Out here in the Permian Basin, seeing a doctor when you’re sick is becoming more difficult. We have always had a shortage of primary care physicians, but this is different. The latest oil boom is great for business in West Texas, but it comes with a population boom that threatens to wreck our struggling primary care infrastructure. If we’re going keep up, we must find ways to attract more primary care physicians to our part of the state.
This problem isn’t unique to us. Texas ranks 47th among states in the ratio of primary care physicians to total population, with rural and border areas suffering much greater shortages than their metropolitan counterparts. And it’s not likely to improve any time soon. A recent report from the Texas Department of State Health Services estimates “the shortage of primary care physicians in Texas will grow from 2,002 full-time equivalents in 2017 to 3,375 in 2030, an increase of 67 percent.”
The Texas Legislature has three simple policy options available that will result in more primary care physicians caring for patients in rural communities: restoring support for family medicine residency programs, creating more rural medicine training opportunities, and boosting our investment in the Physician Education Loan Repayment Program.
Our state’s 33 family medicine residency programs are the lifeblood of our primary care physician workforce, preparing more than 300 new family physicians for practice each year. Most family doctors who complete their residency training in Texas remain in the state to practice.
The Legislature has long recognized the importance of investing in our state’s family medicine residency programs through a funding strategy aptly named the “Family Practice Residency Program.” Because of this budgetary line item, most family medicine residencies receive funds based on the number of residents they have in training.
Last session, legislators cut the program by 40 percent. Restoring that funding would cost the state only $10 million a year, but the investment would protect the residency programs that produce the doctors who make up our primary care infrastructure.
So how do we get these new physicians to practice in rural areas? We train them there. At Texas Tech University Health Science Center, I oversee a relatively new rural training track in which family medicine residents spend one year training in Odessa, then two years living and working in one of a number of rural sites in the Permian Basin.
Four of the program’s five graduates now practice in rural Texas towns and two future graduates have already signed contracts with rural hospitals.
Rep. Trent Ashby, R-Lufkin, and Sen. Lois Kolkhorst, R-Brenham, are currently carrying bills in the Legislature that would create a Rural Resident Physician Grant Program designed to help launch rural residency training tracks like ours. HB 1065 and SB 1084 contain smart policy targeted to improve access in areas that need it most by introducing a generation of new physicians to life and medicine in rural Texas.
Finally, the Texas Physician Education Loan Repayment Program is designed to encourage physicians to practice in underserved communities by helping them pay their student loans in return for a four-year commitment. In the past five years, the program has enrolled more than 750 physicians who are now caring for patients in rural communities, urban centers, community health centers, and correctional facilities – all places where Texans suffer a lack of access to care.
Last session the Legislature cut this program by 25 percent.
This time around, legislators should restore that funding and strengthen the program by increasing the amount participating physicians can receive to reflect the growth in educational debt.
According to the Association of American Medical Colleges, 76 percent of medical students graduate with debt. In 2011, the average educational debt for graduating medical students was $173,000. By 2016, it had grown to $190,000.
HB 2261 by Rep. Armando Walle, D-Houston, and Rep. Matt Schaefer, R-Tyler, and SB 998 by Sen. Juan “Chuy” Hinojosa, D-McAllen, would raise the total amount of available loan assistance for doctors in the program from $160,000 to $180,000, sweetening the deal for physicians to begin their careers where we need them most.
As our population grows and ages, we must ensure that all Texans have access to high-quality primary care, and the most effective way to meet that goal is to recruit and train family physicians here at home. These three measures not only increase our primary care workforce, but they work to encourage new physicians to live and practice in underserved communities. That’s good public policy.
Timothy Benton, MD, is the regional chair of the Department of Family and Community Medicine and associate dean for clinical affairs at the Texas Tech University Health Science Center – Permian Basin School of Medicine, and medical director for the Physician Assistant program at TTUHSC School of Health Professions.
