Cut training positions

[octopusprime]

NRMP data from the 2018 match show 163 programs offered 601 positions, with 25 programs going unfilled.

A 2016 Academic Pathology article reviewed the “challenges of ‘small’ residency programs”, categorized at having 16 or fewer residents (4/yr). “Of the 28 programs with 16 or fewer residents who responded to the survey, the ACGME-approved positions included 9 programs with 16 positions, 7 programs with 12 positions, 4 programs with 10 positions, 2 programs with 9 positions, and 6 programs with 8 positions. The actual number of approved positions filled by residents was different: 6 programs had 16 residents, 1 program had 14 residents, 2 programs had 13 residents, 6 programs had 12 residents, 1 program had 11 residents, 4 programs had 10 residents, 1 program had 9 residents, and 7 programs had 8 residents.”

Identifying the Challenges of “Small” Pathology Residency Programs and Creating Collaborative Solutions

Take what you will from the infamous “shortage” report [ An Error Occurred Setting Your User Cookie ] but one “limitation” not addressed in the results is the reality that as reimbursement goes down & costs go up, volume is the only way to maintain income or fight off income stagnation, and that that volume--to an albeit difficult to define extent--could be absorbed by existing practices without the need for additional bodies. The “anticipated demand vs supply” graph doesn’t factor in this economic reality, it’s simply based on population growth & aging trends.

I sincerely believe we should be able to shave off 1 resident per program and take a hard look at programs that shouldn’t even be in existence (2 or less trainees / yr), and our profession would only be positively affected.

What are peoples' thoughts—how would 1 less position per year harm the profession? Aside from lost departmental funding…aside from getting the grossing done…aside from injuring the egos of PDs and dept chairs…would path departments across the country be irreparably damaged? Would it simply be a boon to the PA profession? We are constantly told to do more work for less money…why should training institutions be immune from this trajectory?

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[Pathbusiness]

We are constantly told to do more work for less money…why should training institutions be immune from this trajectory?

In training institutions, for one person working, there are three who don't. They are stretched too..

 

[octopusprime]

We are constantly told to do more work for less money…why should training institutions be immune from this trajectory?

In training institutions, for one person working, there are three who don't. They are stretched too..

I understand everyone is stretched but they ultimately don't answer to the market, they answer to the university/hospital system where they are located and the ACGME, and if a department can get another resident spot (government funded) it works to their financial advantage.

 

[Pathbusiness]

Of course.

 

[yaah]

I personally think that pathology training should be more limited - to institutions with high volume and wide variety. Limiting spots is less important than limiting the programs that are allowed to exist. The problem is how to decide - there are some smaller programs that do a great job of training residents, and some bigger programs that don't. It's an easy thing to propose but a difficult thing to implement.

 

[MetroPath]

I went to a small residency program with 2 residents per year and we had a volume of at least 20,000. We had a whole rotation dedicated to biopsies and saw/were responsible for looking at all biopsies and signed them out or ordered stains on cases all the way until the end of the day. Good variety of biopsies. It was definitely a good rotation.

Even though it was a smaller program, we didn't have to divide cases with other residents which I've seen in other larger programs. So you got to see a lot since you were the only resident looking at all the biopsies.

 

[octopusprime]

I personally think that pathology training should be more limited - to institutions with high volume and wide variety. Limiting spots is less important than limiting the programs that are allowed to exist. The problem is how to decide - there are some smaller programs that do a great job of training residents, and some bigger programs that don't. It's an easy thing to propose but a difficult thing to implement.

Agree; ultimately if you decreased positions by 1 or 2 per program, you'd in effect gut the programs that shouldn't exist, and shave some fat off the ones that could stand to lose a few.

And I get what you're saying Metro--smaller programs do offer more personalized training and less fighting for scraps, but it's not simply volume, it's variety...we have ~45k cases at my group, a great variety of biopsies and larger surgical cases, but you just don't see some stuff outside large referral centers, and even if the trainees produced at such small-volume institutions are competent, their existence is not predicated on a larger need but rather that typical pride & politics of individual departments and their position within the administration/instutution...lots of places similar to and considerably larger than yours COULD accommodate path trainees, but the need should be perceived though a larger lens.

 

[pianoguy05]

From a practical perspective, I'm curious how we would bring about such a change? Has the ACGME ever limited the number of programs in a given specialty before? Have they said " we have too many psychiatrists, you - community hospital X - cannot open a new one for that reason alone."

It seems to me that the limits are imposed at the local level... my training program which took on 4 residents/yr only received gov't payment to cover 2 of the spots -- the other 2 spots came from the med center's budget. I think it would be difficult to persuade programs to remove free-labor of their own volition. I'm not opposed to limiting the number of spots, but I'm not sure how feasible it is to tell programs "you must decrease the number of spots" without any strong arm behind to support it. I can't imagine the ACGME has anything to gain or really lose from it either way...and in a sense, they surely must be feeling pressure to keep/expand residency spots given the increasing number of medical students that are graduating. Not to argue that they can't expand those spots in other fields (ahem...primary care)...

 

[octopusprime]

...the other 2 spots came from the med center's budget. I think it would be difficult to persuade programs to remove free-labor of their own volition. I'm not opposed to limiting the number of spots, but I'm not sure how feasible it is to tell programs "you must decrease the number of spots" without any strong arm behind to support it. I can't imagine the ACGME has anything to gain or really lose from it either way...and in a sense, they surely must be feeling pressure to keep/expand residency spots given the increasing number of medical students that are graduating. Not to argue that they can't expand those spots in other fields (ahem...primary care)...

This is exactly the point...it's not feasible in the sense we can just wave a magic wand and make it happen, but it's worth a discussion if only for the sake of exploring options to regain the viability of the profession. I neglected to recall this reality--that some positions are funded by individual departments/programs...again pointing to the fact that academic programs insulate themselves from reality while simultaneously claiming the opposite. You're correct, it's free labor, or paid in the instances of ACGME/CMS funded positions.

 

[27G]

From a practical perspective, I'm curious how we would bring about such a change? Has the ACGME ever limited the number of programs in a given specialty before? Have they said " we have too many psychiatrists, you - community hospital X - cannot open a new one for that reason alone."

It seems to me that the limits are imposed at the local level... my training program which took on 4 residents/yr only received gov't payment to cover 2 of the spots -- the other 2 spots came from the med center's budget. I think it would be difficult to persuade programs to remove free-labor of their own volition. I'm not opposed to limiting the number of spots, but I'm not sure how feasible it is to tell programs "you must decrease the number of spots" without any strong arm behind to support it. I can't imagine the ACGME has anything to gain or really lose from it either way...and in a sense, they surely must be feeling pressure to keep/expand residency spots given the increasing number of medical students that are graduating. Not to argue that they can't expand those spots in other fields (ahem...primary care)...

The ACGME does not understand AP/CP pathology residency. If they did they would never justify allowing the majority of CP residents to be paid for doing nothing in rotations like micro, chemistry, transfusion medicine, etc. Do other specialties like medicine, surgery, gas, emergency have residents hanging out doing pretty much nothing for 50-60K of CMS guaranteed salary plus benefits etc.