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lic Health Committee, says the spotlight will shine on GME funding this session as a means of responding to the state’s growing primary care needs, particularly now that PPACA is likely here to stay. “Everyone wants a medical school in their backyard. My focus is going to be solely on GME and how we create resi- dency slots,” she said, adding that she supports an increased ratio of GME positions to in-state medical graduates. “We are very disappointed in the U.S. Congress freezing the number of Medicare [funded] residency slots, which is just unacceptable with Texas growing at the rate it is. I expect nothing from the federal government, so we will have to be creative, and we’re going to need doctors’ help to get creative,” she said. Senator Nelson added that medical education debt is a

barrier to growing the primary care workforce that requires attention. “Medical school graduates often leave school with more than $100,000 in debt. It is not surprising they choose more lucrative specialties over primary care. We need to make primary care a more appealing path for medical students.” TMA sees an opportunity this session to restore the state Physician Education Loan Repayment Program and is aiming for 2009 funding levels.

Despite all the penny-pinching, a push by Republican bud-

get hawks to ensure dedicated funds go where they are sup- posed to — instead of being diverted to cover other gaps like they were last session — could mean loan repayment monies are used as intended. The House Interim Committee on Gen- eral Revenue Dedicated Accounts met in November to discuss ways to maximize such funds. “I’m looking for any way to increase [the number of] pri-

mary care doctors,” Rep. John C. Otto (R-Dayton) said. THECB Assistant Commissioner Dan Weaver testified at the November hearing that the loan repayment program was intended to encourage physicians to practice in underserved areas by offering up to $160,000 in loan assistance to those who practice in federally designated shortage areas and accept Medicaid and CHIP patients. The program “was very effective and worked exactly as intended,” until it was stopped, Mr. Weaver said. “These are four-year awards, so consistency in funding is very important.

24 TEXAS MEDICINE January 2013

We are asking physicians to make a commitment. At the same time, we need the legislature to make the same commitment.” Austin family physician David

P. Wright, MD, chair of TMA’s Council on Medical Education, testified on behalf of TMA and the Texas Academy of Family Physicians (TAFP). He said the loan repayment program has helped nearly 200 doctors over- come the indebtedness that often poses an obstacle to setting up a practice in rural communities.

“This is probably our best recruitment tool, and if we can get this funded again, TMA is confident we can get even more primary care physicians into rural places,” Dr. Wright said. He says TMA supports suggestions to use money dedicated to trauma services to fund enhanced emergency medical train- ing for primary care doctors.


TMA also hopes to capitalize on the legislature’s interest in budget transparency to ensure fees the Texas Medical Board (TMB) collects stay within the agency. The resources could provide extra ammunition against an- ticipated attacks by forces looking to weaken TMB’s ability to appropriately discipline bad doctors. Especially susceptible is a TMB reform TMA won in 2011 that prohibits anonymous complaints against doctors. And a weaker medical board could open the door for lawsuit-happy lawyers to erode hard-won 2003 medical liability protections for physicians. The association also expects to play defense on recurring issues that crop up every legislative session, including end-of- life care, scope-of-practice expansions by nurse practitioners and other allied health professionals, and attempts to under- mine doctors’ independent clinical judgment in hospital em- ployment situations. Trial lawyers and right-to-life groups likely will try to chip away at state liability protections by challenging immunities granted to physicians and hospitals in end-of-life care, Dr. Se- crest says. TMA, through its workgroup on end-of-life issues and in

collaboration with a coalition of the Texas Catholic Confer- ence, the Alliance for Life, and the Texas Hospital Association, will work to protect physicians’ ability to do what’s best for patients in their final days. This includes their ability to write

“do-not resuscitate” (DNR) orders or withdraw care when it would be futile, while balancing the rights of terminally ill patients and their families to be involved in such treatment decisions. Dr. Secrest says legislative attempts to require a patient’s family to first consent to a DNR order when additional care is unwarranted could mean undue suffering for the patient and

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