Valley needs doctors – but who will teach them?

A Fresno medical residency program promoted as the best way to attract and keep doctors in the central San Joaquin Valley is closing because it did not have enough doctors to teach the medical residents.

The Sierra Vista Family Medicine Residency Program, which opened three years ago at a Clinica Sierra Vista center in downtown Fresno, will graduate its last class of residents at the end of June 2017.

One of only a handful of teaching health center programs in California, the Fresno program failed to pass a site review in February by the Accreditation Council for Graduate Medical Education.

The accrediting agency cited faculty shortages for its denial, said Norma Forbes, executive director of the Fresno Healthy Communities Access Partners. The nonprofit has been the sponsoring organization for the residency program. Clinica Sierra Vista provided the training location.

The loss of the program is a blow to medical education in the Valley, but health professionals are not willing to give up on training family physicians. The concept of a residency program as a pipeline for bringing and keeping primary care doctors is a good one, they said.

Fresno still will have medical resident training. The University of California at San Francisco has long trained residents at its medical education program in Fresno. Residents are medical school graduates who are training under senior faculty physicians before practicing on their own.

UCSF-Fresno trains doctors to become specialists – including pediatricians and family practitioners, among others. More than 40 percent of the doctors trained stay in the region.

But the region needs to train more primary care doctors, and the Sierra Vista health center residency program was a welcome addition. Three of the four residents in its first graduating class are practicing medicine in the region, and that success has persuaded a San Joaquin-based health center to apply to start a new residency program to replace the one that is closing.

There is no guarantee, however, that a new program can open before the Sierra Vista residency program ends in less than a year. A new program has to be accredited, funding secured – and it has to have enough teaching staff.

Valley Health Team applying for program

Valley Health Team CEO Soyla A. Reyna-Griffin has taken on the challenge and is applying for accreditation from the same agency that refused to renew the Sierra Vista program. The proposed Valley Health Team Family Medicine Residency Program will need approval quickly. Programs elsewhere are preparing to interview residents for training that will begin July 1.

“It is a very tight timeline, but we’re committed,” Reyna-Griffin said. The private nonprofit operates federally qualified health centers in San Joaquin, Kerman, Kingsburg, Clovis and Firebaugh. Plans are for the residency program to be housed in a new center that is under construction west of Highway 99 in Fresno, she said.

So far, Reyna-Griffin said, Valley Health Team is meeting all the accreditation requirements.

She said she is determined to create a program that is sustainable. She is working to get a transfer of federal funds from the Sierra Vista program once the Valley Health Team program is accredited. The state’s 2016-17 budget also includes $100 million for primary care workforce programs including teaching health center programs, she said.

Opening a residency program won’t be an entirely new venture for Valley Health Team. Sierra Vista residents already had clinical rotations at clinics operated by the health center. And in July, the center in San Joaquin, about 45 minutes southwest of Fresno, became the base for the residency program’s last year. Eight Sierra Vista residents (four first-year and four third-year) remain in the program.

“We wanted to make sure that their graduate medical education was preserved,” Reyna-Griffin said.

However, the upcoming closure of the Sierra Vista program displaced four second-year residents who had to find new programs in June. The final two years of residency must be completed in the same location.

“We had to move them,” Forbes said. “We have been in total chaos to take care of all of that.”

Two of the residents were moved to the Valley Family Medicine Residency of Modesto. One got a residency in Long Beach and one went to Ohio, Forbes said. The residents had to be placed in programs that could accept federal funds for Teaching Health Center Graduate Medical Education, she said. Most family medicine residencies are based in hospitals, where residents treat acute health problems. At health center programs, residents practice inside clinics where there is an emphasis on primary care.

Forbes said residents were pleased with the Fresno program and efforts were made to save it.

“We knew we were having difficulty in getting faculty to teach,” Forbes said. “We had developed a strategy to grow our own. We graduated four residents in family medicine in June. Our intent was for some of those four to actually become faculty,” she said. When two of the graduates were hired as clinicians by Valley Health Team and also agreed to teach residents this year, Forbes said, “we thought we had a solution to solve the faculty problem.”

But the accrediting agency did not agree. It notified the nonprofit it was withdrawing accreditation and gave it until June 2017 to close the program.

Dr. Arvin Fuentes, one of the Sierra Vista program graduates who is teaching residents in San Joaquin, said he wanted to give back to the program. Residents had exposure to inner-city and rural medicine, he said. “We had a very good experience.”

The Sierra Vista program recruited residents who had family or other connections to the Valley with the idea that they would be more likely to remain here. Fuentes, who grew up in the Philippines, had family in Bakersfield. Three of his four graduate classmates are now practicing in the San Joaquin Valley, he said. “Did the program fulfill its mission to increase the primary care physicians in the Valley? I guess the answer to the question is ‘yes.’ ”

Of the third-year residents he is teaching, two are from Madera and one is from Fresno. All four of the first-year residents have roots in the Valley, he said.

Doctors unwilling to teach

Fuentes is hopeful Valley Health Team can open a new residency program, but finding doctors willing to teach residents could be difficult. “In general, it’s really hard to get faculty,” he said. “In the whole country it’s hard to get people in the teaching profession.”

Doctors who are willing to teach tend to prefer to do so in university settings rather than in rural or inner-city clinics, Fuentes said. A teacher’s pay also is less than what a doctor can earn with a full-time private practice. Fuentes said he is fortunate not to have a student loan that has to be repaid.

Stephen Schilling, chief executive officer at Clinica Sierra Vista, said it’s tough recruiting doctors to teach in a medical-shortage area. “We don’t have enough people providing care and we don’t have enough people teaching.”

He and Forbes aggressively recruited doctors for the Sierra Vista residency in Fresno to little avail, he said. They held meetings with local physicians, ran advertisements in newspapers, hired a professional headhunter. And the pay was good. “We just couldn’t get anyone.”

Forbes said the program succeeded in recruiting residents, and in keeping doctors in the Valley, but the accrediting agency would not budge and allow time for teaching faculty to accept a program that was not based in a traditional hospital setting. “We were a casualty of being a brand-new program out there, maybe just a little ahead of its time.”

Reyna-Griffin said Valley Health Team already has had success hiring faculty. The two Sierra Vista program graduates are just two examples, she said. The health center’s chief medical officer, associate medical director and other staff members also are participating in the program. “Our Valley Health Team providers really want to see this program succeed.”

This story was originally published October 7, 2016 at 11:05 AM with the headline "Valley needs doctors – but who will teach them?."