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Texas Senate
January 13, 2000
(512) 463-0300

Senate Interim Subcommittee on Graduate Medical Education Held Austin Hearing

AUSTIN - The Senate Finance Interim Subcommittee on Graduate Medical Education held a meeting today, January 13, 2000, at the Texas State Capitol.

The meeting addressed the Senate Finance Committee's fourth interim charge. The charge evaluates the financial viability and educational effectiveness of graduate medical education in light of changes in Medicaid, managed care, and the impact of uncompensated care. The evaluation will include a review of the role of the state's teaching hospitals in the provision of indigent health care, and the role of graduate medical education in addressing health care needs of underserved regions of the state.

The subcommittee consists of five members appointed by Finance Chair Bill Ratliff. Senator Mike Moncrief of Ft. Worth serves as chair. Other Senate members include Senator Carlos F. Truan of Corpus Christi, John J. Carona of Dallas, Jon Lindsay of Houston, and Royce West of Dallas.

The subcommittee began its hearing with invited testimony relating to Graduate Medical Education (GME). Lois Bready, M.D., Director of Graduate Medical Education, University of Texas Health Science Center (UTHSC) at San Antonio, provided a general overview of GME. Bready stated that the GME program helps to ease the transition of recent medical school graduates into resident programs. Bready referred to various individuals in the residency program at UTHSC to show that post graduate medical work is not as glamorous as it is portrayed in movies and television. She said that medical resident programs are a high stress, low paying, and physically demanding three years of post graduate medical study.

The next witness to testify was Trey Berndt of the Legislative Budget Board. He explained to the subcommittee how funding for GME is provided to Texas' hospitals. Berndt explained that Medicare dollars provide the bulk of federal funds for the GME program in Texas. The funds from Medicare are divided in two ways. The first method of payment by Medicare is called Indirect Medical Education Payments. This method provides $172 million for 74 Texas hospitals. The second method of Medicare payment is called Direct Medical Education Payments. The direct method offers $53 million to 59 Texas hospitals, which is used specifically for education hospitals. Funding for the federally created GME program, on the state level, is mainly provided by Medicare. It provides $44 million to 52 hospitals in Texas.

Next, a group of doctors related their perspectives on GME, to the subcommittee. Dr. James C. Guckian of the University of Texas System, Dr. Roderick E. McCallum of the Texas A&M University System Health Science Center, Dr. Deborah Blackwell of the UNT Health Science Center at Ft. Worth, Dr. David Smith of the Texas Tech University Health Sciences Center, and Dr. Bobby Alford of the Baylor College of Medicine all gave testimony regarding the various GME residency programs and the hospitals they are located at in Texas.

The last invited testimonial was provided by John Guest, Chief Executive Officer, University Hospital, San Antonio. Guest addressed the future of GME programs in Texas. In Guests opinion, GME education is seeing a decline in state funding, which will continue in the years to come. He stated that federal Medicare funding only covers half of the GME expenses in Texas. Guest believes that GME funding needs to be revamped in the coming years. If not, Texas will see a decrease in teaching and health services provided to post graduate residents and hospital patients. Guest also warned the subcommittee that if GME funding issues aren't addressed, they could expect to see a severe decline in the quality of health education services in Texas.

After invited testimony concluded, two public testimonies followed. George Far of the Children's Medical Center of Dallas began public testimony. Far gave the subcommittee a summary of the funding problems facing various children's hospitals in Texas.

Following public testimony the subcommittee recessed. The subcommittee must report back to the Finance Committee by July 1 of 2000. The entire Finance Committee will then meet to discuss the findings.

Session video and all other Senate webcast recordings can be accessed from the Senate website's Audio/Video Archive.