A Texas town is trying to solve the US physician shortage with 'homegrown' clinicians — a possible answer to the primary-care drought plaguing 100 million Americans

• El Paso is among the 95% of Texas counties that have some shortage of primary-care physicians.
• One partnership awards local high-school students with hands-on exposure to the healthcare industry.
• The hope is participants will stay after medical school and residency, one dean told Insider.
• This article is part of "Big Trends in Healthcare," a series exploring the top trends shaping the future of the industry.

Eighteen-year-old Makena Piñon had a first-hand view of the medical gaps in El Paso's healthcare system.

Born with a congenital heart defect, Piñon underwent her first operation at 5 months old, followed by open-heart surgery at 11.

"El Paso is a very underserved community," she told Insider. "Being a patient all my life in Houston and then having hospital visits here in El Paso, you can see the difference in the care and how advanced the medicine is," Piñon said.

This year, Piñon was one of five El Paso teenagers celebrating an unusual milestone for high-school seniors: She was effectively accepted into medical school, at least four years before most aspiring physicians find out whether they got in.  

This nontraditional path to a white-coat ceremony is part of a new, local partnership that aims to combat its hometown's physician shortage with guaranteed spots in medical school, mentorship, Medical College Admission Test preparation, and summer internships. The hope is they will stay and practice medicine in El Paso after medical school and residency.

"I really hope to provide a perspective and knowledge to the community here and help to serve patients who might otherwise have to leave because there aren't as many doctors here and I'd like to slowly but surely help keep more patients here," Piñon said.

El Paso County, which includes the city of the same name, is among the 95% of Texas counties that have a shortage of primary-care physicians. They're not alone — just shy of 100 million Americans live in an area with a shortage of primary-care physicians. And demand for medical care is growing as the American population ages, outstripping supply.

The shortages are especially dire in rural areas, where 20% of Americans live but only 10% of doctors practice. The program in Texas for high-school students is adding needed doctors to the primary-care-physician pipeline and could offer a model for other communities facing similar challenges.

Federal funding could aid and expand the healthcare workforce, but it may not be enough to meet the demand among rural populations. One key to addressing the lack of physicians could be a "homegrown" approach to making — and keeping — more doctors, nurses, and other clinicians in the areas where they are needed most through mentorship opportunities and state- and privately funded scholarships.

Limits to the industry's education system leave some medical students without jobs 

The number of students enrolled in medical school grew by 9% between 2010 and 2021, according to the National Center for Education Statistics — plus another 3% from 2021 to the 2022-23 academic year, according to data from the Association of American Medical Colleges. But the US is on track to have a shortage of around 48,200 to 73,700 doctors by 2024, according to the AAMC. That number could increase to as high as 124,000 by 2034.

While the number of medical students and residents has risen, it's not fast enough to keep up with the increasing demand for care as record numbers of clinicians leave the workforce because of pandemic burnout or retirement.

Dr. Atul Grover, the executive director of the AAMC Research and Action Institute, told Insider this demand was because the federal government arbitrarily capped its share of the costs for medical training in the late '90s.

For example, federal funding for residency programs was largely capped in 1997 — on the heels of worries that the US would have a surplus of doctors — and has only recently been modestly increased.

There was a record 40,375 residency spots for the graduating class of 2023, but it still wasn't enough for all 42,952 graduate applicants to match, meaning nearly 2,600 prospective doctors were left without an opportunity.

Rural areas are prioritized for new residency spots but expected to struggle to bring in new talent, considering that 98% of residency positions in 2020 were at urban hospitals, a Government Accountability Office study found.

And while diversity among medical students is improving, underserved patients of color are still far less likely to get to see a doctor who looks like them, which is linked to better care and outcomes.

Hit with drastic shortages, rural states are investing in medical students from early ages

For physicians, "there is a bit of a geographic battle," Grover said, adding: "We need to figure out how to serve the needs of rural populations — which we've been trying to do for the past 50 years and it hasn't worked — and we can't just diversify the healthcare workforce starting in medical school; even high school is almost too late."

Investing in and keeping the next generation of doctors is the mission of a partnership between the University of Texas at El Paso and the Texas Tech University Health Sciences Center El Paso.

This first cohort is a proof-of-concept. Students will be guided through the process up until admission, which includes a guaranteed interview. If all goes well, they and future students in the program will have a sure path to medical school. 

With considerable sponsorship from local businesses, the pair of universities organize opportunities for El Paso kids to get hands-on exposure to the healthcare industry, starting in elementary school. As part of its new MedFuture program, five high-school students are given preliminary acceptance to medical school (as long as they maintain a qualifying grade-point average), access to summer research opportunities throughout their college years at the University of Texas at El Paso, and help preparing for the MCAT.

"Many of the students are first-generation immigrants; they have not had exposure to healthcare professions or how to get there," Dr. Richard Lange, the president of the Texas Tech University Health Sciences Center El Paso and dean of the Paul L. Foster School of Medicine, told Insider. 

Lange said the program selected students with an interest in supporting their community. The idea, he added, is that those participants will have a higher likelihood of staying after medical school and residency. 

It's up to the students to decide whether they want to go on to medical school, but there are plenty of incentives for them to attend a program in Texas. A large portion of the class at the Foster School of Medicine receives scholarships from a $50 million endowment, Lange said.

As of 2020, more than 80% of students who went to medical school and did their residencies in Texas stayed in state to practice medicine, according to the Association of American Medical Colleges. Lange told Insider he estimated that about 15% of graduates from the Foster School of Medicine were placed in residency programs in the El Paso area.

And that benefits patients beyond an increase in the number of physicians in the region, Dr. Cynthia Perry, associate academic dean for admissions at the Foster School of Medicine told Insider. "For us, it's about cultural competency," she said. "The students that are from our region and go on to train and practice here relate to their patients and understand the obstacles these patients have to endure." 

MedFuture students are uniquely suited to help patients navigate El Paso's particular system and take advantage of resources a physician from elsewhere might be unaware of, she added. 

Some states bootstrap additional residency spots and medical-school scholarships 

Even as medical-school graduates nationwide face the limits of residency-match spots, Texas is uniquely positioned. For each in-state medical-school graduate, the state has 1.1 residency spots per graduate, set by the Texas Higher Education Coordinating Board. While there are technically 1.82 slots per graduate nationwide, according to the National Resident Matching Program, this number includes international applicants — so there are only 0.85 slots per American graduate.

Texas hospitals have accomplished this by taking advantage of a Medicare policy that provides additional funds for new residency programs, while funded slots in existing programs are capped. The state does the same. 

Since 2016, six medical schools have opened in Texas. The number of residency programs in Texas has increased by 49% in the past decade, outpacing the 41% national growth rate.

"The state has been very generous in funding these graduate-medical-education programs to make sure that if these students want to stay here, they can," Lange said.

Texas' model is working, and Grover told Insider he saw similar local efforts produce "homegrown" doctors from a young age and incentivize them to practice in shortage areas across the country. 

While about 20% of people in El Paso are estimated to live in poverty, the city benefits from medical-education funding provided by the state, which has the second-highest GDP in the country. But state funding won't go as far in poorer states with even-worse physician shortages and higher rates of premature deaths, heart disease, obesity, and overall poor health, including Mississippi or Louisiana. 

"We need to figure out how to fortify the pipeline of new physicians, and we need to figure out how to make full use of everyone in all the healthcare professionals," Grover said.