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LEGISLATIVE
INTRODUCTION

KEEP OUR TEXAS

EDUCATED DOCTORS

IN TEXAS

By Jayesh B. Shah, MD

F or 2019, one of the key legislative agenda items for the ing for independent practice. Also, there is a lack of standardization

Texas Medical Association is ensuring that Texas has a
in the educational requirements for online programs for advanced
ratio of 1.1 entry-level residency positions for each
Physician shortages pose a real risk to patients. Some of this
Texas medical school graduate. practice registered nurses (APRNs).
shortage is creating an increased demand for mid-level providers
The United States is facing a serious shortage of but there is a lack of regulation over APRN online education. Also,
physicians mainly due to a growing, aging population. online education for APRNs has become extremely popular. Texas
A 2018 study conducted by IHS Markit, Ltd. for the As- Medical Association is monitoring the lack of regulation over
sociation of American Medical Colleges (AAMC) pre- APRN education. It would be a good idea for standardization in
dicts that the U.S. will face a shortage of physicians APRN education just like medical school education. Medical school
ranging from 42,600 to 121,300 by 2030. clinical rotations and residency training are intensely organized to
provide a clear, definable, and objective set of experiences.
Medical schools have increased enrollment by nearly 30 percent
since 2002. There are new medical schools in the U.S. In the past The Solution:
three years, Texas added two new allopathic medical schools, The
Fixing the physician shortage requires a multi-pronged approach.
University of Texas at Austin Dell and The University of Texas Rio
Grande Valley in Harlingen, along with an osteopathic medical
1. There should be an innovative and better use of technology to
school at the University of the Incarnate Word in San Antonio. In
make more effective and efficient team-based care to improve ac-
addition, there are plans to build three more medical schools
cess to care.
through 2020 and talk of even more. While Texas has a ratio of
1.1 entry-level residency positions per medical school graduate now,
2. There should be additional federal support to generate about
it will be a challenge to maintain this ratio with the increasing num-
3,000 more physicians a year by at least a partial lifting of the cap
ber of medical school graduates on the horizon. In addition, the
on federally funded residency training positions.
1997 cap on Medicare support for graduate medical education
(GME) has served as a disincentive for growing residency training
3. There should be support for physician workforce development
at the same rate as medical schools.
programs like Conrad 30 J-1Visa Waiver Program, National
In the 2018 National Resident Matching Program, 1,078 U.S. al-
Health Service Corps (NHSC), Public Service Loan Forgiveness
lopathic medical students; 849 previous graduates of U.S. allopathic
(PSLF), and Title VII/VIII to recruit a diverse workforce to prac-
medical schools; 846 U.S. osteopathic school medical students/grad-
tice in underserved communities.
uates; 2,175 U.S. citizen students/graduates of international medical
schools; and 3,105 non-U.S. citizen students/graduates of interna-
4. There should be continued state support for the creation of new
tional medical schools did not match on the first day of Match
residency positions.
Week. Over 8,000 fourth-year medical students and physicians, with
more than 15,000 clinical hours of training each did not match on The Texas Legislature took a monumental step in 2015 by creat-
Match Day while mid-level providers with 700 clinical hours are ask- ing the state’s first permanent GME fund to expand the physician

16 San Antonio Medicine • February 2019