Making the Case for Family Medicine Residencies – Ohio Academy of Family Physicians

In light of ProMedica’s announcement in early 2017 that it planned to close the Toledo Hospital Family Medicine Residency Program, the Ohio Academy of Family Physicians created this toolkit of resources to help family medicine residencies prepare for, react to, and potentially avert a residency closure or the threat of a residency closure. Provided below are resources and strategies for fighting back when a closure is considered or announced.

The importance of making a strong economic argument is key. Subspecialty medical staff who recognize the power of family medicine referrals on their future economic viability can be valuable allies. Various articles, studies, and presentations have been collected to help family medicine residency programs make the economic case for their programs with hospital administrators. Resources include:

“Measuring the Economic Impact of Closing a Family Medicine Residency: An E-Publication of the National Conferences of Primary Health Care Access;” Coastal Research Group, January 2012; by Mark E. Clasen, MD, PhD; Mary L. Budzak, MD; Carla M. Clasen, MPH, BSN; and William N. Tindall, PhD
“The Direct, Indirect, and Intangible Benefits of Graduate Medical Education Programs to Their Sponsoring Institutions and Communities; Journal of Graduate Medical Education, June 2010; by Perry Pugno, MD; William Ross Gillanders, MD; and Stanley M. Kozakowski, MD
“Holy Toledo! As Bad Ideas Go, Closing Residency is a Whopper;” American Academy of Family Physicians Leader Voices Blog, January 2017; by Gary LeRoy, MD
The Value and the Future of the Clinton Memorial Family Medicine Residency; presentation by Phil Diller, MD, PhD, and Ed Onusko, MD
The Christ Hospital University of Cincinnati Family Medicine Residency Training Program: First Five Years in Review and Mapping the Future; by Phil Diller, MD, PhD, and Sharon Mullen.

Those who have been through the unfortunate experience of having a residency close recommend maintaining a media list that can be quickly accessed and utilized to issue statements. The OAFP maintains a media list and can assist with this process. In the case of the Toledo Hospital Family Medicine Residency Program, the OAFP quickly issued a statement attributed to the OAFP president and wrote a letter to the editor that was distributed to all Northwest Ohio media outlets. The OAFP staff served as a background source for the Toledo Blade reporters.

The OAFP, the Ohio State Medical Association, the AAFP, and the Family Medicine Education Consortium all communicated and worked together in mobilizing members and networks in support of the Toledo Hospital Family Medicine Residency. Particularly helpful in generating national awareness was a widely-read and widely-published blog post written by AAFP Board Director Gary LeRoy, MD, who recounted his own personal memories about the closure of the St. Elizabeth Family Medicine Residency Program in Dayton, OH. Don’t hesitate to utilize the resources of organized medicine to help you make your case.

Knowing the commitment of the state’s governor to primary care, contacts were made with the Governor’s Office of Health Transformation to explain how the closing of a family medicine residency would negatively impact patients, particularly Medicaid patients; be counter to the Ohio’s stated goal to strengthen primary care workforce; and further jeopardize population health in the state of Ohio. The OAFP sent letters to Northwest Ohio members of Congress, and state senators and state representatives – the emphasis was patients and how the closing of a family medicine residency would further deplete primary care in an area of the state that was already sorely underserved by primary care physicians. Elected officials respond quickly to overwhelming public pressure and their calls to hospital administrators about such pressure should not be underestimated.

Current residents initiated an online petition in support of the residency program. News of the online petition spread via social media, including on the OAFP’s Facebook and Twitter pages. The activism of the program’s current residents generated the following news coverage:

“ProMedica’s Move Upsets its Resident Doctors” in the Toledo Blade on January 17, 2017
“ProMedica Cuts Family Practice Residency Program” ABC 13 on January 16, 2017
“ProMedica to Ramp Down Toledo Hospital Residency Program in Future” WTOL 11 on January 16, 2017
Mike Sevilla, MD, Blog on Family Medicine Closure.

Don’t fail to make use of your alumni. The residency program should maintain an alumni contact list so that alumni can be quickly mobilized for support. Alumni were very active on social media and in contributing personal stories to the press that helped mobilize the public against ProMedica’s decision.

And, of course, don’t dismiss the passion of patients who are very committed to family physicians who have provided them with high quality, cost-effective care over the years.