In another blow to healthcare in inner-city Los Angeles, Charles R. Drew University of Medicine and Science took the first step Wednesday toward closing its long-standing residency program, which has trained doctors in medical specialties for 34 years.
The decision to end residency education was forced on the university after it reached a dead-end in the search for stable financing and long-term accreditation for 251 residents -- physicians who had been serving at a program based at the troubled Martin Luther King Jr./Drew Medical Center.
"We had no choice," Drew University President Susan Kelly said. "We decided to jump rather than be pushed."
She vowed that the retrenchment would be only temporary, taking effect at the end of the school term in July. She said the independent university, long a partner with the adjacent Los Angeles County-operated King/Drew hospital, would slowly rebuild a new residency program as part of a pending push to expand its degree-granting medical school.
The decision hit hard in the healthcare community that serves some of the poorest neighborhoods in Southern California. Already this fall, the federal government announced that it would pull Medicare funding from King/Drew after it failed a last-ditch quality inspection. This, in turn, triggered a decision by the county Board of Supervisors to begin dramatically downsizing the facility.
"This is going to take us back several decades; it means we are going back into darkness," said Dr. David S. Martins, who completed his residency in internal medicine at Drew and serves as medical director of the T.H.E. Clinic, a major primary care facility in South Los Angeles. He credited his time as a Drew resident for inspiring him to serve the area's needy and providing him with the "cultural competency" to do so.
Of the 251 Drew doctors studying 15 specialties, about 50 are set to complete their residency studies at the end of the academic term in mid-2007.
The others, who are in various stages of three- to five-year programs in fields such as emergency medicine and family care, will have to be relocated to other institutions, either locally or elsewhere in the country. Kelly said Drew made its decision to withdraw from residency education now rather than continue grasping at straws in order to help these residents find places to complete their studies.
Last week, the national accrediting body for medical residency studies gave Drew until January to prove that it could provide a stable learning environment for its residents -- a consequence of the federal cutoff of Medicare financing for the county medical center.
On Wednesday, Julie Jacob, spokeswoman for the Accreditation Council for Graduate Medical Education, said Drew bears primary responsibility for relocating its residents. She added: "But certainly, if a sponsoring institution indicated they weren't going to do that, ACGME would take action. The most important thing is to make sure the residents are protected and they get placed in other programs."
The vote by Drew's governing Graduate Medical Education Committee, which goes before the Board of Trustees for ratification Friday, does not resolve the short-term crisis for the school's resident doctors: Funding to pay their salaries from January until spring has yet to be secured and other hospitals in the city haven't stepped forward to accept them on a temporary basis.
Gina Jefferson, a physician studying to be a specialist in head and neck surgery, served as one of the residents' representatives on the university's governing committee and called the decision "devastating." Still, she said, it was necessary for the sake of these doctors to keep them from riding a roller coaster of uncertainty.
Under complex arrangements, Drew has been responsible for the education of residents but the county has signed their paychecks as contract employees to King/Drew. Jefferson said the university and its students are looking to the Board of Supervisors to provide interim financing for their studies through this academic year.
She said the supervisors are contractually bound to "do everything they can to make sure the residents finish their training." And she emphasized the urgency of the decision, saying that the plan is for all residents to be out of King/Drew by Dec. 1.
On Wednesday, the county offered no concrete response to Drew's decision.
"We have a contract with the residents on a yearly basis," said Supervisor Yvonne Brathwaite Burke, whose district includes the university and King/Drew. She added that the board members are waiting on a report from the county health department to determine "what our responsibility is" to the residents.
The future of Drew University is "an issue that the county is concerned about and is weighing, but our responsibility is to our hospital system first and foremost," Supervisor Zev Yaroslavsky said. "That's our focus."
He said county officials would "help place residents wherever those opportunities exist."