Texas-Mexico Border
Health Education Needs
A Report
to
the 77th Legislature
Prepared by the Texas Higher Education Coordinating Board
and
the Texas Department of Health
Texas Higher Education Coordinating Board
Pamela P. Willeford, Chair (2003)
Martin Basaldua, MD, Vice-Chair (2003)
Jodie L. Jiles, Secretary (2001)
William C. Atkinson (2001)
Dolores Hutto Carruth, MD (2001)
(Chair, Health Affairs Committee)
Ricardo G. Cigarroa, Jr, MD (2005)
Kevin Eltife (2003)
Raul B. Fernandez (2003)
Robert I. Fernandez (2001)
Cathy Obriotti Green (2005)
Gerry Griffin (2005)
Carey Hobbs (2005)
Steve Late (2001)
Adair Margo (2003)
Leonard Rauch (2001)
Hector de J. Ruiz, PhD (2005)
Robert W. Shepard (2003)
Terdema L. Ussery, II (2005)
Austin
Houston
Houston
Bryan
Irving
Laredo
Tyler
San Antonio
Fort Worth
San Antonio
Hunt
Waco
Odessa
El Paso
Houston
Austin
Harlingen
Dallas
Terms expire on August 31 of year indicated
Coordinating Board Mission
The mission of the Texas Higher Education Coordinating Board is to provide the
Legislature advice and comprehensive planning capacity for higher education, to coordinate the
effective delivery of higher education, to efficiently administer assigned statewide programs, and
to advance higher education to the people of Texas.
THECB Strategic Plan
Coordinating Board Philosophy
The Texas Higher Education Coordinating Board will promote access to quality higher
education across the state with the convictions that access without quality is mediocrity and that
quality without access is unacceptable. The Board will be open, ethical, responsive, and
committed to public service. The Board will approach its work with a sense of purpose and
responsibility to the people of Texas and is committed to the best use of public monies.
THECB Strategic Plan
Table of Contents
Page
Section 1:
Executive Summary…………………………………..
1-6
Section 2:
Health Education and Training……………………..
7-36
Section 3:
Details on Recommendations for
Health Education and Training……………………..
37-70
Section 4:
Health Care Coordination……………………………
71-98
Section 5:
Details on Recommendations for
Health Care Coordination……………………………
99-106
Appendices
A
Senate Bill 1378 (76th Legislature)
B
Formula Funding for Health-related Programs at Border Region Institutions
C
Special Item Funding for Health-related Initiatives in the Border Region
D
2000 Health Education Questionnaire
E
Retention Rates for All Students
F
Retention Rates for Students Enrolled in Health-related Programs
G
Retention and Persistence Rates for Students by High School Diploma Type
H
Faculty Data for Border Region Institutions
I
New Health-related Programs Introduced at Border Region Institutions Since January 1995
J
Health Facilities Data by County
K
Population-to-Provider Data by County
i
Section 1: Executive Summary
Senate Bill 1378 of the 76th Legislature (Appendix A) directed the Texas Higher Education
Coordinating Board (Board), in consultation with the Texas Department of Health (TDH), the
Health Education Training Centers Alliance of Texas, and the Area Health Education Centers, to
review health care and health education needs in a 43-county area along the Texas-Mexico
border (Border region). Specifically, the Board would “review current methods of medical training
for health care professionals” and TDH would “determine the future medical services, health care
services and other needs of the Border region.” The Legislature directed the Board to report the
findings and recommendations for any necessary legislation not later than January 1, 2001. The
results of the review and the Board’s recommendations to the 77th Legislature are summarized in
this report.
The report is organized in five sections -- Section 1: Executive Summary; Section 2: Health
Education and Training; Section 3: Details on Recommendations for Health Education and
Training; Section 4: Health Care Coordination; and Section 5: Details on Recommendations for
Health Care Coordination. Sections 1-3 were prepared by the Board; Sections 4 and 5 were
prepared by the TDH.
Health Education and Training Findings and Recommendations
In preparing this report, Board staff assembled and reviewed a variety of data on health education
and workforce needs. Staff analyzed the results of a recent health education questionnaire that
was sent to health care providers and educators in the region, interviewed academic
administrators and state agency officials, and compiled enrollment and graduation data from the
region’s 21 two- and four-year public institutions. Staff also studied special reports and longrange plans previously prepared by the Board and by other entities.
As a result of that effort, the Board finds that:
• Academic readiness and retention of students, insufficient program funding, migration of
graduates/workers out of the area, and faculty recruitment and retention are the most
frequently cited education-related factors affecting the supply of health professionals in the
region.
• Based on questionnaire responses, the number of health-related degree programs offered in
the Border region is not a major cause for the shortage of health care professionals in the 43­
county area. Enrollment and graduation numbers show that, overall, the Border region
appears to have benefited from the influx of new state funds and degree programs provided
since 1995. Where state and regional enrollment and graduation numbers show positive
change, the Border region usually shows greater increases than the state at large; where
totals show negative change, the Border usually shows smaller decreases than the state at
large.
The Board makes two general and 12 specific recommendations. In general, the Board
recommends that the Legislature:
• Continue to support the major state initiatives and consider others in the region and provide
new funding for selected degree programs.
1
• Fund new initiatives that will strengthen existing health programs and provide greater
coordination in the delivery of these programs. These new initiatives should promote
academic development, student preparation and retention, faculty and worker recruitment
and retention, and Border coordination.
Each of the following 12 recommendations is explained in more detail in Section 3 of the
report. A check (�) next to a recommendation means that the Board considers it to be a
high priority.
The 77th Legislature should consider the following recommendations:
Academic Programs and Development
� Recommendation 1: Grant Program for Nursing Education
Establish and fund a competitive grant program to support new initiatives by Border
institutions to 1) recruit and retain qualified nursing students in professional degree programs
and 2) increase articulation in nursing education from the certificate level to the associate
degree, from the associate degree to the bachelor’s degree, and from the bachelor’s degree to
the master’s degree. 2003-03 Estimated Amount: $2 million.
� Recommendation 2: Cooperative Pharmacy Program
Fund a cooperative pharmacy program at The University of Texas-Pan American. 2002-03 Estimated Amount: $2 million.
Recommendation 3: Continued Support of Major State Initiatives
Continue to develop four recently established major state initiatives for health instruction and
training in the Lower Rio Grande Valley and Coastal Bend area: South Texas Border Region
Health Education Initiative; Lower Rio Grande Valley Regional Academic Health Center;
Laredo Campus Extension; and Coastal Bend Health Education Center. Continue to support
existing health education and research activities in the Upper Rio Grande Valley and consider
funding one or more initiatives that will best meet the needs of the El Paso area.
2002-03 Estimated Amount: Institutions that administer initiatives in the Lower Rio Grande
Valley and Coastal Bend area have requested $153.3 million (a $126.5 million increase).
Institutions in the Upper Rio Grande Valley/El Paso area have requested $107.25 million in
new initiatives for health education and research.
Recommendation 4: Distance Education and Tele-education
Request that the Telecommunications Infrastructure Fund (TIF) Board finance needed
infrastructure for distance education and tele-education programs in the Border region by giving
priority to meritorious Border projects, especially those for continuing medical education. Provide
funding to Border institutions for the associated costs of distance education and tele-education
(e.g., technical support personnel, faculty development training, curricular development).
Extend funding for telecommunications for educational purposes beyond 2005 (through TIF or
other means).
2002-03 Estimated Amount: TIF funds already allocated ($0); special item funding would vary
from institution to institution.
2
Recommendation 5: Research Development
Establish and fund a new grant program for health-related research at appropriate Border
institutions and entities. Research programs must focus on health problems significantly
affecting the Border region (e.g., diabetes, tuberculosis). The following institutions would
receive special consideration for these grants: 1) Coastal Bend Health Education Center and
2) Health-related institutions (and their satellite operations) that are located in counties
bordering Mexico. 2002-03 Estimated Amount: $6 million.
Student Preparation and Recruitment
� Recommendation 6: Formula Funding Bonus for Recruitment
Provide a formula funding bonus to medical and dental schools as an incentive to recruit and
retain students from the state’s Historically Black and Hispanic-serving colleges and
universities. The funding bonus would equal one-half of the per-student appropriation for each
second-year medical and dental student who was recruited through a Coordinating Boardapproved educational partnership with one of these institutions. All of the Border region’s
universities have been designated as Hispanic-serving institutions.
2002-03 Estimated Amount: $3.6 million.
� Recommendation 7: Recommended High School Program
Make the Recommended High School Program (college preparatory courses) the standard
curriculum for high school students. Ensure that a sufficient number of qualified teachers are
secured and retained to teach the recommended courses.
2002-03 Estimated Amount: The Texas Higher Education Coordinating Board and the Texas
Education Agency are currently determining the costs of implementation.
Recommendation 8: Resident Tuition for Public Health Students from Mexico
Amend Section 54.060 of the Texas Education Code to include Texas A&M University System
Health Science Center and The University of Texas Health Science Center at Houston among
the institutions eligible to waive, under certain circumstances, non-resident tuition for Mexican
citizens who enroll in one of the public health degree programs offered by these institutions in
Kingsville, Laredo, McAllen, El Paso, or Brownsville.
2002-03 Estimated Amount: $ 0 in General Revenue.
Faculty and Worker Recruitment and Retention
� Recommendation 9: Migration Pilot Study
Fund a pilot study at The University of Texas Health Science Center at San Antonio’s
(UTHSC-SA) Center for Health Economics and Policy to determine, in cooperation with
researchers located in other Border institutions, the migration patterns of health care
professionals in and out of the Border region. 2002-03 Estimated Amount: $300,000.
3
Recommendation 10: State Loan Repayment Program
Establish and fund a Health Professional Loan Repayment Program to enhance recruitment and retention of selected health professionals in the Border region. Through this program the state could access new federal matching dollars.
2002-03 Estimated Amount: $1.1 million.
Recommendation 11: Border Faculty Education Loan Repayment Program
Fund the Texas Higher Education Coordinating Board’s appropriation request to increase funding by $888,800 for the Border Faculty Education Loan Repayment Program. 2002-03 Estimated Amount: $988,800 (a $880,000 increase).
Border Coordination
Recommendation 12: Border Health Coordinating Council
Establish a Border Health Coordinating Council in which institutional and agency members
would share information, develop common goals, and devise solutions that address the health
care and medical training needs of the Border region.
2002-03 Estimated Amount: $0
Health Care Coordination Findings and Recommendations
In preparing this report, TDH staff compiled information about the region’s population, health
status, facilities, public health infrastructure, and professional workforce. It also examined
coordination issues.
Health Facilities
Recommendation 1: Creation of a Health Services District
Cameron, Hidalgo, Starr and Willacy counties should proceed with the development of a Health Services District as authorized in Senate Bill 1615, 76th Legislature. Workforce
TDH supports the following recommendations proposed by the Statewide Health Coordinating
Council in the 2001-2002 Texas State Health Plan Update: “Ensuring a Quality Health Care
Workforce for Texas” that are particularly important for the Border region.
4
Recommendation 2: Financial Incentives for Health Professionals
Enhance recruitment and retention of health professionals into Health Professional Shortage
Areas by expanding state financial incentives, including, but not limited to, loan repayment,
loan forgiveness, scholarship, grant programs and accessing federal matching dollars through
the National Health Service Corps. Financial incentive programs should be established for all
health care professionals. (Strategy 3.2.1)
Recommendation 3: Expanded Use of Telemedicine
To address the maldistribution of health care professionals and increase access to health
services for rural and underserved populations, Texas should pass legislation and fund
programs that expand the use of telemedicine. (Strategy 3.1.1)
Public Health Infrastructure
Recommendation 4: Establishment of Epidemiology Response Teams
TDH recommends the establishment of Epidemiology Response Teams in each region to
assist local health departments in detecting/tracking diseases and conducting investigations of
disease outbreaks, as well as establishing an Internet-based reporting and
telecommunications system to improve the state’s capacity to detect diseases when they are
diagnosed.
Recommendation 5: Health and Human Services Commission Consolidated Colonias Initiative
TDH highlights the Texas Health and Human Services Commission Consolidated Colonias
Initiative appropriations request that provides colonia residents with access to state-funded
programs in ways that are tailored to the unique conditions of their environment.
Acknowledgements
Coordinating Board staff is grateful to the many contributors to this report and to those individuals
who commented on its content in writing and at public meetings.
Staff also acknowledges that these recommendations are limited in their effect on the health
education and public health status of the Border region. Issues affecting access to health care
services and health education are numerous and complex. Many of these issues can be linked to
socio-economic factors that go beyond the scope of this report.
5
6
Section 2: Health Education and Training
In evaluating the need for new health education and training programs in the Texas-Mexico border
region (Border region), the Texas Higher Education Coordinating Board studied a variety of data
about the 21 public institutions of higher education located in a 43-county area that stretches from
El Paso to Corpus Christi and from San Antonio to Brownsville. Those institutions are listed
below.
H General Academic Institutions
Sul Ross State University
Sul Ross State University-Rio Grande College
Texas A&M International University
Texas A&M University-Corpus Christi
Texas A&M University-Kingsville
The University of Texas at Brownsville
The University of Texas at El Paso
The University of Texas-Pan American
The University of Texas at San Antonio
�
9 Health-related Institutions
Texas Tech University Health Sciences Center
Regional Academic Health Center at El Paso
The University of Texas
Health Science Center at San Antonio
7
Community and Technical Colleges
Alamo Community College District
(4 colleges)
Coastal Bend College (Service area includes
seven border counties)
Del Mar College
El Paso Community College
Laredo Community College
Odessa College (Service area includes six border
counties)
South Texas Community College
Southwest Texas Junior College
Texas Southmost College
Texas State Technical College-Harlingen
State Health Education Funding For the Border Region
Most of the state funds appropriated to public institutions of higher education each biennium are
determined by funding formulas. The formulas are based upon the number and level of semester
credit hours or contact hours taught in a prior biennium, with different funding rates for various
disciplines. The Board estimates that $247.3 million in formula funding derived from health
education ($228.5 million in General Revenue) was appropriated to the region=s 21 schools for
the current biennium. While it is difficult to compare funding increases or decreases over several
biennial periods, a change in the number of semester credit hours or contact hours reported by
institutions is one indicator of increases or decreases in formula funding. Overall, the institutions
have reported a 6 percent increase in total health education hours from 1995 to 1999. Appendix
B shows the changes in hours and current biennial formula appropriations by institution.
With a few exceptions, the remainder of state funds appropriated directly to schools is not derived
by formula, but, rather, comes from “special item” funding. These special funding items often
support one-time appropriations or unique programs and activities at an individual institution. The
Board estimates that, excluding Tuition Revenue Bonds, $80.4 million ($53.4 million in General
Revenue and $27 million in investment earnings from Tobacco Lawsuit Settlement receipts) was
appropriated as special item funding to schools specifically for health-related education and
research in the Border region. Appendix C shows these special items by institution for the current
biennium.
Total state funding for health-related education in the region was $327.7 million in the 2000-01
biennium.
Needs Assessment
In reviewing the Border region=s health education and training needs, Board staff looked primarily
at three types of information: results of a survey sent to health care providers and educators in the
Border region; statistics and trends affecting academic development in the region; and enrollment
and graduation trends at the schools. Staff also studied special reports and long-range plans
previously prepared by the Board and by others. The Board’s Health Affairs Committee also held
public meetings in Harlingen and El Paso during October 2000.
Survey Results
In May 2000, Board staff sent a survey to health care providers and health education deans and
provosts at institutions in the Border region. The questionnaire, designed to focus on people=s
perceptions of health professional shortages in the region (Appendix D), asked recipients to rate
different reasons for health workforce shortages in the region and to identify instructional
programs that need to be added or expanded. It also asked health care administrators to identify
specific staffing issues at their facilities and asked deans and provosts to identify specific
challenges in individual academic programs. The Board distributed 187 surveys. Of the 70
respondents (37.4 percent response rate), 63 percent represented institutions and 37 percent
represented hospitals, clinics, or other health-related organizations and agencies. Their
responses are summarized below.
8
!
Health care providers and educators were asked to rate the importance of various factors
contributing to the shortage of health care professionals in their local area. The following list
represents the seven factors that were rated the most significant (in order of highest
cumulative rating):
1. Difficulty attracting health care professionals
2. Lack of available instructors/faculty in health education programs
3. Inadequate state/federal funding
4. Inadequate number of graduates from local health education programs
5. Quality of life (e.g., schools, job opportunities for spouses)
6. Low reimbursement rates for insurers/Medicaid/Medicare
7. Migration of qualified graduates/workers out of area
Educators reported that the Alack of available faculty in health education programs@ was the
most significant factor contributing to the workforce shortage, while health care providers
reported a number of factors contributing to the shortage, including difficulty attracting
professionals to the area, inadequate state/federal funding, low reimbursement rates for
insurers, migration of qualified workers out of the area, and the supply of workers lagging
behind changes in demand for workers in the health care marketplace. ALack of needed
health education programs@ was rated 14th among 25 possible reasons listed on the survey
for the workforce shortages.
!
Respondents rated the following factors as the least significant reasons for health workforce
shortages in their local area of the Border region (in order of lowest cumulative rating):
1. Provider competition with Mexico
2. Inadequate number of medical residency programs
3. Lack of continuing education opportunities
4. Inadequate health research facilities
5. Lack of a four-year medical school in the area
Educators rated Ainadequate number of medical residency programs,@ Alack of a four-year
medical school in area,@ and Alack of continuing education opportunities@ as the least
significant reasons for the shortage, while health care providers overwhelmingly rated
Aprovider competition with Mexico@ as the least significant reason.
!
Health care providers and educators also were asked to identify instructional or training
programs (from a list of 44 disciplines or occupations) that should be added or expanded in
their area. The following list represents those programs, listed by profession and degree level,
that were most frequently mentioned (in order of most frequently selected):
1. Nurses (bachelor=s degree)
2. Pharmacists (professional degree)
3. Nurse practitioners (master=s degree)
4. Medical residents in primary care (post-graduate training)
5. Nurses (associate degree)
6. (Tie) Public Health Nurses (master=s degree)
Medical Radiologic Technicians (associate degree)
Physician Assistants (bachelor=s or master=s degree)
9
Requests for new or expanded programs varied by the respondents= vocation and location in
the Border region. Educators agreed that the need for new or expanded nursing programs at
the baccalaureate level should be the first priority. Health care providers also requested
programs in bachelor=s-level nursing but found an almost equal need for programs to produce
pharmacists and nurse practitioners. Respondents from El Paso wanted nursing programs at
all levels. The Corpus Christi and Kingsville respondents requested nurses (bachelor=s level),
medical radiologic technicians, and medical residency programs in primary care. Lower Rio
Grande Valley respondents identified registered nurses (bachelor=s and associate level),
medical lab technicians, and pharmacists. Respondents from rural communities showed a
need for all professions.
!
Health care providers were asked to identify specific staffing issues that represented the
greatest challenges in the workplace. AFinding qualified applicants@ was the greatest
challenge, followed by Asalaries and benefits@ and Aturnover in workers with certificate or
associate degrees.@
• Educators provided information on 74 existing degree programs in health-related fields and
were remarkably similar in their answers about the major challenges they faced. The following
list represents those program-related challenges that were most frequently mentioned by
educators:
1. Academic preparation and readiness of students
2. Financial resources available to the program
3. Faculty recruitment
Of the challenges cited above, respondents from community colleges saw academic
preparation and financial resources as greater problems than their counterparts at four-year
institutions. In contrast, faculty recruitment was a more significant problem for survey
respondents at the universities and health science centers.
!
In summary, survey respondents believed that many of the region=s shortages in health care
professions were due to factors unrelated to the availability of instruction and training. Those
educational factors that they identified as contributing to the shortage of health care workers
were: low retention of students in programs; migration of graduates out of the area; faculty
recruitment.
Issues Affecting Academic Development
Board staff reviewed data on three key issues of academic development that were identified by
survey respondents. It also considered coordination issues.
Academic Preparedness and Retention of Students
The Board has collected information that suggests that the academic preparedness and retention
of students is one of the greatest obstacles to the success of health education programs in the
Border region.
10
• In a recent Border survey, “academic preparedness and readiness of students” ranked as the
number one challenge among educators. (Results of 2000 Health Education Questionnaire,
July 2000).
• Many Border students come from social-economic backgrounds that put them at higher risk of
dropping out of college. Research has shown that many of these risk factors can be mitigated
by better academic preparation in high school.
Appendices E, F, and G reinforce the problem of academic preparedness and retention in the
Border region. Appendices E and F show data collected by Board staff on retention rates of firsttime students enrolled at the state’s public two- and four-year institutions:
• First-year students enrolled in four-year institutions in the Border region are less likely than
students statewide to return to college for their second year.
• Both in the Border region and statewide, only about one-half of students majoring in a healthrelated field in their first year will continue in a health-related field in their second year.
Appendix G shows Board data on retention rates of 1997 college students enrolled in healthrelated programs at Border institutions by the type of high school diploma earned:
• Approximately 75 percent of Border students who earned an advanced high school diploma
(includes college preparatory courses) returned to college for their second year, while only
59 percent of border students who earned a regular high school diploma returned for their
second year.
• About 76 percent of Border students who earned an advanced high school diploma and who
demonstrated college readiness (success on TASP test) returned to college in the third year,
while only 42 percent of Border students who earned the regular high school diploma and who
did not demonstrate college readiness returned to college in the third year.
The data links academic preparation and the success of students in health education programs.
(See also Recommendation in Section 3, page 56).
Migration of Graduates and Employee Turnover
In a recent survey, health care providers and educators rated the Amigration of qualified
graduates/workers out of the area@ as a significant factor contributing to the shortage of health
care professionals in the Border region. Health care providers listed employee turnover as a
particular challenge in the health care workplace and suggested that turnover could be related to
the poor salaries and wages offered in their local areas.
Very little analyzed information exists to show the migration of health care workers in the Border
region, but the existence of health professional shortages suggests that these workers may be
more mobile than other professionals with advanced degrees. In a high-demand market, workers
often have the luxury to choose jobs in and out of the state that offer the best salaries, job
conditions, and opportunities for advancement. The most recent research on the migration of
health care workers in Texas was published in 1978 and focused on allied health occupations.
The study showed that college graduates with higher levels of education were more likely to leave
the area than those with lower levels of education.
11
In view of the continued shortages of health-care workers in the Border region, the state may want
to consider studying relocation trends of health care graduates over a period of years. The study
could help direct state resources to appropriate programs that would maximize the retention of
health care workers in the Border region. (See also Recommendation in Section 3, page 61).
Faculty Recruitment and Retention
In a recent survey, educators identified faculty recruitment and retention as one of the primary
challenges in developing and expanding health education programs in the Border region.
Recent Board reports support this concern. Appendix H shows Border faculty data that were
compiled from the Board=s 1999 Statistical Report:
! The average faculty salaries at all general academic institutions and at one-half of the community/technical colleges in the Border region are below the statewide average. ! The percentage of part-time faculty at 10 of the 21 Border institutions is at or above the statewide average.
The Board also recently completed a legislatively authorized study of trends in faculty turnover.
The findings showed:
! Turnover rates are lower at larger, more-established institutions than at smaller institutions.
! Health professions faculty had the second highest turnover rate, after liberal arts/fine arts faculty.
! Of the general academic institutions located in the Border region, all schools except UTEP
had faculty turnover rates that were at or above the statewide average of 6 percent.
In view of this information, the state may want to consider giving Border institutions new incentives
to help recruit and retain health education faculty. (See also Recommendation in Section 3, page
66).
Coordination Issues
The health care and medical training needs of the Border region concern many institutions and
agencies. For example, in addition to community colleges, universities, and academic health
centers, the following organizations have an interest in or responsibility for Border health issues:
1) Texas Department of Health, Office of Border Health; 2) South Texas Area Health Education
Center (AHEC) and West Texas AHEC; 3) Health Education and Training Center Alliance of
Texas; 4) US Mexico Border Health Association; 5) Texas Center for Rural Health Initiatives; 6)
Paso del Norte Health Foundation; 7) Center for Disease Control (among other federal agencies);
and 8) local health departments.
These organizations and others have generated many valuable sources of data and information
about Border health issues. However, because of differences in geographical locations,
governing boards, missions, and constituencies of the groups, there has not been a formal
mechanism to coordinate their efforts. Such fragmentation can contribute to 1) lack of
communication of information, 2) a duplication of research and other efforts, and 3) widely
12
differing priorities about instructional programs and medical training needs. (See also
Recommendation in Section 3, page 68).
Enrollment and Graduation Trends
On the following page, Table 1 provides a five-year annual comparison of enrollment and
graduation data. Summary observations follow.
13
TABLE 1
Enrollment and Graduation Trends in Selected Health-Related Programs In the Border Region
1995
1996
1997
1995 to 1999
% Change to
Border State
1999 Border
Grads as %
of All Texas
Grads
1998
1999
170,678
18,294
175,578
19,329
6.2%
10.4%
3.7%
5.1%
16.1%
25,478
3,536
23,361
3,702
-4.3%
7.1%
-17.4%
- 4.3%
20.7%
826
188
824
202
BB
1.0%
12.2%
8.6%
17.6%
840
185
838
197
25.3%
23.9%
28.2%
20.8%
31.8%
All Certificate and Degree Programs
Enrolled
Graduated
165,338
17,515
169,749
17,735
172,156
17,942
All Health Professions and Related Disciplines
Enrolled
Graduated
24,413
3,458
25,155
3,646
25,790
3,479
1. Medicine (UTHSC-SA Medical School)
Enrolled
Graduated
824
200
829
194
812
210
2. Dentistry (Dentists, Dental Hygienists)
Enrolled
Graduated
669
159
752
153
818
163
3. Mid-level Providers (Nurse Practitioners, Midwives, Physician Assistants)
Enrolled
Graduated
56
14
147
93
278
127
380
166
402
100
617.9% 130.2%
614.3% 120.4%
21.8%
4. Nursing (Registered Nurses with bachelor=s and associate degrees & Practical Nurses)
Enrolled
Graduated
11,121
1,759
11,184
1,704
11,186
1,656
10,706
1,615
9,892
1,581
-11.1%
-10.1%
-24.5%
-13.3%
20.4%
3,741
368
3,182
477
41.0%
52.4%
- 9.6%
12.5%
26.1%
5. Allied Health (Selected Disciplines)
Enrolled
Graduated
2,256
313
2,645
311
3,234
303
6. Mental Health (Clinical, Counseling, and School Psychologists; Social Workers)
Enrolled
Graduated
619
98
575
115
545
98
569
93
593
117
-4.2%
19.4%
4.1%
18.1%
6.8%
115
30
118
25
24.2%
-7.4%
11.8%
-29.3%
16.6%
207
45
19.7%
12.5%
9.6%
24.5%
14.9%
7. Public Health (Selected Disciplines)
Enrolled
Graduated
95
27
114
31
105
35
8. Pharmacy (Pharmacists and Pharmacy Technicians)
Enrolled
Graduated
173
40
196
42
182
40
199
45
Source: Institution data reported annually to the Texas Higher Education Coordinating Board.
Notes: AEnrolled@ represents the number of students who declare a major in a specific degree program (Board staff regards the
number of declared majors as generally indicative of trends, but not particularly reliable or accurate);
AGraduated@ represents the number of degrees awarded and may include multiple degrees to one student.
Numbers for community/technical colleges represent technical/vocational programs only.
14
Summary Observations
Overall, the Border region appears to have benefited from the influx of new state funds and
degree programs provided since 1995. Where both state and regional totals show positive
change, the Border region usually shows greater increases than the state at large; where totals
show negative change, the Border usually shows smaller decreases than the state at large.
General comments:
! Sixty percent of all certificates and degrees awarded in 1999 by Border institutions were
conferred at universities and health-related institutions. In contrast, 61 percent of healthrelated certificates and degrees were awarded in 1999 by community and technical colleges.
! For the five-year period, the number of total certificates and degrees awarded increased by
more than 10 percent in both the two- and four-year sectors in the Border region. While
enrollment in health-related programs has decreased, the number of health-related degrees
awarded has increased modestly for Border institutions. Four-year institutions showed a 17
percent increase in the number of graduates, whereas two-year institutions reported only a 2
percent increase.
! Seventy-five percent of 1999 graduates from health-related programs at Border institutions
identified themselves as residents of the Border region.
! The percentage of Hispanic students graduating from health-related programs at Border
institutions falls below the percentage of Hispanics in the Border’s general population.
Hispanic residents represent 67 percent of the Border population, but only 53 percent of 1999
graduates from health-related degree programs at Border institutions identified themselves as
Hispanic. The enrollment – rather than graduate – disparity is decreasing; 1999 Hispanic
enrollment represents a 9.3 percent increase over 1995.
Appendix I lists the health-related programs established at Border institutions since 1995.
Overview by Discipline
The eight health education disciplines shown in Table 1 are discussed in more detail on the
following pages. Occupations within these disciplines are grouped according to their roles and
relationships with other health care professions in the workforce rather than how they may be
organized within the administration of higher education. For example, dental hygienists usually
are trained within an allied health school, but for purposes of this report, they are included in the
discipline of dentistry.
15
Discipline 1: Medicine
Table 1 (page 14) shows stable
enrollment and graduation numbers for
medical students at The University of
Texas Health Science Center at San
Antonio (UTHSC-SA), the only four-year
medical school located in the Border
region. NOTE: The totals do not include
approximately 100 third- and fourth-year
students who train each year at the
Texas Tech University Health Sciences
Center (TTUHSC) – El Paso site. The
numbers also do not reflect the number
of students from other institutions that
may complete clinical rotations in the
Border region as part of their medical
education.
: Health-related Institutions
After a student graduates from medical
school, he or she completes a residency
training program which usually lasts from
three to nine years. As a resident, the
medical school graduate is usually an
employee of the hospital or clinic that
operates a residency program. In the Border region, UTHSC-SA, TTUHSC, and Texas A&M
University System Health Science Center (TAMUSHSC) often partner with these hospitals and
clinics to provide the instructional component of the residency program; therefore, establishing a
new residency program would require sufficient resources from both the institution and the health
care facility to meet national residency accreditation requirements. The following table presents
the growth in the number of medical residents affiliated with these three academic health centers
from 1995-1999.
Texas Tech University Health Science Center-El Paso
Campus (3rd and 4th year students)
The University of Texas Health Science Center at
San Antonio
TABLE 2
Number of Medical Residents in the Border Region, 1995-1999
All Residents
Primary Care Residents
1995
896
386
1996
893
394
1997 1998
887
890
411
429
1999
903
431
1995 to 1999
% Change
0.8%
11.7%
Note: Primary care includes family medicine, general obstetrics/gynecology, internal medicine, and
pediatrics.
Source: Texas A&M University System Health Science Center, Texas Tech University Health Sciences Center, The
University of Texas Health Science Center at San Antonio, August 2000.
16
Two of the three medical schools reported plans to expand residency training in the region:
! TTUHSC is currently affiliated with 10 residency programs in the region, of which four are in
primary care fields. Since 1995, the number of residents has decreased from 205 to 184,
partly as a result of closing a pathology residency program.
! UTHSC-SA is affiliated with 62 residency programs in the region, of which eight are in primary
care fields. Since 1995, the number of residents has increased from 677 to 730, including an
increase from 47 to 74 primary care resident positions available outside of Bexar County. By
2004, the institution plans four new residency programs for the region (in internal medicine,
obstetrics/gynecology, pediatrics, and family practice).
! TAMUHSC is affiliated with one primary care residency program in the region, at Driscoll
Children=s Hospital in Corpus Christi. Since 1995, the number of residents in that program has
increased from 32 to 42. The institution has no plans to add new residency programs;
however, residents in the Temple area will in the future complete a new pediatric rotation at
Driscoll Children=s Hospital.
Border Statistics on Medical Education
!
!
!
!
!
!
!
!
One of the state=s eight medical schools is located in the Border region (UTHSC-SA).
73 residency programs in the region are affiliated with three of the state’s medical schools.
903 medical residents were trained in the Border region in 1999; 73 percent of them were at
medical programs in Bexar County.
76 percent of Border residents train at UTHSC-SA affiliated programs.
