Bills target doctor shortage

Brownsville Community Health Center is hiring doctors, but no one is applying for the jobs.

For two years, the federally funded clinic has searched for primary care doctors to fill two vacancies, to no avail. Officials also have been looking for a dentist for nearly eight months with no luck, executive director Paula Gomez said.

"It's difficult because of what we pay. We're competing with a whole community, because everyone's looking for doctors and dentists," Gomez said. "Primary care doctors are hard to come by."

The Brownsville clinic primarily serves low-income, uninsured residents, and with a limited budget can't offer sign-on bonuses and other incentives that the private sector might provide to attract doctors, Gomez said.

Some clinic directors hope that legislation currently under consideration in the Texas Legislature will help ease their struggles to recruit doctors and dentists.

House Bill 1876, filed by Rep. Richard Raymond, D-Laredo, and Rep. Warren Chisum, R-Pampa, would establish the Texas Health Care Access Fund to help repay the debt of doctors and other health professionals if they commit to serving in high-need areas.

The state already has a debt-repayment program for doctors and some health professionals, but the program doesn't provide enough incentive for debt-riddled doctors and dentists to take lower-paying jobs, said Jose Camacho, executive director of the Texas Association of Community Health Centers.

"Right now, (these programs) only pay a fraction of what it would take to pay off someone's loan debt," Camacho said. "This legislation coordinates the repayment programs by placing them all under one umbrella, including federal loan repayment programs, and increasing the amount paid per year toward primary-care providers' debt."

Texas is facing a shortage of primary care physicians in general, according to state figures. The state has 68 primary care doctors per 100,000 people, compared to the national average of 81 per 100,000. Increasingly, U.S. medical students are choosing other specialties besides primary care because they can make more money in other specialties, and thus pay back their debt more quickly, physician advocates say.

The average medical student carries a debt of nearly $140,000 upon graduation, according to the American Medical Association. Currently, the state's debt repayment program offers doctors who work in high-need areas $13,000 for the first year, $15,000 for the second and third years, $18,000 for the fourth year and $20,000 for the fifth. To qualify, doctors must agree to work in federally designated health professional shortage areas, at a community health center or for certain state agencies.

The proposed legislation would increase that amount to $25,000 for the first year, $35,000 for the second, $45,000 for the third, and $55,000 for the fourth year. Dentists, physician assistants, advanced practice nurses, dental hygienists and mental health providers also could qualify for debt repayment.

Funding for the debt-repayment program would come from increasing taxes on smokeless-tobacco products and closing a loophole that allows cheaper smokeless-tobacco products to be taxed at lower rates, officials said.

This new debt-repayment program would provide the "hook" the Rio Grande Valley and other doctor-shortage areas need to attract physicians and health care providers, Camacho said.

"We need a method to tell those students that if you choose primary care and practice (in these places), you really don't have to worry about your debt," he said.

Not everyone thinks this new program is the best approach to addressing the primary care physician shortage.

"We feel there's a definite need for primary care physicians to have a loan-repayment program, but we don't feel this particular bill is the way to go about it," Dr. Albert Gros, chairman of Texas Medical Association's Council on Legislation, said.

TMA supports increasing funding to the state's current loan-repayment program for physicians, rather than establishing a new program that would also include other health professionals, Gros said. Physicians and other health professionals shouldn't compete for repayments through one program, but participate in separate programs instead, he said.

Also, the doctors' group isn't in favor of using a tobacco tax to fund the program because it's not a reliable source, and the ethics of such an arrangement are a concern, Gros said.

"We'd be benefiting from tobacco usage ... ethically, we'd prefer not to go there," he said.

The doctors' group has thrown its support behind Senate Bill 2243, by Sen. Judith Zaffirini, D-Laredo, which would provide repayment assistance to doctors of up to $140,000 over a four-year period. The legislation also would offer similar assistance to dentists.

Local clinic directors, however, think the Texas Health Care Access Fund is a good idea.

"I envision us being able to have more applicants with the loan-repayment program," Lucy Ramirez, executive director of Nuestra Clinica del Valle, said.

Nuestra Clinica, which has nine sites in the western portion of the Valley, currently has three doctor vacancies and two dentist vacancies, Ramirez said. The vacancies limit the number of patients for which the clinics can care, she said.