Try as it might, Texas can’t seem to fill shortages of family physicians.

By Sasha Barnes, sasbarne@ttu.edu

In 2023, the Texas Medical Board broke a state record by issuing nearly 7,000 new physician licenses. By August of the following year, it had surpassed 7,500.

Though in many respects the healthcare sector in Texas is flourishing, the state ranked 50th in the country for primary care providers per 100,000 citizens.

The Texas Department of State Health Services reports that family medicine, internal medicine, and pediatrics, all of which fall under primary care, will face the greatest critical shortages in Texas by 2032.

Taru Bharadwaj, a third-year student at Texas Tech University Health Sciences Center School of Medicine, said while she and other classmates have expressed an interest in primary care, it can be a thankless specialty that doesn’t measure up to the benefits of other specialties.

“A lot of internal hierarchies and stigmas within the physician world can sway people away from primary care,” Bharadwaj said, “You will have people who try to chase the glory or the higher paying specialties.”

The State Health Services Department reports some of the highest paying medical specialties – including plastic surgery, orthopedic surgery, and radiology – are more than meeting the demand for physicians. In fact, there were 2.5 times as many plastic surgeons as needed in 2018, But there were only 69% of the required pediatricians.

While the number of primary care physicians in Texas has risen by 22% since 2015, the number of physicians in other fields have risen by 29%. And with more physicians entering those fields, it has impacted the shortage of family, internal, and pediatric doctors in Texas.

Holes in Rural Practice

Of 254 Texas counties, 70% are rural, according to the Texas Comptroller, and 75% are designated as health professional shortage areas.

Texas is ranked second in the country for the number of public and private medical schools, but the location of these schools in populated, urban areas highlights a growing difference between the haves and the have-nots when it comes to access to healthcare in the state.

Only one out of four medical schools in Texas is located in what the Health Services Department  deems a medically underserved community.

Bharadwaj, who will be applying to residency programs in the fall, said location plays a large role in determining where to continue medical education.

“You should do your residency somewhere where you can get the most diverse array of people and problems – so you learn how to deal with everything,” Bharadwaj said. “So, going somewhere where there is a very large population, a very diverse population, just would ensure that I see the most amount of interesting cases, the most amount of learning that I could possibly do over the course of residency.”

The tendency for hospitals to be built  in cities with larger populations, for those hospitals to receive specialized equipment, and for prospective doctors to seek that kind of environment to make lives for themselves has skewed medical care in Texas away from rural communities. The result is that 64 Texas counties do not have a hospital and 25 have no primary care provider..

In an effort to combat this problem, six new medical schools have opened in Texas in the last nine years, many with programs dedicated to educating physicians who will go on to practice in Texas rural communities.

Nandini Ray, a first-year internal medicine resident at Houston Methodist Hospital, said she served medically underserved members of rural communities while in medical school..

“There are several opportunities to kind of see how healthcare works in these more rural areas surrounding our Texas communities,” Ray said. “So, that's definitely something that takes a very, very big heart to make space for. And I think my medical school did a wonderful job of exposing us to that and showing us the need that these communities have.”

Sam Houston State University’s College of Osteopathic Medicine, founded in 2019, reports in its mission statement an effort to educate doctors to provide primary care access to East Texas counties. Their strategy: enrolling applicants with deep ties and dedication to the communities from which they were recruited.

Texas on the Offensive

According to the Health Services department, Texas ranks third in the country for physician retention from residency, with about 64% of residents who complete their training in Texas ending up practicing medicine in the state.

The key to keeping physicians in Texas, therefore, seems to involve creating more residency openings here.

Since 2011, the Texas Higher Education Coordinating Board has striven to provide residency opportunities at a rate of 1.1 positions for every one medical school graduate. After first achieving this goal in 2017, the number of first-year residency positions increased by 25%.

Grants supporting graduate medical education have risen to over 16 times what they were in 2015, with more specialized grants supporting the training of family doctors and, as of 2024, a rural residency program.

By establishing six new medical schools in Texas, the number of graduates has increased by more than 600 students annually. Together with the development of new residency programs, the Health Services department expects more than 15,000 new doctors will begin practicing in Texas by 2032.

While this may not be enough to provide enough primary care physicians in the state, Texas has begun to implement new programs which will help fill provider gaps in underserved regions, distributing physicians in a way that is more understanding of rural communities.