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HEALTHCARE

New Primary Care Training

in Bexar County

By Thomas Mohr, MS, DO, FACOI, FAODME

The University of the Incarnate Word School of Osteopathic TIGMER achieved accreditation as an Institutional Sponsor for
Medicine (UIWSOM) opened its doors to students in 2017 and will GME programs through the Accreditation Council for GME as
soon begin its third year of training. As a new, privately funded med- well as programmatic accreditation for a new residency program.
ical school, UIWSOM promotes a mission that emphasizes primary TIGMER has received $3.6 million in state funding through the
care, and care for underserved populations in South Texas. To meet GME Expansion Grant Program. The grant provides funding for
this mission, the university recognized that new graduate medical approximately half of the expenses of a residency program. In
education (GME) programs must be created. order to make up the difference, TIGMER has received donations
Since 2013, the Texas Medical Association and the bexar County from the University of the Incarnate Word, the Center for Health
Medical Society have been instrumental in convincing the Texas Care Services (CHCS), and CommuniCare Health Centers. Addi-
legislature to substantially fund new initiatives to develop and main- tional funding was later received through veterans Administration
tain new GME programs in the state. Since the inception of the grants and from baptist Health System.
GME Expansion Grant program, the Texas Higher Education Co- This residency program is unique as it is truly based on a com-
ordinating board has administered this funding to support over munity health model in partnership with multiple clinical entities.
1,200 new training positions. 1 CommuniCare is a Federally Qualified Health Center with 14 clinical
Traditionally, residency programs are funded through the Centers locations in and near San Antonio providing full spectrum primary
for Medicare & Medicaid Services through Medicare payments care to those in need. CommuniCare acts as the outpatient corner-
made to host hospitals. Unfortunately, due to an arcane and out- stone for this residency and the continuity training clinic is housed
dated 20-year-old statute, any hospital which had any existing resi- at their West Campus on barclay Street. Residents also train in out-
dency training programs in 1998 or had allowed any residents from patient pediatrics and obstetrics and gynecology at this site.
other programs to rotate in their facility since that time are subjected The Center for Health Care Services (CHCS) recognized early on
to a federal funding cap. In bexar County, nearly every hospital is that training in primary care could not be complete without a focus
‘capped’ for this funding and therefore cannot afford to host resi- on mental and behavioral healthcare and substance abuse. CHCS is
dency programs. This has made it difficult, if not impossible, to cre- a national leader in integrated mental health care, substance abuse
ate new GME programs. and addiction, and primary care for homeless and underserved pop-
There is a clear lack of primary care training programs in the re- ulations. Residents rotate with CHCS physicians and staff each year
gion. UT Health San Antonio boasts an outstanding Family and during their training program.
Community Medicine Residency program with 15 residents per year Hospital-based rotations such as internal medicine, surgery, ob-
and Christus Santa Rosa recently expanded their Family Medicine stetrics, and emergency medicine are predominately completed at
Residency program to include nine residents per training year. As baptist Health System Hospitals. baptist Health System has been
the seventh largest city in the nation, San Antonio had a total of 72 extremely generous in facilitating the development of the inpatient
family medicine trainees in two programs. This stands in stark con- rotations along with physician groups such as Sound Hospitalists,
trast to the sixth largest city, Philadelphia, which has seven training U.S. Acute Care Solutions, The San Antonio Orthopedic Group,
programs with 156 trainees. 2 South Texas Renal Group, Sports Medicine Associates of San An-
The University of the Incarnate Word School of Osteopathic tonio and dozens of community-based clinicians who have been
Medicine created a GME consortium called the Texas Institute for willing to volunteer their time to work with these residents.
Graduate Medical Education and Research (TIGMER) as a 501(c)3 The program is accredited for eight residents per year and will
nonprofit entity to work towards gathering the resources needed to matriculate its third class in July 2019, at which time the program
establish a residency program without relying on federal funding. will have a full compliment of 24 trainees. The first class will grad-

28 San Antonio Medicine • June 2019