The State of Texas Medical Education

The DFW metroplex has the largest concentration of medical students.

• “Texas has a shortage of physicians, both primary care physicians and specialists. The state currently ranks 42nd out of 50 states and the District of Columbia in physician-to-population ratio for patient care. The shortage is now evident in both rural and urban areas of the state. Even though medical liability reforms have brought more than 21,000 new physicians to Texas, we still don’t have enough physicians to keep up with the state’s robust population growth.”[1]
• According to an October 17, 2010 story in the Houston Chronicle, Texas already loses 45% of its medical graduates to out-of-state residencies.[2]
• Texas will lose $200,000 of its investment in each medical student who will move out of state for residency training.  As the Texas Medical Association has observed, “It is not good fiscal policy to make a state commitment of $200,000 for each Texas medical student over four years, and then force graduates to leave the state for GME. Those new physicians very likely will never return to Texas.”[3]

• In December 2008, the Texas Health Care Policy Council released a report, “Physician Workforce and Graduate Medical Education in Texas,”[4] in which it analyzed future trends in the supply of physicians, physician training opportunities, and the demand for medical care across Texas.  Among the panel’s findings:

Ø      “Texas medical school enrollments are at historically high levels. Entry-level enrollments are on track to meet the AAMC’s recommended 30 percent growth rate… In 2007, there were 1,300 Texas medical school graduates but that number is expected to grow to 1,700 by 2012.” (p. 18)

Ø      “Of the Texas physicians in DPC [direct patient care], 45 percent trained in Texas medical schools; 32 percent trained in other states; and 23 percent trained in other countries.”  (p. 19)

Ø      “The majority of Texas’ first-year medical students are in the metropolitan regions of the Metroplex and the Gulf Coast (see Figure 10).”  (p. 19)

    Ø      “Since the passage of medical liability reform in 2003, the Texas Medical Board (TMB) has licensed 10,878 new physicians (see Figure 2). By comparison, 8,391 new physicians were licensed in the four years preceding the passage of liability reform (1999-2002).”

Ø      “In 2007, the TMB received a record 4,041 physician licensure applications, and issued a record 3,324 new licenses.” (p. 12)

Ø      “The TMB issued 811 more licenses in 2007 than 2006, almost a one-third increase.” (p. 12)

Ø            “Texas is a net importer state. In 2007, of the new Texas licensees, 43 percent were from other states, 31 percent were from Texas, and 26 percent were from another country.” (p. 12)

In 2010, Texas had 1,390 residency slots and 1,404 medical graduates (already a surplus of medical graduates compared to residency slots).[5]  According to the Texas Health Care Policy Council, the entry-level residency slot total for 2010 is actually less than the 1,481 positions reported in 2007.[6] (p. 21)

According to the Texas Higher Education Coordinating Board’s 2008 “Projecting the Need for Medical Education in Texas” report, the “…state should encourage growth of more first-year residency positions with a goal of 10 percent more first-year, entry-level residency positions than graduating medical students.” To achieve the Coordinating Board’s goal of increasing the number of first-year residency slots by 10 percent more than medical school graduates, an additional 150 first-year entry residency positions are needed by 2012. This important step has not yet been done. (p. 32)

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[1] Texas Medical Association.  “Graduate Medical Education Funding.”  Accessed December 26, 2010.  URL: http://www.texmed.org/Template.aspx?id=19657.

[2] Ackerman, Todd.  “Medical emergency: Keeping doctors in Texas.”  Houston Chronicle, October 17, 2010.  URL: http://www.chron.com/disp/story.mpl/metropolitan/7251540.html.

[3] Texas Medical Association.  “Graduate Medical Education Funding.”  Accessed December 26, 2010.  URL: http://www.texmed.org/Template.aspx?id=19657.

[4] Texas Health Care Policy Council.  “Physician Workforce and Graduate Medical Education in Texas.”  December 2008.  Accessed December 26, 2010.  URL: http://www.governor.state.tx.us/files/thcpc/Physician_Workforce_and_GME_in_Texas_12-2008.pdf. 

[5] Ackerman, Todd.  “Medical emergency: Keeping doctors in Texas.”  Houston Chronicle, October 17, 2010.  URL: http://www.chron.com/disp/story.mpl/metropolitan/7251540.html.

[6] Texas Health Care Policy Council.  “Physician Workforce and Graduate Medical Education in Texas.”  December 2008.  Accessed December 26, 2010.  URL: http://www.governor.state.tx.us/files/thcpc/Physician_Workforce_and_GME_in_Texas_12-2008.pdf. 

