Medical residency money on the chopping block

The heart-monitoring unit at St. John's Hospital in Maplewood can be a busy place.

But on this day it's fairly quiet as Jeremy Peterson makes his rounds.

Peterson is in the third and final year of his family medicine residency. A residency is required training for doctors seeking their license to practice in Minnesota. Hospitals that offer residency programs get the benefit of extra help to cover overnight shifts.

"I don't know what I would do without these overnight experiences here at St. John's," Peterson says.

It's also a good recruiting tool because doctors are more likely to work in the state where they received their training.

In a few months Peterson will say goodbye to the St. John's doctors who've supervised him and he'll head off to Princeton, Minnesota to begin his new job at the clinic and hospital there.

"I know I'll be much more comfortable when I get called at two in the morning next year to come in to the hospital and help out with whatever crisis is going on at the moment. I have plenty of things in my repertoire to draw back on."

But residency programs have disadvantages too. All that hands-on training doesn't come cheap. That's why Minnesota subsidizes some of the costs of training programs.

Residents can't handle as many patients as a more experienced doctor - so hospitals make less money, according to Dr. Bill Roberts, who directs the Family Medicine Residency Program at St. John's Hospital.

"We can't see patients at a clip that would allow us to fund the residency just from the patients that we see," Roberts says.

A typical resident usually sees anywhere from four to 10 patients in a half day of clinic work. That's still far short of their private practice colleagues who over the course of a day see up to 30 patients, Roberts says.

"We need that funding to allow us to continue to educate and learn in a setting that isn't quite as demanding in terms of patient volumes."

The state's medical education fund known as MERC (Medical Education Research Costs) is a small supplemental part of the money hospitals receive to train residents. At St. John's Medicaid and Medicare contribute more than a third of the program's costs. Hospitals and clinics kick in some of their own money too. But times are lean and every extra dollar matters more than ever to hospitals that have seen their patient volumes plunge in recent months.

At St. John's Hospital, approximately $175,000 dollars was stripped from revenues when the governor cut the medical education account in December. The sudden loss of funding has CEO Scott North scrambling for ways to plug the gap in his budget. St. John's can't absorb a financial hit of that magnitude without some pain, North says. But he says the hospital is committed to keeping its residency program going.

"The bottom line is the program is very important to the hospital, our community and our patients. So there is a cost to providing it and it would really be unlikely that we would make any significant reductions in that. But it would affect some of our other programs here at the hospital."

Other teaching hospitals might not be as willing or able to hang on to their residency programs. Since he finished his residency in 1981, Bill Roberts says, several Minnesota hospitals have dropped their programs because they couldn't afford them. If that trend continues, care will be compromised, Roberts says.

"If the people of the state don't want to support programs like this and if we can't find other sources of funding then we just won't have the physicians to see them in our specialty or others as we move through the next few years and decades."

In the budget that's wrapping up, the state set aside $50 million a year for medical education over two years. If lawmakers decide to continue the program, it will require $100 million that may be tough to find when so many other programs are also at stake this session.

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