Healthy Vision 2020
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Healthy Vision 2020
Bringing into focus a clear and distinct view of the rest of this decade in Texas health care. Offering a sharp perception of what lies ahead and what we must change to keep us all healthy.
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Rural Physician Training Programs Can Inspire Future Rural Practice

After medical school students spent a summer practicing in a rural community, they were more likely to enter family practice residency training and begin their medical careers in a rural location, according to a recent study.
Texas Medical Association's insight:

Improve rural access to care

 

Physician shortages constitute a special problem in rural areas of the state. The continued urbanization of Texas exacerbates this longstanding problem. Approximately 12 percent of Texans live in rural counties, yet only 10 percent of primary care physicians practice there. In 2011, Texas had 52 primary care physicians per 100,000 population in rural areas versus 72 per 100,000 in urban areas. Physician shortages in rural areas not only hinder access to primary and other specialty care but also lead to potential losses in the local economy, difficulties attracting new businesses, and diminished quality of life for residents. A number of factors hurt physicians’ ability to open and sustain rural practices, including heavy concentration of Medicare, Medicaid, and uninsured patients; professional isolation; and high debt after medical school.

 

Physician practices in rural Texas contribute to the local economy in three critical ways.

 

• They employ administrative and clinical staff to help care for patients. On average, a solo primary care physician in a rural area will employ three staff: a registered nurse, a medical technician or licensed vocational nurse, and a receptionist/billing clerk.

• They contribute revenue to and generate additional employment at local hospitals through inpatient admissions and outpatient services.

• They generate essential tax revenues for their communities.

 

If rural physician practices and rural economies are to thrive, physicians need incentives to practice in those areas. Medical school programs with rural-focused curricula increase the supply of primary care doctors in underserved areas as do loan forgiveness programs like the National Health Service Corps and the State Physician Education Loan Repayment Program (SPELRP).

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Doctors, non-physicians battle over medical turf

Doctors, non-physicians battle over medical turf | Healthy Vision 2020 | Scoop.it
SACRAMENTO -- A series of bills to expand the roles of nurse practitioners and other healthcare professionals has set off a turf war with doctors over what non-physicians can and can’t do in medical practices.
Texas Medical Association's insight:

Texas has a large, growing population that is growing sicker and needs more and better-coordinated health care services. Unfortunately, Texas — even more than most of the rest of the country — needs more physicians and other health care professionals. Although our 2003 liability reforms have brought an influx of new physicians, the current supply won’t be able to keep up with the demand, especially with expanded insurance coverage from the Patient Protection and Affordable Care Act (PPACA). We need more physicians and other health care professionals working in all parts of the state, especially in rural and border Texas. We need to invest more in our medical schools and graduate medical education training programs. We should not fool ourselves into thinking that allied health professionals — who haven’t gone to medical school — can fill the gap as independent practitioners. Instead, we need to work on building physician-led health care teams that can safely meet the diverse needs of the Texas population.

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Health Care Panel, Lacking Budget, Is Left Waiting

Health Care Panel, Lacking Budget, Is Left Waiting | Healthy Vision 2020 | Scoop.it
A commission created to investigate the shortage of health care professionals has never met in two and a half years because it has no money from Congress or the administration.
Texas Medical Association's insight:

Ensure an Adequate Health Care Workforce

 

Texas has a large, growing population that is growing sicker and needs more and better-coordinated health care services. Unfortunately, Texas — even more than most of the rest of the country — needs more physicians and other health care professionals. Although our 2003 liability reforms have brought an influx of new physicians, the current supply won’t be able to keep up with the demand, especially with expanded insurance coverage from the Patient Protection and Affordable Care Act (PPACA). We need more physicians and other health care professionals working in all parts of the state, especially in rural and border Texas. We need to invest more in our medical schools and graduate medical education training programs. We should not fool ourselves into thinking that allied health professionals — who haven’t gone to medical school — can fill the gap as independent practitioners. Instead, we need to work on building physician-led health care teams that can safely meet the diverse needs of the Texas population.

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Where Have All the Primary Care Doctors Gone?

