Steven Lomax is worried about his chances of finding a hospital to complete his medical training when he graduates from the Temple campus of Texas A&M's medical school.
Lomax, 22, who expects to graduate in 2016, joined about 80 students from Texas medical schools who descended on the Capitol last week to urge legislators to increase funding for residencies at Texas hospitals, the last stage of physician training.
If the Legislature doesn't act, Lomax said, Texas could fail in its efforts to recruit more doctors to make up for a shortage and meet the demands of a growing population. "A medical degree has little value until you receive your formal training in residency," he said.
Texas medical schools are expanding to meet the growing need for doctors, but the Legislature last session slashed $25 million from money budgeted to help pay for residencies at Texas hospitals. The action exacerbated a problem that peaked nationally in 2010, when 30,543 medical students from the United States and abroad competed for 25,520 U.S. slots.
The growing shortage of residencies is forcing an increasing number of medical students to find a residency out of state, said Dr. Michael Speer, president of the Texas Medical Association, which had lobbied against the 2011 residency funding reduction. Since doctors tend to practice where they complete their residency, Texas will be educating more doctors to practice in other states if the trend continues, he said.
"We could have fewer doctors in Texas but be training more," he said.
Gap expected to widen
In Texas, the ratio of medical school graduates to residency slots is now about even, but the gap between graduates and in-state residencies is projected to widen over the next few years.
At least 63 graduates will be shut out of Texas residency programs next year and 180 by 2016 if the current trend continues, according to a legislative report. The availability of certain specialties at hospitals and the competition for favored specialties make finding a residency even harder.
"When you look at the actual number of people trying to get in those slots, it's more than one to one, it's really competitive," said Dr. Mary Branbt, associate dean at Baylor College of Medicine.
For example, about 54 percent of students found residencies outside Texas this year after graduating from the University of Texas Health Science Center School of Medicine in San Antonio.
"Close to 50 percent of us have to go out of state to receive our formal training," Lomax said. "A majority of us would like to be in Texas but we can't be."
Medical school enrollment nationally is up 20 percent but residencies are not keeping pace, said Atul Grover, chief public policy officer for the Association of American Medical Colleges.
Grover blamed the problem in part on a 1997 cap on Medicare payments for graduate medical education. The $9.5 million in Medicare money is based on the number of medical school graduates in 1996. Although there are other federal sources for graduate medical education, Medicare is the largest. Grover said an additional $1 billion would fund residencies for more than 2,000 graduates.
This year is the first year nationally and in Texas when the number of medical graduates is starting to exceed the number of hospital slots available.
Compounding the problem is an influx of more than 2,000 students each year from foreign medical schools, Grover said. Those foreign-educated students are competing for the same slots as U.S. graduates, said Dr. Lauree Thomas, associate dean for student affairs at the University of Texas Medical Branch.
Funding may increase
The Legislature in 2011 cut funding for graduate medical education from $79.09 million to $54 million. This year funding could be increased by
$51 million, said Rep. John Zerwas, R-Simonton.
Zerwas, a doctor, said the exact amount will be decided in a conference committee where members from the House and the Senate reconcile differences. A separate effort to tweak the formula for calculating the amount available for graduate medical education and make it more generous is also under way.
At least two new medical schools, one in Austin and one in South Texas, are in planning stages, Zerwas said. Without more funding, the new schools and expansion of existing schools will drive more Texas graduates outside the state, he said.
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