When Dr. Stuart Pickell moved to Fort Worth in 2001, he was surprised to learn most local health systems did not have physician residency programs.
At the time, the only health systems with such programs were and . Fort Worth wasn鈥檛 known as an academic city, he said.
During the past two decades, the need for physicians in Fort Worth grew rapidly. A lot of the need is fueled by population growth and the physician workforce not keeping pace, said Pickell, who now serves as president of the .
In order to meet the needs, several Fort Worth health systems began to pivot.
What is graduate medical education?
Graduate medical education is the step of health care development between medical school and clinical practice. During this phase, residents learn to provide optimal care under the supervision of faculty members.
Most residencies last three to eight years, depending on the specialty.
In recent years, and established residency programs, also known as graduate medical education, in addition to the ones already existing in Fort Worth.
Tarrant County residency programs exist for internal medicine, emergency medicine, OB/GYN, family medicine, general surgery and orthopedics.
鈥淭arrant County鈥檚 medical community began meeting the challenge by starting several new residency programs. This is a welcome, albeit long overdue, development,鈥� Pickell earlier this year.
But, one academic specialty has been left behind 鈥� pediatrics.
Now, physicians are asking a critical question: Should Cook Children鈥檚, the children鈥檚 health system in Fort Worth, establish a physician residency program?
Cook Children鈥檚 declined interview requests for this story. Kim Brown, director of public relations with Cook Children鈥檚, wrote that the health system has other priorities at the moment.
Pediatric need in North Texas
From its inception in 1985, mission has been to improve the well-being of every child across Tarrant County.
The health system has been successful in doing so, by treating patients with board-certified pediatricians and not associating itself with a physician residency program.
Cook Children鈥檚 only offers clinical observations to medical school students affiliated with the and University of North Texas鈥� . Cook Children鈥檚 currently has a pediatric residency program and a postgraduate residency program for
By doing so, Cook Children鈥檚 has been able to recruit physicians who want to be clinicians, not educators, supporters of the hospital鈥檚 existing approach say.
Cook Children鈥檚 Medical Center in Fort Worth is the in the U.S. by bed size. In 2022, the health system $1.77 billion in revenue.
But, has the health system鈥檚 model been enough to meet the growing pediatric need across North Texas?
In 2020, the Texas Health and Human Services Administration identified North Texas as one of the regions with the greatest shortage of pediatricians. The number of medical students pursuing a career in pediatrics has declined over the past five years as the number of pediatric positions available has increased, according to a UT Arlington researcher.
The decrease in pediatric interest is fueled by the subspecialties鈥� relatively lower pay compared with other adult specialties. The lifetime earnings for adult physicians averaged $1.2 million higher than those of the corresponding pediatric physicians, according to another report in the .
The growing demand has led to the establishment of physician residency programs at Texas pediatric hospitals in Austin, Dallas, Houston and San Antonio.
Programs can also be found in Amarillo, Corpus Christi, El Paso, Galveston, Lubbock and Temple 鈥� none in Fort Worth, which in the country and is the fifth largest in Texas with a population of 956,709.
鈥淟ooking at the 30 largest cities in the United States, Fort Worth is the only one that doesn鈥檛 have a pediatric residency program. Jacksonville, Florida, which ranks just ahead of Fort Worth in population, for now, has a pediatric residency program, and it doesn鈥檛 even have a medical school. Fort Worth has two medical schools,鈥� Pickell wrote in a column.
The shortage is expected to worsen during the next decade.
What is needed to establish a program?
In order to launch a graduate medical education program, all health systems have to submit applications and meet requirements with the , which is responsible for accrediting all graduate medical training programs for physicians in the U.S. The application process can take as long as seven to 10 months.
Before it can do that, a health system needs to determine the number and specialties of the residents it wants to train. A program requires physician supervisors, teaching faculty physicians from various specialties, clinicians, a program director and a program coordinator to run it.
There must be a sufficient number of faculty members, facilities and patient load necessary to provide adequate training, as well as investment in equipment for residents to practice procedural and communication skills.
When it comes to funding a program, financing a physician鈥檚 education and training is a mix of federal and state funding and hospitals鈥� investment of its own resources. On average, the cost of training a future physician is $150,000 per resident per year, according to the . That doesn鈥檛 include the $50,000 annual salary each resident would earn.
But, the cost of funding a resident over three to eight years exceeds available government funding, which means medical institutions have to invest more of their own funds as reimbursement rates shrink.
鈥淚f health systems want to grow something, they鈥檙e going to fund it for the most part, unless there鈥檚 a creative way to do it,鈥� said Dr. Stuart Flynn, founding dean of the Anne Burnett Marion School of Medicine at TCU.
Discussion on both sides
Over the past several years, conversations about what a physician residency program could look like at Cook Children鈥檚 have circulated among members of the Fort Worth medical community, said Pickell.
But, several discussions show the establishment of a program wouldn鈥檛 be simple.
The success of a program depends on having a medical staff on board. It would be difficult to uproot the Cook Children鈥檚 model that has existed for over 40 years and ask the staff to change its workload by increasing hours.
While the average American works roughly 40 hours weekly, medical residents can work up to 80 hours a week.
鈥淎 program is time-consuming, because educating residents can be a challenge,鈥� Pickell said.
The program could also affect the experience of care. Currently, patients at Cook Children鈥檚 are getting treated by fully trained physicians in their specialties. With a program, training residents would deliver a significant amount of the care.
鈥淚f there is a program, there wouldn鈥檛 be the same level of physician access for the patient and that鈥檚 a concern,鈥� said Dr. Paul Bowman, who previously served as director of medical education at Cook Children鈥檚. 鈥淪till, when residents take care of patients, families have to consent.鈥�
On the flip side, several Fort Worth physicians advocate for the establishment of a program. If Cook Children鈥檚 established one, it could enhance the hospital鈥檚 national profile to rank it high among other academic institutions, including in Dallas and in Houston, said Pickell.
It could also boost the local economy by creating a pipeline for students who graduate from the medical schools in Tarrant County. A lot of physicians tend to settle down in the city where they train.
More than half of individuals who completed residency training from 2008 through 2017 are practicing in the state of residency training, according to the .
鈥淭his would be good for the local workforce and an amazingly educational opportunity to train the next generation of pediatricians,鈥� said Flynn.
Fresh faces in Fort Worth also fuels new ideas, said Dr. David Donahue, a retired pediatric neurosurgeon who spent over 20 years at Cook Children鈥檚.
鈥淎s physicians, we鈥檙e not questioning as much, and residents can bring fresh perspectives,鈥� he said. 鈥淚鈥檓 convinced medicine is losing its identity because we are forgetting about our jobs which are to teach.鈥�
Other physicians agree.
鈥淵oung doctors are vibrant. They鈥檙e full of life and have new ideas,鈥� said Dr. James Marshall, chair of pediatrics with the TCU Burnett School of Medicine. 鈥淏y having young professionals drawn and attracted to your county and training, we bring all those vigorous things that make a community so much more attractive and vibrant.鈥�
Still, members of the Fort Worth medical community know the decision is beyond them 鈥� it鈥檚 up to Cook Children鈥檚.
鈥淚f [Cook Children鈥檚] wanted to do a residency program, it would be immediately accessible. They have resources that are phenomenal for a residency program,鈥� Pickell said. 鈥淭hey just have to say they want to do it.鈥�
David Moreno is the health reporter at the Fort Worth Report. Contact him at david.moreno@fortworthreport.org or via .
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This first appeared on and is republished here under a Creative Commons license.