1. Pam Danner, MBA Former Program Director, West Texas AHEC Steve Shelton, PA, MBA Program Director, East Texas AHEC

3. The landscape… In 2007, Texas ranked 43 rd with 157 physicians per 100,000 population-the same as it had in 2000, while leading the nation in population growth (Texas Medical Association) In 2007, Texas had fewer residency slots than New York, California and Pennsylvania and the numbers funded by Medicare are capped (TMA) The number of graduates seeking family medicine has dropped 27% from 2002-2007 (Association of American Medical Colleges) The AAMC predicts a shortage of 124,00 – 159,000 physicians by 2025. This prediction is “pre-reform” which is anticipated to increase the shortage by as much as 25% (AAMC)

4. The Process Garnered “political” support State partners Residency Programs Developed the Instrument Literature review, previous state agency surveys IRB University of Texas Medical Branch at Galveston Texas Tech University Health Sciences Center Developed the survey

5. Political Support Interested parties The legislature Trade organizations Policy planners

6. The IRB Formal IRB review Exempt status

7. Major Goals of the Survey To assess the background and educational experiences of primary care resident physicians (family medicine and internal medicine) at State of Texas residency programs Assess resident physicians expectations and desired work environment Evaluate opportunities for AHEC to better meet residents’ need for information about available practice support resources, particularly related to medically underserved opportunities.

8. Objectives of the Survey Determine what residents previous experience in rural and medically underserved communities has been Determine what residents are seeking in practice location Determine what physician residents are seeking in practice relationships with other providers and organizations Determine what residents familiarity is with federal programs available to support or enhance rural or underserved practice Compare and contrast different desires and expectations based on demographic characteristics Determine types of resources that residents would find most beneficial in finding practice opportunity and in establishing practice

9. Survey Methodology 2 Methodologies, one survey document Paper survey, administered at voluntary resident meetings On-line

10. The Survey General demographic information Place of residency history and spouse residence Clinical training experience Practice preferences Call, size, ancillaries, etc. Knowledge of clinic designations Preference in employment or private practice

11. Cont. Knowledge of loan repayment programs Current sponsorship level Current job seeking methods Rate community attributes Interest in working with underserved

12. Survey Response 364 resident physicians responded, 49% male, 51% female

13. Response cont. 34% indicated they had lived in a community of less than 20,000 20% graduated from high school in a rural area 50% had no training in a rural setting as part of medical education Less than 20% did in residency training 51% familiar with rural health clinics, 41% knew about FQHCs or CHC 14% would consider practice in an RHC or FQHC

14. Practice Location Preference 68% interested in practicing in community over 50,000 Only 10% indicated a preference for a community less than 20,000 35% preferred practicing within 50 miles of urban community 27% had no preference for proximity to urban

15. Practice Arrangement Preference 64% prefer a group practice arrangement 74% preferred call no more than once per week 71% considered hospital privileges essential 85% preferred hospital professional staffs of more than 10 85% will consider interdisciplinary practice with a physician assistant or nurse practitioner 17% will consider providing OB services

16. Employment vs. Private Practice 75% indicated a preference for an employment arrangement Defined salary Defined Benefits

17. Loan Repayment 12% are involved in loan repayment commitment situations 39% would be interested in loan repayment programs 77% would accept multi-year contracts for practice entry 75% need financial assistance to enter practice

18. Employment Search 45% will seek employment on their own 18% will use a search firm 21% will use on-line employment methods 44% waited until their second or third year of residency to see employment options 54% would consider practice in underserved community

19. Important Community Attributes Responses ranked on a 5 point scale with 5 being most important Low crime/safety/security – 4.45 Friendliness of community – 4.39 Quality of schools – 4.3 Travel time to work – 4.12 Cost of living – 4.08 Availability of basic shopping – 4.06

20. Community attributes of moderate importance Amenities Recreation Availability of other physicians for peer support Employment opportunities for spouse

21. Lesser important community attributes Being near where spouse grew up Small community Community engagement opportunities Large community size

22. Findings Most residents did not have learning opportunities in rural settings Most are unfamiliar with practice models common in rural areas or used with underserved populations even though more than half were interested in serving the underserved Most do not desire practice opportunity consistent with traditional private practice situation Limited call, etc.

23. Findings Continued Loan repayment is very appealing Safety, security, friendliness, school quality, travel time, etc are important

24. Formal Recommendations Educate, encourage and incentivize communities of advantages to sponsorship of future health professionals Use rural and small community experiences for learning to familiarize career decision makers of practice opportunities Develop emphasis or special focus programs to address unmet healthcare workforce needs in rural and other underserved areas Expand loan repayment programs Incorporate more practice development information into primary care residency programs Allow for employment of phsicians

25. Opportunities for Texas AHEC Programs Increase program areas which promote training with underserved populations (CHCs, RHCs, Rural sites) On-line employment match sites should “work” Increase partnership work with rural communities HealthMATCH, HealthFind

26. Real outcomes for Texas Physician Employment Bill Push to increase residency training sites AHEC asked to be involved and have a voice!