Texas Higher Education Coordinating BoardTexas Higher Education Coordinating Board

Graduate Medical Education Graduate Medical Education State FundingState Funding

Stacey Silverman, PhDStacey Silverman, PhD

April 8, 2008April 8, 2008

Health-Related InstitutionHealth-Related InstitutionHigher education institution, typically degree-Higher education institution, typically degree-granting that educates and trains health care granting that educates and trains health care workforceworkforce

A majority (8 of 10) Texas health-related A majority (8 of 10) Texas health-related institutions include a medical school and another institutions include a medical school and another health professional school (e.g., allied health, health professional school (e.g., allied health, nursing, pharmacy). nursing, pharmacy).

Two institutions are considered health-related, but Two institutions are considered health-related, but do not have a medical school: UTMD Anderson do not have a medical school: UTMD Anderson Medical Center and UT Health Center at Tyler. Medical Center and UT Health Center at Tyler.

Medical SchoolsMedical Schools

Texas has 8 medical Texas has 8 medical schools (7 public and schools (7 public and 1 independent)1 independent)

Medical schools are Medical schools are located in large located in large metropolitan areasmetropolitan areas

Texas graduates Texas graduates 1,300 physicians 1,300 physicians annuallyannually

Regional Academic Health CentersOther Health-Related Institutions

Years of Required GMEYears of Required GME3 Years: 3 Years:

Family Medicine, General Internal Family Medicine, General Internal Medicine, Medicine, General PediatricsGeneral Pediatrics

4 Years:4 Years:Obstetrics/Gynecology, Otolaryngology, Obstetrics/Gynecology, Otolaryngology, Psychiatry, Radiation OncologyPsychiatry, Radiation Oncology

5 Years: 5 Years: General Surgery, Neurological Surgery,General Surgery, Neurological Surgery,

Orthopedic SurgeryOrthopedic Surgery

GME -- Residency Programs GME -- Residency Programs

Waco

Tyler

Temple

Odessa

Dallas

Conroe Austin

McAllen

Lubbock

Houston

El Paso

Baytown

Amarillo

Texarkana

Galveston

Fort Worth

San Antonio

Wichita Falls

Corpus Christi

Bryan

Garland

Harlingen

GME -- Formula FundingGME -- Formula FundingNumber of Residents

Resident Count Date 6/30/05 6/30/06 Count Chg FY 06-09

% Change - FY 06-09

UT Southwestern Medical Center 1,128 1,175 47 4.2%

UT Medical Branch Galveston 555 603 48 8.6%

UT HSC Houston 756 766 10 1.3%

UT HSC San Antonio 637 669 32 5.0%

UT M.D. Anderson Cancer Center 100 107 7 7.0%

UT Health Center Tyler 23 24 1 4.3%

Texas A&M University System HSC 425 475 50 11.8%

University of North Texas HSC 123 141 18 14.6%

Texas Tech University HSC 469 473 4 0.9%

Sub-Total Public Institutions 4,216 4,433 217 5.1%

Baylor College of Medicine 1,126 1,139 13 1.2%

Total GME Formula 5,342 5,572 230 4.3%

GME -- Formula FundingGME -- Formula Funding

FY 06-07 FY 08-09Dollar Chg FY

06-09

% Change - FY 06-09

Biennium Rate $ 4,679.90 $ 11,268.05 $ 6,588.16 140.8%

Yearly Rate $ 2,339.95 $ 5,634.03

Institution  

UT Southwestern Medical Center $ 5,278,922 $ 13,239,962 $ 7,961,040 150.8%

UT Medical Branch Galveston 2,597,342 6,794,636 4,197,294 161.6%

UT HSC Houston 3,538,001 8,631,328 5,093,327 144.0%

UT HSC San Antonio 2,981,093 7,538,326 4,557,233 152.9%

UT M.D. Anderson Cancer Center 467,990 1,205,682 737,692 157.6%

UT Health Center Tyler 107,638 270,434 162,796 151.2%

Texas A&M University System HSC 1,988,955 5,352,324 3,363,369 169.1%

University of North Texas HSC 575,627 1,588,796 1,013,169 176.0%

Texas Tech University HSC 2,194,871 5,329,788 3,134,917 142.8%

Sub-Total Public Institutions $ 19,730,438 $ 49,951,276 $ 30,220,838 153.2%

Baylor College of Medicine $ 5,269,562 $ 12,834,312 $ 7,564,750 143.6%

Total GME Formula $ 25,000,000 $ 62,785,588 $ 37,785,588 151.1%

GME -- Filled 1GME -- Filled 1stst Yr Positions Yr Positions

210

148

269

44

6

163 161 149165166

Baylor TAMU HSC TTUHSC UT Southwestern UNTHSCUT HSC Tyler UT HSC Houston UTHSC SA UTMB Gal Independent PC