64 percent of UTHSC-SA=s 1997 medical residency completers practice in Texas.
29 percent of UTHSC-SA=s 1989, 1990, and 1991 medical school graduates are
now practicing primary care medicine in Texas.
4 percent of UTHSC-SA’s 1989, 1990, and 1991 medical school graduates are
practicing primary care in a Texas federally designated under-served area.
28 of 43 counties in the Border region are designated as (whole county) primary care Health
Professional Shortage Areas by the federal government.
Population-to-Physician Ratio
Border region
Primary Care Physicians
1,752:1
Border region
(Excluding Bexar Co.)
State
2,023:1
1,562:1
Source: Texas Department of Health, August 2000. For more physician workforce data, See Section 4, pages 88-90.
The Texas Department of Health defines primary care physicians as practitioners specializing in
general or family medicine, pediatrics, obstetrics and gynecology, and internal medicine. TDH
reports that the population-to-primary care physician ratio for the Border region is 12 percent
higher than for the state. The ratio is 2,791:1 in the Border=s rural areas, with five rural counties
reporting no primary care physicians and seven rural counties reporting only one physician.
17
Other Information/Key Issues for Medicine
Several recent studies provide little support for a new four-year medical school in the Border
region.
! Survey respondents rated Alack of a four-year medical school@ as one of the least
significant factors affecting health professional shortages in the region. (Results of 2000
Health Education Questionnaire, July 2000)
! The Coordinating Board Planning Committee=s Task Force on Health Care Professions
determined recently that Texas had an adequate number of medical schools and medical
school graduates. Furthermore, the Task Force stated that establishing a new school
could result in weakening existing schools. (Health Professions Education: Higher
Education’s Role, July 2000)
! A Texas Medical Association report supports the view that the supply of physicians in
Texas is adequate through 2005. (Texas Workforce in Texas: A Comparative Analysis
with California and Texas, 2000)
! Using population data from the Texas State Data Center and licensing data from the
Texas Board of Medical Examiners, Board staff estimates a 4.7 percent decrease in the
number of physicians per 100,000 population in the Border region and a 3.4 percent
decrease in the state from 2000 to 2015. Despite this small projected decrease (based on
current models), staff anticipates that unfavorable population-to-physician ratios could best
be addressed through new and expanded residency programs in the Border region and
other initiatives.
While the overall supply of physicians in Texas is adequate, many organizations and planning
groups want to focus efforts on changing the distribution of physicians by specialty, geographic
location, and population. The state currently provides financial support for programs to recruit
physicians to practice in under-served areas; to train medical residents in family medicine,
pediatrics and other primary care specialties; and to recruit students and residents who by their
ethnic/racial identity or geographic origin would appear to be more likely to return to under-served
areas of the state.
Similar efforts are made for medical students to gain direct exposure to the practice of medicine in
the rural areas of the Border region, based on the theory that direct and early exposure will make
them more likely to choose to practice in these areas. Two of the three medical schools that have
a major presence in the Border region offer rural rotations to their students.
! TTUHSC medical students may complete a summer rotation in one or more of its rural
Community Partnership Clinics.
! UTHSC-SA students in medical, dental, allied health, nursing, and public health are
eligible for one-month rotations in rural or under-served areas in the Border region.
These efforts show how medical schools can exert some influence, at least indirectly, on
increasing the diversity of the physician workforce. In recent years, medical schools have
stepped up recruitment efforts and developed more cooperative pre-professional programs with
colleges and universities. Institutions have varying success in recruiting minorities under
restrictions imposed by the Hopwood ruling, which effectively prohibited consideration of race or
18
ethnicity in admissions and financial aid decisions. TTUHSC reported that 12.2 percent of its
1999 first-year medical school enrollment was Black, Hispanic, or Native American. TAMUHSC
reported that 5 percent of its new students identified themselves as under-represented minorities,
while UTHSC-SA reported 21 percent for this same period.
To support recruitment efforts, the Board has recommended that the Legislature include a funding
bonus for medical schools to recruit and retain students from Historically Black and Hispanicserving institutions in Texas. This recommendation is discussed in more detail in Section 3, page
54.
19
Discipline 2: Dentistry
Table 1 (page 14) shows
increases in the number of
students who enrolled and
graduated from selected
programs that prepare them for
careers as dentists
(professional degree), and
dental hygienists (primarily
associate and bachelor=s
degree). The totals in Table 1
do not include six dental
assistant and dental lab
technician programs offered at
community and technical
colleges.
Border Statistics on
Dentistry
:
Health-related Institutions
The University of Texas Health Science Center at San
Antonio
n Community and Technical Colleges
Alamo Community College District
Coastal Bend College
Del Mar College
El Paso Community College
Texas State Technical College-Harlingen
!
12 degree programs are
offered at six institutions;
nine of the programs are
offered at community
colleges.
! One of the state=s three
professional dental schools
is located in the Border
region, at UTHSC-SA.
! 82 percent of UTHSC-SA=s 1993, 1994, and 1995 dental school graduates are
licensed in Texas.
! 6.6 percent of UTHSC-SA=s 1993, 1994, and 1995 dental school graduates are
practicing in a Texas under-served area.
! 26 of 43 counties in the Border region are designated as (whole county) dental Health
Professional Shortage Areas by the federal government.
Population-to-Dentist Ratio
General Dentists
Border region
Border region
(Excluding Bexar Co.)
State
3,831:1
5,479:1
2,748:1
Source: Texas Department of Health, August 2000. For more dentist workforce data, see Section 4, page 92.
TDH defines general dentists as private practitioners specializing in general, pediatric, or public
health dentistry. It reports that the number of general dentists has increased by 8 percent from
20
998 in 1996 to 1,076 in 1999. The population-to-general dentist ratio for the Border region is 39
percent higher than the statewide ratio.
Other Information/Key Issues for Dentistry
Questionnaire respondents at community/technical colleges reported that student interest in
dental hygiene programs continue to exceed program capacity. Two of the limiting factors in
determining the number of new students to be admitted were reported as: 1) recruitment of faculty
to meet accreditation standards for student-to-faculty ratios and 2) capacity of existing laboratory
facilities. Several schools said they were planning new lab facilities to help meet the demand.
(Results of 2000 Health Education Questionnaire, July 2000)
Two academic health centers are planning new dental programs through distance learning and
telemedicine. UTHSC-SA plans to offer a master=s-level dental hygiene program by providing
courses online and by teleconferencing. TAMUSHSC=s College of Dentistry is developing
telemedicine demonstration projects in South Texas and the Coastal Bend area to allow remote
screening for complicated dental disorders. Treatment for identified conditions would be delivered
through local area dentists in consultation with the college.
Like many other health-care providers, dental care professionals are limited by statute in the
scope of their practice. Many educators believe that the shortages of dentists can be relieved in
the Border region by expanding the practice of dental hygienists and by promoting oral health as
an important public health issue.
21
Discipline 3: Mid-level
Providers
(See also Recommendation in Section
3, page 63)
Table 1 (page 14) shows significant
increases in the number of students
who enrolled and graduated from
programs that will prepare them for
careers as nurse practitioners
(master=s degree), certified nurse
midwives (master=s degree), and
physician assistants (bachelor=s or
master=s degree).
:
H
Under appropriate supervision, these
professionals often perform routine
medical procedures and examinations
that are typically or otherwise
performed by a physician.
Health-related Institutions
The University of Texas Health Science Center at
San Antonio
While their roles are highly restricted
by law and still require the oversight of
physicians, these mid-level providers
are highly sought after in
under-served areas where it is difficult to recruit and keep physicians.
General Academic Institutions
Texas A&M University-Corpus Christi
The University of Texas at El Paso
The University of Texas-Pan American
Border Statistics on Mid-level Providers
!
!
12 degree programs are offered at four institutions.
Five nurse practitioner specialties programs and two physician assistant program
have been created since 1996.
! 64 percent of 1998 graduates from mid-level provider programs in the region received degrees
in physician assistant studies.
Population-to-Mid-level Provider Ratios
Border region
Border region
(Excluding Bexar Co.)
Nurse Practitioners
Certified Nurse Midwives
9,790:1
105,685:1
11,317:1
76,702:1
7,903:1
98,500:1
Physician Assistants
11,170:1
12,964:1
10,563:1
Source: Texas Department of Health, August 2000. For more workforce data, See Section 4, pages 91
and 94-95.
22
State
TDH reports that the number of physician assistants practicing in the Border region has
quadrupled from 85 in 1991 to 369 in 1999. The population-to-physician assistant ratio
is 6 percent higher than the statewide ratio. The number of nurse practitioners has
increased from 285 in 1995 to 421 in 1999. The population-to-nurse practitioner ratio is
24 percent higher than the statewide ratio.
Other Information/Key Issues for Mid-level Providers
Questionnaire respondents listed nurse practitioner and physician assistant programs
among the top eight for development or expansion in the Border region. (Results of
2000 Health Education Questionnaire, July 2000)
Several institutions provide nurse practitioner programs in the region through distance
education. Access to live, interactive video and Internet-based courses allows
practicing nurses to complete their advanced degrees while continuing to work as
nurses.
23
Discipline 4: Nursing
(See also Recommendation in
Section 3, page 38)
Table 1 (page 14) shows
significant decreases in the
number of students who enrolled
and graduated from programs that
will prepare them for careers as
licensed vocational nurses
(certificate) and registered nurses
(associate or bachelor=s degree).
NOTE: The totals in Table 1 do
not include data from programs
that produce nurses trained at the
master’s level or nursing
assistants. Totals for nurse
practitioners and nurse midwives
are included under the discipline
called “Mid-level Providers.
H General Academic Institutions
Texas A&M International University
Texas A&M University-Corpus Christi
The University of Texas at Brownsville
The University of Texas at El Paso
The University of Texas-Pan American
:
Border Statistics on Nursing
! 32 certificate or degree programs (excluding nurse practitioners and nurse midwives) are offered at 17 n Community and Technical Colleges
institutions.
Alamo Community College District
! 14 of the 32 degree programs
Coastal Bend College
prepare students to become
Del Mar College
registered nurses.
El Paso Community College
!
All but one community or
Laredo Community College
Odessa College
technical college in the region
South Texas Community College
(Texas State Technical
Southwest Texas Junior College
College) offers either an
Texas Southmost College
associate degree or certificate
Texas State Technical College-Harlingen
in a nursing field.
! Of the 1,581 regional graduates in 1999, an almost equal number of nursing degrees
and certificates were awarded at the bachelor=s, and associate and certificate levels.
Health-related Institutions
The University of Texas
Health Science Center at San Antonio
! Two bachelor’s degree programs have been started in the region since 1994. That
number does not reflect many recent initiatives by institutions to expand their existing
degree-granting authority to offer new nursing degrees at other locations. Many of these
initiatives are cooperative efforts with other local colleges and universities. (For
example, UT Health Science Center at San Antonio began offering new bachelor’s
degree programs through Sul Ross State University-Rio Grande Campus and Palo Alto
College.)
24
Population-to-Registered Nurse Ratio
Border region
Registered Nurses
Border region
(Excluding Bexar Co.)
State
187:1
236:1
168:1
Source: Texas Department of Health, August 2000. For more nurse workforce data, See Section 4, page 93.
TDH reports that the Border region, as well as the entire state, is experiencing a
nursing shortage. The population-to-registered nurse ratio in the Border region has
increased from 160:1 in 1995 to 187:1 in 1999. This change has occurred despite the
addition of 23 nursing programs in the Border region since 1995. Similar changes have
been reported statewide. Nine out of 10 of the Border region=s registered nurses practice
in the Border region=s seven urban counties.
Other Information/Key Issues for Nursing
Of eight health-related occupations most frequently mentioned by survey respondents
as needing expansion or development in the Border region, four are in nursing:
registered nurse (bachelor=s degree), registered nurse (associate degree), nurse
practitioner (master=s degree), and public health nurse (master=s degree). (Results of
2000 Health Education Questionnaire, July 2000)
The Coordinating Board Planning Committee’s Task Force on Health Care Professions
recommended the state increase its financial support of existing nursing programs to
help reduce the projected nursing shortage (anticipated to strain existing programs) and
to create a public relations effort to promote the field of nursing and raise its stature in
the state. The Task Force also supported the idea of a statewide moratorium on new
nursing programs until data showed that an adequate number of qualified nurse faculty
and clinical sites were available. Board staff will continue to review proposals for new
nursing programs and make recommendations to the Board as they have done in the
past, based on an analysis of quality, need, and cost. (Health Professions Education:
Higher Education’s Role, July 2000)
Reports indicate that the supply of nurses is affected by a shortage of nursing faculty,
noncompetitive faculty salaries, changes in career preferences for women, and the aging
of the nursing population. Of those factors, the number of budgeted nursing faculty
positions has been identified as the principal capacity constraint in accepting new
students.
In the Border region, retention -- rather than recruitment -- of nursing students ranks
second behind recruiting and retaining faculty as a problem. Many students have
academic deficiencies, especially in reading and mathematics, which require
remediation.
25
Discipline 5: Allied Health
Representative fields were selected
for study. Allied health professionals
fulfill many non-physician, non-nurse
functions in the delivery of health care.
They account for an estimated onethird of the 10.3 million health care
workers in the United State and
represent approximately 200-300
different occupations and professions.
Nationwide, 31 percent are educated
in community colleges and 36 percent
are educated at general academic
institutions. Others are educated at
proprietary schools and hospital-based
programs.
H General Academic Institutions
Texas A&M University-Corpus Christi
Texas A&M University-Kingsville
The University of Texas at El Paso
The University of Texas-Pan American
The University of Texas at San Antonio
:
Health-related Institutions
The University of Texas Health Science Center at
San Antonio
n Community and Technical Colleges
Alamo Community College District
Coastal Bend College
Del Mar College
El Paso Community College
Laredo Community College
Odessa College
South Texas Community College
Texas Southmost College
Texas State Technical College-Harlingen
Table 1 (page 14) shows increases in
the number of students enrolled and
graduated from 23 selected allied
health programs that prepare students
for careers as respiratory therapy
technicians (primarily associate or
bachelor=s degree); physical and
occupational therapists (bachelor=s or
master=s degree); physical and
occupational therapy assistants
(associate degree) and medical
assistants (primarily certificate).
NOTE: The totals in Table 1 do not
include data from 66 other allied health
programs offered at both four- and
two-year institutions that prepare
students for careers in an additional
18 other allied health occupations. It
also does not include certain dental and physician assistant programs that are normally
under allied health. Dental assistant and dental hygiene programs are considered under
“Dentistry.” Physician assistant programs are discussed under “Mid-level Providers.”
Border Statistics on Allied Health
!
!
!
!
89 certificate or degree programs are offered at 15 institutions.
68 of the 89 programs are taught at community and technical colleges.
48 of the 89 programs were created after 1995.
Seven of 10 community/technical colleges offer a program in Medical Radiology
Technology.
26
Allied Health Population-to-Provider Ratios
Border region
Border region
(Excluding Bexar Co.)
Occupational Therapists
5,897:1
7,844:1
4,630:1
Occupational Therapy Assistants
13,514:1
22,268:1
14,272:1
Physical Therapists
3,641:1
4,504:1
2,818:1
Physical Therapy Assistants
6,274:1
7,935:1
7,061:1
Respiratory Care Technicians
3,750:1
4,887:1
3,388:1
Source: Texas Department of Health, August 2000. For more allied health workforce data, See Section 4,
pages 96-97.
The population-to-provider ratios for occupational and physical therapy assistants are
among the few that are lower for the Border region than for the state. Institutions could
capitalize on this surplus by developing distance education and other articulation
programs to upgrade these assistants to therapists.
Other Information/Key Issues for Allied Health
Because of the scope of these disciplines, the demand for allied health workers is often
very sensitive to external factors. The limits on reimbursement mandated by the federal
Balanced Budget Act have had a major impact. Due in part to changes in
reimbursement, physical therapy programs nationwide are experiencing severe declines
in student interest. Managed care has altered relations among allied health providers
and other professionals. Cost containment has placed pressures on employers to find
the lowest-paid qualified health professionals, and new occupations have been created
while others have been eliminated. Technological changes in medicine also have
created new occupations and responsibilities in allied health.
Among the 15 allied health occupations identified in a recent survey, the medical
radiologic technician (associate degree) profession was the most commonly cited for
further expansion and development through academic programs. Medical laboratory
technicians and physical therapists were in the second tier of high-demand programs.
(Results of 2000 Health Education Questionnaire, July 2000)
Survey respondents also commented that new programs at proprietary institutions have
cut enrollment in similar programs at state-funded institutions. By focusing specifically
on job-related training, these proprietary schools can often respond more rapidly to
changing markets.
As with nursing faculty, the state’s allied health faculty is aging and often choose
private-sector careers rather than lower-paying positions in education.
27
State
Discipline 6: Mental Health
(See Also Recommendation in Section 3,
page 63)
Table 1 (page 14) shows modest
changes in the number of students
enrolled and graduated from programs
that prepare students for careers as
social workers (bachelor=s and
master=s degrees) and clinical,
counseling, and school psychologists
(master=s and doctoral degrees).
Table 1 excludes data for most
undergraduate programs such as
general psychology and focuses on
programs that prepare students for
state licensure and for work in health
care or social welfare settings.
H
Border Statistics on Mental
Health
General Academic Institutions
Texas A&M International University
Texas A&M University-Kingsville
The University of Texas at El Paso
The University of Texas-Pan American
!
!
!
! Seven degree programs (limited
those represented in Table 1) are
offered at four institutions.
76.1 percent of degrees awarded in 1999 were bachelor=s degrees in social work.
Three bachelor’s degree programs in social work were created after 1994.
41 of 43 counties in the Border region are designated as (whole county) mental health
Health Professional Shortage Areas by the federal government.
Population-to-Mental Health Provider Ratios
Border region
Border region
(Excluding Bexar Co.)
Licensed Psychologists
9,767:1
19,176:1
6,643:1
Social Workers
1,583:1
2,011:1
1,353:1
Source: Texas Department of Health, August 2000. For more mental health workforce data, See Section 4,
pages 97-98.
The overall population-to-licensed psychologist ratio for the Border is nearly 47
percent higher than for the state. The social worker ratio is 17 percent higher than for
the state. Both ratios are higher than the population-to-psychiatrist ratio, which is 13
percent higher than for the state.
28
State
Other Information/Key Issues for Mental Health
Graduation and provider statistics suggest a need for new degree programs; however,
questionnaire respondents did not identify mental health programs as a priority for the
Border region. This response could result, in part, from the lack of representation of
mental health care workers in the surveyed population. The Board believes that
additional degree programs in this discipline are needed in the Border region;
however, due to the scope of this report, that need was not fully explored by the
publication deadline.
29
Discipline 7: Public Health
(See also Recommendation in Section 3,
page 59)
Table 1 (page 14) shows mixed trends
in the number of students enrolled and
graduated from selected degree
programs in community health practice
(bachelor=s and master=s degrees),
public health nursing (master=s degree),
general public health (master=s degree),
environmental health (master=s degree),
epidemiology (master=s and doctoral
degrees), occupational health (master=s
and doctoral degrees), and public
health education and promotion
(master=s and doctoral degrees).
:
The drop in graduates from 1995 to
1999 is attributed to enrollment and
reporting changes in master=s-level
degree programs offered by the
University of Texas Health Science
Center at Houston (UTHSC-Houston).
H General Academic Institutions
The University of Texas at El Paso
The University of Texas at Brownsville
(UTEP) and the University of Texas at
The University of Texas at El Paso
Brownsville each offer a public health
nursing degree. UTHSC-Houston
offers a master=s degree in public health through satellite programs at UTEP and UTHSC-SA.
Texas A&M University System Health Science Center (TAMUSHSC) offers new master’s degree
programs through live interactive video at McAllen, Corpus Christi, Kingsville, and Laredo.
Health-related Institutions
Texas A&M University System
Health Science Center (McAllen, Laredo, Corpus
Christi, Kingsville)
The University of Texas Health Science Center at
Houston (San Antonio, El Paso)
Border Statistics on Public Health
! Two public health nursing programs are offered at two institutions.
! Master=s degree programs in public health are offered by UTHSC-Houston, and TAMUHSC at El Paso, San Antonio, McAllen, Corpus Christi, Kingsville, and Laredo.
! 25 students graduated from the UTHSC-H Asatellite@ programs in 1999.
Other Information/Key Issues for Public Health
The discipline of public health has gained greater importance in recent years as the
philosophy of health care has increasingly encompassed not only the treatment of the
causes and effects of illness but the prevention of illness, as well. Public health
practitioners use an array of applied disciplines (epidemiology, biostatistics,
environmental sciences, behavioral sciences, management and biology sciences, and
biological sciences) to prevent the occurrence of disease and promote good health and
well being in a community setting.
30
The full spectrum of public health activities in the Border region has not been captured
fully in this report. The number and diversity of entities and projects that exist and are
planned exemplify both the pervasive nature of the public health problems in the Border
region and the importance of resolving them. For example, the persistence of illness
associated with poor sanitation and water quality in many communities along the TexasMexico border attests to the consequences of poverty and the lack of enough trained,
public health and other professionals to deal with the issue.
Public health nursing was one of the eight most frequently mentioned degree programs
needing expansion in the Border region, according to questionnaire responses.
Two institutions have expanded their master=s programs in public health to sites in
South Texas. UTHSC-H will offer a master=s degree at The University of Texas at
Brownsville, beginning in fall 2001. Activities of the program will include extending
outreach education to public health practitioners, placing students in internships in local
communities, establishing field stations for research into Border public health issues,
and providing public health services.
TAMUSHSC began offering a public health degree program at the South Texas Center
for Rural Public Health in McAllen in spring 1999. The Center has a comprehensive
plan to offer a wide range of public health programs and includes a major outreach
initiative through affiliated partners working in small communities. These affiliates
include border schools such as the South Texas Community College and current and
future initiatives with other A&M components such as Texas A&M University’s College
of Veterinary Medicine and College of Architecture. TAMUHSC also plans to expand
degree programs in Corpus Christi, Kingsville, and Laredo in fall 2000.
Many public health issues, particularly those involving environmental contamination and
infectious diseases, require coordination with Mexican officials. Public health officials in
the region have called for greater efforts to remove barriers to bi-national cooperation
and assist in the exchange of equipment and personnel.
31
Discipline 8: Pharmac y
(See also Recommendation in Section 3,
page 41)
Table 1 (page 14) shows increases in the
number of students who enrolled and
graduated from programs that prepare them
for careers as pharmacists (professional
degree), and pharmacy technicians
(certificate). There are no pharmacy
schools in the Border region; however, the
enrollment and graduation numbers shown
in Table 1 include approximately 30
students who graduate each year from The
University of Texas at Austin (UT-Austin)
Pharmacy School in a joint program with
UTHSC-SA.
H General Academic Institutions
The University of Texas at El Paso
(cooperative program with UT-Austin)
Enrollment figures also show approximately
12 students admitted in 1998 and 1999 to a
new cooperative degree program UT-Austin
and The University of Texas at El Paso
(UTEP). The remaining numbers represent
students at two pharmacy technician
programs at two community colleges.
n Community and Technical Colleges
Alamo Community College District
El Paso Community College
: Health-related Institutions
The University of Texas Health
Science Center at San Antonio
Border Statistics on Pharmacy
(joint degree program with UT-Austin)
!
! Two joint/cooperative professional
degree programs are offered by UTAustin with UTHSC-SA and UTEP.
Two pharmacy technician programs are offered at Alamo Community College District
and El Paso Community College.
Population-to-Pharmacist Ratio
Pharmacists
Border region
Border region
(Excluding Bexar Co.)
1,770:1
2,229:1
State
1,339:1
Source: Texas Department of Health, August 2000. For more pharmacist workforce data, see Section 4, page 96.
TDH reports that the region=s population-to-pharmacist ratio is 32 percent higher than
the state ratio. El Paso County has a ratio of 2,509:1 and urban counties in the Valley
(Cameron, Hidalgo, and Webb) have ratios from 2,232:1 to 2,761:1.
32
Other Information/Key Issues for Pharmacy
Pharmacists (professional degree) were the second most frequently mentioned
occupation needing degree expansion in the Border region, according to survey
respondents. (Results of 2000 Health Education Questionnaire, July 2000)
The University of Texas-Pan American has requested that the state provide $2 million
in start-up funds to develop a cooperative professional program in conjunction with the
UT-Austin. The program would be modeled after the cooperative program at UTEP;
students would complete four years of the six-year pharmacy program in the Border
region.
33
Major Instruction and
Training Initiatives
(See also Recommendation in
Section 3, page 43)
In recent years, the Legislature
has passed major legislation or
appropriated new funds to develop
health education and research
initiatives in the Border region.
l
s
:
n
Laredo Campus Extension
Lower Rio Grande Valley Regional Academic Health
Center
Border Health Institute
Coastal Bend Health Education Center
This section discusses the five
initiatives that are most directly
related to health education and
research: the South Texas Border
Region Health Professional
Education Initiative, Lower Rio
Grande Valley Regional Academic
Health Center, Laredo Campus
Extension, the Coastal Bend
Health Education Center, and the
Border Health Institute.
! The South Texas Border Region Health Professional Education Initiative, created
in Fiscal Year 1996, is a special funding item under The University of Texas Health
Science Center at San Antonio (UTHSC-SA).
Focus and Scope: Funds appropriated to the institution have been used to expand
graduate medical education and other health-related professional education in at least
18 of the 43 counties of the Border region.
Current funding: UTHSC-SA was appropriated $12.6 million for the 2000-01 biennium.
2002-03 Request: UTHSC-SA has requested $20.1 million (a $7.5 million increase) to
support programs.
An identically named special funding item is administered under the Texas Tech
University Health Sciences Center (TTUHSC). The $1.9 million item also was funded
beginning in 1996 and now supports a neurosurgery department at R.E. Thomason
Hospital and the Institute for Border Community Health in partnership with The
University of Texas at El Paso. TTUHSC has not requested any additional funds for
this item in the 2002-03 biennium.
! Senate Bill 606 (75th Legislature) established the Lower Rio Grande Valley Regional
Academic Health Center (RAHC).
Focus and Scope: The RAHC is comprised of three major components: 1) an
academic campus in Harlingen initially to instruct third- and fourth- year UTHSC-SA
medical students, and clinical sites to train students and residents in South Texas; 2) a
research facility located at The University of Texas-Pan American in Edinburg; and
3) a public health satellite of The University of Texas Health Science Center at Houston
(UTHSC-H) in Brownsville.
34
Current funding: The University of Texas System was appropriated $10.2 million in
direct appropriations for the RAHC during the 2000/1 biennium. The Legislature also
established a RAHC Permanent Fund from Tobacco Settlement receipts to support its
development. Estimated investment returns of $2 million are projected for the 2001-02
biennium.
2002-03 Request: UTHSC-SA and UTHSC-H have requested $101 million (a $25.8
million increase to support programs and $65 million in Tuition Revenue Bonds for new
construction at three RAHC locations).
! Senate Bill 1288 (76th Legislature) authorized The University of Texas System to
establish a Laredo Campus Extension (Extension) under the administration of The
University of Texas Health Science Center at San Antonio (UTHSC-SA).
Scope: The Extension is expected to support undergraduate and graduate medical and
dental education and other levels of health education including clinical laboratory
sciences, nursing, occupational therapy, nutrition, respiratory therapy, paramedic
training, and environmental education and research. The development of these
programs is a collaborative effort of UTHSC-SA, Texas A&M International University,
and Mercy Health Systems.
Current Funding: The University of Texas System was appropriated $1.4 million for
Laredo’s educational programs. UTHSC-SA also allocated $2 million of its Tobacco
Settlement proceeds toward the Extension’s infrastructure.
2002-03 Request: UTHSC-SA has requested $22.2 million (a $4.8 million increase in
program funding and $16 million Tuition Revenue Bond for a new teaching laboratory).
! Senate Bill 590 (76th Legislature) established the Coastal Bend Health Education
Center (Center), administered by the Texas A&M University System Health Science
Center (TAMUSHSC) to provide health education in Corpus Christi and area counties.
Focus and Scope: The Center will provide undergraduate clinical education, graduate
education, and health professional education in medicine, dentistry, nursing, and public
health.
Current Funding: TAMUSHSC was appropriated $2.6 million and allocated $600,000 of
its Tobacco Settlement proceeds to support Center programs.
2002-03 Request: TAMUSHSC has requested $10 million (a $7.4 million increase) for
program development.
! House Bill 2025 (76th Legislature) established the Border Health Institute (Institute) in
El Paso as a collaborative effort of The University of Texas at El Paso (UTEP), Texas
Tech University Health Science Center-El Paso site (TTUHSC), El Paso Community
College District, The University of Texas Health Science Center at Houston School of
Public Health (UTHSC-H), Texas Department of Health, and other local institutions and
agencies in the El Paso area.
Focus and Scope: The Institute was created to assist institutions in the Texas-Mexico
Border region in delivering health care, providing health education, and conducting
public health research in fields relevant to the region.
Current Funding: Both UTEP and TTUHSC-El Paso site received $2.5 million in
Tobacco Settlement proceeds that could be used for the establishment and operation
the Institute.
2002-03 Request: The Institute=s governing board is currently discussing possible
locations for the Institute. Both UTEP and TTUHSC have submitted Tuition Revenue
Bond requests for facilities that might serve as the site for the Institute. UTEP has
35
requested $30 million bonds for land and construction of a new biomedical and health
sciences corridor, and $16 million for research and academic infrastructure
development. It also has requested $1 million to help expand an existing satellite public
health program offered by UTHSC-H. TTUHSC has requested a $50 million bond to
expand the existing two-year regional academic center that it operates in El Paso into a
free-standing, four-year medical school. TTUHSC also has requested $10.25 million in
start-up funding for the school.
36
Section 3: Details on Recommendations for Health Education and Training
Section 3 provides detailed information for the recommendations shown in the Executive
Summary. Each recommendation includes background information, analysis of available
data, expansion on the legislative recommendation, cost of implementation, and the
recommendation’s potential impact.
37
Recommendation 1: Grant Program for Nursing Education
Establish and fund a competitive grant program to support new initiatives by Border
institutions to 1) recruit and retain qualified nursing students in professional degree
programs and 2) increase articulation in nursing education from the certificate-level to the
associate degree, from the associate degree to the bachelor’s degree, and from the
bachelor’s degree to the master’s degree.
Background
Of the 21 public higher education institutions in the Border region, 17 of them offer one or
more academic programs in nursing. The number and types of these nursing programs
reflect the encompassing roles that nurses perform in a wide range of health care
environments. For example, nursing assistants and licensed vocational nurses (certificate
level) perform simple tasks -- feeding, bathing, and walking patients -- in hospitals, nursing
homes, and private residents. Registered nurses (associate and bachelor’s level)
administer medication, perform therapeutic procedures, and instruct patients and their
families in proper health care practices in hospitals and neighborhood clinics. Advanced
practice nurses (master’s level) are registered nurses who receive additional academic
and clinical training in a health care specialty area. Many of these nurses may practice
independently -- obtaining medical histories, performing physical examinations, ordering
and interpreting lab tests and x-rays -- through a written protocol with a physician. Public
health nurses (master’s level) work with health care providers to plan, develop, and create
support systems and programs in their local communities to prevent disease and provide
access to care.
Since 1995, Border institutions have started 23 new nursing programs: nine at the
certificate level, two at the associate level, two at the bachelor’s level, and 10 at the
master’s level. Yet, despite the increase in the number of new degree programs, the
demand for professional nurses remains extremely high and the numbers of declared
majors and graduates from nursing programs (primarily at the certificate, associate and
bachelor’s degree level) has decreased during this four-year period.
The Texas Department of Health confirms that the Border region, as well as the entire
state, is experiencing a nursing shortage. While population-to-practitioner ratio is usually
higher in the Border region as compared to the state-at-large, the insurgence of new
programs usually closes that gap. Registered nurses are the exception. The populationto-registered nurse ratio in the region has increased from 160:1 in 1995 to 187:1 in 1999.
