Doctors rushing to practice in Texas after tort reform

Austin Business Journal
by Jon Selden
ABJ Staff

Sign seen hanging in a vacant medical office in New York: “GTT”

Just three years after state lawmakers cured a so-called medical crisis that was supposedly driving hordes of doctors out of the state, the state’s medical board is facing another one — too many doctors driving in.

The state’s sweeping medical malpractice lawsuit reforms in 2003, which capped payouts in medical malpractice cases, created one of the least-risky climates for doctors in the country. As proof, Texas became the first and only state to ever make it off the American Medical Association’s list of states in medical liability crisis.

And, just as in Texas’ republic days, when the phrase “Gone to Texas,” or GTT, symbolized the flight of oppressed and debt-laden folk to a better life in Texas’ warm and debtor-friendly environment, out-of-state doctors are closing up, loading up, and going to Texas’ new doc-friendly legal system.

That land rush is putting a severe strain on the Texas Medical Board, which is responsible for reviewing and granting applications to practice medicine in the state.

“Three years ago, we were having trouble attracting doctors to our state,” says former state Rep. Joe Nixon, R-Houston, who authored the medical malpractice reform bill in the 2003 legislative session. “Now we can’t keep up with the demand.”

In just the last few years, the board’s workload has increased by almost 100 percent, says its executive director — a neurosurgeon and lawyer — Dr. Donald Patrick.

“We’re gaining on double,” he says. “It just threw us into chaos.”

He says the board is outfitted with enough funding and employees to handle 2,400 applicants a year. But last year, new physician applications took a vertical leap — Michael Jordan-style — to 4,026, up 35 percent from 2005. And 2005 was already the board’s busiest year on record. The next busiest was 2004, with almost 3,000 applications.

And it’s not letting up. In just the first half of this fiscal year, the board has already received 1,800 new applications and is on track to get 3,600 total, Patrick says.

“I expect it to go up instead of down,” he adds.

That backlog has created a long line of anxious healers — with almost 2,600 applications pending. But the medical board has stayed roughly the same size with a tiny — by state agency standards — $7.1 million budget.

It recently hired six temporary employees whom it hopes to make permanent “to start making a dent in the backlog,” but funding is still up in the air.

“Right now, we just get further and further behind,” Patrick says.

Just a few years ago, at its quickest, the board could approve a low-complexity application in just 18 days, Patrick says. “We got down where it was just child’s play to get in here.”

But now, at best, that same process takes 86 days, he says. And it can take more than six months for some applications, according to the Texas Medical Association.

Of the 4,026 physician license applications received in 2006, the board only granted 2,516 — 7 percent less than the previous year.

That’s prompting the Texas Medical Association — which represents nearly all of Texas’ physicians — to call on the state Legislature to put some more money into the medical board’s licensing staff to help push the paper pile down.

“Texas can’t afford to turn away good doctors,” TMA President Dr. Ladon Homer wrote in his letter to Sen. Steve Ogden, R-Bryan, chair of the Senate Finance Committee. “In essence, we have 2,500 small businesses waiting six to nine months to begin operations.”

Homer says the average physician in Texas employs five people and contributes more than $600,000 a year to the local economy. That means, he says, Texas is leaving 12,500 jobs and $1.5 billion of economic impact on the table.

TMA wants the Legislature to put an extra $3.8 million into the Medical Board to generate “a big return for a small


Nixon says adequately staffing the medical board — with even as little as a $400,000 emergency appropriation, would allow it to process 4,000 doctors a year.

And the state needs all the doctors it can get, the TMA says. Texas has 194 physicians per 100,000 people, far less than the national average of 239, and ranks 42nd among all states in that category.

But many of the new applications are coming from out-of-state doctors practicing in “judicial hellholes,” as the American Tort Reform Association calls them — states like New York, California and Florida.

New York is the biggest source of doctors seeking Texas licenses — with 145 applications turned into the Medical Board. California is next, with 118 applications, and Florida doctors sent in 100.
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