Closure of EM Residencies in For-Profit/Financially Strained Hospitals

[southerndoc]

I'm hearing some unsubstantiated rumors that quite a few residency programs at for-profit hospitals are at risk of losing accreditation and/or are considering closing as it isn't as profitable for them as they thought.

Has anyone heard anything regarding this with specific programs? Feel sorry for the residents in these programs.

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[EctopicFetus]

I'm hearing some unsubstantiated rumors that quite a few residency programs at for-profit hospitals are at risk of losing accreditation and/or are considering closing as it isn't as profitable for them as they thought.

Has anyone heard anything regarding this with specific programs? Feel sorry for the residents in these programs.

This would be great. Haven’t heard this but it will happen eventually. Only an idiot would do residency at an HCA site in 2023. Em isn’t even competitive and if location matters more than your training than you may as well become an NP.

 

[JacobMcCandles]

Great for taking a step in the right direction for the specialty but I feel bad for the residents it would affect.

 

[Brigade4Radiant]

I thought that they get money from the government about 100k per resident so it makes them very profitable

 

[Apollyon]

I thought that they get money from the government about 100k per resident so it makes them very profitable

I don't think they get the money, because those spots are above the 1997 cap. This is the whole "you don't have funding hurr durr" thing. If anything, I don't know if they get the "IME" payments. That's the Indirect Medical Education, which can, indeed, be near to, or over, 100k. However, def no "DME", Direct Medical Education.

 

[gutonc]

I don't think they get the money, because those spots are above the 1997 cap. This is the whole "you don't have funding hurr durr" thing. If anything, I don't know if they get the "IME" payments. That's the Indirect Medical Education, which can, indeed, be near to, or over, 100k. However, def no "DME", Direct Medical Education.

They get the IME payments, just not the DME. So it's somewhere in the 70-ish% range of what a "funded" spot gets.

 

[carbonizedeyesockets]

I'm hearing some unsubstantiated rumors that quite a few residency programs at for-profit hospitals are at risk of losing accreditation and/or are considering closing as it isn't as profitable for them as they thought.

Has anyone heard anything regarding this with specific programs? Feel sorry for the residents in these programs.

I have a hard time believing this wouldn't bleed over to some not-for-profit hospitals, too. Many seem to function as NFP in tax code only, but run as if for-profit.

 

[DocEspana]

I have a hard time believing this wouldn't bleed over to some not-for-profit hospitals, too. Many seem to function as NFP in tax code only, but run as if for-profit.

I think the the technical hoops NFP needs to jump through are very odious to a hospital that just wants to make money as fast as possible. Which raises a funny dichotomy since I agree that many NFP hospitals run right up against the line of what is allowed but dont cross it because they don't want to lose that NFP status. So basically the hurdles that need to be jumped are actually legitimately important since they serve to skim off the "fat" at the top of truly odious places that can't even be bothered to take minor steps to throttle their drive for profit and re-invest excess income back into the hospital.

You probably shouldn't be training at a place that can't be bothered to make small sacrifices for the good of the hospital - just from the sake of medical education alone. I think possible exceptions are places like DMC, where they are the best educational opportunity around but remain for profit for reasons that I am unaware of. For all I know, DMC may have reversed and become NFP again - I was last there over a decade ago. Those are extreme outliers, and don't reflect the grumpiness I appropriately have for HCA hospitals.

 

[GonnaBeADoc2222]

Great for taking a step in the right direction for the specialty but I feel bad for the residents it would affect.

Why feel bad? These people know exactly what theyre doing by applying to an HCA or other like minded program for training. Their credentials and training are inferior, they dilute our workforce, and they shouldn't be welcome amongst out ranks.

**** em.

 

[bravotwozero]

Would like to hear confirmation, but if true, a welcome development.

 

[JacobMcCandles]

Why feel bad? These people know exactly what theyre doing by applying to an HCA or other like minded program for training. Their credentials and training are inferior, they dilute our workforce, and they shouldn't be welcome amongst out ranks.

