The medical residents at Physicians Medical Center Carraway - who had virtually no notice they would lose their jobs before the hospital filed for bankruptcy Oct. 20 - have found new training facilities, according to hospital officials.
But the process was far from painless, and at least a third of the 59 doctors in training left Alabama to continue their residencies.
The residents had to find hospitals with accredited medical-education programs that either had open spots or were able to create space on short notice. Physicians Carraway had four residency programs, in surgery, internal medicine, family medicine and transitional year.
One of Physicians Carraway's family medicine residents has to wait until May before she can resume her work because the program she is going into does not have room for her until then.
Some of the medical residents were only months away from completing their training. Others had almost five years to go. Of the 59, 26 were able to land positions in Birmingham, at Baptist Health System or UAB Hospital, according to officials at Baptist and the University of Alabama at Birmingham. Others had to leave the city or state, which meant in some cases uprooting family and selling a house.
"It was traumatic both for me and the residents," said Dr. Mary Gipson, who was associate director of the family-medicine residency at Physicians Carraway. "They were in my office every day as I made phone calls, as I pleaded."
Degrees of difficulty:
Family-medicine residents were among the most difficult to place. The program directors over surgery, internal medicine and transitional year had an easier time, but even they report spending hours on the phone for two or three weeks securing spots for their residents.
"I put my heart and soul into training residents," said Dr. Raleigh Kent III, over the surgery residency. "My one relief in all this was that we got them all placed. They all got jobs."
Physicians Carraway transferred its final patients to other hospitals by Oct. 22, and all of the hospital's 1,000 employees have lost their jobs. Employees were paid for the time they worked but not for their accrued vacation.
The closure of Physicians Carraway's medical-education program was not only a hardship on the residents, but also bad news for Alabama. Physicians Carraway had the longest-operating graduate medical education program in the state, and most of the doctors trained there remained in Alabama to practice. The state is woefully short of doctors in rural areas and in some inner cities.
With Physicians Carraway's demise, the state almost certainly will lose the hospital's federally approved and funded education slots. Getting more spots approved and paid for at other programs in the state is unlikely.
"Alabama just lost all of these slots and there's nothing we can do about it," said Dr. Elizabeth Ennis, Baptist Health System's vice president of medical education and research.
Ennis said doctors who complete their residencies here tend to come back to Alabama, even if they get further specialty training elsewhere. Baptist tried to salvage something out of Physicians Carraway's shutdown by taking as many of the residents as possible, she said.
"We realized that if we lost these residents, Birmingham and Alabama's health care would suffer and we would lose some newly trained doctors who otherwise would have practiced in the state," Ennis said.
Baptist took on the most Physicians Carraway residents, adding 18 to its existing program of 82. Baptist, which trains residents at Princeton Baptist Medical Center and Trinity Medical Center, did not have the open spots but implored supervising physicians to take on more.
"It really is a huge undertaking to be able to absorb these doctors with no fiscal planning, she said. "We've pressed people into additional service."
Dr. Hernando Carter, in his final year of an internal-medicine residency, landed at Baptist and was able to start there just two weeks after Physicians Carraway closed. He said he and others sweated those intervening weeks.
"There was a sense of urgency and panic," Carter said. "We knew we had to get on the phone immediately and find a place."
Carter's wife is a physician at Cooper Green Mercy Hospital and they're expecting their second child in January. "Being separated from family was a real concern for me."
The residents also learned that Physicians Carraway's bankruptcy meant they were on their own to find malpractice insurance to cover them for their time at the hospital. Usually, the teaching hospital provides the needed insurance after residents leave.
Ennis said Baptist worked hard to find a carrier who would provide the coverage but the residents had to pay from $1,314 to almost $11,000 out of pocket, depending on their specialties and how long they had been in the program.
UAB Hospital took eight of the displaced residents, according to UAB officials. The Tuscaloosa Family Medicine Residency at the University of Alabama, based at DCH Regional Medical Center, took five residents and wanted to take more, said Dr. John Waits, the residency director.
"We really only had room for one resident, but we created room, feeling like this was a service to the state," Waits said.
Waits said he would like to increase the program's number of slots permanently because Alabama desperately needs more primary-care physicians. But the federal freeze on residents' spots makes that unlikely. In the past several years, Waits said three of the state's family-medicine residency programs have closed - at UAB, in Anniston and now at Physicians Carraway.
"It's really a travesty," Waits said. "There has been a freeze on new training spots for over a decade despite the primary-care shortage."
Gipson, who struggled to place Physicians Carraway's family-medicine residents, said she was disappointed in the state's other family-medicine programs' efforts to help, with the exception of the Tuscaloosa program. Two other family-medicine residents got slots in Alabama, but seven of the 14 went out of state, Gipson said.
"We basically lost seven primary-care physicians who likely would have stayed in state to practice," she said.
Gipson said she was blindsided by the hospital's closure because it had survived other financial problems and because hospital leaders had told her just two weeks earlier to start recruiting next year's residents.
"I didn't see it coming," Gipson said. "I had been through so many things with Carraway over the years."
Dr. Hugh O'Shields, program director over Physicians Carraway's internal-medicine residency and one of the hospital's physician owners, said he was sorry about how the residents ended their experience at Physicians Carraway but was relieved that all found placement.
"They were justifiably angry at what had happened," O'Shields said. "Given the circumstances, though, I think everybody came out fairly well."
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