CoxHealth's Family Medicine Residency program fills training, care needs

Not only is it one of five family practice residencies statewide, it’s also the only one in Missouri that isn’t coordinated through a medical school, according to the American Medical Association.

The AMA lists 120 Missouri residency programs as participants in the National Resident Match Program. Outside Springfield, other family practice residency programs are in Columbia, St. Louis and Kansas City. Those programs are coordinated, respectively, by the University of Missouri, St. Louis University, Washington University, University of Missouri-Kansas City and Truman Medical Center.

“The fact that we are the only residency program here is an advantage – residents get to do all kinds of procedures and get all kinds of medical experiences because they’re not competing with other residents,” said Vickie Greenwood, program administrator for CoxHealth Family Medicine Residency.

CoxHealth’s three-year program, which trains medical school graduates for careers in family medicine, is the only residency program in Springfield and has graduated 113 since its first class started in 1988.

Greenwood said that after students complete medical school, they train as residents in a chosen specialty in order to gain board certification. Residents in the CoxHealth program train for three years by performing four-week rotations in various specialties, to prepare them for what a family physician needs to know about other types of medicine.

“They’ll get experience in all of the different areas of family medicine – orthopedics, surgery, obstetrics, gynecology,” Greenwood said. “It’s to learn what a family doctor needs to know about things like pre-operative consultation, post-operative care, et cetera,” she added.

In between rounds, residents spend time seeing a regular slate of patients at the Cox Family Medical Care Center in Cox North.

Every year, eight doctors finish their residencies, opening spots for eight new residents to join the program.

Access to care

The residency program’s impact, however, extends well beyond its educational role.

The clinic run by the resident physicians plays a key role in the slate of health care offerings for residents of Springfield’s north side.

“We have historically been the major provider for health care in north Springfield,” said Dr. Larry Halverson, senior faculty physician with the residency program, which he directed until 2004.

“We see about 40,000 patient visits a year, and of those, about 50 to 60 percent are (on) Medicaid or have no insurance. There’s a high portion of people who have trouble getting in elsewhere,” he added.

Halverson estimated that about one-third of the center’s patients are on Medicare, one-third are on Medicaid, one-sixth have private insurance and one-sixth have no coverage.

Greenwood said office visits at Family Medical Care Center cost the same as other doctors’ offices in the Cox system, though she declined to provide the actual figure.

She noted, though, that CoxHealth has a financial assistance program to help offset doctor-visit costs for lower-income patients, and she said that the Family Medical Care Center has more patients who qualify for that assistance compared to other clinics.

The Cox Family Medical Care Center augments existing services for the underinsured in Springfield such as Jordan Valley Community Health Center, which serves patients with Medicaid and requires a small co-pay, and The Kitchen Medical and Dental Clinic, which only sees patients without insurance who fall below income guidelines. The Kitchen does not charge a co-pay.

Rorie Orgeron, interim CEO of The Kitchen, said his facility has averaged more than 1,000 monthly patient visits in 2008, up by more than 50 percent from 2007.

“The need is huge,” Orgeron said. “Each facility has their little segment of the population that they work with, and unfortunately, it seems like the group is growing all the time.”

Brooks Miller, executive director of Jordan Valley Community Health Center, said his center averages about 2,600 patient visits a month.

“I consider us partners to a degree, because I think we serve the same clientele socio-economically,” he said, noting that the CoxHealth program’s obstetrics services are a big plus, as Jordan Valley does not offer those services.

Two physicians at Jordan Valley, including Dr. Chan Ngo, the center’s medical director, are graduates of the CoxHealth residency program. “I consider it a privilege to have the kind of working relationship that we have with the residency program,” Miller said.

Filling a need

Halverson said the impetus for the residency program was to help alleviate a shortage of family physicians in southwest Missouri, and he said the best way to accomplish that goal is to train the doctors here.

“Somewhere around 75 (percent) or 80 percent of residency graduates stay close to where they did their residency,” said Halverson, citing research from the American Medical Association. “Medical school graduates go all over the place, but … in our program about 80 percent are within 100 miles of Springfield.”

Greenwood said training for family physicians is vital, particularly since there are fewer entering the specialty.

“There has been a real decline in the number of medical students choosing family medicine,” Greenwood said, noting rising medical malpractice insurance costs and lower pay relative to other medical specialties as causes for the drop. “Graduates all have the same high debt from medical school, so they pick specialties with higher income expectation, in order to pay back those debts.”

Data from the American Academy of Family Physicians shows that the number of medical school graduates matched with family practice residencies dropped 53 percent from 1997 to 2007.

Greenwood said a significant number of residents are considered “nontraditional,” meaning they are getting into family medicine after spending years in a different career.

A Declining Specialty?

The trend of residents moving away from family medicine has been ongoing for more than a decade, according to the American Academy of Family Physicians. In 1997, the National Resident Matching Program, which matches medical school graduates with residency programs, placed 2,340 medical school seniors in family medicine programs. By 2007, the number had dropped to 1,107.

The field may be making a turnaround, however. The matching program placed 1,172 seniors this year, up 5.6 percent from 2007, according to AAFP statistics.

Source: American Academy of Family Physicians

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