Where Have All the Primary Care Doctors Gone? | Healthy Vision 2020 | Scoop.it
The one in five young doctors who still planned on a career in general medicine at the completion of their training may help to provide the answer to the current primary care shortage, a new study found.
Texas Medical Association's insight:

Make sure enough physicians and other health care professionals are working in all parts of Texas Imagine life without access to a physician, for yourself, your aging parent, or your child. Without access to a physician, life-enhancing and lifesaving medical care is virtually impossible. Physicians are the nucleus of the formula needed to achieve the vision of the Texas Medical Association: To improve the health of all Texans. Access to health care depends on the availability of physicians with the skills to match the needs of the state’s population.

 

Texas has a shortage of both primary care physicians and other specialists. Texas ranks behind all the other most-populous states in the number of patient care physicians per capita. To evaluate this shortage across specialties, we have devised a metric that compares the number of Texas physicians per 100,000 population with the U.S. average. We call this the “Texas Specialty Ratio.” The closer this ratio is to 100 percent for a given specialty, the closer Texas is to the national average.

Texas has fewer physicians per capita than the national average for 36 out of 40 medical specialty groups.Texas needs both more primary care physicians and other specialists. A number of specialties have acute shortages.Psychiatry and child/adolescent psychiatry are among the specialties with the lowest Texas Specialty Ratios.

We also must look to the Texas of tomorrow to evaluate the kinds of physicians we will need the most. Texas ranks fourth among the six most-populous states in medical students and resident physicians per capita. Texas continues to be overly dependent on other states and countries for supplying new physicians. Last year, nearly 75 percent of newly licensed physicians graduated from medical schools outside of Texas. [13]We are thus subject to the vagaries of external forces that influence the numbers of physicians we can recruit. To meet future physician demands, Texas needs a stable, high-quality medical education system to produce homegrown physicians. Similarly, we must provide a reasonable opportunity for Texas medical school graduates to obtain their residency training in the state without being forced to leave home. Multiple studies confirm that physicians who complete both medical school and residency training in the state are three times more likely to practice here.

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Disruptive Remedies for the Physician Shortage

Disruptive Remedies for the Physician Shortage | Healthy Vision 2020 | Scoop.it

Extended roles for non-physicians is a direction toward which many hospitals and health systems are moving.

 

TMA says: Texas has a large, growing population that is growing sicker and needs more and better-coordinated health care services. Unfortunately, Texas – even more than most of the rest of the country – needs more physicians and other health care professionals. Although our 2003 liability reforms have brought an influx of new physicians, the current supply won’t be able to keep up with the demand. We need more physicians and other health care professionals working in all parts of the state, especially in rural and border Texas. We need to invest more in our medical schools and graduate medical education training programs. We should not fool ourselves into thinking that allied health professionals – who haven’t gone to medical school – can fill the gap as independent practitioners. Instead, we need to work on building physician-led health care teams that can safely meet the diverse needs of the Texas population. 

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A Looming U.S. Doctor Shortage

A Looming U.S. Doctor Shortage | Healthy Vision 2020 | Scoop.it

Teaching hospitals say they need $9 billion, or Obamacare will fail...

 

The United States is in the midst of a medical education building campaign. Texas is among the leaders, with plans to increase enrollments to the nationally recommended 30-percent growth level by 2015. Texas is setting records in the number of medical school graduates, reaching 1,458 in 2011, a net gain of 80 (6 percent) from the preceding year. The number of graduates is forecasted to peak at more than 1,700 this decade.

 

Texas needs continued and stable state support for both critical parts of a physician’s education and training to help cultivate future generations of Texas physicians, ensuring stable access to health care for all Texans.

 

In 2011, almost half (48 percent) of Texas medical school graduates left the state for residency training.Texas invests almost $200,000 in a medical student’s four years of education. Texas physicians are concerned about the state’s ability to protect that growing investment with enough graduate medical education (GME) positions to meet demand. For 2011, the annual National Resident Matching Program offered 1,476 entry-level GME positions in Texas. By comparison, 1,445 students graduated from Texas medical schools in 2011. The Texas Higher Education Coordinating Board recommends a ratio of 1.1 entry-level GME positions for each Texas medical school graduate. To meet this goal, Texas would have needed 1,590 entry-level training positions in 2011, or 114 additional positions.


