Changing the Landscape of Health Care in West Texas

• By School of Medicine
• April 14, 2020

West Texas is home to highly successful petroleum, natural gas, cotton, and livestock industries — and relatively few population-dense cities. While many people live in the region, they tend to be spread out in rural communities where many of the resources inherent to major metropolitan areas are hard to come by.

Because of this landscape, residents of these rural areas face a wide range of mounting health care challenges. The same rural lifestyle that draws many to the region can make it difficult to receive appropriate medical attention — ranging from preventive care to emergency services.

To ensure the health and safety of West Texas communities, local medical schools, including the Texas Tech University Health Sciences Center School of Medicine, are taking steps to train providers who are eager to provide rural health care services to the people who live in these remote communities.

Health Care Challenges in West Texas

The region of West Texas is facing an evolving health care crisis, marked by limited access to medical services. In fact, the problem is so severe that many of the region’s communities have been designated as Health Professional Shortage Areas and Frontier areas — communities that count more than 3,500 patients per physician. While the industry standard is commonly accepted as 2,500 patients per physician, recent research suggests that even that number may be too high to ensure that patients receive proper attention.

The impact on the people who live in these communities is telling.

“The West Texas population is generally less healthy than the general population,” says Dr. Steven Berk, Dean of the Texas Tech University Health Sciences Center School of Medicine. “There is inadequate care in rural areas — 35 counties have no physician at all.”

The lack of health care services received by many residents of West Texas is the result of a variety of challenges found in the region, including:

Provider shortages: Most challenges related to accessing health care in West Texas can be traced to the region’s lack of qualified providers. There is currently an inadequate number of both primary care physicians and specialists in most rural communities in the area. According to the Fort Worth Star-Telegram, as of March 2019, there were only 63,871 practicing doctors serving 28 million residents in Texas — a shortage that is felt most deeply in rural areas of the state. According to Berk, more than 100 counties do not even have a single obstetrician or psychiatrist.

This trend is not expected to turn around in the near future. In fact, the Texas Department of Health and Human Services predicts that the shortage of primary care physicians alone in the state will increase by 67% by 2030, bringing Texas to a deficit of 3,375 providers. Doctors who are considered to be primary care providers include those in the critical specialties of:

• Family medicine
• Internal medicine
• Obstetrics and gynecology
• Pediatrics

The state-wide shortage of primary care providers is expected to be echoed in West Texas over the next decade, when demand for physicians in this area of practice is predicted to increase, surpassing supply by about 26.5% — a total of nearly 400 providers — by 2030.

Retiring physicians: The current shortage of qualified medical professionals practicing in Texas could be further exacerbated by an unavoidable event — retirement. According to a 2015 report by AMN Healthcare company Merritt Hawkins, 25.1% of physicians in Texas are 60 years of age or older, which means that a quarter of the state’s already limited number of providers is rapidly approaching retirement age. Without adequate new doctors to replace them, these retirements will add to the already severe provider challenge in Texas.

Inadequate residencies: Once students complete medical school, they continue their training in specialty-specific residency programs that last from three to seven years. Completing a residency program is a requirement for becoming board-certified in a medical or surgical specialty, and doctors may do additional sub-specialty training in fellowship programs. While Texas is home to a large number of medical schools, the state does not offer enough residency programs to keep pace with graduate demand. As a result, many students complete residency programs out of state — which can decrease their odds of returning to Texas to practice.

Increasing the number of residencies offered in the state is particularly challenging in light of the high price tag associated with each additional position. According to the industry group Teaching Hospitals of Texas, the average residency slot costs at least $100,000 a year, once supervisor salaries and other costs are factored in.

Hospital closures: Even when health care facilities are available in West Texas, they are often under threat of closure, as it is very difficult for rural hospitals with a low number of beds to stay open. According to Berk, 20 hospitals in rural West Texas have closed in recent years — and many more are at risk of closing

In fact, according to research by the Cecil G. Sheps Center for Health Services Research, 113 rural hospitals were closed nationwide between January 1, 2010, and August. 21, 2019. Of those, 20 were located in Texas, the highest number of closures in any state in the nation.

Addressing the Rural Health Care Crisis Facing West Texas

When it comes to addressing health care challenges in West Texas, increasing the number of qualified providers practicing in the state is a top priority. Medical schools can play an important role in this arena.

“We need to produce not only more primary care physicians, but more physicians who might settle in rural areas,” Berk says. “Medical school admission committees can select for students who might choose family medicine as a career and who are from rural areas and might want to return to rural communities.”

However, making adjustments in health care training alone is not enough. Berk adds that once these primary care physicians are qualified and practicing in rural areas, they need to be better connected to specialists. This type of support is critical for attracting and retaining providers in West Texas. Without specialist support, primary care physicians can be forced to accept a wider array of responsibilities, which can make the roles more stressful and less appealing.

