Texas has too few physicians to meet the health care needs of its growing population. Statewide, there is a severe shortage of primary care physicians, as well as specialists in a number of disciplines, including pediatrics and geriatrics. The number of psychiatrists and other behavioral health care professionals is insufficient to serve all Texans living with mental health or substance use issues. More than 80 percent of Texas counties are designated as mental health professional shortage areas; 70 percent of counties have no practicing psychiatrists. The state also has well-documented shortages of nurses and allied health professionals.
Texas hospitals support continued appropriations to address the state’s critical shortage of physicians, nurses and behavioral health care professionals. THA’s priority for the 85th Texas Legislature was to continue support for the Nursing Shortage Reduction Fund and the state’s graduate medical education programs.
In recent years, the state has invested heavily in graduate medical education programs to increase the number of physicians practicing in Texas. Lawmakers in the 85th Texas Legislature maintained this tradition by appropriating $90 million for health-related institutions to continue the same level of state funding for current graduate medical education programs and add funding for new GME programs at The University of Texas Austin and The University of Texas Rio Grande Valley. To address decreased formula rates at all institutions, the state budget includes an additional $35 million in hold harmless funding. To expand GME training opportunities, the state budget provides $97 million in all funds – an increase of $44 million over the prior biennium. These funds may be used for:
- GME planning and partnership grants to hospitals, medical schools and community based ambulatory patient care centers.
- New or existing GME programs to increase the number of first-year residency positions.
- Unfilled first-year residency positions.
- Grants to GME programs that received a grant for the New and Expanded GME Program in 2015.
Although not a budget item, Senate Bill 1066, passed by Sen. Schwertner, M.D. (R-Georgetown) with THA support, will require new medical schools to submit a plan to the Texas Higher Education Coordinating Board regarding the addition of first-year residency positions for the GME program to be offered in connection with the new degree program. Submitting this plan will be a prerequisite before THECB can approve any new medical school programs.
Lawmakers were not quite as generous in the state budget with other health care workforce-related funding, however. Slightly less funding is appropriated for the physician loan repayment program that provides loan repayment in exchange for physicians’ agreeing to practice in a health professional shortage area and provide care to Medicaid and CHIP enrollees.
The state budget for 2018-19 appropriates $25 million – a decrease of more than $8 million – for the physician education loan repayment program. The professional nursing shortage reduction program also will receive fewer funds. The state budget includes $20 million – a decrease of nearly $14 million – for the program, which provides funds to Texas nursing schools to increase the number of nursing graduates in the state. The state budget continues to allocate nearly $11 million in tobacco earnings for nursing school innovation grants focused on recruitment and retention of students and faculty.