AUSTIN -- Prospects of approval for an M.D. program in Fort Worth, which failed during the 2011 Legislature, remain a long shot at best this session as lawmakers approach a crucial bill filing deadline this week.The 3-year-old proposal to create an M.D. program at the University of North Texas Health Science Center is a top priority for Fort Worth and UNT officials and the business community. But it has also come under fire from osteopathic doctors who fear that it could undercut the health science center's nationally recognized Texas College of Osteopathic Medicine.Despite a push by UNT leaders to stoke momentum for the proposal, no bill had been filed late last week to authorize the M.D. program.Friday, the 60th day of the 2013 Legislature, is the deadline for filing all legislation and joint resolutions except for local bills, emergency appropriations and issues designated as an emergency by the governor, according to the Texas Legislative Council."I don't think it's going to happen this session," said Rep. Charlie Geren, R-Fort Worth, whose district includes the health science center. Geren, a top member of House Speaker Joe Straus' leadership team, said he would support any move to "grow" the health science center but warned that the state must first create needed residency slots before funding additional medical schools.Geren said that he would "be happy" to support the proposal in the future and would also embrace efforts to graduate more osteopaths. "Any way that we can grow [the health science center], I'm for," Geren said.Sen. Jane Nelson, R-Flower Mound, chairwoman of the Senate Health and Human Services Committee, also questioned whether the proposal could clear the Legislature this session. Nelson, whose support is considered crucial to the effort, has repeatedly said she wants assurances that an M.D. program would not undermine the osteopathic program before she fully commits to the effort.In an interview last week, Nelson said she senses a more conciliatory tone on the issue under the interim health science center president, Dr. Michael Williams, who is an osteopathic physician, an M.D. and a TCOM graduate. "It may not be this session but if there's going to be a medical school in the Metroplex, we want it to be in Fort Worth and we want it to be an affiliate of the University of North Texas," she said.Deadline approachingWilliams, who became interim president after his predecessor, Dr. Scott Ransom, was fired in December, said in a statement Friday that UNT officials are continuing to hold discussions on the issue."It is possible that this proposal will be considered this session as the State looks for ways to expand graduate medical education," Williams said in an email. "The Legislature may authorize other new medical schools elsewhere in Texas and we will ask them to consider the needs of Fort Worth and our local hospitals in that process."The UNT System regents endorsed the proposal in 2010 and unsuccessfully pushed for approval in the 2011 Legislature.Mayor Betsy Price, the Fort Worth Chamber of Commerce and other local leaders have rallied behind the effort this year by trying to sell the M.D. program as a major asset to both Fort Worth, saying it would complement rather than impair TCOM."We believe having a medical school alongside an osteopathic school would enhance Fort Worth as a medical destination," said Matt Geske, director of governmental affairs for the Fort Worth Chamber of Commerce.Geske, however, conceded that time may be running out."I hope a bill comes up but right now it's not looking like a bill will be filed," Geske said. "We weren't able to accomplish it last session, but even if it doesn't come to fruition this session, it'll still be a top priority going into the 2015 session.""They need to have had some progress made by this point, I think," said Sen. Kel Seliger, R-Amarillo, chairman of the Senate Higher Education Committee.The Texas Osteopathic Medical Association and the American Osteopathic Association both contend that a school of allopathic medicine, which awards M.D.s, would endanger the osteopathic college. A key lobbyist against the proposal is former Texas House Speaker Gib Lewis, a former state legislator from Fort Worth who sponsored the bill that created TCOM in the 1970s. The school's library is named for Lewis."Anybody who came up with the idea of having an M.D. program [at the center] should have their head examined," said Lewis, who is representing the Texas Osteopathic Medical Association. "Why don't they just expand on the [osteopathic] program instead of having an M.D. program? It's a bad idea."Williams, however, said the proposal includes a key assumption to "protect and enhance and continue to grow the Texas College of Osteopathic Medicine." Williams, UNT System Chancellor Lee Jackson and other supporters also note that they have raised $25 