Analysis
The Texas Higher Education Coordinating Board has collected information that supports
the need for new state funding for nursing programs in the Border region:
! When health care providers and educators were asked in a recent survey to
identify instructional or training programs (from a list of 44 disciplines or
occupations) that should be added or expanded, four of the eight top occupations
that they named were in nursing fields. Nursing (bachelor=s level) was the number
one occupation needing new programs or expansion, according to both health care
providers and educators; nurse practitioners (master=s level) ranked third after
pharmacists; nurses (associate level) ranked fifth; and public health nurses
(master=s level) tied for sixth.
38
!
A recent Coordinating Board Task Force on Health Care Professions
recommended that the state increase its financial support of existing nursing
programs to help address the projected nursing shortage and create a public
relations effort to promote the field of nursing and raise its stature in the state. The
Task Force also supported the idea of a statewide moratorium on new nursing
programs until data showed that an adequate number of qualified nurse faculty and
clinical sites were available. Board staff will continue to review proposals for new
nursing programs and make recommendations to the Board as they have done in
the past, based on an analysis of quality, need, and cost.
!
Reports indicate that the supply of nurses is affected principally by a shortage of
nursing faculty, noncompetitive faculty salaries, changes in career preferences for
women, and aging of the nursing population. Of those factors, the number of
budgeted nursing faculty positions has been identified as the principal capacity
constraint in accepting new students in existing programs. Board staff recognizes
that nursing schools in the Border region, as well as throughout the state, have
had extreme difficulty hiring qualified faculty.
!
Other reports suggest that the declining enrollments in nursing schools mirror the
declining prestige of the profession among women. In the Border region, nursing is
still considered to be a desirable occupation, particularly among minority women
and men. Consequently, the number of students applying to nursing programs in
the Border region usually exceeds program capacity. Academic preparedness,
rather than the interests of students, often determines whether a Border program
will reach enrollment capacity in a given year. Many applicants to these schools
do not meet minimum admissions requirements.
!
In the Border region, after finding and keeping faculty, retention of nursing
students, rather than recruitment, appears to be the principal problem. Many
students have academic deficiencies, especially in reading and mathematics,
which require remediation.
!
Academic preparedness and retention are issues at all levels of nursing, even for
those students entering certificate-level programs. Many institutional
representatives believe that scholarships are the most effective means of retaining
first-year nursing students in the Border region. Once the students have acclimated
to the program and achieved academic success, other types of financial aid
programs can be used to keep them enrolled.
Recommendation to the Legislature
The Texas Higher Education Coordinating Board recommends that the Legislature
establish and fund a competitive grant program that will support the best proposals by
Border institutions to increase the recruitment and retention of nursing students in
professional degree programs, and to increase articulation in nursing education from the
certificate to the associate degree, from the associated degree to the bachelor’s degree
and from the bachelor’s degree to the master’s degree. The grant competition would focus
on specific issues of the Border region: faculty appointments, academic preparation,
recruitment of qualified students, tutorials and counseling, student stipends and
scholarships, and articulation initiatives.
39
Cost of Implementation
The Board recommends $2 million in grant funding for the 2002-03 biennium. That
amount would provide a $200,000 grant to one or more institutions located in each of the
10 counties where nursing schools reside in the Border region.
Impact
The new grants program would support initiatives that address the unique nursing
education and workforce issues of the Border region.
40
� Recommendation 2: Cooperative Pharmacy Program
Fund a cooperative pharmacy program at The University of Texas-Pan American.
Background
Texas has four colleges of pharmacy which offer the six-year Doctor of Pharmacy
(Pharm.D) degree: The University of Texas at Austin, Texas Southern University,
University of Houston, and Texas Tech University Health Sciences Center at its facilities in
Amarillo. Of the four colleges, The University of Texas at Austin (UT-Austin) has been the
most active in the Border region, offering a joint pharmacy degree with The University of
Texas Health Science Center at San Antonio for over 30 years, and since 1990, partnering
with local practitioners in more than eight cities to train pharmacy students in communitybased settings. In 1997, UT-Austin also began a cooperative Pharm.D program with The
University of Texas at El Paso (UTEP). The model for that cooperative program is
comprised of two years of pre-pharmacy instruction at UTEP, two-years of pharmacy
instruction at UT-Austin, and two final years of distance education from UT-Austin with onsite training and internships in El Paso.
The University of Texas-Pan American (UT-PA) and UT-Austin would like to use the UTAustin/UTEP model for a similar Pharm.D program in South Texas. Both institutions
believe the cooperative program has many advantages for the state and South Texas
communities:
! The cooperative model would maximize the use of existing resources at both
institutions.
! Because students would return to South Texas to complete the clinical portion of
the degree program, the model would encourage graduates to stay and practice in
a region where there appears to be a significant shortage of pharmacists.
! The proposed program would complement other planned academic and research
components of the Lower Rio Grande Valley Academic Health Center in Harlingen
and Edinburg.
The University of Texas System has made an early commitment to the program. UT-PA
redirected $200,000 of special item funding originally intended for a distance learning
initiative in law, and The University of Texas System Board of Regents approved $5 million
in Permanent University Funds for construction of pharmacy facilities as an extension of
the biomedical sciences building in Edinburg. For the 2002-03 biennium, UT-PA has
requested $2 million in special item funding to operate the Edinburg facility, which is
expected to accommodate 72 students, and support a regional assistant dean, 10
pharmacy faculty, and four staff.
UT-PA and UT-Austin plan to enroll 12 students from the Rio Grande Valley each year
beginning in fall 2001 and graduate their first class in 2007. Students completing the
program would receive a diploma designation showing that “The University of Texas at
Austin in cooperation with The University of Texas-Pan American awards the degree of
Doctor of Pharmacy.”
41
Analysis
The Texas Higher Education Board has collected information that supports the need for a
Pharm.D program in South Texas.
! A recent Board survey showed that pharmacists were the second most frequently
mentioned health education occupation needing degree expansion in the Border
region.
! The Texas Department of Health reports that the 1999 population-to-pharmacist
ratio was 32 percent higher in the Border region than for the state (1,770:1 in the
Border region compared to 1,339:1 for the state. Urban counties in the Valley -­
Cameron, Hidalgo, and Webb -- have population-to-pharmacist ratios from
2,232:1 to 2,761:1).
Some of the factors contributing to the shortage of pharmacists in South Texas include: 1)
a rapidly expanding population with relatively high health care needs, 2) a relatively
constant number of graduates from the four schools in the state, and 3) difficulty in
recruiting and retaining pharmacists in the region.
Recommendation to Legislature
The Texas Higher Education Coordinating Board believes that there is sufficient evidence
to show a need for a cooperative Pharm.D program in South Texas and supports UT-PA’s
funding request to develop the program.
Cost of Implementation
The Board recommends $2 million in special item funding for the 2002-03 biennium.
Impact
The program will prepare students from the Rio Grande Valley for pharmacy careers in
South Texas.
42
Recommendation 3: Continued Support of Major State Initiatives
Continue to develop four recently established major state initiatives for health instruction
and training in the Lower Rio Grande Valley and Coastal Bend area: South Texas Border
Region Health Education Initiative, Lower Rio Grande Valley Regional Academic Health
Center, Laredo Campus Extension, and Coastal Bend Health Education Center.
Continue to support existing health education and research activities in the Upper Rio
Grande Valley and consider funding one or more initiatives that will best meet the needs
of the El Paso area.
Background
Most of the state funds appropriated to public institutions of higher education each
biennium are determined by funding formulas (see page 8); this report assumes that
funding provided to Border institutions through those formulas will continue. Those funds
support the on-going health-related education provided by all institutions in the region.
This section of the report, however, focuses on several non-formula “special item”
appropriations made in the last few years to support health education in the Border region.
It also discusses other proposed initiatives and funding requests and provides
recommendations.
Lower Rio Grande Valley and Coastal Bend Area
In recent years, the state has passed major legislation and appropriated new funds to
develop health education in the Lower Rio Grande Valley and the Coastal Bend area.
While many initiatives have been introduced, four are considered to be the most directly
related to health education: the South Texas Border Region Health Professional Education
Initiative, Lower Rio Grande Valley Regional Academic Health Center, Laredo Campus
Extension, and the Coastal Bend Health Education Center.
The South Texas Border Region Health Professional Education Initiative (Initiative),
created in Fiscal Year 1996, is a $12.6 million special funding item under the appropriation
for The University of Texas Health Science Center at San Antonio (UTHSC-SA). Funds
appropriated for the Initiative have been used to expand graduate medical education and
other health professional education in at least 18 of 43 counties of the Border region.
UTHSC-SA shows the actual and estimated results of state support in the following
legislative performance measures:
43
Performance Measure
1999
2000
Number of programs in South Texas area
100
88
Number of locations served by programs
240
104
12,238
12,342
755
714
1,794
722
137
106
Number of K-12 students participating in programs
Number of certificate, associate, and baccalaureate degree students
participating in programs
Number of medical and dental students and post-baccalaureate
allied health, nursing, and graduate school students participating in
programs
Number of resident physicians and dentists participating in programs
Source: The University of Texas Health Science Center at San Antonio, November 2000.
The Lower Rio Grande Valley Regional Academic Health Center (RAHC),
established in 1997 (Senate Bill 606, 75th Legislature), is a $10.2 million special funding
item under the appropriation for The University of Texas System. The RAHC is comprised
of three major components under the administration of UTHSC-SA and The University of
Texas Health Science Center at Houston (UTHSC-H). The first component is an
academic campus in Harlingen for third- and fourth-year medical students enrolled at
UTHSC-SA. UTHSC-SA is constructing a $25 million medical education building that is
expected to be completed by mid-2002. Another $30 million building is planned in
Harlingen for research and continuing education activities. The Harlingen component is
also expected to support increased clinical training of UTHSC-SA medical students and
residents at various sites in the Lower Rio Grande Valley. The second component of the
RAHC is a research facility to be built adjacent to The University of Texas-Pan American in
Edinburg. The building will support bio-technological research and house administrative
and faculty offices. The third component is a satellite public health program on the
campus of The University of Texas at Brownsville and Texas Southmost College and
administered by UTHSC-H. The program is expected to enroll its first class of 25
students in a new building that is scheduled to be completed in fall 2001.
UTHSC-H’s program is one of two new public health programs in the area. Texas A&M
University System Health Science Center (TAMUSHSC) began offering a public health
degree program at the South Texas Center for Rural Public Health in McAllen in spring
1999. The Center plans to offer a wide range of public health programs and includes a
major outreach initiative through affiliated partners working in small communities. It also
plans to expand degree programs in Corpus Christi, Kingsville, and Laredo in fall 2000.
For the 2002/3 biennium, TAMUSHSC has requested $4.5 million in bonds and $6 million
for operations to continue a program that is currently supported by local funds.
The Laredo Campus Extension (Extension), established in 1999 (Senate Bill 1288, 76th
Legislature), is a $1.4 million special funding item under the appropriation for The
University of Texas System; it is administered by UTHSC-SA. The Extension is expected
to support undergraduate and graduate medical and dental education and other levels of
44
health education, including clinical laboratory sciences, occupational therapy, nutrition,
respiratory therapy, paramedic training, and environmental education and research.
The development of these programs is a collaborative effort of UTHSC-SA, Texas A&M
International University, and Mercy Health Systems. UTHSC-SA is currently constructing
a facility with institutional and gift funds and plans to build another $16 million building on
land donated by the City of Laredo.
The Coastal Bend Health Education Center (Center), established in 1999 (Senate Bill
590, 76th Legislature) is a $2.6 million special funding item administered by the Texas
A&M University System Health Science Center (TAMUSHSC). The Center is expected to
provide health education in Corpus Christi and surrounding counties, with plans for
undergraduate clinical education, graduate education, and health professional education
in medicine, dentistry, nursing, and public health. The Center is currently located at
facilities on the campuses of Texas A&M University-Corpus Christi and Texas A&M
University-Kingsville.
Future Funding Requests
The Texas Higher Education Coordinating Board has compiled 2002-03 funding requests
for the four initiatives in this area of the Border region:
2000-01 Funding
2002-03 General Revenue Funding Requests
Initiative (Current Funding)
[excludes Tobacco proceeds]
Tuition Revenue
Bonds
Programs/
Operations
Grand
Total
South Texas Border Region Health
Professional Education Initiative
($12.6 million)
$0
$7.5 million
Lower Rio Grande Valley Regional
Academic Health Center
($10.2 million)
$30 million (Edinburg)
$30 million (Harlingen)
$ 5 million (Brownsville)
$24.4 million
Laredo Campus Extension
($1.4 million)
$16 million
$ 4.8 million
$22.2 million
Coastal Bend Health Education Center
($2.6 million)
$0
$ 7.4 million
$10 million
$20.1 million
$101 million
$ 1.4 million
Upper Rio Grande Valley/El Paso Area
For the 2000-1 biennium, the Coordinating Board estimates that $29.3 million in formula
funding and $14.7 million in special item funding were appropriated for health education
and related activities to Texas Tech University Health Sciences Center for its El Paso site
(TTUHSC-El Paso), The University of Texas at El Paso (UTEP), and El Paso Community
College District. With these state funds: TTUHSC-El Paso educates 100 third- and fourthyear medical students each year and affiliates with 10 medical residency programs; UTEP
offers degree programs in nursing, allied health, and mental health to more than 1,500
health professions education students and participates in a cooperative pharmacy degree
program with The University of Texas at Austin; and El Paso Community College District
offers a wide range of certificate and associate degrees in dentistry, nursing, allied health
and pharmacy. Both UTEP and TTUHSC also provide research activities. In 1999, UTEP
45
spent $28 million in research and development with nearly $6 million directed at healthrelated projects, while TTUHSC-El Paso spent $1.3 million in research.
Despite the number of health education and research opportunities in the El Paso area,
the county appears to have shortages in most health-related professions. Texas
Department of Health workforce data show that El Paso County has higher population-to­
provider ratios than the state, the Border region, and the average ratios for the Border
region’s seven urban counties (Bexar, Cameron, El Paso, Hidalgo, Nueces, San Patricio,
and Webb). El Paso health care providers and educators who responded to a recent
Coordinating Board survey identified “inadequate state or federal funding,” “difficulty
attracting health care professionals,” “insufficient local tax base to support health care
delivery,” “migration of qualified graduates/workers from the area,” and “lack of available
instructors/faculty” as the major factors contributing to these shortages.
While health educators and providers agree that new efforts are needed to reduce the
shortages of health professionals, reaching consensus for action among these different
interests takes time and concerted effort. One prominent initiative at the center of these
discussions is the Border Health Institute (Institute). It was established in 1999 (House
Bill 2025, 76th Legislature) as a collaborative effort of UTEP, TTUHSC-El Paso, El Paso
Community College District, The University of Texas Health Science Center at Houston
School of Public Health (UTHSC-H), and other local institutions and agencies in the El
Paso area. The Institute was created to assist institutions working in the Texas-Mexico
Border region in delivering health care, providing health education, and conducting public
health research in fields relevant to the region. None of the institutions named in the
enabling legislation were given state funds specifically to develop the Institute; however,
UTEP and TTUHSC-El Paso both received an estimated $2.5 million in Tobacco
Settlement proceeds that could be used for its establishment and operation. In Fiscal Year
2000, each institution spent these funds to support their individual health-related research
ventures. Future allocations of Tobacco Settlement funding are at the discretion of the
Legislature.
Future Funding Requests
Both UTEP and TTUHSC have submitted new funding requests for the 2002-03 biennium
that are generally consistent with the broad mission of the Institute. UTEP has requested
$30 million in bonds for land and construction of a new biomedical and health sciences
corridor, and $16 million for research and academic infrastructure development. Because
the $16 million request also supports other non-health-related research and instruction, it
is unclear how much of the total is linked to activities related to the mission of the Institute.
UTEP also has requested $1 million for a satellite public health program that UTEP hosts
on its campus for The University of Texas Health Science Center at Houston. In addition,
UTEP has requested $2 million in new funding from Tobacco Settlement proceeds.
TTUHSC has requested $50 million in bonds to expand the existing two-year regional
academic center that it operates in El Paso into a free-standing, four-year medical school.
TTUHSC also has requested $10.25 million start-up funding for the school. At its October
25, 2000 meeting, the Border Health Institute’s governing board endorsed the 2002-03
legislative appropriations requests submitted separately by UTEP and TTUHSC, and a
statewide initiative that would benefit health-related programs at El Paso Community
College District. The following table summarizes the first two of those endorsed requests:
46
2000-01 Funding
Border Health Institute
Current funding, excluding Tobacco
proceeds ($ 0)
• Texas Tech University Health
Sciences Center-El Paso Site
(Four-year medical school)
The University of Texas at El Paso
(Research and Public Health)
2002-03 General Revenue Funding Requests
Tuition Revenue
Bonds
Programs/
Operations
Grand
Total
$50 million
$10.25 million
$60.25 million
$30 million (Research)
$16 million (partial)
$ 1 million
(Public Health)
$47 million
Recommendation to the Legislature
The Legislature should consider continued financial support of the four previously funded
state initiatives in the Lower Rio Grande Valley. It also should consider current activities in
the Upper Rio Grande Valley and then determine more directly how similar needs in this
area of the Border region could be met.
Cost
The Board makes no specific funding recommendations at this time. Institutions have
requested $153.3 million (a $126.5 million increase) for initiatives that serve the residents
of the Lower Rio Grande Valley/Coastal Bend. Institutions in the Upper Rio Grande
Valley/El Paso area have requested an estimated $107.25 million in new initiatives for
health education and research.
Impact
With new funding, institutions would be able to develop new instructional and training
programs and extend the benefits of their research and patient care activities to local
communities in the Border region.
47
Recommendation 4: Distance Education and Tele-education
Request that the Telecommunications Infrastructure Fund (TIF) Board finance needed
infrastructure for distance education and tele-education programs in the Border region by
giving priority to meritorious Border projects affecting health-related education, especially
those for continuing medical education. Provide funding to Border institutions for the
associated costs of distance education and tele-education (e.g., technical support
personnel, faculty development training, curricular development). Extend funding for
telecommunications for educational purposes beyond 2005 (through TIF or other means).
Background
The Public Utility Regulation Act of 1995 established the Telecommunication Infrastructure
Fund (TIF), which is intended to distribute approximately $150 million per year for ten
years to provide telecommunication access for Texas public schools, hospitals, libraries,
and institutions of higher education. The Act also established a TIF Board to disburse the
funds in accordance with the Board’s mission of building telecommunications infrastructure
that strengthens education and health care in Texas. The TIF Board is scheduled to
expire in September 2005 unless continued by the Legislature.
In 1998-99, the TIF Board provided more than 2,200 grants to public schools and provided
nearly 40,000 classrooms with Internet access. TIF also awarded nearly 1,200 grants and
loans to higher education institutions and other eligible entities to provide equipment,
wiring, and other related infrastructure costs. Appropriations to the TIF Board for the 2000­
01 biennium total $416 million. Despite the distribution of these funds, Texas’ educational
and health institutions (including those in the Border region) remain unable to fully provide
and support telecommunications for educational purposes.
Telecommunication technology allows institutions to provide courses (and degree
programs) to be delivered electronically to sites at a distance from the institution providing
the instruction. For example, live two-way interactive video allows a class at one institution
to be broadcast to students at multiple sites around the state. The potential advantages of
distance education are significant, particularly in disciplines such as nursing; shortages of
nursing faculty are a problem for many Texas institutions. While all nursing programs
might be able to provide adequate instruction in core areas, distance education allows
nursing programs to “share” faculty who have different specialty expertise. Such
collaboration among institutions promotes a more efficient use of educational resources.
Distance education also provides for greater access to courses and programs for students
who live and work in locations that are far from academic institutions. Distance education
has been particularly helpful for working nurses who wish to seek advanced degrees
without having to leave their jobs. Although distance education has limitations, it has the
potential to enhance a number of goals of higher education. And while Texas institutions
do offer distance education programs (including some in the Border region), the full
potential of distance education cannot be realized until all parts of the state have the
technology to use this mode of instruction.
48
Telecommunication technology also provides for the practice of telemedicine, in which
consultations with practitioners can take place even though the patient is located far from
the consulting health care provider. Since its inception, this practice (also known as tele­
health) has been a natural partner with distance education; the same technology that
connects rural and urban practitioners for consultation and treatment purposes also can be
used for educational purposes. For example, a surgeon performing an operation can
teach the surgical procedure to students at multiple medical schools through live
interactive videoconferencing. Similarly, live procedures (and seminars) can be broadcast
to practicing physicians and other health care providers all over the state (including rural
areas), providing much-needed continuing health education for these individuals. This type
of continuing education can help lessen the professional isolation that many rural health
care practitioners experience. (Isolation is a significant factor given by rural practitioners
for leaving their positions.)
The practice of using telecommunications for health education (sometimes called tele­
education) is becoming more commonplace. Institutions such as the Mayo Clinic and
medical schools at the University of Tennessee, University of Kentucky, and East Carolina
University are known for their wide use of tele-education. Texas health science centers
also make significant use of tele-education, including Texas Tech Health Sciences Center
and The University of Texas Health Science Center at San Antonio. However, the ability
of these institutions and others to project their expertise through telecommunications is still
limited by the fact that a number of isolated rural communities (in the Border region and
elsewhere) are the last to receive the physical infrastructure required to support the
technology. Some clinics and hospitals in urban areas also lack this technology.
Even with the necessary physical network in place, other costs can impede the
development of distance education and tele-education. Academic institutions rely largely
on their faculty as the content experts in creating distance education curricula and
programs. The development process requires extensive preparation time. In the previous
round of higher education funding, TIF did not fund curriculum development -- an important
issue in creating high quality instruction through distance education.
Other costs associated with developing and maintaining distance education programs
include salaries of support staff needed to provide technical expertise to maintain
equipment and to consult with faculty in curriculum development. And continued
maintenance costs of equipment and connectively costs (to lease the use of cable lines)
also have to be borne by the institutions. TIF funds do not (and should not) cover these
continuing costs.
Recommendation to the Legislature
The Texas Higher Education Coordinating Board requests that the TIF Board provide
needed infrastructure for distance education and tele-education programs in the Border
region. In responding to grant requests from institutions, the TIF Board should give priority
to Border projects, particularly those for continuing health education.
The Coordinating Board encourages the TIF Board to allow institutions to include in their
proposals certain support costs, such as funds for curriculum development, as long as
these costs are short term and non-continuing. The Coordinating Board also recommends
that the Legislature be receptive to funding requests by the institutions to support distance
education and tele-education (e.g., full-time positions for technical support staff).
49
While much of the state will have telecommunication access by 2005, there very likely will
remain a continued need for building telecommunication infrastructure in the Border region
and elsewhere. The Legislature should plan to continue to fund such projects either by
extending TIF beyond 2005, or by other means.
The Board also acknowledges that while the implementation of this recommendation would
relieve the need for technical infrastructure and staff support, it does not address the
important issues of reimbursement of telemedicine services and liability associated with
tele-health. Those issues are under consideration at the federal level and within the
insurance industry.
Cost of Implementation
Most of the costs associated with this recommendation would come from funds already
allocated to TIF. Special item requests from institutions for distance education and tele­
education could vary greatly and are difficult to estimate.
Impact
Much of the Border region (particularly in rural areas) remains without adequate
telecommunication infrastructure that allows full access to distance education and tele­
education programs. Without this technology, these Border residents will have limited
access to the full array of distance education programs, and health care practitioners will
not be able to take advantage of needed continuing education opportunities.
By requesting the TIF Board to give priority to Border projects, this part of the state would
be able to realize the full benefits of distance education and tele-education programs. And
by providing institutions with additional means to support their programs, distance
education and tele-education could continue to expand.
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Recommendation 5: Research Development
Establish and fund a new grant program for health-related research at appropriate Border
institutions and entities. Research programs must focus on the prevention or treatment of
health problems significantly affecting the Border region (e.g., diabetes, tuberculosis).
The following institutions would receive special consideration for these grants: 1)
Coastal Bend Health Education Center and 2) health-related institutions (and their
satellite operations) that are located in counties bordering Mexico.
Background
The Texas Higher Education Coordinating Board defines research as the “systematic
study directed toward fuller scientific knowledge or understanding of the subject studies,”
and development as “the systematic use of knowledge or understanding gained from
research, directed toward the production of useful materials, devices, systems, or methods
including design and development of prototypes and processes.” Health-related research
and development (conducted by academic institutions) serves a critical function in
identifying causes and treatments of diseases and other health conditions.
During Fiscal Year 1999, Texas public universities spent $829 million on research and
development (R&D), including $238 million in medical-related fields. In addition, Texas
public health-related institutions spent $646 million in R&D during Fiscal Year 1999.
However, with two notable exceptions, the border institutions do not engage in significant
R&D spending.
Although universities have many different missions, it should be noted that of the nine
public universities in the Border region, only The University of Texas at El Paso (UTEP)
had R&D expenditures greater than $8 million in 1999. UTEP spent $28 million in R&D
with nearly $6 million of those monies going for health-related research. The University of
Texas Health Science Center at San Antonio (UTHSC-SA) spent $77 million in R&D; the
Regional Academic Health Center in El Paso of Texas Tech University Health Sciences
Center expended $1.3 million for R&D.
Many reasons can account for limited R&D expenditures for Border institutions. Seven of
the nine universities in the Border region are currently classified as “Master’s I” universities
according to the Carnegie Classification System, which clusters institutions with similar
programs and purposes. This classification for the institutions suggests that these
universities are primarily “teaching institutions,” with the master’s degree being the highest
level a student can obtain in most disciplines. However, two of the Border universities
(Texas A&M University-Kingsville and UTEP) have Carnegie classifications of
“Doctoral/Research Intensive,” a classification intended to group universities in which
some doctoral degrees are awarded. In addition, master’s-only degree programs can and
do generate research dollars, particularly in “niche” areas. Institutions such as The
University of Texas-Pan American and The University of Texas at San Antonio could
increase R&D expenditures (and have indicated a desire and plan to do so). These
institutions and any other Border institution must be willing to provide resources for the
necessary infrastructure for research and establish appropriate reward systems for faculty
who seek and conduct research (much as UTEP has done).
Another entity that plans to increase R&D expenditures is Texas Tech University Health
Sciences Center’s El Paso site. The high demand on faculty for direct patient care
currently limits the amount of time and attention given by faculty to research interests.
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Texas Tech Health Sciences Center (TTUHSC) has indicated a commitment to expand
research activities at the El Paso site and its main campus.
The major source of R&D funding for many universities and health science centers is
federal grants. For example, of the $28 million of R&D expenditures at UTEP in 1999, 86
percent came from federal funding, and 70 percent of the $77 million of R&D funds at
UTHSC-SA came from federal grants. Other state institutions such as The University of
Texas Southwestern Medical Center at Dallas and The University of Texas Health
Science Center at Houston also have a high ratio of federal to state R&D dollars (greater
than ten to one). However, many institutions are more dependent on state appropriations
for their R&D monies. For example, Texas A&M University-Kingsville received $2,138,000
in state funding for R&D while receiving only $1,771,000 in federal funds. Additional state
funding available for Border institutions for health-related research could increase
significantly the amount of research conducted at these institutions.
Recommendation to the Legislature
The Texas Higher Education Coordinating Board recommends that the Legislature
establish and fund a new competitive grant program for health-related research for Border
institutions. The following institutions could apply for this grant money:
•
•
•
•
•
•
•
Any of the nine Border universities
Texas Tech University Health Sciences Center – El Paso site
Lower Rio Grande Valley Regional Academic Health Center
UTHSC-SA main campus
Border Health Institute
Coastal Bend Health Education Center
Public health satellites in McAllen, Laredo, Kingsville, San Antonio, Brownsville,
and El Paso that are affiliated with The University of Texas Health Science Center
at Houston and Texas A&M University System Health Science Center
• Any of the above institutions and entities in partnerships with another Texas public
university or heath science center
As indicated above, grant proposals from Border institutions in partnership with other
Texas public universities and health science centers would be encouraged. These
partnerships would allow Border institutions with more limited resources to collaborate with
larger research institutions.
Grants submitted for review should address health issues that are of particular concern to
the Border region. Health conditions such as diabetes, tuberculosis, hypertension,
dengue fever, infectious diseases, diet-related conditions, effects of uncontrolled
pharmaceuticals, and intestinal and waterborne diseases (e.g., hepatitis A, salmonellosis)
should be the subjects of the proposed research. Priority also should be given to applied
research that investigates the effects of medical interventions.
Grant proposals would be peer reviewed and grants would be awarded by the
Coordinating Board.
Cost of Implementation
Grant awards would total $6 million for the biennium. The Coordinating Board would
administer the grant program with current staff.
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Impact
Research conducted by academic institutions about Border health issues helps to identify
public health conditions in the area and determine effective interventions in addressing
these conditions. There are a number of academicians from outside the state or region
who come to the Border region to collect data and then return to their institutions to
analyze and perhaps publish their results. For example, a study on the health
consequences of maquiladora work was conducted by researchers from the University of
California, Berkeley and published by the American Journal of Public Health. While the
state benefits from all health research conducted in the Border region, there are additional
benefits if Border institutions themselves conduct and publish such research.
Researchers located on the Border have continual access to data and subjects. Because
of the severity of some health problems in the area, and because there are health
problems particular to the Border, the area serves (unfortunately) as an ideal learning
laboratory for resident researchers. These researchers are also familiar with the problems
in the area and familiar with the population of the Border region, thus potentially
strengthening their ability to work with local subjects. Finally, if Border institutions had
more prominent research agendas, then the institutions would likely be able to draw more
qualified faculty and retain them.
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Recommendation 6: Formula Funding Bonus for Recruitment
Provide a formula funding bonus to medical and dental schools as an incentive to recruit
and retain students from the state’s Historically Black or Hispanic-serving colleges and
universities. The funding bonus would equal one-half of the per-student appropriation for
each second-year medical and dental student who was recruited through a Coordinating
Board-approved educational partnership with one of these institutions. All of the Border
region’s universities have been designated as Hispanic-serving institutions.
Background
In recent years, the Texas Higher Education Coordinating Board has implemented a
number of legislative initiatives to address the uneven distribution and specialty shortages
of health care professions. These initiatives have supported efforts to recruit physicians
and dentists to practice in under-served areas and train medical residents in high-demand
primary care specialties. Other efforts have focused on improving the representation of
minorities in the health care workforce. Research has shown that Blacks and Hispanics
are underrepresented in many medical and dental professions.
The state’s medical and dental schools also have exerted some influence, at least
indirectly, on increasing the diversity and distribution of the physician and dentist
workforce. In more recent years, however, that influence has been weakened by the
Hopwood decision that effectively prohibited consideration of race or ethnicity in
admissions and financial aid decisions. Public and private institutions from other states
not bound by the Hopwood decision have had greater flexibility to recruit the most capable
of Texas’ high school and college graduates with attractive scholarships and financial aid
packages.
Admissions data show that the state’s medical schools have had varying results in
recruiting minorities under the restrictions imposed by the Hopwood. Among the three
medical schools that have the largest presence in the Border region, Texas Tech
University Health Sciences Center reported that 12.2 percent of its 1999 first-year medical
school class was Black, Hispanic, or Native American. Texas A&M University System
Health Science Center reported that 5 percent of its first-year students identified
themselves as minorities, while The University of Texas Health Science Center at San
Antonio (UTHSC-SA) reported 21 percent minority admissions for this same period.
UTHSC-SA also reported that 19 percent of its 1999 first-year dental school class was
minority.
Creative outreach efforts by the state’s medical schools show some promise for increasing
diversity in enrollments. For example, The University of Texas-Pan American and Baylor
College of Medicine have established a Premedical Honors College (PHC), through which
university students in Edinburg are provided a curriculum and an environment designed to
prepare students for medical school. More than 90 percent of PHC students are Hispanic.
The first three graduating classes of that partnership have yielded 31 medical students -­
22 attending Baylor College of Medicine and nine attending other Texas medical schools.
Similar partnerships exist between other Texas medical schools and institutions of higher
education.
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Data Analysis
To support recruitment efforts, the Coordinating Board’s Formula Funding
Recommendations for the 2002-03 biennium (April, 2000) included a new funding bonus
for medical and dental schools. The funding bonus would equal one-half of the per-student
appropriation for each second-year medical and dental student who was recruited through
a Coordinating Board-approved educational partnership with a Historically Black or
Hispanic-serving higher education institution in Texas. All of the Border region’s four-year
schools have been designated as Hispanic-serving institutions.
