Grady Hospital and Emory Gas

[Dr Serenity]

I read this article today in the New York Times...I've heard quite a few people on the interview trail talk about Grady Hospital's current financial situation, but this article today makes things seem a lot worse that I first thought.

It seems that despite what I've been told to this point about Grady (i.e., that it'll never shut down; the other hospitals in Atlanta won't allow it, etc, etc), it seems as if there is a real danger that Grady may have to close its doors, and that Emory and Morehouse may pull their physicians out.

Anyone on this board have any thoughts or insights? Is Grady really in danger of shutting its doors? What are the chances that the docs at Atlanta's med schools would pull out? I'd especially like to hear from anyone at Emory, but any other thoughts would be appreciated as well...I am interviewing soon at Emory's anesthesia program and it seems as if it would be a real blow to the program (not to mention the healthcare "scene" in Atlanta) if Grady had to shut its doors.

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[coprolalia]

The story with Grady is a very familiar one...

http://www.latimes.com/news/nationw...ory?coll=la-home-headlines&ctrack=1&cset=true

-copro

 

[usnavdoc]

I read this article today in the New York Times...I've heard quite a few people on the interview trail talk about Grady Hospital's current financial situation, but this article today makes things seem a lot worse that I first thought.

It seems that despite what I've been told to this point about Grady (i.e., that it'll never shut down; the other hospitals in Atlanta won't allow it, etc, etc), it seems as if there is a real danger that Grady may have to close its doors, and that Emory and Morehouse may pull their physicians out.

Anyone on this board have any thoughts or insights? Is Grady really in danger of shutting its doors? What are the chances that the docs at Atlanta's med schools would pull out? I'd especially like to hear from anyone at Emory, but any other thoughts would be appreciated as well...I am interviewing soon at Emory's anesthesia program and it seems as if it would be a real blow to the program (not to mention the healthcare "scene" in Atlanta) if Grady had to shut its doors.

The consensus here is that grady is not going to close. The money will come from somewhere. The money has actually been offered already the hold up was that the stipulation was that the politically elected governing body step down for an independant non-profit group to run it. There is alot more to this but most of what I know is heresay from listening to higher-ups in the program talk. As far as emory pulling the physician out. Wont happen. not until/if they close. Emory provides the physicians/residents for free. Emory is owed a substantual amount from grady each year and this is essentially wiped clear on a yearly basis. They talk about this in the town meetings all the time. And morehouse cant pull out. If they do they have no medical school so they will close as well.

But the bottom line for the anesthesia program is this. We get exactly two things out of grady...trauma and OB.

We are already doing CA3 OB rotations at Crawford long which has double the volume of OB compared to Grady. It would be very easy to transition all of our OB faculty and learning experience there.

As far as trauma goes. Atlanta medical center is a level two trauma facility. If Grady closed they would have to be expanded to become a level one facility. Currently they have no anesthesia residents. They are covered by a private practice group. It would be an easy deal to work out to provide coverage for trauma. We have the benefit of being the only anesthesia residency in town I think that gives us bargiaining power to make this deal happen.

I didnt just make these scenarios up I got them from several higher-ups within the dept. Noone here is worried.

If I were you I would ask these questions when you interview. I bet you will get similar responses. Plus it shows you are up on current events with regards to emory.

Now there are some intagibles that we get from grady due to the patient population. But all those patients will have to go somewhere so I think you will still get that benefit.

There are alot of programs out there with no trauma experience at all. They tend to claim that they do other cases (transplant) that give you the same educational value. Well we do transplant as well as trauma. And the higher-ups are committed to maintaining the trauma experience.

Anyway Ill answer any questions I can but remember this is all from a residents viewpoint. I am obviously not sitting in on the financial planning meetings. Another point to mention quickly is that this is not the first time Grady needed to be bailed out. It happens about every 5-7 years or so. And It is still open. Like I said the big contention point is that the people who hold the money want the governing body to step down.

 

[jwk]

Grady is hopefully on the path to recovery, but it's going to be painful. Governance of the hospital will be passing to a private non-profit corporation and thankfully out of the hands of the political appointees and buffoons that are running it now who actually think they've done a good job while they ran the hospital into the ground. Grady won't be closing - and hopefully in the next year or so as the new management folks move in, things will get a lot better.

Navdoc - you get much more than trauma and OB at Grady - you do all the surgical subspecialties. It would not be as easy as you think to place all those residents in other facilities at the drop of a hat. Just because Emory is the only anesthesia residency in town doesn't mean everyone else is dying to have them there. Few if any of the private practice hospitals would have any desire to have residents of any type, anesthesia or otherwise. AMC is a teaching hospital, but as you noted, is covered by a private anesthesia practice. The reason they're not a Level 1 trauma center, as with all the other trauma centers in the Atlanta area, is that there is no 24-hr in-house neurosurgery coverage - there are always at least two anesthesia providers in-house 24/7.

 

[usnavdoc]

Grady is hopefully on the path to recovery, but it's going to be painful. Governance of the hospital will be passing to a private non-profit corporation and thankfully out of the hands of the political appointees and buffoons that are running it now who actually think they've done a good job while they ran the hospital into the ground. Grady won't be closing - and hopefully in the next year or so as the new management folks move in, things will get a lot better.

Navdoc - you get much more than trauma and OB at Grady - you do all the surgical subspecialties. It would not be as easy as you think to place all those residents in other facilities at the drop of a hat. Just because Emory is the only anesthesia residency in town doesn't mean everyone else is dying to have them there. Few if any of the private practice hospitals would have any desire to have residents of any type, anesthesia or otherwise. AMC is a teaching hospital, but as you noted, is covered by a private anesthesia practice. The reason they're not a Level 1 trauma center, as with all the other trauma centers in the Atlanta area, is that there is no 24-hr in-house neurosurgery coverage - there are always at least two anesthesia providers in-house 24/7.

