Psychiatry Residents Threatened By Michigan’s Budget Crisis

Confronted with a $319 million budget shortfall for Fiscal 2002, Michigan Governor John Engler issued a sweeping executive order last month slashing funding for numerous state services. The cuts contained in his executive order could mean significant downsizing and even the possibility of closure for two of the state’s psychiatry residency programs.

The general psychiatry residency at Michigan State University (MSU) in Lansing is reeling after the executive order yanked $535,000, or 48 percent, from its training budget. For Wayne State University’s (WSU) adult and child and adolescent residency programs in downtown Detroit, the cuts amounted to more than $3 million, again about half of the psychiatry department’s training budget and 15 percent of its total budget.

The state’s remaining psychiatry residency programs, at MSU’s Kalamazoo campus, the University of Michigan in Ann Arbor, and the program based at the Henry Ford Health Sciences Center in Detroit, do not rely on state contracts for funding and thus are not affected by the executive order.

“Everybody’s going to feel pain here,” Christopher Colenda III, M.D., M.P.H., chair of the psychiatry department at MSU, told Psychiatric News. “There are going to also be GME [graduate medical education] funding cuts from the state that will be passed through to all of the hospitals. But I’m feeling a greater amount of pain—I’ve just had part of my program amputated.”

The cuts in residency funding stem from an $85 million reduction in the state’s budget for its Department of Community Health, which oversees mental health services. The programs at MSU and WSU had contracts with the department for funding of their PGY-3 and PGY-4 student salaries. The department slashed that funding to meet the reductions mandated by the governor.

Cuts Affect Recruiting

In light of the severe adjustments in funding, both MSU and WSU are having to rethink their priorities. Indeed, the timing of the cuts could not have been worse for the programs, coming at the critical point at which they are facing deadlines for residency matches for the 2002-2003 academic year.

“This is now an issue of whether you cut the overall training budget to preserve the residents, or you cut residents to preserve training,” said Manuel Tancer, M.D., training director for WSU’s adult general psychiatry residency program.

Beth Ann Brooks, M.D., training director for WSU’s child and adolescent psychiatry program, told Psychiatric News that prior to the cuts, she was prepared to offer three resident positions through the child psychiatry match, which had a deadline of December 19.

“Now, we hope to still be able to offer two,” she said. (This issue of Psychiatric News went to press prior to that deadline and an announcement about the final number.)

“The University of Michigan and WSU are the only two child and adolescent psychiatry residencies left in Michigan,” Brooks said. “These two residencies don’t produce enough child psychiatrists now to replace those who have died, retired, or relocated.”

The adult general psychiatry residencies at both WSU and MSU were in the midst of recruiting for next year’s match, which has a deadline of mid-January for D.O. positions (at MSU) and mid-February for M.D. positions (at both WSU institutions.)

“It’s tough,” Brooks told Psychiatric News, “to do any ethical recruiting if you do not know that you can fund positions for July 1, 2002.”

WSU is adjusting its departmental budget in the short term to preserve its current total of about 40 residency positions, reducing the full-time-equivalence percentages of various faculty to help do so. More faculty cuts could be ahead, Brooks said.

Similar adjustments are being made by Colenda at MSU. He is even willing, he told Psychiatric News, to go into deficit spending to preserve the current 15 residency positions through the end of the academic year.

“We are going to protect the integrity of the program for as long as possible,” Colenda said, but he admitted that the cuts could eventually close the program.

Michelle Riba, M.D., an APA vice president and associate chair for education and academic affairs in the University of Michigan psychiatry department, told Psychiatric News that she is especially concerned that the inability to commit fully to a defined number of positions is troubling for potential residents who are international medical graduates (IMGs).

“This is a big concern for residents who are here on a J-1 visa,” Riba said. “They are not even allowed a one-day break in service.” A J-1 visa would expire immediately if the IMG is no longer in residency training. “MSU has to dip into its department reserves to keep the residents going. Wayne State is going to have to find money and is looking at faculty cuts. In the short term, this is affecting academic departments. In the very near future, it will be affecting patient care, especially in the public sector.”

Patient Care at Risk

While the program at WSU is typical of a large, urban, hospital-based psychiatry residency, the MSU program is not hospital intensive.

“Our [PGY-3 and PGY-4] residents are community based,” Colenda told Psychiatric News. “They are in public health and community mental health centers, as well as rural health centers. They also have rotations through the state prison system.”

In many instances, the MSU residents may provide the only mental health care that some patients receive. The 30-year-old program has trained more than 300 residents and is one of the few programs in the U.S. with full accreditation from both the allopathic and osteopathic professions.

With an emphasis on public sector psychiatry, MSU residents saw nearly 4,500 patients visits from 1999 through 2001, with more than 80 percent of those patients having severe, persistent mental illness.

Colenda said that the impact of the state’s budget cuts are clear. “We’ll have to close the program unless we find some form of alternative funding.”

Members of the faculties of all five Michigan residency programs have met to devise a strategy to combat the cuts. They plan to take a multipronged approach—appealing directly to the state legislature for funding relief, instituting public-awareness campaigns to increase pressure on the legislature, and working with patient-advocacy groups.

“I believe that the funding cuts will impact the public health,” Colenda said. “We’re dealing with a highly stigmatized patient population who do not vote. Who is going to advocate for them, except us?” ▪