In determining the cost to the state for the funding bonus in the 2002-03 biennium, the
Board estimated that 5 percent of the state’s second-year medical and dental school
students would be recruited from Historically Black or Hispanic-serving institutions. The
Board expects that this percentage will increase as schools develop additional formal
educational partnerships with these institutions. Institutions would receive an additional
$27,035 for each medical student and $26,187 for each dental student who was recruited
through a partnership at one of the targeted institutions. The total cost to the state (for an
estimated 110 medical students and 24 dental students) would be $3,602,338 for the
2002-03 biennium.
Recommendation to the Legislature
The Texas Higher Education Coordinating Board believes that enrolling and retaining
minority students in the state’s medical and dental schools is important, and that success
in those efforts should be rewarded. The Board believes that formula funding can be used
as an incentive to support the state’s goal to recruit students who are traditionally under­
represented in higher education, particularly in professional degree programs. The
Board’s legal counsel also has determined that the recommendation is consistent with
post-Hopwood restrictions on recruitment and admissions policies.
Cost of Implementation
The funding bonus is estimated to be a $3.6 million increase in formula funding to the
state’s medical and dental schools for the 2002-03 biennium.
Impact
Adoption of the funding bonus would create an incentive and provide funding support for
health-related institutions that are successful in working with undergraduate institutions to
prepare minority students for professional degrees in medicine and dentistry.
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Recommendation 7: Recommended High School Program
Make the Recommended High School Program (college preparatory courses) the
standard curriculum for high school students. Ensure that a sufficient number of qualified
teachers are secured and retained to teach the recommended courses.
Background
Some Students are Less Likely to Remain and Succeed in College
Board data shows that first-year students enrolled in four-year colleges in the Border
region are less likely than students statewide to return to college for their second year
(see Appendix E).
Research shows that certain characteristics 1) lower the chances that a high school
graduate will enroll in college, and 2) if enrolled, put the student at risk for not remaining in
college until the degree is completed (persistence). These risk factors include coming
from a low-income family, having parents who did not attend college, and attending a high
school located in an area of high poverty (defined as a high school in which 25 percent or
more of the students are eligible for free or reduced-priced lunches).
These risk factors are characteristic of many high school students in the Border region. A
report presented to the Texas Higher Education Coordinating Board by the Advisory
Committee on Criteria for Diversity shows that 65 percent of the students enrolled in
elementary and secondary schools in the Border region are classified as economically
disadvantaged, and that only 9 percent of the over-25 population of the Border region has
a college degree.
However, research also shows that academic preparation in high school can overcome
the risk factors associated with both the lower rates of enrollment in college and lower
rates of persistence in college.
• A 1992 study of at-risk high school graduates who were enrolled in a four-year college
by 1994 showed that none of the high school graduates who were unprepared
academically had enrolled in college. In contrast, 57 percent of those who were at
least minimally prepared had enrolled.
• A 1995 study of at-risk high school graduates who were enrolled at any four-year
college in 1998 showed that only 61 percent of the at-risk students who had not
completed the New Basics curriculum in high school (recommended in A Nation at
Risk by the National Commission on Excellence in Education) were still enrolled. In
contrast, at-risk students who had completed the New Basics curriculum stayed in
college at almost the same rate as those not-at-risk students who completed the New
Basics curriculum (83 percent for at-risk students versus 88 percent for not-at-risk
students).
Better Preparation Helps Health Care Students
A similar pattern emerges when the view is of students beginning college in health-related
programs at public academic institutions and community/technical colleges in the Border
region. Using data available at the Coordinating Board, Board staff compared two groups
of these health-care students -- those who had received a regular high school diploma in
1997, and those who had received an advanced high school diploma in 1997 (includes
56
college preparatory courses). The comparison showed that 75 percent of the students
who earned an advanced high school diploma returned to college for their second year,
while only 59 percent of the students who earned a regular high school diploma returned
in their second year. (See Appendix G.)
Further comparison showed a greater difference in the retention of these students when
college readiness was considered. “College-ready” students were defined as those
students who either had passed all three components (reading, writing, and math) of the
Texas Academic Skills Program (TASP) test, or who were exempted from taking the test
due to previous academic achievement. The comparison showed that 76 percent of the
students who earned an advanced high school diploma and who demonstrated college
readiness (success on TASP test) returned to college in the third year, while only 42
percent of the students who earned a regular high school diploma and who did not
demonstrate college readiness returned to college in the third year. (See Appendix G).
Analysis
In the recent survey sent to health care providers and educators in the Border region,
educators listed academic preparation and readiness of students as the number one
challenge they face in health-education programs (see Questionnaire Results, Section 2).
Board data shows that only about 50 percent of the four-year college students who major
in a health-related field in their first year continue to major in a health-related field in their
second year (see Appendix F). This continuation rate in a health-related major drops to
about 40 percent for first-year community college students (see Appendix F).
To help our students enroll and remain in college, we must prepare them in advance for
the academic experience. This is particularly true for health-related programs requiring
math and science course work. Remediation after enrollment in college is not generally
effective in retaining them. Research shows that the need for remedial reading or
remedial math in college is associated with a lower likelihood of completing a two- or
four-year degree.
Research also shows that effective teachers produce outcomes that can result in students
performing at a full grade level or higher than those taught by the least effective teachers.
Further, there is evidence that teaching effects are long-lived, whether teachers advance
student achievement or diminish it.
Recommendation to the Legislature
The Texas Higher Education Coordinating Board recommends that the Legislature make
the Recommended High School Program (college preparatory courses) the standard
curriculum for high school students statewide. Students who are planning a career in a
health-related profession should be encouraged to take advanced placement math and
science course work in high school. Emphasis should be placed on ensuring that a
sufficient number of qualified teachers are secured and retained to teach the
recommended and advanced placement courses.
Cost of Implementation
The cost of implementation is being determined. The Coordinating Board and the Texas
Education Agency are working together through the K-16 Council and are looking at the
potential costs of having all students complete the Recommended High School Program.
57
Impact
Automatically enrolling all public high school students in the college-preparatory
curriculum, unless a student opts out of this curriculum with parental consent, would help
ensure that students receive the basic course work needed for better academic
preparation for college.
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Recommendation 8: Resident Tuition for Public Health
Students from Mexico
Amend Section 54.060 of the Texas Education Code to include Texas A&M University
System Health Science Center and The University of Texas Health Science Center at
Houston among the institutions eligible to waive, under certain circumstances, non­
resident tuition for Mexican citizens who enroll in one of the public health degree
programs offered by these institutions in Kingsville, Laredo, McAllen, El Paso, or
Brownsville.
Background
Texas Education Code, Section 540.060 (b) specifies that foreign students may be eligible
to pay resident tuition at a state university located in a county adjacent to the country in
which they reside. The intent of this “waiver” of nonresident tuition rates is to provide
education for qualified Mexican citizens at resident tuition rates. The implied benefit is that
both countries might gain knowledge, understanding, and cooperation through higher
education.
Current statutory language does not afford this benefit to foreign students who enroll in
border programs that are administered by institutions located in other, non-border
counties. Consequently, Mexican citizens who cross into Texas to attend The University of
Texas at El Paso and The University of Texas at Brownsville are eligible to pay Texas
resident tuition, while those who enroll in the public health programs in El Paso and
Brownsville offered through The University of Texas Health Science Center at Houston
(UTHSC-H) will pay non-resident tuition.
The same situation exists for Mexican citizens who enroll in the Texas A&M University
System. While Mexican citizens may be eligible for in-state resident tuition at Texas A&M
University components in Laredo and Kingsville, Mexican citizens who enroll in Texas A&M
University System Health Science Center’s (TAMUSHSC) public health program in
McAllen and Laredo will pay non-resident tuition. NOTE: Texas A&M University-Kingsville
is not located in a county that borders Mexico but is specifically included in the current
language of Section 54.060, allowing it to waive non-resident tuition.
Analysis
The current eligibility requirement for in-state tuition “waivers” inhibits an obvious
opportunity for bi-national collaboration on public health issues. Eliminating this barrier is
important to both higher education institutions and public health agencies. In its
discussion of Border health issues (Section 4 of this report), the Texas Department of
Health calls for greater coordination between Texas and Mexico in addressing regional
public health problems. The agency’s recommendation is supported by health statistics
that show high incidence of certain communicable and intestinal diseases that can be
attributed to poor sanitation and water quality in the region. (The rates for tuberculosis,
campylobacteriosis, salmonellosis, shigellosis, and hepatitis A are higher in the Border
region than for the rest of the state. Hepatitis A rates are more than twice as high in the
Border region than in non-border counties.)
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Recommendation to the Legislature
The Texas Higher Education Coordinating Board believes that effective solutions to binational public health problems can begin with education. It recommends that the
Legislature amend Section 540.060 of the Texas Education Code to include TAMUSHSC
and UTHSC-H among the institutions eligible to waive, under certain circumstances, non­
resident tuition for Mexican residents who enroll in one of the public health degree
programs these institutions offer in Kingsville, Laredo, McAllen, El Paso, or Brownsville.
Cost of Implementation
The amendment will not require any new General Revenue funds; however, expanding the
in-state resident tuition rates to Mexican students enrolled in the public health programs
will reduce tuition and fee income at UTHSC-H and TAMUSHSC.
Impact
By providing in-state tuition eligibility to Mexican students interested in public health
education along the Border, the state would be contributing to the training of additional
health professionals in the Border region. The shared learning experience will foster
cooperation in finding solutions to the region’s health care problems.
After reviewing the success of this particular program, the Legislature may want to
consider expanding in-state tuition eligibility to Mexican students in other health-related
degree programs.
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Recommendation 9: Migration Pilot Study
Provide funding to support a pilot study at The University of Texas Health Science Center
at San Antonio’s (UTHSC-SA) Center for Health Economics and Policy to determine, in
cooperation with researchers located in other Border institutions, the migration patterns
of health care professionals in and out of the Border region.
Background
In recent years, the Legislature has funded initiatives to develop new academic programs
in the Border region, anticipating that when students graduate from these programs, the
graduates would remain in the Border region to practice their profession. However, there
is little in the way of analyzed data in Texas that maps the migration of these graduates.
Staff of the Texas Higher Education Coordinating Board learned that the most recent study
of the migration of allied health care graduates in and out of the Border region was
published in 1978. One of the findings of this early study was that the graduates with
higher levels of education were more likely to leave the area than graduates with lower
levels of education.
Analysis
Results of the recent survey sent to health care providers and educators in the Border
region showed that “migration of qualified graduates/workers out of the area” was rated as
a significant factor contributing to the shortage of health care professionals in the Border
region. Health care providers listed employee turnover as a particular challenge and
suggested that turnover could be related to the poor salaries and wages offered in their
local areas (See Questionnaire Results, Section 2).
As noted in Section 2, the Board estimates that $247.3 million in health education derived
formula funding ($228.5 million in General Revenue) was appropriated to the Border
region’s 21 schools for the 2000-01 biennium. In view of continued shortages of health
care workers, an up-to-date assessment to determine where health care graduates go to
provide health care services could inform program and funding plans.
The Center for Health Economics and Policy (CHEP) of The University of Texas Health
Science Center at San Antonio is well suited to conduct such a pilot study. CHEP, in
partnership with the Texas Nurses Foundation and the Texas Institute for Health Policy
Research, is in the process of addressing the lack of current data about the nursing
workforce in Texas. This partnership has created the Nurse Workforce Data System. The
system, located at CHEP, is being used to store, organize, and update current and
historical data relevant to the nursing workforce in Texas.
Additionally, CHEP has been collecting data from various state licensing agencies since
1987 and has been routinely storing such data on an annual basis since 1995. According
to CHEP, such storage is needed because not all state licensing agencies store historical
data on their licensees. Further, certain state licensing agencies retain more
comprehensive data on their licensees than others. Nevertheless, CHEP would be able to
use its set of compiled data on certain health-care professions to conduct a pilot migration
study of graduates of: 1) specific health-care programs of public higher education
institutions located within the Texas Border region and 2) graduates of professional
medical and dental programs of public higher education institutions located within Texas.
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Recommendation to the Legislature
The Texas Higher Education Coordinating Board recommends that the Legislature provide
funding to support a pilot program at The University of Texas Health Science Center at
San Antonio’s (UTHSC-SA) Center for Health Economics and Policy to determine the
migration patterns of health care professionals in and out of the Border region.
Cost of Implementation
The Board estimates that a migration study would cost $300,000 for the 2002-03
biennium, based on CHEP’s calculations. CHEP estimates that it will cost $200,000
annually to maintain the system and to update annual reports.
Impact
A migration study of health care graduates would give state planners and policymakers
more detailed information to determine the relocation trends of the graduates of the state’s
multi-million dollar health care programs. In future years, studies could be broadened to
include survey research of those who have dropped out of their health-care profession and
the reasons for doing so.
Final Note: Support for SHCC Recommendation
The Coordinating Board supports the recommendation of the Statewide Health
Coordinating Council (SHCC) that licensing boards for specified health-care professionals
should change their licensing/renewal forms and data systems to include the collection of
the minimum data set developed by SHCC’s Ad Hoc Committee on Health Personnel Data.
Certain state licensing agencies currently retain very comprehensive data on their
licensees; others retain little more than the licensee’s name, address, and phone number.
This minimal information on licensees is not useful to state planners and policymakers who
need more comprehensive data to analyze migration patterns.
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Recommendation 10: State Loan Repayment Program
Establish and fund a Health Professional Loan Repayment Program to enhance
recruitment and retention of selected health professionals in the Border region. Through
this program the state could access new federal matching dollars.
Background
Since its authorization by Congress in 1987, the National Health Services Corps Loan
Repayment Program (NHSC/LRP) has provided federal funds to repay educational loans
of certain health care professionals. Through the NHSC’s State Loan Repayment
Program (SLRP), the federal government provides a dollar-for-dollar match to states to
assist in the repayment of qualifying educational loans for specified primary health care
practitioners. The practitioner must agree to a two-year commitment to provide primary
health care services in a priority health professional shortage area (HPSA). The primary
health care professions eligible for these federal matching dollars are:
1. Physicians specializing in family medicine, general pediatrics, general internal
medicine, general psychiatry, and obstetrics/gynecology
2. Dentists
3. Dental hygienists
4. Primary care nurse practitioners
5. Certified nurse-midwives
6. Physician assistants
7. Clinical social workers
8. Clinical psychologists
9. Marriage and family therapists
10. Licensed practical counselors (in 2001)
Texas currently has two state loan repayment programs for health care professionals that
draw down federal matching dollars through the NHSC/SLRP. The programs are
administered by the Texas Higher Education Coordinating Board:
• The Physician Education Loan Repayment Program (PELRP) was authorized by
Texas statute in 1985 to recruit and retain qualified physicians at practice sites where
services are critically needed. The program repays eligible student loans of physicians
who meet the stipulated requirements. Texas has been accessing federal matching
funds for the program since 1987, when Congress established the State Loan
Repayment Program. The PELRP has been very successful in recruiting and retaining
physicians in Texas HPSAs. From 1987 to May 2000, the Board has made loan
repayments totaling approximately $10.6 million in state funds for 716 physicians, and
approximately $3.4 million in federal funds for 249 physicians.
• The Dental Education Loan Repayment Program (DELRP) was recently authorized by
House Bill 3544, 76th Legislature. Similar to the PELRP, this program is intended to
recruit and retain qualified dentists to provide dental care in areas of Texas that are
under-served with respect to dental care. The program authorizes repayment of
eligible student loans received by a dentist who meets the stipulated requirements. In
its first year of funding in fiscal year 2000, the Board distributed $30,000 to three
dentists.
63
Analysis
In addition to the population-to-practitioner ratios of physicians and dentists, the
population-to-practitioner ratios for most other health care professions are higher in the
Border region than they are statewide. Establishing a new loan repayment program that
includes additional primary care professionals could help recruit and retain these
practitioners in the Border region as well as in underserved areas statewide. Such a
program could draw down federal matching funds for the following health care
professionals:
1.
2.
3.
4.
5.
6.
7.
8.
Dental hygienists
Primary care nurse practitioners
Certified nurse-midwives
Physician assistants*
Clinical social workers
Clinical psychologists
Marriage and family therapists
Licensed practical counselors (in 2001)
*The state created the Rural Physician Assistant Loan Reimbursement Program in
1996 to encourage qualified physician assistants to practice in rural Texas. The
program is administered by the Center for Rural Health Initiatives. However, because
the National Health Services Corps State Loan Repayment Program will not contract
with more than one state agency within a given state, the Center is not eligible to
access federal matching funds for the program.
The following chart shows the 1999 population-to-practitioner ratios reported by the Texas
Department of Health (TDH) in August 2000 for three categories of professionals
(advanced practice nurses are primary care specialist nurses with advanced degrees):
Practitioner
Advanced Practice Nurses
Social Workers
Licensed Psychologists
Population-to-Practitioner Ratio
Border region
Border region
(Excluding Bexar Co.)
4,754:1
6,123:1
1,583:1
2,011:1
9,767:1
19,176:1
State
3,964:1
1,353:1
6,643:1
Recommendation to the Legislature
The Texas Higher Education Coordinating Board recommends that the Legislature
enhance recruitment and retention of health professionals in the Border region by
establishing and funding through general revenue appropriation a Health Professional
Loan Repayment Program. Through such a program the state could access federal
matching dollars through the National Health Services Corps Loan Repayment Program.
Specifically, the Board recommends that this new program include loan repayment funding
for four additional high-demand, health-related occupations: 1) advanced practice nurses,
2) clinical social workers, 3) clinical psychologists, and 4) licensed practical counselors.
Further, the Board recommends that priority be given to repaying the loans of practitioners
who provide care in critically underserved areas of the Border region. Finally, the Board
recommends that the Legislature configure the Texas Rural Physician Assistant Loan
Reimbursement Program in such a way as to generate federal matching dollars for the
64
program. While other health-care professions would benefit from the implementation of
similar loan repayment programs, only those programs specified for primary health-care
professionals would be eligible to draw down federal matching dollars.
The Board’s recommendation does not exactly mirror a similar recommendation of the
Statewide Health Coordinating Council (SHCC). SHCC has requested that the loan
repayment program be expanded but does not prioritize the new professions to be
included. The Board’s recommendation adds four specific professions, based on 1) priority
as determined by TDH health professions workforce data, 2) the results of a recent survey
of health care providers and educators in the Border region, and 3) available staff time to
administer a new program.
Cost of Implementation
The new loan program is estimated to cost $1.1 million and is expected to support 191
professionals for the 2002-03 biennium.* The distribution of funds and loans are shown
below:
1.
2.
3.
4.
5.
Advanced practice nurses:
Clinical social workers:
Clinical psychologists:
Counseling psychologists:
Administration Costs (2 FTEs):
Total:
Funds
Available
$350,000
$265,000
$ 75,000
$265,000
$150,000
$1,105,000
Number of
Loans
70
53
15
53
191
*The estimated costs for the biennium are based on 2 percent of the of the tuition charges
for resident students enrolled in each of the four degree programs statewide. However,
the Board recommends that the Legislature fund the program through general revenue
appropriation to avoid diverting funds from the institutions’ educational programs.
Impact
An additional loan repayment program for health professionals should help attract and
retain selected health practitioners critically underserved populations in the Border region
and other underserved areas statewide.
65
Recommendation 11: B
order Faculty Education Loan Repayment
Program
Fund the Texas Higher Education Coordinating Board’s appropriation request to increase
funding by $888,800 for the Border Faculty Education Loan Repayment Program.
Background
House Bill 713 (76th Legislature) authorized the Texas Higher Education Coordinating
Board to establish a new educational loan repayment program for faculty located at
institutions that border Mexico. The purpose of the new program was to recruit faculty to
these campuses, as well as to provide an incentive to retain faculty. To be eligible to
receive repayment assistance, a faculty member must have received a doctoral degree not
earlier than September 1, 1994 from a public or private institution of higher education and
be employed as a full-time faculty member with instructional duties. The Legislature
appropriated $50,000 to the Board to distribute in each year of the 2000-01 biennium.
To administer the program, the Board established rules and identified five
community/technical colleges and five universities that could apply for loan repayments:
Community/Technical Colleges
El Paso Community College
Laredo Community College
South Texas Community College
Texas State Technical College-Harlingen
Texas Southmost College
Universities
Sul Ross State University
Texas A&M International University
The University of Texas at Brownsville
The University of Texas at El Paso
The University of Texas-Pan American
The Board excluded from program eligibility instructional sites belonging to institutions that
are not located in Border counties, such as Texas Tech University Health Science
Center’s El Paso site and The University of Texas System’s instructional and research
sites in Brownsville, Edinburg, and Harlingen.
The Board determined maximum funding allocations for each school and individual
recipients. With $50,000 available in each year of the current biennium, each of the ten
institutions is allocated one award, and each recipient is limited to a maximum payment of
$5,000 in each year. A faculty member may be eligible to receive loan repayments for a
maximum of 10 years.
Analysis
Information collected by the Board suggests that faculty recruitment and retention is a
significant problem among Border institutions.
!
In a recent survey, educators identified faculty recruitment and retention as one of the
primary challenges in developing and expanding health education programs in the
Border region. In all disciplines, but particularly in nursing and allied health, higher
education institutions compete with the private sector in recruiting new faculty.
!
The Board’s 1999 Statistical Report shows that the average faculty salaries for all
general academic institutions and one-half of the community/technical colleges in the
Border region are below the statewide average.
66
!
The Board’s recent report on faculty turnover and retention showed that of the general
academic institutions located in the Border region, all schools but UTEP had faculty
turnover rates that were at or above the statewide average of 6 percent. Health
professions faculty had the second highest turnover rate, after liberal arts/fine arts
faculty.
Recommendation to the Legislature
The Texas Higher Education Coordinating Board recommends that the Legislature
increase the Border Faculty Loan Repayment Program’s funding by $880,000 for the
2002-03 biennium to meet the needs of institutions located in Border counties. The
additional funding is supported by the results of a Board survey to determine the number
of faculty members at the ten institutions who would be eligible to submit applications for
loan repayment in each year of the 2002-03 biennium. The increased funding would
provide loan repayments to approximately 72 faculty members in Fiscal Year 2002 and
approximately 125 faculty members in Fiscal Year 2003.
The Board also recommends that the Legislature consider expanding the program to
include loan repayments for research faculty at these ten institutions and for faculty at
academic health centers located in border counties, such as the Texas Tech University
Health Sciences Center-El Paso site.
Cost of Implementation
The Texas Higher Education Coordinating Board requests $988,800 (a $880,000
increase) for the 2002-03 biennium.
Impact
Providing additional funds to this loan repayment program would allow institutions that
border Mexico to offer more financial incentives to new and existing faculty who might
otherwise leave for positions at larger, more-established institutions.
67
Recommendation 12: Border Health Coordinating Council
Establish a Border Health Coordinating Council in which institutional and agency
members would share information, develop common goals, and devise solutions that
address the health care and medical training needs of the Border region.
Background
The health care and medical training needs of the Border region concern many institutions
and agencies. For example, in addition to community and technical colleges, universities,
and academic health centers, the following organizations have an interest in or
responsibility for Border health issues: 1) Texas Department of Health, Office of Border
Health, 2) South Texas Area Health Education Center (AHEC) and West Texas AHEC, 3)
Health Education and Training Center Alliance of Texas, 4) US Mexico Border Health
Association, 5) Texas Center for Rural Health Initiatives, 6) Paso del Norte Health
Foundation, 7) Center for Disease Control (among other federal agencies), and 8) local
health departments.
These organizations and others have generated many valuable sources of data and
information about Border health issues. However, because of differences in geographical
locations, governing boards, missions, and constituencies of the groups, there has not
been a formal mechanism to coordinate their efforts. This fragmentation can contribute to
1) lack of communication of information, 2) a duplication of research and other efforts, and
3) widely differing priorities about Border health issues.
A coordinating council is a means to address some of these problems and to foster more
cooperative relationships among the stakeholders of Border health issues. Similar state
councils exist that serve a collaborative function, such as the K-16 Council (formerly the
Public Education Higher Education Coordinating Group). This council is made up of
representatives of the Texas Education Agency, Texas Higher Education Coordinating
Board, State Board of Educator Certification, Governor’s Office (and other legislative
representatives), university system offices, university administrators, Texas Association of
Community Colleges, and the Texas Business and Education Coalition. Members meet
every two months to discuss issues of mutual interest and attempt to ensure that the
constituents of the member representatives plan and work together to advance common
goals of the entire educational system. The K-16 Council is but one model for a
coordinating group.
Recommendation to the Legislature
The Texas Higher Education Coordinating Board recommends the establishment of a
Border Health Coordinating Council in which institutional and agency members would
share information and develop common goals that address the health care and medical
training needs of the Border region. The Council is not envisioned as another level of
bureaucracy; it would serve as a coordinating body for institutions with mutual interests.
Members would be representatives from:
• Institutions associated with the Lower Rio Grande Valley Regional Academic
Health Center, Laredo Campus Extension, Coastal Bend Health Education Center,
and Border Health Institute
• The University of Texas System Texas-Mexico Border Health Coordination Office
68
• South Texas Area Health Education Center; West Texas Area Health Education
Center *
• Health Education and Training Center Alliance of Texas
• US Mexico Border Health Association
• South Texas Advanced Technology Education (or STATE, a coalition of community and technical colleges in South Texas) • Texas Department of Health, Office of Border Health
• Parallel organizations and institutions from Mexico
* The Legislature should seriously consider funding Area Health Education Centers when federal funding for these coordinating bodies is discontinued.
The Texas Higher Education Coordinating Board would initiate the founding and
organization of the Council. After its first year, the Council should become self-sustaining.
The charge of the Council would be to: 1) develop long-range and short-term goals for the
heath care and medical training needs of the Border, 2) share information about research,
education, and service initiatives, and 3) develop legislative agendas for Border health
issues.
The Council would meet on a regular basis (e.g., quarterly) and would rotate meeting sites
among member institutions and agencies. Some meetings could take place through
telecommunications (e.g., teleconferencing).
Cost of Implementation
Individual member institutions and agencies would be expected to provide for the cost of
hosting meetings and for travel expenses.
Impact
The Border Health Coordinating Council could foster cooperative efforts among member
institutions and agencies. Border health science centers (or regional academic health
centers), universities, community colleges, and governmental and non-profit agencies
would all be represented in the coalition.
The Council would provide a formal mechanism for members to share information,
exchange ideas, and develop consensus on identifying priorities for the health needs and
health training needs of the Border region.
69
70
Section 4: Health Care Coordination
In determining the future medical and health care needs of the Texas-Mexico Border
region (Border region), the Texas Department of Health (TDH) compiled information about
the region’s population, health status, facilities, public health infrastructure, and
professional workforce. It also examined coordination issues.
General Description of the Area
The Border region has been described as a “bi-national, bicultural and bilingual state,” a
-culture” within the state of Texas, representing 4.1 million people and an annual
economy of more than $88 billion.1 As defined by Senate Bill 1378, the Border region
(Border region) is a 43-county area, stretching from El Paso to Corpus Christi, and from
San Antonio to Brownsville. The counties are:
Atascosa
Dimmit
Jeff Davis
Kleberg
Pecos
Terrell
Bandera
Duval
Jim Hogg
La Salle
Presidio
Uvalde
Bexar
Edwards
Jim Wells
Live Oak
Real
Val Verde
Brewster
El Paso
Kenedy
McMullen
Reeves
Webb
Brooks
Frio
Kerr
Maverick
San Patricio
Willacy
Cameron
Hidalgo
Kimble
Medina
Starr
Zapata
Crockett
Hudspeth
Kinney
Nueces
Sutton
Zavala
Culberson
Of these 43 counties, 36 counties are classified as rural, and seven are designated as
urban. These seven urban counties -- Bexar, Cameron, El Paso, Hidalgo, Nueces, San
Patricio and Webb -- represent 86 percent of the Border population.2
Racial/Ethnic Population Groups
The population of the Border region was estimated at 4.1 million in 1999, roughly 20
percent of the state population of 20 million. Hispanic residents constitute 67 percent of
the population, compared with 28 percent statewide. Almost one-half of the state’s
Hispanic population (48 percent) lives in the Border region. The emerging picture of what
the area will look like in the future can be seen now in the population segment of children
under four years of age. Hispanic children constitute 80 percent of that population.
71
Table 1
Ethnic Distribution for Children Under Four Years of Age
Texas Border Counties and the Remainder of the State, 1998
100%
80%
Hispanic
80%
White
60%
52%
40%
20%
Other
30%
18%
16%
4%
0%
Border Counties
Remainder of the State
Source: Texas State Data Center, Department of Rural Sociology, Texas Agricultural
Experiment Station, Texas A & M University System. Estimates for July 1998.
From 1990 to 2030, the Border region’s population is projected to double and will
continue to represent about 20 percent of the total Texas population. The ethnic
composition of the population, however, will likely change dramatically. Hispanics, as a
proportion of the total population, are projected to increase from about 70 percent in 2000
to 75 percent by 2010. By 2030, Hispanics are projected to represent 83 percent of the
border population. The white population in the Border region will decline as a percentage,
from 25 percent in 2000, to 20 percent in 2010, and to 12 percent in 2030.3
Migrant Seasonal Farm Workers
Migrant seasonal farm workers comprise a significant segment of the region’s population,
impacting its health and socioeconomic characteristics. One researcher wrote: “Their
demographic patterns, socioeconomic conditions, life–style characteristics and disease
categories reflect agrarian third-world conditions rather than those of the most affluent
nation in the world. Factors such as poverty, malnutrition, infectious and parasitic
diseases, poor education, a young population, and poor housing equate to a highly
vulnerable population in need of resources.” 4 Migrant seasonal farm workers are
employed primarily in agriculture and work on a seasonal basis. Because of their mobility,
these workers present unique challenges for the provision of health and human services.
The estimation of their numbers is difficult because of their mobility. Many are
undocumented workers and are reluctant to share certain types of personal information. A
1990 publication of the Migrant Health Service estimated the total number of migrant
seasonal workers for the 15 counties bordering the Rio Grande at 344,334 persons.5 In
that 1990 estimate, 51 percent of the population of Hidalgo County was composed of
migrant and seasonal workers and their families. A 1993 study estimated a statewide total
of 370,815 people.6
72
Poverty
The people of the Border region experience high levels of poverty as compared to persons
living in other parts of the state. In 1999, 27 percent of all people living on the border had
incomes that were below federal poverty guidelines, significantly higher than the 14
percent figure for the remainder of the state. Starr County has the highest percentage (45
percent) of its population with incomes below the federal poverty level. McMullen County
7
has the lowest percentage at 16 percent.
Table 2
Estimated Percent of Persons Living Below Poverty
by Selected Age Groups
Texas Border Counties and the State, 1998
Border Counties Remainder of State Total State
Total Population
27%
14%
17%
Children Under 18 years of
Age
38%
20%
24%
Persons 65 Years of Age and Older
23%
14%
16%
Source: Research Department; Fiscal Policy Division Texas Health and Human Services Commission, 5/99
Insurance Coverage
Approximately 29 percent of the region’s population does not have health insurance
coverage. The percentage of uninsured in each of the border counties ranges from a high
of 35 percent in Starr County to a low of 18 percent for Bandera.8
Table 3
Estimated Percent of Persons Without Health Insurance
by Selected Age Groups
Texas Border Counties and the State, 1998
Border
Counties
Total Population
Children Under 18 years of
Age
Persons 65 Years of Age
and Older
Remainder of State Total State
29%
22%
24%
29%
24%
25%
32%
26%
27%
Source: Research Department; Fiscal Policy Division
Texas Health and Human Services Commission, 5/99
73
Medicaid is a major source of health care coverage for the Border region, particularly
among pregnant women, children, and the elderly. The number of average monthly
Medicaid eligibles per 1,000 population (162 per 1,000 population) was more than double
the rate for the remainder of the state (73.2 per 1,000 population).9 Similarly, the
unduplicated number of Medicaid recipients per 1,000 population in the Border region
(203.4 per 1,000 population) was twice the recipient rate in the remainder of the state
(95.8 per 1,000).10
Table 4
Medicaid Eligibles and Recipients per 1,000 Population
Texas Border Counties and the State, 1998
Border
Counties
Remainder of State Total State
Average Monthly Medicaid
Eligibles*
162.0
73.2
91.2
Unduplicated Count of
Medicaid Recipients**
203.4
95.8
117.7
Source: Texas Department of Human Services
*
Individuals with family income less than a predetermined level who meet other qualifying criteria (for
example, impoverished families headed by a single parent, low income pregnant women, and certain aged or
disabled individuals meeting specific qualifications).
