31 Days, 31 Ways: State Slashes Funding for Residency Programs

Throughout the month of August, The Texas Tribune is featuring 31 ways Texans' lives will change come Sept. 1, the date most bills passed by the Legislature — including the dramatically reduced budget — take effect. Check out our story calendar here. 

Day 22: Lawmakers slash funding for residency programs in Texas, making it even more difficult for the state to meet its growing physician shortage. 

The 2011 legislative session was devastating for graduate medical programs in Texas. Despite strong opposition from organizations like the Texas Academy of Family Physicians and the Texas Medical Association, lawmakers severely cut funding for some residency programs at a time when demand for doctors in Texas is ever-growing.  

Watch the Tribune's interview with Dr. Bruce Malone, president of the Texas Medical Association, about the impact of these cuts on the state's ability to maintain an adequate physician training pipeline. He warns that the effect on patient care will not be seen immediately, but cannot be fixed later with an influx of cash. "There is a long queue for that training, so if you cut the people at the beginning of the training process, there's no way you can make them up quickly," Malone said.

Since 2006, Texas lawmakers have used Graduate Medical Education funding formulas to provide the state's medical schools with support to offset the costs of training residents. According to the TMA, the state has never fully funded the program to start with. But with the expiration of some federal funding and the Legislature's decision to balance the state budget solely through cuts, GME programs will face staggering challenges over the next two years.

The Texas Higher Education Coordinating Board, which administers the funding for these programs, reports that the sharp reductions will affect the following programs:

• The Family Practice Residency Program was hit with a 72 percent reduction in state support, from $20.2 million in 2010-11 to $5.6 million for the next biennium. This is money used for the education and training of residents in the state's 26 accredited family practice residency programs. Currently, about 680 residents each receive $14,564. That amount will be reduced to $4,000 per resident. In its analysis of the reduction, THECB says some training programs may be forced to close. At the very least, it may have to reduce the number of resident it can train.

• The Primary Care Residency Program (which previously served 122 primary care residents in internal medicine, pediatric, and obstetric/gynecology programs) was completely eliminated.

• Another $570,000 cut from the Graduate Medical Education program will affect 15 independent primary care residency programs and 309 residents.

• The Physician Education Loan Repayment Program, which pays off the medical school bills of doctors who agree to work in underserved communities, will be reduced by 76 percent, from $23.3 million to $5.6 million. THECB estimates 750,000 citizens will have "decreased or eliminated access to physician services" as a result of the cuts. While the program will honor its commitment to the 172 doctors currently serving in the program, no new doctors will be added. (The Tribune's Emily Ramshaw's reported on this issue during the session. See her story here.)

In the bigger picture, Texas is looking at a major shortage of trained doctors at a time when the state holds the distinction of having the fastest-growing population and the highest number of uninsured citizens. TMA credits the state's 2003 tort reforms as the major reason 21,000 new physicians have moved into the state, but Texas continues to rank 42nd in the number of active doctors per 100,000 residents. In addition, the state is anticipating that federal health care reform will make an estimated 2 million to 3 million new people eligible for Medicaid here. 

**As part of The Texas Tribune's ongoing effort to explain the fallout from the 2011 regular and special sessions, we encourage you to engage with us and be part of our coverage. Respond to our stories below. Post a comment on our Facebook page. Send photos to our Tumblr site. We may come to you in the future to help us tell the story of how Texas is changing.