REPORT OF COMMITTEE ON PHYSICIAN DISTRIBUTION AND HEALTH CARE ACCESS
PDHCA Report 3-A-07
Subject: Expedited Medical License Application Processing for Physicians Seeking Practice inTexas Border Areas
Presented by: Woody V. Kageler, MD, Chair
Referred to: Reference Committee on Science and Education
Concerns about a chronic shortage of physicians in El Paso and other border communities were brought to the Physician Distribution and Health Care Access Committee in 2006. It was stressed that the recent backlog of medical licensing applications at the Texas Medical Board, including those from El Paso, has further stymied recruitment efforts in these areas. The committee was aware of the longstanding physician recruitment problems in El Paso and in some other border [1] areas through its ongoing monitoring of physician workforce trends in the state.
The border area of Texas is among both the fastest growing regions in the nation and the poorest, as reflected by the high poverty rates. As a demonstration of the likelihood of reduced patient access to physicians in border areas, the 2006 ratio of physicians per 100,000 population of 97.3 for border areas is less than half the ratio of 155.3 for Texas as a whole. For El Paso County, the ratio of physicians per 100,000 population is 107, compared with a state average of 155.3, ranking El Paso County 51st out of 254 Texas counties in physician access (source: Health Professions Resource Center, Texas Department of State Health Services). In comparison, El Paso County ranks 6th among Texas counties in population size.
In response to El Paso concerns, the committee conducted research on whether border areas qualify under existing provisions for expedited medical licensure. Current law allows only rural communities or communities expected to be served by physicians with J-1 Visa Waivers [2] to qualify for expedited medical licensure.
Recognizing the chronic shortage of physicians in El Paso and longstanding difficulties in recruiting physicians to this area, the committee recommends adoption of TMA policy in support of amending state law to allow border areas to also qualify for expedited medical licensure as shown below. The committee further determined that a definition of "shortage areas" and "border area" could be added to the law to facilitate implementation of the proposed changes.
Proposed Change in Current Statute and Program Rule:
(1) the applicant intends to practice in a rural community as determined by the Office of Rural Health Initiatives; or
(2) the applicant intends to practice in a border area with a shortage of physicians ; or
(3) the applicant:
(A) has requested and is eligible for an immigration visa waiver as described by Section 12.0127 of the Texas Health and Safety Code; and
(B) intends to practice medicine in a medically underserved area or health professional shortage area designated by the United States Department of Health and Human Services that has a shortage of physicians.
On this basis, the committee recommends adoption of the following as TMA policy:
Recommendation : That the Texas Medical Association supports the addition of border areas of the state to the list of geographic areas defined in state law as being eligible for expedited medical licensure. This is recommended in recognition of the chronic shortage of physicians in El Paso and some other urban border areas and longstanding difficulties in recruiting physicians to these areas of the state.
[1] The definition of border areas in this case encompasses 43 Texas counties, as defined by the Texas Department of State Health Services.
[2] J-1 Visa Waivers are immigration waivers issued to physicians who trained in a U.S. residency program under a J-1 Visa. This type of visa carried with it the requirement for the physician to return home on completion of training for a two-year waiting period before applying for U.S. immigration. Physicians with J-1 status can apply for a J-1 Visa Waiver which negates the two-year waiting period and requires the physician to practice in an underserved area in the U.S. for three years.
TMA House of Delegates: TexMed 2007