Nueces County weighs in on loss of Christus Spohn emergency medicine residency

Christus Spohn defended plans to eliminate the hospital’s emergency medicine residency program at a Nueces County Commissioners Court meeting Thursday, sharing arguments that many health care professionals in attendance disagreed with.

About 80 people packed into the Commissioners Courtroom in the Nueces County Courthouse, filling every seat and standing along the back and sides of the room. Many health care professionals came in their white lab coats or scrubs.

This is the second community meeting this week where doctors have made their voices heard. About 50 people attended a Corpus Christi City Council meeting Tuesday, speaking during public comment, though their concerns were not on the agenda.

The county meeting was dedicated specifically to considering the future of the emergency residency program.

But what, if anything, either the county or the city could do to save the program is unclear. The Christus Spohn Health System is a private entity, but it does partner with the Nueces County Hospital District to provide care for the county’s indigent population, which includes low-income residents who don’t qualify for other state or federal health care programs.

According to the Nueces County Hospital District agreement, Christus Spohn must have at least two residency programs.

County Judge Connie Scott announced the county’s intention to form a working group, including representatives from Christus Spohn, the Nueces County Hospital District and the medical community to potentially find solutions.

But it was unclear Thursday whether Christus Spohn would participate in the group. Christus Spohn CEO Dom Dominguez said that after a recent conversation with faculty was recorded without his knowledge, he was unsure about participating in a working group.

Dominquez said he would meet with the commissioners and a hospital district representative. After being pressed by commissioners, he said he would consider participating in a group with community representation but did not commit.

“I’m disappointed,” Commissioner Brent Chesney said. “We had a conversation outside and all the progress that was made this morning, you’re kind of throwing out the window if you don’t reconsider.”

Chesney said Dominguez had previously given his word that he would participate.

“If you’re backing out of the peace talks, that puts me in a bad spot because there’s no point in going and having a meeting if they’re (the medical community) not involved and included in this because I can’ speak for them,” Chesney said, referencing the doctors involved in the residency program.

Dominguez gave a 10-minute presentation to the commissioners, starting by reading a statement before expanding with additional remarks. Dominguez left the meeting while doctors pleading for support saving the program were still speaking.

The hospital plans to phase out the emergency medicine residency program by 2026, finishing out its commitment to current residents.

The Christus Spohn program began in 2007 when there were only two other emergency medicine residencies in the state. Now there are 18.

The hospital has said the decision was made with consideration to community needs and available resources. Separately, Christus Spohn remains committed to its family medicine residency program and fellowship programs. Dominguez said. The health system has also invested in a nurse residency program.

Dominguez’s remarks indicated that Christus Spohn is shifting focus to primary care and specialty clinics. Dominguez said the community needs about 162 primary care providers from Christus Spohn, but currently has 63.

“Right now, if you go to Portland for our clinic, it might take you 90 days to get in,” Dominquez said. “Over on the island where we have the only clinic through the health system, it will take you 30 to 40 days.”

Nueces County Medical Society President Dr. Ruben Pedraza also addressed the commissioners. The medical society held an emergency meeting on the closure, Pedraza said.

“Our stance on the matter is that we have a critical shortage of healthcare in the area,” Pedraza said. “While we appreciate their (Christus Spohn’s) vision of bolstering primary care in the community, which is an absolute necessity, that is going to take time and for now the indigent population in this community is deeply dependent on the ER and their resources.”

Dominguez cited a workforce study by the American College of Emergency Physicians predicting an oversupply of emergency physicians by 2030.

But doctors in attendance said the national figures do not reflect the local situation. Dr. John Herrick, the associate program director for the emergency medicine residency, said that study did not take into account the high rate of attrition in the field after the pandemic.

Dominguez also referenced hundreds of unfilled emergency medicine residency spots across the country last year.

“In our own class, we did see a reduction last year slightly in the number of applicants, this year that had already reversed,” Herrick said.

On the first day the program opened applications for next year, the program received 600 applications for 12 spots.

The Christus Spohn emergency medicine residency is the only program of its kind in the Coastal Bend. It has also never struggled to find residency applicants, and many graduates of the program continue to work in the region, Herrick said.

“We have about 50% retention rate,” Herrick said, explaining that half of last year’s resident class found jobs in the community and four out of 12 of this year’s third-year residents have expressed hopes to stay local when they complete the program this summer.

