Improving the Primary Care Workforce in Texas

Primary care is the key to better health outcomes and lower health care spending, but many Texans don’t have a primary care physician to care for them. For years, health care policymakers have warned of an impending shortage of primary care physicians. Without access to primary care, patients delay treatment, leading to more severe health problems, or they seek care in expensive and overcrowded emergency rooms. It’s a crisis of quality and cost that not only affects the health of Texans, it affects the health of our economy.

The most effective way to get more primary care physicians like family doctors practicing in our communities is to train them right here in Texas. For decades, the Texas Legislature has recognized the importance of increasing and supporting the state’s health care workforce, and through investments in medical schools, programs to help fund medical residency training, physician education loan repayment programs, and other initiatives, Texas has become renowned for excellence in medical education.

But today, other states reap the rewards of our investment, while Texans struggle to find a medical home. While enrollment in Texas medical schools has increased by 31 percent since 2002, the number of first-year residency training positions has not kept pace. According to a 2012 report by the Texas Higher Education Coordinating Board, by 2016, Texas will produce 180 more medical school graduates than the amount of first-year residency positions available. Texas invests $168,000 in each medical school graduate, so when those graduating medical students leave to find training programs, Texas will lose an investment of more than $30 million.

“The state’s already invested in their medical education, they want to get trained. If they can’t find the opportunity here they will go somewhere else to another state. And what we also know is they will stay. They are not likely to come back,” said TAFP President Troy Fiesinger, M.D.

Our need for more primary care physicians and primary care residencies becomes more acute as our population grows, but last session the Legislature slashed funding for graduate medical education by 44 percent, reserving the most drastic cuts for programs designed to recruit and train primary care physicians.

Altogether, cuts to primary care residency programs, the Physician Education Loan Repayment Program, and the elimination of the Statewide Primary Care Preceptorship Program constitute a withdrawal of 80 percent of the state’s investment in building its primary care workforce. 

“The Legislature had to make some difficult choices last session, and I know those didn’t come easily, but if we’re going to be able to prepare the next generation of physicians for the state of Texas we have to come back and rebuild a support for our education programs,” said Lewis Foxhall, M.D., vice president of health policy for the University of Texas MD Anderson Cancer Center. “This is an important investment for the state of Texas.”

The Texas Legislature can lay the foundation for innovation and improvement in our health care delivery system by reinvesting in our primary care workforce. First, create incentives for medical schools to produce the primary care physician workforce Texas needs. Next, recruit primary care physicians to practice in underserved communities by recommitting to the promise of physician education loan repayment. Finally, restore funding to primary care residency training programs.

“The Legislature can decide to act now, invest money in training more physicians so that there will be physicians to take care of those people, or it can choose not to,” Fiesinger said. “But if it chooses not to, it sets the state up for a worse crisis that puts financial burdens on the cities, the counties, the state, all the taxpayers.”

TAFP has developed a bold set of initiatives to grow and improve Texas’ primary care physician workforce and to increase access to primary care services for all Texans. You can find these at www.tafp.org/Media/Default/Downloads/advocacy/83rd_recommendations.pdf. With a robust primary care physician workforce, we can ensure Texas patients will receive the right care at the right time for the right price.