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Sat, 15 Jun 2002 23:31:12 -0700

Competition for residents is, as we all know, fierce.  Certainly worse in
some specialties than others.  However, we must be careful not to comprise
the quality of the physicians graduating from residency programs while
trying to become sensitive to work-life issues.  If Dr. Mattox's slots are
not being filled, solely because the work is too 'hard', then I'm certain
that the graduates from his program will be more highly sought by employers
of surgeons.  

As an employer, I have seen a change in the 'work ethic' during particularly
the last 5 to 10 years.  Graduates no longer are interested in working long
hours, weekends, evenings, etc.  However, healthcare, as we all know is a
24/7 business.  Healthcare is also becoming far more complex requiring even
more training.  Dr. M's suggestion to coordinate all of these demands from
the various regulatory bodies, in addition to concerns over labor relations
issues, warrants serious discussion.  And, the solution(s) may even start
much earlier than residency.  Are we selecting the proper candidates for
medical school?

I also feel compelled to stress that academic teaching hospitals (those
directly associated with Colleges of Medicine) share GME funding much more
openingly than teaching hospitals not owned/operated by Colleges of
Medicine.  Let's not lump all hospitals, and their administrators, folks
like me, into one basket. 

Now, I have to turn back to my FY02-03 budget problems.  Decreases in DSH
funding (disproportiate share), decrease in the Upper Payment Limit (UPL),
etc. have meant finding $9 million in expense reductions.  These are not
related to executive salaries (I think you would all be surprised at how low
our executive salaries and bonuses, if any, are - since we are state
employees). Our Executive Director or CEO, is an MD. The COO is an RN.  The
'fat' is gone.  The decision now facing us is what programs we will continue
and which we simply cannot afford to.  As Dr. Mattox pointed out,
ultimately, these decisions result in the patient suffering.  

I do think, though there is some overlap, the question of resident education
is separate from hospital funding and how hospitals are operated.  Residency
coordinators will have to determine how to maintain the quality of their
graduates in light of the new regulations.

Just my late night, number crunching mind numbing, opinion.

Greg Prouty
University of California, Irvine Medical Center
(the above represent my personal opinion with absolutely no reflection on
official UC policy or position)

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