Posts Tagged ‘higher education’
Physician workforce – particularly in family medicine and primary care – has dominated TAFP’s focus during the past six months of the 82nd Texas Legislature and special session. Workforce issues emerge in all policy areas: health and human services, education, and their respective budgets – through medical school funding, graduate medical education, the Texas Statewide Preceptorship Program, and Texas Physician Education Loan Repayment program.
On June 11th, 2011, after the regular session ended and in the middle of the special session, I was very fortunate to be in the audience at the Stanford Medical School Commencement to see my sister receive her M.D./Ph.D., and to hear one of her classmates, David Austin Craig, M.D., give a thoughtful and humorous speech reflecting on his experience in med school and looking forward to the future.
Seeing the class of nearly 100 brand-new doctors “preparing to go from the frying pan of medical school to the Armageddon of residency,” as Craig said, reminded me why TAFP members spent so much time at the Capitol and in district offices meeting with legislators, testifying at hearings, developing and distributing issue briefs and policy papers, and reporting back to friends and colleagues in their communities. It’s all to support and protect the noble profession of medicine.
To each physician who participated in TAFP’s advocacy effort this year, we are grateful to you and hope you are proud of the myriad accomplishments you achieved in the midst of a tough session. We’ll need your help in the interim and the 83rd Legislature to keep the momentum going.
Until then, I invite you to read an excerpt from Dr. Craig’s speech and remember how you felt when you graduated from medical school and prepared to enter residency and beyond.
“We are headed far and wide next year, the newest foot soldiers in the war against disease that leaves not one of us on this planet untouched – a true World War in a pure and timeless sense.
“And, my classmates, though your staggering debt load may prevent you from sleeping on an actual bed, you can at least sleep soundly knowing that you have chosen to fight on the right side of this war.
“We all know that there is profit to be made quickly and in abundance by spreading fear and ignorance, in promoting poor health, in disregarding or denying the sorrow of another human being. You have instead chosen to hold a candle against these things, to enter into a profession where even your daily commute is a statement against suffering and a habitual reaffirmation that good exists.
“And, believe me, this is the only way that a 1993 rusted Geo Metro driving at 6 a.m. will ever be considered a sign of good in the world.”
“In truth, after spending the last several years with you, I can say honestly that medical school has only made you doctors in the way that a microphone makes somebody a singer. The letters “M.D.” will magnify your impact and open doors for you; will let you reach into more and darker corners of the world to spread hope and comfort there. That is true.
“However, those letters work only like a microphone, only amplifying what you put into them, and a microphone will never make you a singer just as an “M.D.” will never make you a doctor. It is now, just as it has always been: You have to bring your own voice and it is, in the end, the only thing that matters.”
See the full speech on YouTube: Stanford Medical School Commencement 2011 David Craig
The Senate Finance Committee has held hearings for the past two weeks on every section of the budget, and because so many primary care programs suffered cuts (as did most other programs), many interesting exchanges have come to light. In all the discussions, though, both lawmakers and those testifying agree that primary care is of the utmost importance to ensuring Texans’ access to care.
Because residency programs play such a large role in producing the primary care physician workforce, here enters Paul Klotman, M.D., president and CEO of Baylor College of Medicine. He testified during the Feb. 8 hearing of the Senate Finance Committee, and Sen. Bob Deuell of Greenville questioned him on the closing of the Baylor College of Medicine Kelsey-Seybold Family Medicine Residency Program. Here’s their exchange.
Sen. Deuell: A family medicine program closed. What’s your take on that?
Dr. Klotman: Our family medicine program is doing fine. [Person in audience speaks]. Oh, are you talking about Kelsey-Seybold?
Klotman: My understanding is they just didn’t want to be in the education business, that they didn’t want to continue to have residents there.
Deuell: Was that because of finances?
Klotman: They’re driven by patient care, they’re at risk now, they need efficiencies in their system. It’s hard. One of the challenges is working in the educational piece into efficient organizations, but I actually believe you can do that. It just needs to be done in an integrated way and I don’t think that’s their primary mission.
My understanding is they just didn’t want to be in the education business, that they didn’t want to continue to have residents there.
–Paul Klotman, M.D., President and CEO, Baylor College of Medicine
So why did the program close? It turns out that it was financial. As Jonathan Nelson writes in “On the Brink,” the cover story of the first-quarter 2009 issue of Texas Family Physician, it began in 2006 when the program’s primary teaching hospital, St. Luke’s Episcopal Hospital, cut support for the program in half.
That sent Baylor and Kelsey-Seybold FMRP scrambling to find new sources of funding, none of which were stable from year to year. By fall 2009, they agreed that the program was no longer financially sustainable. Kelsey-Seybold needed a subsidy from BCM of between $400,000 and $450,000 to keep the program viable. But Baylor, which has operated at a substantial deficit for the past several years, couldn’t save the program.
Baylor College of Medicine’s 2010-2011 appropriation for GME formula funding— money intended to support their affiliated residency programs—is $15.3 million. That’s $2.5 million more than they received in the previous biennium.
The program closing certainly wasn’t because of lack of interest from the faculty or the applicants. Again, from “On the Brink”: In an era when family medicine residencies only manage to fill 45 percent of available residency positions with U.S. medical school graduates, 97 percent of the recruitment classes at the Kelsey-Seybold program over the last three years graduated from U.S. medical schools. More than 600 physicians applied for the four open positions at the residency in 2009, and of the four chosen, two are from out of state. “I’m constantly bombarded with people that would just love to come to our program,” says Tricia Elliott, M.D., F.A.A.F.P., the residency’s program director.