Joint Hearing: Senate Health and Human Services Committee With the Senate International Relations and Trade Committee
May 28, 2008
Presented by: Ladon W. Homer, MD
Past President, Texas Medical Association
My name is Ladon Homer. I am a pathologist, now retired, who practiced 39 years in Fort Worth. I come before you today representing the Texas Medical Association, and I appreciate the opportunity to speak.
As an organization that represents 43,000 physicians and medical students, care for our patients is our first priority. With that in mind, I feel compelled to share with you today critical concerns your physicians have about the future of patient care in the state.
Texas has a shortage of physicians, especially primary care physicians and specialists. We need more geriatricians to treat our seniors, more pediatric specialists to treat our sickest children, more endocrinologists to treat diabetes, more surgeons and emergency room physicians at our hospitals, more dermatologists to detect skin cancer, and more adult and child psychiatrists to treat mental health needs, to name only a few.
Texas ranks 43rd among 50 states and the District of Columbia in the ratio of physicians to population. We fall below not just small states but large ones as well. Texas ranks behind California, New York, Florida, Pennsylvania, and Illinois - the most populous states in the country - and 37 other states.
Leaders in workforce planning are calling for significant increases in the number of new physicians, recommending a 30-percent increase in medical school enrollments and a 15-percent increase in graduate medical education, or GME, slots. Texas medical schools have responded. They are on track to increase the state's medical school enrollment by 30 percent by 2015. But if we do not expand GME at the same time, we will do little to produce more physicians for Texas. A physician is not qualified to enter practice after medical school. Medical school graduates must go on to train in a GME program that ranges from three to eight years in length, depending on the specialty. I'm sure you agree it is not good fiscal policy to make a state commitment of $50,000 a year for each Texas medical student for four years and then force our graduates to leave the state for GME because we do not have enough GME slots.
Our legislature, including many of you, took a strong position in support of GME expansions in 2007. Additional GME slots were added. However, those residents have just started their training. There is still need to fund the faculty costs for the duration of the residents' training.
Primarily due to tort reform, Texas has been able to attract record-high numbers of new physicians, more than 10,000 physicians in four years after passage of Proposition 12. But, is it enough?
You've heard descriptions of the expected population gains from speakers today, and you know well that our population is aging. From 2000 to 2007, the Texas physician supply grew 17 percent. Not bad. However, at the same time, the number of Texans grew 16.6 percent. Our physician supply barely kept pace.
When we make projections to 2015, the results are troubling, with population growth expected to exceed additions to the physician supply. This would indicate that we likely have not done enough. We need to expand our medical school enrollments, increase GME slots in a commensurate fashion, maintain a stable practice environment to continue to recruit new physicians, and retain those we have. We also need an adequate amount of loan repayment dollars to serve as an effective tool for recruiting physicians to practice in underserved communities.
In closing, I also would like to emphasize that physicians recognize that health care is best delivered as a team. We are concerned about the shortage of bedside nurses and nursing faculty. The legislature has worked hard on this issue in recent sessions, and we encourage you to stay the course.
- Texas needs more physicians and bedside nurses.
- There is a need to sustain our growth in medical school enrollments and GME with adequate formula funding and restoration of Medicaid GME funding.
- There is a need to maintain a stable practice environment for Texas physicians including adequate Medicaid fees and loan repayment amounts.
Thank you for the opportunity to speak to you today.