Audit Reports Affecting Multiple Agencies
A Report on the Family Practice Clerkship Funding Program Compliance and Effectiveness Audit
Report Number 97-059
May 1997
Overall Conclusion
The Family Practice Clerkship Funding Program (Clerkship Program) produces benefits and should be continued, though it is difficult to specify the Clerkship Program's precise effect on medical education, medical practice, and physician supply in Texas. A better system for tracking medical students, clerks, residents, practicing physicians, and medical market conditions would simplify determining the effect of the Clerkship Program and other medical education programs. Opportunities exist to improve the efficiency and effectiveness of the audit process. All medical schools are in compliance with all statutory provisions on the levels and uses of funds, clerkship curricula, and required examinations.
Summary of Recommendations
Medical schools could enhance the clerkship experience by lengthening the clerkship, requiring electives and/or rotations in rural or underserved areas, strengthening market research links with clerkship communities, bolstering clerkship evaluation, increasing Family Practitioner representation on admissions committees, and expanding efforts to recruit students and faculty from rural and underserved areas.
The Legislature might consider continuing the Clerkship Program as a separately appropriated strategy, expanding incentives to attract Family Practitioners to rural and underserved areas, using Clerkship Program funds used to improve interfaces between clerkship sites and medical schools, exploring how managed care entities might contribute to the clerkship, and routinely assessing the reasonableness of the goal that 25 percent of all residencies be filled in Family Practice.
The State's ability to track medical students, residents, physicians, and medical market trends could benefit from expanding contact between the various entities involved in the tracking system, finding ways to support the estimated $60,000 annual cost of resources needed by the Texas State Board of Medical Examiners to improve the data stream, standardizing key definitions and data elements, using regular surveys and questionnaires, developing better indices of physician supply adequacy, and interfacing with other data systems. The audit process could better align with established low risk of noncompliance and low materiality by eliminating the audit, combining the audit with the Texas Higher Education Coordinating Board's annual audit of the Family Practice Residency Program, using performance measures to certify accountability, and/or auditing less often or less regularly. With a few minor exceptions, the medical schools generally agree with the recommendations in the report.
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