By now, it’s common knowledge that Texas faces a growing shortage of primary care physicians. We currently have approximately 18,000 primary care physicians to care for more than 25 million Texans, an unfavorable ratio that will worsen as fewer medical students choose to enter primary care fields and as the population continues to balloon at both ends of the age spectrum.
In an op-ed published Feb. 10 in the Houston Chronicle, Sen. Jane Nelson, R-Flower Mound, wrote about this dire need to address primary care access in Texas, acknowledging that the non-emergency medical services and coordinated care primary care physicians provide for their patients has been shown to increase quality and efficiency, and lower costs.
She has worked with TAFP and other stakeholders over the last decade to build the primary care workforce to improve the health of Texans and make health care costs sustainable for our state, and last session authored a comprehensive package of reforms to the state’s health care delivery system that aims to improve quality and efficiency in the health delivery system by testing and implementing various performance-based payment methods that provide incentives for improved patient outcomes.
“Initiatives like these hold great promise. However, realizing the full potential of these reforms will require a strong primary care workforce,” she wrote in the op-ed.
Sen. Nelson identified the need to invest in more primary care residency slots to ensure that more Texas medical school graduates (in which the state has invested taxpayer funds) can remain in the state to complete their graduate medical education and hopefully practice, and she identified the need to examine how payment inequalities between primary care and other specialty physicians impact the primary care workforce.
The Chronicle published a thoughtful response on Feb. 15, agreeing with the senator. “A major concern is that Texas, already ranked 42nd in the number of physicians per capita of population, loses far too many of its medical school graduates. Almost half of them, educated at an average cost to taxpayers of $200,000 per student, leave the state for residency training, and most of them never return — a situation that will be exacerbated this year when steep cuts in already inadequate funding go into effect.”
As you’ll remember, some of the most painful cuts from the 82nd Legislature for family medicine slashed total state funding to graduate medical education, the line item supporting family medicine residency programs, the Statewide Primary Care Preceptorship Program, and the Physician Education Loan Repayment Program. But while the state’s action last session was disheartening, some medical schools and the federal government have announced efforts to address the shortage and the disincentives that discourage medical students from pursing primary care.
The Chronicle highlighted a pilot program being conducted by the University of Texas System that would enable medical students to graduate a year ahead of schedule, presumably similar to Texas Tech Health Science Center’s three-year family medicine accelerated track, or F-MAT.
A news article published Feb. 19 in the LA Times mentions new medical schools opening in Florida, Pennsylvania, and Connecticut that emphasize primary care, others in California changing their curricula to boost the number of primary care graduates, preceptorship programs placing students in community clinics “so they see firsthand what it’s like to practice preventive care and manage chronic diseases,” and efforts to recruit applicants from diverse backgrounds who might be more likely to practice in poor or underserved areas.
And a Feb. 18 CBS News story covered a new loan repayment program from the National Health Service Corps that will award $9.1 million in funding to medical students who commit to practicing primary care in underserved areas. The program will provide up to $120,000 to medical students in their last year of education in exchange for three years of full-time service or six years of half-time service in rural and urban areas of greatest need.
Our state can’t stop our population from growing, but we can promote innovative programs and proper investment of taxpayer funds that support the medical workforce that Texas needs to care for its population. As the Chronicle wrote, “We urge our lawmakers to pay close attention. This is a dire situation that will only grow worse if not addressed.”