Those of us in academic medicine are well aware of the pressures to increase medical school enrollment to address the nationwide physician shortage. At UTMB, we have increased our medical student class size by 10 percent over the last four years. But increasing medical school enrollment will not address the physician shortage without an accompanying increase in residency slots to train those future physicians.
When medical students complete their residencies in the same state where they completed medical school, approximately 70 percent remain in state to practice. If a medical student goes to another state for residency, there is only a 50 percent chance of that individual returning to practice in the state where he or she became a doctor. This is bad news for Texas, as we see every year on National Match Day, when medical school students learn where they will receive their residency training.
Certainly medical students choose to do their residency in another state for many reasons. However, given the fact that the number of medical school graduates exceeds the number of residency slots, some of the students finishing medical school in Texas today will have to go out of state for residency training. The Texas Medical Association projects that by 2013, the state will graduate 1,564 new physicians. More than 10 percent of those graduates will likely have to leave the state to complete their residency.
The shortage of residency slots is both a state and national problem. At the federal level, the Centers for Medicare and Medicaid Services funds the vast majority of residency training in the United States. CMS funding levels have not increased for the last 10 years, and most hospitals are at the cap of residents that are funded by CMS.
Therefore, the cost of more residents will have to be fully funded by either city, county or state governments, or local hospitals. In Texas, this is an acute problem because the population will continue to rapidly increase over the next 30 years — projections are that up to 45 million people will live in Texas by 2040 — compared to 25.1 million today.
The best solution to the need for increased residency slots seems to be one that involves both federal and state governments. As a state, we have done the right thing by increasing medical school enrollment. Now, we have to do the right thing and work to increase residency slots so the medical students we educate here are more likely to practice in Texas.
Dr. Garland D. Anderson is Provost and Dean, School of Medicine