by Kendra Mayer

Residency program dies from lack of support,” read the headline in The Courier, Montgomery County’s daily newspaper, Nov. 26, 2002. But just two days later, rising like the phoenix from the ashes, the Conroe Family Medicine Residency Program announced it would remain open, thanks to the tremendous efforts of Sen. Todd Staples, Sen.-elect Tommy Williams and Rep. Ruben Hope, and an ongoing commitment from the Montgomery County Hospital District and Conroe Regional Medical Center. The decision to remain open through June 2006 is, for now, the conclusion to what has been a roller coaster of events over the past few months.

Around the country, residency programs and private physicians, faced with declining revenue and increasing overhead costs, are struggling to keep their doors open. The Conroe program is no exception. In a press release announcing the closure of the program, the stated reasons included decreased federal funding for training of medical residents, declining reimbursement from government health programs, decreasing patient revenues from other sources and runaway increases in medical liability insurance and other operating expenses.

Adding to the program’s operational problems is the fact that the program provides care for Montgomery County’s neediest residents. More than half of the program’s patient base has medical coverage through the Montgomery County Assistance Program, another 30 percent is covered through Medicare, Medicaid, or CHIP, and the remainder has no insurance. Any of these factors is difficult to bear, but the combination was too much for the sponsoring hospital.

Since the University of Texas Medical Branch in Galveston dropped its affiliation with the Conroe residency program beginning in 2001, the Conroe Regional Medical Center, an HCA affiliate, has been covering the program’s operating costs, approximately $1.8 million for the 2001-02 academic year, according to The Courier.

In October, the hospital announced a plan to limit its support of the program for fiscal year 2003 to $600,000, leaving the program at least $1.2 million short of its budget. At that point, Dr. Joe Ewing, president of the Conroe Medical Education Foundation called TAFP for help. “They were looking for any support they could find, federal and state grants, left over coordinating board money, anything to help them keep the doors open,” says Tom Banning, TAFP Director of Public Affairs.

“If the program were to shut down, it would have had a devastating impact on Montgomery County and its citizens. It would have caused a severe disruption in access to care and placed a significant burden on the private physicians in the area, the local emergency rooms and ultimately the tax payers,” Banning says. Fearing the program would not find the needed money, Banning called Sen. Staples to alert him of the situation.

Sen. Staples then called an emergency meeting of leaders from the residency program, Conroe Regional Medical Center, and the Montgomery County Hospital District. No solution was reached at the first meeting, but the parties agreed to continue to search for additional funding to keep the program open. A week later, the hospital district board voted 6-1 to provide the program needed funds to stay open. It seemed that the residency program had been pulled from the brink.

Shortly thereafter, negotiations began to break down between the hospital and the hospital district. The restrictions required for an agreement of support by the hospital district were too great for Conroe Regional Medical Center. On Friday, Nov. 22, the program and hospital agreed to close the program effective June 2003.

As the first- and second-year residents prepared to look for new programs to finish out their residencies, program staff began meeting with the hospital administration to begin the transition process. It quickly became apparent the hospital did not have a plan in place to care for the 100 to 120 patients who receive care at the clinic each day, nor did it have a plan to handle the program’s annual average of 600 obstetrical patients. The day before Thanksgiving, the residency program received a letter from Conroe Regional stating their intention to financially support the program through 2006.

The residents and staff at the program were elated by the news, Ewing says, adding that the loss of the program could have had a terrible effect on the community. “The residency provides the bulk of indigent care in the county,” he says.

The program not only benefits indigent patients, but provides the area with a pipeline of future physicians as well. “We have produced 30 doctors that have stayed within this county,” Ewing says.

“I appreciate and applaud all of those who participated in resolving the issues faced by the Conroe Medical Education Foundation,” Sen. Staples says. “Due to the dedication of these visionary thinkers, a strong commitment and partnership have been established to support the residency program.”

The threat faced by the Conroe Family Practice Residency Program is one with which many physicians and clinics are all too familiar. “Texas’ health care delivery system is at a critical juncture. The number of patients needing care continues to increase within a system that does not adequately pay the costs of delivering that care,” Banning says. “Without immediate corrective action this next legislative session, we will continue to see similar situations to what nearly happened in Conroe – but what did happen in Beaumont.”

In June 2002, CHRISTUS St. Elizabeth Hospital in Beaumont closed the doors of the hospital’s family practice residency program and its associated clinic for the last time citing financial reasons. The effects of the closure on the community cannot be evaluated yet, but the 5,000 patients who regularly received treatment at the clinic have had to find other sources for their health care or they have gone without. Residents who had planned to practice in the community have moved on to continue their education elsewhere, removing a major pipeline for new physicians in the area.

“I believe there is no question patients will have decreased access to care in Beaumont, but the long term implication of the closure are far more troubling,” says Roland Goertz, M.D., chair of the Higher Education Coordinating Board’s Family Practice Advisory Committee. “If we aren’t able to train the physicians of tomorrow, who will be there to deliver care in the future?”

Banning says he hopes the close call in Conroe acts to rally physicians and legislators to restore sanity to the business side of medicine. “Right now there is a small window of opportunity to make significant and important changes or we will see this kind of crisis across the board.”