Doctors clamoring to come to Texas, creating backlog of applicants

More than 2,000 doctors awaiting Texas licenses, as patients wait to see certain specialists
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By Mary Ann Roser
AMERICAN-STATESMAN STAFF

An influx of doctors into Texas has caused long waits for medical licenses, inconveniences for patients wanting to see certain specialists and anxiety for physicians awaiting new colleagues to help with high caseloads.

People in the medical field say the state’s limits on malpractice lawsuits have generated a surge of doctors, including specialists, who want to practice in Texas, which is helping bring more doctors to areas of the state that don’t have enough.

But the state’s popularity has overwhelmed the Texas State Board of Medical Examiners, which screens doctors before issuing them a Texas medical license, a process that involves verifying medical education and doing a criminal background check, among other steps.

Lawmakers have approved $1.2 million to hire six more staffers to process applications faster. Meanwhile, the board is using temporary workers and paying staffers overtime but still can’t keep up, spokeswoman Jill Wiggins said.

“The pipeline is just clogged,” Wiggins said.

The board received 4,000 applications for medical licenses in 2006, compared with 2,992 the previous year. Wiggins said the board expects to approve 2,750 new licenses this year, 235 more than the previous year.

There is a backlog of 2,398 license applications awaiting approval. The most complicated applications take an average of 6.3 months to process, and the simplest ones average 41 days, according to data provided by the board. The most complicated applications include ones that come from out-of-state doctors or from veteran doctors who have long histories to be checked.

In 2003, the most complex applications took an average of 45 days, and the simplest took 20 days, Wiggins said.

Dr. James E. Kreisle Jr., an Austin psychiatrist, said he and two colleagues have been been waiting since the fall for two psychiatrists from South Carolina and Georgia to get licensed in Texas so they can join the practice.

“There’s a shortage of psychiatrists in this town,” Kreisle said.

He said patients have to wait at least three weeks to get in to see him. Some Austin psychiatrists aren’t taking any new patients, he said, which can pose serious problems for patients who are severely depressed or have some other condition that requires immediate treatment.

Many doctors are coming to Texas because of a 2003 law that has created a favorable legal environment for them, physicians and others said. The law limits damage awards in malpractice lawsuits and thus has discouraged lawyers from representing patients or their loved ones who want to sue a doctor.

On average, malpractice insurance premiums in Texas have gone down 21.3 percent since the tort law took effect in September 2003, said Jon Opelt, executive director of Texas Alliance for Patient Access. The alliance, which supported changing the medical liability law, describes itself as a coalition of doctors, hospitals, nursing homes, health care providers and medical liability insurers.

The law is “a big factor why Texas has become a popular state to practice in,” said Dr. Punit Chadha, an oncologist who moved to Austin from Chicago last summer. “When medical recruitment firms send out information, . . . they will tout the friendliness” of the malpractice environment.

Chadha, who grew up in Houston, said he wanted to come back to Texas but would not have returned if not for the 2003 law. His malpractice insurance premium is now about one-fourth of what it would have been in Chicago, which has some of the highest rates in the nation, he said.

It took him five months to get his license approved in Texas, he said.

Dr. Kevin H. Brown, who started practicing obstetrics in Round Rock in May, applied for a Texas license the same day in September as his obstetrician wife and partner, Ingrid W. Brown. It took six months for his license to be approved; his wife is still waiting for hers because of a paperwork delay, he said.

Brown said that his wife was able to get a temporary license and that their practice is helping alleviate Round Rock’s shortage of obstetricians.

The medical board can issue temporary licenses to doctors who have completed the licensing process and are only waiting for final approval from the board, which meets every other month, Wiggins said.

Brown said he and his wife paid $130,000 a year for both of them to have malpractice insurance in Georgia. Now, they pay a combined premium of $82,000 a year, he said.

“It was a $24,000 raise for each of us before we even got started,” Brown said.

Many parts of the state that have had doctor shortages are seeing new physicians arrive, Opelt said. Beaumont once had to fly some trauma patients to other cities for treatment because the city didn’t have enough trauma surgeons, Opelt said. Now, enough surgeons have moved to Beaumont to handle the caseload.

“Most every area of the state is seeing gains except for far East Texas,” Opelt said.

Still, Kreisle, the Austin psychiatrist, said he fears that the backlog could cause physicians to go elsewhere.

Wiggins estimated that it will take “a little over a year” before the new staffers at the medical board can bring the backlog of license applications under control.

“You’re turning a battleship around,” she said.
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