 

 

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Primary Care for the 21st Century: Ensuring a Quality, Physician-led Team for Every Patient -- Primary Care for the 21st Century: Ensuring a Quality, Physician-led Team for Every Patient -- America...

Primary Care for the 21st Century: Ensuring a Quality, Physician-led Team for Every Patient -- Primary Care for the 21st Century: Ensuring a Quality, Physician-led Team for Every Patient -- America... | Healthy Vision 2020 | Scoop.it

The United States can solve the primary care physician shortage by fully implementing physician-led patient-centered medical homes.

 

Texas has a fast-growing population and needs to work toward a 21st century health care workforce. More than ever, caring for larger panels of patients – particularly in primary care medical homes – will involve the skills of many different practitioners. Central to this concept is that these physician-led teams will utilize a number of health care professionals, each bringing important skill sets and training to patient care. Physicians will continue to provide patient care services, but they also will be called upon to manage the team’s care for larger populations, out of necessity and for essential coordination.

 

Team care will require cooperation and collaboration among all professionals, with a focus on quality, measureable outcomes, and efficient utilization of resources. It will be essential that the patient receive the right care, at the right time, by the right professional, in the right venue.

 

The physician is the highest-trained team member. It therefore falls to the physician – as both provider of care and manager of services delivered by others on the team – to supervise, implement science-driven and objective treatment protocols, coordinate the services of other professionals as well as medical specialists, and ultimately remain accountable for each patient’s care.

 

Integrating the talents of a diverse medical team under physician leadership will be one of the key challenges in the coming decade. Without physician direction, supervision, and management (or if the system evolves to accommodate teams led by practitioners with lesser training), medical care will trend toward even more fractured care, higher-than-necessary utilization, and creeping inefficiencies. This will lead to even higher costs, duplications of services, and lower-quality patient care. These inefficiencies in turn will hamper efforts to improve access to care.

 

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The doctor won’t be seeing you now

The doctor won’t be seeing you now | Healthy Vision 2020 | Scoop.it

Next time you go for a checkup or medical procedure, bear in mind: There’s a good chance the person writing that prescription—or holding that scalpel—never went to medical school.

 

We need more physicians and other health care professionals working in all parts of the state, especially in rural and border Texas. We need to invest more in our medical schools and graduate medical education training programs. We should not fool ourselves into thinking that allied health professionals – who haven’t gone to medical school – can fill the gap as independent practitioners. Instead, we need to work on building physician-led health care teams that can safely meet the diverse needs of the Texas population 

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Health-Care Reform and the 'Doctor Shortage'

Health-Care Reform and the 'Doctor Shortage' | Healthy Vision 2020 | Scoop.it

How many doctors are needed to serve the population, and what the impact of health care reform would be on that, are much debated but hard to measure, an economist writes

 

Texas has a large, growing population that is growing sicker and needs more and better-coordinated health care services. Unfortunately, Texas – even more than most of the rest of the country – needs more physicians and other health care professionals. .

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Too Few Doctors in Many U.S. Communities

Too Few Doctors in Many U.S. Communities | Healthy Vision 2020 | Scoop.it

Even as the new health care law expands insurance coverage, another problem faces many areas of the country: a lack of physicians, particularly primary care ones.

 

Texas has a large, growing population that is growing sicker and needs more and better-coordinated health care services. Unfortunately, Texas – even more than most of the rest of the country – needs more physicians and other health care professionals. Although our 2003 liability reforms have brought an influx of new physicians, the current supply won’t be able to keep up with the demand. We need more physicians and other health care professionals working in all parts of the state, especially in rural and border Texas. We need to invest more in our medical schools and graduate medical education training programs. We should not fool ourselves into thinking that allied health professionals – who haven’t gone to medical school – can fill the gap as independent practitioners. Instead, we need to work on building physician-led health care teams that can safely meet the diverse needs of the Texas population. 

