TheBakersfieldCalifornian.com

Kern Medical Center has decided not to accept first-year family medicine residents and likely will close that program altogether, a move local doctors say could have disastrous consequences and worsen Kern County's primary care shortage.

Family Medicine residents, or doctors in their final stages of training, often stay in Kern County after graduation, adding to the community's overall supply of primary care physicians. While they're training at KMC, they also see patients.

"To see that program go is shocking," said Dr. Ramon Neufeld, who started that KMC residency in 1976. "It doesn't make any sense, and it will deal a severe blow to our need for primary care manpower in Kern County."

Cost concerns

Kern Medical Center CEO Paul Hensler told staff Thursday about the decision not to take a new class of family medicine residents, citing cost concerns. The program loses more than $6 million a year, much from overhead, Hensler said.

Family medicine residency is a three-year program, with six physicians in each class. The other two years of residents will continue to graduation.

A final decision on ending the program has not yet been made. The Board of Supervisors doesn't need to approve eliminating the incoming class of residents, though a full closure would require a public hearing, Hensler said.

"It's not necessarily closing, though it looks that way," he said. "We're continuing to look at ways to turn financials around."

Hensler said he'd been considering the move for months, and told the head of the family practice program Wednesday -- the day the hospital was supposed to submit its choices for next year's class of residents.

To deal with the shortage of doctors, Hensler plans to expand the internal medicine department and recruit more physician assistants and nurse practitioners.

Filling Kern's need

About 33 to 40 percent of KMC's family medicine residents stay in the county after graduation, Hensler said.

One of those is Dr. Tiffany Pierce, who completed the program in 2010 and now works for Kaiser Permanente in Kern County. In her class, five out of the six graduates stayed nearby. At Kaiser, many of her colleagues also graduated from the program, she added.

Pierce says she fears ending the residency would have a big impact on the county. Along with the immediate needs of patients KMC serves, there will also be a ripple effect on the greater community.

"There are not enough primary care physicians in Kern County, period," she said. "If we're losing a course of training for new physicians, I don't know what's going to happen."

Those sentiments were also echoed by other local doctors who predicted a public outcry about the news.

"I was shocked when I heard this," said Dr. Jennifer Abraham, an internal medicine physician who recently turned in her resignation to KMC for other reasons. "I don't know why they would do this. This is not good for our community."

Since its creation in 1976, the KMC program has provided a significant number of physicians to Kern County, said Neufeld, the program's founder and a current medical director for GEMCare. With the primary care shortage, retiring physicians, and aging baby boomers, that need has only intensified.

For now, Neufeld said he's waiting calmly to get the facts.

"We need to take a hard look at Mr. Hensler's rationale, and see if it's supported by information and data," he said. "There may be issues and problems, but you don't want to throw the baby out with the bathwater."

KMC's financial woes

The latest move is another symptom of KMC's overall financial challenges. Hensler said KMC is still profitable, but cash flow is a major problem, and he expects cost pressures to worsen.

On Tuesday, Kern County supervisors agreed, in an emergency action, to increase the hard cap on the loan of Kern County general operational revenues that KMC uses to pay its bills when revenue is short from $70 million to $75 million.

The county-owned hospital is owed more than $41.3 million in state and federal funds that it has not been able to collect.

Hensler told supervisors that the hospital was at risk of missing payroll if the loan cap was not raised. Supervisors, very reluctantly, agreed to raise the cap after County Auditor-Controller Ann Barnett told them she would be forced to ignore the loan cap because, she said, she is obligated to pay county employees for the work that they have done.

-- Staff writer James Burger contributed to this report