Carlos Guerra: Texas must invest now in training its health-care workforce

Web Posted: 03/29/2005 12:00 AM CST
San Antonio Express-News

While state leaders are haggling over a tight budget, University of Texas Chancellor Mark Yudof — whose system trains two-thirds of the state's medical students and many of its nurses — is focusing on medical workforce issues that could overwhelm us.

"The two biggest challenges we face are the shortage of physicians and nurses and the escalating cost of uncompensated care," Yudof says.

"Texas needs 34,000 more registered nurses to catch up to the national average and (we need to) increase the number of residency positions for our medical graduates to increase the number of physicians practicing in Texas."

Robin Fromin, dean of the nursing school at the University of Texas Health Science Center in San Antonio, says that the national nursing shortage is worse in Texas and is critical along the Texas-Mexico border.

Among the factors feeding this shortage is that with greater career options, many women are pursuing other professions. Men are only 9 percent of nurses, and women tend to enter nursing later than people start other careers and also retire younger.

Scarcity of qualified nursing-school applicants is not the problem in training new nurses.

"We turned down 4,000 qualified applicants last year," Yudof says, "but we have no room because the appropriations are not there."

As for the physician shortage, neither Yudof nor Dr. Francisco Cigarroa, president of the Health Science Center, believes Texas needs to dramatically expand its medical school capacity as much as it needs to expand doctors' postgraduate training opportunities, or its residency slots.

"When you look to cost-effective ways to address medical workforce shortage issues, residency expansion is an important tool," Cigarroa says. "But it's hard now to get federal funding for that because of decisions made in the past."

A federal misdiagnosis in the early 1990s concluded that there was an overabundance of physicians, and Congress responded by ending the creation of residency positions beyond those that existed in 1996. Since then, hospital support of residents also has declined.

What's more, many of Texas' existing residency slots go unfilled because they are in specialties graduates don't wish to pursue, while slots in very popular specialties — like Texas' one emergency medicine residency — are dramatically oversubscribed. A costly out-migration of Texas' medical graduates is the net result — and each costs almost $400,000 to train.

"Less than 60 percent of the doctors that attend medical schools in this state stay in Texas," Yudof says, "and a large reason for that is that we have a relative paucity of residencies in the state."

Cigarroa says they tend not to return to Texas: "Two-thirds will end up practicing in the environment where they developed their network ... or they will fall in love with someone there and stay to raise a family."

State-funded creation of new residency slots will also help solve the growing problem of adequately caring for uninsured patients.

"It is a highly efficient way to offer high-quality care to people who do not have insurance if they are treated by residents, which is much less expensive than having them treated by faculty physicians and others," Yudof points out.

"And obviously the name of the game is to keep them out of emergency rooms," he says, "and to treat them in other settings where you can control the costs."

But will state leaders see the wisdom of such investments now?

To contact Carlos Guerra, call (210) 250-3545 or e-mail