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“The goal of any GME program in Texas, regardless of whether it is AOA- or ACGME-accredited, is for the money we put into medical education to be used to take care of patients in Texas.”

Winners and losers? Still, Dr. Gates anticipates at least some future costs with the change. His South Texas program has strong ties to TCOM and its OPTI, and an af- filiation with a hospital system, HCA Healthcare, whereas not all osteopathic programs are as fortunate. If they lack a strong academic spon-

sor, for example, “some rural programs may have issues with the research re- quirement. And our hospital has already allowed us to have some paid faculty positions, both full- and part-time,” Dr. Gates said. “At this time, I do not see our program’s viability being threatened. I would anticipate there will be needed changes, but our administrative team has always been willing to support any new requirement.” If a training program were to close,

Fortunately for the school, whose fam- ily medicine residency program was du- ally accredited until last June, Dr. Cook is board certified in both allopathic and osteopathic family medicine. Such savings could go towards pro- gram improvements that directors might have delayed for lack of resources, and because many dually accredited residen- cy programs focus on family medicine, a streamlined system could provide an ad- ditional boost to primary care training, as well. For Texas DO graduates in particu-

lar, the move also would help open up the pool of residency slots to those who might otherwise leave the state because there were too few osteopathic positions to go around, particularly in specialties, Dr. Cook says. “Once residents leave Texas to get training, they are gone. Maybe 50 per- cent return, but most stay within a 50- to 75-mile radius of where they train,” he said. “The goal of any GME program in Texas, regardless of whether it is AOA or

46 TEXAS MEDICINE January 2013

ACGME-accredited, is for the money we put into medical education to be used to take care of patients in Texas. This [merger] is good for Texas because it means any graduate of a GME program in Texas can more easily stay in Texas.” A unified system also could help

eliminate the administrative hassles that often keep DOs who train in allopathic programs from returning to osteopathic medicine, he says. At the same time, because some other

states exclusively designate certain resi- dency positions to osteopathic training, some of those slots remain vacant — of- ten those in primary care — due to fac- tors like geographic distribution, a com- plicated and competitive match system, and specialty preferences.

“One of our goals is that with all of these programs meeting the same stan- dards, they would be optimally filled, which would give us some more capac- ity,” Dr. Nasca said. “One potential sce- nario is that primary care educational capacity is slightly expanded.”

however, that would put those residen- cy slots in jeopardy at a time when the number of medical school graduates is on track to exceed the number of GME training positions, medical education leaders say. The problem is even more acute in Texas, where strong population growth has made it difficult to grow the physician supply. Twice in recent years, CMS used a mechanism to redistribute unused, fed- erally funded residency slots based on factors related to geography and special- ty mix. The positions within the region were placed in a federal pool for the gov- ernment to redistribute out of state. “All of that is subject to federal budget constraints,” Dr. Nash said. Texas suffered under the last federal distribution of unused Medicare-funded GME positions in August 2011, losing rather than gaining positions, despite the population growth. The state lost direct funding for 50 GME positions and indirect funding for 40 slots from 21 hospitals, according to Texas Medical Association data. The Patient Protection and Affordable Care act required CMS to reduce unused residency slots by 65 per- cent and redistribute them according to certain criteria. Texas did not qualify to receive any redistributed slots. Nobody wants to see programs close,

the ACGME’s Dr. Nasca and the AOA’s Dr. Buser both say. Both organizations

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