How Many Medical Schools are Enough for Texas?

Many of us grew up in an era when the number of medical schools in Texas was a pretty stable number. Most knew what schools were available and basic information about the pros and cons of each school. In the last few years, however, the number of new and proposed medical schools in Texas has greatly increased. Most are likely unaware of the changing landscape of medical education in Texas. I would like to provide a very brief overview of the current state of medical education in Texas.

Long Established Texas Medical Schools:

University of Texas Medical Branch-Galveston-Established in 1891, it was the state's first medical school and has weathered many significant storms including the storm of 1900 and, more recently, Hurricane Ike. Class size is around 220.

Baylor College of Medicine-originally known as the University of Dallas Medical Department, the school opened its doors in 1900 in Dallas. It moved to its current location in the Texas Medical Center in 1943. Class size is around 180.

University of Texas-Southwestern-Established as the Southwestern Medical Foundation in 1939, the affiliation with the University of Texas System was established in 1949. The medical center has thrived and grown since that time. Class size is around 220.

Long School of Medicine at UT Health San Antonio-Established by a House Bill a decade earlier, the medical school opened its doors in 1968 to establish a medical training site for the rapidly growing city of San Antonio. Class size is around 210.

University of Texas Houston-McGovern Medical School-Established in 1969 in the Texas Medical Center, the school became the second medical school in Houston. In 2015, a name change occurred to honor the transformational gift of the McGovern Foundation. Class size is around 240.

Texas Tech University Health Science Center School of Medicine-Founded in 1969 to address the shortage of doctors in West Texas, the school formally opened in Lubbock in 1972 and has expanded to clinical campuses in Amarillo and Odessa. Class size is around 150.

University of North Texas Health Science Center-Texas College of Osteopathic Medicine-Founded in 1970 and based in Fort Worth, this was the first osteopathic medical school in Texas (and the only one until 2015). Class size is around 225.

Texas A&M University College of Medicine-The charter class entered in 1977 with a split campus with basic sciences in College Station and clinical sciences in Temple at Scott & White Hospital. Today, the school has clinical sites in Temple, Dallas, College Station, and Houston. The Round Rock clinical site is being phased out. Class size is around 200.

Recently Opened Medical Schools in Texas:

Texas Tech University Health Science Center El Paso Paul L. Foster School of Medicine-Opened in 1973, this campus was initially a satellite clinical campus for the Lubbock based Texas Tech School of Medicine. The school gained independent status for a four year campus and the first class was seated in 2009. Class size is around 100.

University of Texas-Dell Medical School-Established in 2013 in Austin with the support of a large grant from the Dell Foundation, this school seated its inaugural class of 50 students in 2016. It is located in the heart of downtown Austin.

University of Texas Rio Grande Valley School of Medicine-Established by the Texas legislature in 2013 and located in Edinburgh, the school enrolled its first class of 50 students in the fall of 2016. It was established to serve the medical needs of the underserved Rio Grande Valley in South Texas.

University of the Incarnate Word School of Osteopathic Medicine-In 2015, this private medical school in San Antonio became the second osteopathic medical school in Texas. The school enrolled its inaugural class of 162 students in 2017.

Texas Christian University and University of North Texas Health Science Center School of Medicine-A joint educational venture private medical school located in Fort Worth, plans include an inaugural class of 60 students to begin in the summer of 2019. This will be Fort Worth's second medical school, but their first MD program.

Planned New Medical Schools in Texas:

University of Houston College of Medicine-The initial class of 30 students is projected to enter in Fall 2020, with plans to progressively increase class size to 120 students per year in 2024. This proposed medical school would be the 4th medical school with a campus in Houston.

Sam Houston State University College of Osteopathic Medicine-Located in Conroe, this proposed medical school would be the third osteopathic medical school in Texas. Accreditation is progressing for a targeted opening date of 2020. Class size information could not be found.

So, if you are counting, that is 15 medical schools in Texas that will soon be graduating over 2200 students per year. The proliferation of new medical schools has not necessarily coincided with an expansion of new residency positions. There has been some modest growth in residency positions, but there has also been some contraction of positions in many areas. Many of our politicians are finally starting to get the message that increasing medical student numbers does not fix the shortage of Texas physicians. It is only part of the equation. The state or federal government needs to provide funding for more residency positions as well if the physician shortage is to be adequately addressed.

In 1997, the Balanced Budget Act froze the funding of residency positions that would be funded by Medicare dollars. All growth in GME since that time has been funded by individual programs and hospitals. As the belts tighten in healthcare, the willingness/ability of the hospitals to foot the bill for these trainees is dissipating. Recently, a small amount of funding has become available for establishment of new programs that did not have residency positions previously. However, well established programs have been tied to their 1997 numbers with almost no exceptions.

Too often, we train medical students in Texas and they go away to other states for residency training. There is a large body of evidence that shows that many of those students do not return to Texas to practice. Instead, they often stay near where they received their residency training. So, in essence, a large investment of dollars goes into training future doctors and then we lose them to other states in the final phase of their training due to the number of residency positions in Texas lagging behind the number of medical school graduates.

Texas is not the only state to see an expansion in the number of medical schools over the past few years. As more graduating medical students enter the process, even more medical students will be left unmatched into residency programs. These students have an average school loan burden of $200,000. There are currently thousands of unmatched physicians who have been unable to secure residency positions over the last several years. Given the large growth in medical school numbers and only modest growth in residency position numbers, I can't help but think that this problem will only become worse.