**** em.

I feel bad for them on an individual level but I still support closing down a bunch of residencies.

 

[EctopicFetus]

I feel bad for them on an individual level but I still support closing down a bunch of residencies.

Likely these are people who have bad credentials or make bad choices.. either way... on a personal level i feel bad for them.. but thats life

 

[Prehealth1011]

Are the residency applicant # from this year already available?

 

[EctopicFetus]

From pDs looks like applications down 5-10%. Great news. Wish it was more.

 

[BoardingDoc]

From pDs looks like applications down 5-10%. Great news. Wish it was more.

IDK that declining application numbers really mean much. Until we see the number of spots unfilled after SOAP skyrocket, all this means is that these new garbage EM "residencies" will continue to churn out swarms of unqualified candidates, many of whom aren't even "bottom of the barrel EM applicants" but are rather "bottom of some other specialty applicants who failed to match AND soap into that field."

I was talking with a colleague the other day and we were both saying how terrified we were about the prospect of needing to go to the ER as a patient years from now. The only upside is that if I do actually go to the ER for something in 20-30 yrs, that there will be at least one marginally competent EM doctor in the room at the time.

 

[Prehealth1011]

From pDs looks like applications down 5-10%. Great news. Wish it was more.

That doesn't sound as bad as last year, right? I was expecting a more catastrophic drop

 

[southerndoc]

Having not heard anything else but rumors, it seems like this is all it is. Was curious if people here had any inside knowledge. I do foresee the downfall of these residencies, but thought it was a little quick to be happening now. Perhaps in 5-10 years we will see it.

 

[The Knife & Gun Club]

That doesn't sound as bad as last year, right? I was expecting a more catastrophic drop

Down 5-10% from last years already catastrophic match would be an even worse catastrophic match.

At least in my limited GME involvement the powers at be are concerned and they’ve seen a significant narrowing in the application pool.

One thing that’s interesting is anecdotally the “top” applicants are still around and numbers haven’t changed much. But the number of middle of the road and marginal candidates has dropped significantly. That’s my N=1.

It seems to fit with more “flavor of the month EM applicants” going to other moderate competitive fields.

 

[EctopicFetus]

10% drop in applicants is 350 or so fewer applicants. There will be even more spots this year. I suspect 1k open spots. Post soap 250-350. That’s great. Some programs will have 3-4 holes. At some point it’s time to shut it down.

 

[psychemdoc]

Why feel bad? These people know exactly what theyre doing by applying to an HCA or other like minded program for training. Their credentials and training are inferior, they dilute our workforce, and they shouldn't be welcome amongst out ranks.

**** em.

lol, I love this assumption that these med students know what HCA even is or the difference. Students that are passionate about EM will have reach, moderate, and safe programs like everyone else when they applied to residencies. They will look for friends, connections, fellowships, ideal locations, success of grads at boards, and a host of other variables before they contemplate the tax status of the paying institution. And I doubt the report that they are closing residencies. Would be welcome news as long as the residents aren’t stranded, but I still doubt it. Residents especially EM are way too profitable and productive early on from my limited understanding.

 

[The Knife & Gun Club]

lol, I love this assumption that these med students know what HCA even is or the difference. Students that are passionate about EM will have reach, moderate, and safe programs like everyone else when they applied to residencies. They will look for friends, connections, fellowships, ideal locations, success of grads at boards, and a host of other variables before they contemplate the tax status of the paying institution. And I doubt the report that they are closing residencies. Would be welcome news as long as the residents aren’t stranded, but I still doubt it. Residents especially EM are way too profitable and productive early on from my limited understanding.

I don’t have the data in front of me but an internal report from I believe team health found that EM residents don’t generate any significant revenue until PGY3. PGY1 is a loss and PGY2s are kind of neutral.

