Don't residents have control of program expansions?

[thesauce]

Amidst all of the residency expansions, there have been 2 cases that I know about where the expansions were denied due to insufficient case volume. These were programs with more than enough cases, but the determination was based on patient volume stated in resident case logs. In one of the cases, the PD submitted a list of sims from an administrator in the department showing more than enough volume and the expansion was still denied.

This got me thinking. Why don't all residents just log their required 450 (maybe ~25 extra just in case) sims and then just stop? Then committees will not have the evidence to support recommending an increase. This will not stop new programs from opening, but at least it takes care of the old ones expanding which is where most of the new spots are coming from.

I've seen grads take great pride in their case log numbers and even list them on their CVs, but I can say that I was never once asked about this in my job interviews (and I went on a lot of them) and I never once brought it up - and I still got a great job in the location that I wanted.

What do you think? Can we all just band together in this effort?

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[Neuronix]

I love the idea of this, but I think it would backfire on the residents. If we refused to log over 450 cases, even covertly, I suspect that our research/elective time would suddenly disappear so that we could get more cases. I worry that will happen even in the expansion rejections you described.

In my personal experience, despite the amount of attention to this issue on SDN, the vast majority of residents are burying their heads in the sand about these issues. There seems to be a general attitude that your personal relationships with attendings are most important for your future job search, so don't make waves by trying to change things. Thus, I doubt we'll get enough traction to act upon this issue until the problem is glaringly obvious (e.g. pathology, radiology), instead of just looming on the horizon. Even then we'll still probably be powerless to fix things. Academic programs love more residents and fellows, and academic faculty control the residency expansions. This is a perfect combination for continued expansion.

 

[thesauce]

I love the idea of this, but I think it would backfire on the residents. If we refused to log over 450 cases, even covertly, I suspect that our research/elective time would suddenly disappear so that we could get more cases. I worry that will happen even in the expansion rejections you described.

That's a valid concern, but I would counter that:
1. It did NOT happen in either of the cases that I mentioned.
2. The programs that would erase elective or research time would subsequently lose their competitive edge in gaining the highest quality applicants.
3. Research and elective time are other metrics that the committees use to determine the potential for expansion. Cutting those will actually weaken their application for expansion.

In my personal experience, despite the amount of attention to this issue on SDN, the vast majority of residents are burying their heads in the sand about these issues. There seems to be a general attitude that your personal relationships with attendings are most important for your future job search, so don't make waves by trying to change things. Thus, I doubt we'll get enough traction to act upon this issue until the problem is glaringly obvious (e.g. pathology, radiology), instead of just looming on the horizon. Even then we'll still probably be powerless to fix things. Academic programs love more residents and fellows, and academic faculty control the residency expansions. This is a perfect combination for continued expansion.

You may be surprised to hear that there are several PDs that understand and respect that this is a problem. Other faculty or chairman may pressure them to expand, but this gives them an excuse for denial.

This strikes me as a very easy way to passively combat the problem. It takes no effort on the part of the residents and actually reduces the amount of work required. I think it's worth a shot.