After six weeks of tense negotiations, a health system that planned to shutter its emergency medicine (EM) residency program came to an agreement with the local county hospital district to keep the program open.

In Corpus Christi, Texas, the Nueces County Hospital District (NCHD) Board of Managers unanimously voted on December 12 its final approval of an agreement to keep the EM residency program at Christus Spohn open for the next six years. The EM Residency Program is actively recruiting 12 residents for the 2024 Match.

On October 13, the Christus Spohn hospital system, part of the larger multi-state Christus Health system, announced plans to gradually phase out its 36-member EM residency program, launched in 2007 in partnership with Texas A&M University, by 2026—when the last group of currently enrolled residents graduates. But public outcry against the move led to local government hearings and meetings with the NCHD, which authorized negotiations with Christus Spohn aimed at saving the program. NCHD is a county government entity whose mission is to arrange for indigent health care services for county residents.

On Nov. 8, local television station KRIS 6 reported a tentative agreement with the hospital to preserve the program, based on additional financial support from NCHD in the amounts of $1.4 million for 2024, $2.8 million for 2025, and then $4.25 million annually thereafter. NCHD already pays the hospital to provide indigent medical care to local residents through its Nueces Aid program.

But the NCHD voted not to give final approval to the proposed solution in a meeting on Nov. 14. KRIS 6 reported that doctors testifying at the meeting said the tentative agreement “isn’t enough.” Emergency physician John Herrick, DO, FACEP, the residency program’s associate program director, said the residency “needs to be transitioned to a program that does want us.” After hearing this testimony, the NCHD instructed its director to continue working on the plan.

J.D. Cambron, DO, an associate director of the Texas A&M-Spohn residency program, and a graduate of the program, told ACEP Now by phone from outside the board’s meeting room that it is obvious that the NCHD and the community have the residency program’s survival in mind. “This is a strong program with a cohesive vision to provide great care. I am hopeful that a long-term solution can come to life,” he said.

Why Was it Being Closed?

Christus Spohn has stated that the hospital’s emergency services would remain intact at all of its local hospitals. “It will not impact patient care at all,” said hospital CEO Dominic Dominquez. But as the residency program’s future was placed in doubt, numerous questions were raised in the local community about the potential impact on the hospital, the physicians, and the community itself.

Would all of the current residents have stuck it out knowing that the program was winding down? Would faculty have stayed once their teaching role went away? How would Christus Spohn have staffed the emergency department, and how would it have best delivered care to the community? What about the emergency medicine residents’ role in staffing the hospital’s medical and trauma ICUs? What would happen to the hospital’s accreditation status as a Level II Trauma Center?

It is not clear, especially given all of these questions, why Christus Spohn chose to close the residency program in October. Hospital leaders have not spoken to the press or made themselves available for interviews, including a request from ACEP Now. But in an October 17 statement and at public meetings, the hospital and its representatives cited financial concerns.

“The difficult decision to phase out the Emergency Medicine Residency Program was made with thorough consideration of our community’s needs and our available resources to serve those needs. We ultimately determined that our ability to sustain this program would end with graduating the current residents in 2026,” the hospital’s statement noted.

The hospital also expressed its intention to concentrate on residency training in family medicine, another need for rural areas such as South Texas. “Ultimately we are simply unable to sustain the [emergency medicine] program for the long-term future.”

The hospital noted that emergency medicine residencies in Texas have grown from three when its program was launched in 2007, to 18 programs today. On this year’s Resident Match Day, 555 emergency medicine slots initially went unfilled, compared with 219 from the Match Day in 2022, although most of the unfilled slots were filled through the Supplemental Offer and Acceptance Program (SOAP). An EM study projecting an oversupply of emergency physicians by 2030 was cited by Christus Spohn as another reason to close the program.¹

ACEP responded with a letter to health system leaders explaining that the study, published in 2021, was based on pre-pandemic 2019 data and fails to reflect a maldistribution of the emergency physician workforce, unfilled needs for emergency medicine board-certified physicians in rural and underserved areas, and high rates of burnout among emergency physicians.

“Emergency medicine residency training programs provide lasting benefits to an institution and the community it serves that are not captured on simple financial analysis,” states the letter, signed by ACEP President Aisha T. Terry, MD, MPH, FACEP. “There are numerous studies describing how EM residencies drive improvements in the quality of care, care coordination, addressing social determinants of health, and preparation and response to disasters and large-scale events.”

Gillian Schmitz, MD, FACEP, an ACEP Past President and associate professor at the Uniformed Services University of the Health Sciences in San Antonio, co-authored a recent editorial on the Workforce Study in Annals of Emergency Medicine stating, “The long-term effect of supply and demand remains complex and difficult to predict but the sky is not falling.”² She explained to ACEP Now, “From the perspective of the local environment, of course we want residents. From a national perspective, it gets more complicated.”

Dr. Schmitz credited Christus Spohn for planning to close the program gradually, allowing current residents to finish their training, instead of leaving them scrambling, as happened when Hahnemann University Hospital in Philadelphia closed in 2019. But an important take away is the effect on the pipeline of future physicians, she said. Physicians often tend to stay in an area where they enjoyed their medical training.

Christus Spohn provided a unique learning environment, far from academic settings and competing residency programs, Dr. Schmitz said. “By all accounts, it’s a wonderful place to train. It feels emotional to the people there … But people have to understand that training residents is expensive.”

Angela Gardner, MD, FACEP, an ACEP Past President and professor of emergency medicine at University of Texas Southwestern in Dallas, said the cost of supporting and teaching residents outweighs the inexpensive labor they provide.

“I still believe in our mission of having an emergency department residency-trained doctor in every emergency room in the country,” she said. “I never had to lift a finger to get a job in emergency medicine. People wanted emergency doctors back then. Maybe that’s what has changed.”

Larry Beresford is a freelance medical journalist based in Oakland, Calif., with a specialty in hospice and palliative care and thorough experience covering hospital medicine.

References

1. Marco CA, Courtney DM, Ling LJ. The Emergency Medicine Physician Workforce: Projections for 2030. Annals of Emergency Medicine. 2021 Dec.; 78(6): 726-737.
2. Schmitz GR, Jarou ZJ. The emergency medicine match: Is the sky falling or is this just growing pains. Annals of Emergency Medicine. 2023 Nov.; 82(5):608-610.

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