University of Wyoming medical students searching for residency programs in the state might have a difficult time in the future.
The Family Medicine Residency Program has a clinic in both Cheyenne and Casper. The clinics’ mission is twofold — educating students in a realistic setting and providing quality care to patients, College of Health Dean Joe Steiner said.
“We use them as training sites,” he said. “They have an impact on the education of pharmacists, nurses, social workers. There are not many places available for that type of training in Wyoming.”
Each location has a complement of faculty members but, unlike many other professors, have a duty other than education and research.
“While their primary responsibility is teaching and observing students working with patients, they also maintain their own clinical practice,” he said.
The faculty positions are filled by doctors, which can make recruiting difficult, said Kevin Murray, director of medical education and public health.
“Because of the (low) salaries, (the Cheyenne clinic) has had about half of their faculty positions empty for more than four years,” he said. “The faculty that are left have to spend a larger portion of their time providing the resident teaching, training, supervision that is required for the educational program.
“That, in turn, means they are less available, personally, to deliver direct patient care, which gives you less patient visits and less revenue,” Murray continued. “The dominoes keep going down.”
These problems have created revenue problems in Cheyenne for years, Murray explained. However, the clinic was recently declared a federally qualified health center. The federal government now provides larger reimbursement payments for Medicaid and Medicare patients.
The Casper clinic has been qualified for about 10 years, Murray said, allaying some of the funding woes.
“Casper has always been larger, so they’re more productive and successful,” he said.
Becoming federally qualified can also benefit community members, Murray said.
“One of the many things you have to do is be willing to see people without insurance,” he said. “It’s part of our service mission.”
Regardless of the clinics’ size or revenues, the residency program relies on Legislative funding to continue operation, Steiner said.
“Both residencies still need state funding,” he said. “They’re educational enterprises — neither are made to make money.”
Like nearly all other state entities, the residency program will likely take a funding cut.
“Since we’ve become federally qualified health centers, that’s opened up some federal funding to us, so we can use some of that to defray the operating costs,” Steiner said. “But one of the problems we have is — we’re losing state money, but it’s costing more and more to provide quality health care. We’re looking at other funding options to at least help us stay even.”
The residency program has a clinical reserve account it needs permission to use for the upcoming fiscal year, Murray said. He wants to keep the program funding where it currently is to give the program time to figure out how much federal funding it will receive for coming years.
“We’re in a position where we could be generating more revenues than we do now, but we don’t know exactly what that is yet,” he said. “My pitch has been, ‘Instead of having us cut these people and positions, for this first year, when these new funds are just beginning to flow, let us use them to make up any cut funding.’”
Like many departments on campus, losing faculty positions can lead to difficulties in teaching and research requirements, and the same is true for the residency program, Murray said.
“When you lose half your faculty, you’re no longer talking about trimming around the edges, you have to redirect where you spend most of your time. Then your only other choice is reduce the number of residents you take, but then you’re shrinking the entire program, which is counterproductive to why it’s there.”
Currently, the Cheyenne clinic can have six residents at one time, with Casper hosting eight. Reducing the clinics’ residency rate can have large long-term effects on the state, Murray said.
“About 50 percent of the family physicians operating in Wyoming now have been graduates of one of these two programs over the last 30-35 years,” he said. “Our retention rate, recently, is about 40-50 percent of graduates staying in the state.”