Avery Tomanec, a seventh-grade student at River Hills Christian Academy and the daughter of residency program director Dr. Alainya Tomanec, presented a binder full of over 3,000 names of people who signed a petition to save the program.

Retired trauma surgeon Dr. Michael Halpert called the program a “gem” and a “major league quality program.”

"Mr. Dominguez stated that this closure will absolutely not impact the quality of care that patients receive,” Halpert said. “He simply cannot say this. How can the closure of a program that attracts the best and brightest young physician trainees to our county, many of whom remain here to practice, not impact the quality of care?”

Despite promises that the program won’t end until 2026, Herrick expressed concerns about the program’s accreditation, noting that a program needs at least 18 residents to maintain accredited. But under Christus Spohn’s plan, there will only be 12 residents in its final year, if all current residents decide to stay.

The three-year program includes a total of 36 residents and 16 faculty members. The doctors work in the emergency room and intensive care units at Christus Spohn Hospital Shoreline, as well as in emergency rooms across the region.

This team of doctors pitched in to help the community make it through the COVID-19 pandemic, and are also essential during disasters like hurricanes, doctors and advocates said.

Herrick was the first faculty member to move to Corpus Christi to help launch the program in 2006. Herrick recalled a shift in the Shoreline emergency room before the residency program, when he had 17 patients, including five or six he described as “deathly ill,” all waiting to be seen.

“There’s no way they should have been waiting with those wait times,” Herrick said. “With the residents, we solved that. The day the residency moved from Memorial to Shoreline, the metrics decreased greatly.”

Herrick said that waiting times today are due to nurse shortages.

Herrick predicted that without residents, the emergency room at Shoreline would most likely be staffed by travelling replacements who don’t live locally, but fly in and out of Corpus Christi for shifts.

Herrick also predicted that the community would lose trauma surgeons, saying that many take jobs at Christus Spohn in order to work with residents. 

“There would be substantial attrition of our trauma surgeons, some of whom have already said they’re gone and they feel that the (Christus Spohn Hospital Shoreline) Level II Trama Designation would be at risk,” Herrick said.

Dr. Sandra Williams, a Houston doctor and president of the Texas College of Emergency Physicians, traveled to Corpus Christi to attend the meeting.

Williams stressed the special training and value of emergency medicine residency-trained physicians, who have already completed medical school by the time they begin a residency.

“The other specialists out there such as physician’s assistants and nurse practitioners do not have anywhere near the training that we do,” Williams said. “They finish undergrad and get a two-year degree and that’s it. There’s absolutely no comparison.”

Dr. Bryan Dunn, secretary of the Texas College of Emergency Physicians, said he has ties to the Kingsville community.

“If this residency program is in jeopardy due to economic or financial concerns, please, please investigate whatever reasonable alternatives might exist to keep this priceless resource here in South Texas,” Dunn said. “Once it’s gone, the prospects of getting one back will be very grim.”

Dr. Marilyn Brodeur, a dentist and the wife of a faculty member of the residency program, said that time is short to save the program, which has halted recruitment for the next class of residents.

“The reputation of this program has been shattered and unless something is done in a timely fashion, this program will be severely limited,” Brodeur said.

After hearing over an hour of public comment, the county judge and commissioners expressed their hopes for the working group, but acknowledged that Christus Spohn is the decision-maker.

“Let me also be clear, I am not going to give anybody any false hope,” Scott said. “I’m not sure what kind of authority we would have over this, but we want to listen to you.”

Commissioner John Marez said the county’s working group will be formed swiftly.

“We need to put our money where our mouth is now because we cannot miss out on any more potential residents blacklisting us because of the problems we’re going through now,” Marez said. “We will get this resolved in minutes and days rather than weeks and months.”

Chesney expressed his clear support for the residency program.

“It’s everybody’s fight,” Chesney said. “This is every elected official’s fight. This is every community leader’s fight. If we don’t stand up for this, then we’re going to lose this and it will never be replaced.”

Chesney said he intends to contact donors in the community and anyone with influence over the hospital.

“I feel very good about if we get Spohn to the table, that maybe we can come up with something,” Chesney said. “But again, don’t leave here with false hope. Leave here with a little bit, but don’t leave here with false hope.”

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Closure of Corpus Christi emergency medicine residency is great loss for the community

This article originally appeared on Corpus Christi Caller Times: Doctors petition Nueces County for help saving ER training program