Thecb April 8 2008 Hcpc Gme Stakeholder Forum
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Thecb April 8 2008 Hcpc Gme Stakeholder Forum

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Thecb April 8 2008 Hcpc Gme Stakeholder Forum Thecb April 8 2008 Hcpc Gme Stakeholder Forum Presentation Transcript

  • Texas Higher Education Coordinating Board Graduate Medical Education State Funding Stacey Silverman, PhD April 8, 2008
  • Health-Related Institution
    • Higher education institution, typically degree-granting that educates and trains health care workforce
    • A majority (8 of 10) Texas health-related institutions include a medical school and another health professional school (e.g., allied health, nursing, pharmacy).
    • Two institutions are considered health-related, but do not have a medical school: UTMD Anderson Medical Center and UT Health Center at Tyler.
  • Medical Schools
    • Texas has 8 medical schools (7 public and 1 independent)
    • Medical schools are located in large metropolitan areas
    • Texas graduates 1,300 physicians annually
    Regional Academic Health Centers Other Health-Related Institutions
  • Years of Required GME
    • 3 Years:
    • Family Medicine, General Internal Medicine, General Pediatrics
    • 4 Years:
    • Obstetrics/Gynecology, Otolaryngology, Psychiatry, Radiation Oncology
    • 5 Years:
    • General Surgery, Neurological Surgery, Orthopedic Surgery
  • GME -- Residency Programs
  • GME -- Formula Funding Number 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 Funding FY 06-07 FY 08-09 Dollar 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 1 st Yr Positions
  • GME -- Filled Total Positions
  • GME “formula” for BCM
    • Baylor College of Medicine receives a “formula” for GME
    • Based on the formula for the public HRIs, BCM contracts with the CB to receive funds
    • FYs 2008-09 based on equivalent funding method
    • Biennial Amount = $12,834,312
  • Trusteed Programs Legislative Session 77th 78th 79th 80th Program FY 2002-2003 FY 2004-2005 FY 2006-2007 FY 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
  • Texas Targets Primary Care
    • State funding began in 1979
    • FY 2003 state appropriations totaled $28 m to support six programs
    • FY 2004/05 -- 2 programs not funded ($12 m loss to programs)
    • CB funds targeted at producing more primary care physicians who will stay in Texas (aligned with closing the gaps and the original Task force on Health Professions)
    • CB contracts with medical schools, hospitals, and foundations
  • Trusteed Programs
    • Joint Admissions Medical Program
    • (JAMP) -- $5.6 m
    • Family Practice Residency -- $8.7 m
    • Operational Grants
    • Rural and Public Health Rotations
    • Faculty Development
    • Physician Education Loan Repayment Program -- $ 1 m
  • What is JAMP?
    • In 2001, the Texas Legislature created JAMP to support and encourage highly qualified, economically disadvantaged students to pursue medical education
    • Students receive both undergraduate and medical school support through mentoring and scholarships
    • Students receive a stipend to attend a summer internship at one of the Texas medical schools following their sophomore and junior years of college
    • Importantly, JAMP students receive assistance to prepare for medical school as undergraduates
    • Students who satisfy both academic and non-academic requirements receive a guarantee of admission to at least one participating Texas medical school
  • JAMP -- Current Status
    • 80th Texas Legislature increased JAMP funding by $2,300,000 for the biennium
    • 96 undergraduate students were accepted into the program in 2008
    • 284 participating JAMP students in the educational pipeline
    • Expanded eligibility to students attending Texas independent general academic institutions
  • JAMP -- Participation
  • JAMP -- Information
    • Mandate to prepare economically disadvantaged students
    • Funds provided to both undergraduate and health-related campuses
    • Example of a long-term approach to foster higher education and provide educational resources to those who have not traditionally had it
    • National model for other states
  • JAMP -- Concerns/Issues
    • Where will the JAMP MD/DO physicians train? Will they eventually practice in TX?
    • Residency matching is a national rather than a state market.
    • This issue will become more important in two years, when the first cohort of JAMP students graduates from medical school.
  • JAMP -- Information
    • Efforts to expand program, possibly to include dental students
    • Additional funding needed to expand program
    • Need an additional $5 m for the next biennium
  • Family Practice Residency Program
    • Established in 1977 by the Texas Legislature to increase the numbers of physicians selecting family practice as their medical specialty and to encourage those physicians to establish their practices in rural and underserved communities in Texas
    • Since its inception, the program has provided funding support for more than 6,800 family practice residents, 80 percent of those practice in Texas
  • Family Practice Residency Programs
  • Family Practice Residency Program
    • Family Practice Residency Operational Programs – $8,109,148/year
    • Annual grants are provided to 26 residency programs
    • Funding recommendations are made to the Commissioner by the statutory 12-member Family Practice Residency Advisory Committee.
    • The Advisory Committee members serve voluntarily and do not receive travel or per diem reimbursement for their participation.
  • Family Practice Residency Program
    • Family Practice Faculty Development Center – $383,000/year
    • Rural and Public Health Rotations – $240,000/year
      • 80+ optional one-month rural experiences
      • Support for optional experience in public health setting (2 per residency program)
  • Physician Education Loan Repayment Program (PELRP)
    • Authorized in 1985 to address the state’s critical need for primary care physicians in certain state agencies and in rural or economically depressed areas of the state that are medically underserved
    • One of the first programs of its kind nationally and it has served as a model for other programs in Texas and other states.
    • Today, 33 other states have loan repayment programs to address the problem of inadequate access to health care in certain areas and populations. Loans are paid after service completed
  • PELRP -- Current Recipients Medical 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 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 its support of GME?
    • Targeted funding of primary care
    • Financial commitment over time to support training of “needed” physicians
    • Funds may be outside of the “control” of the traditional administration
    • Annual financial reports alert staff to areas of concern
    • Over a long period, gain a better understanding of physician practice patterns in Texas