A call for transparency and reinvestment in family medicine from University Hospitals of Cleveland: Hannah Hutchinson Clarke and Olivia Mangat Dhaliwal

CLEVELAND — We are medical students in Northeast Ohio passionate about family medicine. We include two student directors of the Ohio Academy of Family Physicians Board of Directors, several student delegates to the American Academy of Family Physicians, a Pisacano Scholar, and a National Health Service Corps Scholar.

Several weeks ago, we learned that University Hospitals chose to end its Family Medicine Residency program at Cleveland Medical Center after graduating the current cohorts. In response, we sent the UH administration a letter of protest that has garnered over 200 student signatures.

The culture surrounding generalism at specialist, research-focused institutions is often neither encouraging nor positive. Attending physicians, professors, and peers have told us that we should aim beyond family medicine, or that we will likely change our minds as we progress through medical school.

But we all choose primary care for the satisfaction that personalizing and integrating whole-person, whole-life care offers. We understand the risks that come with practicing primary care, including burnout, overwork, and being undervalued in a fee-for-service, “sick care” system that places procedures and profits before prevention and people. As our awareness of this critical care gap deepens, our drive to become physicians to meet that need only intensifies.

Hannah Hutchinson Clarke holds a master’s degree in public health and is a third-year medical student at Case Western Reserve University.

Discontinuing the UHCMC FM Residency (FMR) demonstrates disinvestment in primary care, with detrimental consequences to the Cleveland community and the medical community, including students, trainees, and attending physicians. Among them:

· Impact on the community: The FMR plays a pivotal role in addressing health disparities in marginalized populations. The closure of this program disproportionately hinders access to care for underserved communities who rely on residents and faculty for quality health care services. We believe that Ohio’s medical institutions have a responsibility to address, not worsen, the glaring primary care inequities of the communities they exist to serve.

· Impact on the medical professional community: Closure of this training program exacerbates the need for primary care physicians that train and stay in Ohio, a state projected to be short 700 generalist physicians by 2030. This places an undue burden on colleagues in other departments and at neighboring institutions because, unlike pediatrics, internal medicine, and obstetrics-gynecology, family medicine is the only primary care specialty that can and is eager to care for the whole family from birth to death. Northeast Ohio’s health care infrastructure will surely feel the devastating effects of a primary care shortage as fewer residents are trained and fewer family medicine faculty are recruited.

· Impact on local medical students: Closure of the residency program impacts medical student training, culture, and specialization by sending a message to students that family medicine is not valued by the institution. This will discourage students from pursuing careers in primary care, which is already a struggling field. Neither should it be overlooked that residents serve as highly engaged mentors and teachers in curricular and extracurricular activities for Northeast Ohio medical students, which is vital in forming positive perceptions of family medicine.

Olivia Mangat Dhaliwal

Olivia Mangat Dhaliwal is a fourth-year medical student at Case Western Reserve University who advocates on a national scale for rural and family medicine.

We hold the expectation that academic medical institutions be attentive and responsive to the needs of our community, region, and state. We are calling for two actions: 1) That UH communicate its decision to all patients, faculty, and students in acknowledgement of these groups as stakeholders, and 2) That UH commit to reinvestment in family medicine, demonstrating renewed dedication to primary care, trainees and patients alike, in Northeast Ohio.

Hannah Hutchinson Clarke holds a master’s degree in public health and is a third-year medical student at Case Western Reserve University (CWRU), interested in family and preventive medicine, adolescent health, and working in a government health agency some day. Olivia Mangat Dhaliwal is a fourth-year medical student at CWRU, eager to embark on her journey to being a whole-person, whole-life healer in rural America. She advocates on a national scale for rural and family medicine. They are joined in this opinion article by Carlee Mitchell, Ellen Hutchinson, Trina Pal, Andrew Halza, and Anirudh Prabu, all third-year medical students at CWRU.

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