By Jonathan Nelson
We’re well into the third week of the Texas Legislature and now that the opening ceremonies are out of the way, lawmakers are beginning to get down to business. Both the House and the Senate have released their proposed budgets for the coming biennium, and both have announced committee assignments. Now the real work begins.
This session TAFP aims to fight for the restoration of funding for our family medicine residency programs to help address the increasing shortage of primary care physicians practicing in the state.
According to the Association of American Medical Colleges, Texas ranks 47th among states in the ratio of primary care physicians to total population. The U.S. Health Resources and Services Administration has designated 123 of Texas’ 243 counties as full Primary Care Health Professional Shortage Areas and 84 as partial HPSAs.
This problem isn’t likely to get better any time soon. A recent report from the Texas Department of State Health Services estimates “the shortage of primary care physicians in Texas will grow from 2,002 full-time equivalents in 2017 to 3,375 in 2030, an increase of 67 percent.”
Our state’s 33 family medicine residency programs are the lifeblood of our primary care physician workforce, preparing more than 300 new family physicians for practice each year. We know that most family doctors completing residency in Texas remain in the state to practice.
We know the clinics associated with these residency programs deliver well-coordinated, cost-effective care to communities that need it. A significant portion of the care they provide is for Medicaid and CHIP patients, Medicare patients, and the uninsured.
We also know many of these training programs operate at dangerously narrow margins, often teetering on the brink of closure. In 2008, the Texas Tech University Rural Program in Abilene closed its doors for financial reasons. The Kelsey-Seybold Family Medicine Residency Program in Houston closed in 2009 due to financial instability.
The most recent closure occurred last year, when the family medicine residency program in Wichita Falls closed due to — you guessed it — a lack of funding. When it shut down, the community lost a medical home that had provided care for more than 40 years; a program that graduated well over 200 family doctors, 44 of whom still practice in the Wichita Falls area; and a critical source of primary care to area hospitals, nursing homes, the Texas Women’s Health Program, the county indigent program, and the Wichita Falls Health Department.
The Legislature has long recognized the importance of investing in our state’s family medicine residency programs through a funding strategy administered by the Texas Higher Education Coordinating Board, aptly named the “Family Practice Residency Program.” Through this budgetary line item, most family medicine residencies receive funds based on the number of residents they have in training.
In recent years, this funding has varied dramatically, putting many of our existing family medicine programs in jeopardy. In FY 2010-11, they received $21.2 million through the program but the following biennium, the Legislature slashed the funding to just $5.6 million. Over the next two sessions, residency programs worked to recover from the trauma of such a drastic reduction. TAFP fought for more funding and the Legislature acted, raising the amount to $16.8 million.
Then last session, the Legislature cut the funding by 40 percent, leaving just $10 million for the programs in the current biennium.
Our goal is to double that for 2020-21. Check out our latest issue brief, “Support Texas’ Existing Family Medicine Residency Programs,” and stay tuned for news on this and other legislative action throughout the session.
Restoring funding for the Family Practice Residency Program would cost the state only $10 million more, but the investment would protect those existing residency training programs that produce the doctors who make up our primary care infrastructure. As our population grows and ages, we must ensure that all Texans have access to high-quality primary care and the most efficient way to meet that goal is to recruit and train family physicians here at home.