In the past three months, the University of Oklahoma-Tulsa School of Community Medicine shuttered a clinic and issued contract non-renewals to its surgical teaching staff to bring down a projected $18 million deficit this fiscal year. These are part of ongoing changes.  The budget woes are sp ecific to the Tulsa campus, and the interim dean of the OU-Tulsa medical school said the latest moves are getting the budget back into balance. Though some physicians who taught at the school question if the moves will ultimately hurt medical education and health care in the city.  Dr. Boyd Burns, who has been serving as the OU-Tulsa School of Community Medicine interim dean since July, said reasons for the deficit are outside influences affecting all medical institutions. Those pressures are on top of the school not having a dedicated academic hospital, typical of other medical schools, which helps control the bottom line.  Among the recent hits is the 2023 privatization of Medicaid in Oklahoma, which moved thousands of patients to other insurance providers. It has resulted in lower reimbursement rates and increased denials for services. Also, the health access network that provided services to patients made contractual changes that reduced revenue for services, Burns said. An OU audit of its health campuses found that in the 2025 fiscal year, patient care income decreased by $9.4 million, primarily due to patient volume at the Tulsa clinics. The previous year shows an $8.5 million decrease in patient care income.  “These changes hit us pretty suddenly, and we are responding to that in order to right the ship financially,” Burns said. “It is more and more difficult for every health care system to make ends meet. We’re spending more and more time to keep the lights on. That’s not just here but every hospital system I know of nationally.” The OU-Tulsa School of Community Medicine does not have an academic hospital, unlike OU Health in Oklahoma City. OU-Tulsa medical school students and teaching faculty are placed across the city’s hospitals and at its clinic. That has been the model since it opened in 1972 to educate third- and fourth-year students. The first class of a four-year medical degree at OU-Tulsa began in 2015.  In December, the surgical teaching staff at OU-Tulsa received notices of contract non-renewals, and the surgical clinic personnel were informed the office was closing. That represents fewer than 10 of 170 physicians, Burns said. “Our faculty are not being terminated,” Burns said. “They will be getting new letters. We are making some necessary changes for the stability and longevity of our program and school in the future.” Discussions between OU-Tulsa and the area hospitals are ongoing, with the goal of having staff more integrated into the medical centers, Dr. Burns said. The idea is to shift more of the cost to hospitals benefiting from faculty and student work.  “They would be primarily employed through the hospitals and partially employed with us,” Burns said. “That still allows them to have protected time for their scholarly pursuits and for their academic research for their teaching and mentoring. With some of those deficits, the current model we have now is just not sustainable for the future, with reimbursements going down and not having our own hospital.”  The changes so far have narrowed the projected deficit to about $12 million with the fiscal year ending on June 30. Adjustments in other departments are being considered, Burns said. “Each month that goes down a little bit more,” Burns said. “We’re being very frugal around here. What we are doing with the other departments is strategizing, moving to more of a professional services agreement type model to maximize our reimbursement, decrease operating costs and improve our efficiency.” In mid-November, the school’s clinic near 101st Street and Memorial Drive closed, moving those patients to the OU Health Physicians Family Medicine Clinic at 1111 S. St. Louis Ave. Former surgery department chair, Anthony Howard, M.D., who was part of the OU-Tulsa faculty from 1993 to 2021, said more than 1,500 residents and fellows have been trained at OU-Tulsa since 2001. Hundreds of those physicians stayed in the Tulsa area, providing specialty care across the region.  “Assuring ongoing support and viability of the OU School of Community Medicine is vital to northeast Oklahoma’s health care systems,” Howard said. “Eliminating a major department, faculty research and patient base in a university medical school as part of a cost-cutting plan, in my opinion, puts the accreditation and future of the medical school in jeopardy.” Current and former staff are questioning the equitable allocation of resources and dedicated legislative funding among medical institutions in Oklahoma. “The OU School of Community Medicine has historically faced financial challenges,” Howard said. “There are undoubtedly many factors involved in recent financial shortfalls. These likely include lower Medicaid receipts and state funding allocation to Oklahoma medical schools.” “Correction of these deficits could be approached in a comprehensive fashion with key community and state government officials facilitated by OU administrative leaders in Norman and Oklahoma City, at the direction of the OU Regents. I would hope that these planned actions could be tabled before they are implemented. These financial deficits should be solvable.“ Professor emeritus, William Jennings, M.D., said the shift of staff to more hospital-based employment will detract from teaching and research. Jennings is known as a groundbreaking vascular surgeon in hemodialysis and worked in medical education for more than 30 years. “(The changes) will result in continued loss of existing faculty in addition to stifling recruitment of new academic and teaching physicians,” Jennings said. “As an example, the very successful OU vascular fellowship department is the only vascular training program in Oklahoma and will be a significant and disappointing loss for Oklahoma and the United States.” With two Tulsa hospitals reaching the Level 1 Trauma designation last year, Jennings said the city will depend more on having a pipeline of surgeons, specialty physicians and other medical professionals. That need will be in addition to the OU general and vascular surgery faculty, fellows and residents offering an important role in supporting the trauma centers. “Funding for these University of Oklahoma medical and surgical training programs in Tulsa is decreasing and not sufficient, leading to faculty and program disruptions, contractions and closures; not just in general and vascular surgery, but in several other departments,” Jennings said.  Burns said accreditation will not be affected, and the day-to-day experience of students and faculty won’t look much different. He said lawmakers are being informed of how public policy changes in health care affect patient service and medical schools.  “Our health care systems are trying our best to be good stewards of the resources that we have,” Burns said. “We’re working with state officials in making sure they understand what this tension looks like, especially on the patient side. The OU-Tulsa School of Community takes great pride in providing care for a vulnerable group of patients. If there is a service that is discontinued or people lose insurance or coverage, that has very real effects on their lives, their longevity and their health and we care deeply about that.” The plan is for the OU-Tulsa medical school to be operating out of the deficit by the time the Stephenson Cancer Center opens in 2028. The 176,000 square-foot facility at 41st Street and Yale Avenue on the Schusterman campus is part of a goal to reduce the state’s No. 4 ranking in cancer deaths. “I see so many possibilities for cancer care and integration of services between the School of Community Medicine, Schusterman Clinic and Stephenson Cancer Center for the future,” Burns said. “We’ve got great relationships with all systems here and we’re supported very well by them. “That is what, in part, gives me confidence as we move into the future and have to make some really difficult changes,” he said. “You can’t do this in isolation. You need to have support from the university, which we do at all levels. We have support from our hospital systems. These are going to be good changes, and it’s good to have conversations about them to reassure everyone.” Ginnie Graham is a Tulsa-based journalist and contributor to Oklahoma Watch. Contact her at [email protected]. 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