Only One Viable Hypothesis


By Donald W. Patrick, MD, JD
Executive Director
Texas Medical Board

Texas is experiencing an unparalleled growth in licensure applications from physicians seeking to practice in Texas. During the first half of this fiscal year, there was an 88 per cent increase over the same period of fiscal year 2003. While there was mostly steady growth between 2000 and 2005, projections for 2006 are dramatically higher as evidenced by the chart. 

Texas_license_applications We have considered a variety of explanations for this influx of physicians seeking licensure in Texas. 

Two which appear to have little or no correlation are the following: 

Displacement of physicians caused by Hurricane Katrina: Data shows only a small percentage of applications received from applicants in states impacted by the hurricane.

  • More residents wanting a license in order to moonlight now that the 80 hour work week is being enforced: Data shows the number of residents seeking licensure remains relatively stable.

Some have even suggested that the increase is driven by bad doctors fleeing medical malpractice actions in their home states. As Executive Director, I examine each applicant with a history of medical malpractice issues. Compared to the huge growth in the number of applicants, there is no significant increase in numbers of physicians with one or more documented malpractice action.

We are left with only one viable hypothesis : Tort reform as enacted appears to be working as envisioned by the Texas Legislature. Physicians with no malpractice history are flocking to Texas because it provides a more encouraging environment for the practice of medicine.

While Texas patients can celebrate the improved access to medical care, they can rest assured that consumer protection has also been strengthened. With the decreased accountability in the Texas tort system comes a patient complaint-driven system that understands its duty and responsibility to respond to those patients to redress their grievances against their erring physicians. TMB's strength in holding physicians accountable for the treatment of their patients has reached new highs, creating a deterrent for those practitioners who violate the Medical Practice Act.

So, where is the bad news in this story? If there is a downside it is that the resources of the agency are stressed.  Data for the most recent quarterly report shows that the time to review and approve a licensure application has now increased to 95 days. This delay affects physicians, their employers, and the public, especially people in communities that are medically underserved. The increased vigilance in public protection has also strained resources in the areas of investigations and litigation. While the agency's ability to provide services in required or expected time frames is threatened, the public and the profession can be assured that quality will not be sacrificed.



Reprinted with permission. "From The Executive Director," Texas Medical Board Bulletin, the newsletter of the Texas Medical Board, Spring 2006, Volume 3, Number 2