Tort Reform Working: Texas Physician Workforce Still Growing
Texas Medical Board (TMB) statistics show the number of physicians in the state is continuing to increase, due in large part to the tort reform legislation and accompanying state constitutional amendment the Texas Medical Association succeeded in passing in 2003. During the 2013 fiscal year (FY) that ended Aug. 31, TMB licensed 3,594 new physicians, the third largest number in history. The 2013 total was only 1 percent less than last year’s historic peak of 3,630. The second highest number was in FY 2008.
Since 2003, Texas licensed almost 32,000 new physicians — an average of 3,200 newly licensed doctors each of the past 10 years. This average was 800 above the average recorded for the decade preceding tort reform when the annual average for newly licensed was only 2,400.
Texas also saw a record number of applications for a medical license in 2013. The 4,610 applications are 8 percent higher than in the 2012 fiscal year. Texas consistently received more than 4,000 license applications each of the past eight years.
In related news, Texas lost some ground in the national ranking of patient care physicians per 100,000 population. Texas slipped from 42nd to 43rd in the latest national update based on 2011 physician data from the American Medical Association.
The ratio itself didn’t drop; it actually increased from 193 patient care physicians per 100,000 population to 195, but other states saw greater improvements in the past year. The Texas physician supply has grown faster than the population in seven of the past 10 years. This was no small feat considering Texas led the nation in population growth during this time.
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Unified MD-DO Residency Accreditation Proposal Fails
After nearly two years of negotiations, a venture by allopathic and osteopathic groups to merge their separate accreditation systems for graduate medical education (GME) into a joint system fell apart in July. The Accreditation Council for Graduate Medical Education (ACGME), American Osteopathic Association (AOA), and American Association of Colleges of Osteopathic Medicine (AACOM) said they failed to agree on a plan for unification.
The move would have consolidated the nation’s 10,000 GME programs — 9,000 allopathic and 1,000 osteopathic — under one roof, the ACGME, and created a common pool of residency slots, competency expectations, and standards for GME programs.
Medical education leaders viewed the collaboration as an opportunity to improve the quality and efficiency of GME programs, although the threat of losing some residency programs and slots in such a merger was a concern.
ACGME CEO Thomas J. Nasca, MD, called the disagreement over the joint accreditation system “regrettable,” adding that “efforts to achieve that system were sincere and in furtherance of quality of health care for the public.”
AOA and AACOM representatives said they “believe strongly that the health of the American public will benefit from a uniform path of preparation for the next generation of physicians,” but also “remain strong in protecting the identity and distinctiveness of the osteopathic medical profession.”
All three organizations indicated they remain open to continued discussions.
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AMA Starts Mentoring Program
The American Medical Association has started a mentoring program to allow practicing physicians early in their careers to be mentors to members of the AMA Medical Student, and Resident and Fellow sections.
AMA says the program will allow young physicians, residents, and students to share information on enhancing career advancement; sharing advocacy, professional, or research interests; and promoting an enriched experience in organized medicine.
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Keep Medicare Payment Reform Moving
Difficult as it may be to believe, Congress is actually making some progress on replacing Medicare’s broken Sustainable Growth Rate (SGR) formula. Thanks to the leadership of two Texans — U.S. Reps. Michael Burgess, MD (R-Lewisville), and Kevin Brady (R-The Woodlands) ― an SGR replacement bill is moving through the House with bipartisan support.
HR 2810 repeals the SGR and replaces it with annual 0.5-percent rate increases. Beginning in 2019, physicians could report quality-of-care data under a new program and earn up to an extra 1-percent increase ― or possibly face a 0.5-percent cut. The bill says medicine will play a central role in designing the quality metrics. It also sets up ways for physicians to establish alternate payment models that would be exempted from the new quality reporting program.
The bill is not perfect. TMA is concerned about the size of the payment increases and the potential for a new set of bureaucratic hassles to spring up around the quality reporting program. We don’t know yet how Congress will decide to pay for the bill. But it’s been years since we've seen this much progress toward repealing the SGR.
The Centers for Medicare & Medicaid Services (CMS) will release information on how much the SGR will reduce physician payments if Congress does not act in November. Previously, CMS estimated the SGR will cut payments by 24.4 percent effective Jan. 1.
Please contact Sens. John Cornyn and Ted Cruz and your representative and ask them to keep HR 2810 moving so we can repeal the SGR this year.
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“Hey, Doc” Gives You Answers to Patients’ ACA Questions
Americans’ physicians are their most trusted source for information about the Affordable Care Act (ACA), according to a new national poll, but that’s not where people are learning about it.
TMA is about to change all of that, and not by turning your practice into ACA information-central.
Using a combination of video, the Internet, traditional news media, and social media outlets, TMA's “Hey, Doc” project will bring answers to the most frequently asked questions about the new ACA insurance marketplaces directly to your patients. The project also will give TMA member physicians monthly fact sheets to help you answer those questions that come up as the ACA marketplaces begin accepting applications on Oct. 1, 2013. The ACA’s requirement that Americans have health insurance (the “individual mandate”) kicks in Jan. 1, 2014.