I’m sure it varies from place to place but I was slow as molasses as an intern and I’d imagine most EM PGY1s are similar. It would be dangerous not to be slow.

 

[psychemdoc]

I don’t have the data in front of me but an internal report from I believe team health found that EM residents don’t generate any significant revenue until PGY3. PGY1 is a loss and PGY2s are kind of neutral.

I’m sure it varies from place to place but I was slow as molasses as an intern and I’d imagine most EM PGY1s are similar. It would be dangerous not to be slow.

Yeah of course they’re slow which is fine. How many RVUs do they need to break even on their negligible salaries? I’m having a hard time imagining they don’t become productive quick. Now whether they slow down attendings enough to make them money losers that may be another thing. I was just under the assumption that the profit is fairly quick due to the low overhead of each resident, and how many RVUs they can generate, even as slow as they are.

 

[Brigade4Radiant]

I don’t have the data in front of me but an internal report from I believe team health found that EM residents don’t generate any significant revenue until PGY3. PGY1 is a loss and PGY2s are kind of neutral.

I’m sure it varies from place to place but I was slow as molasses as an intern and I’d imagine most EM PGY1s are similar. It would be dangerous not to be slow.

Kind of skeptical PGY2 mid year are often by themselves and work so many shifts and are paid peanuts

 

[EctopicFetus]

Kind of skeptical PGY2 mid year are often by themselves and work so many shifts and are paid peanuts

I think that study is nonsense. There was some data in the past that showed that academic centers staff 1 attending hour per 3 patients. If a hospital collects $150/pt that extra patient (profit) per houris well above what the resident is paid. Even if you assume an EM resident is paid with benefits $40/hr which is not too far off in EM there is money to be made. Even an intern in the back 6 months of their intern year can see 1pph. a 3rd year more. Yes you have to pay for conferences and such but residents make 2/3 (or less of what an MLP makes). Only crooked CMGs use MLP as anything more than an intern.

im sure the "researchers" had their motives but common sense says residencies are profitable pretty early on. Throw in some medicare dollars from uncle sam and the profit just leaps.

 

[ScepticSkeksis]

I think that study is nonsense. There was some data in the past that showed that academic centers staff 1 attending hour per 3 patients. If a hospital collects $150/pt that extra patient (profit) per houris well above what the resident is paid. Even if you assume an EM resident is paid with benefits $40/hr which is not too far off in EM there is money to be made. Even an intern in the back 6 months of their intern year can see 1pph. a 3rd year more. Yes you have to pay for conferences and such but residents make 2/3 (or less of what an MLP makes). Only crooked CMGs use MLP as anything more than an intern.

im sure the "researchers" had their motives but common sense says residencies are profitable pretty early on. Throw in some medicare dollars from uncle sam and the profit just leaps.

Remember though, they are also paying an EM attending $200-$300/hour to be there. Teaching the intern, going over cases, and seeing the intern's patients takes a lot of time away from the most productive member of the team. When I have to teach our rotating interns, it's very very time consuming. For example, demonstrating, explaining, and doing the infant LP for an intern is a lot more time consuming than having a PGY2 or PGY3 do it, and just be present for several moments of the procedure. A lot of these interns had absolute garbage med school training due to unscientific COVID Zoom rotations.

 

[EctopicFetus]

Remember though, they are also paying an EM attending $200-$300/hour to be there. Teaching the intern, going over cases, and seeing the intern's patients takes a lot of time away from the most productive member of the team. When I have to teach our rotating interns, it's very very time consuming. For example, demonstrating, explaining, and doing the infant LP for an intern is a lot more time consuming than having a PGY2 or PGY3 do it, and just be present for several moments of the procedure. A lot of these interns had absolute garbage med school training due to unscientific COVID Zoom rotations.

