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Spending money on medical students

I have two things to say about this story, which is about a budget rider that would concentrate the money the state spends on graduate medical residencies into the doctors’ first three years of training regardless of how long their residencies take to complete, which would have the effect of favoring general practitioners, who only need three years, over specialists. Actually, before I get into that let me say that I had no idea the state spent any money on this. The story doesn’t get into the details of who the beneficiaries are or how they qualify for it. Anyway, I have two things to say:

Proponents say the budget rider would give residency programs an incentive to produce the primary care doctors Texas desperately needs, because those slots would be fully funded. They say residents who go into specialties that take longer than three years are often paying for themselves — because they’re providing services their supervisors can bill for.

“It is the state’s obligation to use tax dollars in a fashion that best serves the citizens of Texas,” said Dr. Nancy Dickey, president of the Texas A&M Health Science Center, which has one of the state’s largest family medicine residency programs. “As we try to address a physician shortage in a state that continues to grow its population, it would be appropriate for legislators to consider selective use of graduate medical education funds.”

But opponents say it’s misleading to suggest residents in any specialty are making money for their hospitals, especially since they’re now barred from working more than 80 hours a week. They say cutting off funding for years four through seven would have a devastating effect on surgical specialties and those that lose the most residents to other states, from neurology to urology.

“Texas needs specialists and primary care physicians,” said Dr. Susan Bailey, president of the Texas Medical Association. “I would hate to see us sacrifice one for the other.”

In case you haven’t noticed, this budget is full of sacrifice, as far as the eye can see. The vast majority of that sacrifice is being placed on children, the elderly, the poor, the sick, and so forth. I trust you will forgive me if I feel somewhat less sympathy for medical students than I do for these folks. If you find this budget rider intolerable, then by all means please join with the rest of us in demanding that the state generate the revenue to pay for the things it needs to do. But if it comes down to how we allocate the insufficient funds that we now have, there are a lot of other things I’d prioritize over this.

Texas has a physician shortage across all medical fields: In 37 out of 40 major specialties, it ranks below the national average of physicians per 100,000 people. It’s particularly pronounced in primary care, where last year, just 8 percent of Texas medical students went into family practice, down from 14 percent in 2001. More than a quarter of those students left Texas for out-of-state residencies, a strong indicator that they won’t practice in Texas.

Gee, wasn’t tort “reform” supposed to solve that problem? What a shock (*snort*) to learn that it was not the case.

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