A&M College of Medicine Cuts Fall Class Size in Wake of Proposed Cuts
Fifty Texas applicants to the Texas A&M College of Medicine on the school’s alternate admissions list for the 2017 fall semester have been informed that proposed state budget cuts have forced the medical school to suspend offers of class placements to those on the alternate list. Admissions are frozen at 150 until further notice, a 25-percent reduction. The Texas A&M Health Science Center reports proposed cuts ranging from $6 million to $50 million-plus in the draft House and Senate 2018-19 budget proposals (Senate Bill 1 and House Bill 1).
Senate Finance Committee Chair Jane Nelson (R-Flower Mound) appointed a five-person workgroup to study special item funding to higher education programs, including medical schools. The workgroup is charged with developing a proposal for restoring special item funding in SB 1. In the current state budget, $1.1 billion is allocated through special items across all of higher education. Sen. Kel Seliger (R-Amarillo) chairs the workgroup, joined by Sens. Juan “Chuy” Hinojosa (D-McAllen), Lois Kolkhorst (R-Brenham), Larry Taylor (R-Friendswood), and Kirk Watson (D-Austin). Medical education, graduate medical education (GME), and research programs are at risk as a result of cuts to special item funding. The House budget proposal keeps the special item funding at nearly the same level as the current budget.
Both chambers propose 3-percent cuts to the base rate for medical student formula funding in 2018-19, for a total of $45,301 per student per year. In addition, the Senate is not proposing state formula funding for the two new University of Texas medical schools — Dell Medical School in Austin and Rio Grande Valley School of Medicine. The House includes funding for both schools, with a total of 6,598 medical students at 11 medical schools eligible for state formula funding for a total of $598 million.
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Governor Abbott Exempts New Entry-Level GME Positions From State Hiring Freeze
The Texas Higher Education Coordinating Board successfully obtained an exemption for 486 new entry-level GME positions for 2017 from the state hiring freeze enacted by Gov. Greg Abbott. This included newly created positions that received grants from the state’s GME expansion grant programs as well as other new entry-level positions. If the waiver had not been granted, the freeze would have prevented these positions from being filled and delivered a significant setback to the state’s efforts to increase GME, by invalidating the state grant funds awarded for this purpose.
In granting the exemption, the governor’s budget office explained, “It is our understanding that filling these positions is necessary to get Texas closer to its goal of achieving a ratio of 1.1 residents to each medical student. Your waiver request is approved.” The letter further stated that the “Governor’s office is also asking your agency to work with general academic and health related institutions to identify administrative and non-academic related savings within their individual budgets that will offset the costs of funding these residency positions.”
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Medical Student Takes GME Concerns to Budget Writers
In the midst of hearing comments on GME by Texas medical school presidents and medical deans in late February, the House Appropriations Subcommittee on Article III (education) heard from someone on the front lines — a medical student.
Kayla Riggs, a fourth-year student at McGovern Medical School at The University of Texas Health Science Center at Houston, asked legislators to adequately fund the GME positions that have been created through state grants.
Ms. Riggs, a TMA Board of Trustees member, testified that Texas will add more than 300 medical school graduates by 2022, and residency slots must keep pace. If those Texas students cannot stay in Texas, they’ll look out of state but still might face difficulties.
“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,” her written testimony says. “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.”
“Selecting a residency is one of the most difficult decisions a physician makes,” Ms. Riggs told legislators, adding many factors go into the decision. “If only limited opportunities are offered, however, many graduates will have to go elsewhere — and as you know when a physician leaves the state for training, 40 percent do not return to the state.”
TMA’s written testimony noted these chief areas of concern for 2018-19 funding:
- The need for sustained state support for GME positions previously developed using GME expansion grant funds;
- The gaps between the number of newly created GME positions since 2014 and the number of additional positions needed to keep pace with growing medical school graduates, and also in meeting the state’s target ratio of 1.1 entry-level GME position per Texas medical school graduate; and
- Proposed reductions to special item funding for health-related institutions (for medical education, GME, and research programs).
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Where State GME Funding Proposals Stand for 2018-19
We have seen no changes since the last issue of It’s Academic for the dollar amounts proposed for GME programs in the budget proposals filed by both the Senate and the House for the state’s 2018-19 budget. Here’s a recap of the two draft budgets:
The Senate and House propose about the same total amount through four state GME programs. The House comes out ahead, by $4 million, for a total of $194 million, and the Senate is close, with a total of $190 million. The House increase is 21 percent above current spending, while the Senate increases it by 19 percent.
While both chambers propose additional funding for GME, the Senate trims some money from the state GME formula funding, while the House proposes $4 million above the current budget for a total of $90.1 million. Formula funds are provided to medical schools to help offset the teaching costs for residents. The Senate proposal does not provide funding for residents at the two new University of Texas medical schools, Dell (Austin) and Rio Grande Valley. Some of these resident positions are not new and previously had received GME formula funding.
The Senate would give more to the GME expansion grant programs, allotting $97 million. The House would provide $82.8 million; both would be significantly above the current two-year budget for that item, $53 million. Additional monies are needed for the expansion program to provide continued support to residents in newly created positions as they progress in their training.
The state coordinating board estimated an additional $18 million is needed beyond the Senate funding proposal to provide enough funds for residency positions to be “refilled” after the initial residents complete training. Much more would need to be added to the House proposal — about $32 million — to allow for refilling. Neither budget proposal provides sufficient funding to allow the coordinating board to give additional grants to create new residency positions in 2018-19.
