According to the Association of American Medical Schools, the Lone Star State ranks 41st in the country for the number of active physicians per 100,000 residents. It ranked 47th in active primary care doctors per capita. And the ones we have are not evenly distributed, since they tend to cluster in the state’s urban and suburban locales.
Thirty-five of our 254 counties have no doctor at all; an additional 30 depend on just a single doctor, invariably overworked. In 159 counties, there are no general surgeons. In 121 counties, there are no medical specialists. The stress of the coronavirus pandemic and the aging out of rural physicians all but guarantee that the doctor shortage will get worse.
It’s a complicated problem involving hospital economics, health insurance regulations, demographics, medical schools, physicians’ groups and public policy. The Biden administration is at least taking a stab at addressing it.
Vice President Kamala Harris announced last week that the administration will invest $1.5 billion from coronavirus relief legislation to address the shortage of primary care physicians, nurses and behavioral health care providers in rural areas and minority communities. The money will buttress programs that provide scholarships and loan forgiveness for health care professionals willing to leave the city and set up practice in a small town or a predominantly minority area.
Imagine a recent medical school grad — with on average a debt load exceeding $200,000 — spurning the established medical community clustered around, say, Memorial Hermann on Gessner at I-10, the Texas Medical Center or a thriving, specialty practice in Sugar Land or Katy to set up practice in a Texas Panhandle town where her view out the office window takes in a wind-blown cotton field stretching to the horizon.
Despite the professional and personal satisfaction of going where you know you’re needed, small-town Texas might be a hard sell without incentives. According to national studies, fewer than 2 percent of recent medical school grads want to practice in towns smaller than 25,000. Loan forgiveness is an incentive.
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The vice president also announced plans last week to begin awarding $330 million in funding from President Joe Biden’s $1.9 trillion coronavirus relief plan to the Teaching Health Center Graduate Medical Education. The goal is to help expand the number of primary care physicians and dentists in underserved communities.
Both Biden initiatives are welcome, but they won’t solve the physician-shortage problem alone, in Texas or anywhere else. A 2020 study sponsored by the Texas Health and Human Services Commission predicted that the Texas shortage will increase through 2032.
“Current projections in medical school enrollment and resident positions by the Texas Higher Education Coordinating Board indicate that the state’s graduate medical education system will not create a supply of physicians that can meet projected demand,” the study concluded.
The federal government designates nearly 80 percent of rural America as “medically underserved.” Nevertheless, the Texas situation is exacerbated by related health care issues. We tolerate the highest uninsured rate in the nation; 21 percent of our fellow Texans tempt fate with no health insurance coverage at all. We also have the most rural hospital closures. A third of Texas counties are forced to get by with no hospital.aside">