Due to the isolated nature of many West Texas communities, patients have limited options when it comes to seeking specialty care. However, rural providers can receive support in a variety of ways, Berk reports, including through:

• Telemedicine and telehealth programs
• Hand-held device connections
• Visiting specialists with weekly or monthly clinics
• Nurse call systems to ease the daily call burden

Due to the region’s low population density, establishing traditional hospitals to increase accessibility to health care is not necessarily feasible. According to Berk, a more pragmatic solution for many rural communities is to establish viable clinics in lieu of hospitals and create well-established transportation mechanisms from clinics or ERs to more distant — and well-equipped — hospitals. Community leaders can play an important role in helping to attract and maintain physicians and hospital leaders in order to ensure availability and continuity of care.

Training Students to Meet the Unique Needs of West Texas

Texas Tech University Health Sciences Center School of Medicine was founded in 1969 to address provider shortages in the state. At that time, West Texas’s physician-to-population ratio was only half the national recommendation.

As the region’s health care challenges have changed, TTUHSC School of Medicine has evolved to help meet the needs of its rural communities. In response to the current physician workforce shortage facing communities in West Texas, the school created the Family Medicine Accelerated Track and expanded family medicine residency programs to help increase the number of primary care providers working in the area.

“Our Family Medicine Accelerated Track was the first of its kind in the U.S.,” Berk says. “Students committed to family practice are able to graduate from medical school in only three years with almost no debt and then receive acceptance into TTUHSC family medicine residency programs.”

According to Berk, about 10 other medical schools in the nation have since adopted this model for family medicine health care training. Based on the numbers, the approach appears to be effective in attracting and producing future family medicine physicians. The TTUHSC School of Medicine ranks in the top eight among allopathic medical schools for the number and percentage of students who go into family medicine practice upon graduation. And of TTUHSC’s nearly 28,000 alumni from each of our five schools, 24% provide care within the university’s 108-county service area — providing critical services to rural Texans.

Your Medical Career at the TTUHSC School of Medicine

For more than 50 years, one of TTUHSC School of Medicine’s primary goals has been to improve rural health care outcomes in the most unreached, underserved communities in West Texas and throughout the world. At the School of Medicine, you’ll find a curriculum and a community that not only holds this mission, but also shares students’ determination to provide care to those who need it most.

TTUHSC is one of the largest health care universities in the United States for depth and breadth of health care programs. As the university’s founding school, the TTUHSC School of Medicine offers rural, urban and community training experiences across the training continuum.

• M.D. program
• Family Medicine Accelerated Track
• Dual Degree programs
• Residency programs
• Fellowship programs

In addition to our unique Family Medicine Accelerated Track, the TTUHSC School of Medicine stands out among other medical schools for a variety of reasons:

Affordability: The TTUHSC School of Medicine has one of the lowest tuitions in the country and is the sixth most affordable medical school in the U.S. based on tuition, debt at graduation and availability of scholarships. Because primary care is generally less lucrative than other specialties, this low cost may help you feel freer to pursue family medicine or a similar specialty.

Cross-disciplinary commitment: At the TTUHSC School of Medicine, we recognize that physicians are not the only members of effective health care teams. As a community, we are committed to training doctors who work well with other health care professionals. The School of Medicine often collaborates with students from the School of Pharmacy and School of Health Professions to provide opportunities for interprofessional training.

In fact, we are one of the few schools of medicine in Texas that is housed in the same university as a Doctor of Nursing Practice program. TTUHSC School of Medicine faculty volunteer an enormous number of hours to train physician assistants in their clinical year, helping to ensure that Texans have access to qualified providers at every stage of their health care journey.

Location: Unlike many schools, the TTUHSC School of Medicine uses a regional campus system, which allows the school to have an important impact on patient care and medical training in three different communities in West Texas—Amarillo, the Permian Basin cities of Odessa and Midland, as well as Lubbock. All TTUHSC medical students complete their first two years of on our Lubbock campus. For the final two years of clinical training, students are distributed among campuses in Amarillo, Lubbock, and the Permian Basin. On these regional campuses, you will experience a diverse group of faculty and health care training environments, including medical teaching experiences with community physicians to gain a deeper understanding of how both academic and private physician practices operate.

Innovation: As the first medical school to launch an accelerated track for primary care physicians, we have innovation in our DNA. And that boundary-breaking spirit is not limited to our Family Medicine Accelerated Track. The School of Medicine is always looking for innovative ways to develop interprofessional education that will have a meaningful impact on students in the hospital and clinic environment and on the patients they will one day serve.

Want to learn more about launching your health care career at the TTUHSC School of Medicine? Visit the TTUHSC School of Medicine program page on our website. Contact us to speak with an admissions representative and explore how a Texas Tech University Health Sciences Center education can help you play an important role in addressing the rural health care crisis.