Policy analysis of graduate medical education policies and funding in Texas

Graduate medical education (GME) is the predominant path to becoming a practicing physician in the United States (U.S.). Every state requires physicians to complete at least one year of GME, also known as medical residency training, in order to become eligible to apply for a medical license. The federal government invests $10 billion per year on medical residencies through Medicare GME payments. State governments also fund GME, but pay a smaller proportion than the federal government. There are other avenues of funding through different federal agencies, community organizations, and Medicaid that make up a smaller proportion of total GME funding than Medicare and state funding. State agencies and organizations such as the Texas Higher Education Coordinating Board and the Texas Medical Association have contended that the projected number of physicians is not enough to serve the growing Texas population. Reasons for this proposed physician shortage include a shortage of funding from the federal and state government as well as a shortage of residency programs. This policy analysis aims to understand the funding streams and GME programs in Texas. A literature review of all federal and state funding was performed. Physician and medical resident data available from the Texas Medical Board were analyzed. State of birth, medical school, medical specialty, and location of residency program were tabulated in a spreadsheet to track the number of in-state and out-of-state physicians and medical residents. Approximately 60.4% of all active physicians practicing in Texas were born out-of-state and 66.4% graduated from an out-of-state medical school.