Future of Threatened New York City Family Medicine Residency Precarious

A family medicine residency program threatened by the closing of a bankrupt New York City hospital may get a reprieve of sorts, thanks to intense negotiations by the program director, the New York State AFP and other stakeholders.

Montgomery Douglas, M.D., director of the New York Medical College Brooklyn-Queens Family Medicine Residency Program, told AAFP News Now there's a chance the residency will move to the Queens Hospital Center in Jamaica, N.Y. That's barely a mile away from the program's former sponsoring institution, Mary Immaculate Hospital, which, along with St. John's Queens Hospital, closed March 1.

Both Queens-based hospitals had been operated by Caritas Health Care Inc., which filed for bankruptcy last month.

Douglas estimated the likelihood that the residency program could be salvaged to be about "30 to 40 percent."

"We are just waiting," he said. "I'm trying to see if we can bring the parties together." Those parties, according to Douglas, are the hospital, which has said it needs state funding to make the move happen, and the state department of health, which seems reluctant to provide that support.

Meanwhile, said Douglas, the residency's ambulatory site, the John S. Hong Family Practice Center, hopes to remain at its present location at St. Dominic's Family Health Center for four months under the auspices of the new owner, Addabbo Family Health Center, which is a federally qualified community health center. After that, it's anticipated the site will move to one of Queens Hospital Center's clinics, assuming all goes as planned.

According to local news accounts, Caritas had sought millions of dollars in funding from the New York State Department of Health to continue operating the two failing hospitals. Although the state did step in last month with $6 million to help Caritas make payroll, when further funding was not forthcoming, the company's board of directors voted to close the hospitals.

The company officially filed for Chapter 11 protection on Feb. 6.

Douglas said that ever since he was notified of the likelihood that Mary Immaculate would close, he has been talking with hospitals all over the country to explore options for his program's 21 resident physicians. At press time, most of those residents had been accepted into other programs, although nearly all told Douglas they would return to a revamped Brooklyn-Queens program if given the chance.

The AAFP and the New York AFP also have been trying to help the beleaguered residency program since Caritas announced its financial crisis in January. According to Perry Pugno, M.D., M.P.H., director of the AAFP Division of Medical Education, the national Academy has provided various support resources and advice during the process.

Vito Grasso, C.A.E., EVP of the New York AFP, said the chapter had talks with numerous state and federal lawmakers and other officials on the issue, trying to find a resolution that would permit the family medicine residency to continue operations.

"With the paucity of primary care capacity in New York State, we need to preserve the programs because they generate the primary care physicians that we need," Grasso said, noting that more than 62 percent of the Brooklyn-Queens residency graduates practice in the state.

He added that trying to preserve the residency has been "a very chaotic process. There are so many issues and players involved."

And for now, at least, the final resolution is still unclear.

The Brooklyn-Queens program is not alone in its struggles. Within the past two years, eight family medicine residencies have announced their closings, said Pugno.

"The economic downturn has put a stress on every U.S. industry, and medical education is no exception," he said.

The Mayo Clinic Scottsdale Family Medicine Residency is an example. Last fall, physician leaders at the clinic announced that the residency would close in 2010 because of economic considerations and a shrinking pool of family medicine candidates.

At the Mayo residency, second- and third-year residents will be able to finish their programs, but first-year residents have been making decisions, including switching to internal medicine; accepting positions in other states; or looking at research.

"This is an enormously painful decision for our institution," said Tamara Kary, vice chair of the division of education administration of Mayo Clinic Arizona, which sponsored the program. "With the economic downturn, there is less available revenue and shrinking reimbursement. Return on investment is not as it was in the past. We have to make difficult decisions to stay economically viable -- keeping exceptional patient care as the primary focus."