME formula funding is allocated as part of the health science center budget.

For these reasons, the THECB’s programs have been a lifeline for several decades for primary care residency programs. Unfortunately two of the three programs received zero funding in the current budget. They also received zero funding in the base budget for the next biennium. The state GME formula funding also was reduced by 28 percent, with a net loss of $22.2 million.  Overall, state GME funding in the current budget is cut 41 percent. 

TMA strongly supports full funding of all three THECB programs and state GME formula funding.

TMA also strong supports other programs trusteed to the Texas Higher Education Coordinating Board:

  • The Physician Education Loan Repayment Program is critically important to improving Texas’ primary care physician shortage. Plus it provides a valuable and effective incentive for physicians to choose a practice in an underserved community. Texas needs only 500 primary care physicians to remove ALL federal “health professional shortage area” designations in our state. Loan repayment can help us reach this goal. This incentive is more attractive than ever given the increasingly high levels of education-related debt young physicians accumulate, which now averages $161,000.
  • Primary care preceptorship programs: Physicians in primary care volunteer as preceptors to medical students for a short period to give the students exposure to primary care practice and sometimes, rural practice.  We could line up doctors in this room to testify how this program was key to their decision to choose a career in primary care. This relatively inexpensive program lost every bit of its $900,000 in 2012, and it remains zeroed out in the base bill for the next biennium.
  • The Joint Admission Medical Program (JAMP) is unique to Texas and has received national attention. All of our medical schools set aside 10 percent of their enrollment positions for JAMP students. Through collaboration with colleges and universities, this program tailors its support to economically disadvantaged students — students who very likely would otherwise have NOT gone to medical school or stayed in school — to become doctors. JAMP admissions have two times more underrepresented minorities than other admissions.

Along with our medical school and teaching hospital partners, TMA is proud to share the 2013 Medical Education and Physician Workforce Consensus Statement. This marks the fourth time the TMA Council on Medical Education, of which I am a member, collaborated with our partners in this way. With a single voice, we are presenting consensus priority issues surrounding the basic question of whether there will be enough physicians for Texans.

Thank you for the opportunity to speak before you today. I am glad to answer any questions.

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