November 18, 2007
The rural doctor shortage

Rural Texas has a severe shortage of doctors.

Kent County has not had a doctor in 53 years.
"The last one we had died in 1954," County Judge Jim C. White said matter-of-factly. "When we need medical care we go to Lubbock or Abilene or to the district county hospital in (neighboring) Fisher County."

The community of 734 residents, down from 859 in the 2000 Census, is not the only county in West Texas without a physician.

Twenty-seven other counties in the region do not have a physician, said Dr. Steven Berk, dean of the School of Medicine at Texas Tech University Health Sciences Center.

"It is definitely a very critical problem," said Berk, who is interim vice president of the F. Marie Hall Institute for Rural and Community Health at Health Sciences Center. "We have a shortage of doctors in the United States but it is more severe in West Texas."

The Office of Rural Community Affairs is aware of the severity of the physician shortage. That's why ORCA is offering stipends of up to $15,000 to physicians willing to work in a rural community for at least a year.

"We hope to get some doctors interested," said Theresa Cruz, director of the rural health division at ORCA. "We are seeing a downward trend of applicants. Most doctors, especially those just out of medical school, are not all that interested in moving to rural areas."

The Texas Health Service Corps Program has been around since 2001 and on average, the agency gets about five applicants a year, Cruz said. The deadline to apply for the stipends is May 28.

Berk said there are several reasons for the growing shortage of doctors everywhere.

First, the medical profession didn't recognize that a shortage was on the horizon until about five years ago.

In addition, young physicians don't want to work as many hours as their older peers.

And for rural areas, there is an additional problem. Fewer and fewer medical students are going into family medicine because they don't make as much money as they can in specialized medicine, Berk said.

I assume none of this is a surprise to anyone. The reasons cited for the shortage are quite understandable. The thing is, just four years ago, the Texas Medical Association was claiming there was a different reason for rural doctor shortages: Greedy trial lawyers suing them out of existence. The solution, naturally, was tort "reform", in the guide of 2003's Proposition 12, which was ratified by a fairly close margin. Well, guess what? It's had no effect whatsoever on the problem.

Proposition 12, and the far-reaching changes in Texas civil law that it dragged behind it, was built on a foundation of mistruths and sketchy assumptions. The number of doctors in the state was not falling, it was steadily rising, according to Texas Medical Board data. There was little statistical evidence showing that frivolous lawsuits were a significant force driving increases in malpractice premiums.

Perhaps the most insidious sleight of hand employed by Proposition 12 backers was their repeated insistence that medical malpractice insurance rates were somehow responsible for doctor shortages in rural Texas.

"Women in three out of five Texas counties do not have access to obstetricians. Imagine the hardship this creates for many pregnant women in our state," Gov. Rick Perry told a New York audience in October 2003 at the pro-tort-reform Manhattan Institute for Policy Research. "The problem has not been a lack of compassion among our medical community, but a lack of protection from abusive lawsuits."

The campaign's promise, that tort reform would cause doctors to begin returning to the state's sparsely populated regions, has now been tested for four years. It has not proven to be true.


On a Texas map inside the beguiling-baby mailer, blood red marked the 152 counties in Texas that did not have obstetricians in 2003. Rural doctor shortages were kept front and center as the state's physicians, led by the Texas Medical Association and the Texas Association of Obstetricians and Gynecologists, campaigned for Proposition 12.

A flier printed by the TMA in English and Spanish and posted in waiting rooms across the state told patients that "152 counties in Texas now have no obstetrician. Wide swaths of Texas have no neurosurgeon or orthopedic surgeon. ... The primary culprit for this crisis is an explosion in awards for non-economic (pain and suffering) damages in liability lawsuits. ... vote "YES!" on 12!"

As of September 2007, the number of counties without obstetricians is unchanged--152 counties still have none, according to the Observer's examination of county-by-county data at the state Medical Board.

Nearly half of Texas counties--124, or 49 percent--have no obstetrician, neurosurgeon, or orthopedic surgeon. Those specialists aside, 21 Texas counties have no physician of any kind. That's one county worse than before Proposition 12 passed, when 20 counties had no doctor.

There's more to the story there - the Observer did its usual thorough job on the subject - but you get the idea. We were fed a load of crap about tort "reform" back in 2003, and we're still eating it today. I suppose the good news is that now that this particular bogeyman can no longer be used as an excuse for real problems like this, we can maybe start thinking about solutions for them that might actually work. Heckuva job, TMA!

Posted by Charles Kuffner on November 18, 2007 to The great state of Texas

Proposition 12 was just another scam like so many others that are perpetrated through "propositions" on our ballots. Reality is the majority of people who vote do so on the basis of how someone tells them to vote and they never really think about it until it is too late to think about it.

The Democrats are just as guilty as the Republicans of this "flag waving" at the polls.

Being an informed voter does not mean listening to what the party leadership or a politician or even a community leader says. It means doing a little investigating and a little thinking on your own.

The majority of eligible voters in this country have become apathetic and don't vote. One reason is that the majority of those who do vote are too easily swayed by the slick partisan ads and the equally slick politicians and community leaders and so why bother?

Posted by: Baby Snooks on November 18, 2007 11:46 AM

A flier printed by the TMA in English and Spanish and posted in waiting rooms across the state told patients that "152 counties in Texas now have no obstetrician. Wide swaths of Texas have no neurosurgeon or orthopedic surgeon. ... The primary culprit for this crisis is an explosion in awards for non-economic (pain and suffering) damages in liability lawsuits. ... vote "YES!" on 12!"

Well, duh. Most rural counties in Texas don't have hospitals. Surgeons don't work out of the back of a car. They need modern hospitals. Some clinical practice docs like family physicians and pediatricians work out of rural clinics. But not surgeons. A modern surgical practice requires a modern hospital with operating rooms, intensive care, recovery rooms, lots of highly trained staff, and millions of dollars of equipment. You don't find those things in dying Texas small towns where the only thing on main street is a Dairy Queen and a John Deere dealership.

In any event, talking about counties isn't very meaningful in this day and age. Rural county boundaries were established in the pre-industrial era when people traveled by horse-drawn wagon on dirt roads and farms were 40 acres. The idea being that no citizen should be more than a day's wagon ride from the county seat.

The idea that tort reform ever had anything to do with rural medicine was ridiculous from the start. There are no doctors in small dying Texas towns for the same reason there are no Nordstroms. It's about economic and demographics.

Posted by: Kent on November 18, 2007 11:12 PM