Health care advocates have for years worried about a shortage of doctors serving rural and low-income Texas communities, but in Austin and the surrounding areas, which have one of the highest doctor-to-patient ratios in the state, there is a different challenge, according to Dr. Jonathan MacClements, assistant dean of graduate medical education at The University of Texas Dell Medical School.

“We really don’t have a physician shortage,” MacClements said. “What we have is a physician distribution issue.”

With the late May opening of the Dell Seton Medical Center at The University of Texas, which serves as a teaching hospital for The University of Texas Dell Medical School, health care educators said they hope new technology and a collaborative, multidisciplinary approach to medical training will offer solutions to address a perceived need for more primary care options statewide and better medical access locally.

“We’re really interested in training the next generation of physicians to focus on overall health,” said Christann Vasquez, the new teaching hospital’s president.

Faster rise in specialists

Texas ranked 41st among U.S. states in 2015 for its ratio of physicians per 100,000 residents, requiring roughly 13,000 more physicians to reach the national average, according to a study from physician consulting firm Merritt Hawkins.

As the state population has grown during the past 20 years, so has the number of doctors holding licenses to practice in the state, according to data from the Texas Medical Board.

However, the statewide growth rate for licensed specialist physicians has risen by 72.55 percent over the past two decades compared to 42.54 percent for primary care physicians, according to the data.

The ratio of licensed primary care doctors to residents varies among Hays, Travis and Williamson counties.[/caption]

Travis County had a 154.66 percent increase in specialists holding licenses between 1997 and 2017 compared to an 81.96 percent increase in primary care doctors during the same time period. As of January the board counted 2,348 doctors licensed as specialists in Travis County and 1,261 licensed in primary care.

Not every licensed doctor may actually be practicing, and some may only work part-time.

Higher pay attracts doctors to pursue specialties, although they require longer training and oftentimes a greater student-debt load, said Dr. Norman Chenven, the founding CEO of Austin Regional Clinic, a multispecialty medical group serving Central Texas.

Specialists also tend to receive better payment for care due to more patients having health insurance, he added.

Chenven said doctor distribution issues are more apparent in areas with high numbers of low-income patients who generally lack adequate health insurance, known as the safety-net population.   

“For the most part, primary care has been a challenge over the last decade or two,” he said

Doctors who work within the safety-net population often treat patients with more complex and chronic health care issues as well as encounter cultural challenges and language barriers, said Dr. Alan Schalscha, chief medical officer for CommUnityCare, which operates federally qualified health centers in Travis County to serve low-income residents who often lack insurance coverage.

In terms of physician numbers, Chenven said Travis, Williamson and Hays counties do not face the types of shortages seen elsewhere in Texas and around the country. But without better distribution, the counties will continue to have issues with people of lower income levels not having the ability to access care, he said.

“If you took all the doctors in these three counties, organized them into an efficient delivery system, you have plenty of physician power,” Chenven said. “Plus, you add to that the nurse practitioners and physician assistants, and you’ve got a lot of medical care that can be delivered.”

Bettering care

One strategy Dell Medical School is using to improve distribution of care is to decentralize the residency training the school does with Seton Healthcare Family, MacClements said.

Dell Medical School recently moved its internal medicine program from the former University Medical Center Brackenridge in downtown Austin to Central Health’s Southeast Health and Wellness Center on Montopolis Drive in Southeast Austin, he said.

The city’s fledgling health district, a concentration of the new medical school and teaching hospital in downtown Austin, has promised to take on health care disparities facing the Travis County community, particularly those dealing with mental health, and reducing the stigma locally of receiving care for such disorders as depression, anxiety and bipolar disorder, according to the medical school’s website. The area should continue to fill out with more health care providers that aim to innovate.

With its technological capabilities and collaborative design, the new Dell Seton Medical Center is also meant to transform the landscape of medical training and health care delivery in Central Texas, said Greg Hartman, chief of external and academic affairs for Seton Healthcare Family.

MacClements said Dell Medical School’s focus is not just looking at increasing the size of its training programs but also changing its overall approach to health care.

“We literally are rethinking everything,” MacClements said.

A primary care physician acts as a point of first contact for a patient. The physician takes responsibility for providing continued, comprehensive care and may oversee referrals to specialists. The following disciplines, which are tracked by the Texas Medical Board, are generally seen as primary care areas.[/caption]