TMA Testimony by Tim Benton, MD
House Higher Ed Committee Meeting
House Bill 1065 by Rep. Trent Ashby
March 6, 2019
Good morning, chair Turner and members of the committee. I am Dr. Tim Benton, and I practice both family and academic medicine in Midland. By academic medicine, I mean that I both treat patients and train physicians. Today, I appear before the committee to represent the nearly 53,000 members of the Texas Medical Association. I am speaking in support of House Bill 1065.
Thank you, Rep. Ashby, for sponsoring this bill and for your support of improving access to medical care. That is what the bill is about. Texas needs more physicians in rural areas. We also need to make sure that physicians are prepared for practice in a rural setting.
Texas is extremely fortunate to have a relatively large number of regional medical centers. They provide an excellent training ground for high-level medical care.
Rural medical practice is different. Often you are the only physician. You are not able to refer a patient with complex health issues to a specialist across town because the nearest specialist may be 150 miles away.
To be prepared for that type of practice, a physician needs to receive the right kind of training. That is the purpose of rural training tracks. Right now, Texas does not have enough rural training tracks to meet the state’s needs for rural physicians. That is the purpose of HB 1065 – to fill that need.
You will often hear the question, “Why are there so few residency training programs in rural Texas? Given the strong relationship between where a physician trains and where he or she practices, won’t we solve the rural shortage by putting residency programs in rural areas?”
This is not an option for most rural areas because they do not provide the kind of training environment needed – for example, for a three-year family medicine residency program. Residency programs have to qualify for national accreditation. That means the training experience for a family physician must be substantially equivalent wherever the physician trains. Every family medicine residency program, regardless of location, must have a “patient population with the volume and variety of clinical problems and diseases sufficient to enable all residents to learn and demonstrate competence for all required patient care outcomes.” That is not always possible in rural areas.
That is what is different about a rural training track. The tracks are created through a partnership between an urban and a rural hospital. The resident trains at the urban hospital for the first year, then goes out to the rural training program for the second and third years. This exposure to real-world medicine makes all the difference in preparing physicians for rural practice. They not only learn the skills they need but also build the confidence that is so important for practice in isolated settings.
Research on rural training track programs in other states has shown solid success: Three out of four physicians who train in a rural track go on to practice in rural areas.
One of the biggest restrictions to expanding graduate medical education (GME) is the cap Medicare has placed on the funding of residents. The cap was put in place in 1997. What that means is that hospitals that had residents in 1997 are capped at the number they had 22 years ago!
Generally, there is no way to change that cap. However, the federal government has seen the benefits of rural training tracks and created a special provision for them in Medicare policy. Urban and rural hospitals that partner to do rural training tracks can have their Medicare GME funding cap adjusted to add the positions in the track. It takes five years before this goes into effect. During those five years, the state can help by providing the grants included in HB 1065.
Rural Texans need HB 1065. The bill offers incentives to create rural tracks. We urge your support.
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