Of note, this is the first time funding is available from the new state GME permanent fund. The first allotment of $21.8 million is included in both the Senate and the House budget proposals.
Both the Senate and the House propose to keep the same budget allotments as the current budget for the other GME and medical education programs, including the Family Medicine Residency, Primary Care Preceptorship, Primary Care Innovation Grants, Emergency and Trauma Care Grants, Joint Admission Medical, and physician loan repayment programs.
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Send Your Students and Residents to Austin
First Tuesdays at the Capitol are TMA’s highly applauded grassroots lobby days in Austin. The “white coat invasion” attracts attention as it gives physicians, medical students, and TMA Alliance members a great chance to educate legislators on complex health care issues.
The April 4 First Tuesdays event is a designated lobby day for medical students and residents. Give your young charges a great opportunity to shape their own future by encouraging them to come to Austin next month. Students who wish to attend should email Karen Kollar at TMA to register; the deadline is March 15. Residents can register online at the link provided from www.texmed.org/FirstTuesdays.
TMA, the TMA Alliance, and TEXPAC also strongly encourage academic physicians to play a significant role in advancing medicine’s priorities at the Capitol. TMA’s 2017 legislative agenda includes priorities to help advance patient care in Texas. Tops on the list are the state budget, insurance reform, scope of practice, the Texas Medical Board, and public health priorities. For details, see “Building on Success” in the January issue of Texas Medicine magazine.
Here are some ways you can help:
- Register for First Tuesdays at the Capitol;
- Testify before a House or Senate committee;
- Learn more about TEXPAC; and
- Subscribe to TMA Legislative News Hotline daily or weekly summary email with video or both. Here’s how: Just log in to your member profile on texmed.org and visit the subscriptions page at texmed.org/profile/subscriptions. TMA Legislative News Hotline keeps you informed of the latest dealings throughout Texas’ 85th legislative session. Updates on the latest bill action affecting medicine will be sent to your inbox each day lawmakers convene at the Capitol. TMA’s weekly edition of Hotline summarizes the week’s legislative activity, and includes TMA’s video recap.
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AMA Honors State Senator for Medical School Effort
The American Medical Association presented State Sen. Kirk Watson (D-Austin) with the Dr. Nathan Davis Award for Outstanding Government Service, primarily for his work in helping The University of Texas at Austin launch a new medical school in the city.
Senator Watson was selected for AMA’s top government service award for asserting his community vision for health care and economic prosperity, most notably for leading the successful effort at The University of Texas at Austin to build a new medical school from the ground up.
“Senator Watson laid out a groundbreaking ‘10 Goals in 10 Years’ initiative for Austin, which included a comprehensive plan to bring a state-of-the-art medical school to The University of Texas in Austin,” said AMA Board Chair Patrice A. Harris, MD. “Just five years later, the Dell Medical School opened its doors to the first class of 50 students in 2016. Through his bold vision and hard work, Senator Watson is not just inspiring great change in Austin, but helping shape the landscape of medicine and medical schools well into the future.”
Senator Watson is one of 10 honorees chosen this year to receive the Dr. Nathan Davis Award for Outstanding Government Service. The award, named for the founding father of AMA, recognizes elected and career officials in federal, state, or municipal service whose outstanding contributions have promoted the art and science of medicine and the betterment of public health.
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Coordinating Board Reallocates $7 Million in GME Grant Funding
The Texas Higher Education Coordinating Board has reallocated $6.675 million in GME grants for 89 residency positions for state fiscal year 2017. The funds became available after being returned to the board by the sponsoring institutions that received the initial grants. Some needed more time before filling the slots, while other programs decided not to go forward with GME expansion plans. Nineteen residency programs received funds through the reallocation process, with the largest number going to general surgery (30 percent):
The majority of the reallocations — 67, or 75 percent — were made to residency positions in nonprimary care specialties, and 22 were made to primary care programs. The list of eligible programs was extracted from the grant applications received in the request for applications issued in October 2015. The current grant reallocations are the first time that grant awards were made to applicants in the Priority 4 application category, which was made up of nonprimary care specialties. No grants were made to the Priority 4 application category during the first round of grant awards in June 2016.
In the initial grant application cycle in 2015-16, the board received applications requesting funding for 98 residency programs. The board awarded $49.2 million to support 683 positions in 65 residency programs over an approximate two-year period.
Of the total residency position awards, 514, or 75 percent were made to primary care medical specialties of internal medicine, family medicine, general pediatrics, and obstetrics-gynecology.
Before the grant funds can be disbursed, state law requires the applicants to verify that residency positions selected for funding have been filled. If the positions are not filled, the grant funds are forfeited and returned to the board for reallocation.
The reallocations for grants to the 89 residency positions were distributed among nine urban geographic areas. The largest total reallocations were made to programs in Houston (36 percent) and Midland/Odessa (32 percent), as shown below:
A total of 684 residency positions are approved for grant funding for the 2016-17 biennium, for a total of $49.3 million.
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This Month in Texas Medicine
The March issue of Texas Medicine features a cover story on the rise in school vaccine exemptions among Texas students. Physicians hold hope this year’s dramatic national increase in cases of mumps, including an outbreak in Texas, might give medicine-friendly lawmakers further opportunity to release more data to parents on how many students in their children’s schools have received an exemption. The issue also includes coverage of legal concerns regarding updates to the National Practitioner Data Bank’s NPDB Guidebook, new TMA data showing physicians’ passion and persistence are paying off as they attempt to negotiate the terms of their health plan contracts, and a guide to understanding how health care rating websites operate.
Check out our digital edition.
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