Like many rural counties, Delta County, about an hour northeast of Dallas, doesn’t have a dedicated primary care doctor.
“Sometimes the treatment that our residents are seeking, or specialty treatments, they may need to be referred outside of Delta County to receive,” Delta County Judge Tanner Crutcher told KERA News.
A new law going into effect next week aims to address a projected shortage of more than 10,000 doctors in Texas over the next several years, especially in places like Delta County.
Under current law, foreign doctors, no matter how much experience they have, need to spend at least three years in medical residency – a yearslong practical training all doctors must complete – before getting licensed in Texas. But House Bill 2038, also called the Doctor Act, removes that requirement for foreign physicians and offers an alternative licensing pathway to physician graduates.
The law focuses on rural communities, so doctors that go through the licensing pathway must spend one year with a provisional license working in a rural community or area designated by the U.S. Department of Health and Human Services as having a health professional shortage. After that, they can work wherever they want.
“I appreciate what the legislature is doing by focusing on this, and I hope to see that expanded and really improved upon in future legislative sessions,” Crutcher said.
He and others say the law might not go far enough to increase access to medical care in the state. While Crutcher welcomes the bill, he said health care struggles for rural residents go beyond how many doctors they have.
“I think one of the bigger issues that we see in rural counties is transportation,” he said. “Some of them don't have reliable means of transportation to get to those specialty doctors that they may have to travel outside of the county or into a more urban area to receive that type of treatment.”
Dr. Ogan Gurel, the BioHealth Innovation Specialist at the University of Texas at Arlington, told KERA's Vital Signs in July he thinks the Doctor Act is a step in the right direction, but it doesn’t address the “core bottleneck” behind the shortage: a lack of residency positions in Texas.
There are more Texas medical school graduates than there are residency positions, so many leave to other states where they’ll end up practicing medicine, Gurel said.
“Most doctors practice where they do residency,” he said. “And so, in effect, Texas is exporting its medical students to other states.”
A recent study published in the Journal of Graduate Medical Education pointed out challenges laws like the Doctor Act face in addressing rural health care shortages. A big issue is the laws don’t require the “foreign-trained physicians,” or FTPs, to actually work in rural areas once they get their full licenses.
“Overall, while FTP legislation offers a potential near-term solution to the current US physician shortage, it may not address the maldistribution of US physicians,” according to the study.
The law also excludes doctors, who are not already U.S. citizens or work visa holders, from countries identified in the Annual Threat Assessment of the U.S. Intelligence Community released by the Director of National Intelligence – which includes Russia, China, Afghanistan, North Korea, Cuba, Iran, Syria and others.
Dr. Jeffrey Singer, a general surgeon and fellow at the Cato Institute, a libertarian think tank, has been following similar legislation across the country and has been a vocal critic of the Texas bill’s provision to exclude doctors from certain countries.
“The country that you came from is not a proxy for whether you're a good or a bad doctor,” Singer said. “It's the training and the quality of the medical schools and training programs in that country.”
Singer told KERA News he’s worked with many talented immigrant doctors who had to decide between retaking three to seven years of medical residency or taking a lower-level position where their skills wouldn’t be fully utilized.
He recalled a time when he was consulting with his assistant on a challenging surgery when his operating room technician, Jamil, spoke up. He offered advice beyond what someone in his position would be expected to know, Singer said, and it wasn’t the first time either.
“I'm thinking, how does he know this? He's not a doctor, he's an (operating room) tech, which is like, you know, a technician has an associate level degree,” Singer said. “And then one day I actually asked him, and he said, ‘Well, I was a surgeon back in Syria, but I didn't want to go back to do a residency.’”
Because of the bill’s provision, someone from Syria, like Jamil, wouldn’t benefit from the Doctor Act.
The bill’s author – Texas Rep. Tom Oliverson, who is also an anesthesiologist – said under questioning from Rep. Gene Wu the provision to exclude certain countries was a compromise to get the bill passed.
“I am accepting this reluctantly,” Oliverson said, “but I would rather that we get this done than get nothing done.”
The law will go into effect amid the Trump administration’s deportation campaign and stricter immigration laws, which has led to the immigrant population in America dropping by 1 million – the first time it has dropped since the 1960s, according to Pew Research Center.
Dylan Duke is KERA's Fall news intern. Got a tip? Email Dylan Duke at dduke@kera.org.
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