THE ENVIRONMENT

In 1969, the city of Waco, Texas and surrounding McLennan county (population approximately 180,000) faced a health care crisis. The area had an acute shortage of primary care physicians. Just thirteen of a total of only 130 physicians practicing in the county were primary care providers. Specialists shouldered most of the burden of delivering primary care and many were becoming "burned out" doing so. The average age of the local physicians was considerably higher than the national average age. Therefore, many physicians were expected to retire in the coming years. Furthermore, inadequate coverage for and provision of emergency medical services was a persistent problem in area hospitals. Because significant amounts of episodic primary care was delivered in these institutions as elsewhere in the U.S., basic health care for indigent populations remained inadequate and a substantial financial burden was placed on local hospitals for uncompensated care. Finally, area mortality rates exceeded both state and national averages.

Waco’s large indigent population and semi-rural nature created an unattractive environment for luring and retaining new physicians. The city had no public health facilities and no hospital tax, even though the state allowed local taxation for creation of hospital districts and support of indigent care. Local political leaders viewed the creation of additional property taxes to fund a hospital district as too expensive for many poorer constituents.

The growing concern over the lack of access to basic health care was a major issue within the community’s large indigent minority population. Many local leaders feared this concern created a strong possibility for race riots in Waco. As many of these conditions and trends materialized, there developed a consensus among area civic officials and physicians that the local healthcare delivery system was desperately in need of improvement.

WHAT TO DO: INITIATING INFLUENCES, GOALS, DESCRIPTION OF A COMMUNITY PARTNERSHIP

In the late 1960s, several local civic and political leaders, including many physicians from the county medical society, approached Waco’s minority community leadership to discuss the health care access problem and attempt to agree on some strategies to address it. One of the significant agreed upon proposals called for the local medical society to examine the feasibility of establishing a local family practice residency program. During this same period nationwide, family practice had become an accredited medical specialty.

Upon further investigation and completion of the process to seek accreditation of a new training program, the McLennan County Medical Society along with a group of several civic and political leaders formed the McLennan County Family Practice Residency Program, one of the first such accredited training programs in Texas and west of the Mississippi river. Right from the beginning, area physicians and community leaders agreed the residency’s mission would house two inseparable goals. The residency program would provide 1) primary care services to those county residents without a regular source of primary care, and 2) high quality primary care education to family medicine physicians. Founding officials believed a freestanding, community-based family medicine residency was the most cost-effective way to achieve the following:

a) comprehensive, outpatient quality care for the underserved, low-income and indigent;

b) a continuous supply of family physicians for Waco and surrounding areas, allowing medical specialists to balance the array of services;

c) a more attractive environment for recruitment of new physicians;

d) additional coverage in the hospital emergency room;

e) reduction in the financial burden on local hospitals;

f) a decrease in the area’s mortality rate; and

g) improved opportunities for continuing medical education for county physicians.

Only later in beginning to fulfill these objectives, did the residency program realize the value of establishing significant partnerships with medical schools and other teaching programs.