executive officer of Baylor College of Medicine; Kenneth I. Shine, MD, execu- tive vice chancellor for health affairs for The University of Texas System; T. Sam- uel Shomaker, MD, JD, dean of medicine and vice president for clinical affairs at Texas A&M University Health Science Center; and Steven L. Berk, MD, dean of the school of medicine and executive vice president and provost at Texas Tech University Health Sciences Center. An additional concern, Dr. Peska says, is that Texas medical schools are at- tempting to comply with an Association of American Medical Colleges recom- mendation that U.S. medical schools in- crease enrollment by 30 percent by 2015. Texas schools have increased enroll- ment significantly over the past few years which, in turn, has strained the state’s teaching hospitals’ ability to ac- commodate any additional third- and fourth-year students.
“In so doing, we have saturated all of the currently developed teaching sites for third- and fourth-year students,” Dr. Peska said.
What’s more, Texas needs roughly
200 more training slots within the next three years as new medical students progress into their third and fourth years. Plus, at least three new medical schools are proposed for Texas, including one in South Texas that has considerable sup- port in the legislature. “If even two of the three medical schools that are on the drawing board come into fruition over the next couple of years, then by 2020 we could see another 400 to 600 students who need these resources,” Dr. Peska said. “And we haven’t yet developed all the hospitals and training sites we need to accommo- date our own students.”
Training slot squeeze Dr. Wright says Texas must preserve its clinical clerkship slots for Texas medical students. “The third- and fourth-year rotations
are probably the most critical aspect of a medical student’s education,” he said. While the first two years focus on the ba- sic sciences, students really get exposure to clinical medicine during their third and fourth years, he says.
But finding opportunities for more medical students is growing increasingly difficult in an era when major teaching hospitals are downsizing, and the trend is to move patient care out of the inpa- tient setting and into physician offices and outpatient clinics. “What has happened is the mega teaching hospitals, for all kinds of dif- ferent reasons, have had to downsize. So the capacity and the bed space have gone down. Therefore, that has some ef- fect on the ability to slot students into these particular rotations,” he said. “A perfect example is what takes place here in Austin, where UTMB sends a num- ber of its students here in the third and fourth years. It has to do with the fact that they cannot place all of their stu- dents into these critical rotations, either at the teaching hospital in Galveston or in the teaching hospitals that they use in South Houston.” Drs. Peska and Wright say competi-
tion from offshore medical schools for available training slots could jeopardize training for Texas students with no ben- efit to the state of Texas. “… as we struggle to address the phy- sician shortages in our state, we have no assurances that these students from off- shore schools who would train in Texas hospitals and take up valuable clinical training space are committed in any way to providing care for our citizens,” the medical school officials wrote Commis- sioner Paredes. “There is no data to sup- port that medical students from offshore schools who complete any training in Texas will establish their practices here.”
Getting a second opinion Despite objections from the medical schools and TMA, it appeared the Coor- dinating Board might approve the AUC request. However, the board chose to delay action after House Speaker Joe Strauss (R-San Antonio), state Rep. John Zerwas, MD (R-Richmond), and state Sens. Judith Zaffirini (D-Laredo) and Robert Duncan (R-Lubbock) all wrote letters voicing opposition. In a letter to THECB Chair Fred Hel- denfels, Speaker Strauss urged the Coor- dinating Board to delay action. “Because the proposal could have
consequences that extend far beyond the immediate decision and could im- pact the ongoing investment made by the Texas Legislature for the expansion of our own state medical schools to pro- duce enough in-state physicians to meet the needs of our growing population, I respectfully request that you postpone action on this proposal in order to allow the Texas Legislature to consider the is- sue in the broader context of our state’s medical schools and overall health care system and workforce,” he wrote. In separate letters to Mr. Heldenfels, Senator Zaffirini, who chairs the Senate Higher Education Committee, and Sen- ator Duncan, chair of the Senate State Affairs Committee, argued approving the AUC request would open the door to other foreign medical schools to com- pete for training slots in Texas and ques- tioned the board’s authority to approve the request. “There are also legal and statutory questions revolving around the board’s authority regarding certificates of au- thority for professional programs,” Sen- ator Duncan wrote. “These questions need to be addressed and resolved by the legislature prior to any further ac- tion on this matter.” In addition, the Coordinating Board
also asked its staff to study the state’s clerkship capacity and the extent to which it could accommodate students from foreign institutions.
UT proceeds with Austin, South Texas medical schools
Medical schools in Austin and South Texas moved closer to reality May 3 when The University of Texas System Board of Regents authorized Chancel- lor Francisco Cigarroa, MD, to go ahead with plans to establish medical schools in Austin and South Texas. The regents pledged about $25 mil-
lion a year toward operating costs, but it is contingent upon local governments,
June 2012 TEXAS MEDICINE 51
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