**
Medicaid eligibles who receive Medicaid funded services.
Colonias
Colonias are a unique expression of the relative poverty of the Border region. One
researcher wrote: “colonias are generally understood to be subdivisions in unincorporated
areas with inadequate infrastructure and inhabited by residents with very low incomes.
They are defined by the absence of one or more of the following facilities: paved streets,
numbered street addresses, sidewalks, storm drainage, sewers, potable water or electricity.
A subdivision is not deemed a Colonia unless it is within 100 miles from the Texas-Mexico
border and has at least five structures.” In 1995, the Texas Water Development Board
(TWDB) estimated that more than 340,000 Texas residents lived in 1,436 colonias, and that
75 percent of all colonia residents live in Hidalgo, Cameron, Webb, Starr and El Paso
counties.
In 1997 and 1998, TDH’s Office of Border Health conducted a survey of health and
environmental conditions using a sample of more than 1,200 households in Cameron, El
Paso, Hidalgo, Maverick, Starr, and Webb counties. The sample represented an estimated
32 percent of colonia residents. The survey consisted of a questionnaire assessing
demographics, links to Mexico, health care and health information, health risks and health
conditions, child health and well-being, living environment, and neighborhood problems and
solutions. Blood samples also were collected from a sub-sample of children age 12 and
under, and water samples were collected from households that relied on stored water for
their needs. Selected findings from that study demonstrate that:
74
• The population was 83 percent Hispanic and 34 percent of inhabitants were under 18
years old.
• Thirty-five percent of households fell below the federal poverty level.
• Public sewer services were available to only about half of the colonia households.
• Only about 45 percent of colonia households had drinking water supplies in their
houses.
• Of the households that relied on containers for their drinking water, chlorine residual
was adequate in only 10 percent of tested water samples.
• Exposure to pesticides was a potential problem, with 21 percent of the households
being located within a quarter mile of an agricultural field.
• In general, border residents reported they were in good health.
• Older respondents (over 65 years of age) reported high rates of diabetes (20 percent),
high blood pressure (30 percent), and heart disease (15 percent).
• A higher percentage of children under five years of age in the colonias were reported
as having diarrhea in the last two weeks, as compared with non-colonia children.
• Twice as many 7-12 year old colonia children had elevated blood lead levels
compared to non-colonia children.
• Colonia children had a significantly higher percentage of Reactive Hepatitis A Test
compared to non-colonia children.
• The presence of antibodies for Hepatitis A ranged from 10percent overall to 48 percent
of the 1-12 year olds residing in colonias in Maverick, Val Verde, and Webb counties.
• The majority of colonia residents did not have health insurance (64 percent), and only
36 percent reported having seen a dentist in the past year.11
75
Health Status
An examination of major health status measures for the Border region highlights
differences between the population in the 43-county Border region and the population in
the remainder of the state. Rates of low birth weight and infant mortality are lower in the
region than in the rest of the state, even with the high number of teen mothers and lack of
prenatal care that usually are associated with unfavorable birth outcomes.
Table 5
Fertility, Selected Birth Characteristics, and Infant Mortality
Texas Border Counties and the State, 1998
Border Counties
Remainder of
State
Total State
88.8
72.8
76.1
26.2%
19.0%
20.7%
pounds 9 ounces)
7.0%
7.6%
7.4%
Percent of Live Births to mothers
Under 18 Years of Age
7.4%
6.0%
6.4%
5.7
6.6
6.4
Measure
Fertility Rate (no. of births per
100,000 women aged 15-44)
Percent of Live Births to Women
Who Had Late (initiated during third
trimester) or No Prenatal Care
Percent of Live Births Weighing
Less Than 2500 Grams (less than 5
Infant Mortality Rate
(no. of deaths under 12 months of age
per 1,000 live births)
Source: Bureau of Vital Statistics, Texas Department of Health
Age-adjusted death rates per 100,000 population are lower in the Border region than in other
areas of Texas for all selected causes noted below with the exception of diabetes.
76
Table 6
Age-Adjusted Death Rates per 100,000 Population
for Selected Causes
Texas Border Counties and the State, 1998
Age-Adjusted Death Rates per 100,000
Population
Border
Counties
Cause of Death
All Causes
Diseases of the Heart
All Cancers
Lung
Breast
Stroke
Diabetes
Chronic Obstructive
Pulmonary Disease
Remainder of State Total State
461.3
123.4
111.4
27.2
17.7
26.2
24.4
514.8
143.3
127.1
40.1
18.9
30.3
16.2
504.1
139.3
124.0
37.6
18.7
29.5
17.8
16.4
23.2
21.9
Source: Bureau of Vital Statistics, Texas Department of Health
Rates for external causes of mortality also are lower in the Border region than in nonborder
counties.
Table 7
Age-Adjusted Death Rates per 100,000 Population
for Selected External Causes
Texas Border Counties and the State, 1998
Age-Adjusted Death Rates per 100,000 Population
External Cause of Death Border Counties Remainder of State Total State
Unintentional Injuries
Motor Vehicle Accidents
Suicide
Homicide
29.1
15.7
7.9
6.4
35.2
19.4
11.0
7.8
34.0
18.7
10.4
7.5
Source: Bureau of Vital Statistics, Texas Department of Health
Indicators for communicable disease show that rates of tuberculosis and chlamydia are
higher in the Border region than in the remainder of the state, while the Border region
performs better on syphilis, AIDS, and gonorrhea.
77
Table 8
Reported Cases of Selected Communicable Diseases per 100,000 Population
Texas Border Counties and the State, 1998
Reported Cases per 100,000 Population
Communicable Disease
Tuberculosis
Syphilis
AIDS
Gonorrhea
Chlamydia
Varicella
Border
Counties
Remainder
of State
Total
State
12.0
0.8
13.2
75.0
316.8
57.8
8.2
2.5
21.8
190.0
304.2
115.4
9.2
2.2
21.3
166.7
306.8
103.7
Sources: Bureau of HIV/STD and Bureau of Epidemiology
Texas Department of Health
Many of the border’s health problems appear to be related to poor sanitation and water
quality. Rates for the most common enteric diseases -- campylobacteriosis, salmonellosis,
shigellosis, and Hepatitis A -- are higher in the Border region than in the rest of the state.
The incidence of Hepatitis A, a virus transmitted by the fecal-oral route, often through the
ingestion of contaminated food or water, has declined significantly along the Texas-Mexico
border since 1997 due to vaccination initiatives implemented during 1998.12 Even so,
Hepatitis A rates remain more than twice as high in border than in nonborder counties.
Table 9
Reported Cases of Selected Enteric, Food, and Waterborne Diseases per 100,000 Population
Texas Border Counties and the State, 1999
Reported Cases per 100,000 Population
Enteric Disease
Amebiasis
Campylobacteriosis
Cryptosporidiosis
Hepatitis A
Salmonellosis
Shigellosis
Border
Counties
Remainder
of State
Total
State
0.1
8.8
0.2
23.4
14.2
19.0
0.2
5.0
0.4
9.8
10.0
9.5
0.2
5.8
0.3
12.6
11.0
11.4
Sources: Bureau of Epidemiology, Texas Department of Health
78
Public Health Infrastructure
Public health touches the lives of every Texan every day. The tasks of Texas’ public
health workers include ensuring that drinking water is clean, that food is free of
contaminants, and that septic tanks are properly functioning. Public health workers also
collect health data, provide health education, and prevent and control the mortality and
morbidity associated with communicable and chronic diseases. The public health
infrastructure in Texas includes state and local health departments (LHDs) as well as other
state and local agencies that carry out public health activities (e.g., animal control activities
sometimes conducted by county sheriffs).
Cities and counties in Texas are not required to maintain LHDs or to provide any of the
core public health functions. In accordance with Chapter 121 of the Health and Safety
Code, municipalities or counties can choose to create a local health department or can
choose to collaborate with other municipalities or counties to create a public health district.
In order to be designated as a LHD or a public health district, the entities must provide at
least the following public health services:
• Personal health promotion and maintenance services;
• Infectious disease control and prevention services;
• Environmental and consumer health programs for the enforcement of health and
safety laws relating to food, water, waste control, general sanitation, and vector
control;
• Public health education and information services;
• Laboratory services; and
• Administration services.
Source: Bureau of Regional/Local Health Operations, Texas Department of Health
79
A majority of counties in Texas, covering 20 percent of the state’s population, do not have
LHDs.13 In the Texas-Mexico Border region, there are 11 LHDs among the 43 counties.
All seven urban border counties are served by a local health department compared to only
four of the 36 rural border counties (Atascosa, Live Oak, Medina, and Uvalde).14
In compliance with the Local Public Health Reorganization Act, TDH performs the duties of
a local health authority if there is no local health authority or the local health authority fails
to perform the duties listed in the Reorganization Act. TDH recognizes the need to bolster
the local public health infrastructure throughout the state. In its Self-Evaluation Report to
the Sunset Advisory Commission in 1997, TDH identified “Public Health Services at the
Local Level” as its number one policy issue. Also in the report, TDH recommended that
TDH produce a public health improvement plan every two years, which defines standards
for health protection including an accounting of deficits in the ability to perform essential
services.15
Future improvements to the Border region’s public health infrastructure should focus on
the following issues that disproportionately affect the region: (a) diabetes control and
prevention, (b) tuberculosis control and prevention, (c) infectious disease surveillance, (d)
birth defects surveillance, and (e) other conditions in the environment that are detrimental
to the health of the public (e.g., community sanitation, injury prevention, childhood asthma,
cancer, fish contamination, pesticide poisoning). These functions should be strengthened
through the provision of additional regional epidemiologists with disease control and
prevention expertise and by the establishment or expansion of border public health
laboratory capacity. A local public health laboratory would enable rapid and efficient
testing in support of infectious disease surveillance, tuberculosis control and prevention,
and water and food quality monitoring.
Environmental Health
Over the past decade, both sides of the Texas-Mexico border have experienced more than
a 25 percent increase in population. This dramatic population increase has given rise to a
number of environmental related health conditions, including exposure to pesticides, poor
water quality, potential trans-boundary pollution, transportation of hazardous wastes, food
and drug safety, contamination of fish, rabies, consumer product safety, birth defects, and
cancer.
Several state agencies and numerous non-governmental organizations are addressing the
environmental issues of the Texas-Mexico border. Twenty-eight of the 43 Border region
counties are included in the Texas Water Development Board’s Economically Distressed
Areas Program (EDAP).16 EDAP provides financial assistance to bring water and
wastewater services to economically distressed areas where present water and
wastewater facilities are inadequate to meet the minimal needs of residents. One of the
qualifications for an area to be included in EDAP is that water supply or wastewater
systems are inadequate to meet minimal state standards.
Given the environmental problems related to population growth in the Border region,
increasing the number of both registered sanitarians and physicians with expertise in
pediatric environmental medicine are policy issues with important ramifications for the
public’s health. The Texas Department of Health (TDH) General Sanitation Division
reports that only 35 border residents are registered with TDH as sanitarians. Registered
Sanitarians, who can also serve as food inspectors, are required to have graduated from a
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college or university of recognized standing with a B.S. or B.A. degree with at least 15
semester hours in basic science or natural science or combination thereof. They must also
17
have acquired two (2) years of experience in the field of sanitation. Over the last two
years, relationships have strengthened among TDH, the Health and Human Services
Commission, and the 12 other agencies that make up the Texas Health and Human
Services (HHS) enterprise. The links that should occur to advance coordinated services
for the people of the state have been tightened, not only in administrative, planning, and
management areas, but also in programmatic areas.
In a recent survey conducted by the TDH Office of Border Health (OBH), investigators
recommended an assessment of the potential for pesticide exposures, especially in
children living in colonias of the Lower Rio Grande Valley and El Paso areas. The
National Institute of Environmental Health Sciences has stated among its objectives a
need to increase the number of physicians with expertise in pediatric environmental
medicine. 18
Coordination with Health and Human Service Agencies
HHS agencies have collaboratively developed the HHS Strategic Priorities. The Texas
Department of Health will lead in advancing three of these priorities, one of them dealing
specifically with colonias.19 Although colonias exist throughout the state of Texas, the
majority are located on the Texas-Mexico border. HHSC has been proactive in addressing
the needs of colonias residents by establishing a Colonias Initiative workgroup. The
purpose of the HHSC Colonias Initiative workgroup is to develop a uniform plan that
ensures coordination among HHS agencies so that their services are accessible to
residents of the Texas-Mexico border colonias.
One source of service coordination is the Texas A&M Center for Housing and Urban
Development (CHUD) Program. This program has established thirteen community
resource centers in colonias throughout the Border region. Various state agencies
provide their services at the centers connecting isolated communities with available health
and human services.
Another important border initiative is the certification of promotores (as), lay community
workers, who provide cultural mediation between communities and health and human
service systems, informal counseling and social support, and culturally and linguistically
appropriate health education; advocate for individual and community health needs; assure
that people get the health services they need; build individual and community capacity;
and/or refer individuals to services. These workers, recruited from the community, are
natural connections to the people of the Border region and serve as an extension of the
state’s public health workforce for improving health status along the Texas/Mexico Border
region.
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Texas-Mexico Health Coordination
State health programs in both Texas and Mexico need a better understanding of each
other’s initiatives and policies in order for public health efforts to be effective. Various
barriers (legal and institutional) currently inhibit collaboration between Texas and Mexico.
These barriers exist in the areas of information exchange of health data, technology
transfer, laboratory testing, sharing of resources, and related public health practices.
Senate Bill 1857 required the Texas Department of Health to study federal and state laws
inhibiting the exchange of information on disease and epidemiological reporting between
Texas and Mexico and the exchange of equipment and personnel necessary for obtaining
and exchanging the information. A comprehensive report with recommendations is due to
the legislature by January 2001.
In recommendations to the Senate Border Affairs Committee, the Texas Department of
Health recently suggested that the Committee consider a Continuing Resolution to the
U.S. Congress requesting the development of an agreement or treaty that specifically
addresses health issues of mutual concern between the U.S. and Mexico, including the
elimination of legal and institutional barriers.
Reducing barriers to working with Mexico would enhance binational public health
coordination. Important binational public health initiatives include: emergency response
planning, disease control and prevention, environmental investigations, training and
technology transfer, and development of communications infrastructure (telemedicine,
internet, etc.). Among the recommendations made by the Texas Department of Health to
the Senate Committee on Border Affairs was the development of human resources to
serve as binational public health coordinators. Such positions are necessary for
developing and sustaining binational public health initiatives.
Health care providers and policy makers must also take into account the potential for
cross-border health care utilization, health education, and health care delivery.
Inadequate health insurance coverage, poverty, and the isolation of some colonias
communities point to the reasons why many border residents seek less expensive care
from Mexican physicians, dentists, and pharmacists.
Established through an agreement signed between the federal governments of the U.S.
and Mexico, the U.S.-Mexico Border Health Commission (BHC) is charged with identifying
and evaluating the health problems of the border and encouraging and facilitating action to
address these problems. The definition of “border” used by the BHC is the area located in
the U.S. and Mexico within 100 kilometers of the international boundary between the two
countries (in Texas, this includes 32 counties). Three commissioners per state have been
named to serve the BHC and El Paso, Texas has been selected as the site of the U.S.
office.
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Coordination Between Counties: Health Services District
Senate Bill 1615 authorizes the establishment of health services districts for the provision
of indigent health services. Although the legislation was enacted principally to assist the
four counties of the Lower Rio Grande Valley (Cameron, Hidalgo, Starr, and Willacy), any
group of counties and hospital districts may form a health services district to pool their
local resources for the provision of health care to the indigent. Such districts are
authorized to issue bonds but may not levy taxes under the legislation. The Texas
Department of Health is facilitating the implementation of Senate Bill 1615 for the Lower
Rio Grande Valley.
House Bill 3504 is related to SB 1615. Among other provisions, HB 3504 authorizes TDH
to construct a new outpatient facility in Harlingen, with possible additional outpatient
facilities in McAllen and Brownsville. The new facility would replace the current South
Texas Hospital in Harlingen. If a health services district were formed in the Lower Rio
Grande Valley, it could contract with TDH to manage and operate the new outpatient
facilities described in HB 3504.
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Health Facilities
A broad range of public and private health facilities serve the needs of Texans. Some of
these facilities focus on serving low income or uninsured individuals. Access to these
facilities and services reduces barriers, which may otherwise affect individual and the
public health in this region. (Note: the dot density maps provided below indicate the
numbers -- but not the locations of health related facilities). Appendix J shows health
facilities data by county.
Rural Health Clinics
Rural health clinics are facilities located in a rural area designated as a medically
underserved area or a health professional shortage area. These clinics provide primary
health care services. There were 95 established rural health clinics in the 43-county
Border region during 1998. The majority of these, 71, were located in 24 of the 36 rural
border counties. The remaining 24 rural health clinics were located in rural areas of six of
the seven urban border counties.
Source: Health Facility Compliance Division, Texas Department of Health
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Community Health Centers
Community health centers are prevention focused federally funded entities that provide necessary
health services to low-income workers and the uninsured. Seventy-five percent of those served
are women of childbearing age and children under 19. Sixteen of the 30 Community Health
Clinics established in Texas are located in the border and serve 23 of the 43 counties examined in
this report. Eight of these (Brownsville Community Health Center, Gateway Community Health
Centers, Nuestra Clinica del Valle, South Texas Rural Health Services, Su Clinica Familiar, United
Medical Centers, Uvalde County Clinic, and Vida Y Salud Health Systems) are also designated as
Migrant Health Clinics.20
Acute Care Hospitals and Beds
Eighty of the 477 acute care hospitals operating in Texas during 1998 were located in the 43
border county area. Fifty-nine of the 80 acute care hospitals operated in the seven urban
counties; 24 of these facilities were located in Bexar County. The remaining 21 hospitals were
located in 17 of the rural border counties. Nineteen counties had no hospitals.
There was little difference in the number of staffed beds per 1,000 population between the border
counties (2.8 per 1,000) and the remainder of the state (2.9 per 1,000). However, the supply of
staffed hospital beds in urban border counties (3.0 per 1,000 population) was nearly twice the
supply located in rural border counties (1.7 per 1,000 population).
Source: TDH/AHA/THA Annual Survey of Hospitals,
Texas Department of Health
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Nursing Homes and Licensed Beds
Almost 15 percent (155) of the state’s nursing homes operating in 1998 were located in the Border
region. The majority (113) of nursing homes were concentrated among the 7 urban counties.
Nearly one-half (54) of these facilities were located in Bexar County. Eighty-six percent (36) of
rural nursing homes were located in the 19 counties with populations greater than 10,000. The
remaining six nursing homes were distributed among the 17 smaller counties.
The number of licensed beds per 1,000 population was greater among the rural counties (7.3 per
1,000) than the urban counties (3.9 per 1,000) in the Border region. On average, nonborder
counties had more available licensed nursing home beds (7 per 1,000) when compared to all
border counties (4.4 per 1,000).21
Ambulatory Surgical Centers
Ambulatory Surgical Centers (ASC) serve patients who receive surgical treatment or medical
procedures on an outpatient basis. Procedures performed at an ASC are typically less expensive
than those performed in an acute care facility where the patient is admitted for an overnight stay.
Forty-four of the state’s 218 ambulatory surgical centers were located in the 43-county Border
region. All but two of the border county ambulatory care surgical centers were located in six of the
seven urban counties. Eighteen of these 42 facilities were located in Bexar County. The two rural
counties (Kerr and Maverick) that had an ASC had populations over 40,000.
Source: Health Facility Licensing Division, Texas Department of Health
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End Stage Renal Disease Facilities
The Border region includes 68 end stage renal dialysis (ESRD) facilities or 34 facilities per
100,000 border residents. Fifty-seven of these facilities were located in urban counties. Of these
57 ESRD facilities, 26 were located in Bexar County. The number of ESRD stations per 100,000
population was slightly higher among urban border counties (35 per 100,000) compared to rural
counties (28 per 100,000). However, both urban and rural border counties had more stations per
100,000 population than nonborder counties (23 per 100,000) or the state as a whole (25 per
100,000).
Source: Health Facility Licensing Division, Texas Department of Health
Birthing Centers
Birthing centers provide an alternative means for a pregnant woman to deliver in a setting other
than at home or in a hospital. Birthing centers are frequently operated by midwives and are
concentrated along the Texas-Mexico border. More than one-half (22) of the state’s 40 centers
were located among the 43 border counties. The majority of these institutions (17 of 22) were
located in three of the seven urban border counties (Cameron, El Paso, and Hidalgo counties).
Three of the four rural border county birthing centers were located in Val Verde county.22
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Health Professional Shortage Areas
In general, the counties representing the Border region lag behind the Texas average for the
population-to-provider ratios for most types of health care provider. In addition, even though the
population of the border counties is predominately Hispanic, the health care providers are
predominately white. The difficulty that most rural border counties have in recruiting health care
providers may be indicated by a higher population-to-provider ratio than in the metropolitan
counties. Appendix K lists population-to-provider data by county.
Health Professional Shortage Areas (HPSAs) include geographic areas, population groups, and
facilities recognized by the U.S. Department of Health and Human Services (USDHHS) as having
an acute shortage of health care personnel. The HPSA program recognizes personnel shortages
in three professions: primary medical care physicians (medical doctors and doctors of osteopathy),
dentists, and mental health professionals.
As evidence to the shortage of primary care providers on the Texas-Mexico border, USDHHS has
designated 65 percent (28) of the border counties as whole county primary care Health
Professional Shortage Areas (HPSAs), 95 percent (41) as whole county mental health HPSAs,
and 61 percent (26) as whole county dental HPSAs.
Primary Care Physicians
Primary care physicians include both allopathic and osteopathic physicians in the following
specialties: general or family practice, pediatrics, obstetrics and gynecology, and internal
medicine. In September of 1999 there were approximately 2,250 primary care physicians
practicing in the 43 border counties. Two of every three of these practitioners were male. The
average age for primary care physicians was 54 years, slightly older than the average age of 50
years statewide.
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Since 1995, 371 internationally trained primary care physicians with a J-1 waiver have begun
practicing in Texas. Forty percent (144) of these physicians practice in the 43-county Border
region. Sixty-four physicians with J-1 waivers practice in the seven urban counties, while the
remaining 80 physicians practice in rural counties. There are currently 13 National Health Service
Corps physicians practicing in this area. Four of these physicians practice in rural counties. Nine
practice in the urban counties.
In 1996, the Council on Graduate Medical Education (COGME) evaluated five projection models
for physician requirements and concluded that the national range will be “between 60-80 per
100,000 population . . . in the early 21st century.” Based on this benchmark, the supply of
physicians in Texas in 1999 was within the lower limits of this range.23 However, the supply of
physicians in the Border region was well beneath this benchmark.
Based on 1999 information, five rural border counties (Hudspeth, Kenedy, McMullen, Presidio,
and Terrell) have no primary care physicians. An additional seven rural counties have only one
physician. The population per primary care physician ratio for the 43-county area is 1,752:1,
approximately 12 percent higher than the state ratio of 1,562:1. Excluding Bexar County from the
Border region, the resulting population per primary care physician ratio is 2,023:1, nearly 30
percent higher than the state ratio. Within the Border region, the average population per physician
ratio was 2,791:1 for the rural areas, nearly two-thirds higher than the 1,654:1 ratio for the seven
urban counties. The population per physician ratio fluctuates significantly from county to county.
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Physician Assistants
The number of physician assistants (PAs) practicing in the 43-county Border region has
quadrupled from 85 in 1991 to 369 in 1999. A similar growth rate was reflected statewide. In
1999, 80 percent of PAs practiced in the seven urban counties in the Border region. The
population to PA ratio was 11,170:1 in the 43-county area, approximately six percent higher than
the statewide ratio of 10,563:1. Excluding Bexar County from the Border region, the resulting
population per PA ratio was 12,964:1, nearly 23 percent higher than the statewide ratio. The ratio
of population per PA was 12,637:1 in the Border region’s seven urban counties and 6,554:1 in the
rural counties. Of all the professions presented in this report, this is the only one with a higher
population-to-provider ratio in the urban counties than in the rural counties, indicating a more
widespread use of non-physician primary care providers in less populated areas.
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General Dentists
General dentists include dentists in private practice specializing in general, pediatric, or public
health dentistry. The number of dentists practicing in the 43-county Border region increased from
998 in 1996 to 1,076 in November 1999, a growth rate of eight percent. The ratio of the
population to general dentist was 3,831:1 in the 43-county area, approximately 39 percent higher
than the statewide ratio of 2,748:1. Excluding Bexar County from the Border region results in a
population to general dentist ratio of 5,479:1. nearly double the statewide ratio. The ratio of
population per general dentist was 3,629:1 in the Border region’s seven urban counties and
5,776:1 in the 36 rural counties.
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Registered Nurses
In 1999 there were 22,100 registered nurses (RNs) practicing in the 43 border counties. Nine out
of ten (92%) RNs practiced in the Border region’s seven urban counties.
Based on 1999 information, there were no RNs employed in Kenedy and five or fewer RNs
employed in Edwards, Hudspeth, Jeff Davis, Kinney, McMullen and Terrell counties. The
population per RN ratio for the 43-county area was 187:1, approximately 11 percent higher than
the state ratio of 168:1. Excluding Bexar County from the Border region results in a population per
RN ratio of 236:1, approximately 40 percent higher than the statewide ratio. The average
population per RN ratio was 336:1 for the Border region’s rural counties, over twice the 174:1 ratio
for the seven urban counties.
The Border region, as well as the entire state, is experiencing a shortage of nurses. In 1997, the
number of actively employed RNs per 100,000 population was 772 per 100,000 for the nation.
The statewide average for Texas was 595 per 100,000 population in 1999, nearly 23 percent
below the 1997 national average. In the Border region, the average rate was 536 per 100,000, 31
percent below the national average. The number of RNs per 100,000 population in the 43-county
Border region declined from 625 per 100,000 population in 1995 to 536 per 100,000 population in
1999, a drop of 14 percent. Similar declines have been recorded statewide.
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Advanced Practice Nurses
There were 867 registered nurses recognized as Advanced Practice Nurses (APNs) reporting
employment in the 43-county Border region in 1999. Ninety-three percent (806) of the total APNs
practiced in the seven urban counties. Of the 36 rural counties, 16 counties had no actively
employed APNs, while the remaining eight had only one.
The population to APN ratio for the Border region was 4,754:1, approximately 20 percent greater
than the 3,964:1 population to APN ratio for the state. Excluding Bexar County from the Border
region results in a population to APN ratio of 6,123:1, approximately 55 percent greater than the
statewide ratio. The average population to APN ratio was 9,563:1 in the rural counties, more than
double the 4,390:1 ratio in the urban counties.
Certified Nurse Midwives
Thirty-nine (39) certified nurse midwives (CNMs) reported employment in the 43-county Border
region in 1999, a slight decline from the 45 CNMs employed in the area in 1995. This declining
trend is also reflected at the state level.
Thirty-seven of the 39 CNMs were employed in five of the urban counties in the Border region -Bexar, Cameron, El Paso, Hidalgo and Nueces. One CNM was employed in Maverick County and
one in Starr County.
Nurse Practitioners
Four hundred twenty-one registered nurses recognized as nurse practitioners (NP) reported
employment in the 43-county Border region in 1999, an increase over the 285 NPs employed in
1995. A similar increase was reflected at the state level. However, the 1999 supply of NPs per
100,000 in the border was 10.2 per 100,000 population, nearly 20 percent lower than the state
rate of 12.7 NPs per 100,000 population. Nearly three out of four (72%) NPs were white, while
slightly less than one of every four (23%) were Hispanic.
Ninety-one percent of the NPs employed in the Border region were employed in the seven urban
counties. Nineteen of the 36 rural border counties had no NP. One employed NP was reported
for each of eight remaining counties. The population per NP ratio for the 43-county Border region
was 9,790:1, nearly 24 percent higher than the 7,903:1 ratio for the state. Excluding Bexar
County from the Border region results in a population per NP ratio of 11,317:1, 43 percent greater
than the statewide ratio. The average population per NP ratio was 14,958:1 for the rural areas,
nearly 61 percent higher that the 9,263:1 ratio of population per NP in the seven urban counties.
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Pharmacists
There were 2,329 pharmacists practicing in the 43-county Border region in 1999. Approximately
nine out of every 10 pharmacists (2,082) were employed in the seven urban counties. The
remaining 247 pharmacists were employed in 29 of the area’s 36 rural counties. No pharmacists
reported employment in seven of the rural counties. The population to pharmacist ratio was
1,770:1 in the Border region, 32 percent higher than the 1,339:1 ratio at the state level. Excluding
Bexar County from the Border region results in a ratio of population per pharmacist of 2,229:1,
approximately two-thirds (67 percent) greater than the statewide ratio. The average population to
pharmacist ratio in the area’s rural counties was 2,362:1, 39 percent greater than the average
ratio of 1,699:1 in the area’s urban counties.
Respiratory Care Technicians
There were 1,099 respiratory care technicians practicing in the 43-county Border region in 1999.
Ninety-four percent (1,030) of the technicians practiced in the seven urban counties. The
remaining 69 respiratory care technicians practiced in 16 of the 36 rural counties in the Border
region. Approximately one-third of these (22) were employed in Jim Wells and Kerr counties. The
population to respiratory care technician ratio for the total Border region was 3,750:1, 11 percent
greater than the 3,388:1 ratio for the state. Excluding Bexar County from the Border region results
in a population per respiratory care technician ratio of 4,887:1, approximately 60 percent greater
than the statewide ratio. The average population to provider ratio was 8,454:1 in the rural border
counties and 3,435:1 in the urban border counties.
Physical Therapists and Physical Therapy Assistants
There were 1,132 physical therapists practicing in the 43-county Border region in 1999. Ninetyfour percent (1,059) of the therapists practiced in the seven urban counties. The remaining 73
physical therapists practiced in 18 of the 36 rural counties in the Border region. The population to
physical therapist ratio for the total Border region was 3,641:1, 29 percent greater than the
2,818:1 ratio for the state. Excluding Bexar County from the Border region results in a population
per physical therapist ratio of 4,504:1, approximately 60 percent greater than the statewide ratio.
The average population to provider ratio was 7,991:1 in the rural border counties and 3,341:1 in
the urban border counties.
There were 657 physical therapy assistants practicing in the 43-county Border region in 1999.
Ninety-one percent (598) of the assistants practiced in the seven urban counties. The remaining
59 physical therapy assistants practiced in 20 of the 36 rural counties in the Border region. The
population to physical therapy assistant ratio for the total Border region was 6,274:1, 11percent
lower than the 7,061:1 ratio for the state. Excluding Bexar County from the Border region results
in a population per physical therapy assistant ratio of 7,935:1, approximately 12 percent greater
than the statewide ratio. This is one of the few professions where the ratio for the border counties
was lower than the ratio for the entire state. The average population to provider ratio was 9,887:1
in the rural border counties and 5,917:1 in the urban border counties.
Occupational Therapists and Occupational Therapy Assistants
There were 699 occupational therapists practicing in the 43-county Border region in 1999.
Ninety-four percent (659) of the technicians practiced in the seven urban counties. The remaining
40 occupational therapists practiced in 14 of the 36 rural counties in the Border region. The
population to occupational therapist ratio for the total Border region was 5,897:1, 27 percent
greater than the 4,630:1 ratio for the state. Excluding Bexar County from the Border region results
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in a population per occupational therapist ratio of 7,844:1, approximately 70 percent greater than
the statewide ratio. The average population to provider ratio was 14,584:1 in the rural border
counties and 5,369:1 in the urban border counties.
