Physician
Shortage
in Texas
by William L. Henrich, MD, MACP
The Physician Workforce debate has been around for a long time and it remains an important topic today. Texas is facing a physician shortage most prominently in the rural areas. The "Code Red" report, which I have referred to in previous articles, made specific Physician Workforce recommendations as part of the solution
to the critical condition of health in Texas which I will elaborate on later.
In 1996, the Institute of Medicine (IOM) issued a report titled, "The Nation's Physician Workforce: Options for Balancing Supply and Requirements." This report, and many other articles discussing the physician workforce issues, stated that the United States had a surplus of physicians. The report went on to say that the rising number of physicians would have negative consequences on our population and warned that concrete steps needed to be taken immediately. Recommendations varied from admitting fewer medical students, to restricting Grad-uate Medical Education (GME), to
limit the immigration of foreign-trained physicians.
Since the IOM report, the "Code Red" report and the American Association of Medical Colleges (AAMC) Statement on Physician Workforce, among others, have determined that those predictions were inaccurate. The inaccuracies have been attributed to the assumption in 1996 that managed care would drastically alter delivery of care and to the fact that there has been very little to no convincing documentation that this surplus exists.
In the past two decades, enrollment at medical schools has remained flat. Schools of Medicine in Texas are experiencing the same issues - but on a larger scale. With the substantial population growth we are experiencing, we will not be able to meet physician demands by the year 2015. The "Code Red" report recommends that we increase the number of physicians graduating from our medical schools by 20 percent; this is 5 percent more than the national increase recommended by the AAMC and the American Medical Association (AMA). In addition to the basic shortage problem, we also have a maldistribution problem. The rural areas in Texas remain substantially underserved.
The question then becomes, do we fund more Schools of Medicine or provide more GME's to increase the number of physicians? The argument for increasing funding to the Schools of Medicine supports the belief that if we increase enrollment now, we will increase the percentage of students that we are turning out into the field. An expansion of medical school loan repayment plans for students who provide care in public institutions or institutions whose patient population is more than 50 percent uninsured is an option that may serve a dual purpose - to increase the overall number of physicians and to increase the diversity of students that enter the medical profession. However, a stronger argument has been made that increasing the number of physicians cannot happen without an increase in residency training. The AMA states that "for a graduate of a Texas medical school who obtains a residency within the state,
the probability is 85 percent that the physician will practice in Texas." This
is substantial.
We also have seen that physicians who complete their residencies in underserved areas often stay and establish practices in those areas. Another factor that cannot be ignored is that the cost of education for residents is substantially lower than the cost of educating a medical student. Residents play a critical role in providing patient care and are a major source of highly qualified well-trained physicians, without which many of our hospitals could not function.
The Physician Workforce debate is ongoing; however, the "Code Red" report has clearly shown us that now is the time for us to band together and take the bold steps necessary to protect the health of our state. At UTHSCSA, we have increased class size this year by about 10 percent (from 200 to 220 students). Further, we are working to increase the number of residency slots in several areas. Our goal is to be responsive to the Texas physician shortage, and to be particularly responsive to the need for physicians in traditionally underserved areas.
Warm regards,
William L. Henrich, MD, MACP
Dean, School of Medicine; Vice Presi-dent for Medical Affairs; John P. Howe, III, MD Distinguished Chair in Health Policy
