California public hospital set to close residencies

The 233 medical residents at Martin Luther King Jr./Charles R. Drew Medical Center are wondering if they'll have a paycheck this month, and two thirds are scrambling to figure out how they'll finish their training as the inner-city medical center in Los Angeles closes its residency programs.

The Charles R. Drew University of Medicine and Science announced in November that it would move its residents to other hospitals as of Dec. 1 then shutter its 15 residencies as of July 1, 2007.

The King/Drew medical center lost graduate medical education funding and more than half its annual general budget when the hospital failed a Centers for Medicare & Medicaid Services quality inspection this fall.

With the facility no longer allowed to participate in Medicare and Medicaid as of Nov. 30, residents will move to other area hospitals to complete the academic year. Drew's programs are scheduled to officially close July 1, 2007, with 71 residents graduating and 162 residents looking for new training sites, according to Nancy Hanna, MD, associate dean for graduate medical education at the university.

Uncertainty has characterized residents' lives for some time, as financial shortfalls and patient deaths sparked investigations into the hospital.

"This has been rough," said Erold Jean-Francois, MD, an ophthalmology resident. "We've been assured we'll continue our training, but not knowing where is hard."

Dr. Jean-Francois works in a clinic outside the medical center, which he has been told will retain its training status. But the medical center is no longer an approved surgical site, and an alternative has yet to be approved.

Dr. Hanna said four residents had found new jobs on their own. The university is working to help place the rest.

About 80 program directors have contacted Dr. Hanna with offers of openings after the Accreditation Council for Graduate Medical Education sent an e-mail asking other programs that could accommodate additional residents to contact Drew University. But students might not be quick to snap up these offers.

"My residents want to stay in California, and 95% of the communication is coming from outside the state," she said.

Program directors at the King/Drew medical center said they were asking their colleagues in the area to help residents find new jobs.

Medicare has a cap on the number of residents it will pay for at each institution. But under these circumstances, Medicare payments will follow each of the residents to their new institution for the duration of their training, which should make it easier to place them.

As the university loses its residents, it is shifting its medical students to clinical sites outside of the King/Drew medical center. Because of these changes, some of the medical center's 250 full-time faculty are leaving as well, Dr. Hanna said.

Muhammad Farooq, MD, director of the King/Drew family medicine residency, said via e-mail that "it is getting difficult to provide the patient care now," because of the residents' departures.

In the past decade, one or two other hospitals have faced widespread program closures when hospitals themselves folded, according to anecdotal reports. But this might be the first time a university has closed all its residencies while its host hospital remained open.