GME -- Filled Total PositionsGME -- Filled Total Positions1147

517

1200

13024

774658

111

655

388507

Baylor TAMU HSC TTUHSC UT Southwestern

UNTHSC UT HSC Tyler UT HSC Houston UTHSC SA

UT MD Anderson Cancer Center UTMB Gal Independent PC

GME “formula” for BCMGME “formula” for BCM

Baylor College of Medicine receives a Baylor College of Medicine receives a “formula” for GME“formula” for GME

Based on the formula for the public Based on the formula for the public HRIs, BCM contracts with the CB to HRIs, BCM contracts with the CB to receive fundsreceive funds

FYs 2008-09 based on equivalent FYs 2008-09 based on equivalent funding methodfunding method

Biennial Amount = $12,834,312 Biennial Amount = $12,834,312

Legislative Session 77th 78th 79th 80th

ProgramFY 2002-

2003FY 2004-

2005FY 2006-

2007FY 2008-

2009

Joint Admissions Medical Program (JAMP) $4,000,000 $3,490,900 $3,316,355 $5,616,355

Statewide Preceptorship Programs $1,941,436 $997,400 $904,289 $904,289

Family Practice Residency Program $20,599,709 $18,383,522 $17,464,310 $17,464,310

Primary Care Residency Program $5,886,460 $5,253,104 $4,990,440 $4,990,440

Graduate Medical Education Program $15,200,000 $3,828,222 $3,636,804 $600,000

Resident Physician Compensation Program $8,070,238 $0 $0 $0

Family Practice Residency Pilot Project $1,974,400 $0 $0 $0

Total $57,672,243 $31,953,148 $30,312,198 $28,981,394

Trusteed ProgramsTrusteed Programs

Texas Targets Primary CareTexas Targets Primary Care

State funding began in 1979State funding began in 1979 FY 2003 state appropriations totaled FY 2003 state appropriations totaled

$28 m to support six programs$28 m to support six programs FY 2004/05 -- 2 programs not funded FY 2004/05 -- 2 programs not funded

($12 m loss to programs)($12 m loss to programs) CB funds targeted at producing more CB funds targeted at producing more

primary care physicians who will stay in primary care physicians who will stay in Texas (aligned with closing the gaps Texas (aligned with closing the gaps and the original Task force on Health and the original Task force on Health Professions)Professions)

CB contracts with medical schools, CB contracts with medical schools, hospitals, and foundationshospitals, and foundations

Trusteed ProgramsTrusteed ProgramsJoint Admissions Medical Program Joint Admissions Medical Program

(JAMP) -- $5.6 m(JAMP) -- $5.6 m

Family Practice Residency -- $8.7 m Family Practice Residency -- $8.7 m Operational GrantsOperational GrantsRural and Public Health RotationsRural and Public Health RotationsFaculty DevelopmentFaculty Development

Physician Education Loan Repayment Physician Education Loan Repayment Program -- $ 1 mProgram -- $ 1 m

What is JAMP?What is JAMP?In 2001, the Texas Legislature created JAMP to In 2001, the Texas Legislature created JAMP to support and encourage highly qualified, economically support and encourage highly qualified, economically disadvantaged students to pursue medical education disadvantaged students to pursue medical education

Students receive both undergraduate and medical Students receive both undergraduate and medical school support through mentoring and scholarshipsschool support through mentoring and scholarships

Students receive a stipend to attend a summer Students receive a stipend to attend a summer internship at one of the Texas medical schools internship at one of the Texas medical schools following their sophomore and junior years of collegefollowing their sophomore and junior years of college

Importantly, JAMP students receive assistance to Importantly, JAMP students receive assistance to prepare for medical school as undergraduates prepare for medical school as undergraduates

Students who satisfy both academic and non-Students who satisfy both academic and non-academic requirements receive a guarantee of academic requirements receive a guarantee of admission to at least one participating Texas medical admission to at least one participating Texas medical school school

JAMP -- Current StatusJAMP -- Current Status80th Texas Legislature increased JAMP 80th Texas Legislature increased JAMP funding by $2,300,000 for the biennium funding by $2,300,000 for the biennium

96 undergraduate students were accepted 96 undergraduate students were accepted into the program in 2008into the program in 2008

284 participating JAMP students in the 284 participating JAMP students in the educational pipelineeducational pipeline

Expanded eligibility to students attending Expanded eligibility to students attending Texas independent general academic Texas independent general academic institutionsinstitutions

2008 2009 2010 (projected) 2011 (projected)

UG Soph UG JRUG SR MS 1MS 2 MS 3MS 4 PGY 1

284

510

380

640

JAMP -- ParticipationJAMP -- Participation

JAMP -- InformationJAMP -- InformationMandate to prepare economically Mandate to prepare economically disadvantaged studentsdisadvantaged students

Funds provided to both undergraduate and Funds provided to both undergraduate and health-related campuseshealth-related campuses

Example of a long-term approach to foster Example of a long-term approach to foster higher education and provide educational higher education and provide educational resources to those who have not resources to those who have not traditionally had ittraditionally had it

National model for other statesNational model for other states

JAMP -- Concerns/IssuesJAMP -- Concerns/Issues

Where will the JAMP MD/DO physicians Where will the JAMP MD/DO physicians train? Will they eventually practice in train? Will they eventually practice in TX?TX?

