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Expanding Graduate Medical Education in Texas

Graduate medical education, also known as residencies, is a critical part of a physician’s training. Supporting graduate medical education ensures that newly minted physicians learn, train, and remain in the state that provides their medical education.

A proper funding balance between medical school and graduate medical education opportunities is important. Without it, medical school graduates will head to other states for their residencies. And, it is unlikely they will return to practice medicine. When this happens, the state’s investment in medical school graduates is lost. This means millions of wasted dollars when they leave the state to do a residency. Therefore, balance is important. The Association of American Medical Colleges (AAMC) found retention is highest for physicians who completed medical school and residency training in the same state.

According to the Accreditation Council on Medical Education (ACGME) there are 141,826 active residents in the U.S. Of these, Texas has 9,284 active residents and fellows training in 705 graduate medical education programs. The average, annual cost to train a primary care resident is $157,000. The national average resident salary is $59,300.

Completing the medical school/residency equation in Texas

Texas is working hard to strike a balance between funding new and existing medical schools and supporting ample graduate medical education opportunities for the state’s physician graduates.

Texas has met and surpassed the 2006 challenge from the AAMC to increase medical education in the nation by more than 30 percent over 2002 enrollment levels. As recently as 2009 Texas had a shortage of medical schools. But, the state realized the need and soon e two new medical schools that will graduate their first classes in spring 2020. Now, the state has 12 medical schools enrolling more than 2,000 new students per year. In addition, three new medical schools are in works, with one scheduled to enroll students in fall 2019.

Now it is time to turn to the completion of the equation: to maintain and expand graduate medical education. As Texas Commissioner of Higher Education Raymund A. Paredes says: “This is an expensive and less glamorous endeavor than creating a new medical school. There are no great reservoirs of state or federal resources, no line of donors waiting in the wings to give to graduate medical education. It is going to be a tough road, but it is the right way to achieve the state’s much-needed physician workforce.”

The good news is that the Texas Legislature and medical community recognize this challenge. In 2013, nine new primary care and two non-primary care residency programs opened. In addition, 100 new first-year residency positions were funded. Two years later, Texas passed landmark legislation that expands state support for graduate medical education. Per-resident funding to residency programs increased from $65,000 per year to $75,000. In addition, approximately 130 new residency positions were funded in 2016-17.

Achieving a 1.1 to 1 ratio

By 2017, Texas had 10 percent more first-year residency positions than annual Texas medical school graduates, with 1,660 medical school graduates and 1,868 filled, first-year resident positions.

This 1.1 to 1 ratio is possible due to state-funded graduate medical education grant programs. The Texas Higher Education Coordinating Board (THECB) administers the programs that support efforts to increase the number of first-year residency positions. One area of focus is rural health care.

Rural and public health rotations are supported by family practice residency program funds. These rural rotations have been in place since 1991, providing an opportunity to more than 750 family medicine residents to spend a month in a rural Texas community. The use of the term rural is generous, and includes a county having a total population of 50,000 or less, or a county having a rural population of 50 percent or more.


Of the physicians who graduate from a Texas medical school, 60 percent remain in the state to practice. When physicians complete their medical school education and residency training in the state, 80 percent remain in Texas. The state’s goal is to maintain, if not improve, that retention.

With additional funding provided by the Texas legislature, the state is well poised to meet its goal. But, continued residency funding is critical. As of mid-May, the legislature is on course to approve a $60 million increase to state graduate medical education expansion grants. This will fund the projected additional residencies necessary to maintain the 1.1 to 1 ratio through 2021.

Texas’ work to achieve a balance between medical schools and residency funding is gaining notice from other states. Most recently, the New Mexico legislature recognized how important graduate medical education is to that state’s physician workforce and looked to the Texas program as a model.

Kelly Carper Polden is a GovLoop Featured Contributor. She is the assistant director of external relations, responsible for state agency communications and media relations, for the Texas Higher Education Coordinating Board. She has more than 25 years of experience as an award-winning, strategic communication professional with extensive experience in media and public relations, C-suite communications, global events management, brand/corporate image management, and strategic and crisis communication management. You can read her posts here.

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Catherine Andrews

I’ve been so impressed with all the education initiatives you’ve been writing about – Texas is really onto something!