There were 305 occupational therapy assistants practicing in the 43-county Border region in
1999. Ninety-two percent (281) of the assistants practiced in the seven urban counties. The
remaining 59 occupational therapy assistants practiced in 11 of the 36 rural counties in the Border
region. The population to occupational therapy assistant ratio for the total Border region was
13,514:1, six percent lower than the 14,272:1 ratio for the state. Excluding Bexar County from the
Border region results in a population per occupational therapy assistant ratio of 22,268:1,
approximately 56 percent greater than the statewide ratio. This is one of the few professions
where the ratio for the border counties was lower than the ratio for the entire state.
Certified Emergency Medical Service Personnel
Emergency medical services (EMS) personnel are certified by the state to ensure high standards
and training to provide emergency medical treatment. Sixteen percent (6,938) of the state’s
42,864 EMS personnel certified as of 1998 served in the 43 border counties. The overall
population to EMS personnel ratio in the 43-county Border region was 579:1, approximately 26
percent higher than the 461:1 ratio for the state. Excluding Bexar County from the Border region
results in a population to EMS personnel ratio of 551:1, nearly 20 percent greater than the
statewide ratio. The ratio of population to EMS personnel in the urban areas, 162:1, was
substantially smaller that the ratio found for the rural areas of the border, 237:1. On average,
urban border counties were served by two certified EMS personnel per square mile. This is in
contrast to the rural border counties, which were served by approximately one certified EMS
personnel per 50 square miles.
Mental Health Professionals: Psychiatrists, Licensed Psychologists, and Social Workers
Two hundred and forty-seven (247) psychiatrists practiced in the 43-county Border region in 1999.
Ninety-two percent (227) of these licensed medical doctors practiced in five urban counties of the
Border region (Bexar, Cameron, Hidalgo, El Paso, and Nueces). Twenty psychiatrists practiced in
six rural counties in 1999. Fourteen of these were employed in Kerr County. The overall
population to psychiatrist ratio in the 43-county Border region was 16,687:1, approximately 13
percent higher than the 14,800:1 ratio for the state. Excluding Bexar County from the Border
region results in a population per psychiatrist ratio of 26,809:1, approximately 81 percent higher
than the statewide ratio.
There were 422 licensed psychologists practicing the in Border region in 1999. Ninety-six percent
of these practitioners were employed in the seven urban counties in the Border region. The
remaining 18 psychologists practiced in eight rural counties. Six of the 18 were employed in Kerr
County. The overall population to psychologist ratio in the 43-county Border region was 9,767:1,
nearly 47 percent higher that the 6,643:1 ratio for the state. Excluding Bexar County from the
Border region results in a population per psychologist ratio of 19,176:1, nearly three times the
population per psychologist ratio for the state.
There were 2,603 social workers employed in the Border region in 1999. While nearly 93 percent
(2,409) of the practitioners were employed in the seven urban counties, the remaining 194 social
workers were employed in 24 of the 36 rural counties. The overall population to social worker
ratio in the 43-county Border region was 1,583:1, approximately 17percent higher than the 1,353:1
ratio for the state. Excluding Bexar County from the Border region results in a population per
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social worker ratio of 2,011:1, nearly 50 percent greater than the statewide ratio. The average
population per social worker ratio was 3,007:1 for the rural areas, twice the 1,469:1 ratio in the
seven urban counties.
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Section 5: Details on Recommendations for Health Care
Coordination
Section 5 provides detailed information for the recommendations shown in the Executive
Summary.
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Recommendation 1: Development of a Health Services District
Cameron, Hidalgo, Starr, and Willacy counties should proceed with the development of a Health
Services District as authorized in Senate Bill 1615, 76th Legislature.
Background
Senate Bill 1615 authorizes the establishment of health services districts for the provision of
indigent health services. Although the legislation was enacted principally to assist the four
counties of the Lower Rio Grande Valley (Cameron, Hidalgo, Starr, and Willacy), any group of
counties and hospital districts may form a health services district to pool their local resources to
enhance the quantity, quality and coordination of indigent health care services provided. Such
districts are authorized to issue bonds but may not levy taxes under the legislation. The Texas
Department of Health is facilitating the implementation of Senate Bill 1615 for the Lower Rio
Grande Valley.
A companion bill, House Bill 3504, provides for the “construction of new physical facilities for
outpatient health care services” in the Lower Rio Grande Valley. The bill directs the Texas
Department of Health to contract for this construction out of funds appropriated to the department
for that purpose. House Bill 3504 further specifies that the initial outpatient facility must be located
at the site of the South Texas Hospital in Harlingen, Texas, or co-located with the initial site of the
University of Texas Regional Academic Health Center in Harlingen, Texas.
Several characteristics of the four county area's population illustrate the unique need for the
formation of a health services district in this part of the Border region:
�
The Lower Rio Grande Valley is projected to have high rates of population growth. By
2020, the population of Starr County is expected to be 134 percent larger than in 2000,
while the Hidalgo County population is expected to increase by 86 percent during this time
period. The population of Cameron County is projected to increase by 53 percent by
2020.
�
It is estimated that approximately one out of every two children under 18 years of age in
the Lower Rio Grande Valley lived below the federal poverty level in 1999. Nearly onethird of the persons in the 18 to 64 year age group fell below the federal poverty level in
1999.
�
Approximately one-third of the children under 18 years of age living in this area had no
health insurance in 1999. Nearly 38 percent of the adults aged 18 to 64 were uninsured.
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Recommendation 2: Enhance Recruitment and Retention of Health Professionals
Enhance recruitment and retention of health professionals into Health Professional Shortage
Areas by expanding state financial incentives, including but not limited to, loan repayment, loan
forgiveness, scholarship, grant programs and accessing federal matching dollars through the
National Health Service Corps. Financial incentives should be established for all health care
professionals.
Background
The Statewide Health Coordinating Council included this recommendation in the 2001-2002
Texas State Health Plan Update: “Ensuring a Quality Health Care Workforce for Texas.”
(Strategy 3.2.1.)
Thirty-six of the 43 counties in the Border region defined in Senate Bill 1378 are classified as
rural. Only 14 percent of the border's 4.1 million residents, less than 600,000 persons, live in
these rural counties, often in remote areas with little or no access to medical care. For example,
five rural border counties have no primary care physician. An additional seven rural counties in
the Border region have only one physician. Additional Information on the supply of health
professionals in the Border region is included in Section 4. As a result, the U.S. Department of
Health and Human Services has designated 28 of the border counties as whole county primary
care Health Professional Shortage Areas (HPSAs). Forty-one counties are designated HPSAs for
mental health providers and 26 counties are designated as dental care HPSAs.
Ongoing recruitment strategies in Texas fall into any or all of three categories. Practiceenvironment strategies aim to influence the practice decisions of health care professionals after
completion of training. These strategies include financial incentives for practicing in shortage
areas, strengthening the physician recruitment and practice infrastructure in rural and
underserved areas, and attempting to make practice in these communities more attractive.
Medical education strategies aim to promote graduates' interest in practicing in underserved
communities by providing them with experience in caring for underserved populations during their
training. Applicant-pool strategies provide interventions to identify, prepare, and recruit individuals
who may be predisposed to care for rural and/or underserved populations because of personal
characteristics, such as being a member of an ethnic or racial minority group, or having been
reared in a rural area.
An equally critical and overlooked component of the access equation is the necessity of retaining
those professional in the rural after recruitment. Retention often only becomes an issue after a
practitioner has made the decision to leave a community or has actually left. Retention is
significantly affected by the reimbursement rates for services provided to patients by practitioners.
The federal shortage area designation process for underserved communities affects the ongoing
availability of resources and/or financial incentives to rural practitioners. This can have a direct
effect on the viability of rural practices and the decision to maintain those practices.
101
Recommendation 3: Expand Use of Telemedicine
To address the maldistribution of health care professionals and increase access to health
services for rural and underserved populations, Texas should pass legislation and fund programs
that expand the use of telemedicine.
Background
The Statewide Health Coordinating Council included this recommendation in the 2001-2002
Texas State Health Plan Update: “Ensuring a Quality Health Care Workforce for Texas.”
(Strategy 3.1.1.)
Although this recommendation was identified to address a statewide concern, it is significant for
the Border region, especially for the 36 rural counties that are home to nearly 600,000 Texans.
The lack of available qualified health professionals in these areas continues to be a major barrier
to accessing health care in rural Texas.
Telemedicine technologies hold promise for providing greater access to medical care, ensuring
quality of care, and containing costs through early diagnosis and intervention. Telemedicine is an
innovative application of telecommunications technology and computers, including video-imaging,
data transmission and voice in real-time that enables patients and providers access to far away
specialized centers or faculty for consultation on areas of practice that are not available locally.
The use of the same technology also offers the potential for innovative approaches to retention
strategies, particularly when coupled with clinical resources available through academic health
science centers, medical schools, tertiary care centers and regional health care facilities. It can
also be used to bring continuing medical education to rural or isolated locations, a fact that is of
particular importance in the Border region.
The availability of telemedicine services is greatly influenced by state and federal policies
regarding reimbursement for services performed by providers. A significant barrier exists in that
only nonprofit providers have access to state and federal telecommunications grant programs
while the most common type of primary health care providers in rural communities may fall into the
for profit category. Additional policy issues that are coming to the forefront pertain to equipment
standards, costs of establishing rural telemedicine links, medical regulation, network development,
and confidentiality and security.
102
Recommendation 4: Establishment of Epidemiology Response
Teams
TDH recommends the establishment of Epidemiology Response Teams in each region to assist
local health departments in detecting/tracking diseases and conducting investigations of disease
outbreaks, as well as establishing an Internet-based reporting and telecommunications system to
improve the state’s capacity to detect diseases when they are diagnosed.
Background
The examination of demographic projections, current socio-economic and health status
information available for the Border region supports the need to emphasize disease surveillance
and control efforts in the Border region. Specific issues that disproportionately affect the region
include:
�
Tuberculosis control and prevention. The reported case rate of tuberculosis per
100,000 population is 12.0 in the border, about one and a half higher than for the rest
of the state. Only aggressive vigilance to detect new cases and the infrastructure to
treat them can control the spread of the disease.
�
Enteric disease surveillance. Many of the border health problems appear to be
related to water quality and foodborne illness. Rates for the most common enteric
diseases -- campylobacteriosis, salmonellosis, shighellosis, and Hepatitis A -- are
significantly higher in the Border region than in the rest of the state. The incidence of
Hepatitis A, a virus transmitted by the fecal-oral route, often through the ingestion of
contaminated food or water, has declined significantly since 1997 due to vaccination
initiatives implemented during 1998. Even so, Hepatitis A rates remain more than twice
as high in the border (23.4 per 100,000 population) than in non-border counties (9.8
per 100,000 population). (See Section 4 for more details on Border region health
status).
The Texas Department of Health has requested funding for the 2002-2003 biennium to establish
Epidemiology Response Teams in each of the state’s public health regions. Consisting of an
epidemiologist, a public health nurse, and a public health technician, the team will conduct or
assist local health departments and hospitals in conducting timely and effective disease
surveillance activities and investigations. With linkage into the developing statewide electronic
disease reporting systems (the Texas National Disease Surveillance System and the Health Alert
Network), these teams will perform front line disease detection and control of outbreaks and
epidemics.
103
Recommendation 5: Health and Human Services Commission
Consolidated Colonias Initiative
Texas Department of Health highlights the Texas Health and Human Services Commission
Consolidated Colonias Initiative appropriation request that provides colonia residents with
access to state-funded programs in ways that are tailored to the unique conditions of their
environment.
Background
In 1997-1998 the Office of Border Health at the Texas Department of Health conducted a
comprehensive survey of health and environmental conditions of a representative sample of over
1200 households in Cameron, El Paso, Hidalgo, Maverick, Starr, and Webb counties, the six most
populous counties of a 32-county Border region. This population-based household survey is the
first comprehensive description of health and environmental conditions facing Texas families living
in the border with Mexico.
The study demonstrated the lower-socioeconomic levels and environmental conditions faced by
residents of colonias. For instance:
�
Thirty-five percent of colonia households fall below the federal poverty level, more
than 50 percent receive public assistance and 12 percent report being unemployed.
Respondents from colonias reported fewer years of formal education: 31 percent of
the colonia respondents had a high school diploma versus 56 percent of non-colonia
residents
�
Public sewer services were available to only about one-half of the colonia households,
and only about 45 percent of colonia households have drinking water supply in their
houses. Of the households that relied on containers for their drinking water, water
samples tested indicated that the chorine residual was adequate in only 10 percent of
the samples. Exposure to pesticides and agrochemicals is a potential problem, with 21
percent of the colonia households being located within one-quarter of a mile of an
agricultural field.
The conditions in colonias lead to a high demand for social services as well as challenges to the
health status of their residents (See Section 4 for details of the study’s findings).
Texas’ Health and Human Service agencies have requested an appropriation from the 77th Texas
Legislature to improve access to health and human services in the Border region of the state. This
Consolidated Colonias Initiative will work to enhance services in the colonias with:
•
•
•
•
Formal training and certification for promotoras (community health workers);
Development of culturally and linguistically appropriate materials;
Establishment of self-help and advocacy models;
Continued development of best practices for coordination of the multiple agencies’ services; and
• Community resource centers to house case management staff.
The initiative requests approximately $19 million for the fiscal year 2002-2003 biennium. In
addition to seven of the state health and human service agencies24, the Consolidated Colonias
Initiative would work in concert with the ongoing Colonias Initiative of the Texas A&M University
104
Center for Housing and Urban Development.
1
State Comptroller of Public Accounts, Bordering the Future, Austin, 1998.
2
Texas State Data Center, Department of Rural Sociology, Texas Agricultural Experiment Station,
Texas A & M University, Estimates for July 1998.
3
Ibid.
4
G.E. Alan Dever, Ph.D, “Profile of a Population with Complex Health Problems,” Migrant
Clinicians Network Monograph Series, 1991.
5
U.S Department of Health and Human Services, Migrant Health Program, An Atlas of State
Profiles which Estimate the Number of Migrant and Seasonal Farm Workers and Members of
their Families, 1990.
6
Alice Larson, Ph.D and Luis Plascencia, Ph.D, Migrant Enumeration Project: 1993, Migrant
Legal Services, 1993.
7
Edli E Colberg, Texas Health and Human Services Commission, Research Department, Fiscal
Policy Division, Estimates of the Texas Population Living Below Poverty in 1999 by County,
May 1999. Online. Available at: http://www.hhsc.state.tx.us/cons_bud/dssi/cntypov99.htm.
8
Edli E.Colberg, Texas Health and Human services Commission, Research Department, Fiscal
Policy Division, Estimated Number of persons without Health Insurance in Texas by County in
1999, May 1999. Online. Available at:
http://www.hhsc.state.tx.us/cons_bud/dssi/cntyunin99.htm.
9
Texas Department of Human Services, Budget Management Services, Texas Medicaid Program,
MI 379 Report, Federal Fiscal Year 1997.
10
Texas Department of Human Services, 1998 Annual Report.
11
Texas Department of Health, Office of Border Health, Survey of Health and Environmental
Conditions in Texas Border Counties and Colonias: Preliminary Findings, 1997
12
Texas Department of Health, Associateship for Disease Control and Prevention, Epidemiology
in Texas 1998 Annual Report, 1999, pg 39.
13
Texas Department of Health, Texas Department of Health Strategic Plan Fiscal 1999-2003, pgs
38-40.
14
Texas Department of Health, Bureau of Regional/ Local Health Operations.
15
Texas Department of Health, Texas Department of Health Strategic Plan Fiscal Years 1999­
2003, pgs 39-40.
16
Texas Water Development Board, Economically Distressed Areas Program, Report as of
February 29, 2000.
105
17
Texas Department of Health, General Sanitation Division, Professional Sanitarian Registry
Program. Online. Available at: http://www.tdh.state.tx.us/beh/geinfo.htm.
18
National Institute of Environmental Health Science. Online. Available at:
http://www.niehs.nih.gov/external/plan2000/goodsci.htm.
19
Texas Department of Health, Texas Department of Health Strategic Plan Fiscal Years 2001­
2005, pgs 5-6.
20
Texas Association of Community Health Centers, Membership Directory 1999.
21
Texas Department of Human Services, Bureau of Long Term Care, Texas Department of
Human Services, Long Term Care Regulatory, Directory of Nursing Facilities, January 5, 1999.
22
Texas Department of Health, Health Facility Licensing Division.
23
Council on Graduate Medical Education, Patient Care Physician Supply and Requirements:
th
Testing COGME Recommendations, 8 Report, November 1996.
24
Health and Human Service Commission, Texas Department of Health, Texas Department of
Human Services, Texas Department of Mental Health and Mental Retardation, Texas
Commission on Alcohol and Drug Abuse, Texas Commission for the Deaf and Hard of Hearing,
Texas Department on Aging.
106
APPENDIX A
Senate Bill 1378 (76th Legislature)
AN ACT
relating to the review of medical training needs for health care professionals in the
Texas-Mexico border region.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. (a) In this Act, "border region" means the area composed of the
counties of Atascosa, Bandera, Bexar, Brewster, Brooks, Cameron, Crockett,
Culberson, Dimmit, Duval, Edwards, El Paso, Frio, Hidalgo, Hudspeth, Jeff Davis, Jim
Hogg, Jim Wells, Kenedy, Kerr, Kimble, Kinney, Kleberg, La Salle, Live Oak, Maverick,
McMullen, Medina, Nueces, Pecos, Presidio, Real, Reeves, San Patricio, Starr, Sutton,
Terrell, Uvalde, Val Verde, Webb, Willacy, Zapata, and Zavala.
(b) The Texas Higher Education Coordinating Board, in consultation with the Texas
Department of Health, the Health Education Training Centers Alliance of Texas, and the
Area Health Education Centers, shall conduct a review of medical training needs of health
care professionals in the border region. In conducting the review:
(1) the Texas Higher Education Coordinating Board shall review current
methods of medical training for health care professionals in the border region; and
(2) the Texas Department of Health shall determine the future medical
services, health care services, and other needs requirements of the border region.
(c) The Texas Higher Education Coordinating Board and the Texas Department of
Health shall make recommendations on any action needed to address the medical
training needs of health care professionals in the border region after considering the
future medical services, health care services, or other needs the border region will
require.
(d) Not later than January 1, 2001, the Texas Higher Education Coordinating Board
shall report to the governor, lieutenant governor, speaker of the house of
representatives, and 77th Legislature the findings and recommendations for any
necessary legislation to address the medical training needs of health care professionals
in the border region after considering the future medical services, health care services, or
other needs the border region will require.
SECTION 2. This Act expires January 2, 2001.
SECTION 3. The importance of this legislation and the crowded condition of the
calendars in both houses create an emergency and an imperative public necessity that
the constitutional rule requiring bills to be read on three several days in each house be
suspended, and this rule is hereby suspended.
_______________________________
President of the Senate
_______________________________
Speaker of the House
I hereby certify that S.B. No. 1378 passed the Senate on April 19, 1999, by the
following vote: Yeas 30, Nays 0.
______________________________
Secretary of the Senate
I hereby certify that S.B. No. 1378 passed the House on May 22, 1999, by a
non-record vote.
_______________________________
Chief Clerk of the House
Approved:
_______________________________
Governor
APPENDIX B
Formula Funding for Health-Related Programs at Border Region Institutions
1994-95
Base Year
SCH
1998-99
Base Year
SCH
General Academic Institutions
Sul Ross State University
Sul Ross State University-Rio Grande
Texas A&M University-Corpus Christi
Texas A&M International University
Texas A&M University-Kingsville
University of Texas at Brownsville
University of Texas at El Paso
University of Texas-Pan American
University of Texas at San Antonio
Total, GAI Institutions
1,892
0
5,994
170
1,682
60
17,950
12,199
3,235
43,182
1,728
0
6,950
1,108
2,224
476
19,050
16,470
3,983
51,989
Health-related Institutions
Texas Tech Univ. HSC - El Paso *
University of Texas HSC at San Antonio
Total, Health-related Institutions
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
1,173,536
193,720
489,102
514,476
275,028
380,906
83,340
44,984
389,952
160,680
3,705,724
995,253
247,513
696,894
507,832
274,678
329,173
325,882
65,918
279,762
182,395
3,905,300
-15%
28%
42%
-1%
-0.1%
-14%
291%
47%
-28%
14%
5%
Institution
Community & Technical Colleges
Alamo CC District (Four Colleges)
Coastal Bend College
Del Mar College
El Paso Community College
Laredo Community College
Odessa College
South Texas Community College
Southwest Texas Junior College
Texas Southmost College
TSTC-Harlingen
Total, Comm/Tech Colleges
Total, Border Region Institutions
$3,748,906 $3,957,289
* Total represents funding for 204 medical students.
Percent
Change
-9%
-16%
552%
32%
693%
6%
35%
23%
25%
6%
2000/1 Biennium
Formula
GR Formula
Appropriation Appropriation
$686,528
0
$3,937,958
$608,304
$944,730
$273,204
$10,134,090
$7,411,380
$1,396,538
$25,392,732
$539,808
0
$3,096,360
$478,301
$742,827
$214,816
$7,968,289
$5,827,460
$900,244
$19,768,105
$14,035,982 $12,941,175
$166,512,321 $154,456,806
$180,548,303 $167,397,981
$13,926,553
$2,195,958
$6,803,528
$5,131,166
$2,476,077
$3,306,829
$2,720,033
$464,214
$2,581,192
$1,773,412
$41,378,962
$13,926,553
$2,195,958
$6,803,528
$5,131,166
$2,476,077
$3,306,829
$2,720,033
$464,214
$2,581,192
$1,773,412
$41,378,962
$247,319,997 $228,545,048
APPENDIX C
Special Item Funding for Health-Related Initiatives in the Border Region
Health-related Initiatives by Institution
1996
1997
1998
1999
2000
2001
1996-2001
General Academic Institutions
The University of Texas System
Lower Rio Grande Valley RAHC
1,300,000
Tuition Revenue Bonds - RAHC
Health Care Partnerships - Laredo
Sub-Total, UT System
2,500,000
5,000,000
0
2,722,692
700,000
700,000
$1,300,000
$3,200,000
$8,422,692
72,145
72,145
$12,922,692
The University of Texas at El Paso
Rural Nursing Health Care Services
Rehabilitative Sciences
Cooperative Programs*
Border Community Health Education Institute
Center for Environmental Resource Management
Pharmacy Program*
Occupational Therapy
Sub-Total, UT-El Paso
73,073
73,073
72,145
72,145
4,080
4,080
4,028
4,028
31,484
31,484
266,201
266,201
890,000
890,000
31,084
31,084
31,084
31,084
325,000
325,000
325,000
325,000
262,820
262,820
262,820
262,820
878,697
878,697
878,697
878,697
698,633
701,669
$1,264,838
$1,264,838
$2,272,407
$2,275,443
$1,569,746
$1,569,746
Nursing Program Enhancement*
Valley Health Coordinating Office*
Allied Health Enhancement*
Health Care Education
Diabetes Registry
$414,818
$414,818
$409,550
$409,550
$409,550
$409,550
128,083
128,083
126,456
126,456
126,456
126,456
78,211
78,211
77,218
77,218
77,218
77,218
50,000
50,000
50,000
50,000
139,805
371,577
252,443
252,443
252,443
252,443
Sub-Total, UT-Pan American
$760,917
$992,689
$915,667
$915,667
$915,667
$915,667
Life and Health Science Education Building
$2,906,368
$2,906,368
Sub-Total, UT-Brownsville
$2,906,368
$2,906,368
$10,217,018
The University of Texas - Pan American
$5,416,274
The University of Texas at Brownsville
$5,812,736
Texas A&M University
School of Architecture
Sub-Total, Texas A&M University
817,843
817,843
857,456
857,456
857,456
857,456
$817,843
$817,843
$857,456
$857,456
$857,456
$857,456
$5,065,510
Special Item Funding for Health-Related Initiatives in the Border Region
Health-related Initiatives by Institution
1996
1997
1998
1999
2000
2001
1996-2001
Texas A&M University - Corpus Christi
Undergraduate Nursing Outreach Program*
86,188
Allied Health*
267,000
School Nursing Program/Early Childhood Development Center
Sub-Total, TAMU-Corpus Christi
Sub-Total, General Academic Institutions
86,188
85,093
85,093
85,093
85,093
267,000
263,609
263,609
263,609
263,609
250,000
250,000
350,000
350,000
$353,188
$353,188
$598,702
$598,702
$698,702
$698,702
$3,301,184
$3,196,786
$3,428,558
$4,644,232
$5,947,268
$10,147,939
$15,370,631
$42,735,414
Health-Related Institutions
The University of Texas Health Science Center at Houston
Service Delivery in the Valley/Border Region
Sub-Total, UTHSC- Houston
528,471
528,471
542,001
542,000
566,625
566,247
$528,471
$528,471
$542,001
$542,000
$566,625
$566,247
655,327
660,352
$3,273,815
The University of Texas Health Science Center at San Antonio
Academic and Research Support**
South Texas Health Research Center**
3,547,010
512,174
502,678
499,228
503,056
South Texas Border Health Initiative
Sub-Total, UTHSC-SA
6,471,000
9,279,000
7,774,988
7,774,988
6,680,041
5,960,035
$10,530,184
$13,326,515
$8,929,543
$8,938,396
$6,680,041
$5,960,035
2,068,340
505,192
$2,068,340
$505,192
3,544,837
$54,364,714
Texas A&M University System Health Sciences Center
Coastal Bend Health Education Center
Sub-Total, TAMUS HSC
$2,573,532
Texas Tech University Health Sciences Center
Border Health Care Support - Academic Expansion
Border Health Care Support - Residential Support
Academic Operations - Border Region Development
South Texas Border Health Initiative
Sub-Total, Texas Tech HSC
Subtotal, Health-Related Institutions
3,850,000
3,850,000
3,801,105
3,735,783
4,034,895
4,035,023
365,159
364,753
360,777
353,932
402,189
402,487
365,037
364,631
360,521
353,813
408,099
408,398
1,125,000
1,125,000
1,112,195
1,094,914
995,576
884,957
$5,705,196
$5,704,384
$5,634,598
$5,538,442
$5,840,759
$5,730,865
$34,154,244
$16,763,851
$19,559,370
$15,106,142
$15,018,838
$15,155,765
$12,762,339
$94,366,305
Special Item Funding for Health-Related Initiatives in the Border Region
Health-related Initiatives by Institution
Total, Health-Related Initiatives
1996
$19,960,637
1997
$22,987,928
1998
$19,750,374
Tobacco Settlement Receipts ( Estimated Interest Earnings)
UT Health Science Center at San Antonio
UT El Paso (Border Health)
Texas Tech University Health Sciences Center (El Paso)
Lower Rio Grande Valley RAHC
Total, Tobacco Settlement Interest Earnings
* Special Item funding consolidated into Institutional Enhancement funding for 2000-01.
** Special Item funding included in health-related funding formulas for 2000-01.
1999
$20,966,106
2000
2001
$25,303,704
$28,132,970
10,000,000
10,000,000
1,250,000
1,250,000
1,250,000
1,000,000.00
1,250,000
1,000,000
$13,500,000
$13,500,000
1996-2001
$137,101,719
$27,000,000
APPENDIX D
2000 Health Education Questionnaire
The information collected from this questionnaire will be used by the Texas Higher Education Coordinating Board, in
th
consultation with other Texas state agencies and health organizations, to make recommendations to the 77 Legislature on
health education training needs for the South Texas Border Region. If you would like more information about the intent or
use of this document, contact Ms. Chris Fowler at the Texas Higher Education Coordinating Board at 512/483-6217.
1. The U.S. Department of Health and Human Services has designated 37 of the 43 South Texas border
counties as either whole or partial county health professional shortage areas. This means that these
counties are experiencing shortages of physicians, nurses, or other health professionals. How significant
would you rate each of the following as reasons for these shortage(s) in your area of South Texas?
(1=not a significant reason; 5=a very significant reason)
Not a Significant Reason
Very Significant Reason
Health Financing
insufficient no. of insured patients to support providers
low reimbursement rates from insurers/Medicaid/Medicare
insufficient local tax base to support health care delivery
inadequate State or Federal funding
1
1
1
1
2
2
2
2
3
3
3
3
4
4
4
4
5
5
5
5
Area Demographics
population growth
difficulty serving rural populations
severity of health problems in area
quality of life (e.g., schools, job opportunities for spouses)
1
1
1
1
2
2
2
2
3
3
3
3
4
4
4
4
5
5
5
5
Workforce/Providers
inadequate salaries for health care workers
difficulty attracting health care professionals
migration of qualified graduates/workers out of the area
supply of workers lags behind changes in market demand
lack of continuing education opportunities
professional isolation in rural areas
provider resistence to competition
provider competition from Mexico
provider reluctance to serve the uninsured & under-insured
1
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
2
2
3
3
3
3
3
3
3
3
3
4
4
4
4
4
4
4
4
4
5
5
5
5
5
5
5
5
5
Instruction and Training
inadequate no. of graduates from local health ed programs
lack of available instructors/faculty in health ed programs
lack of needed health education programs
inadequate no. of qualified students for existing programs
inadequate number of clinical training sites
inadequate number of medical residency programs
lack of a four-year medical school in area
inadequate health research facilities
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
2
3
3
3
3
3
3
3
3
4
4
4
4
4
4
4
4
5
5
5
5
5
5
5
5
Other_________________________________________
1
2
3
4
5
Of the reasons that are rated above, list the three most significant reasons for the shortages. Briefly describe each, explain its impact on the shortage(s), and how you are addressing it or would address it. 1)
2)
3)
2. To better meet the health education needs of your area of South Texas, which of the following
kinds of instructional or training programs (for the listed occupations) need to be added or
expanded? Please check all that are needed:
Medicine (MD, DO)
___ Undergraduate education
___ Residency Training - primary care
___ Residency Training - other specialties
___ Other ________________________________
Dentistry
___ Dentists (undergraduate)
___ Dentists (advanced practice)
___ Dental Hygienists
___ Dental Assistants
___ Other _______________________________
Nursing
___ Nurse Practitioners
___ Nurse Midwives
___ Nurses (BSN)
___
___
___
___
Nurses (AA)
Practical Nurses (LPN)
Nurse Assistants
Other _______________________________
Mental Health
___ Alcohol/Drug Counselor (Certificate/AA)
___ Licensed Counselors
___ Social Workers
___
___
___
___
Clinical Psychologist
Counseling Psychologists
School Psychologists
Other _______________________________
Pharmacy
___ Pharmacists (PharmD)
___ Pharmacy Technicians
___ Other _______________________________
Allied Health
___ Physician Assistants
___ Emergency Medical Technicians
___ Nuclear Medical Technicians
___ Medical Radiologic Technicians
___ Medical Assistants
___ Medical Laboratory Technicians
___ Clinical Lab Scientists
___ Audiologists/Speech Pathologists
Public Health
___ Public Health Administrators
___ Dieticians/Nutritionists
___ Environmental Health Workers
___ Public Health Sanitarians
___ Optometrists/Opticians
___ Respiratory Therapy Technicians
___ Physical Therapists
___ Physical Therapy Technicians
___ Occupational Therapists
___ Occupational Therapy Technicians
___ Vocational Rehabilitation Counselors
___ Other _______________________________
___ Epidemiologists
___
___
___
___
Community Health Workers (Promotores)
Public Health Nurses
Health Education & Promotion Specialists
Other _______________________________
Of the programs that are checked above, list the three which are most needed in your area of
South Texas. Briefly identify where you think these programs should be located, discuss any
special issues about curriculum content and describe how these programs should be delivered.
1)
2)
3)
Respondent: _________________________________________ Title: __________________________ Organization: _________________________________________ City: _____________________________ Thank you for completing this questionnaire.
APPENDIX
Section B: Workplace Profile
Please respond to the following questions about staffing issues for your workplace.
