Fort Worth faces a shortage of pediatricians. Could Cook Children’s provide a solution?

dfwnewsa | December 2, 2023 | 0 | Dallas News , Fort Worth , Fort Worth News

Fort Worth faces a shortage of pediatricians. Could Cook Children’s provide a solution?
Cook Children’s Medical Center is a not-for-profit, pediatric hospital in Fort Worth. The hospital is located at 801 7th Ave. (David Moreno | Fort Worth Report)

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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 JPS Health Network and Medical City. Fort Worth wasn’t 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 Tarrant County Medical Society

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, Baylor Scott & White and Texas Health Resources 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.

“Tarrant County’s medical community began meeting the challenge by starting several new residency programs. This is a welcome, albeit long overdue, development,” Pickell wrote in a column earlier this year.

But, one academic specialty has been left behind — pediatrics. 

Now, physicians are asking a critical question: Should Cook Children’s, the children’s health system in Fort Worth, establish a physician residency program? 

Cook Children’s declined interview requests for this story. Kim Brown, director of public relations with Cook Children’s, wrote that the health system has other priorities at the moment.

Pediatric need in North Texas

From its inception in 1985, Cook Children’s 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’s only offers clinical observations to medical school students affiliated with the TCU Burnett School of Medicine and University of North Texas’ Texas College of Osteopathic Medicine. Cook Children’s currently has a pediatric residency program for nurses and a postgraduate residency program for pharmacy students. 

By doing so, Cook Children’s has been able to recruit physicians who want to be clinicians, not educators, supporters of the hospital’s existing approach say. 

Cook Children’s Medical Center in Fort Worth is the 10th largest children’s hospital in the U.S. by bed size. In 2022, the health system reported $1.77 billion in revenue.

But, has the health system’s 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’ 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 American Academy of Pediatrics

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 — none in Fort Worth, which is the 13th-largest city in the country and is the fifth largest in Texas with a population of 956,709. 

“Looking at the 30 largest cities in the United States, Fort Worth is the only one that doesn’t 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’t even have a medical school. Fort Worth has two medical schools,” 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 Accreditation Council for Graduate Medical Education, 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.

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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’s education and training is a mix of federal and state funding and hospitals’ investment of its own resources. On average, the cost of training a future physician is $150,000 per resident per year, according to the Texas Hospital Association. That doesn’t 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.

“If health systems want to grow something, they’re going to fund it for the most part, unless there’s a creative way to do it,” 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’s have circulated among members of the Fort Worth medical community, said Pickell. 

But, several discussions show the establishment of a program wouldn’t be simple.

The success of a program depends on having a medical staff on board. It would be difficult to uproot the Cook Children’s 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. 

“A program is time-consuming, because educating residents can be a challenge,” Pickell said. 

The program could also affect the experience of care. Currently, patients at Cook Children’s are getting treated by fully trained physicians in their specialties. With a program, training residents would deliver a significant amount of the care.

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Visitors wait at the emergency department at Cook Children’s Medical Center in Fort Worth. (Courtesy photo | Cook Children’s)

“If there is a program, there wouldn’t be the same level of physician access for the patient and that’s a concern,” said Dr. Paul Bowman, who previously served as director of medical education at Cook Children’s. “Still, when residents take care of patients, families have to consent.”

On the flip side, several Fort Worth physicians advocate for the establishment of a program. If Cook Children’s established one, it could enhance the hospital’s national profile to rank it high among other academic institutions, including Children’s Health in Dallas and Texas Children’s Hospital 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 Association of American Medical Colleges

“This would be good for the local workforce and an amazingly educational opportunity to train the next generation of pediatricians,” 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’s.

“As physicians, we’re not questioning as much, and residents can bring fresh perspectives,” he said. “I’m convinced medicine is losing its identity because we are forgetting about our jobs which are to teach.” 

Other physicians agree. 

“Young doctors are vibrant. They’re full of life and have new ideas,” said Dr. James Marshall, chair of pediatrics with the TCU Burnett School of Medicine. “By 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.”

Still, members of the Fort Worth medical community know the decision is beyond them — it’s up to Cook Children’s.

“If [Cook Children’s] wanted to do a residency program, it would be immediately accessible. They have resources that are phenomenal for a residency program,” Pickell said. “They just have to say they want to do it.”

David Moreno is the health reporter at the Fort Worth Report. Contact him at david.moreno@fortworthreport.org or via Twitter.

At the Fort Worth Report, news decisions are made independently of our board members and financial supporters. Read more about our editorial independence policy here.

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