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The Gulf Between Doctors and Nurse Practitioners

The Gulf Between Doctors and Nurse Practitioners | Healthy Vision 2020 | Scoop.it
Nurse practitioners believe that they can lead primary care practices and admit patients to a hospital and that they deserve to earn the same amount as doctors for the same work. Physicians disagree.
Texas Medical Association's insight:

Promote physician-led team care

 

Texas has a fast-growing population and needs to work toward a 21st century health care workforce. More than ever, caring for larger panels of patients — particularly in primary care medical homes — will involve the skills of many different practitioners. Central to this concept is that these physician-led teams will utilize a number of health care professionals, each bringing important skill sets and training to patient care. Physicians will continue to provide patient care services, but they also will be called upon to manage the team’s care for larger populations, out of necessity and for essential coordination.

 

Team care will require cooperation and collaboration among all professionals, with a focus on quality, measureable outcomes, and efficient utilization of resources. It will be essential that the patient receive the right care, at the right time, by the right professional, in the right venue.

 

The physician is the highest-trained team member. It therefore falls to the physician — as both provider of care and manager of services delivered by others on the team — to supervise, implement science-driven and objective treatment protocols, coordinate the services of other professionals as well as medical specialists, and ultimately remain accountable for each patient’s care.

 

Integrating the talents of a diverse medical team under physician leadership will be one of the key challenges in the coming decade. Without physician direction, supervision, and management (or if the system evolves to accommodate teams led by practitioners with lesser training), medical care will trend toward even more fractured care, higher-than-necessary utilization, and creeping inefficiencies. This will lead to even higher costs, duplications of services, and lower-quality patient care. These inefficiencies in turn will hamper efforts to improve access to care.

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Match Day: More medical graduates entering primary care

Match Day: More medical graduates entering primary care | Healthy Vision 2020 | Scoop.it
The number of medical students committing to primary care rather than specialties increased for the fourth straight year in the largest 'match program'' in history, a report says.
Texas Medical Association's insight:

Make sure enough physicians and other health care professionals are working in all parts of Texas

 

Imagine life without access to a physician, for yourself, your aging parent, or your child. Without access to a physician, life-enhancing and lifesaving medical care is virtually impossible. Physicians are the nucleus of the formula needed to achieve the vision of the Texas Medical Association: To improve the health of all Texans. Access to health care depends on the availability of physicians with the skills to match the needs of the state’s population.

 

Texas has a shortage of both primary care physicians and other specialists. Texas ranks behind all the other most-populous states in the number of patient care physicians per capita. To evaluate this shortage across specialties, we have devised a metric that compares the number of Texas physicians per 100,000 population with the U.S. average. We call this the “Texas Specialty Ratio.” The closer this ratio is to 100 percent for a given specialty, the closer Texas is to the national average.

 

• Texas has fewer physicians per capita than the national average for 36 out of 40 medical specialty groups.

• Texas needs both more primary care physicians and other specialists. A number of specialties have acute shortages.

• Psychiatry and child/adolescent psychiatry are among the specialties with the lowest Texas Specialty Ratio.

 

We also must look to the Texas of tomorrow to evaluate the kinds of physicians we will need the most. Texas ranks fourth among the six most-populous states in medical students and resident physicians per capita. Texas continues to be overly dependent on other states and countries for supplying new physicians. Last year, nearly 75 percent of newly licensed physicians graduated from medical schools outside of Texas.We are thus subject to the vagaries of external forces that influence the numbers of physicians we can recruit. To meet future physician demands, Texas needs a stable, high-quality medical education system to produce homegrown physicians. Similarly, we must provide a reasonable opportunity for Texas medical school graduates to obtain their residency training in the state without being forced to leave home. Multiple studies confirm that physicians who complete both medical school and residency training in the state are three times more likely to practice here.

 

Because the human body is complex, the mastery of medical care is correspondingly complex, requiring a lengthy educational and training pipeline. Following college, physicians traditionally complete a four-year medical school education, followed by specialty training in residency programs for three to eight additional years, depending on the specialty.

 

The United States is in the midst of a medical education building campaign. Texas is among the leaders, with plans to increase enrollments to the nationally recommended 30-percent growth level by 2015. Texas is setting records in the number of medical school graduates, reaching 1,458 in 2011, a net gain of 80 (6 percent) from the preceding year.  The number of graduates is forecasted to peak at more than 1,700 this decade.

