Texas has a significant shortage of physicians, ranking 42 out of 50 states in physicians per capita. We rank below all other large-population states - New York, California, Florida, and Pennsylvania - with shortages in most all specialties.
While the total Texas physician population is expanding, we lead the nation in population growth with large numbers of both the very young and the elderly, groups that use the most health care services. Physician shortages result in reduced access to care. Policies of Congress and the U.S. government have diminished their role in addressing the country's physician workforce needs.
The shortage of training positions hampers Texas' ability to retain its own medical graduates. Where a physician pursues residency training is still the strongest predictor of where that physician will eventually practice! Our state's lack of growth in graduate medical education (GME) slots constrains growth in physician supply and, ultimately, hurts access to care. The physician shortage is projected to worsen over the next decade.
GME is a necessary part of physician training and is required for licensure, board certification, hospital privileges, and becoming part of a health plan network. GME training takes place in clinical settings, with residents providing patient care under the supervision of clinical faculty. Hospitals' Medicare GME funding depends on the amount of care provided to Medicare patients; hence Medicare's support of GME contributes to building the physician workforce and ensuring access for Medicare recipients.
Severe Medicare GME funding limits imposed in 1997 have hurt GME in Texas and other fast-growing states. Those limits were based on a projected oversupply of physicians that never materialized. Funding remains frozen at 1996 levels with no provision for adding positions or new programs. This combines with cuts in federal funding for the Title VII primary care and Children's Hospital GME programs to reduce overall federal support for physician training.
TMA Strongly Supports:
- Removing existing caps on Medicare GME funding so additional resident physicians may be trained based upon population growth.
- Increasing base-level Medical GME funding amount for Texas teaching hospitals and other community-based teaching programs to make them commensurate with other states.
- Retaining the Medicaid GME funding match program.
- Texas needs to produce more physicians to address intensifying physician shortages and reverse the adverse impact on patient care access.
- Medicare GME funding is critically important to the ability of Texas medical schools and teaching hospitals to produce the increased numbers of physicians needed.
- An adequate physician workforce is an absolute requirement for ensuring access to care for patients, including Medicare recipients. Medicare GME funding can provide a valuable incentive for teaching hospitals to provide Medicare services.
2009 Federal Legislative Issue Briefs
U.S. Congressional main page