“Physician shortages will worsen if we don’t increase GME training slots, and Texas already has a physician shortage.”


imposed a limit on the number of resi- dency positions the Medicare program will fund, explained AAMC Director of Hospital and GME Payment Policies Lori Mihalich-Levin. Congress did not, however, prohibit hospitals that were not training residents as of 1996 from becoming new teaching hospitals reim- bursed by Medicare. A new teaching hos- pital may also establish a resident cap. “Congress has no desire to pay ad- ditional money for anything right now, and GME is no exception,” Ms. Mihalich- Levin said, applauding Texas’ attempt to do something about it.


ganized a forum of state and national experts to educate and share resources with hospitals that are new to the con- cept and likely need academic partners to get residency programs off the ground. View the presentations at www.texmed .org/gmeForum.


GME bottleneck


The confluence of health care reform and an exponential growth in the Texas population makes feeding the physician pipeline more critical than ever. Based on the current trajectory of medical school enrollments, however, “if every graduate wanted to stay in Texas, the state could not accommodate them,” TMA Council on Medical Education Chair David Wright, MD, said. That’s largely because Texas medi- cal schools already have met the Asso- ciation of American Medical Colleges’ (AAMC’s) goal of increasing enrollments 30 percent by 2015, and the number of active residents and fellows has grown 15 percent since 2000. But the number of available residency slots lags, while Texas still ranks near the bottom at 43rd in the state ranking of patient care physi- cians per 100,000 population. “Physician shortages will worsen if we


don’t increase GME training slots, and Texas already has a physician shortage,”


38 TEXAS MEDICINE November 2013


said Susan Cox, MD, regional dean for the UT Southwestern Medical Center in Austin.


Lawmakers heard that message. Senate Finance Chair Tommy Wil-


liams (R-The Woodlands) says the short- fall in GME slots forces many Texas medical graduates to leave the state and not return. “When that happens, we lose the four-year investment we make in medical students,” which costs at least $170,000 per student, according to TMA data. For the first time, Senator Williams says, the legislature provided seed mon- ey to encourage hospitals to become teaching grounds for new residents, rec- ognizing that it can take years. Once hospitals achieve that status, they can leverage additional Medicare dollars to continue the residency programs in hopes of retaining homegrown medical school graduates and ultimately address- ing growing physician shortages. The approach, first proposed by The University of Texas System and backed by TMA, helps overcome certain hurdles within federal rules for GME funding. TMA’s forum sought to help nonteach- ing hospitals understand Medicare GME funding rules so they could become eli- gible for those additional dollars. To contain costs, Congress in 1997


Starting from scratch The planning grants are meant to help hospitals and other eligible entities de- termine the feasibility of establishing a GME program. They will examine finan- cial viability and availability of teaching faculty, for example, to determine the type of residency program that could be offered based on Accreditation Council for Graduate Medical Education (AC- GME) or American Osteopathic Associa- tion (AOA) standards. Because starting from scratch is


not easy, the extra money will come in handy, Dr. Coultas says, adding that the effort is worthwhile.


The pulmonologist and vice president for clinical and academic affairs at UT Health Northeast, the clinical arm of UT Health Science Center at Tyler, helped launch an internal medicine residency training program with Good Shepherd Medical Center in Longview in 2012. By opening up 18 residency slots, the program helps fill an important need in the rural and largely underserved area with a high Medicaid population and a growing number of retirees. It received more than 1,000 applications for those residency positions, “so there is a huge demand out there among Texas gradu- ates, too,” Dr. Coultas said. An internal medicine residency pro- gram can cost between $100,000 and $130,000 per resident per year, and sus- taining program costs is a valid concern, UT representatives acknowledge. But the programs aren’t meant to be money- makers, and with Medicare funding, the Good Shepherd program breaks even.


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