1. How many full-time equivalent employees (hired and contracted) do you currently have?
___ 1-25 employees
___ 26-50 employees
___ 51-100 employees
___ 101-200 employees
___ 201-400 employees
___ more than 400 employees
2. In which fields, do you hire or contract for health care professionals, and technical and
non-technical support staff? (For examples of positions in each field, see Section A, Question
2) Check all that apply:
___
___
___
___
Medicine
Dentistry
Nursing
Pharmacy
___
___
___
___
Allied Health
Mental Health
Public Health
Other _____________________________________
3. How many vacancies in professional positions (requiring a bachelor=s degree or better)
do you currently have? ___________
4. How many of those professional vacancies would be filled, if qualified applicants were
available? ___________
5. Which of the following staffing issues represent the greatest challenges for your
workplace? Check all that apply:
Applicants
___ Finding qualified applicants for advertised positions
___ Quality of recent hires from local higher education institutions
___ Filling specific professional positions (Positions requiring a bachelor=s degree or better)
Staff Turnover
___ Professional staff (Positions requiring a bachelor=s degree or better)
___ Technical staff (Positions requiring an associate=s degree or certificate)
___ Non-technical staff (Positions not requiring higher education)
Work Environment
___ Salaries and benefits
___ English and/or Spanish language skills of professional staff
Instruction and Training
___ Continuing education opportunities
___ Access to computer resources and instructional technology
___ Financial resources available for staff training and development
___ Other ___________________________________________________
Of the issues that are checked above, list the three most significant staffing challenges. Briefly
describe each issue and explain its impact on providing services, and how you are or would like to
address it.
1)
2)
3)
Questions 6-8 deal with ACGME and AOA accredited medical residency programs. If you do not
have a medical residency program, turn to the next page and complete the respondent information.
6. For the period from July 1, 1999 to June 30, 2000, list each residency program. For each
program, list the number of Approved Positions, the number of All Filled Positions of residents in
training, and finally, the number of All Filled Positions of residents in training who are IMGs
(International Medical Graduates, a subset of All Filled Positions).
Residency Program
Approved
Positions
All Filled
Positions
IMGs
1._____________________________________
______
______
______
2._____________________________________
______
______
______
3._____________________________________
______
______
______
4._____________________________________
______
______
______
5._____________________________________
______
______
______
6._____________________________________
______
______
______
7._____________________________________
______
______
______
Please attach additional sheets if needed.
7. How many residents are expected to complete the residency program(s) during the period
between July 1, 1999 and June 30, 2000: All Completers
IMG Completer
_________
_________
8. Of those residents expected to complete the residency program(s) during this period, how
many are expected to:
All Completers
IMG Completer
Continue their graduate education in South Texas _________
_________
Enter practice in South Texas _________
_________
Respondent: _________________________________ Title: ________________________
Organization: ________________________________ City: _________________________
Thank you for completing this questionnaire.
Section B: Degree Program Profile
The Coordinating Board would like to collect detailed information about specific programs that
will receive special attention in the report to the 77th Legislature. Please respond to the following
questions about the existing ___(merge)______________ program at ___(merge)_____________:
1.
Fall 1999 enrollment (headcount): _________
2. Maximum enrollment capacity (headcount) for Fall 1999: _________
3. Which of the following factors represent the greatest challenges to the program? Check all
that apply:
___
___
___
___
___
___
Students
Student interest in program exceeds program capacity
Student interest in program is less than program capacity
Academic preparation and readiness of students
Retention of students in the program
Local placement of graduates
Migration of graduates from South Texas
Employees
___ Faculty recruitment
___ Faculty turnover
___ Professional support staff recruitment/turnover
Physical and Technological Resources
___ Quality of facilities, labs and equipment
___ Computers and instructional telecommunications capabilities
___ Distance education opportunities
Collaborations
___ Partnerships with health care providers/clinical training sites
___ Partnerships with other educational institutions
___ Transferring credits across institutions
Other Support
___ Financial resources available for the program
___ Scholarships and other financial aid
___ Institutional support for program
___ Other ____________________________________________________________________
Of those factors that are checked above, list the three most significant challenges to the program.
Briefly describe each factor and explain its affect on the program=s success, and how you are or
would like to address it.
1)
2)
3)
Please attach any information that would support your comments,
e.g., retention data for students, employment data on graduates.
Respondent: __________________________________________ Title: _____________________________
Thank you for completing this questionnaire.
APPENDIX E
Retention Rates for All Students
Table 1
Percentage of First-time, Full-time Students Enrolled in Texas Public Four-year
Academic Institutions Who Returned to College for Their Second Year
Students
Returned to
Same
Institution
Any
Institution1
1998/99
Border
State
Region
Percentage of Students
1997/98
1996/97
Border
State
Border
State
Region
Region
1995/96
Border
State
Region
60.5%
72.3%
58.2%
70.9%
57.6%
70.1%
58.9%
69.6%
78.0%
85.7%
76.7%
84.3%
76.4%
84.0%
76.1%
83.8%
Source: Texas Higher Education Coordinating Board
Note:
1. Second row of percentages includes students who returned to either the same or another Texas
public higher education institution statewide.
Table 2
Percentage of First-time, Full- or Part-time Students Enrolled in Texas Public
Community/Technical Colleges Who Returned to College for Their Second Year
Students
Returned to
Same
Institution
Any
Institution3
1998/99
Border
State
Region2
Percentage of Students1
1997/98
1996/97
Border
State
Border
State
Region
Region
1995/96
Border
State
Region
47.7%
44.6%
45.6%
42.1%
46.1%
42.7%
47.5%
40.6%
57.7%
56.7%
54.6%
53.5%
54.8%
53.5%
55.5%
53.9%
Source: Texas Higher Education Coordinating Board
Notes:
1. Students who did not return to a Texas public higher education institution because they received
certificates during their first year are excluded from this analysis.
2. Alamo CCD NW Vista College is not included in this retention analysis due to the college’s recency.
3. Second row of percentages includes students who returned to either the same or another Texas
public higher education institution statewide.
APPENDIX F
Retention Rates for Students Enrolled in Health-related Programs
Table 1
Percentage of First-time, Full-time Students with Declared Majors in a Healthrelated Field at Texas Public Four-year Academic Institutions Who Continued in
the Same Major for Their Second Year
Students
Continued in
Health Major at
Same
Institution
Health Major at
Same or Other
Institution1
1998/99
Border
State
Region
Percentage of Students
1997/98
1996/97
Border
State
Border
State
Region
Region
1995/96
Border
State
Region
49.4%
51.5%
46.1%
50.7%
46.9%
49.8%
45.6%
50.8%
57.0%
57.4%
55.6%
57.2%
53.4%
56.0%
53.0%
57.1%
Source: Texas Higher Education Coordinating Board
Note:
1. Second row of percentages includes students who returned to either the same or another Texas
public higher education institution within the designated area (i.e., either within the Border region or
the state).
Table 2
Percentage of First-time, Full- or Part-time Students with Declared Majors in a Health-related
Field at Texas Public Community/Technical Colleges Who Continued in the Same
Major for Their Second Year
Students
Continued in
Health Major at
Same
Institution
Health Major at
Same or Other
Institution3
1998/99
Border
State
Region2
Percentage of Students1
1997/98
1996/97
Border
State
Border
State
Region
Region
1995/96
Border
State
Region
36.7%
33.4%
40.6%
38.1%
41.6%
37.7%
40.7%
35.3%
37.9%
36.7%
42.0%
41.6%
42.9%
41.3%
42.3%
41.4%
Source: Texas Higher Education Coordinating Board
Notes:
1. Students who did not return to a Texas public higher education institution because they received
certificates during their first year are excluded from this analysis.
2. Alamo CCD NW Vista College is not included in this retention analysis due to the college’s recency.
3. Second row of percentages includes students who returned to either the same or another Texas
public higher education institution within the designated area (i.e., either within the Border region or
the state).
APPENDIX G
Retention and Persistence Rates for Students by High School Diploma Type
Retention and Persistence of 1997 Freshmen in Health-related Programs
in the Border Region by High School Diploma Type
1997 Freshmen
Still Enrollled in
Fall 1998
“Retention Rate”
Fall 1999
“Persistence Rate”
With Either a Regular
or Advanced High
School Diploma
Percentage of Students1
With a Regular High
With an Advanced
School Diploma
High School Diploma2
68.0%
59.1%
75.1%
56.2%
41.7%
(regular diploma +
not “college ready” 3)
57.9%
(advanced diploma +
not college ready)
57.8%
(regular diploma +
college ready)
76.3%
(advanced diploma +
college ready)
Sources: Texas Education Agency and Texas Higher Education Coordinating Board
Notes:
1. Students include 1997 high school graduates who enrolled as full-time freshman in a Texas public four-year
academic institution in the Border region in Fall 1997 (or Spring/Summer 1998) with a declared major in a
health-related discipline, or who enrolled as full- or part-time freshman in a Texas public community college
in the Border region in Fall 1997 (or Spring/Summer 1998) with a declared major in a health-related
discipline.
2. Advanced high school diploma includes college preparatory courses.
3. College readiness defined as those students who either passed all three components of the Texas
Academic Skills Program (TASP) test (reading, writing, and math) or who were exempted from taking test
due to previous academic achievement.
APPENDIX H
Faculty Data for Border Region Institutions
Institution
General Academic Institution
Sul Ross State University
Sul Ross State University-Rio Grande College
Texas A&M International University
Texas A&M University-Corpus Christi
Texas A&M University-Kingsville
University of Texas at Brownsville
University of Texas at El Paso
University of Texas-Pan American
University of Texas at San Antonio
Total, General Academic Institutions
Total
Faculty
Percent
Non-Tenured
Percent
Part-time
Average *
Salary
161
40
155
418
403
176
835
694
858
25,063
52%
50%
31%
55%
39%
36%
50%
56%
57%
52%
19%
43%
21%
42%
18%
66%
25%
22%
36%
22%
$46,689
$45,482
$47,170
$47,781
$45,076
$46,557
$50,256
$48,810
$53,552
$57,246
Community & Technical Colleges
Alamo Community College District (Four Colleges)
Coastal Bend College
Del Mar College
El Paso Community College
Laredo Community College
Odessa College
South Texas Community College
Southwest Texas Junior College
Texas Southmost College
Texas State Technical College-Harlingen
Total, Community/Technical Colleges
1839
162
546
1203
303
278
461
193
336
157
23,415
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
61%
43%
46%
68%
42%
43%
61%
58%
72%
5%
61%
$41,271
$33,889
$41,927
$41,213
$40,821
$36,983
$33,078
$38,509
$40,042
$28,059
$39,855
Source: Texas Higher Education Coordinating Board, 1999 Statistical Report, 2000.
* For General Academic Institutions: Average faculty salaries for professors, associate professors, assistant
professors and instructors
* For Community and Technical Colleges: Average faculty salaries for full-time faculty
APPENDIX I
New Health-related Programs Introduced at Border Region Institutions Since January 1995
General Academic Institutions
University
Program Name
Degree (see end of table for
Date
abbreviation codes)
Texas A&M International University
NURSING
SOCIAL WORK
BSN
BS
1995
1999
Texas A&M University-Corpus Christi
ADULT NURSE PRACTITIONER
FAMILY NURSE PRACTITIONER
GENERAL NURSING
NURSING ADMINISTRATION
NURSING EDUCATION
PEDIATRIC NURSE PRACTITIONER
MSN
MSN
MSN
MSN
MSN
MSN
1997
1997
1997
1997
1997
1997
Texas A&M University-Kingsville
COMMUNICATION SCIENCES & DISORDERS
SOCIAL WORK
MS
BSW
1995
1997
The University of Texas at Brownsville
NURSING
PUBLIC HEALTH NURSING
BSN
MS
1995
2000
The University of Texas at El Paso
OCCUPATIONAL THERAPY
PHYSICAL THERAPY
BSOT
MPT
1997
1997
The University of Texas-Pan American
ADDICTION STUDIES
FAMILY NURSE PRACTITIONER
OCCUPATIONAL THERAPY
PHYSICIAN ASSISTANT STUDIES
REHABILITATION COUNSELING
SOCIAL WORK
BS
MSN
BS
BS
MS
MSSW
1999
1998
1999
1999
1997
1995
Health-related Institutions
Institution
Program Name
Degree (see end of table for
Date
abbreviation codes)
The University of Texas Health Science
Center at San Antonio
ACUTE NURSING CARE OF ADULTS
CLINICAL LAB SCIENCE
CLINICAL LABORATORY SCIENCES TOXICOLOGY
DENTAL HYGIENE
DENTAL HYGIENE
DENTAL LAB SCIENCE
EMERGENCY HEALTH SERVICE
HEALTH CARE SCIENCES
IMMUNOHEMATOLOGY
OCCUPATIONAL THERAPY
PEDIATRIC NURSE PRACTITIONER
PHYSICAL THERAPY
RADIALOGICAL SCIENCES
MSN
MS
MS
BS
MS
BS
BS
BSHCS
MS
MOT
MSN
MS
MS
1996
1996
1996
1996
1996
1995
2000
1995
1996
1998
1997
1995
1999
Community & Technical Colleges
College
Program Name
Award (see end of table for abbreviation codes)
Date
Alamo Community College District­
Northwest Vista College
COMMUNITY HEALTH
AAS
Community Health Liaison
1995
HEALTH ADMINISTRA TIVE SERVICES
CERT1 Health Unit Coordinator/Ward Clerk
CERT1 Medical Transcription
CERT2 Medical Transcription
1996
1996
1996
PHARMACY TECHNOLOGY
CERT1 Pharmacy Technician/Assistant
1996
Alamo Community College District­
Palo Alto College
VETERINARY TECHNOLOGY
AAS
Veterinarian Assistant/Animal Health Technician
CERT1 Veterinarian Assistant/Animal Health Technician
ESC
Veterinarian Assistant/Animal Health Technician
1995
1995
1995
Alamo Community College District­
San Antonio College
DENTAL ASSISTING TECHNOLOGY
ESC
Dental Assistant
CERT1 Dental Assistant
1997
2000
EMERGENCY MEDICAL SERVICES
AAS
CERT1
CERT2
CERT1
1999
1999
1999
2000
MEDICAL ASSISTING TECHNOLOGY
CERT1 Medical Assistant
1997
PHARMACY TECHNICIAN
CERT1 Pharmacy Technician/Assistant
2000
HEALTH UNIT COORDINATOR
CERT1 Medical Transcription
CERT1 Medical Records Technology/Technician
1997
1998
LICENSED VOCATIONAL NURSES TO RN
AAS
1997
MEDICAL LABORATORY TECHNICIAN
CERT2 Health & Medical Laboratory Technology/Technician,
Other
1999
RADIOGRAPHY TECHNOLOGY
CERT1 Diagnostic Medical Sonography Technician
ESC
Medical Radiologic Technology/Technician
1997
1998
RESPIRATORY CARE TECHNOLOGY
AAS
1996
EMERGENCY MEDICAL SERVICES
AAS
Emergency Medical Technology/Technician
CERT1 Emergency Medical Technology/Technician
2000
2000
HEALTH INFORMATION TECHNOLOGY
AAS
1995
VOCATIONAL NURSING
CERT1 Practical Nurse (LPN Training)
Alamo Community College District­
St. Phillip’s College
Coastal Bend College
Emergency Medical Technology/Technician
Emergency Medical Technology/Technician
Emergency Medical Technology/Technician
Emergency Medical Technology/Technician
Nursing, General
Respiratory Therapy Technician
Medical Records Technology/Technician
2000
College
Program Name
Award (see end of table for abbreviation codes)
Date
Del Mar College
EMERGENCY MEDICAL TECHNOLOGY
CERT1 Emergency Medical Technology/Technician
1998
HEALTH INFORMATION TECHNOLOGY
AAS
INTERPRETER FOR THE DEAF
Sign Language Interpreter
AAS
Sign Language Interpreter
ESC
CERT1 Sign Language Interpreter
MEDICAL LABORATORY TECHNOLOGY
ESC
Medical Laboratory Technician
1996
OCCUPATIONAL THERAPY ASSISTING
AAS
ESC
Occupational Therapy Assistant
Occupational Therapy Assistant
1996
1996
PHYSICAL THERAPIST ASSISTING
AAS
ESC
Physical Therapy Assistant
Physical Therapy Assistant
1996
1996
RADIOLOGIC TECHNOLOGY
ESC
Medical Radiologic Technology/Technician
1996
REGISTERED NURSE EDUCATION
ESC
Nursing, General
1996
RESPIRATORY THERAPY
ESC
Respiratory Therapy Technician
1996
SURGICAL TECHNOLOGY
ESC
Surgical/Operating Room Technician
1996
DENTAL ASSISTING
Dental Assistant
ESC
Dental Hygienist
ESC
CERT1 Dental Assistant
1997
1997
2000
DIETETIC TECHNOLOGY
ESC
Medical Dietician
1997
MEDICAL ASSISTING TECHNOLOGY
Medical Assistant
ESC
CERT1 Medical Assistant
1997
2000
MEDICAL LABORATORY TECHNOLOGY
ESC
NUCLEAR MEDICINE TECHNOLOGY
Medical Radiologic Technology/Technician
ESC
CERT1 Diagnostic Medical Sonography Technician
1996
1998
NURSING
CERT1 Nursing Assistant/Aide
Nursing, General
ESC
1995
1996
OPHTHALMIC TECHNOLOGY
ESC
Opticianry/Dispensing Optician
1997
PHYSICAL THERAPIST ASSISTANT
ESC
Physical Therapy Assistant
1996
RESPIRATORY CARE TECHNOLOGY
ESC
Respiratory Therapy Technician
1996
SURGICAL TECHNOLOGY
ESC
Surgical/Operating Room Technician
1996
El Paso Community College
Medical Records Technology/Technician
Medical Laboratory Technician
1999
1996
1996
1999
1996
College
Program Name
Award (see end of table for abbreviation codes)
Date
Laredo Community College
HUMAN SERVICES
CERT1 Psychiatric/Mental Health Services Technician
1995
MEDICAL LABORATORY TECHNOLOGY
CERT1 Medical Laboratory Technician
1997
MEDICAL OFFICE ASSISTING
CERT1 Medical Assistant
1995
NURSING ASSISTING
CERT1 Nursing Assistant/Aide
1998
OCCUPATIONAL THERAPY ASSISTING
AAS
EMERGENCY MEDICAL TECHNOLOGY
CERT2 Emergency Medical Technology/Technician
2000
NURSING
CERT1 Practical Nurse (LPN Training)
CERT2 Practical Nurse (LPN Training)
2000
2000
EMERGENCY MEDICAL TECHNOLOGY
CERT1 Emergency Medical Technology/Technician
1999
HEALTH AND HUMAN SERVICES
AAS
Odessa College
South Texas Community College
Occupational Therapy Assistant
Community Health Liaison
Medical Records TechnologyTechnician
CERT1 Health Unit Coordinator/Ward Clerk
Medical Records Technology/Technician
ESC
HEALTH UNIT COORDINATION TECHNOLOGY AAS
1997
1995
1996
1996
1997
NURSING
AAS
Nursing, General
1998
OCCUPATIONAL THERAPY ASSISTING
AAS
Occupational Therapy Assistant
1997
PATIENT CARE ASSISTANT
CERT1 Nursing Assistant/Aide
PHYSICAL THERAPY ASSISTING
AAS
Physical Therapy Assistant
1998
RADIOLOGIC TECHNOLOGY
AAS
Medical Radiologic Technology/Technician
1997
VOCATIONAL NURSING
CERT2 Practical Nurse (LPN Training)
Texas Southmost College
RADIOLOGIC TECHNOLOGY
AAS
Texas State Technical College Harlingen
DENTAL ASSISTING
CERT1 Dental Assistant
1998
EMERGENCY MEDICAL TECHNOLOGY
CERT1 Emergency Medical Records Technology/Technician
2000
HEALTH INFORMATION TECHNOLOGY
ESC
Diagnostic Medical Sonography Technician
Medical Records Technology/Technician
1995
1995
2000
1997
Abbreviation Codes
AAS
BS
BSHCS
BSN
BSOT
BSW
CERT 1
CERT 2
ESC
MOT
MPT
MS
MSN
MSSW
Associate’s degree
Bachelor of Science degree
Bachelor of Science in Health Care Sciences degree
Bachelor of Science in Nursing degree
Bachelor of Science in Occupational Therapy degree
Bachelor of Social Work degree
Level One Certificate
Level Two Certificate
Enhanced Skills Certificate
Master in Occupational Therapy degree
Master of Physical Therapy degree
Master of Science degree
Master of Science in Nursing degree
Master of Science in Social Work degree
APPENDIX J
Health Facilities Data by County
Local Health Departments, Rural Health Clinics*, and Certified EMS Personnel
Texas Border Counties and the State, 1998
County Name
Bexar
Total Population
EMS
EMS
Local Health Rural Health Personnel Personnel/
Depts
Clinics*
certified
sq. mile
EMS
Personnel/
100,000
population
1,351,304
1
1
2,173
1.74
161
Cameron
317,240
1
5
371
0.41
117
El Paso
690,855
1
1
1,290
1.27
187
Hidalgo
522,081
1
6
448
0.29
86
Nueces
311,752
1
4
859
1.03
276
San Patricio
Webb
URBAN TOTAL
69,387
1
7
177
0.26
255
193,743
1
0
296
0.09
153
3,456,362
7
24
5,614
0.58
162
Atascosa
35,294
1
6
75
0.06
213
Bandera
15,505
0
1
72
0.09
464
Brewster
9,205
0
4
50
0.01
543
Brooks
8,434
0
2
24
0.03
285
Crockett
4,617
0
0
32
0.01
693
Culberson
3,189
0
1
10
0.00
314
Dimmit
10,635
0
0
11
0.01
103
Duval
13,620
0
4
39
0.02
286
3,111
0
0
15
0.01
482
15,638
0
3
23
0.02
147
Hudspeth
3,169
0
0
8
0.00
252
Jeff Davis
2,080
0
0
28
0.01
1346
Edwards
Frio
Jim Hogg
5,019
0
1
7
0.01
139
Jim Wells
40,014
0
4
87
0.10
217
Kenedy
422
0
0
0
0.00
0
43,264
0
0
85
0.08
196
Kimble
4,315
0
1
25
0.02
579
Kinney
3,454
0
0
10
0.01
290
Kleberg
31,141
0
2
58
0.07
186
Kerr
La Salle
6,129
0
2
6
0.00
98
Live Oak
10,036
1
4
31
0.03
309
755
0
0
9
0.01
1192
Maverick
McMullen
46,421
0
5
59
0.05
127
Medina
35,133
1
5
81
0.06
231
Pecos
15,919
0
2
68
0.01
427
Presidio
7,665
0
2
21
0.01
274
Real
2,595
0
0
25
0.04
963
Reeves
14,999
0
2
55
0.02
367
Starr
51,679
0
4
49
0.04
95
4,502
0
0
32
0.02
711
Sutton
Terrell
1,160
0
1
13
0.01
1121
Uvalde
25,066
1
8
69
0.04
275
Val Verde
43,307
0
5
61
0.02
141
Willacy
19,185
0
0
48
0.08
250
Zapata
10,672
0
1
25
0.03
234
Zavala
11,894
0
1
13
0.01
109
559,243
4
71
1,324
0.02
237
4,015,605
11
95
6,938
0.09
173
REMAINDER OF STATE
15,743,914
53
312
35,549
0.19
226
TEXAS
19,759,614
64
407
42,864
0.16
217
RURAL TOTAL
BORDER COUNTY TOTAL
*Rural Health Clinic: a facility located in a rural area designated as a shortage area, and is neither a
rehabilitation agency nor a facility primarily for the care and treatment of mental diseases. A shortage
area is a defined geographic area, designated as having either a shortage of personal health services
or a shortage of primary medical care manpower.
Sources: Health Facility Licensing and Compliance Division, Bureau of Regional/Local Health Operations,
and Bureau of Emergency Management, Texas Department of Health.
Number of Ambulatory Surgical Centers, End Stage Renal Disease Facilities, and
Birthing Centers
Texas Border Counties and the State, 1998
County Name
Bexar
# Ambulatory
Total Population Surgical Centers
# of End Stage
Renal Disease
Facilities
# of ESRD
Stations
ESRD Stations
per 100,000
population
# Birthing
Centers
564
42
0
1,351,304
18
26
Cameron
317,240
4
3
95
30
5
El Paso
690,855
8
9
184
27
3
Hidalgo
522,081
6
8
170
33
9
Nueces
311,752
5
7
130
42
0
San Patricio
Webb
URBAN TOTAL
69,387
0
2
28
40
0
193,743
1
2
45
23
1
3,456,362
42
57
1,216
35
18
Atascosa
35,294
0
0
0
0
0
Bandera
15,505
0
0
0
0
0
Brewster
9,205
0
0
0
0
0
Brooks
8,434
0
0
0
0
0
Crockett
4,617
0
0
0
0
0
Culberson
3,189
0
0
0
0
0
Dimmit
10,635
0
0
0
0
0
Duval
13,620
0
0
0
0
0
3,111
0
0
0
0
0
15,638
0
1
11
70
0
Hudspeth
3,169
0
0
0
0
0
Jeff Davis
2,080
0
0
0
0
0
Jim Hogg
5,019
0
0
0
0
0
Jim Wells
40,014
0
2
26
65
0
Edwards
Frio
Kenedy
422
0
0
0
0
0
43,264
1
1
15
35
0
Kimble
4,315
0
0
0
0
0
Kinney
3,454
0
0
0
0
0
Kleberg
31,141
0
1
15
48
0
La Salle
6,129
0
0
0
0
0
Live Oak
10,036
0
0
0
0
0
755
0
0
0
0
0
Maverick
46,421
1
1
24
52
1
Medina
35,133
0
1
8
23
0
Pecos
15,919
0
0
0
0
0
Presidio
7,665
0
0
0
0
0
Real
2,595
0
0
0
0
0
Reeves
14,999
0
0
0
0
0
Starr
Kerr
McMullen
51,679
0
2
25
48
0
Sutton
4,502
0
0
0
0
0
Terrell
1,160
0
0
0
0
0
Uvalde
25,066
0
1
16
64
0
Val Verde
43,307
0
1
14
32
3
Willacy
19,185
0
0
0
0
0
Zapata
10,672
0
0
0
0
0
Zavala
11,894
0
0
0
0
0
559,243
2
11
154
28
4
BORDER TOTAL
4,015,605
44
68
1,370
34
22
REMAINDER OF
STATE
15,743,914
174
187
3,589
23
18
TEXAS
19,759,614
218
255
4,959
25
40
RURAL TOTAL
Source: Health Facility Licensing and Compliance Division, Texas Department of Health.
Acute Care Hospitals, Licensed Beds, and Staffed Beds
Texas Border Counties and the State, 1998
County Name
Total Population
Acute Care Hospitals
Licensed Beds
Staffed Beds
Staffed Beds
per 1,000
1,351,304
24
5,415
4,473
3.3
Cameron
317,240
5
1,121
852
2.7
El Paso
690,855
8
2,062
1,728
2.5
Hidalgo
522,081
9
1,393
1,307
2.5
Nueces
311,752
10
1,864
1,593
5.1
69,387
1
75
69
1.0
193,743
2
453
437
2.3
3,456,362
59
12,383
10,459
3.0
Atascosa
35,294
1
65
30
0.9
Bandera
15,505
0
0
0
0.0
Brewster
9,205
1
50
25
2.7
Brooks
8,434
0
0
0
0.0
Crockett
4,617
0
0
0
0.0
Culberson
3,189
1
25
25
7.8
Dimmit
10,635
1
48
35
3.3
Duval
13,620
0
0
0
0.0
3,111
0
0
0
0.0
15,638
2
40
40
2.6
Hudspeth
3,169
0
0
0
0.0
Jeff Davis
2,080
0
0
0
0.0
Jim Hogg
5,019
0
0
0
0.0
Jim Wells
40,014
1
131
120
3.0
422
0
0
0
0.0
43,264
3
200
182
4.2
Kimble
4,315
1
18
15
3.5
Kinney
3,454
0
0
0
0.0
Kleberg
31,141
1
100
100
3.2
La Salle
6,129
0
0
0
0.0
10,036
0
0
0
0.0
755
0
0
0
0.0
Maverick
46,421
1
77
69
1.5
Medina
35,133
1
34
27
0.8
Pecos
15,919
2
51
44
2.8
Presidio
7,665
0
0
0
0.0
Real
2,595
0
0
0
0.0
Reeves
14,999
1
49
44
2.9
Starr
51,679
1
44
44
0.9
Sutton
4,502
1
21
13
2.9
Terrell
1,160
0
0
0
0.0
Uvalde
25,066
1
62
51
2.0
Val Verde
43,307
1
93
76
1.8
Willacy
19,185
0
0
0
0.0
Zapata
10,672
0
0
0
0.0
Zavala
11,894
0
0
0
0.0
Bexar
San Patricio
Webb
URBAN TOTAL
Edwards
Frio
Kenedy
Kerr
Live Oak
McMullen
RURAL TOTAL
559,243
21
1,108
940
1.7
4,015,605
80
13,491
11,399
2.8
REMAINDER OF STATE
15,743,914
397
59,063
46,321
2.9
TEXAS
19,759,614
477
72,554
57,720
2.9
BORDER TOTAL
Source: TDH/AHA/THA Annual Survey of Hospitals, Office
of Policy and Planning, Texas Department Health.
Nursing Homes and Licensed Beds
Texas Border Counties and the State, 1998
County Name
Total Population
Nursing Homes
Licensed
Beds
Licensed Beds per
1,000 population
1,351,304
54
6,636
4.9
Cameron
317,240
12
1,255
4.0
El Paso
690,855
11
1,318
1.9
Hidalgo
522,081
14
1,563
3.0
Nueces
311,752
15
1,955
6.3
69,387
4
472
6.8
193,743
3
440
2.3
3,456,362
113
13,639
3.9
Atascosa
35,294
5
326
9.2
Bandera
15,505
1
62
4.0
Brewster
9,205
1
56
6.1
Brooks
8,434
1
98
11.6
Crockett
4,617
1
56
12.1
Culberson
3,189
0
0
0.0
Dimmit
10,635
1
100
9.4
Duval
13,620
1
90
6.6
3,111
0
0
0.0
15,638
2
183
11.7
Hudspeth
3,169
0
0
0.0
Jeff Davis
2,080
0
0
0.0
Jim Hogg
5,019
0
0
0.0
Jim Wells
40,014
4
499
12.5
Bexar
San Patricio
Webb
URBAN TOTAL
Edwards
Frio
Kenedy
422
0
0
0.0
43,264
5
513
11.9
Kimble
4,315
1
70
16.2
Kinney
3,454
0
0
0.0
Kleberg
31,141
1
162
5.2
La Salle
6,129
0
0
0.0
Live Oak
10,036
2
174
17.3
0.0
Kerr
McMullen
755
0
0
Maverick
46,421
1
120
2.6
Medina
35,133
4
409
11.6
Pecos
7.5
15,919
1
120
Presidio
7,665
0
0
0.0
Real
2,595
1
86
33.1
Reeves
14,999
1
90
6.0
Starr
51,679
1
100
1.9
Sutton
4,502
1
39
8.7
Terrell
1,160
0
0
0.0
Uvalde
25,066
2
315
12.6
Val Verde
43,307
3
268
6.2
Willacy
19,185
1
120
6.3
Zapata
10,672
0
0
0.0
Zavala
11,894
0
0
0.0
559,243
42
4,056
7.3
4,015,605
155
17,695
4.4
REMAINDER OF STATE
15,743,914
1,008
109,742
7.0
TEXAS
19,759,614
1,163
127,437
6.4
RURAL TOTAL
BORDER TOTAL
Source: Texas Department of Human Services, Bureau of Long Term
Care, Texas Department of Human Services, Long Term
Regulatory, Directory of Nursing Facillities, January 5, 1999.
Community Health Centers
By Migrant Health Designation and Counties Served, Texas Border Counties, 1999
Community Health Center Name
Sites Designated as
Migrant Health Clinics
County Served by Clinic
Atascosa Rural Health Clinic
Atascosa
Barrio Comprehensive Family Hlth Care Center, Inc.
Bexar
Brownsville Community Health Center
Yes
Cameron
Centro de Salud
El Paso
Centro San Vicente
El Paso
Chaparral Health Clinic Corporation
Duval
Community Action Council of S. Texas
Duval, Jim Hogg, Starr, Zapata
El Centro Del Barrio
Bexar
Gateway Community Hlth Centers, Inc.
