UH ends a family medicine residency program that cares for poor, creates pipeline for public health leaders - cleveland.com

CLEVELAND, Ohio — University Hospitals is closing a family medicine residency program, a move some local health experts say could affect sources of care for the urban poor and close a pipeline that produced leaders in Cleveland public health.

It could also hurt the medical school's ability to recruit primary care students, and contribute to the shortage of family medicine and primary care physicians, they said. The shortage contributes to lengthy waits to get a doctor appointment.

"UH is shirking its responsibility to Northeast Ohio by choosing to abandon the residency rather than invest in its success," said Dr. Lisa Navracruz, assistant professor of family medicine in the Center for Medical Education at Case Western Reserve University and an alumnus of the program. Navracruz also served as assistant program director for about five years, ending in 2012.

However, UH said in a Sept. 12 staff memo announcing the move that it would allow UH to "pivot to meet the needs of ever-evolving health care and education landscapes."

The memo also said that teaching the next generation of physicians requires constant reevaluation of its training programs and difficult decisions based on changing realities.

In a follow-up email, UH said its Rainbow Ahuja Center for Women & Children in midtown Cleveland and UH Otis Moss Jr. Health Center are outpatient care options for patients living in that area.

The health system cited, as a reason for the change, the fact that family medicine has become more community-based and focused on outpatient care in the past two decades. It will continue to train those already in its residency programs, the memo said. When asked why it made the change, the health system referred back to the memo.

This year, UH admitted six residents in its family medicine program at the main campus.

UH will not recruit family medicine residents for the upcoming match, a system that pairs residency candidates with first-year and second-year post-graduate training positions at teaching hospitals across the country.

Physicians in training complete a three-year residency program after undergraduate and medical school training.

After their residency, physicians can sit for their board certifications, or take on more training to enter a sub-specialty, such as gastroenterology or endocrinology, said Dr. Vanessa Maier, assistant professor at the Case Western Reserve University School of Medicine, and medical director of the school health program at MetroHealth System.

The family medicine program that is being closed is based at UH's main hospital. It trains doctors in allopathic, or the classical form of medicine, said Maier, who is a graduate of the UH family medicine residency program.

UH also offers family medicine residency training programs at UH St. John in Westlake and UH Geauga in Chardon. Those programs will continue admitting new residents, UH said in a follow-up email.

This year, UH admitted five residents to the St. John program and four in the Geauga program. There are a total of 42 family practice residents at all three campuses, UH said.

The hospital system also maintains numerous other residency programs for other specialties across the system, UH said.

An estimated one-third of all physicians in the U.S. are primary care doctors – who include family medicine physicians, general internists and pediatricians – according to the Robert Graham Center, a research and analysis organization that studies primary care.

• University Hospitals set to open $236 million Ahuja expansion in Beachwood with emphasis on sports medicine, other outpatient care

Yet that's not enough to meet future demand.

A national primary care physician shortage of between 17,800 and 48,000 is projected by 2034, according to a 2021 report prepared for the Association of American Medical Colleges.

To maintain the status quo, Ohio will require an additional 681 primary care physicians by 2030, the Robert Graham Center report said.

Program closure may affect community health

UH family medicine residents cared for infants, children, pregnant women and adults, whether they were in the hospital or needed outpatient care, Maier said.

"The family medicine residents at the UH Main Campus residency program cared for some of the most complex patients that lived in the local surrounding community," said Maier, who is an alumnus of the program and later taught in the UH family medicine program that is being cut.

"Graduates care for patients in our federally qualified health centers, neighborhood family practices, all throughout the city doing public health," Maier said. "So it's concerning that we won't have that sort of pipeline of physicians who are really focused on staying and caring for these communities."

UH has neglected the program by not replacing key faculty for several years, Maier said.

Graduates from this program also have become community health leaders currently working around the city in positions at the Cuyahoga County Board of Health and Neighborhood Family Practice, said Navracruz.

"All of this is possible because we graduated as competent, compassionate and exquisitely trained family physicians from the UH family medicine residency — and we launched into the community ready to serve in the areas of highest need," Navracruz said.

Maier provided a list of alumni of this particular program who went on to fill top roles in local healthcare organizations.

The terms family medicine and primary care are related.

Primary care is an umbrella term that includes family medicine. Family medicine is the specialty that cares for people across their entire life, for both inpatient and outpatient care. Primary care physicians can be family medicine physicians, and can also be specialists trained to provide pediatrics care, adult medicine care and OB GYN care.

Julie Washington covers healthcare for cleveland.com. Read previous stories at this link.

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