Not exactly true. We do not do Peds, Cardiothoracic, ICU, and Pain at Grady. NSG is covered at grady but the vast amount of experience comes from Emory and Crawford.

However, Of course we get more than OB and Trauma at Grady. What I am telling the op is that OB and Trauma are what Grady gives us that no other facility currently provides us with. The subspecialty experience at grady(other than trauma) is covered at other hospitals already. Ex...Sure we do ENT at Grady. We also do ENT at Emory, Crawford, and Eggleston. The same can be said for any and all subspecialty areas.

You are overstating the numbers of residents we have at grady as well. At any one time there are 8 CA1s on general service, 1-2 Ca3s on PACU/General service, 2-4 CA2s on OB, and 1-3 CA3s on OB. That is all. We could easily move those people into the other facilities that we already cover. All it would mean is that we have to hire fewer CRNAs and PAs. Which is an easy sell financially.

I never mentioned moving residents into private practice hospitals that we dont already service. I said that it is not a far leap that AMC would have to transition to a level 1 facility if Grady closed. And that the anesthesia services could easily be transitioned to some capacity from a private group to Emory.

Bottom line to the op. Grady isnt going anywhere at present.

 

[jwk]

Not exactly true. We do not do Peds, Cardiothoracic, ICU, and Pain at Grady. NSG is covered at grady but the vast amount of experience comes from Emory and Crawford.

However, Of course we get more than OB and Trauma at Grady. What I am telling the op is that OB and Trauma are what Grady gives us that no other facility currently provides us with. The subspecialty experience at grady(other than trauma) is covered at other hospitals already. Ex...Sure we do ENT at Grady. We also do ENT at Emory, Crawford, and Eggleston. The same can be said for any and all subspecialty areas.

You are overstating the numbers of residents we have at grady as well. At any one time there are 8 CA1s on general service, 1-2 Ca3s on PACU/General service, 2-4 CA2s on OB, and 1-3 CA3s on OB. That is all. We could easily move those people into the other facilities that we already cover. All it would mean is that we have to hire fewer CRNAs and PAs. Which is an easy sell financially.

I never mentioned moving residents into private practice hospitals that we dont already service. I said that it is not a far leap that AMC would have to transition to a level 1 facility if Grady closed. And that the anesthesia services could easily be transitioned to some capacity from a private group to Emory.

Bottom line to the op. Grady isnt going anywhere at present.

Agreed, Grady isn't going anywhere.

However, I was commenting on your assertions as well, some of which I think are incorrect, especially in regards to AMC. They don't "have to transition to a level 1 facility if Grady closed". Nor does their hospital / anesthesia group suddenly have to bow down to Emory just because Emory wants to put their residents somewhere, which is what you're implying in your post. All of the gas residents could easily be absorbed into the current Emory system, since Emory, as with many of the other hospitals in Atlanta, can never seem to hire enough AA's or CRNA's. Of course all the other non-gas residents may have a huge problem since there are far higher numbers of them to divvy up elsewhere.

But again, we both agree Grady isn't going anywhere.

 

[core0]

Agreed, Grady isn't going anywhere.

However, I was commenting on your assertions as well, some of which I think are incorrect, especially in regards to AMC. They don't "have to transition to a level 1 facility if Grady closed". Nor does their hospital / anesthesia group suddenly have to bow down to Emory just because Emory wants to put their residents somewhere, which is what you're implying in your post. All of the gas residents could easily be absorbed into the current Emory system, since Emory, as with many of the other hospitals in Atlanta, can never seem to hire enough AA's or CRNA's. Of course all the other non-gas residents may have a huge problem since there are far higher numbers of them to divvy up elsewhere.

But again, we both agree Grady isn't going anywhere.

Morehouse has a much bigger problem than Grady. Most of the services have just in case plans for Grady but at least in the ones that I deal with they don't think they are going to have to use them.

David Carpenter, PA-C

 

[Dr Serenity]

Thanks, everyone, for your responses. Others I had talked to before reading that article said that Grady ain't going anywhere.

I'll definitely ask about the issue when I interview at Emory.

copro- you're definitely right...Grady isn't the only public hospital facing financial problems...many nationwide have been closing their doors.

 

[Coastie]

Gotta love socialized medicine.

I've worked in an inner-city hospital comparable (if not greater than) to Grady in terms of size, trauma, volume; It's quite the hell-hole, with physicians overworked and lacking basic safety from even their own patients since security is banned from carrying anything other than an ipod while on duty. Maybe they will clean some things up, stop admitting every repeat crack chest pain, and save a few dollars in order to attract paying customers.

I read this article today in the New York Times...I've heard quite a few people on the interview trail talk about Grady Hospital's current financial situation, but this article today makes things seem a lot worse that I first thought.

It seems that despite what I've been told to this point about Grady (i.e., that it'll never shut down; the other hospitals in Atlanta won't allow it, etc, etc), it seems as if there is a real danger that Grady may have to close its doors, and that Emory and Morehouse may pull their physicians out.

Anyone on this board have any thoughts or insights? Is Grady really in danger of shutting its doors? What are the chances that the docs at Atlanta's med schools would pull out? I'd especially like to hear from anyone at Emory, but any other thoughts would be appreciated as well...I am interviewing soon at Emory's anesthesia program and it seems as if it would be a real blow to the program (not to mention the healthcare "scene" in Atlanta) if Grady had to shut its doors.