Changing Physician Landscape in Texas

Executive Director Richard Howe, Irving, Texas


Working under the Dallas Fort Worth Hospital Council Education and Research Foundation (DFWHCF), the North Texas Regional Extension Center (NTREC) supports primary care providers in the north east section of Texas. Over the span of the NTREC grant, the practice environment has changed considerably as the result of health system mergers and the absorption of many independent practices into health systems. These changes have also enlarged NRTEC geographic reach. As a result, NRTEC determined a need to objectively quantify the distribution of physicians in Texas by location, by size, and by specialty of practice.

Current State:

NTREC commissioned an outside firm to conduct a study of the physician workforce in its 42 counties and in the State of Texas. The study was completed in 2015, and is currently being updated.


The study revealed a variety of notable characteristics about the physician workforce in Texas, including:

  • Texas ranks 41st among the 50 states in active patient care physicians per 100,000 population.
  • Texas ranks 47th in the nation in active primary care physicians (PCPs) per 100,000 population.
  • 35 Texas counties have no physicians of any kind.
  • 80 Texas counties have five or fewer physicians.
  • 147 Texas counties have no obstetrician/gynecologist.
  • 158 Texas counties have no general surgeon.
  • 185 Texas counties have no general psychiatrist.
  • There is a ratio of only 52 physicians per 100,000 population in counties of 40,000 people or less in Texas, compared to 228 per 100,000 for the five most populous counties and 183 per 100,000 for the entire state.
  • Texas has the highest number of physicians in solo practice (29%) of any state.
  • Texas physicians have relatively low Medicaid and Medicare acceptance rates: 35% do not accept Medicaid and 20% do not accept Medicare, compared to 18% and 13% of physicians nationally.
  • Texas ranks 43rd in number of physicians participating in the state insurance exchanges established by the Affordable Care Act (ACA).
  • Texas ranks 39th in number of physicians participating in Accountable Care Organizations (ACOs).

Lessons Learned:

Physician demographics change over time, and EHR support has to change appropriately. These shifts have an impact on both physicians, who need to manage their costs and effort effectively; and on Regional Extension Centers (RECs) that need to direct services for PPCPs to reflect the highest needs.

Next-Steps/Future Vision:

The information from this study will enable NTREC to focus on primary care physicians that are not part of a large practice or health system and who have a greater need for outside assistance with Meaningful Use (MU) support.

The data will also allow researchers to identify disparities in physician practice distribution and provide this information to various planning agencies and service organizations to help address many of the underserved areas.

Contact Information:

Richard C Howe, Executive Director


Success Story Topic
Quality Improvement Measurement
workforce development