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,” he said. “What we have is a physician distribution issue.”
With the 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 address a perceived need for more primary care options statewide.
“We’re interested in training the next generation of physicians to focus on overall health,” said Christann Vasquez, the 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 13,000 more physicians to reach the national average, according to a study by 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.
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 the 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, and specialists tend to receive better payment for care due to more patients having health insurance, said Dr. Norman Chenven, CEO of Austin Regional Clinic, a multispecialty medical group serving Central Texas.
Chenven said doctor distribution issues are more apparent in areas with high numbers of low-income patients who 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 health centers in Travis County to serve low-income residents.
“If providers don’t have a passion for the mission, they burn out of the safety-net population quickly,” he said.
In terms of physician numbers, Chenven said Travis, Williamson and Hays counties do not face the types of shortages seen elsewhere in Texas. 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.”
Medical providers such as Baylor Scott & White Health have made efforts to research and evaluate ways to serve all areas of the Austin community, including what type of health care resources are needed at each of its location, said Jay Fox, Baylor Scott & White Health regional president.
“[Baylor Scott & White’s] mission to create a healthier population in Texas by serving more people [begins] with its well-positioned primary care clinics and [spans] to its full-service community hospitals,” he said.
The new Baylor Scott & White primary care clinic in Westlake, located at 1001 Westbank Drive, West Lake Hills, is an example of how expansion can result in better coverage for patients in the area, Fox said.
Spokesperson Deke Smith said services at many Baylor Scott & White locations develop over time, and additional services can be introduced months or years after a clinic or hospital opens, once a need is identified.
BETTERING CARE
One strategy Dell Medical School is using to improve its 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 in Southeast Austin, he said.
With its technological capabilities and collaborative design, the new Dell Seton Medical Center is 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.
NURSES SEEK GREATER ROLE
For many years, Texas nurse practitioners have sought to expand their role in primary care, arguing that doing so could help alleviate doctor shortages or distribution issues, particularly in low-income or rural communities.
Two bills filed in the 85th Texas Legislature this year—House Bill 1415, filed by Rep. Stephanie Klick, R-Fort Worth, and Senate Bill 681, filed by Sen. Kelly Hancock, R-North Richland Hills—proposed to remove state regulations that allow nurse practitioners to treat and write prescriptions for patients but only if nurse practitioners first sign contracts with doctors.
Groups backing the bills, such as the Texas Nurse Practitioners, the Texas Nurses Association and the AARP, argue that doing away with contracts would encourage nurse practitioners to stay in Texas. They argue Texas-based nurse practitioners have a competitive disadvantage with their counterparts in other states due to the costs of maintaining such contracts.
Opponents of the effort, including the Texas Medical Association, argue that nurse practitioners play important roles in health care, but the lengthier training and expertise required of doctors make contracts necessary to keep patients safe.
Both bills were left pending in committee at the end of the Legislature’s regular session in May.
Nicholas Cicale and Emily Donaldson contributed to this story.