“Our goal is to position TMA and Texas physicians as caring sources of credible information within the maelstrom of confusion surrounding the ACA marketplace rollout,” said Steve Levine, TMA vice president for communication.
Look for the “Hey Doc” project materials to begin appearing by mid-September.
In the meantime, the U.S. Health and Human Services Department awarded $67 million in grants to 105 organizations to be “navigators,” to help consumers shop for and enroll in health plans through the marketplace. The eight Texas organizations that received almost $11 million in navigator grants are:
- Change Happens, $785,000;
- East Texas Behavioral Healthcare Network, $1.3 million;
- Migrant Health Promotion Inc., $589,750;
- National Hispanic Council on Aging,* $646,825;
- National Urban League, $376,800;
- Southern United Neighborhoods,* $600,678;
- United Way of El Paso County, $642,121; and
- United Way of Metropolitan Tarrant County, $5.9 million.
* These organizations were selected as navigators in more than one state.
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National, State Lawmakers to Address Fall Conference
The patient-physician relationship will be the focus of TMA Fall Conference Friday and Saturday, Oct. 18-19, at the AT&T Conference Center in Austin.
Saturday’s session begins at 7:30 am with a Dawn Duster session on TMA’s new Physician Services Organization for Patient Care.
The general session begins at 8:45 am with remarks by TMA President Stephen Brotherton, MD. Sen. Ted Cruz (R-TX) will follow with an update on issues in Congress.
Next on the agenda will be a panel discussion on Protecting the Patient-Physician Relationship. Panel members will include Rep. Susan King (R-Abilene), Rep. Sarah Davis (R-Houston), and Rep. Nicole Collier (D-Fort Worth).
The session ends with a recap of the 2013 legislative session by Evan Smith, chief executive officer and editor-in-chief of The Texas Tribune.
Need a flu or Tdap (tetanus, diphtheria, and pertussis) vaccination? If so, you can get one or both at the conference. Physicians and their families, medical students, and office staff can get a vaccination from 7:30 to 8:30 am on Saturday. The event is sponsored by TMA’s Committee on Infectious Diseases and TMA’s Be Wise — ImmunizeSM. Costs are: flu shots, $27; FluMist, $40; and Tdap shots, $80.
Be sure to reserve your vaccination when you register for the conference.
TMA councils, boards, committees, and sections will meet during the conference.
Book your hotel reservation at www.texmed.org/fall by Sept. 26 to receive a discounted room rate.
Be Wise — Immunize is a joint initiative led by TMA physicians and the TMA Alliance, funded by TMA Foundation through generous grants from H-E-B and TMF Health Quality Institute. Since the program began in 2004, more than 235,000 vaccinations have been given to Texas children, adolescents, and adults.
Be Wise — Immunize is a service mark of the Texas Medical Association.
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Join or Renew TMA Today: We Could Use Your Help!
TMA has been a longtime advocate for academic faculty and medical schools — monitoring legislation, determining the potential impact on patients, and lobbying for your interests.
The results of the 2013 legislative session were outstanding for academic medicine. Our efforts in this legislative session, including public testimony provided by TMA leadership at every applicable legislative committee hearing and through personal visits with legislative members and staff, paid off. For example, lawmakers restored graduate medical education formula funding, which took a 31-percent hit in 2011, with a 15-percent, or $8.8 million, increase this budget cycle. Lawmakers also restored the Family Medicine Residency and Physician Education Loan Repayment programs, which were almost eliminated in the past. Medical education also received a boost of 7 percent in per student funding. TMA helped stop off-shore medical schools from buying up clerkship spots in Texas hospitals and repealed a 2011 law that forced international medical graduates to spend three years working in only medically underserved areas.
TMA is extremely successful in Texas — for one reason only. TMA speaks with one strong, firm, and consistent voice, the voice of its members. Only with grassroots support … only with your support … can we continue to be successful.
Join or renew today at www.texmed.org/join and see what a difference TMA membership can make. Within your department and/or academic institution, funds may be available to cover the cost of your membership. Please check with your department administrator or chair to see if applicable.
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New-to-Texas Physicians Can Start Here
Are you a physician who is new to Texas? Have you recruited a physician for your school, your practice, or your community from out of state?
TMA's New to Texas webpage can help new or returning Texans get their practices up and running. The page provides links that doctors need to obtain a Texas license, plus contact information for relevant state and federal agencies, and links to resources such as practice consulting for set-ups, health insurance plan contacts, and employee salary data.
TMA members can email the TMA Knowledge Center or call (800) 880-7955 for fast answers to questions about membership, TMA member benefits and services, practice management or legal information, and more.
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This Month in Texas Medicine
The September issue of Texas Medicine marks the 10th anniversary of tort reform with an examination of how it has lowered your liability premiums, brought more doctors to Texas, and improved patients’ access to care. You can also read about optimism that the Medicare Sustainable Growth Rate formula may be on its way out, the new TMA-won law against “silent PPOs,” and how physicians are working to reduce maternal deaths. And, you’ll find out where the Bridges to Excellence lead and learn what a “doctorpreneur” is.
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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