 

Texas needs continued and stable state support for both critical parts of a physician’s education and training to help cultivate future generations of Texas physicians, ensuring stable access to health care for all Texans. 

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Battles Erupt Over Filling Doctors' Shoes

Battles Erupt Over Filling Doctors' Shoes | Healthy Vision 2020 | Scoop.it
As physician assistants and other midlevel health professionals fill growing gaps in primary health care, turf battles are erupting in many states over what they can and can't do in medical practices.
Texas Medical Association's insight:

What’s your vision of scope-of-practice expansion? Better team-based care under the supervision of a physician? Or potentially unsafe independent practice for allied health practitioners? TMA supports the former and vehemently opposes the later.

 

Texas law clearly defines the practice of medicine and the educational qualifications necessary to diagnose, independently prescribe, and direct patient care — and to be held accountable for that care. Now, and in the future, physicians and other professionals will practice in teams to provide comprehensive patient care, and these patient-focused teams must be physician-led to ensure quality, continuity, and efficiency in care.

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Thinly spread primary-care doctors face surge of patients from health law | Dallas-Fort Worth Business News - News for Dallas, Texas - The Dallas Morning News - The Dallas Morning News

Thinly spread primary-care doctors face surge of patients from health law | Dallas-Fort Worth Business News - News for Dallas, Texas - The Dallas Morning News - The Dallas Morning News | Healthy Vision 2020 | Scoop.it

Both Texas and the U.S. will need more family physicians to care for millions of newly insured flowing into the health care system in 2014.

 

TMA Says:

Texas has a large, growing population that is growing sicker and needs more and better-coordinated health care services. Unfortunately, Texas – even more than most of the rest of the country – needs more physicians and other health care professionals. Although our 2003 liability reforms have brought an influx of new physicians, the current supply won’t be able to keep up with the demand, especially if the Patient Protection and Affordable Care Act (PPACA) withstands constitutional scrutiny. We need more physicians and other health care professionals working in all parts of the state, especially in rural and border Texas. We need to invest more in our medical schools and graduate medical education training programs. We should not fool ourselves into thinking that allied health professionals – who haven’t gone to medical school – can fill the gap as independent practitioners. Instead, we need to work on building physician-led health care teams that can safely meet the diverse needs of the Texas population.

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There may be way more medical school graduates than residency positions by 2015

There may be way more medical school graduates than residency positions by 2015 | Healthy Vision 2020 | Scoop.it

While medical schools have increased their medical school positions by about 30%, residency slots have increased at only 8%. Future doctors may have to pay for their residency if these numbers don't balance out.

 

Texas continues to be overly dependent on other states and countries for supplying new physicians. Last year, nearly 75 percent of newly licensed physicians graduated from medical schools outside of Texas.[i] We are thus subject to the vagaries of external forces that influence the numbers of physicians we can recruit. To meet future physician demands, Texas needs a stable, high-quality medical education system to produce homegrown physicians. Similarly, we must provide a reasonable opportunity for Texas medical school graduates to obtain their residency training in the state without being forced to leave home. Multiple studies confirm that physicians who complete both medical school and residency training in the state are three times more likely to practice here.


[i] Texas Medical Board. 2011. Available at http://www.tmb.state.tx.us/. ; Accessed April 2012.

 

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PAs and FPs join together to increase the primary care workforce - Journal of the American Academy of Physician Assistants

PAs and FPs join together to increase the primary care workforce - Journal of the American Academy of Physician Assistants | Healthy Vision 2020 | Scoop.it

"Will the existing primary care workforce be able to care for the extra 50 million people who will gain access to health care..."

 

Texas has a fast-growing population and needs to work toward a 21st century health care workforce. More than ever, caring for larger panels of patients – particularly in primary care medical homes – will involve the skills of many different practitioners. Central to this concept is that these physician-led teams will utilize a number of health care professionals, each bringing important skill sets and training to patient care. Physicians will continue to provide patient care services, but they also will be called upon to manage the team’s care for larger populations, out of necessity and for essential coordination.

