The Right Prescription

UT System Residency Programs Provide Critical Care in a Troubled Climate.

In the fall of 2008, R. Matthew Camarillo, a former student regent on The University of Texas System Board of Regents, began his post-graduate training at the very same institution where he earned his medical degree: The University of Texas Health Science Center at Houston. Drawn to the institution’s orthopedic surgery program because of its solid reputation and the scope of the work performed at the teaching hospital, Camarillo realizes he is one of the lucky ones. With eight orthopedic surgery residency programs in Texas, and only a handful of slots available in each, candidates outnumber open positions by a wide margin.

"About half those seeking orthopedic surgery (residencies) in Texas got them," Camarillo says. "The other half had to go to other states."

Even as the UT System is working to expand medical school education and residency opportunities in Texas, the challenge of providing sufficient residency slots is becoming more pronounced. In the last five years, UT System health institutions have shown an 11.6 percent increase in the number of medical school graduates it has produced. Over the same period, the number of accredited residency program slots has risen by 4.7 percent at UT System institutions. With a new medical school in El Paso — not to mention augmentations to existing programs — Texas medical school enrollment is projected to increase nearly 30 percent by 2011 from 2004 enrollments.

"We know the need for more residency programs is critical," says UT System interim Chancellor Kenneth I. Shine. "And it’s not just the number of residency slots we have to worry about — we must be mindful of the areas where graduates want to pursue their careers."

Arguably the most compelling point about the need for more residency program slots is that statistics show Texas medical school graduates are less likely to remain in Texas if they complete their residency programs in other states. In California, Massachusetts and New York, for instance, first-year residency slots outnumber medical school graduates by at least 50 percent.

"As we graduate more medical school students, we are concerned that a growing number of those students will go out of state to pursue their residencies," says interim Chancellor Shine. "That’s why we are trying to find ways to increase the number of residencies we offer in Texas."

According to a recent survey compiled by the American Association of Medical Colleges, 80 percent of Texas medical school graduates who completed their residencies in Texas chose to remain in the state to practice medicine while only 59 percent of those who completed their residencies in other states elected to return to Texas to practice medicine. In 2008, more than 40 percent of Texas medical school graduates left the state to pursue residency programs elsewhere.

A Growing Need

Currently, Texas lags most other states in the country in the ratio of physicians per 100,000 people. In 2007, according to the Texas Department of State Health Services, 156.7 direct patient care physicians were practicing in Texas per 100,000 residents, well below the 237.1 per 100,000 reported nationally in 2004.

For family physicians the figures are even more troubling. According to the National Center for Health Workforce Analysis, Texas had fewer than 58 primary-care physicians per 100,000 residents — well below the 69 per 100,000 recorded nationally by the center in 2000.

While Texas is producing doctors at a faster clip than it was at the beginning of the decade, the rate at which physicians are earning their licenses is perilously close to losing pace with the state’s fast-rising growth. Add to that the increasing number of aging Texas residents, who typically require more frequent and more serious medical care, and the dilemma becomes more precarious.

Dr. J. James Rohak, director of Temple-based Scott & White Center for Healthcare Policy and president-elect of the American Medical Association, estimates Texas already needs a minimum of 1,000 additional graduate medical education positions. Without them, a substantially higher number of prospective graduate medical education students may have to leave the state to pursue their residencies.

Keeping Texas Healthy

Graduate medical education is critical to the clinical well-being of Texans, as residents provide the majority of patient care to the uninsured and for a significant portion of trauma care. Texas’ rate of uninsured patients is 25 percent — the highest in the country — and well above the 15 percent rate nationally.

Essentially the "on-the-job-training" component of medical education, residency programs generally last three to five years in a clinical setting, after graduation from medical school, and involve a partnership between health science centers and teaching hospitals.

"Residency programs are, in essence, importers of doctors," says Patrick Francis, assistant vice chancellor in the Office of Health Affairs at The University of Texas System.

They also make up a significant part of our safety-net (government-run) hospitals, says Dr. Lois L. Bready, associate dean for graduate medical education at The University of Texas Health Science Center at San Antonio. "You couldn’t do trauma care without residents," says Dr. Bready.

Part of the challenge in creating new residency opportunities is that these programs are funded largely by the federal Medicare program, which is currently capped and unable to support new residency spots. That means the state’s medical community must look to the state for the necessary funding to augment graduate medical education.

That funding could come in one of several ways: through more dollars for the existing graduate medical education formula, which helps offset the costs of faculty members who oversee residents; through restoration of the Medicaid share of funding for residents, which was eliminated by the Legislature in the tight times of 2003; or through direct funding for the creation of new resident positions that would go toward the stipends paid to students and other costs.

Such an investment by the Legislature, UT System officials say, would provide an opportunity for the state to determine the types of residency programs to create. Not only would it help address deficiencies in types of available residencies, it could improve access to primary and specialty care in underserved regions of the state.

The University of Texas System is doing its part to grow the number of doctors Texas produces each year by expanding medical school and residency programs in the state, says interim Chancellor Kenneth I. Shine.

— Matt Flores

Kenneth I. Shine in his office at the UT System

Kenneth I. Shine, Chancellor ad Interim and Executive Vice Chancellor for Health Affairs, UT System

Around the System

The University of Texas Southwestern Medical School at Dallas admits about 230 medical students each year. By law, 90 percent of students are from Texas, assuring the state a consistent source of high-quality physicians. Faculty members annually train nearly 2,300 clinical residents and fellows and provide continuing medical education to physicians and other health professionals through seminars, teaching rounds and instruction on and off campus.

The School of Medicine at The University of Texas Medical Branch at Galveston has provided medical school or residency training to one in six Texas physicians. With 20 departments, three institutes and a unique partnership with The University of Texas at Austin and Seton Healthcare in Austin, UT Medical Branch - Galveston offers 33 residency and 37 subspecialty fellowship programs.

The Emergency Medicine residency at The University of Texas Health Science Center at Houston is one of more than 20 residency programs at Memorial Hermann, a Level I Trauma Center and urban teaching hospital

In the General Surgery Residency Program at The University of Texas Health Science Center at San Antonio all levels of faculty work side-by-side with the residents on all services. For example, trauma surgery service residents work with a mix of senior faculty (including past presidents of major surgical organizations) and full-time trauma faculty.

Ranked the nation’s No.1 cancer hospital in U.S. News & World Report’s "America's Best Hospitals" survey, The University of Texas M. D. Anderson Cancer Center offers a vast number of programs that provide training in clinical practice, laboratory sciences, teaching skills, verbal and written communication, and clinical, translational and basic science research.

The University of Texas Health Science Center at Tyler offers residency programs in Occupational Medicine and Family Medicine that are "university administered" but "community oriented," meaning, they provide students with a solid academic foundation and a wealth of real-world clinical experience. The Family Medicine residency program has produced a substantial number of physicians who have decided to practice in rural communities throughout Texas.