NORTH HOLLYWOOD — An innovative program to train family practice doctors has forged a relationship between one of the most prominent medical schools on the West Coast and a San Fernando Valley hospital.
The USC University Hospital/North Hollywood Medical Center Family Practice Residency Program will bring eight residents to the Valley hospital in its first year, as well as to the tiny Avalon Community Hospital on Catalina Island.
"Traditionally, residency programs are based in only one hospital," said Dr. Ricardo Hahn, chair of the Department of Family Medicine at USC. Family medicine emphasizes general medical care of the whole patient, as opposed to treatment solely of specific conditions by specialists.
"These residents will get to function at a university hospital, a community hospital and a rural hospital. They will get experiences in clinical sites that are very isolated and community based.
"That way, they can see what it is like to function as a 1997 doctor."
With the inauguration of the program, North Hollywood Medical Center became the second private teaching hospital in the Valley. Northridge Hospital Medical Center has had a family practice residency through UCLA's medical school since 1976.
The $2.5-million USC program, which began quietly earlier this month, was three years in the planning and is the first of its kind in the state to be licensed for multiple facilities, Hahn said.
The North Hollywood facility, currently with 160 beds, has focused on family care since it opened in 1952 as Valley Doctors' Hospital.
The Avalon hospital, with only 12 beds, is considered one of the most isolated and rural medical facilities in the state, Hahn said. But his program also considers the Valley hospital to be a remote outpost.
"North Hollywood happens to be as isolated as Catalina," said Hahn, "if you are trying to drive there from downtown during rush hour. In terms of traffic, it is an island. An urban island."
At both the North Hollywood and Avalon facilities, medical students will be connected to USC via an experimental, telemedicine communications system that can transmit two-way audio and video, and be used to search the university's medical archives.
The communications equipment, which is scheduled to be installed this fall, was funded by a federal grant. It's especially critical on Catalina, Hahn said, because of the lack of specialists there.
"It's a totally new world in how medicine deals with these situations," he said.
The new world of medical finances--including managed care, a decline in government funding and the corporate ownership of private hospitals--was also a major influence on how the program was designed.
The building of a relationship between USC and the North Hollywood hospital was eased by the fact that there was already a financial connection. The North Hollywood hospital is owned by Tenet Healthcare Corp., the second largest hospital chain in the country.
Tenet also owns and manages USC's University Hospital, although it is located on the school's Boyle Heights campus and staffed by the university's medical faculty.
North Hollywood Medical Center's CEO, Dale Surowitz, said he approached USC about a 1 1/2 years ago with the suggestion that the Valley facility be a part of the residency program.
"When you have residents, it brings up the energy," said Surowitz. "They are asking questions and bringing their own training to situations . . . everyone gets involved. It keeps everyone highly educated."
Through an association with a major medical school, a community hospital also can gain status--which is especially valued at a time when medical care is highly competitive.
"A university teaching program as fine as USC's," Surowitz said, "would enhance any hospital's reputation."
The program offers USC's first in-house family practice training. The university decided to get more closely involved because of the medical community's increased interest in family practice.
"The cost of health care becomes prohibitively expensive when everyone is selecting sub-specialties," said Hahn. "People want to go to a favoritologist--a neurologist for a headache, a cardiologist for chest pain."
In this era of managed care, with medical institutions under pressure to keep costs down, treatment by a less expensive generalist becomes highly desirable, Hahn said.
Educational programs have to at least break even in such an environment. Hahn said the new program, which will pay participants a salary of $33,000 per year, will earn revenue directly from the residents' involvement in seeing patients.
"It's a common practice," said Hahn. "For example, I saw two patients today with one of my residents. The resident did part of the work and I did part of the work, so part of the billing will be in my name and part will be in the resident's."
But patients will not be charged extra because both the resident and the teaching physician treat them, Hahn said.
The fact that the program is designed to at least break even was a requirement of the commercial partner in the program.
"Tenet does not view its role as experimental in that way," said Hahn. "They have stockholders to satisfy."