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Deficits Threaten Doctors' Training

County: As the health department faces cuts, medical schools fear loss of funding for hospital residencies.

July 10, 2002|CHARLES ORNSTEIN | TIMES STAFF WRITER

Major health-care cuts in Los Angeles County are likely to upend medical education programs locally and reduce the number of physician faculty members and medical residents who train at county hospitals, officials say.

Medical schools are confronting this bleak reality as county health officials try to eliminate a budget deficit that could reach $800 million in three years.

Though details of the cutbacks are still being worked out, "the bottom line is that there will be fewer medical residency positions for the students finishing medical school in Southern California," said Dr. Charles K. Francis, president of Charles R. Drew University of Medicine and Science. Drew trains many minority doctors at Martin Luther King Jr./Drew Medical Center in Willowbrook.

Fewer slots for residents, or physicians in training, could lead to fewer physicians practicing in the region, Francis and others say.

"The level of health care that's practiced in the city has a lot to do with the quality of the training that's taking place in the residency programs and the medical schools," said Dr. Lawrence Stock, a clinical faculty member at Harbor-UCLA Medical Center near Torrance. "People tend to stay where they're trained."

The prospect leaves many young doctors nervous.

"I try to put it far in the back of my mind, but it's there," said Dr. Melanie Midget, a third-year psychiatry resident at King/Drew's Augustus Hawkins mental health clinic. "You're trying to finish your residency, your education, and then there's the thought that my program may close. Where am I going to go?"

County health officials don't dispute the harm that could be caused by medical education cutbacks, but say they may not have a choice.

If the county does not receive a $350-million bailout from the federal government, there will be "dramatic downsizings in our affiliations" with medical schools, said Dr. Thomas Garthwaite, director of the county Department of Health Services.

The county pays USC $70.2 million annually to run County-USC Medical Center in Boyle Heights, including physicians' salaries. It pays Drew $11.9 million to run King/Drew, and UCLA $19.1 million to manage Harbor-UCLA Medical Center near Torrance and Olive View-UCLA Medical Center in Sylmar. The payments to Drew and UCLA do not include the salaries of doctors who are county employees.

Without a budget miracle, county officials will consider massive service cuts this fall at Harbor and Olive View, possibly eliminating emergency rooms and even ending inpatient services.

All high-end services, such as transplants, are expected to be consolidated at County-USC.

Garthwaite and his advisors are also thinking of dropping historic affiliations between individual hospitals and medical schools. In their place, the county would ask the medical schools to work with the county system as a whole.

That might provide space for some faculty members and residents squeezed out by the budget cuts. It also might allow a greater emphasis on training doctors to work in community health programs, which are less costly than hospital care.

County-USC, Harbor, Olive View and King/Drew could see big changes in their personnel, training and medical cultures. Now, each county hospital is a bit of a fiefdom for the medical school that runs it.

"The view of all health care being tied to a facility that's next-door to a university is awfully myopic," Garthwaite said. "I want to take advantage of the financial crisis we have here and push toward a new system of care. I think it's the right thing."

UCLA has the most to lose because its affiliates are the only ones that could be converted from inpatient hospitals to clinics. (UCLA will continue to train medical residents at its Westwood and Santa Monica hospitals.)

"There's no doubt that ... there's a little bit of edginess," said Dr. J. Thomas Rosenthal, vice provost for the UCLA Medical Group.

Health officials should ensure that UCLA remains in the county system, Los Angeles County Supervisor Zev Yaroslavsky said.

"It's common sense to me that we should do everything we can to keep a relationship with one of the best medical schools in the United States, in the world," he said.

Still, both sides agree that it would be strange for faculty members from UCLA and USC to work side by side at County-USC.

"From one faculty to another, a culture develops," Rosenthal said. "You don't transpose people from one culture to another easily."

USC officials said reorganization always produces conflicts.

"This has nothing to do with, 'This is our turf' and 'That's your turf,' " said Dr. Ron Kaufman, senior associate dean for administration at the Keck School of Medicine at USC and former County-USC administrator. "This is going to be very complicated, and it's going to take years."

Faculty members said the cutbacks could threaten the quality of training and medical care.

Drew University's Francis said he, too, is worried that recruitment and retention of minority physicians will suffer.

"It's conceivable that a less diverse faculty may result," Francis said.

"We have a much better record of our graduates' ending up serving minority and underserved communities. That's really the strength of Drew."

Garthwaite said the county will continue to place a priority on educating minority physicians and treating patients in a culturally appropriate way.

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