Texas doc boom leaves many out

While the healthcare labor force in the Dallas-Fort Worth area is growing along with its population and economy, it's a tale of two Texases, as lower-income parts of the region and the state face shortages in physicians, nurses and other skilled staffers, and primary-care providers remain in short supply.

Meanwhile, the infusion of federal money from the Patient Protection and Affordable Care Act that potentially could help remedy those shortages has been limited by the state's political resistance to Obamacare and its Medicaid expansion.

A record 4,610 doctors applied for Texas medical licenses last year. The number of physicians in Dallas County increased to 5,972 from 5,876. In Tarrant County, which includes Fort Worth and Arlington, the number of physicians grew to 3,568 from 3,478. In Collin County, which includes Frisco, McKinney and Plano, the doctor supply jumped to 1,763 from 1,657.

But most of the new physicians in Texas are going to Dallas-Fort Worth, Houston, San Antonio or Austin, said Dr. David Wright, an Austin family physician and chairman of the Texas Medical Association's Council on Medical Education. That choice is “widening the disparity between rural or semi-rural healthcare and the tremendous growth in suburban areas,” he said. The state needs more physicians in family medicine, general internal medicine, obstetrics-gynecology, psychiatry, general pediatrics and pediatric cardiology, nephrology and surgery, he said.

“Overall, we do have a healthy doctor workforce, though, like most places, we can use more primary-care physicians,” said Michael Darrouzet, the longtime executive vice president and CEO of the Dallas County Medical Society. “The economy is good, so there are patients with insurance and employers who believe in healthcare.”

He attributes at least part of the growth in Texas' physician supply—the number of new-physician state licensures rose from 2,088 in 2001 to 3,594 in 2013—to the Legislature's 2003 decision to cap pain and suffering damages in medical malpractice suits.

While the Dallas-Fort Worth physician workforce is keeping up with population growth in terms of numbers, Josh Halverson, a principal with ECG Management Consultants in Plano, said new physicians tend to work shorter hours than the retiring doctors they're replacing. So simply matching the numbers of retirees to new hires won't be enough to keep up. “It's not a one-to-one replacement ratio,” he said. “It's more like 1 to 1.5, and then some.”

Meanwhile, the Texas Center for Nursing Workforce Studies reported that the state's nurse supply exceeded demand by 9.8% in 2011, as the Great Recession prompted many nurses to delay retirement, or brought them back into the workforce. Nursing job vacancies in hospitals fell to 6.8% in 2010 from 11.2% in 2008. The state had 185,000 nurses in 2011, an increase of more than 43% from the 129,000 working in 2001. Their median age was 46 in metro regions and 49 in other areas. The center, however, is now projecting that the state will be short 71,000 nurses by the year 2020.

The number of nurse practitioners in Texas also grew from 2,517 in 2000 to 6,676 in 2011.

Marianne Fazen, executive director for the Dallas-Fort Worth Business Group on Health, said NPs, physician assistants and retail clinics will provide a bigger share of her metro area's primary-care services in the future. There are not enough caregivers, she said, adding that “access is a concern.”

Dallas-area providers are building or expanding their mid-level staffing strategies and NPs are in particularly high demand, said David Cornett, senior executive vice president at St. Louis-based Cejka Search.

Even so, the Texas Medical Association, in its Healthy Vision 2020 report, said that the state had fewer doctors per capita than the national average in 36 out of 40 specialties. “Texas has a large, growing population that is growing sicker, and needs more and better-coordinated healthcare services,” according to the report.

While there may be enough doctors to go around for insured patients, Halverson said safety net facilities that serve a high percentage of uninsured patients, such Parkland Health & Hospital System in Dallas and John Peter Smith Hospital in Fort Worth, are struggling to fill positions.

That situation could change if a large number of previously uninsured patients gain private coverage through the Obamacare insurance exchange and can seek care from a broader range of providers. Texas' Republican leaders, however, have refused to expand Medicaid under the healthcare reform law to adults with incomes up to 138% of the federal poverty level. Using U.S. Census data, the Texas Health and Human Services Commission calculates that 6 million Texans, or about 25% of the state's population, are uninsured. It estimates that 23% of that group would have been covered had Texas expanded Medicaid.

Jim Dunn, chief talent officer at Parkland Health, said his hospital's affiliation with the University of Texas Southwestern Medical School and its role as the area's largest teaching hospital helps keep it well staffed. Parkland also manages to adequately staff registered nurses, but struggles to fill specialty nursing positions for the emergency department and operating rooms, Dunn said. It also has a hard time finding enough nurse practitioners. To that end, Parkland offers tuition reimbursement to staff registered nurses taking NP classes.

Follow Andis Robeznieks on Twitter: @MHARobeznieks