Dr. Scott Stoll's reasons for opposing the MD option at UNTHSC

The following  letter dated January 5th, 2009 by Scott Stoll, DO, PhD.

This letter is intended to provide my input regarding the possibility of an MD degree option at UNTHSC.  As I understand it, you are Chair of the Study Group charged with collecting input regarding this issue and that all UNTHSC faculty and other interested parties have been directed by President Ransom to provide you with input into this important decision making process.  As I provide this input to you, I also will provide similar input to the TCOM Interim Dean, the UNTHSC Provost, the UNTHSC President, the UNT System Board of Regents, and the UNT System Chancellor.

As you know, I have a relatively long history of involvement at UNTHSC, in this community, and with both the MD and DO professions.  Having been accepted at both MD and DO medical schools, I chose to matriculate at TCOM in 1985.  From 1985-1992, I completed a DO degree from TCOM, a PhD in Physiology from UNT, and a Family Medicine Internship at OMCT in Fort Worth.  During these years, I also served UNTHSC as an employee sequentially as a Student Tutor, Teaching Assistant, Predoctoral Fellow, and Research Assistant.  I sat for and passed both the DO NBOME and the MD FLEX national medical licensing examinations.  I completed an ACGME (MD) accredited PM&R residency that I personally had to make ACOGME (DO) accredited.  I chose to make a career at UNTHSC and have been employed as a full time faculty member in the medical school with adjunct appointment in the graduate school since 1995.  I have served as a Department Chairman for over 10 years; I was the founding Executive Director for the national Osteopathic Research Center at UNTHSC; and I am Co-Director of the Physical Medicine Institute.  I have been Principal Investigator for over $6 million in competitive grant awards at UNTHSC and have been a Co-Investigator or key collaborator for several million dollars more.  I have served for over 10 years on the Board of Directors for UNTHSC-TCOM and UNTHSC clinical practice plan (UNTHealth) as well as for the Easter Seals Society of North Texas.  Throughout this time, I have maintained active clinical practice on campus and at local hospitals including the JPS Health Network.  I am currently a Tenured Professor and my wife Myra and I are preparing our three sons for college and adult life in our west Fort Worth home.  I say these things not to brag, but only to illustrate my deep love for and commitment toward this community and this institution.  Further, I want to highlight the fact that I am familiar with what it takes to train medical students, conduct research, practice medicine and raise funds – and have done so arm-in-arm with MD physicians every step of the way.

With this longwinded introduction out of the way, I wish to state unequivocally, that it is wrong to offer an MD degree at UNTHSC.  It is wrong:  1) because it is unnecessary; 2) because it is harmful to TCOM and our community; 3) because it institutionalizes professional discrimination and prejudice; and 4) because of the manner in which the decision making process is being conducted.

Toward Osteopathic Psychiatry

I was surprised to find that my commentary was referrenced as introduction of a psychiatry article, recently published in the Journal of American Osteopathic Association. Dr. Niall McLaren, a psychiatrist practicing in Australia, embraces the holistic approach of osteopathic medicine. Holistic approach to mental disorders or diseases should be emphasized instead of the reductionist approach which places priority of bio-chemical imbalances. This article is scholarly and an eye-opening. It is also interesting that an Australian medical doctor appreciates  the philosophy of osteopathic medicine.

• "In a thoughtful commentary, Delengocky1  offered three reasons why osteopathic medicine should remain parallel to but distinct from allopathic medicine. First, there is the widespread and growing interest in complementary and alternative medicine (CAM) in the United States. For a number of reasons, osteopathic medicine is an alternative to the reductionist biological tradition of allopathic medicine. Osteopathic medicine places great emphasis on the fact that the body is a self-regulating unit in which structure and function are reciprocally interrelated, providing a basis for a rational, holistic therapy.
• Second, he argued that because of the prevalence, the morbidity, and the huge cost of musculoskeletal disorders, there is a place for a form of medicine that sees a need to manage these debilitating conditions as more than “simply pains.”
• Third, he saw a political advantage in medicine having two “separate but equal” traditions to counter the aggressive push by nonmedical professions for equal rights (eg, laboratory investigation, prescribing, procedures) with physicians within their narrowly defined areas. Medicine must see the patient as a whole, must advance by rational scientific research and must be distinct from the paramedical professions, which seek to advance themselves by legislative advantage. Medicine is strengthened, not weakened, by having the two traditions of allopathic reductionist biology and osteopathic holism."

You can read the entire article at http://www.jaoa.org/cgi/reprint/110/12/725 or in the publication page above.