BCM on the closing of Kelsey-Seybold FMRP: “They just didn’t want to be in the education business”

The Senate Finance Committee has held hearings for the past two weeks on every section of the budget, and because so many primary care programs suffered cuts (as did most other programs), many interesting exchanges have come to light. In all the discussions, though, both lawmakers and those testifying agree that primary care is of the utmost importance to ensuring Texans’ access to care.

Because residency programs play such a large role in producing the primary care physician workforce, here enters Paul Klotman, M.D., president and CEO of Baylor College of Medicine. He testified during the Feb. 8 hearing of the Senate Finance Committee, and Sen. Bob Deuell of Greenville questioned him on the closing of the Baylor College of Medicine Kelsey-Seybold Family Medicine Residency Program. Here’s their exchange.

Sen. Deuell: A family medicine program closed. What’s your take on that?

Dr. Klotman: Our family medicine program is doing fine. [Person in audience speaks]. Oh, are you talking about Kelsey-Seybold?

Deuell: Yes.

Klotman: My understanding is they just didn’t want to be in the education business, that they didn’t want to continue to have residents there.

Deuell: Was that because of finances?

Klotman: They’re driven by patient care, they’re at risk now, they need efficiencies in their system. It’s hard. One of the challenges is working in the educational piece into efficient organizations, but I actually believe you can do that. It just needs to be done in an integrated way and I don’t think that’s their primary mission.

My understanding is they just didn’t want to be in the education business, that they didn’t want to continue to have residents there.

–Paul Klotman, M.D., President and CEO, Baylor College of Medicine

So why did the program close? It turns out that it was financial. As Jonathan Nelson writes in “On the Brink,” the cover story of the first-quarter 2009 issue of Texas Family Physician, it began in 2006 when the program’s primary teaching hospital, St. Luke’s Episcopal Hospital, cut support for the program in half.

That sent Baylor and Kelsey-Seybold FMRP scrambling to find new sources of funding, none of which were stable from year to year. By fall 2009, they agreed that the program was no longer financially sustainable. Kelsey-Seybold needed a subsidy from BCM of between $400,000 and $450,000 to keep the program viable. But Baylor, which has operated at a substantial deficit for the past several years, couldn’t save the program.

Baylor College of Medicine’s 2010-2011 appropriation for GME formula funding— money intended to support their affiliated residency programs—is $15.3 million. That’s $2.5 million more than they received in the previous biennium.

The program closing certainly wasn’t because of lack of interest from the faculty or the applicants. Again, from “On the Brink”: In an era when family medicine residencies only manage to fill 45 percent of available residency positions with U.S. medical school graduates, 97 percent of the recruitment classes at the Kelsey-Seybold program over the last three years graduated from U.S. medical schools. More than 600 physicians applied for the four open positions at the residency in 2009, and of the four chosen, two are from out of state. “I’m constantly bombarded with people that would just love to come to our program,” says Tricia Elliott, M.D., F.A.A.F.P., the residency’s program director.

Read the full article here.

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One Response to “BCM on the closing of Kelsey-Seybold FMRP: “They just didn’t want to be in the education business””

  • Dana Sprute, MD, MPH:

    As a program director in a Texas family medicine residency program, I want to comment on the tragedy of the closure of the Kelsey-Seybold family medicine residency program. The Kelsey-Seybold program was excellent by any standard measures: strong program director leadership, excellent faculty and residents, a 5-year accreditation cycle (the best you can do) and a combined MBA program (which helps to build physician leaders with an understanding of health care financing and administration).

    Over the last decade, GME slots in family medicine have decreased (inspite of the continued increased demand for primary care physicians and multiple health care provider shortage areas). Texas medical schools currently graduate more medical students annually than there are residency training (GME) slots. This makes Texas an EXPORTER of physicians trained at the State of Texas expense who are unable to find a residency position in Texas and MUST leave the state to complete their residency training. A majority of physicians practice in the state where they complete their residency training.

    Here is a partial list of the negative impact Texas has or will experience due to the closure of this valuable program:
    * A DECREASE in GME slots in family medicine (at a time when Texas needs MORE primary care family physicians).
    * A decrease in primary care physicians graduating in Texas (who are likely to continue to practice in Texas).
    * Worsening patient access to primary care.

    At a time when our state and our nation face a crisis in access to care and shortages of primary care physicians, our priorities should be to invest in primary care residency training (not close a strong, well established program based on local politics). Closing the Kelsey-Seybold family medicine residency program is tragic and short sighted. We are going backwards.

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