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As part of its interim report for the current session, the House Select Committee of Health Care Reform (HSCHCR) recommended increased funding for medical education and workforce development to expand the supply of physicians, nurses, and mental health professionals in the state.
Speaking to State of Reform on Tuesday, TMA President Gary Floyd, MD, said the push to expand the provision of physician services to individuals who are underqualified and expediently trained is misguided.
“Most of us did not learn how to take care of patients in medical school,” Floyd said. “We learned it in our postgraduate training, after we graduated medical school. We learned it in our residency training, three to nine years extra, where we were exposed to not just well patients in the clinics, but very, very sick, ill, and injured patients in ICU settings.
We were monitored and watched by any number of faculty physicians who had significantly more experience and in that teaching, in that learning, [the knowledge] is invaluable and helps us in any walk of life. To say, ‘Well I’ve served six months in one or two clinics doing well-patient care,’ that’s not nearly equivalent. Taking care of critically ill and injured patients actually teaches us a lot more about well-care and a lot more about who is well and who is sick, the differentiation between two.”
He nonetheless believes supporting and growing the workforce is a top priority and hopes this year’s session will continue to fund programs that encourage students and doctors to pursue medicine in the state. Floyd said the number of licensed physicians practicing in Texas has kept up with the population growth in recent years, pointing to the record number of doctors, some 7,000, licensed last year.
Despite that growth, Floyd admits there remain challenges to serving rural parts of the state.
Lawmakers will be looking at ways to bridge access through telehealth this session. Bills proposed in both the House and Senate would pilot a program to provide emergency medical services to rural communities through telemedicine.
The Texas Broadband Development Office recently concluded its application process for the federal Affordable Connectivity Outreach grant, which aims to bridge the digital divide under the Infrastructure Act in the most critically unserved areas of Texas. In addition to ongoing rural recruitment and training efforts, telemedicine could play an impactful role in access, according to Floyd.
“If something good came out of COVID, [telemedicine] could be one of the things because before COVID, less than 5% of our physicians did much with telemedicine,” Floyd said. “They did answer phone calls and things like that, but as far as a video conference, most of us had no knowledge of how to do that.
And now over 70% of physicians use this routinely. And I do think that it certainly helps. Post-surgical care: when folks travel to a city 50 to 100 or more miles away, have surgery done, and then are returned home, for them to make that trip back for follow-up sometimes is onerous. Some of that can be done over a telemedicine call.
… telehealth and telemedicine are definitely part of the future of increasing access to medicine.”
Another legislative priority for TMA is women’s reproductive health, especially maternal health. HSCHCR also recommended expanding postpartum coverage from the current 6 months to 12 months.
The focus on maternal health equity remains after key data and recommendations from the joint 2022 Maternal Health and Safety Initiatives Biennial Report revealed severe maternal morbidity rates were disproportionately higher for Black women than other racial groups at 117.3 deaths per 10,000 hospital deliveries, more than double the rate for white women.
“[The report is] disappointing to all of us,” Floyd said. “Since 2020, the numbers have not changed and we can blame some of that on COVID and isolation, but still, there were some things put into place that [state obstetricians] thought would help ameliorate [maternal mortality]. Relooking at those studies, continuing those studies, the academic centers are doing several different approaches, to look more into the diversity part of it. As far as diversity of trainees goes, it’s also being addressed at the residency level.”
Floyd shared his insights on the association’s engagement with policy makers during the interim to ensure the needs and concerns of patients and physicians are addressed during the 88th Legislature.
“We’ve had numerous meetings,” Floyd said. “Our legislative staff and our legal staff, as well as many physicians, have met with numerous committees throughout this interim period. We hope that we have answered the questions that have been posed to us. We hope we’ve given advice that can be utilized, and we feel like that has been accomplished. We’ll see as the bills start rolling in, as they already have.
I can’t tell you what respect I have for all of our representatives, both in the House and the Senate. They don’t get paid a lot to come for 140 days and do what they do, and listen to all types of constituents. We understand, certainly not all agree with our stance, but I do hope when it comes to medical issues and patient care issues, I think that’s where our expertise becomes very valuable. And hopefully we have the relationships built with our legislators that they will seek us out [and] that they will listen to us. So that’s what we’ve tried to accomplish.”