Simple math in my opinion. Rough numbers, normal EM job $200/hr seeing 2pph. Academics see 3pph and often pay is below community medicine but lets assume the same pay. That extra patient per attending hour is $150.. Even if you have 2 residents per attending hour (or even 3) it’s a net financial win assuming the $40/hr cost of a resident. I know it is more in some places .The numbers are purposely round. Let’s be honest, sure the intern LP takes a while. Let’s also be real how many of those do you do? The answer is not many.

I work with EM residents and did before As well. If motivated the EM resident is a $$ maker for the EM docs employer.

 

[doggydog]

Texas Residency Program Unexpectedly Announces Closure - ACEP Now

ACEP Now offers real-time clinical news, news from the American College of Emergency Physicians, and news on practice trends and health care reform for the emergency medicine physician. ACEP Now is an official publication of the American College of Emergency Physicians.

www.acepnow.com

 

[EDThoracotomy]

Leave it to the bean counters.

Sounds like they want to expand FM residency and needed the cap space. Great program hosed by the Yale's with the bow ties and their freaking calculators. Corporate hospital admin is a freaking joke.

The thing is they stated it was for "financial" reasons. Reality is EM is probably one of the few residencies that can generate more income for hospitals.

 

[ScepticSkeksis]

Wow, an actually decent TX program shutting down, while garbage HCA programs continue to proliferate.

 

[alpinism]

Surprisingly the residency was just taken over by the PE backed firm SCP health this June.

The residents have stated that leadership wants to replace the EM docs with FM docs.

 

[WildEMDoc]

Surprisingly the residency was just taken over by the PE backed firm SCP health this June.

The residents have stated that leadership wants to replace the EM docs with FM docs.

was going to say the same, likely played some role in this. PE takeover was likely because the hospital was already having money issues. I was shocked that SCP had taken the corpus site when they took those contracts in the area, it was a fantastic training program.

Possible they lost some of the boarded docs when SCP came on. SCP wants to bring FM docs but can't because of a residency -> therefore get rid of residency

Seems like they have doubled down on pulling money out of the ER, which I don't think has ever worked out for any system.

 

[EctopicFetus]

Surprisingly the residency was just taken over by the PE backed firm SCP health this June.

The residents have stated that leadership wants to replace the EM docs with FM docs.

Who ran it before scp. Was it Victoria?

 

[WildEMDoc]

Who ran it before scp. Was it Victoria?

I know it wasn't VEA at least in any recent time I am aware of. I think it was a single group or a local one at least for the residency site

 

[LChristmas]

The ER has been a SCP site for many years, before that it was TH. The ICU became SCP in August 2019.

SCP will not be happy about this because they will be losing resident labor (that they don't pay for) and need to add extra attending and APP coverage to make up for it.

No attendings have left the program for many years, but they did hire at least 2 or 3 new ones over the last few years. It's a VERY stable group of core faculty with essentially no turnover for the last 5-10 years.

I don't think they can have any FM docs staff the ER after the program closes because it's a level 2 trauma center.

 

[bravotwozero]

So who axed the program and why?

 

[emergentmd]

I know friends who were residents or currently working in the area. No one knows why or can explain why this happened. They were all shocked. It essentially was admin/ER doc meeting coming out of nowhere then they informed the residents soon after. No going back from here.

Typically it is a money deal but how are they going to save money?

The EM residents typically are paid by the Government. These residents not only covered the ER but also the ICU up to 80 hrs/wk. Now they have to hire 2 PAs/NPs for each residents to cover the 80 hrs which is 200K+/yr. Makes no sense at all.

This stable EM group is going to bleed docs.

 

[southerndoc]

I moved the posts from the dedicated thread on the CHRISTUS Health residency closure to this thread since it's related.

 

[ScepticSkeksis]

I have a friend who did residency there. The ED physicians covered MICU and Surgical ICU. They had a decent volume of trauma patients in the SICU. The hospital will now have to hire MLPs to take over coverage in the ICUs for the scut-work rounding. Corpus is already short EM physicians with Envision advertising $280/hr for their sites. As someone mentioned they cannot hire FM docs to staff the ED as it's level 2, though they do have a separate "Fast-track" area that has been staffed by FM docs in the past, so they might use those there.

