Dr. Gillian Morris couldn’t stop smiling the day she found out she had been accepted to the new family medicine program at Carney Hospital in Dorchester. She drank champagne with friends and looked forward to spending the next three years at a community hospital where she could develop her skills and help patients.
Her exuberance didn’t last long.
Soon after the Tufts University medical school graduate joined Carney as a resident last summer, she noticed problems. Indeed, from its first days in 2014, the family medicine training program suffered from a shortage of patients, support staff, and faculty, according to Morris, other residents, and people with knowledge of the situation.
The result: Residents often found themselves running the clinic and treating patients with little help or supervision. Worried that they weren’t getting necessary training, several residents complained last November to a national accrediting agency.
In December, Carney decided to end the residency program, effective at the end of this month, without graduating a full class. The hospital’s medical teaching operation is on probation for failing to meet substantial requirements.
Officials at Carney, which is owned by for-profit Steward Health Care System, said they decided to end the training program so they could focus on providing patient care. They said unhappy residents exaggerated complaints, and that they are not concerned by the hospital’s probationary status, arguing that such a designation was expected after they decided to close a program.
But the short-lived family medicine program represents another hitch for Carney, the 153-year-old hospital on Dorchester Avenue that has failed to thrive even though Steward has spent millions of dollars on upgrades, and several executives have sought to turn it around. Like many community hospitals, it has struggled to compete with bigger, prestigious medical centers that have deeper pockets.
The impending shutdown of Carney’s training program is also a setback to efforts to produce more family doctors. Family medicine is the field of primary care for patients of all ages, from newborns to the elderly. There are only five other family medicine programs in Massachusetts — compared with 16 training programs for the more popular field of internal medicine, and many experts believe there aren’t enough family doctors to meet demand.
Eighteen residents joined Carney to train in family medicine over the past two years, eager to be part of a new initiatve in a diverse and underserved part of Boston. But nearly all of them had to take the unusual step of finding another place to finish their training. Some moved across the country for an open spot in another program. Some had to add months to their training.
“We had started to build something for the community, and that’s gone,” said Dr. Lauren Ciszak, a former Carney resident who transferred to Maine Medical Center in December.
Carney, which serves a higher than usual share of seniors and low-income patients, has been challenged for years. Its former owner, the Archdiocese of Boston, threatened to close the hospital amid poor performance. Steward, backed by the private equity firm Cerberus Capital Management, acquired Carney and five other hospitals from the Archdiocese in 2010.
The strategy to grow family medicine at 159-bed Carney began under Bill Walczak, a well-known local health care executive who was hired as hospital president in 2011. Walczak departed after about a year, following clashes with Steward executives. Carney launched a family medicine practice and residency program under its next president, Andy Davis, who served about three years, leaving in 2015.
But Carney’s current executives, including Walter J. Ramos, who became president just over a year ago, said building a family medicine practice and training residents at the same time proved to be too ambitious. So they chose to end the residency program and focus just on growing patient numbers.
“We decided to change direction,” Ramos said in an interview. “There are always hard feelings when you change direction.”
Ramos told the Globe last year that Carney was on track to break even, but Steward’s own numbers show the hospital lost about $8 million last year, and $9 million each in 2014 and 2013. It is one of many community hospitals with financial troubles in a market dominated by big teaching hospitals that are paid higher rates from insurers.
Carney executives said they have spent more than $27.5 million to “save and expand” Carney, including improvements to the hospital building, refurbished operating rooms, and the construction of an almost $2 million family medicine clinic. They said the number of patients seeking care at the hospital continues to grow.
But residents said hospital leaders seemed unwilling or unable to invest adequately in family medicine. Ciszak was part of the first resident class in July 2014. She immediately noticed things were off. Residents had been told they would be working in a new family medicine clinic, but it was not ready.
Family physicians must be trained in pediatrics and maternity care, but because Carney mainly treats adult patients, residents had to travel for that experience.
They had been told that they would learn how to deliver babies at Steward’s neighboring Quincy Medical Center, which had plans to add labor and delivery services. But months after the first class of residents began their training, Steward suddenly closed the Quincy hospital. Residents started rotating to Steward’s Good Samaritan Medical Center in Brockton for deliveries, but most of their pregnant patients from Dorchester did not want to make the 15-mile trip.
For pediatrics, the residents traveled to a different part of the state: 30 miles to North Shore Medical Center, a Partners HealthCare hospital in Salem and Lynn.
Meanwhile at Carney, the residents said, there were not enough faculty members with time to focus on teaching. By November 2015, they said they were down to just one core faculty member for 18 residents. By comparison, Boston Medical Center has more than one family medicine faculty member for each of its 36 residents.
“It was fly-by-the-seat-of-my-pants medicine,” said Ciszak, 32.
Residents said Carney was also slow to hire support staff, such as medical assistants, which meant they were tasked with administrative duties such as answering phones, mailing letters, and checking patients in and out.
Carney officials said the residents’ complaints about the program were overblown.
They said it is common for residents at other programs to travel for some of their training. They said their faculty-to-resident ratio was consistent with industry standards. They acknowledged that residents sometimes had to help with administrative duties because of turnover among office staff, but said the clinic is now fully staffed.
In November, hospital leaders fired Dr. Glennon O’Grady, a noted physician who chaired the family medicine department, according to residents and other people with direct knowledge of the situation. The move upset residents who saw him as their advocate. Hospital officials would not comment about O’Grady’s termination.
The same day, a group of residents, concerned that their program was violating a host of requirements, fired off a complaint letter to the Accreditation Council for Graduate Medical Education, or the ACGME.
But before the organization took any action, Carney executives decided to end the residency program. The ACGME visited Carney in March for a regularly scheduled inspection, and put the hospital on probation, a status ascribed to just two institutions out of nearly 800 nationwide. Hospitals on probation must address a list of citations, but the lists are not public.
Carney officials said it is “neither surprising nor unexpected that the planned and voluntary phase-out of this academic program led to a change in status.” They noted that the hospital still has a strong internal medicine training program, with 36 residents. That individual program is not on probation.
But the Carney experience was discouraging for Morris, 27, who is now training in Brown University’s family medicine program.
“Beyond how this has impacted my training, I am disappointed for Dorchester,” she said. “Family medicine is the future of health care, and we were trying to serve a community that desperately needed the services full spectrum family physicians are able to provide.”