Capitol Update: House committee hears testimony on IMG licensure bill

posted 03.10.11

The House Committee on Public Health heard testimony Wednesday, March 9, on a measure that would allow international medical graduates to receive a medical license after two years of graduate medical education instead of three. House Bill 1380 by Rep. Vicki Truitt, R-Keller, is intended to help IMGs become eligible for board certification earlier than the current process allows.

“This bill would require IMGs to complete two years of residency training to obtain medical licensure,” Truitt said at the hearing. “This change will make it easier for IMGs to live and work in Texas. It will also improve Texans’ access to health care by helping to relieve our physician shortage.”

Under current law, IMGs must complete three years of residency training before obtaining a Texas medical license. Graduates of U.S. medical schools are required to complete one year of residency training before they are allowed to obtain a Texas medical license. While this law is in place to ensure all licensed doctors provide patients with the highest-quality care, a “praise-worthy objective,” she said, studies show that different requirements for IMGs are unnecessary and create unintended negative consequences.

Testifying in support of the bill, Rodney Young, M.D., chair of the Department of Family Medicine at the Texas Tech University Health Science Center School of Medicine in Amarillo, explained some of these consequences to committee members. He has more than 10 years of experience training family doctors and during his tenure has graduated approximately 60 practice-ready physicians.

“One impediment I want you to understand is that in order to apply for and take the certifying examination in family medicine and many other medical specialties, you have to hold an unrestricted state medical license. So these physicians who are in Texas and are training in Texas are not eligible to meet the application deadline for their board certification exams, so they’re required to get licenses in other places even though they hopefully don’ t have any intention of practicing there.”

Young said that out 30 graduates in the past five years, 20 had to get licenses in other states, and of those 20, eight departed Texas and practiced in the states where they have their license, where they continue to practice to this day.

“Eight out of 30 is a pretty significant brain drain, particularly because these are physicians who in part have been funded through support by the Texas Education Coordinating Board, so the state of Texas has dollars invested in these individuals even though it wasn’t at the undergraduate medical education level.”

A more recent example is his soon-to-be chief resident, an IMG who wants to practice family medicine in rural Texas. “He has advised me that it is not financially possible for him to wait around for 4-6 months to be able to get through the licensure and credentialing process and become financially viable in private practice in a rural area in Texas,” Young said. “His stated words for me were ‘if this bill passes I will stay and practice family medicine in rural Texas; if it doesn’t, I will leave the state. I don’t have any choice.’”

TAFP recently released an issue brief, “Keep Texas-trained International Medical Graduates Practicing in Texas,” that explains the full issue. Go to www.tafp.org/advocacy/resources to access it, and stay tuned as we follow this issue.

Family doctors gather to advocate for specialty

Report from TAFP’s Legislative Action Day

TAFP member family physicians and general internal medicine physicians from the Texas Chapter of the American College of Physicians gathered in Austin today for TAFP’s inaugural Legislative Action Day. Attendees, representing all areas of Texas, received a legislative briefing from TAFP’s lobby team before heading to the Capitol to meet with their legislators and advance issues important to the specialty.

TAFP CEO Tom Banning and lobbyists Marshall Kenderdine, Dan Hinkle, and Jerry Philips opened the meeting, presenting the top issues for primary care and how the first 60 days of the session had been.

“I feel that now, more than ever before, family medicine is well-positioned to make major gains during the legislative session,” Banning said. “This is because of the work we’ve done in past sessions to educate lawmakers on the value of primary care, and to put in place programs to build the primary care workforce.”

Armed with TAFP’s issue briefs, the physicians left the briefing ready to speak to their legislators. Access these issue briefs on the Advocacy Resources page of TAFP’s website, www.tafp.org/advocacy/resources.

TAFP CEO testifies on health care financing

In testimony before the House Committee on County Affairs in a hearing on Wednesday, March 8, TAFP CEO Tom Banning told legislators that the state must find a new way to pay for health care.

He used the visual of a balloon. “When you look at the continuum of health care—from county indigent health care, Medicaid, Medicare, and CHIP to private insurance and the uninsured—they’re all inescapably linked together. And when you squeeze on one area of that funding, you’re going to manifest that cost in another area of the balloon, or in this case, health care financing.”

Senate bills 7 and 8, as well as others in House and at the agency level, propose to change the way the state finances health care. These solutions hold great potential.

“It’s moving us away from a truly fractured delivery system of care to more of a clinically integrated delivery system where you align incentives, where you align payments for outcomes, for quality to ultimately reduce costs,” Banning said.

“From a physician standpoint, Medicaid is absolutely critical to the safety net, as is CHIP. We want to participate in the Medicaid program, we want to participate in the CHIP program. Unfortunately, the way we pay for Medicaid and CHIP services makes it very difficult for physicians to participate as business owners. Their cost for running a practice is increased while private reimbursement rates have declined, Medicare has remained flat, and Medicaid has remained flat as well.”

Watch for more coverage of reforms to health care financing as the session progresses.

Senate and House committees approve smoking ban

The Senate Health and Human Services Committee on Tuesday and the House Public Health Committee approved on Wednesday both approved a measure that would ban smoking in public places in Texas, including bars and restaurants. The bills—Senate Bill 355 by Sen. Rodney Ellis, D-Houston, and House Bill 670 by Rep. Myra Crownover, D-Denton—now go to their respective bodies of the legislature for consideration.

Supporters of the measure have been trying to pass a smoking ban for several sessions to reduce the amount of exposure the general public, and especially restaurant and bars workers, to second-hand smoke that causes lung cancer, heart disease, and other chronic diseases. Opponents say the bill violates the private property rights of business owners and could hurt local businesses. The bill exempts cigar bars and tobacco shops from the ban.

TAFP, along with the Texas Medical Association and 26 other organizations, is a member of the Texas Public Health Coalition. TPHC supports the bills. Read more about the coalition and its priorities at www.texmed.org/publichealthcoalition and browse tobacco cessation resources at www.texmed.org/Template.aspx?id=7249.

Also, read an article published Tuesday, March 8 in the Dallas Morning News about this and other public health bills (subscribers only): “Health bills in Texas Legislature invoke ‘nanny state’ concerns.”

Thanks to the Physicians of the Day; volunteers still needed

Thanks to the physicians who volunteered for the Physician of the Day program this week: N. Christopher Lawrence, M.D., of McKinney; David Armbruster, M.D., of Pearland; Thomas Cherry, M.D., of Chandler; and I. L. Balkcom IV, M.D., of Sulpher Springs.

The Physician of the Day program brings a family physician to the Capitol each day of the legislative session to provide health care to members of the Capitol community. Dates are still available in April and May. For more information on how to sign up and to view the calendar of open dates, go to the Physician of the Day page of the TAFP website.