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Texas counties without obstetricians four years after Proposition 12 passed. whole. The number of obstetricians in Texas increased only 4.27 percent over the same six years, including three years under tort reform. More telling is where the new obstetriciansand neurosurgeons and orthopedic surgeonsdecided to go. The Medical Board’s latest obstetrician data for the 254 Texas counties reveals that several counties led the gains. Collin County, the Dallas suburb that is the wealthiest in Texas in terms of per capita income, gained the most obstetricians. Its 34 new ones increased its obstetrician ranks by an impressive 45 percent since Proposition 12 passed. In second place is Montgomery County, Houston’s northern neighbor along the booming Interstate 45 corridor, and the state’s fourth-fastest growing county, according to the U.S. Census 2006 estimate. Montgomery gained 19 obstetricians. Tarrant County followed with 17. Next, at 12 each, are Galveston and Hidalgo counties. Among the rest, a few counties gained in single digits, a few lost, and the majority of countiestwo thirdsremained the same. With well-equipped, well-staffed hospitals, plenty of colleagues, and insured patients, it’s not hard to see why Collin County would attract the most obstetricians or offer them the most jobs. Collin’s population grew 42.1 percent from 2000 to 2006; the county encompasses Plano, Carrollton, and a small part of Dallas. The county’s Presbyterian Hospital of Plano alone has 73 obstetricians and 30 neonatologists for newborns. Two allied hospitals serve nearby Allen and Dallas, and the three are far from Collin’s only hospitals. Margot and Ross Perot gave $6 million last October to the Presbyterian Hospital of Plano for maternal and infant care. The Margot Perot Center for Women and Infants has been named “Best Place to Have a Baby” by DallasChild magazine 11 years in a row. The Presbyterian system has even been honored locally for its baby sign-language classes. The pattern of doctors’ opting to practice in more affluent, urban areas holds true for Texas’ overall gains in neurosurThe number of neurosurgeons statewide increased 8.8 percent in the past four years. The biggest share, again, went to Collin County, which gained seven. Bexar and Harris counties each gained five, while Lubbock gained four, and Tarrant, three. At last count 216 counties, or 85 percent, have no neurosurgeon. Texas has added 185 orthopedic surgeons since 2003, a 10.3 percent increase. Harris County gained the most with 25, followed by Dallas County with 21, Tarrant County with 19, Travis County with 16, and Collin County with 15. There are no orthopedic surgeons in 169 Texas counties. Surely, state leaders and the TMA knew that tort reform wouldn’t deliver doctors and specialists to rural Texas. The persistent struggle to get rural, underserved Texans care by obstetricians, brain surgeonsany specialistshas little to do with lawsuits or high premiums. Rural health care has been strained by a steady, decades-long migration of Texans from rural to urban areas. Rural areas have fewer hospitals and facilities, and tend to have higher concentrations of patients on Medicaid. “The enormity of Texas OCTOBER 19, 2007 THE TEXAS OBSERVER 11