 

[WildEMDoc]

Hopefully they don't drop their trauma level to save money too.

 

[ScepticSkeksis]

Hopefully they don't drop their trauma level to save money too.

That would be bad. South Texas is underserved by proper trauma centers. There is only Corpus Christi and Valley Baptist in Harlingen. San Antonio is the next closest proper trauma system, about 3 hours away.

 

[beebermd]

This is pretty tragic and hits close to home for me. The only residencies there are FM and EM. Being virtually unopposed, they covered the floor, ICU, Trauma among everything else. Its an incredible learning environment, because the residents are involved in everything. The residents from both programs get along great and often overlap on rotations. I will say that at least in the beginning of the EM residency, It was my understanding that both programs were intertwined by some metric, maybe GME funding? The FM program had been around forever. I cant remember, but I want to say they actually had more spots open than they could get funding for, so the hospital was subsidizing these spots. They have also increased spots over the years. So the financials are complicated im sure.

I will say that I think this will be hard blow for the area. The hospital just went under a huge renovation with a large expanded ER. I honestly dont know how they will staff the facility without residents. I doubt the current facualty would want to take that on. Not that they could even if they wanted to. There are also surrounding areas that really depend on the 3rd year moonlighting residents to fill the schedule. The FM program also usually has a resident or two go into the rural ERs after graduation, due to the training that is available to them with the EM program. Both of those will be gone. So the impact of this will go further than most people realize. That area has pretty good rates ($280-$310), and they still have a hard time getting docs down there to fill shifts.

 

[LChristmas]

CHRISTUS Spohn residency to remain open: Tentative Agreement has been reached to save Christus Spohn's Emergency Medicine Residency Program

 

[ScepticSkeksis]

This looks like a shakedown to get local funds nothing more. $4.25 million annually? If resident salary + benefits comes to 70K, then 30 residents is $2.1 million. Where does all that extra money go?

 

[Porfirio]

Family medicine residency program?

 

[EctopicFetus]

This looks like a shakedown to get local funds nothing more. $4.25 million annually? If resident salary + benefits comes to 70K, then 30 residents is $2.1 million. Where does all that extra money go?

Good lord. That’s a lot of cheddar. $2m to the faculty and hospital. Crazy stuff. Paying $4m a year to get 10 residents to graduate a year seems insane.

 

[FlaminHotER]

So these worthless hospital admins have conned the city/county to pay for the EM residency?!!?

The amount of sheet we put up with from these empty suits is unbelievable

 

[RustedFox]

So these worthless hospital admins have conned the city/county to pay for the EM residency?!!?

The amount of sheet we put up with from these empty suits is unbelievable

For real. I would hate myself if my everyday was sitting in an office, in a shirt, coat, and tie, looking at paperwork, and not doing anything really tangible... and having to look myself in the mirror and tell myself that I'm a good man.

 

[EctopicFetus]

For real. I would hate myself if my everyday was sitting in an office, in a shirt, coat, and tie, looking at paperwork, and not doing anything really tangible... and having to look myself in the mirror and tell myself that I'm a good man.

Tangible? The hospital con men just squeezed the county for $4m per year in perpetuity it seems. Thats pretty tangible. How they can look in the mirror at themselves is beyond me.

 

[EMhawkeye]

Didn’t the article say it was still phasing out the program by 2026?

 

[RustedFox]

Tangible? The hospital con men just squeezed the county for $4m per year in perpetuity it seems. Thats pretty tangible. How they can look in the mirror at themselves is beyond me.

Yeah, poor choice of adjective - you're right.

Tangible. Like, we don't need administrators in the apocalypse. Your cognitive "labor" means nothing. The ER tech is more useful and valuable than you, C-suiter. Grab a rifle and STFU.