TMA Written Testimony
House Appropriations’ Article III Workgroup
Wednesday, Feb. 22, 2017
This testimony is submitted on behalf of the 50,000 physician and medical student members of the Texas Medical Association.
The addition of new medical schools in the state this decade will push the number of medical school graduates up by at least 20 percent by 2022. This represents a net gain of 343 graduates from 2016 to 2022. Unless the state’s GME capacity is expanded in a similar manner, more than 200 Texas medical school graduates will likely not have an opportunity to train in the state in 2022. There also are no guarantees they will be able to find a training position elsewhere because the shortage of entry-level GME positions is a national crisis. If training positions are not available, these graduates ultimately will be delayed in entering practice or in a worst case scenario, will be forced to forego a career in medicine.
Research has shown that about 40 percent of Texas medical school graduates who leave the state for postgraduate training fail to return to Texas to practice medicine. However, if both medical school training and postgraduate training occur in Texas, the retention rate rises to 82 percent, a greatly improved return on the state capital invested in educating medical students and a strong boost to the state’s physician workforce and economy.
TMA recognizes the:
- Importance of having an adequate number of GME positions to enable the training of the state’s medical school graduates and allow the state to recruit top graduates from other states; and
- Continued importance of educating and training more physicians in order to build a physician workforce to meet the state’s escalating needs for medical care.
TMA is aware of the progress that has been made in expanding the state’s GME capacity through the incentives offered by the state’s GME Expansion Grant program since 2014. Unless this investment by the state is continued, the newly created positions will lose the grant funding needed to sustain the new positions and those positions are then likely to be terminated and subsequently lost to the state. Gone with them are the related training opportunities for future medical school graduates but also the considerable time and expense of securing the initial state grant and accreditation status.
In addition to the state’s GME Expansion Grant program, the state GME formula funding process also plays an important role in supporting existing GME positions. GME formula funding is intended to help medical schools pay the faculty costs related to training residents. These costs are not covered by other sources such as Medicare GME funding. The per resident amount does not come close to actual costs and has been inconsistent since the process was initiated in 2006, ranging from $2,340 per resident/year in 2006-07 to a peak of $6,653 in 2010-11. In comparison, the estimated annual cost is $18,000 per resident. HB 1 contains a reduction of 7.1 percent to GME formula funding. These cuts could have a direct impact on the ability of medical schools to pay for the teaching costs related to GME.
Although GME funding is a priority for TMA, it is also recognized that state budget makers have less available state dollars to work with in forming the next state budget and a plurality of pressing state needs.
The following areas are of chief concern to TMA in relation to GME and health-related institution funding for 2018-19.
- The need for sustained state support for GME positions that were developed using GME Expansion Grant Funds.
Approximately 700 GME positions received funding from the state’s GME Expansion Grant Program since the start of the program in 2014. Although HB 1 includes additional funding for this program, it is not enough to sustain the newly created positions. Funds may be available to allow the initial resident to progress to a subsequent year of training but there are not enough funds to allow the positions to be refilled with a new resident.
The Texas Higher Education Coordinating Board (THECB) estimates an additional $32.2 million is needed in HB 1 to provide enough funds to “refill” the residency positions created since 2014, after the initial resident completes training. TMA recognizes the importance of adequate funding to allow the new positions to be sustained going forward. These positions help to meet the current demand for residency training but the need for additional GME positions becomes even more critical when the projected number of graduates exceeds 2,000, beginning in 2021, as shown in the graphic below.
- The gaps between the number of newly created GME positions since 2014 and the number of additional positions needed to increase the state’s GME capacity in line with projected medical school graduates and also to meet the state’s target ratio of 1.1 entry-level GME position per Texas medical school graduate.
THECB projects a total of 1,777 first-year GME positions in Texas in 2017. In comparison, Texas medical schools are projected to graduate over 2,000 students, beginning in 2021 as noted above, leaving a gap of more than 200. To reach the state target of 1.1 entry-level GME position per Texas medical school graduate in 2021, a total of 2,200 entry-level GME positions would be needed. That would require a net increase of over 400 entry-level GME positions by 2021. It is critically important for the growth in GME capacity to be directly correlated to the state’s physician workforce needs.
- Proposed reductions to special item funding for medical schools and health-related institutions. HB 1 contains proposed cuts to special item funding for medical education, GME, and research programs at Texas medical schools and health-related institutions. This includes medical education programs, such as Texas A&M University’s Round Rock Medical School campus; GME programs at several medical schools, such as primary care at The University of Texas (UT) Southwestern Medical Center and UT Health Science Center at Tyler; and various types of residency programs at the Texas Tech University Permian Basin Regional Academic Health Center.
A long list of research programs at the medical schools and health-related institutions also have proposed cuts. Much of this research is collaborative and has resulted in translational programs that offer best practices for physicians in community practice. This research, in critical areas such as Alzheimer’s Disease and heart disease/stroke, plays a role in improving the health status of Texans. In short, these programs improve and save lives.
TMA greatly appreciates the opportunity to offer written testimony and stands ready to assist the workgroup however possible.
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