Lack of primary care doctors to worsen
State projects over next 12 years shortage will rise despite new Texas medical schools
The University of Houston and Sam Houston State University took steps last week toward the creation of new medical schools focused on primary care, but a new report suggests the shortage of such doctors is going to get worse before it gets better.
Despite concerted efforts by the medical community in recent years to increase the pipeline, the shortage of primary-care doctors over the next 12 years will grow more than 250 percent in Houston’s region and more than 67 percent throughout Texas, according to projections by the Department of State Health Services.
“I can’t say I’m terribly surprised,” said Dr. Rodney Young, an Amarillo family physician and former chairman of the Texas Medical Association’s council on medical education. “We’d love to see the trend start to change, but it seems ongoing efforts have been better at increasing the overall number of doctors than primary care doctors.”
The 2018 report attributes the shortage to continued growth in the state and says projections in medical school enrollment and resident positions are not sufficient to meet the projected demand.
The report is just the latest to project or document shortages in primary care, which has been a national problem, locally and na-
tionally, for more than a decade. Texas ranks 47th among 50 states in the ratio of primary care doctors per person, according to a 2017 Association of American Medical Colleges report.
The report is distributed to the governor, Legislative Budget Board, legislative appropriations and finance committees and to the Texas Higher Education Coordinating Board.
Dr. George Santos, president of the Harris County Medical Society, said the projections show the need for more Texas residency slots, essential for keeping students in the state because doctors typically end up practicing where they train.
“The key is to grow funding for medical education, not just shift it around,” said Santos, a psychiatrist. “The Texas Legislature has shown growing concern about the shortage of physicians currently and projected, but if new residency slots aren’t created we’ll fall back.”
A state health spokesman said the projections took into account Texas’ recently opened medical schools — Dell Medical School at the University of Texas at Austin, the UT Rio Grande Valley School of Medicine in Edinburg, and the University of the Incarnate Word School of Osteopathic Medicine in San Antonio. They did not take into account the planned medical schools at UH and Sam Houston State and a joint Texas Christian-University of North Texas medical school in Fort Worth.
UH regents voted Thursday to build the school on campus rather than in the Texas Medical Center and Sam Houston State officials held groundbreaking ceremonies at its school’s Conroe site on Friday.
Both school’s proposals have been approved by the Coordinating Board, but both still require approval by accrediting bodies.
Although the medical schools are taking different paths — UH will award doctorates in medicine, Sam Houston doctorates in osteopathic medicine — but both hope to produce classes of which about half will go into primary care and practice in underserved areas.
But in even in a best-case scenario, that would take time for both to ratchet up to make an impact. The schools hope to begin enrolling students in fall 2020 — that’s still contingent on permission from their accrediting bodies — and grow from initially smaller classes, specifically from 30 to 120 at UH and from 75 to 150 at Sam Houston State.
It would be at least 2030 before significant numbers of the new doctors will have finished their residency programs and begun practices in primary care.
By 2030, the Texas health services department is projecting a shortage of 3,375 primary care doctors throughout Texas, up from 2,002 in 2017.
It is projecting a shortage of 694 primary care doctors in the 16-county Gulf Coast region, up from 196 in 2017. That is the highest increase in the state.
The health department projects the demand will significantly outstrip the supply for family medicine doctors, general internists and obstetricians-gynecologists, three branches of primary care.
The supply of pediatricians, the report’s fourth branch, will actually exceed the demand, according to the projections.
The report also projects a 13 percent increase in the shortage of psychiatrists. Those numbers will go from 1,067 in 2017 to 1,208 by 2030.
The continuing shortage of primary care doctors comes despite escalating numbers of licensures and applications in Texas in the years since the state’s 2003 passage of tort reform laws capped the amount of money for which doctors could be sued.
The number of medical license applications received by the state has grown from under 4,100 in 2009 to nearly 5,600 in 2017 and the number approved in the same period has grown from 3,000 to more than 4,700.
TMA’s Young suggests the primary care shortage may require a new strategy.
“The problem may be that much residency funding comes from hospital partners, who have an interest in training doctors to do work performed in hospitals, meaning specialty care,” said Young. “The job of primary care doctors is to keep people out of hospitals.”