Shocking, heartbreaking, and discouraging.
Current and former family-medicine residents used such words regarding ProMedica’s decision to end the Toledo Hospital Family Medicine Residency program. The move was announced Thursday in a letter to ProMedica trustees and in meetings with current residents and staff at the W.W. Knight Family Medicine Center, where the residency program operates.
It’s left graduates surprised, and they are asking ProMedica to reconsider ending what they call a critical community resource.
“I would not be a physician in Toledo, Ohio, if it wasn’t for that residency program,” said Dr. Holly Dickman, 28, who graduated in July from the program that she first encountered during a medical-school rotation.
She initially planned to move to Cincinnati, where her husband has family, after graduation but instead practices now in Sylvania.
“I had no intentions of staying [in Toledo], but it was the quality of the program and being in the community that made me stay,” said Dr. Dickman, who called the news “a complete shock.”
“It almost seems like all of our hard work isn’t getting the appreciation it deserves,” Dr. Dickman said. ”You hear about residency programs that do struggle to succeed and meet the requirements, but we’re not one of those.”
Landscape changes
Dr. Lee Hammerling, ProMedica’s chief medical officer, said the move, while a difficult decision to make, creates an opportunity to train more primary-care doctors than in previous years.
Given recent shifts in affiliations and programs in northwest Ohio, the residency landscape looks different from several years ago. ProMedica used to train 30 family-medicine residents: 18 at Toledo Hospital and 12 at St. Luke’s Hospital, but it dropped the latter as part of its divestiture of St. Luke’s.
The University of Toledo Medical Center, the former Medical College of Ohio, agreed to resume sponsoring that residency, as it did from 1997 and 2007.
Now, after the 2015 affiliation agreement between ProMedica and the University of Toledo College of Medicine and Life Sciences, 12 family-medicine residents will come to ProMedica from UT.
Dr. Hammerling also pointed to the newly created family-medicine residency program at ProMedica Monroe Regional Hospital, which began in 2013 and graduated its first three-year class last year. Dr. Hammerling said ProMedica has begun paperwork to expand the Monroe program to 24 from its current 18-person cap.
ProMedica also plans to add a 12-person internal-medicine residency, bringing its total number of primary-care residency slots to 48.
It had completed the phase-out of an 18-person family-medicine residency program at Flower Hospital in 2015.
Besides its residents, the Toledo Hospital Family Medicine program employs a half-dozen faculty and 40 support staff.
“We’re repositioning our training program for the next 40 years,” Dr. Hammerling said. “We believe we will be more cost-effective to be a good steward of our resources.” Family medicine is among the most expensive residency programs to operate, he said.
“It was a challenging decision, and I wish we didn’t have to,” he said. “Hopefully in two to three years people will see the wisdom of it.”
In the letter sent to ProMedica trustees on Thursday, Arturo Polizzi, president of Toledo Hospital, said the “decision was based on national trends as family-medicine residency programs around the country are shifting from a large, tertiary-care medical centers to community hospital centers.”
Community needs
Dr. Deema Yousef, 31, is in her third year of the residency program at Toledo Hospital and will graduate in June. She came to family medicine through a medical school mentor, and seeing family medicine in action fit with her lifelong vision of what it meant to be a doctor, she said.
“The relationships with the patients are the best thing about family medicine,” she said. “If you don’t know a patient, you won’t be able to treat them well.”
Program residents see about 5,000 patients in the Toledo area, many of them low-income or with limited resources, Dr. Yousef said.
“Preventive and comprehensive care by a primary-care doctor is needed [in Toledo],” she said. “Residencies like ours need to be expanded and not closed down.”
Shutdown opponents say there are already months-long waits to get new appointments with local primary-care doctors, and fewer doctors trained here will exacerbate the problem.
Dr. Hammerling said ProMedica will work to make sure patients continue to have access to primary-care doctors and said expansion of the Monroe program addresses family-doctor shortages in that community.
While ProMedica officials have said current residents can complete the program through 2019, Dr. Yousef said she worries about residents in their first and second years who will not have incoming residents to learn from.
The American Academy of Family Physicians lists 23 family-medicine residency programs in Ohio, including Toledo Hospital’s. According to ProMedica’s website, the Toledo Hospital Family Medicine Residency program has operated since 1974 and is “the oldest continually operating family medicine residency in the region.”
‘Not a snap decision’
The news came as a shock to Dr. Yousef and to many others asked to attend a mandatory meeting last week held by hospital executives, she said. She described the officials as empathetic and said they took questions, assuring participants they would work to maintain instruction levels for the remaining years.
The mood in the room was disheartened and surprised, she said.
Dr. Yousef said she hopes ProMedica officials will change their minds, citing recent programs spared from the chopping block. In 2015, Columbia University-New York Presbyterian officials quickly reversed a decision to close their family residency program after backlash.
An online petition calling on ProMedica to reverse its decision has collected nearly 500 signatures.
Dr. Hammerling said the decision had been about a year in the making and a reversal “would be shortsighted at this point. This is not a snap decision we reached.”
Physicians complain
An Ohio Department of Health assessment of state primary-care needs in 2016 designated Lucas County as a “Primary Care Health Professional Shortage Area,” based on percentage of the population below the poverty line and eligible for Medicaid.
“It is most disturbing to hear that ProMedica plans to close its family-medicine residency program at Toledo Hospital at a time when we have a shortage of primary-care physicians in Ohio,” Dr. Ryan D. Kauffman, president of the Ohio Academy of Family Physicians, said in a statement. “ProMedica’s claim that the decision was based on national trends shifting family medicine residency programs from large, tertiary care medical centers to community hospital settings seems disingenuous given their decision just over two years ago to close the family medicine residency at Flower Hospital, which is a smaller community hospital.
“Granted, residency slots for primary care don’t generate the money that subspecialty residency slots generate,” he continued. “Therefore, subspecialty residency slots are favored. Nevertheless, we should be producing the types of physicians that meet population health needs, not the ones that are going to make the most money for the hospital system.”
Contact Lauren Lindstrom at llindstrom@theblade.com, 419-724-6154, or on Twitter @lelindstrom.
First Published January 17, 2017, 5:00 a.m.