New TMA Policies Aim to Strengthen Physician Workforce Pipeline
By Alisa Pierce

The Texas Medical Association’s House of Delegates adopted a host of new policies at TexMed 2024, hosted in Dallas May 2-4, designed to grow the state’s physician workforce.

One of the most divisive topics debated was the proposal to reverse TMA policy adopted in 2015 that opposes a Texas licensing program for medical school graduates without residency training. This proposal was defeated by a narrow margin by the House. Instead, delegates adopted an alternate proposal to assist unmatched graduates.

This policy, put forward by the TMA Council on Medical Education, calls for study of a proposed Texas grant program for one-year transitional or preliminary residency programs for unmatched Texas medical students.

The policy:

• Seeks guidance from the Accreditation Council for Graduate Medical Education to ensure the residency positions created will meet accreditation standards, and
• Will study successful models in place in other states for the potential of replicating those programs in Texas.

Since 2014, the Council on Medical Education has tracked the number of unmatched medical students in the state and related licensing programs in other states. From 2014 to 2023, Texas averaged an annual 30 unmatched medical students at the end of Match Week. By the end of Match Week 2023, 17 Texas fourth-year medical students remained unmatched.

“The Texas Medical Association recognizes the personal investment medical students have made to prepare for a career in medicine by completing thousands of hours of medical education and clinical training, and the academic rigor required to pass a succession of exams during four years of medical school,” the policy states. “TMA believes it is imperative that new options be evaluated to potentially assist fourth-year Texas medical students who do not match.”

The House also called for TMA to encourage an increase in the per-resident amount for state GME formula funding to medical schools to “help offset their increasing faculty costs for teaching residents.” There has been no change in the rate since 2008 while the costs for faculty salaries have increased.

Such an increase, however, “should not result in a decrease in the number of eligible residents funded through the program and should be contingent on the availability of state funding to support the full complement of eligible residents,” the policy states.

The policy adds that increasing the per-resident funding rate in the state's GME formula funding will benefit the state by:

• Making a positive impact on GME training programs throughout the state, in all specialties and all years of training;
• Helping residency programs respond to recent changes in national residency program accreditation requirements, which increase faculty administrative time and reduce time available for patient care;
• Promoting the success of residency positions created through the state's GME Expansion Grant Program through increased support for faculty; and
• Helping to retain top teaching faculty in the state, a vital component for producing high-quality physicians for Texas.

Delegates also adopted new policy that advocates for the continuation of recruitment and retention activities, allowable by the Texas Legislature, that promote representation and opportunities at Texas medical schools and residency programs. These include:

• Academic course instruction;
• Scholarly research or a creative work by an institution of higher education's students, faculty, or other research personnel or the dissemination of that research or work;
• An activity of a student organization registered with or recognized by an institution of higher education;
• Guest speakers or performers on short-term engagements;
• Policy, practice, procedure, program, or activity to enhance student academic achievement or postgraduate outcomes that is designed and implemented without regard to race, sex, color, or ethnicity;
• Data collection; and
• Student recruitment or admissions.

“TMA recognizes the continued need to promote increased representation of underrepresented individuals within medicine and the importance of enabling public medical schools and residency programs to meet national accreditation standards and collect the student data required for certain grants,” the policy states.

On other education measures, the House voted in favor of: 

• Preserving the availability of academic tenure for physicians at Texas medical schools;
• Acknowledging the importance of diversity-focused student affinity groups in medical education;
• Promoting equal acceptance of the United States Medical Licensing Examination and Comprehensive Osteopathic Medical Licensing Exam at all Texas residency programs; and
• Encouraging Texas graduate medical education programs to consider economic and wellness-related hardships when evaluating their salary and benefits packages for trainee physicians.

For more information about the Texas physician workforce or medical education, visit TMA’s Workforce webpage.