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Dr. Francisco Fernandez, dean of the UT-RGV School of Medicine, spoke at a Harlingen Area Chamber of Commerce event on March 23. The event was part of Harlingen Chamber's monthly Buenos Dias, Harlingen! series.

HARLINGEN, RGV – Statistics show that a large number of medical students set up practice in the city or region where they completed their residency program.

This is the hope of Rio Grande Valley leaders for students that attend the new UT-Rio Grande Valley School of Medicine, because the Valley has, per capita, far fewer physicians than the state average.

However, Dr. Francisco Fernandez, dean of UT-RGV School, says it would be wrong to assume that most of those participating in residency programs at Valley hospitals will automatically stay in the region once they have completed their program.

Fernandez believes the financial debts medical students rack up at college could force many to leave the Valley because of the region’s patient mix. The Valley has a lower than average number of insured patients and higher than average number of Medicaid and Medicare patients.

So, Fernandez is proposing a task force be set up to look at ways of helping students overcome the financial debt they incur from their studies. He believes physicians, legislators, regulatory agency officials, financiers and business leaders should be on the task force.

“A lot of doctors do not end up coming, especially the younger ones. Once you train them how do you keep them here? How do you create an environment that is going to be feasible for them to be able to pay off their debt in primary care without going into, say, pediatric neurosurgery?” Fernandez asked.

“You can see the patient mix and just plug in the numbers. This is what the annual salary is going to be. How long will it take to complete my debt in primary care versus taking a sub, sub, sub discipline? If you have a family, they are going to really struggle with that.”

Fernandez made his comments in a recent talk to members of the Harlingen Area Chamber of Commerce. It was part of Buenos Dias, Harlingen, the Chamber’s monthly breakfast series. Fernandez’s remarks were topical because UT-RGV had just announced details of Match Day, the name given for the day when medical students learn where they will complete their residencies.

UT-RGV announced that 42 medical students would be residents at Valley hospitals. Of these, ten new residency slots in internal medicine have been filed at Valley Baptist Medical Center in Harlingen and six new residency slots in family medicine have been filed at McAllen Medical Center.

“Match Day, as the third Friday in March is called in the medical profession, is considered by many to be the most exciting day of the medical school experience,” said Dr. Yolanda Gomez, UT-RGV’s associate dean of graduate medical education, in a news release. “This happens simultaneously throughout the nation.”

Gomez said matches of students to programs are computer-generated by the National Resident Matching Program. After candidates complete applications and interviews at the residency programs of their choice, they rank their preferences; residency programs, in turn, rank the applicants, and the computer determines the outcome.

“Locally, residency programs have been established at three hospitals;  Valley Baptist and McAllen Medical have had residency programs for more than ten years; Doctors Hospital at Renaissance will start residency training in July,” Gomez said. “All our residents will start this chapter of their lives on July 1.”

In his remarks at the Harlingen Chamber event, Dr. Fernandez said he would like to see a think tank set up to look at ways to help medical student overcome the debt incurred in pursuing a career in medicine.

“There are regulatory solutions and there are solutions that have to do with finances. For example, one could extend the Pell Grants to medical students. I would argue that their entire third and fourth year (in a residency program) is volunteerism, in the sense that students are in hospitals. I would argue there might be some kind of mechanism to do some pay back for some of the work they do.”

Fernandez said universities cannot get into the business of financing loans with a favorable rate but there might be ways in which they could collaborate with not for profit or for profit partners that could generate loans at favorable rates. “Some type of think tank that includes legislators, people from the business community, and finance community. They could look at just this issue because it is a big issue. You could go into UTRGV, do three years of college and three years of medical school. I think there are things you can do.”

Another idea the think tank could look at, Fernandez said, is to ask the Accreditation Council for Graduate Medical Education if it could be possible to let students who finish medical school early go into their residency program early. “The programs say we cannot take rolling admissions. That is not necessarily true.”

Fernandez said that as the UT-RGV School of Medicine is new, this is the time to experiment. “It is the last chance to be creators when you are starting something new, so we might as well do it now.”

In an exclusive interview with the Rio Grande Guardian after his remarks at the Harlingen Chamber event, Fernandez expanded on his ideas. He gave the example of a doctor who had lived and trained in California who was interested in moving to the Valley. “The hospital was offering a loan repayment plan if he worked there. Now he is a sub, sub, specialist practicing medicine in the northeast. He would have been a great catch for the Valley, not just because of the teaching component he could offer, both to residents and medical students. We need people like that to expand from primary care to create centers of excellence in different areas. Unfortunately, there was no infrastructure here to be able to do something that creative.”

As the Valley’s population grows and more large corporations move in, the opportunities for physicians to make a good career in the region will improve, Fernandez said.

“There is an enormity of opportunities in terms of hospitalists. If you want that kind of a practice, if you want a little predictability, there are plenty of opportunities here in various disciplines. You could start employee programs with the large employers, firms like SpaceX, and create networks that currently do not exist. Those things are pretty much established elsewhere but not here,” Fernandez said.

So, despite the challenges young physicians face with student debt, Fernandez said the Valley can be a place that offers opportunities.

“I do not view it as a negative because I do not think all the opportunities have been explored. Think about it. There has got to be a reason that you have for profits down here and there has got to be a reason why people come to the Valley try to take business away from the Valley. Part of it is we do not have the right cadre of disciplines. Once all of that gets into place I really do not think it will be difficult.”

Fernandez said that while the first wave of physicians coming out of the medical school might concentrate on family medicine and preventative medicine, the expansion of medical research initiatives and the related business that flows from that will provide greater variety in the future. “Depending on how things evolve there will be a different set of recruits in the second wave and the third wave. It depends what industries we attract. For example, there could be enormity of opportunity in international medicine.”

Another thing that the think tank could look at, Fernandez said, is approaching Congress for a waiver to allow more residency programs to be developed. Currently there is a cap in place.

“The RGV should be thinking about waivers. For five years you should be able to do x, y, and z, and expand your base (of residencies_ to meet the needs of the region. You are not asking for an exception to be made, simply a waiver that allows you to catch up with the rest of Texas,” Fernandez said.

“Right now, Valley Baptist is limited on what it can apply for. The same is true for McAllen Medical Center. They were the pioneers. Why should the pioneers be punished for having been the first ones on the ground with residency programs? You could look at the future workforce needs and ask for a waiver so you can do something specific over a period of time. And that would be it. Effectively, you would be getting a second chance, if you will. If you were going to do any catching up, this is the time to do it.”

Fernandez acknowledged to get the waiver the Valley would need congressional support. “Not an easy task, but…,” he said.