The Senate Finance Committee began holding budget hearings this week, taking up Article III on Wednesday, which contains appropriations for graduate medical education and other programs administered by the Texas Higher Education Coordinating Board. TAFP provided testimony advocating a set of proposals that comprise a significant portion of the Academy’s legislative priorities for the session:
- Increase funding for the Family Practice Residency Program;
- Invest $5 million to expand the state’s five existing family medicine obstetrics fellowship programs and to establish 10 new ones;
- Maintain funding for the Physician Education Loan Repayment Program;
- Maintain funding for the Texas Statewide Preceptorship Program;
- Increase funding for rural residency training programs; and
- Invest $10 million to create a Primary Care Research and Innovation Lab.
Together, these proposals would go a long way to increasing access to critical primary care services and maternal care services across the state, particularly in rural and underserved communities. “The need to educate, train, recruit, and retain adequate numbers of family physicians remains critically important to ensuring access to medical care for all Texans,” the Academy stated in its testimony.
The Family Practice Residency Program
Dating back to 1977, a strategy called the Family Practice Residency Program is among the state’s oldest physician workforce developments programs. It provides grants directly to the state’s family medicine residency programs, which prepare more than 300 new family doctors to care for patients.
Even as the state has increased the number of residents in training, the amount of THECB funding for family medicine residents has withered over the years, dropping from $14,300 per resident each year in 2011 to less than $8,850 in 2025. In its testimony, TAFP called on the Legislature to appropriate an additional $11.85 million over what was budgeted for the current biennium to support family medicine residencies. For more information, download the Academy’s issue brief on the proposal.
Family medicine obstetrics fellowships
In Texas 47% of counties are “maternity care deserts,” lacking OB care services entirely, compared to 33% nationally. This fact is compounded by the vast distances expecting and new mothers in these deserts have to travel to access necessary care.
In many rural and underserved communities, family physicians are the only sources of primary care, including maternal care, and they are the most likely physicians to set up practice in these communities.
“According to the Robert Graham Center, family physicians deliver babies in more than 40% of all U.S. counties, and more than half of these counties are in nonmetropolitan areas,” the Academy stated in its testimony. “Family physicians are the sole maternity care clinicians delivering babies in 16% of maternity care deserts across the country.”
Unlike states with large rural populations like Colorado and Kansas, Texas has limited graduate medical education opportunities for family medicine residents seeking additional maternal and women’s health care training. Texas has only five such fellowship programs. We know that out-of-state programs have succeeded in attracting Texas family medicine residents, and we need them to stay here.
In its testimony, the Academy called for an allocation of $5 million to expand the existing five FMOB fellowships and to establish 10 more. For more information, download the Academy’s issue brief on the proposal.
The Physician Education Loan Repayment Program and the Texas Statewide Preceptorship Program
Two of the most successful programs lawmakers have supported over the past several years to strengthen primary care in the state are also administered by the THECB, and TAFP called for continued funding for both at Wednesday’s hearing. The Physician Education Loan Repayment Program provides loan repayment assistance of up to $180,000 over a four-year period to physicians practicing in Health Professional Shortage Areas and for specific state agencies. Since 2009, more than 2,300 physicians have participated in the program.
Texas’ Primary Care Preceptorship Program has a longstanding record of introducing students early in their careers to the fields of internal medicine, family medicine and pediatrics. These programs have placed more than 9,300 medical students in primary care clinics for two- to four-week internships since 1995 with remarkable results.
As the administrator of the Texas Family Medicine Preceptorship Program, TAFP applauds those family doctors who serve as preceptors to interested medical students. For more information on the program and to sign up to be a preceptor, visit the program website.
Rural residency training programs
In the last Legislature, lawmakers appropriated $3 million to the Rural Resident Physician Grant Program, which funds new residency positions in nonmetropolitan areas. This is a wonderful start but more has to be done to introduce the next generation of family physicians to the possibilities of rural practice.
In its testimony, the Academy called for an additional $1 million for the program.
Research to make primary care better
To solve our state’s primary care workforce shortage, not only do we need more family doctors and a more equitable distribution of them around the state, but we need to invest in research to improve the efficiency and effectiveness of our primary care workforce. TAFP has called for the creation of a Primary Care Research and Innovation Lab that would be dedicated to evaluating strategies to improve primary care resiliency, capacity, access, efficacy, cost effectiveness, and interprofessional collaboration.
“Texas has long incubated state-of-the-art medical and specialty services, such as cancer research to improve cancer treatment,” the Academy stated in its testimony. “That expertise now should be harnessed to research and reimagine a sustainable, resilient, integrated, cost-effective, and accessible primary care model that can power Texas’ health care system.”
Read more about this idea in the September edition of Texas Family Physician: “Lawmakers should address access to care by investing in primary care research and innovation.”