Residency matching is a national rather Residency matching is a national rather than a state market. than a state market.

This issue will become more important in This issue will become more important in two years, when the first cohort of JAMP two years, when the first cohort of JAMP students graduates from medical school.students graduates from medical school.

JAMP -- InformationJAMP -- Information Efforts to expand program, possibly Efforts to expand program, possibly

to include dental studentsto include dental students

Additional funding needed to expand Additional funding needed to expand programprogram

Need an additional $5 m for the next Need an additional $5 m for the next bienniumbiennium

Family Practice Residency Family Practice Residency ProgramProgram

Established in 1977 by the Texas Established in 1977 by the Texas Legislature to increase the numbers of Legislature to increase the numbers of physicians selecting family practice as physicians selecting family practice as their medical specialty and to encourage their medical specialty and to encourage those physicians to establish their those physicians to establish their practices in rural and underserved practices in rural and underserved communities in Texas communities in Texas

Since its inception, the program has Since its inception, the program has provided funding support for more than provided funding support for more than 6,800 family practice residents, 80 percent 6,800 family practice residents, 80 percent of those practice in Texasof those practice in Texas

Family Practice Residency ProgramsFamily Practice Residency Programs

Waco

Tyler

Temple

Odessa

Dallas

Conroe Austin

McAllen

Lubbock

Houston

El Paso

Baytown

Amarillo

Texarkana

Galveston

Fort Worth

San Antonio

Wichita Falls

Corpus Christi

Bryan

Garland

Harlingen

Family Practice Residency Family Practice Residency ProgramProgram

Family Practice Residency Operational Family Practice Residency Operational Programs – $8,109,148/yearPrograms – $8,109,148/year

Annual grants are provided to 26 residency Annual grants are provided to 26 residency programsprograms

Funding recommendations are made to the Funding recommendations are made to the Commissioner by the statutory 12-member Commissioner by the statutory 12-member Family Practice Residency Advisory Family Practice Residency Advisory Committee.Committee.

The Advisory Committee members serve The Advisory Committee members serve voluntarily and do not receive travel or per voluntarily and do not receive travel or per diem reimbursement for their participation. diem reimbursement for their participation.

Family Practice Residency Family Practice Residency ProgramProgram

Family Practice Faculty Development Family Practice Faculty Development Center – $383,000/yearCenter – $383,000/year

Rural and Public Health Rotations – Rural and Public Health Rotations – $240,000/year$240,000/year 80+ optional one-month rural 80+ optional one-month rural

experiencesexperiences Support for optional experience in public Support for optional experience in public

health setting (2 per residency program)health setting (2 per residency program)

Physician Education Loan Physician Education Loan Repayment Program (PELRP)Repayment Program (PELRP)

Authorized in 1985 to address the state’s critical Authorized in 1985 to address the state’s critical need for primary care physicians in certain state need for primary care physicians in certain state agencies and in rural or economically depressed agencies and in rural or economically depressed areas of the state that are medically underservedareas of the state that are medically underserved

One of the first programs of its kind nationally One of the first programs of its kind nationally and it has served as a model for other programs and it has served as a model for other programs in Texas and other states. in Texas and other states.

Today, 33 other states have loan repayment Today, 33 other states have loan repayment programs to address the problem of inadequate programs to address the problem of inadequate access to health care in certain areas and access to health care in certain areas and populations. Loans are paid after service populations. Loans are paid after service completedcompleted

Medical SpecialtiesMedical Specialties

Family Medicine 40

General Pediatrics 7

Psychiatry 7

General Internal Medicine 4

Emergency Medicine 4

Obstetrics/Gynecology 2

General Practice 1

General Surgery 1

Total 66

PELRP -- Current RecipientsPELRP -- Current Recipients

PELRP – Current RecipientsPELRP – Current Recipients

Health Professional Shortage Area (HPSA)

WHOLE COUNTY 29

GEOGRAPHIC AREA 16

STATE AGENCY 11

POPULATION GROUP 10

  66

What does the State get for What does the State get for its support of GME?its support of GME?

Targeted funding of primary careTargeted funding of primary care Financial commitment over time to support Financial commitment over time to support

training of “needed” physicianstraining of “needed” physicians Funds may be outside of the “control” of Funds may be outside of the “control” of

the traditional administrationthe traditional administration Annual financial reports alert staff to areas Annual financial reports alert staff to areas

of concernof concern Over a long period, gain a better Over a long period, gain a better

understanding of physician practice understanding of physician practice patterns in Texaspatterns in Texas