million in private donations and would not have to ask the state for special startup money for the next five years.Other medical schoolsIn addition to confronting well-organized opponents from the osteopathic community, the Fort Worth effort faces competition with other proposed medical schools.The University of Texas System is pushing for a medical school at its flagship campus in Austin. UT System Chancellor Francisco Cigarroa has also advanced a proposal to create a multi-campus university in South Texas that would include a medical school. That proposal envisions the consolidation of UT Brownsville and UT Pan American in Edinburg."Those are the only two I know of right now that there's any momentum behind," said Dominic Chavez, spokesman for the Texas Higher Education Coordinating Board.Another crucial factor in creating medical schools is a potential shortage of residency slots in Texas hospitals to accommodate medical school graduates as they go into advanced training before beginning a practice. "If we're going to fund more medical schools, we need to create more residency slots before we do that," Geren said.Without an increase in first-year residency positions, beginning in 2014, at least 63 graduates of Texas medical schools will not have an opportunity to enter a Texas residency program, according to the Texas Higher Education Coordinating Board. The number will triple to 180 by 2016, the board predicted in a 2012 report.Because of the shortages, say lawmakers and health officials, medical school graduates are forced to enter residency programs in other states, where they will likely remain to set up practice instead of returning to Texas."Lack of residency slots is kind of a deal breaker," Seliger said. "Because if all we're doing is training new doctors who will train out of state and practice out of state it's not a very good investment of state funds."'Our top priority'UNT Chancellor Jackson, during a visit to the State Capitol this year, said that the M.D. program remains "our top priority" at the health science center, and that if it is approved, it would help Texas meet a growing need for new doctors.The M.D. program would be offered along with the doctor of osteopathy training at TCOM, and Jackson predicted that "the two together can grow and expand." Legislative approval is needed to lift a ban that prevents TCOM from granting M.D. degrees.TCOM, founded in 1970, is one of five colleges at the 1,700-student health science center, which also includes a new Ph.D. program in pharmacy.The osteopathic school, which has about 685 students, has repeatedly received national rankings for specialties such as primary care, family medicine, geriatrics and rural medicine. It has produced more than 2,800 alumni, many of them fiercely loyal to the Fort Worth school.M.D.s and doctors of osteopathy, or D.O.s, use many of the same skills in their training and practice, health experts say. But D.O.s are also trained to perform "osteopathic manipulative treatment," in which they use their hands to diagnose injury and illness "and encourage the body's natural ability to heal itself," according the Texas Osteopathic Medical Association Website. D.O.s focus heavily on preventive medicine and the whole body, rather than treating symptoms.Opposition to the M.D. program surfaced even before it was officially proposed, underscoring the influence of the osteopathic community.The Texas Osteopathic Medical Association set up a fund designed solely to finance opposition to the proposal, drawing contributions from across the country, Executive Director Sam Tesson said.Dr. Mark Baker of Fort Worth, a TCOM graduate and a board member of the American Osteopathic Association, said efforts to protect TCOM reached well beyond state lines. Members of the association's house of delegates, in their annual meeting in Chicago last year, signed a petition opposing the medical school, he said."TCOM is one of the finest medical schools in the nation," Baker said. "You would think the leadership in the city and the county would be extremely proud of the institution they have and put the time and energy they have to advance TCOM."Dave Montgomery is the Star-Telegram's Austin bureau chief. 512-739-4471Twitter: @daveymontgomery
Dr. Michael Williams
Education: Graduated from Richland High School in 1972; bachelor's degree from Texas Wesleyan University; a doctor of osteopathic medicine degree from the University of North Texas Health Science Center; a medical degree from Ross University, a master's of business administration from Duke University and a master's in healthcare management from Harvard University.
Professional: Former CEO of Hill Country Memorial Hospital in Fredericksburg; board-certified by the American Board of Anesthesiology in anesthesiology and critical care medicine.
Family: Wife, Ann; and daughters, Emma, 23, and Hannah, 18.