On Sept. 22 the chancellors of the six public university systems in Texas took the stage at the Texas Tribune Ideas Festival for a panel discussion called “Chancellor Confedential.” The chancellors fielded audience questions about tight budgets, school culture and community outreach, but the most difficult question came from a white-coated Baylor Medical School student. The unnamed student asked UT System Chancellor Francisco Cigarroa, “Why vow to build more medical schools when Texas lacks adequate graduate medical education?” The student had a point: Texas needs more medical schools, but more medical schools will not fix the physician shortage in Texas. To do that, we need more medical residencies, too.
Earlier this year, the Texas Higher Education Coordinating Board issued the “Graduate Medical Education Report,” which said that between fall of 2002 and fall of 2011, medical schools in the state of Texas had increased their enrollment by 31 percent. Unfortunately, residency programs had not kept pace. The report estimated that by 2014, 63 graduates of Texas medical schools will not be able to find residencies in Texas. By 2016, this number will triple to at least 180.
Why is the lack of Texas residencies a problem? At first glance, it’s not. Working in a different place — often under different socioeconomic or cultural conditions — than where one went to medical school can give a doctor a valuable change of scenery and experience. But, when you consider that doctors generally stay and practice medicine in the region where they complete their residency, the problem becomes clear: Texas invests $42,000 annually in each of its medical students, which amounts to a total of $168,000 per student over the course of their education. The state pays $30.2 million in medical tuition every year. If a student at a Texas medical school can’t find a residency in Texas, then he or she must go elsewhere — to a neighboring state like Oklahoma. And if that Texas-educated medical student completes their residency in Oklahoma they are much more likely to stay there. Texas subsidizes medical students’ tuition so that we create doctors to serve our own state. But if Texas doesn’t create enough medical residencies, we end up using state funds to produce doctors for other states.
This May, when the UT System Board of Regents announced its intention to establish medical schools in both Austin and the Rio Grande Valley, the plans were roundly cheered. Austin has wanted a medical school for years; the Rio Grande Valley has needed one for even longer. The announcement stated that the Austin medical school was to be funded with $30 million from the available university funds — provided that UT-Austin can raise $35 million annually and maintain its partnership with Seton Health Care.
That partnership with Seton, a Central Texas health care provider, appears to solve the problem of residency slots in Austin. In 2009, Seton became officially affiliated with UT Southwestern, assuming sponsorship of all the residency programs in Austin. Since then, Seton has increased residency programs in the city and, by 2013 will have added six residency programs and approximately 30 residency spots. By 2017, they expect to raise that figure to about 70 residency spots.
The medical school in the Valley will begin as an extension of the Regional Health Center in Edinburgh, which itself is a state-funded extension of the UT San Antonio Health Science Center. In the upcoming legislative session, the Texas Legislature will need to promise to maintain and increase the current funding for the Regional Health Center if a medical school is to be established in the Valley. Though the UT System and regional congressmen will no doubt lobby hard for the funds, there’s no guarantee they will get them. And even if the Valley’s medical school is established, it has no Seton-like partner. Though the Regional Health Center currently has two residency programs, two is far from enough. Doctors educated in the Valley will likely be forced to leave the area after graduation, as they will be unable to find a local residency. The proposed medical school in the Valley, unlike its Austin counterpart, faces the dual challenge of securing state funding and locating elusive residency spots.
Hospitals have an incentive to establish residencies: though supporting a single resident for a year costs upwards of $150,000, residents provide cheap labor and later, when their residency is complete, often practice at the hospital where they were trained.
Is this enough incentive for the hospitals in the Valley to establish enough new residencies? It’s not yet clear. But when the Capitol legislators make their decision on increased funding for graduate medical education this spring, they should consider not what Austin already has (a stellar hospital system, a flagship university and a booming biotech industry) but what the Valley lacks — access to quality health care and a large pool of corporate hospitals with which to partner. As one Valley resident recently told me, the Valley has no Michael Dell. Which is why it falls to the state to fund it.
Wright is a biology and Plan II junior from San Antonio.