Texas lawmakers this year passed a bill to help offset a projected shortage of more than 10-thousand doctors by 2030.
House Bill 2038, also known as the Doctor Act, allows experienced international medical graduates to skip residency programs required in the U.S.
Dr. Ogan Gurel, a physician and faculty expert in the Health Care Administration program at the University of Texas at Arlington’s business college, tells KERA'S Sam Baker why he doesn't think the Doctor Act addresses the real cause of the doctor shortage – a lack of residency positions.
Dr. Gurel: I believe Texas is the last in the nation in the ratio of residency spots to medical school graduates. In other words, there are less residency spots in Texas than medical school grads.
Most doctors practice where they do residency. And so in effect, Texas is exporting its medical students to other states.
So, I think the core bottleneck is the lack of residency positions. And of course, that fits with the Doctor Act because there's a lack of residency positions even for American medical graduates in Texas. Therefore, requiring the foreign medical graduates to take that residency is effectively even making that problem worse. So having them jump over residency is a solution.
Baker: Do you look at this as a sustainable approach to trying to resolve the shortage of physicians?
Dr. Gurel: Increasing the number of residency positions is going to be the sustainable solution. But residency costs a lot of money. It's about a million dollars. And that comes essentially through Medicare and Medicaid.
Texas is aware of its particular shortfall in residency positions. And there are some state initiatives to supplement the financing of residency position. But that hasn't really ramped up. And I would encourage the legislature to really accelerate. Uh, state financing of residency positions.
Baker: How in the world do you make that happen?
Dr. Gurel: Well, like anything, more money. Allocate more funds to residency education, the technical term is graduate medical education, by the state of Texas.
Baker: If we don't address this by the target date for reaching this major shortage, what happens?
Dr. Gurel: So in public health, we have what's called the Iron Triangle. The three pillars that a public health system tries to optimize to ensure the health of the population. Quality, cost, and access. So we wanna maximize the quality, minimize the cost, and maximize the access. The most important is access.
Reduced access to healthcare has significant consequences because obviously, people don't get taken care of. And they will die. And ironically, the cost to the system also increased because care that's deferred typically then progresses to more intensive care, and that is gonna be more costly, or primary care that is not seen ends up in the emergency room, which is also more expensive. So, I think that not addressing the issue is going to have pretty significant bad consequences.
But there are other measures we can take. And one of them is increasing medical literacy among the population. Knowing how to talk with the doctor and knowing how diagnosis works and knowing the medical system works, the basic principles of how to get better if you are sick. And I think some degree of medical literacy can increase the efficiency of people's interaction with the healthcare system can help this situation.
It's not gonna turn people into doctors. That's not what I'm advocating, of course. But to be a partner with your doctor, to understand how the process works. And I think that can actually ameliorate to some extent the physician burnout because working with patients who really lack that medical literacy can be really exhausting and challenging and frustrating when they don't follow the instructions, and the outcomes are not good, and so forth. So, I think I would add bringing some programs around medical literacy can be quite helpful as well.
RESOURCES:
Physician Supply and Demand Projections 2021-2032
Help Wanted: Texas’ physician growth strong, but recruitment, diversity still needed
Perez: Governor signs bill making it simpler for foreign doctors to practice in Texas
UNT and Midland College Partner To Recruit And Train Doctors For Rural Areas
Hundreds Of New Residencies Planned Could Ease Doctor Shortage In Texas
