Ascension Seton Doctors: State Should Fund Program Fostering More Primary Care Physicians

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AUSTIN, Texas – (Feb. 20, 2015) – Last week before the Texas Senate Finance Committee and this week before the Texas House Appropriations Committee, Drs. Alejandro Moreno and Ildefonso Ismael Rodriguez testified in favor of restoring state funding to preceptorship programs that match medical students with practicing primary care physicians across the state.

According to Moreno, internal medicine associate director at University Medical Center Brackenridge and associate professor with The University of Texas Dell Medical School, preceptorship programs lost all state funding in 2011. The Texas Chapter of the American College of Physicians continues to run the program, but annual student placements dropped from a high of 240 to to just more than 50.

Rodriguez, chief resident of the UMC Brackenridge’s internal medicine program, echoed concerns raised by Ascension Seton about the need to increase the number of local primary care physicians to ensure healthier communities; reduce health disparities among different communities; improve health outcomes; and lessen dependency on emergency rooms for health care.

Here are somewhat edited versions of their testimony:

Alejandro Moreno, MBBS, MPH, JD, FACP, FCLM

I work training medical students and residents just three blocks from here. I am here today as the president of the Texas Chapter of the American College of Physicians. The college is the second largest medical organization in the country, with 140,000 members. In Texas, it has more than 7,000 members.

I want to ask you to restore funding for the Statewide Preceptorship Program, a program run through the Texas Higher Education Coordinating Board in partnership with the Texas Chapter of the American College of Physicians, the Texas Pediatric Society and the Texas Academy of Family Physicians.

Texas has made gains in the number of physicians over the past years; however, the state continues to lag behind this critical need because the population is growing at an even faster pace (20 percent compared to the eight percent national average).

As a result, Texas has only 68 primary care physicians for every 100,000 people when the national average is 81 per 100,000. The state has more than 115 counties designated primary care shortage areas, of which 19 have only two physicians, 17 have only one physician, and 25 have no physician at all.

Seventy-six counties experienced reductions in the number of primary care physicians in the past 10 years. We need an additional 4,500 primary care physicians by the end of this year to care just for the state’s underserved population.

The foundation of an efficient health care system is the three primary care specialties: internal medicine, family medicine, and pediatrics. Access to primary care physicians produce better health outcomes for less cost.

Small increments, of just 1 percent in the primary care physician workforce have a significant impact – for instance, reducing 500 unnecessary hospital admissions and 3,000 emergency room visits.

The benefits of a strong primary care workforce extend well beyond health outcomes. A primary care physician generates approximately $1.5 million in revenue, $900,000 in payroll and 23 jobs.

The Statewide Preceptorship Program plays an important role in the training pipeline of a primary care physician and is synergistic with other state programs, such as the Joint Admission Medical Program, the Primary Care Residency Funding Program and the loan repayment programs for young physicians. All these programs invest at critical steps along the training of a physician.

The Statewide Preceptorship Program exposes medical students to an early clinical curricular experience in primary care. The General Internal Medicine Statewide Preceptorship program has placed more than 2,522 medical students with practicing internists around the state since the program began two decades ago.

The Preceptorship Programs lost all state funding in 2011. The Texas Chapter of the American College of Physicians continues to run the program; however, we had to make drastic cuts. The program went from a high of 240 student placements per year to just over 50.

There is still significant interest among students to gain this early clinical exposure, although our records indicate that in recent years, we lose up to a third of initial applicants to paid research opportunities. Each dollar invested in Statewide Preceptorship Program returns to the community as it is more likely that those students will practice in one of the primary care specialties and remain in Texas.

We kindly ask this committee to restore the funding for the primary care preceptorship programs in the amount of $4 million per biennium and help us to fill the growing need for primary care physicians in Texas.

Ildelfonso Ismael Rodriquez, MD

I am a member of the American College of Physicians and a chief resident at the internal medicine residency program here in Austin. My grandmother was hospitalized on 9/11 in 2001 with multiple strokes. My previously lucid and independent 94-year-old second mother was suddenly severely handicapped, bedridden and unable to communicate.

I was frustrated with not being able to help her, and I was inspired by those physicians around her trying to do the same. And so, on this day, I decided to become a doctor.

I was born and raised in Edinburg. I attended medical school at the University of Texas Southwestern in Dallas. I had the opportunity to participate in the Preceptorship Program as a medical student. I spent the summer between my first and second year of medical school with Dr. Fadi Torres, a pediatric physician in McAllen.

I learned many things from Dr. Torres, such as the importance of listening to your patients and their relatives; taking care of the patient as a whole; and being compassionate with those who are suffering. But by far, the most important lesson was understanding the key role an internist, pediatrician or family medicine doctor plays in the delivery of health care. For these reasons, Dr. Torres remains a role model for me.

Texas is facing a shortage of primary care physicians, as Dr. Moreno mentioned earlier. One reason behind the shortage is the number of medical students choosing a career in internal medicine, pediatrics or family medicine. Only 18 percent of medical students, for instance, train in internal medicine. However, the rate is 40 percent among those students, like me, who participate in the Statewide Preceptorship Program.

We know the program is effective at doing what is supposed to do: incentivize students to stay in Texas and practice in one of the primary care specialties. I am grateful for the opportunity to participate in the program as a student, because I knew early-on what my future and role in health care would be like.

I believe the program has been successful because of experiences like mine. I knew several years before I participated that I wanted to be a doctor. Going through the preceptorship helped solidify my choice to practice primary care. My goal was in sight and I understood better what I had to do to get there.

How does the Preceptorship Program run? Simply, students are matched with practicing primary care physicians who are members of one of the three primary care specialties across the state. Students learn not only from the practicing physician, but from their staff and team.

How are the funds invested? They are used primarily for student stipends that help defray the costs of associated with relocating during the summer. The funds also pay for the administrative support necessary to match the students with their local mentors. Neither the medical societies nor the mentors profit from the program.

We kindly ask this committee to restore the funding for the Statewide Preceptorship Programs so more students have the same opportunity that I did to learn from practicing physicians in communities across the state caring for patients at all stages of life. Patients like my grandmother. Thank you for your consideration and time.