Penny Wise and Pound Foolish

Thursday, August 4, 2011 // Uncategorized

The only way health care reform can succeed is by increasing the number of primary care physicians.  the current impetus for budget cutting reduces the number of residency training programs and this includes general internal medicine residencies.

Residency program cuts could worsen Texas doctor shortage

Posted Saturday, Jul. 30, 2011

By Alex Branch

[email protected]


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‘ & –>The JPS Health Network and other Texas teaching hospitals are bracing for possible deep cuts in federal funding for doctor residency programs, a move some warn would exacerbate the state’s physician shortage.

Deficit reduction proposals call for cutting federal subsidies for graduate medical education by 20 to 60 percent. That’s a potential decrease of about $60 billion over 10 years.

In Texas, federal cuts would follow state funding reductions enacted during the 2011 legislative session. At JPS, state cuts will cost the public hospital almost $800,000, about an 18 percent drop.

Other hospitals had a 25 percent decrease, which could force medical centers to eliminate some training programs, said Dr. Gary Floyd, JPS chief medical officer and chairman of the Texas Medical Association’s Council on Legislation.

“After what the state has done, if the federal government comes in and hits us again with a 30 percent cut, then you’ve cut the funding in half to most centers,” Floyd said. “I think a lot of them would have to think twice about what programs they can and can’t continue.”

Contraction of residency programs is the last thing Texas needs given its shortage of physicians, according to the Association of American Medical Colleges. Texas ranks 42nd nationally in the prevalence of physicians, with about 158 doctors for every 100,000 residents.

Surveys show that 1 in 3 physicians will retire within 10 years, the association says. Meanwhile, about 32 million Americans are expected to gain coverage through healthcare reform, not to mention an influx of aging baby boomers.

“All we see is an increasing demand for more physicians,” said Christiane Mitchell, the association’s director of federal affairs. “To cut a program like this seems contradictory.”

Medicare subsidies

Proposed federal cuts would reduce funding for graduate medical training through smaller Medicare subsidies. Medicare is the main financial resource for medical residencies.

The funding serves two purposes, Mitchell said. One is to pay part of the costs of training a resident doctor because teaching hospitals treat many Medicare patients. The other is to fund a share of the unique services teaching hospitals provide, she said. Those services may include Level 1 trauma centers, burn centers, disaster preparedness and pediatric intensive care units.

“All of those really unique kind of services that, if teaching hospitals didn’t do them for the community, they wouldn’t be there,” Mitchell said. “So if we see reductions in support for both training physicians and providing special services, what we see is an access crisis.”

With deficit reduction plans seemingly changing daily, it is not certain that the cuts will wind up in the final budget deal. But if they do, Texas hospitals could lose about $150 million annually, she said.

Teaching hospitals account for only about 6 percent of hospitals nationally, she said. “Teaching hospitals are carrying the massive burden on these heathcare cuts,” Mitchell said.

JPS has 13 residency programs and 194 resident slots, including a new emergency department program. The largest program is family medicine, with about 85 residents.

The public hospital has not yet determined how it will handle the state’s cuts. Hospital officials will take it up with the board of managers as they finalize the 2011-12 budget, Floyd said. But the losses would likely have to be absorbed initially through the operations budget until the hospital “could get out and try to raise philanthropic funds.”

“It’s going to hurt,” Floyd said. “In these economic times, with our tax base still not stabilized, it is not a good time to be putting anything else into the operations budget.”

Reducing the number of residents the hospital trains would affect the community, he said. About three-quarters of resident doctors start a practice within 100 miles of where they train.

“If we train physicians they are more likely to stay in the state and that benefits the entire Metroplex community,” he said.

The cuts could also affect students graduating from Texas medical schools, including the Texas College of Osteopathic Medicine in Fort Worth. In May 2010, 1,404 students graduated from state medical schools, but Texas had just 1,390 spots for first-year residents.

By 2012, the gap is estimated to be closer to 100.

Stephen Shannon, president of the American Association of Colleges of Osteopathic Medicine, called the current number of residencies “insufficient” in a July 13 letter to President Barack Obama arguing against the cuts.

Nationwide, more than 19,000 students are enrolled in osteopathic medical schools, and many will pursue careers in primary care and practice in rural and underserved communities, Shannon wrote.

“It is very important to recognize that if we are to meet the challenges posed by aging population with high incidences of chronic diseases, we must increase, not decrease, physicians in training,” he said.

Alex Branch, 817-390-7689


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