 

Team care will require cooperation and collaboration among all professionals, with a focus on quality, measureable outcomes, and efficient utilization of resources. It will be essential that the patient receive the right care, at the right time, by the right professional, in the right venue.

 

The physician is the highest-trained team member. It therefore falls to the physician – as both provider of care and manager of services delivered by others on the team – to supervise, implement science-driven and objective treatment protocols, coordinate the services of other professionals as well as medical specialists, and ultimately remain accountable for each patient’s care.

 

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The Healthy Benefits of Texas Medical Liability Reform « D Healthcare Daily

The Healthy Benefits of Texas Medical Liability Reform « D Healthcare Daily | Healthy Vision 2020 | Scoop.it

It’s clockwork. Nine years ago this week, Texas voters approved our desperately needed medical liability reforms. Just like every other year at this time, the trial lawyers’ propaganda machine is once again trying to convince Texans to ignore the improvements they’re seeing all around them.

I’m pleased to report on some new research that soundly contradicts the naysayers’ rhetoric.

 

In our generation, Texas has taken no more important step to strengthen our health care delivery system than passing the 2003 medical liability reforms. The 2003 law swiftly ended an epidemic of lawsuit abuse, brought thousands of sorely needed new physicians to Texas, and encouraged the state’s shell-shocked physicians to return to caring for patients with high-risk diseases and injuries. As recently reported in The New York Times,[i]however, tort reform is a never-ending political and legislative maneuver in Texas. We cannot relax our guard against direct attacks on the 2003 law, attempts to weaken the Texas Medical Board, nor cynical schemes to turn Texans’ final days into lawsuit battlegrounds


[i] Ramsey, Ross. Fight Over Lawsuits Now Shapes State Politics. The Texas Tribune. March  2012 Available at. http://www.nytimes.com/2012/03/25/us/in-texas-trial-lawyers-and-a-pro-business-group-shape-politics-ross-ramsey.html. Accessed April 2012.

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Doctor Shortage May Swell to 130,000 With Cap on Residency Positions

Doctor Shortage May Swell to 130,000 With Cap on Residency Positions | Healthy Vision 2020 | Scoop.it

With a shortage of doctors in the U.S. already and millions of new patients set to gain coverage under President Barack Obama’s health-care overhaul, American medical schools are struggling to close the gap.

 

TMA supports:

Preserve and protect state support for undergraduate medical education and the cultivation of the future generation of Texas physicians, thus ensuring stable access to health care for all Texans. Support and develop new GME programs in the specialties that best reflect the state’s health care needs. Support incentives for hospitals and other community-based agencies to develop residency programs in the specialties most needed. Direct the Texas Higher Education Coordinating Board to coordinate the availability of graduate medical education training positions so that Texas can retain our graduates for residency training. Sponsor research to identify and promote innovations in training primary care residents for practice in Texas, and to address the factors that influence why few U.S. medical school graduates select this training.

 

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Health care act is expected to magnify Texas doc shortage

Health care act is expected to magnify Texas doc shortage | Healthy Vision 2020 | Scoop.it

Health care providers scrambling to find more nurses are calling Novak, a vice dean at the UTHSC's School of Nursing, asking to hire recent graduates or even partner with current students so they can work part-time while finishing their classes.

 

Physicians must be the backbone of such a complex system of care if it is to be cost-effective. Otherwise, the state’s efforts to increase preventive care, improve medically necessary treatment for the chronically ill, and reduce inappropriate emergency department utilization will falter. Physicians also play an important role in helping develop and partnering with the public health system. This partnership can enhance local coordination of care, disease surveillance, access, and health promotion.

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A Doctor Shortage Means Less Access

A Doctor Shortage Means Less Access | Healthy Vision 2020 | Scoop.it

Although our 2003 liability reforms have brought an influx of new physicians, the current supply won’t be able to keep up with the demand, especially if the Patient Protection and Affordable Care Act (PPACA) withstands constitutional scrutiny. We need more physicians and other health care professionals working in all parts of the state, especially in rural and border Texas. We need to invest more in our medical schools and graduate medical education training programs. We should not fool ourselves into thinking that allied health professionals – who haven’t gone to medical school – can fill the gap as independent practitioners. Instead, we need to work on building physician-led

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