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Residents and HospitalsProuty, Gregory firstname.lastname@example.org
Sat, 15 Jun 2002 23:31:12 -0700
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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)