Swetha Maddipudi

Medical Student Issues and Perspectives in the 87th Legislative Session

By Ryan Wealther and Swetha Maddipudi

Now that the dust has settled and the Texas Legislative Session has ended, we can unpack what the session had in store for medical students. At the forefront of many of our medical student minds was funding for residency positions through the state’s Graduate Medical Education (GME) Expansion Grant Program. Many Texas medical students want to stay in Texas for residency, but if there are not enough spots for Texas medical students to complete residency in Texas, students are forced to leave. What is concerning about this is Texas-educated physicians are about 30% less likely to practice in Texas if they complete their residency out of state.2 According to the most recent State Physician Workforce Data Report by the Association of American Medical Colleges (AAMC), Texas is ranked number 41 out of 50 in the country for physicians per capita.1 Fortunately, Texas’ final budget allocated enough money to GME to maintain the 1.1 ratio of first-year residency slots for every medical school graduate, which will help retain medical students in the state of Texas.2

The Texas state budget also allocated $385 million for medical student education; this adds up to about $45,000 per student per year of medical education.2 This generous allocation to medical education keeps Texas public medical schools amongst the most affordable medical schools in the nation, which helps retain talented pre-medical students in Texas and attracts talent from out of state to attend Texas medical schools.3 It also allows Texas medical school graduates to keep their overall debt burden low.

Audrey Phan, a fourth-year medical student at the UT Health San Antonio Long School of Medicine (UTHSA LSOM) and Illinois native, was excited to hear the state decided to continue providing generous funding for medical education. “Growing up with a low socioeconomic background and dreams of becoming an obstetrician-gynecologist, the financial barriers to a medical education seemed nearly insurmountable until I found UT Health San Antonio. With high standards of education and exceptionally affordable tuition, there was no question in my mind that I would make the journey across the country to come to medical school in Texas. Being here has allowed me the opportunity to not only become a physician, but also leave medical school with financial security instead of burdening debt. I couldn’t be more grateful for the future that the state of Texas has generously awarded me, and I’m happy Texas has decided to continue investing in medical education for future students.”

Medical students faced some disappointing news in the state budget as well. The budget sustained cuts to loan repayment programs, family practice residency programs and the statewide primary care preceptorship programs. These budget cuts have resulted in decreased opportunities for students interested in primary care, which is troubling because Texas is ranked number 47 out of 50 in primary care physicians per capita. The statewide primary care preceptorship programs, which match medical students to primary care physicians, provide early primary care experiences to students during a formative phase of their training. Similarly, the promises of loan repayment for primary care practitioners can serve as an added motivator for students leaning towards choosing a primary-care-oriented specialty. Having cuts to the training pathway is disappointing for many of our students, as it increases the difficulty of matching into a primary care specialty.

The preceptorship program was especially influential to UTHSA LSOM fourth-year medical student, Christi Jackson. "I had never considered a career in primary care upon entering medical school. Towards the end of my first year, I saw a flyer about the Texas Family Medicine Preceptorship Program and applied, thinking it would be a great way to get some early clinical exposure while also earning some money. I didn’t anticipate enjoying my experience so much that I am now applying to family medicine residency programs solely in the state of Texas. Texas needs more medical students interested in pursuing a future in primary care."

These were just some of the issues in the legislative session we, as medical students, witnessed. However, medical students were more than just casual bystanders in the legislative session−we actively participated in First Tuesdays. Medical students have long been involved in First Tuesdays with the Texas Medical Association (TMA). For many, this event has served as a foundational experience in understanding how impactful conversations with legislators can lead to better health care for Texans. When we (the authors) first attended a session as first-year medical students, our chapter put together our own internal briefings and talking points to guide

our conversations with legislators, making sure we represented the medical student community at our school to the best of our ability. This was a part of the inspiration for a new briefs project we helped to create as leaders of the TMA Medical Student Section (MSS) Executive Council.

Over the past year, we mobilized MSS members who were interested in writing about topics that were advocacy focused. We specifically called upon some of the authorship teams to pen briefs on topics we knew would come up during First Tuesdays. Two of the six briefs published in the first iteration of this project focused on TMA’s legislative priorities, immunizations and Medicaid expansion, and specifically focused on explaining important advocacy points in a digestible way for medical students. Our medical student members used these briefs to develop their own talking points and anecdotes they could then share with legislators. By providing medical students with data-driven briefs, they were able to identify points for implementing new policies and provided both trainee and clinical perspectives during discussions.

Rishi Gonuguntla, a second-year medical student at UTHSA LSOM and President of the school’s TMA Chapter, also participated in First Tuesdays and has reflected on his experience. “As a first-year medical student, I was excited to attend First Tuesdays, although I was unsure what that would entail. Although I’d only intended to watch and learn, I quickly found myself an active participant. During my first meeting, I was encouraged by the other physicians to talk about how expanding GME funding would affect me as a medical student. Being able to advocate for myself and my peers to a legislator who had the ability to enact change was a powerful experience. When I discovered Texas did expand GME funding, I felt I had contributed to a tangible difference in the world during my first year of medical school. Participating in First Tuesdays is one of the best experiences I have had in the field of medicine, and I look forward to participating again in the future!”

Acknowledgements:

Thank you to the quoted students from the UT Health San Antonio Long School of Medicine for providing their perspectives and to Marcia Collins, Associate Vice President for Medical Education at the Texas Medical Association, for providing essential information to this article.

References: 1. Association of American Medical Colleges. (2019). 2019 State

Physician Workforce Data Report (pp. 8, 13). Association of

American Medical Colleges. https://store.aamc.org/downloadable/download/sample/sample_id/305/ 2. Price, S. (2021, June 23). Physician-Led Results: Lawmakers Invest in Texas’ Future Physicians. Texas Medicine Today. https://www.texmed.org/TexasMedicineDetail.aspx?id=57194 3. Satyanarayana, M. (2017, October 30). Med school on the cheap: Why becoming a doctor in Texas is a bargain. The Texas

Tribune. https://www.texastribune.org/2017/10/30/medschool-cheap-why-becoming-doctor-texas-bargain/

Ryan Wealther is a fourth-year medical student at the UT Health San Antonio Long School of Medicine. He currently serves as Chair of the Texas Medical Association Medical Student Section.

Swetha Maddipudi is a fourth-year MD/MPH student at the UT Health San Antonio Long School of Medicine and serves as the student representative to the TMA Board of Trustees.