Would all of the current residents have stuck it out knowing that the program was winding down? Would faculty have stayed once their teaching role went away? How would Christus Spohn have staffed the emergency department, and how would it have best delivered care to the community? What about the emergency medicine residents’ role in staffing the hospital’s medical and trauma ICUs? What would happen to the hospital’s accreditation status as a Level II Trauma Center?

It is not clear, especially given all of these questions, why Christus Spohn chose to close the residency program in October. Hospital leaders have not spoken to the press or made themselves available for interviews, including a request from ACEP Now. But in an October 17 statement and at public meetings, the hospital and its representatives cited financial concerns.

“The difficult decision to phase out the Emergency Medicine Residency Program was made with thorough consideration of our community’s needs and our available resources to serve those needs. We ultimately determined that our ability to sustain this program would end with graduating the current residents in 2026,” the hospital’s statement noted.

The hospital also expressed its intention to concentrate on residency training in family medicine, another need for rural areas such as South Texas. “Ultimately we are simply unable to sustain the [emergency medicine] program for the long-term future.”

The hospital noted that emergency medicine residencies in Texas have grown from three when its program was launched in 2007, to 18 programs today. On this year’s Resident Match Day, 555 emergency medicine slots initially went unfilled, compared with 219 from the Match Day in 2022, although most of the unfilled slots were filled through the Supplemental Offer and Acceptance Program (SOAP). An EM study projecting an oversupply of emergency physicians by 2030 was cited by Christus Spohn as another reason to close the program.¹

ACEP responded with a letter to health system leaders explaining that the study, published in 2021, was based on pre-pandemic 2019 data and fails to reflect a maldistribution of the emergency physician workforce, unfilled needs for emergency medicine board-certified physicians in rural and underserved areas, and high rates of burnout among emergency physicians.

“Emergency medicine residency training programs provide lasting benefits to an institution and the community it serves that are not captured on simple financial analysis,” states the letter, signed by ACEP President Aisha T. Terry, MD, MPH, FACEP. “There are numerous studies describing how EM residencies drive improvements in the quality of care, care coordination, addressing social determinants of health, and preparation and response to disasters and large-scale events.”