When Travis County voters approved a ballot measure this month that paved the way for a new University of Texas medical school in Austin, many South Texans had to stifle their frustration and resentment. They had been trying for decades to secure financing for a medical school in the Rio Grande Valley, only to watch a wealthier area to the north seal a deal first.

Francisco Cigarroa, the chancellor of the University of Texas System, does not share those sentiments. With the wheels greased in Austin, Dr. Cigarroa said, he is even more confident that the Valley will get its medical school.

This only gives me more resolve to get the South Texas school of medicine accomplished, he said. Weve set the pathway for Austin. Im not giving myself an A on my report card unless I get this done.

But his commitment is just one piece of the South Texas puzzle. And what has worked in Austin substantial public-private investment, financing set aside by the State Constitution for flagship institutions, and a voter-approved 5-cent property tax increase is not necessarily a fit in the Rio Grande Valley.

South Texas leaders must persuade hospitals to finance 120 residency slots, get local voters in the impoverished region to sign off on a taxing district, and the toughest but most critical selling point ask the cash-strapped Texas Legislature to provide $20 million a year.

If you were going to pick a time in the history of the Texas budget to create a new medical school, this is probably not the time you would pick to do it, said R. K. Whittington, the president of the South Texas Medical Foundation. But with local support for the medical school growing and the economy improving, Mr. Whittington said, Im more confident now than I was a year ago.

The need is unquestionably there: studies show the fast-growing Valley, where the population is approaching 1.5 million, has 110 doctors per 100,000 people half the national rate and well below the state average. And the existing physicians are aging; at Doctors Hospital at Renaissance in Edinburg, which, along with other regional hospitals, would be a hub for medical residents under the South Texas plan, 38 percent of physicians will approach retirement in the next 5 to 10 years.

We have many young people that forgo their plans, their dreams of becoming physicians, because its a major sacrifice to leave the area, said Dr. Leonel Vela, the South Texas regional dean for the University of Texas Health Science Center at San Antonio. Roughly 80 percent of all Texas medical school graduates stay and practice in the communities where they perform their residencies, but U.T. has just 33 medical residency slots in the Valley.

The University of Texas has long pledged to establish a medical school in South Texas, but residents there remain skeptical. The first bill to establish a South Texas medical school was introduced in the 1940s, Mr. Whittington said. And serious negotiations spurred by a severe shortage of physicians in the region, and an underserved population plagued by epidemics date back more than 20 years.

Were the part of the state everyone ignores we basically get whatevers left over, said Alonzo Cantu, a Rio Grande Valley developer and the founder of Doctors Hospital at Renaissance. Theres a lot of frustration, a lot of, Why them and not us?

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South Texas Leaders Keep Pushing for Medical School