When bodies began piling up at Rio Grande Valley hospitals and in refrigerated morgue trailers during the height of the pandemic, experts sought an explanation for the high fatality rate.
Health officials familiar with well-known factors affecting border communities — like high rates of poverty, obesity, diabetes and the uninsured — urged the public to take preventive action to safeguard their health.
But Valley residents who try to heed that advice by seeking preventive care with primary care physicians face a predisposed disadvantage.
Data obtained from the Texas Medical Board shows the Valley doesn’t have as many primary care physicians — family, internal, pediatrics, and OBGYN — as Central or East Texas counties.
When considering the per capita rates of primary care physicians in the 20 most-populous Texas counties, three border communities score lowest. Hidalgo and Cameron counties are 16th and 17th, respectively, and Webb County comes in last with 45.5 primary care physicians per 100,000 residents.
Meanwhile, counties like Dallas, Lubbock and Harris have per capita rates between 113 and 119.
Starr and Willacy counties rank poorly in the overall list compiled from the state data.
More people are sharing physicians in Starr County than in any other Valley county. It claims the 181st spot on the list with a per capita rate of 26.2, or 16 physicians for a population of 60,968.
Willacy County does fairly better coming in at 145 on the list with a rate of 40.7, or nine physicians for a population of 22,134.
Yet, there are some counties, like Zapata and Jim Hogg County, that couldn’t be ranked, because there are no primary care practices based in their jurisdiction.
How we calculated the data:
The Monitor used physician data purchased from the Texas Medical Board dataset. The doctors who had active licenses and who listed Texas-based practice addresses were counted and divided by county. Approximately 22,000 doctors are out-of-state physicians who are allowed to work in Texas. These were not included in the total count. Of the 22,000 about 250 had a partial Texas address but failed to include the county, or input the wrong zip code. Those 250 were individually and manually corrected and added to the list used to calculate the per capita rates of primary care physicians in Texas.
Communities lining the Rio Grande are statistically struggling more with poverty, leading to high uninsured or under-insured rates. Many more Valley residents than those in the rest of the state are also dependent on federal insurance like Medicaid.
In the Valley, an average of 29% of the population is uninsured, according to data from the U.S. Census Bureau. That’s compared to the state’s average of 21% and the national average of 9%.
Less money in the pockets of residents translates to less money in the pockets of doctors.
Dr. E. Linda Villarreal, an Edinburg doctor and the Texas Medical Association president-elect, said many doctors need to consider the bottom line.
“The mathematics of it is it costs more to see a patient with Medicaid, federal government insurance, than it does to just not see them at all,” she said.
The mission for any doctor who’s a member of the Texas Medical Association is to provide medical attention to any Texan, Villarreal noted. But doctors with private practices have to consider the cost.
“Unfortunately, we do still have to lose money, if it costs me $50 to see a patient and Medicaid pays me $30, I’ve lost $20. It’s not about the money itself, but it’s a matter of — as much as I hate to call the profession of medicine a business — it is a business. I was a fellow practitioner for 29 years. You have to balance things,” she said.
As the population at-large and uninsured population continue to expand in the Valley, the number of doctors taking patients with federal aid is trending in the opposite direction.
“The population of physicians who take Medicaid is decreasing because of the poor parity of payment in comparison to Medicare. We have not had an increase in physician payment in over 20 years,” Villarreal said referring to the Medicaid fee increase set by the 76th Texas Legislature in 1999.
Logistically, primary care physicians see fewer patients a day than subspecialty physicians who can focus on only one part of the body. The average for Villarreal, an internist seeing adults, is about 20 patients a day, but that’s a higher average than doctors just starting out.
Some physicians are required to see a certain number of patients.
Hospitals are responsible for recruiting a lot of the new physicians in the Valley, Villarreal said. Many times, they will be offered contracts that expire after two years. After it expired, “suddenly their guaranteed salary is based on production,” Villarreal said, noting this is not a new practice. But after the first contract expires, Villarreal said many will leave.
Villarreal said many doctors, like herself, have opted to become employed physicians to avoid balancing the books of a private practice. Though she had a private practice for over 20 years, she is now working for WellMed the last nearly four years.
“If they will allow us to practice medicine and they take care of the business of medicine, then it’s an equal partnership,” she said. However, she added, “If they put restrictions on the number of patients you can see, or the number of Medicare patients or the number of Medicaid patients, then it’s lopsided.”
As president-elect, Villarreal is set to take office in May of next year. A goal is to continue asking the legislature for more funding of the graduate medical education slots opened by hospitals every year.
Texas saw an increase in GME funding in the last legislative session. Villarreal described it as “not as much as we needed, definitely not as much as we wanted but they did provide some increase in funding.”
She’s hoping that will help attract more doctors.
Retaining them may be a harder challenge, but she feels getting primary care physicians to this region will be key to keeping them here.
“One of the best ways for our legislators to help us with this is to continue to fund our graduate medical education, continue to fund these residency programs that will allow us to show these physicians what it’s like to practice in the Valley, and let them see that the opportunity is here to establish a practice,” Villarreal said.