Ken Ortolon’s research while affiliated with Texas Medical Center and other places

Physicians hoped the health system reform law would eliminate the Sustainable Growth Rate (SGR) formula that drives down Medicare fees. The SGR, however, remains in place, and the law created a new board with the authority to cut fees even further, possibly on top of cuts under the SGR.

An increasing number of medical graduates in the country, particularly in Texas, are finding it hard to match to a residency program in their preferred specialty. While medical educators say there are various reasons for that, almost all point to a growing imbalance in the ratio of medical graduates to residency slots. That imbalance is particularly apparent in Texas, where the state offered fewer first-year residency positions in 2010 than it had medical graduates.

With nearly 70 Texas hospitals with some type of physician investment, the state is a national leader in the physician-owned hospital industry. And, members of that industry say it has been good for patients. But the health system reform law Congress passed earlier this year slams the door on new physician-owned hospitals by prohibiting them from obtaining a Medicare provider number.

Some people may love it, while others definitely hate it. Still more are just trying to figure out what's in it. But health system reform is now law, and it's likely to the biggest change in American health care since Congress created Medicare in 1965. Physicians, patients, insurers, and others are scrambling to determine how to deal with it.

Texas faces shortages in virtually every recognized medical specialty, but experts say the need for primary care doctors is particularly critical. The Senate Health and Human Services Committee began a study of the current and long-range need for physicians and other health professionals in the state. TMA officials say that study is definitely timely, but fear there may be little opportunity to expand training for physicians due to the state's projected budget shortfall.

Congressional passage of the health system reform bill, the Patient Protection and Affordable Care Act, sent physicians and patients scrambling to examine the fine print to determine how the new law will impact health care for all Americans. TMA launched a massive new education campaign to help Texas physicians and their practices survive and thrive in the new health care environment.

Texas Medical Association leaders say there is no doubt members of Congress understand the importance of fixing the broken Medicare physician payment system. They understand it. They just haven't done anything about it.

The East Texas community of Crockett showed its growing commitment to medical education earlier this year when it launched construction of a Rural Physicians Education Center to provide housing for Texas College of Osteopathic Medicine students and family medicine residents from the Texas A&M Health Science Center doing one- to two-month rotations.

Some physicians, hospital executives, and health care policy analysts are pushing accountable care organizations (ACOs) to replace fee-for-service medicine. In an ACO, physicians and other health care professionals have financial incentives to contain costs and improve quality by coordinating care for a specific group of patients. Hospitals, physicians, and other health care professionals in the organization share the savings.