TMA Urges Comprehensive Rural Health Care Reform Amid Workforce Shortages
By Emma Freer

Last December, Adrian Billings, MD – a family physician serving Alpine, Marfa, and Presidio – responded to a small plane crash on his way home from work. After he called 911, he saw the lone ambulance in Presidio pass by the crash, on its way to another call. He said the two plane passengers likely wouldn’t have survived had emergency medical services (EMS) from nearby cities not intervened.  

That’s just one example of the long-standing funding and workforce shortages that challenge health care in rural Texas and require investment in “a cohesive, enduring, long-term rural health enhancement plan,” Dr. Billings told the Texas House Committee on Public Health on Sept. 14. In the run-up to the 2023 state legislative session, which begins in January, the committee is tasked with strengthening the state’s health professional workforce and rural health care system, among other interim charges. 

Dr. Billings, who testified on behalf of the Texas Medical Association and the Texas Academy of Family Physicians, commended committee members for recent legislation, including TMA-backed laws that increased funding for rural hospitals and expanded telehealth access. But he also spoke about how physicians in rural areas – which account for 186 of Texas’ 254 counties – remain under-resourced.  

For instance, Big Bend Regional Medical Center, a 25-bed critical care facility serving a 12,000-square-mile area, had stopped delivering babies from Thursday mornings to Monday mornings each week – for 13 months – because of a lack of labor and delivery nurses, he said.  Presidio EMS has one ambulance and operates on a shoestring budget, both of which make it difficult to serve a vast region, especially in times of overlapping emergencies like the plane crash he described.  

Demographic challenges also contribute to Texas’ rural health care woes. Rural Texans are statistically more likely to be older, sicker, and poorer than Texans overall, which means they also are more likely to struggle with other needs, including food security and health care coverage. 

Piling on, low rates of health insurance coverage affect rural physicians and other health care professionals by driving up uncompensated health care costs, a key factor in rural hospital and practice closures, Dr. Billing said. And residents and young physicians with student debt are wary of practicing in rural areas, where many patients are unable to pay for care.  

State Rep. Jolanda Jones (D-Houston) asked Dr. Billings about how to attract physicians to rural communities, where their expertise is desperately needed. She mentioned her sister, a physician, works in a small community in order to qualify for a loan repayment program – but plans to return to Houston, with all its big-city amenities, as soon as possible.  

In response, Dr. Billings said state legislation is critical to incentivize medical schools and training hospitals to admit rural students, who are more likely to return to – and lay down roots in – rural communities. Such a policy would have a positive ripple effect across the state, including in urban and suburban areas.  

Attracting and keeping physicians in rural areas is key to TMA’s recommendations for developing a comprehensive bill related to rural health care, which include:  

  • Expanding access to comprehensive, affordable health coverage; 
  • Restoring funding for the State Physician Education Loan Repayment Program, which incentivizes physicians to practice in health professional shortage areas; 
  • Funding the Professional Nursing Shortage Reduction Program; 
  • Allocating $20 million to the Family Medicine Residency Program to help entice family medicine residents to rural training programs, which often receive less federal funding than hospital-based programs for other specialties; 
  • Sustaining the physician residency positions created through the State Graduate Medical Education Expansion Grant Program;  
  • Allocating $1 million to the State Rural Training Track Grant Program;  
  • Ensuring telehealth payment parity so rural physicians can afford to continue providing telehealth services; and  
  • Promoting the adoption of value-based payment models, including those focused on rural maternal and mental health services.   

“Whether living and working in rural Texas, vacationing, or just passing through, people get sick, have car accidents, or deliver babies,” he said. “That means access to high-quality, safe, and effective rural health care is important to all Texans as well as the millions of visitors to [rural] Texas annually.”  

Read the full testimony

Last Updated On

September 22, 2022

Originally Published On

September 19, 2022

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Emma Freer


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Emma Freer is a reporter for Texas Medicine. She previously worked in local news, covering city politics, economic development, and public health. A native Clevelander, she graduated from Columbia Journalism School and the University of St. Andrews.

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