The Texas physician workforce: current status and future direction

The United States is facing serious physician workforce challenges. These include a shortage of physicians; declining interest in primary care; a maldistribution of doctors, particularly in inner-city and rural areas; the lack of a coherent workforce planning mechanism; and a workforce that does not reflect the diversity of the general population. Texas has many of the same issues, but problems are magnified by a historically low physician-to-population ratio; a rapidly growing and increasingly diverse population; and significant access-to-care issues, driven by a large uninsured population. This article reviews the current status of the US physician workforce and the challenges facing the nation over the next 20 years, and compares the national situation with prevailing and future conditions in Texas. Unless current trends are altered, Texas will face a growing shortage of physicians (particularly in primary care and certain specialty areas) that will be worse in rural and border areas. Although Texas medical schools are increasing enrollment, the growth in their graduate medical education slots is not keeping pace, creating a bottleneck that will constrain growth in the number of practicing physicians.