Yes
La Esperanza Clinic
Webb
Crocket, Sutton
Nuestra Clinica Del Valle
Yes
Hidalgo
South Texas Rural hlth Srvcs, Inc.
Yes
Dimmit, Frio, La Salle, Medina
Su Clinica Familiar
Yes
Cameron, Hidalgo, Willacy
United Medical Centers
Yes
Kinney, Maverick, Val Verde
Uvalde County Clinic, Inc
Yes
Edwards, Real, Uvalde, Zavala
Vida Y Salud Health Systems, Inc.
Yes
Dimmit, La Salle, Uvalde, Zavala
Total of 23 border counties
Source: Texas Association of Community Health Centers,
Membership Directory, 1999
APPENDIX K
Population-to-Provider Data by County
Primary Care Physicians
Texas Border Counties and the State, 1999
County Name
Population
Providers
Population to Provider Ratio
1,360,411
983
1,384
Cameron
328,158
183
1,793
El Paso
755,339
286
2,641
Hidalgo
528,300
295
1,791
Nueces
315,965
289
1,093
67,988
26
2,615
182,195
77
2,366
3,538,356
2,139
1,654
Bexar
San Patricio
Webb
URBAN TOTAL
Atascosa
36,915
10
3,692
Bandera
13,915
1
13,915
Brewster
10,814
4
2,704
Brooks
8,959
1
8,959
Crockett
4,310
2
2,155
Culberson
4,101
1
4,101
Dimmit
11,251
6
1,875
Duval
14,676
2
7,338
2,497
1
2,497
16,456
4
4,114
Hudspeth
3,347
0
0
Jeff Davis
2,184
1
2,184
Edwards
Frio
Jim Hogg
6,290
2
3,145
Jim Wells
39,837
18
2,213
520
0
0
41,958
36
1,166
Kimble
4,121
2
2,061
Kinney
3,341
1
3,341
Kleberg
32,089
16
2,006
La Salle
6,408
1
6,408
Live Oak
10,026
2
5,013
866
0
0
Kenedy
Kerr
McMullen
Maverick
44,277
20
2,214
Medina
34,164
8
4,271
Pecos
17,617
4
4,404
Presidio
8,502
0
0
Real
2,518
2
1,259
Reeves
17,050
4
4,263
Starr
61,722
7
8,817
Sutton
4,506
2
2,253
Terrell
1,522
0
0
Uvalde
25,872
15
1,725
Val Verde
44,190
18
2,455
Willacy
19,915
11
1,810
Zapata
12,866
3
4,289
Zavala
13,745
4
3,436
583,347
209
2,791
RURAL TOTAL
4,121,703
2,348
1,752
REMAINDER OF STATE
15,873,725
10,457
1,518
TEXAS
19,995,428
12,805
1,562
BORDER COUNTY TOTAL
Source: Texas State Board of Medical Examiners, 1999.
Physician Assistants
Texas Border Counties and the State, 1999
County Name
Population
Providers
Population to Provider Ratio
1,360,411
156
8,721
Cameron
328,158
19
17,271
El Paso
755,339
34
22,216
Hidalgo
528,300
39
13,546
Nueces
315,965
22
14,362
67,988
9
7,554
182,195
1
182,195
3,538,356
280
12,637
Atascosa
36,915
5
7,383
Bandera
13,915
2
6,958
Brewster
10,814
5
2,163
Brooks
8,959
2
4,480
Crockett
4,310
2
2,155
Culberson
4,101
0
0
Dimmit
11,251
1
11,251
Duval
14,676
5
2,935
2,497
0
0
16,456
3
5,485
Hudspeth
3,347
0
0
Jeff Davis
2,184
0
0
Jim Hogg
6,290
0
0
Jim Wells
39,837
5
7,967
Bexar
San Patricio
Webb
URBAN TOTAL
Edwards
Frio
520
0
0
41,958
6
6,993
4,121
1
4,121
Kinney
3,341
0
0
Kleberg
32,089
2
16,045
La Salle
6,408
1
6,408
Live Oak
10,026
2
5,013
866
6
144
Maverick
44,277
0
0
Medina
34,164
6
5,694
Pecos
Kenedy
Kerr
Kimble
McMullen
17,617
2
8,809
Presidio
8,502
2
4,251
Real
2,518
0
0
Reeves
17,050
1
17,050
Starr
6,172
61,722
10
Sutton
4,506
0
0
Terrell
1,522
1
1,522
Uvalde
25,872
7
3,696
Val Verde
44,190
7
6,313
Willacy
19,915
2
9,958
Zapata
12,866
0
0
Zavala
13,745
3
4,582
583,347
89
6,554
4,121,703
369
11,170
REMAINDER OF STATE
15,873,725
1,524
10,416
TEXAS
19,995,428
1,893
10,563
RURAL TOTAL
BORDER COUNTY TOTAL
Source: Texas State Board of Medical Examiners, 1999.
General Dentists
Texas Border Counties and the State, 1999
County Name
Population
Providers
Population to Provider Ratio
1,360,411
572
2,378
Cameron
328,158
54
6,077
El Paso
755,339
118
6,401
Hidalgo
528,300
87
6,072
Nueces
315,965
109
2,899
67,988
16
4,249
182,195
19
9,589
3,538,356
975
3,629
Atascosa
36,915
9
4,102
Bandera
13,915
1
13,915
Brewster
5,407
Bexar
San Patricio
Webb
URBAN TOTAL
10,814
2
Brooks
8,959
0
0
Crockett
4,310
1
4,310
Culberson
4,101
0
0
Dimmit
11,251
1
11,251
Duval
14,676
0
0
2,497
0
0
16,456
3
5,485
Hudspeth
3,347
0
0
Jeff Davis
2,184
1
2,184
Jim Hogg
6,290
0
0
Jim Wells
39,837
6
6,640
Edwards
Frio
520
0
0
41,958
21
1,998
Kimble
4,121
2
2,061
Kinney
3,341
1
3,341
Kleberg
32,089
13
2,468
La Salle
6,408
0
0
Live Oak
10,026
2
5,013
Kenedy
Kerr
866
4
11,069
McMullen
44,277
0
0
Medina
34,164
6
5,694
Pecos
17,617
2
8,809
Presidio
8,502
0
0
Real
2,518
0
0
Reeves
17,050
3
5,683
Starr
Maverick
61,722
4
15,431
Sutton
4,506
1
4,506
Terrell
1,522
0
0
Uvalde
25,872
5
5,174
Val Verde
44,190
9
4,910
Willacy
19,915
3
6,638
Zapata
12,866
1
12,866
Zavala
13,745
0
0
583,347
101
5,776
4,121,703
1,076
3,831
REMAINDER OF STATE
15,873,725
6,201
2,560
TEXAS
19,995,428
7,277
2,748
RURAL TOTAL
BORDER COUNTY TOTAL
Source: Texas State Board of Dental Examiners, 1999.
Registered Nurses
Texas Border Counties and the State, 1999
County Name
Population
Providers
Population to Provider Ratio
1,360,411
10,418
131
Cameron
328,158
1,372
239
El Paso
755,339
3,160
239
Hidalgo
528,300
2,117
250
Nueces
315,965
2,528
125
67,988
146
466
182,195
621
293
3,538,356
20,362
174
Atascosa
36,915
76
486
Bandera
13,915
39
357
Brewster
10,814
42
257
Brooks
8,959
17
527
Crockett
4,310
15
287
Culberson
4,101
8
513
Dimmit
11,251
26
433
Duval
14,676
14
1,048
2,497
Bexar
San Patricio
Webb
URBAN TOTAL
2,497
1
16,456
38
433
Hudspeth
3,347
2
1,674
Jeff Davis
2,184
5
437
Jim Hogg
6,290
11
572
39,837
126
316
520
0
0
Edwards
Frio
Jim Wells
Kenedy
41,958
416
101
Kimble
4,121
22
187
Kinney
3,341
4
835
Kleberg
32,089
114
281
La Salle
6,408
55
117
Live Oak
10,026
15
668
866
1
866
Maverick
44,277
110
403
Medina
34,164
93
367
Pecos
17,617
50
352
8,502
8
1,063
Kerr
McMullen
Presidio
2,518
10
252
Reeves
17,050
32
533
Starr
61,722
64
964
Sutton
4,506
16
282
Terrell
1,522
2
761
Uvalde
25,872
100
259
Val Verde
44,190
157
281
Willacy
19,915
30
664
Zapata
12,866
11
1,170
Real
Zavala
RURAL TOTAL
BORDER COUNTY TOTAL
13,745
8
1,718
583,347
1,738
336
4,121,703
22,100
187
REMAINDER OF STATE
15,873,725
96,829
164
TEXAS
19,995,428
118,929
168
Source: Texas Board of Nurse Examiners, 1999.
Advanced Practice Nurses
Texas Border Counties and the State, 1999
County Name
Bexar
Population
Providers
Population to Provider Ratio
1,360,411
416
3,270
Cameron
328,158
55
5,967
El Paso
755,339
144
5,245
Hidalgo
528,300
76
6,951
Nueces
315,965
79
4,000
67,988
5
13,598
182,195
31
5,877
San Patricio
Webb
URBAN TOTAL
3,538,356
806
4,390
Atascosa
36,915
2
18,458
Bandera
13,915
1
13,915
Brewster
10,814
5
2,163
Brooks
8,959
0
0
Crockett
4,310
0
0
Culberson
4,101
1
4,101
Dimmit
11,251
2
5,626
Duval
14,676
1
14,676
Edwards
2,497
0
0
16,456
2
8,228
Hudspeth
3,347
0
0
Jeff Davis
2,184
1
2,184
Jim Hogg
6,290
1
6,290
Jim Wells
39,837
1
39,837
520
0
0
41,958
12
3,497
Kimble
4,121
0
0
Kinney
3,341
0
0
Kleberg
32,089
0
0
La Salle
6,408
2
3,204
Live Oak
10,026
0
0
Maverick
44,277
6
7,380
Frio
Kenedy
Kerr
McMullen
866
0
0
Medina
34,164
4
8,541
Pecos
17,617
4
4,404
Presidio
8,502
0
0
Real
2,518
0
0
Reeves
17,050
1
17,050
Starr
61,722
1
61,722
Sutton
4,506
0
0
Terrell
1,522
0
0
Uvalde
25,872
4
6,468
Val Verde
44,190
8
5,524
Willacy
19,915
2
9,958
Zapata
12,866
0
0
Zavala
13,745
0
0
583,347
61
9,563
4,121,703
867
4,754
REMAINDER OF STATE
15,873,725
4,177
3,800
TEXAS
19,995,428
5,044
3,964
RURAL TOTAL
BORDER COUNTY TOTAL
Source: Texas Board of Nurse Examiners, 1999.
Certified Nurse Midwives
Texas Border Counties and the State, 1999
County Name
Population
Providers
Population to Provider Ratio
1,360,411
3
453,470
Cameron
328,158
10
32,816
El Paso
755,339
16
47,209
Hidalgo
528,300
7
75,471
Nueces
315,965
1
315,965
Bexar
67,988
0
0
182,195
0
0
3,538,356
37
95,631
Atascosa
36,915
0
0
Bandera
13,915
0
0
Brewster
10,814
0
0
Brooks
8,959
0
0
Crockett
4,310
0
0
San Patricio
Webb
URBAN TOTAL
4,101
0
0
Dimmit
11,251
0
0
Duval
14,676
0
0
2,497
0
0
16,456
0
0
Hudspeth
3,347
0
0
Jeff Davis
2,184
0
0
Jim Hogg
6,290
0
0
Jim Wells
39,837
0
0
520
0
0
41,958
0
0
Kimble
4,121
0
0
Kinney
3,341
0
0
Kleberg
32,089
0
0
La Salle
6,408
0
0
Live Oak
10,026
0
0
Culberson
Edwards
Frio
Kenedy
Kerr
866
0
0
Maverick
44,277
1
44,277
Medina
34,164
0
0
Pecos
17,617
0
0
Presidio
8,502
0
0
Real
2,518
0
0
Reeves
17,050
0
0
Starr
61,722
1
61,722
Sutton
4,506
0
0
Terrell
1,522
0
0
Uvalde
25,872
0
0
Val Verde
44,190
0
0
Willacy
19,915
0
0
Zapata
12,866
0
0
Zavala
13,745
0
0
583,347
2
291,674
McMullen
RURAL TOTAL
4,121,703
39
105,685
REMAINDER OF TEXAS
15,873,725
164
96,791
TEXAS
19,995,428
203
98,500
BORDER COUNTY TOTAL
Source: Texas Board of Nurse Examiners, 1999.
Nurse Practitioners
Texas Border Counties and the State, 1999
Population
Providers
Population to Provider Ratio
1,360,411
177
7,686
Cameron
328,158
29
11,316
El Paso
755,339
61
12,383
Hidalgo
528,300
43
12,286
Nueces
315,965
48
6,583
67,988
5
13,598
182,195
19
9,589
3,538,356
382
9,263
Atascosa
36,915
1
36,915
Bandera
13,915
1
13,915
Brewster
10,814
4
2,704
Brooks
8,959
0
0
Crockett
4,310
0
0
Culberson
4,101
1
4,101
Dimmit
11,251
1
11,251
Duval
14,676
0
0
2,497
0
0
16,456
County Name
Bexar
San Patricio
Webb
URBAN TOTAL
Edwards
16,456
1
Hudspeth
3,347
0
0
Jeff Davis
2,184
1
2,184
Jim Hogg
6,290
0
0
Jim Wells
39,837
1
39,837
Frio
520
0
0
41,958
7
5,994
Kimble
4,121
0
0
Kinney
3,341
0
0
Kleberg
32,089
0
0
La Salle
6,408
2
3,204
Live Oak
10,026
0
0
866
0
0
Maverick
44,277
4
11,069
Medina
34,164
3
11,388
17,617
4
4,404
8,502
0
0
0
Kenedy
Kerr
McMullen
Pecos
Presidio
2,518
0
Reeves
17,050
0
0
Starr
61,722
1
61,722
Sutton
4,506
0
0
Terrell
1,522
0
0
Uvalde
25,872
2
12,936
Val Verde
44,190
3
14,730
Willacy
19,915
2
9,958
Zapata
12,866
0
0
Zavala
13,745
0
0
Real
583,347
39
14,958
4,121,703
421
9,790
REMAINDER OF TEXAS
15,873,725
2,109
7,527
TEXAS
19,995,428
2,530
7,903
RURAL TOTAL
BORDER COUNTY TOTAL
Source: Texas Board of Nurse Examiners, 1999.
Psychiatrists
Texas Border Counties and the State, 1999
County Name
Population
Providers
Population to Provider Ratio
1,360,411
144
9,447
Cameron
328,158
10
32,816
El Paso
755,339
35
21,581
Hidalgo
528,300
13
40,638
Nueces
315,965
25
12,639
67,988
0
0
182,195
0
0
3,538,356
227
15,587
Atascosa
36,915
2
18,458
Bandera
13,915
0
0
Brewster
10,814
1
10,814
Brooks
8,959
0
0
Crockett
4,310
0
0
Culberson
4,101
0
0
Dimmit
11,251
0
0
Duval
14,676
0
0
2,497
0
0
16,456
0
0
Hudspeth
3,347
0
0
Jeff Davis
2,184
0
0
Jim Hogg
6,290
0
0
Jim Wells
39,837
0
0
520
1
520
Bexar
San Patricio
Webb
URBAN TOTAL
Edwards
Frio
Kenedy
41,958
14
2,997
Kimble
4,121
0
0
Kinney
3,341
0
0
Kleberg
32,089
0
0
La Salle
6,408
0
0
Live Oak
10,026
0
0
866
0
0
Maverick
44,277
1
44,277
Medina
34,164
0
0
Pecos
17,617
0
0
Presidio
8,502
0
0
Real
2,518
0
0
Reeves
17,050
0
0
Starr
61,722
0
0
Sutton
4,506
0
0
Terrell
1,522
0
0
Uvalde
25,872
0
0
Val Verde
44,190
1
44,190
Willacy
19,915
0
0
Zapata
12,866
0
0
13,745
0
0
583,347
20
29,167
Kerr
McMullen
Zavala
RURAL TOTAL
4,121,703
247
16,687
REMAINDER OF STATE
15,873,725
1,104
14,378
TEXAS
19,995,428
1,351
14,800
BORDER COUNTY TOTAL
Source: Texas State Board of Medical Examiners, 1999.
Licensed Psychologists
Texas Border Counties and the State, 1999
County Name
Bexar
Population
Providers
Population to Provider Ratio
1,360,411
278
4,894
Cameron
328,158
8
41,020
El Paso
755,339
41
18,423
Hidalgo
528,300
28
18,868
Nueces
315,965
42
7,523
67,988
2
33,994
182,195
5
36,439
3,538,356
404
8,758
San Patricio
Webb
URBAN TOTAL
Atascosa
36,915
1
36,915
Bandera
13,915
3
4,638
Brewster
10,814
3
3,605
Brooks
8,959
0
0
Crockett
4,310
0
0
Culberson
4,101
0
0
Dimmit
11,251
0
0
Duval
14,676
0
0
2,497
0
0
16,456
0
0
Hudspeth
3,347
0
0
Jeff Davis
2,184
0
0
Jim Hogg
6,290
0
0
Jim Wells
39,837
1
39,837
Edwards
Frio
Kenedy
520
0
0
41,958
6
6,993
Kimble
4,121
1
4,121
Kinney
3,341
0
0
Kleberg
32,089
2
16,045
La Salle
6,408
0
0
Live Oak
10,026
1
10,026
866
0
0
Maverick
44,277
0
0
Medina
34,164
0
0
Pecos
17,617
0
0
Presidio
8,502
0
0
Real
2,518
0
0
Reeves
17,050
0
0
Starr
61,722
0
0
Sutton
4,506
0
0
Terrell
1,522
0
0
Uvalde
25,872
0
0
Val Verde
44,190
0
0
Willacy
19,915
0
0
Zapata
12,866
0
0
Kerr
McMullen
Zavala
RURAL TOTAL
BORDER COUNTY TOTAL
13,745
0
0
583,347
18
32,408
4,121,703
422
9,767
REMAINDER OF STATE
15,873,725
2,588
6,134
TEXAS
19,995,428
3,010
6,643
Source: Texas State Board of Examiners of Psychologists, 1999.
Social Workers
Texas Border Counties and the State, 1999
County Name
Population
Providers
Population to Provider Ratio
1,360,411
1,230
1,106
Cameron
328,158
153
2,145
El Paso
755,339
367
2,058
Hidalgo
528,300
327
1,616
Nueces
315,965
254
1,244
67,988
15
4,533
182,195
63
2,892
3,538,356
2,409
1,469
Atascosa
36,915
11
3,356
Bandera
13,915
10
1,392
Brewster
10,814
10
1,081
Brooks
8,959
1
8,959
Crockett
4,310
0
0
Culberson
4,101
0
0
Dimmit
11,251
1
11,251
Duval
14,676
1
14,676
2,497
0
0
16,456
1
16,456
Hudspeth
3,347
1
3,347
Jeff Davis
2,184
0
0
Jim Hogg
6,290
0
0
Jim Wells
39,837
28
1,423
Bexar
San Patricio
Webb
URBAN TOTAL
Edwards
Frio
520
0
0
41,958
38
1,104
Kimble
4,121
0
0
Kinney
3,341
0
0
Kleberg
32,089
19
1,689
La Salle
6,408
0
0
Live Oak
10,026
1
10,026
866
1
866
Maverick
44,277
7
6,325
Medina
34,164
13
2,628
Pecos
17,617
0
0
8,502
1
8,502
Kenedy
Kerr
McMullen
Presidio
2,518
3
839
Reeves
17,050
2
8,525
Starr
Real
61,722
6
10,287
Sutton
4,506
0
0
Terrell
1,522
0
0
Uvalde
25,872
11
2,352
Val Verde
44,190
14
3,156
Willacy
19,915
10
1,992
Zapata
12,866
1
12,866
Zavala
13,745
3
4,582
583,347
194
3,007
RURAL TOTAL
4,121,703
2,603
1,583
REMAINDER OF STATE
15,873,725
12,178
1,303
TEXAS
19,995,428
14,781
1,353
BORDER COUNTY TOTAL
Source: Texas State Board of Social Worker Examiners, 1999.
Respiratory Care Technicians
Texas Border Counties and the State, 1999
County Name
Population
Providers
Population to Provider Ratio
1,360,411
534
2,548
Cameron
328,158
86
3,816
El Paso
755,339
153
4,937
Hidalgo
528,300
102
5,179
Nueces
315,965
135
2,340
67,988
7
9,713
182,195
13
14,015
3,538,356
1,030
3,435
Atascosa
36,915
4
9,229
Bandera
13,915
0
0
Brewster
10,814
2
5,407
Brooks
8,959
0
0
Crockett
4,310
1
4,310
Bexar
San Patricio
Webb
URBAN TOTAL
4,101
0
0
Dimmit
11,251
3
3,750
Duval
14,676
0
0
2,497
0
0
16,456
0
0
Hudspeth
3,347
0
0
Jeff Davis
2,184
0
0
Jim Hogg
6,290
0
0
Jim Wells
39,837
10
3,984
Culberson
Edwards
Frio
520
0
0
41,958
12
3,497
Kimble
4,121
0
0
Kinney
3,341
0
0
Kleberg
32,089
8
4,011
La Salle
6,408
0
0
Live Oak
10,026
1
10,026
Kenedy
Kerr
866
0
0
Maverick
44,277
9
4,920
Medina
34,164
4
8,541
Pecos
17,617
3
5,872
Presidio
8,502
0
0
Real
2,518
0
0
Reeves
17,050
2
8,525
Starr
McMullen
61,722
2
30,861
Sutton
4,506
0
0
Terrell
1,522
0
0
Uvalde
25,872
3
8,624
Val Verde
44,190
3
14,730
Willacy
19,915
2
9,958
Zapata
12,866
0
0
Zavala
13,745
0
0
583,347
69
8,454
4,121,703
1,099
3,750
REMAINDER OF STATE
15,873,725
4,802
3,306
TEXAS
19,995,428
5,901
3,388
RURAL TOTAL
BORDER COUNTY TOTAL
Source: Division of Professional Licensing and Certification, Texas Department of Health, 1999.
Physical Therapists
Texas Border Counties and the State, 1999
County Name
Population
Providers
Population to Provider Ratio
1,360,411
519
2,621
Cameron
328,158
67
4,898
El Paso
755,339
187
4,039
Hidalgo
528,300
91
5,805
Nueces
315,965
167
1,892
67,988
6
11,331
182,195
22
8,282
3,538,356
1,059
3,341
Atascosa
36,915
4
9,229
Bandera
13,915
2
6,958
Brewster
10,814
4
2,704
Brooks
8,959
0
0
Crockett
4,310
0
0
Culberson
4,101
0
0
Dimmit
11,251
0
0
Duval
14,676
1
14,676
Bexar
San Patricio
Webb
URBAN TOTAL
2,497
0
0
16,456
2
8,228
Hudspeth
3,347
0
0
Jeff Davis
2,184
0
0
Jim Hogg
6,290
0
0
Jim Wells
39,837
6
6,640
Edwards
Frio
520
0
0
41,958
13
3,228
Kimble
4,121
0
0
Kinney
3,341
0
0
Kleberg
32,089
4
8,022
La Salle
6,408
0
0
Live Oak
10,026
2
5,013
Kenedy
Kerr
866
0
0
Maverick
44,277
4
11,069
Medina
34,164
9
3,796
Pecos
17,617
3
5,872
Presidio
8,502
0
0
Real
2,518
1
2,518
Reeves
17,050
1
17,050
Starr
61,722
0
0
4,506
1
4,506
Terrell
1,522
0
0
Uvalde
25,872
8
3,234
Val Verde
44,190
6
7,365
Willacy
19,915
2
9,958
Zapata
12,866
0
0
Zavala
13,745
0
0
583,347
73
7,991
4,121,703
1,132
3,641
REMAINDER OF STATE
15,873,725
5,964
2,662
TEXAS
19,995,428
7,096
2,818
McMullen
Sutton
RURAL TOTAL
BORDER COUNTY TOTAL
Source: Texas Board of Physical Therapy Examiners, 1999.
Physical Therapy Assistants
Texas Border Counties and the State, 1999
County Name
Bexar
Population
Providers
Population to Provider Ratio
1,360,411
309
4,403
Cameron
328,158
19
17,271
El Paso
755,339
69
10,947
Hidalgo
528,300
69
7,657
Nueces
315,965
68
4,647
67,988
0
0
182,195
64
2,847
3,538,356
598
5,917
Atascosa
36,915
7
5,274
Bandera
13,915
2
6,958
Brewster
10,814
0
0
8,959
1
8,959
San Patricio
Webb
URBAN TOTAL
Brooks
Crockett
4,310
0
0
Culberson
4,101
1
4,101
Dimmit
11,251
1
11,251
Duval
14,676
1
14,676
2,497
0
0
16,456
0
0
Hudspeth
3,347
0
0
Jeff Davis
2,184
0
0
Jim Hogg
6,290
2
3,145
Jim Wells
39,837
5
7,967
520
0
0
41,958
7
5,994
0
Edwards
Frio
Kenedy
Kerr
Kimble
4,121
0
Kinney
3,341
0
0
Kleberg
32,089
2
16,045
La Salle
6,408
0
0
Live Oak
10,026
3
3,342
866
1
866
44,277
1
44,277
McMullen
Maverick
Medina
34,164
4
8,541
Pecos
17,617
0
0
Presidio
8,502
0
0
Real
2,518
0
0
Reeves
17,050
2
8,525
Starr
61,722
5
12,344
Sutton
4,506
0
0
Terrell
1,522
0
0
Uvalde
25,872
5
5,174
Val Verde
44,190
7
6,313
Willacy
19,915
1
19,915
Zapata
12,866
1
12,866
Zavala
RURAL TOTAL
BORDER COUNTY TOTAL
13,745
0
0
583,347
59
9,887
4,121,703
657
6,274
REMAINDER OF STATE
15,873,725
2,175
7,298
TEXAS
19,995,428
2,832
7,061
Source: Texas Board of Physical Therapy Examiners, 1999.
Occupational Therapists
Texas Border Counties and the State, 1999
County Name
Bexar
Population
Providers
Population to Provider Ratio
1,360,411
347
3,920
Cameron
328,158
34
9,652
El Paso
755,339
102
7,405
Hidalgo
528,300
69
7,657
Nueces
315,965
89
3,550
67,988
4
16,997
182,195
14
13,014
3,538,356
659
5,369
Atascosa
36,915
4
9,229
Bandera
13,915
0
0
Brewster
10,814
0
0
Brooks
8,959
0
0
Crockett
4,310
0
0
Culberson
4,101
0
0
Dimmit
11,251
0
0
Duval
14,676
1
14,676
San Patricio
Webb
URBAN TOTAL
Edwards
Frio
2,497
0
0
16,456
2
8,228
Hudspeth
3,347
0
0
Jeff Davis
2,184
0
0
Jim Hogg
6,290
0
0
Jim Wells
39,837
2
19,919
Kenedy
Kerr
520
0
0
41,958
13
3,228
0
Kimble
4,121
0
Kinney
3,341
0
0
Kleberg
32,089
1
32,089
La Salle
6,408
0
0
Live Oak
10,026
1
10,026
866
0
0
44,277
1
44,277
McMullen
Maverick
Medina
34,164
5
6,833
Pecos
17,617
1
17,617
Presidio
8,502
0
0
Real
2,518
0
0
Reeves
17,050
0
0
Starr
61,722
0
0
Sutton
4,506
0
0
Terrell
1,522
0
0
Uvalde
25,872
4
6,468
Val Verde
44,190
3
14,730
Willacy
19,915
1
19,915
Zapata
12,866
1
12,866
Zavala
RURAL TOTAL
BORDER COUNTY TOTAL
13,745
0
0
583,347
40
14,584
4,121,703
699
5,897
REMAINDER OF STATE
15,873,725
3,620
4,385
TEXAS
19,995,428
4,319
4,630
Source: Texas Board of Occupational Therapy Examiners, 1999.
Occupational Therapy Assistants
Texas Border Counties and the State, 1999
County Name
Population
Providers
Population to Provider Ratio
1,360,411
181
7,516
Cameron
328,158
10
32,816
El Paso
755,339
23
32,841
Hidalgo
528,300
23
22,970
Nueces
315,965
30
10,532
67,988
1
67,988
182,195
13
14,015
3,538,356
281
12,592
Atascosa
36,915
4
9,229
Bandera
13,915
2
6,958
Brewster
10,814
0
0
Brooks
8,959
0
0
Crockett
4,310
0
0
Culberson
4,101
0
0
Dimmit
11,251
0
0
Duval
14,676
0
0
2,497
0
0
16,456
0
0
Hudspeth
3,347
0
0
Jeff Davis
2,184
0
0
Jim Hogg
6,290
0
0
Jim Wells
39,837
2
19,919
Bexar
San Patricio
Webb
URBAN TOTAL
Edwards
Frio
520
0
0
41,958
3
13,986
Kimble
4,121
0
0
Kinney
3,341
0
0
Kleberg
32,089
0
0
La Salle
6,408
2
3,204
Live Oak
10,026
0
0
866
0
0
Maverick
44,277
1
44,277
Medina
34,164
2
17,082
Pecos
Kenedy
Kerr
McMullen
17,617
0
0
Presidio
8,502
0
0
Real
2,518
0
0
Reeves
17,050
0
0
Starr
61,722
1
61,722
Sutton
4,506
0
0
Terrell
1,522
0
0
Uvalde
25,872
1
25,872
Val Verde
44,190
4
11,048
Willacy
19,915
0
0
Zapata
12,866
2
6,433
Zavala
13,745
0
0
583,347
24
24,306
4,121,703
305
13,514
REMAINDER OF STATE
15,873,725
1,096
14,483
TEXAS
19,995,428
1,401
14,272
RURAL TOTAL
BORDER COUNTY TOTAL
Source: Texas Board of Occupational Therapy Examiners, 1999.
Pharmacists
Texas Border Counties and the State, 1999
County Name
Population
Providers
Population to Provider Ratio
1,360,411
1,090
1,248
Cameron
328,158
147
2,232
El Paso
755,339
301
2,509
Hidalgo
528,300
227
2,327
Nueces
315,965
218
1,449
67,988
33
2,060
182,195
66
2,761
3,538,356
2,082
1,699
Atascosa
36,915
18
2,051
Bandera
13,915
13
1,070
Brewster
10,814
8
1,352
Brooks
8,959
5
1,792
Crockett
4,310
3
1,437
Culberson
4,101
2
2,051
Dimmit
11,251
4
2,813
Duval
14,676
5
2,935
2,497
0
0
16,456
7
2,351
Hudspeth
3,347
0
0
Jeff Davis
2,184
0
0
Jim Hogg
6,290
0
0
Jim Wells
39,837
24
1,660
Bexar
San Patricio
Webb
URBAN TOTAL
Edwards
Frio
520
0
0
41,958
42
999
Kimble
4,121
3
1,374
Kinney
3,341
2
1,671
Kleberg
32,089
20
1,604
La Salle
6,408
3
2,136
Live Oak
10,026
4
2,507
Kenedy
Kerr
866
0
0
Maverick
44,277
9
4,920
Medina
34,164
16
2,135
Pecos
17,617
5
3,523
Presidio
8,502
1
8,502
Real
2,518
3
839
Reeves
17,050
6
2,842
Starr
McMullen
61,722
8
7,715
Sutton
4,506
1
4,506
Terrell
1,522
0
0
Uvalde
25,872
15
1,725
Val Verde
44,190
11
4,017
Willacy
19,915
4
4,979
Zapata
12,866
2
6,433
Zavala
13,745
3
4,582
583,347
247
2,362
RURAL TOTAL
4,121,703
2,329
1,770
REMAINDER OF STATE
15,873,725
12,602
1,260
TEXAS
19,995,428
14,931
1,339
BORDER COUNTY TOTAL
Source: Texas State Board of Pharmacy, 1999.