Modesto Bee Article

By Ken Carlson, Modesto Bee Staff Writer
last updated: July 27, 2009


Modesto Bee - Stanislaus Family Practice Residency Program, young first year physician Liana Seneriches, D.O. examines medical records. Nine current students who've completed their 3 year residency graduate this month and will go on to practice medicine. Carlson reporting.(Bart Ah You / The Modesto Bee)

Stanislaus County officials are seeking approval for a physician training program that would replace the Family Medicine Residency Program based at Doctors Medical Center.

Other hospitals, including Memorial Medical Center of Modesto, would be involved with training medical school graduates, thereby preserving a tool for recruiting primary care physicians to the county.

The Valley Family Medicine Residency of Modesto would have the same mission to train primary care doctors, but would have 30 residents (three more than the current program) and enhanced electronic learning capabilities. It would accept some residents with osteopathic medical degrees and could be expanded to offer training in internal medicine, emergency medicine and surgery, officials said.

Since 1975, the county's Family Medicine Residency Program has trained more than 250 young doctors, many of whom stayed in the area to practice medicine, and it has played a vital role for the county health system.

The residents and 30 faculty members care for patients in the six county health clinics serving 70,000 to 80,000 low-income patients per year.

The three-year residency lost its federal funding last year after the Centers for Medicare and Medicaid Services said the funding was approved in error for more than 10 years. The county and DMC had to return $19.1 million to the federal government and agreed to keep funding the training through June 2010.

The issue, according to CMS, is that the residency program formerly based at Stanislaus Medical Center no longer qualified for graduate medical education funding after the county hospital closed in 1997. The training was moved to DMC after the county hospital closed.

Federal officials have suggested that a new program could qualify for funding, so local officials are developing one. A 200-page proposal was sent this month to the Accreditation Council for Graduate Medical Education, which could give approval within six weeks.

Possible 2010 start

If it is approved, the county and its partners would apply to CMS for the federal funding. The new program could begin in July 2010.

"The program is very different in its organization, curriculum, the rotations and the use of more than one hospital," said Patty Hill Thomas, assistant executive officer for the county. "It has the potential to enhance primary care physician training, which is badly needed in the community. We want to go beyond family medicine into other areas of training."

A nonprofit consortium made up of the county, DMC and Memorial recently was formed to oversee the new program.

Residents will treat patients and deliver babies under supervision at Doctors Medical Center, but also will have clinical rotations at Memorial and possibly Kaiser Modesto Medical Center and Emanuel Medical Center in Turlock, said Dr. Peter Broderick, director of the current program. Kaiser Permanente has said it is interested in joining the consortium but hasn't signed on.

Federal officials have said that to qualify for funding they expect a new program, with a new faculty and new director, and that issue is being discussed.

For now, Broderick is the interim director for the consortium, which envisions appointing a co-director with a background in osteopathic medicine.

It appears the current faculty would be incorporated in the new program, but the faculty would be expanded to include doctors affiliated with other hospitals, officials said.

"The discussions so far with CMS have been productive," said Steve Mitchell, chief operating officer for Memorial. "We would survey the physicians (at Memorial) for their interest in serving as faculty and their availability."

Broderick said other aspects of the program would be new, too, including a system for thoroughly documenting the skills training given to residents.

Need and cost

Local hospitals have a stake in the physician training, Mitchell said, because without it the area would fall behind on meeting the need for primary care doctors. An expanded program could fill a need for internal medicine physicians, he added.

Memorial and other members of the consortium have agreed to share program expenses not covered by federal funding. Before the funding was lost, the federal government covered $2.7 million of the cost of running the Family Medicine Residency Program, leaving $1.5 million in costs shared equally by the county and DMC.

The proposal for a University of California at Merced medical school could become another tool for recruiting physicians to the area. But Broderick and others have said it needs to be coupled with the expansion of physician training in the San Joaquin Valley.

Otherwise, the medical school graduates will leave the valley or the state to get their practical training. Surveys have shown that physicians often go into practice within 70 miles of where they complete their residency.

Bee staff writer Ken Carlson can be reached at kcarlson@modbee.com or 578-2321.