Residents and Hospitals

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Clearly the change has been profound.  I am on the admissions committtee =
and teach both MS and residents and have done the later for more years =
than I want to remember.  You never hear the applicants discuss limited =
hours.  They avoid that.  I am convinced that they have been coached about =
this both at their college/university and via the web.  You can find out =
what people have to say about the admission process at various universities=
 from the web.  So you do not know this and cannot find out.  It is =
expectations that have been lowered and the problem of not having the =
freedom that we once had.  For lots of reasons, but that would take =
several pages at least.  I agree that the patients will suffer.  I think =
that we will just have to learn how to transition (learned a new word the =
other day--it is not change, that is a dirty word, but transition).  It is =
a new world and probably not what we think it should be, but probably not =
going to change.  "Things are not the way when I was a resident."  I can =
even say that now, let alone Ken's and my teachers and mentors.
Dan

Dan R. Thompson, MD, MA,  FCCM
Associate Professor of Surgery
Chair, IRB
Albany Medical College MC-162
Critical Care Medicine A300C
47 New Scotland Ave
Albany, NY 12208
518-262-5099 Phone
518-262-5560 FAX
thompsdr@mail.amc.edu

>>> "Prouty, Gregory" <gprouty@msx.ndc.mc.uci.edu> 06/16/02 02:31AM >>>
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. =20

As an employer, I have seen a change in the 'work ethic' during particularl=
y
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.=20

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. =20

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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