MEDICAL EDUCATION
Encouraging exports? GME cuts could send Texas graduates elsewhere BY KEN ORTOLON Texas medical schools are graduating re-
cord numbers of new physicians, but an increasing number of them likely will head out of state for residency training be- cause of huge cuts in graduate medical education (GME) fund- ing the legislature passed earlier this year. In its budget for 2012–13, the legislature slashed formula funding for residency slots by 33 percent and cut funding for a family practice residency program run by the Texas Higher Education Coordinating Board (THECB) by 75 percent. Law- makers eliminated funding for anoth- er primary care residency program THECB operates and all money for a primary care preceptorship program. State officials and residency pro-
gram directors say the cuts almost certainly will abolish some residen- cy slots, particularly in the primary care specialties. And some residency programs that relied heavily on the THECB funding may close. “When you don’t have the money to support those residents, we may well see residency programs reducing the number of residents they support or shutting their doors,” said Stacey Silverman, PhD, senior director for academic research and grant pro- grams in THECB’s Academic Affairs and Research Division. Some medical educators say the decision to cut GME fund- ing at a time when Texas needs to be training and retaining more doctors is shortsighted.
“The case will be made that they were penny-wise and
pound-foolish — or whatever other adage you want to use — by cutting this type of training funds when what they re- ally need is to be expanding them,” said Roland Goertz, MD, president of the McLennan County Medical Education and Re- search Foundation and chair of the THECB Family Medicine Residency Program Advisory Committee. “We’re spending so much money on medical students who now have no place to stay in the state and end up having to leave.”
Cutting to the bone
“We’re just going to try to be
smarter in how we manage our resources.”
While higher education funding saw significant cuts across the board, GME was hit particularly hard. The legislature cut for- mula funding to state health-related institutions that support GME faculty costs and development of new GME positions from $6,653 per resident per year to $4,436. That’s a reduc- tion of $25 million for 2012–13. Funding for the THECB’s Family Practice Residency Pro- gram was cut from $21.2 million for fiscal years 2010 and 2011 to $5.6 million for the next two years. The board’s $4.99 million Prima-
ry Care Residency Program saw its funding wiped out and the Gradu- ate Medical Education Program and State Preceptorship Program also were zeroed out, losing $600,000 and $904,289, respectively. And, the Joint Admission Medi-
cal Program (JAMP), which encour- ages disadvantaged students to go to medical school, was cut from $10.6 million to $7 million. Dr. Silverman says the Family Practice Residency Program funds 29 nationally accredited family medi- cine residency programs across the
state. Under the current budget, those programs get roughly $13,000 per resident. Under the 2012–13 budget, that will be cut to about $3,900, she says. The Primary Care Residency Program supports 23 of 41 pri-
mary care residency programs in the state, including programs in internal medicine, pediatrics, and obstetrics/gynecology. Those programs now will receive no state funding. Dr. Silverman says the Graduate Medical Education Pro- gram, which also was eliminated, provided supplemental fund- ing for 15 independent primary care residency programs that are not affiliated with state medical schools and, therefore, do not receive GME formula funding. “Most of those programs also received funding under either the primary care or family practice residency programs,” she
September 2011 TEXAS MEDICINE 45
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