The following op-ed appeared in a recent issue of the Houston Chronicle. It was authored by Nancy W. Dickey, M.D., president of the Texas A&M Health Science Center and vice chancellor for health affairs for The Texas A&M University System, and Giuseppe N. Colasurdo, M.D., president ad interim of The University of Texas Health Science Center at Houston and dean of The University of Texas Medical School at Houston.
There is much to agree with in Bill Hammond’s recent op-ed, “Texas faces critical shortage of primary-care providers” (Dec. 19, 2011). Our state does indeed face a shortage of physicians, most significantly those who specialize in primary care. The Association of American Medical Colleges (AAMC) recently noted that Texas ranks an alarming 46th in the number of active physicians per 100,000 population. It ranks an even worse 48th in the number of active primary care physicians per 100,000 population.
We must find solutions to address this challenge. Though we concur with many of Hammond’s recommendations—particularly the need to expand our residency programs and to better integrate nurse practitioners into our primary care delivery system—we disagree with his assertion that “(w)e should reduce the number of slots at (Texas’ public) medical schools.” This prescription would exacerbate an already serious problem.
Most physicians spend their careers practicing medicine in the communities where they receive training. Reducing the number of medical school slots would actually force aspiring physicians to leave Texas for their training and might well cause us to lose them from the state’s health professions roster forever. It would also penalize the many qualified Texans seeking admission to our schools.
While Hammond states “that doctors are being forced to leave the state to complete their residency training,” Texas actually approaches “equilibrium” in terms of the number of medical students who graduate each spring and the number of first-year residency slots to be filled each summer. So, while some graduates from Texas’ great medical schools seek residency positions in other states, out-of-state graduates are simultaneously moving to Texas to join our many fine programs.
It’s a dynamic, valuable “market” that allows students and programs to find appropriate residency matches. In order to capitalize on this market and allow Texas’ training programs to recruit highly qualified Texans and also the “best of the best” from outside the state, we need to increase from this equilibrium to an excess of first-year residency slots compared to graduating medical students.
Texas’ statistics go from dismal to dazzling when it comes to retention of our graduates and trainees. We rank second in the nation in retention of our medical school graduates; fifth in retention of those physicians who completed their residencies in the state; and third in retention of physicians who completed both their medical school and residency training in state.
Given these data, why is Texas facing a shortage of physicians at all?
The crux of the issue is that Texas is one of the nation’s largest and fastest-growing states. Our population has grown by more than 21 percent since 2000—twice the nation’s population rate. Medical training programs have simply failed to keep pace with population growth.
Given Texas’ exemplary retention rates, we need more medical school graduates and residency trainees to address our physician shortage. And in order to do that, there needs to be a comprehensive review and redistribution of federal funding for residency programs in Texas.
Texas medical schools are tremendous assets. We have highly talented and diverse student populations and offer some of the lowest tuition costs in the country. Collectively, our medical schools constitute a multi-billion dollar research enterprise, which improves the health of Texans and serves as an important economic driver. And we provide essential clinical care—including highly specialized, innovative treatments only available through academic medicine.
Population growth is our biggest challenge to meeting the healthcare needs of Texas. While we are doing an exceptional job of retaining the physicians that we train, we are still 46th in the country in the number of active physicians per 100,000 population.
Texas shouldn’t be 46th in anything.
Giuseppe N. Colasurdo, M.D.
President ad interim, The University of Texas Health Science Center at Houston and Dean, The University of Texas Medical School at Houston
Nancy Dickey, M.D.
President, Texas A&M Health Science Center and Vice Chancellor for Health Affairs, The Texas A&M University System