As anyone who reads this blog ought to know, I love Texas. I used to have the bumper sticker that said that I wasn't born here but I got here as fast as I could. I don't know if it'll happen, but I'd greatly like for my wife and I to settle down in Texas. If my fondness for Texas were any less, though, I would have told the whole state that it can go to Hell courtesy of its medical board.

As it stands right now we're going to be in Austin for at least a year longer than initially planned. I'm not complaining, mind you, but we're largely doing it because my wife was passed up on a couple fellowships out of state. It's possible that she would have been passed up anyway, but she had the huge strike against her that she would not have been able to start on their start date. Why? Because she will be finishing her tour here a month late. Why? Because of the Texas Medical Board that honestly didn't seem to care if my wife set herself up in Texas or somewhere else.

Texas has an impending shortage of doctors and you would think that they would be chomping at the bit to get doctors accredited as quickly as possible (barring legitimate reason for concern) to prevent that from happening. At the very least you would think that they would avoid being antagonistic towards the doctors that want to set up practice in this state. But instead, Texas has the reputation for being a difficult state for licensure and a headache for would-be Texas doctors.

It would be one thing if the purpose of this was to root out bad doctors, but as far as I know Texas's approval rate for doctors seeking licensure is no lower than other states. But they still drag doctors seeking licensure in front of hostile panels over issues where no crimes have occurred, no one has been hurt, and no AMA or state regulations have been skirted. Eric Scheffey ruined bodies and lives for years and they couldn't find a way to do anything about it until 2003, but they nonetheless have a new would-be doctor track down her medical records dating back ten years (from a dozen doctors in three states) and more-or-less strip her of her medical confidentiality (it's all in her file now) for having the nerve to want to practice medicine in Texas with a less-than-pristine medical history of her own back in Oklahoma, a decade ago.

Again, we're talking about things that have affected patient care in the three years she was a resident in Idaho or when she was a medical student making the rounds in Louisiana. All of this for a physician-in-training license wherein even now that she has it she couldn't practice without another doctor's supervision (she's more than a resident, but less than a fully licensed doc).

Since we're going to be staying in Texas, though, she's going to have to do some temp work (also known as "locum tenens") to try to bide time to try again for another fellowship. To do so she's going to have to apply for full medical licensure. As it turns out the Chronicle had an unusually worthwhile article on the subject and how it pertains to Texas's shortage of doctors in general.

Dr. Kimberly Bingaman, a pediatric neurosurgeon at San Antonio's Christus Santa Rosa, tells a different temping tale.

The 39-year-old mother of three moved to San Antonio from Augusta, Ga., last May, expecting to begin working in June. The license she applied for in February, however, did not arrive until October.

"I have licenses in nine other states, so I started traveling" to places like Missouri and Minnesota in order to support her family, she said.

A month before Bingaman began working at Santa Rosa, she read a news article about a shortage of neurosurgeons in San Antonio.

"Meantime, here I was, ready, willing and able to work and traveling all over the country, essentially, providing coverage when people in San Antonio couldn't get treated here," she said. "It was very ironic."

Some states are promoting a fast-track process for temporary licensure, though of course Texas isn't one of them. The powers-that-be say that they just hadn't thought about it. Fair enough, as who would expect the Texas Medical Association to try to think of ways to address the doctor shortage?

The fact that a doctor who wants to work a temp job in Texas has to have a Texas license in hand or go through the long approval process, just like a doctor seeking permanent posts, is such an "inhibiting factor" that Staff Care has mostly given up trying to get out-of-state doctors licensed in Texas, Miller said in an interview.

Of the some 200,000 doctor days Staff Care filled in 2006, assignments in Texas account for 18,000 days, he said.

If the licensure turnaround in Texas were 90 days, like it is in many states, Staff Care estimates it would have twice the number of doctors working in Texas than it does now — which would lead to roughly twice as many days filled per year, Miller said. [...]

Texas ranked 42nd out of 51 in the American Medical Association's 2005 measurement of patient-care doctors per capita, said Marcia Collins, director of the medical education department at the Texas Medical Association. The ranking includes the District of Columbia.