Effect of Arizona Law On Residency Programs

[exPCM]

With the new Arizona law illegal aliens are leaving Arizona.
http://www.nydailynews.com/news/nat...new_immigration_law_takes_effect_in_july.html

The effect on hospitals is now being seen:
From a colleague on Sermo:
"1400 OB/Ped/NICU nurses layed off
AZ SB 1070, the Arizona law recently passed which makes it a state crime "as well as a Federal crime" to be here illegally, has already started to make it's self felt. The two major hospitals in Phoenix which deal with large numbers of illegals aliens, Maricopa Medical Center and Good Samaritan, announced to their staff that there would be large layoffs of all personel, including nurses, that are in areas of the hospital that have heavy utilization of services by Illegal aliens. This has centered primarily around OB, the NICU at both hospitals. According to my sources, the number of OB patients at both facilities has plummeted since the passage of AZ SB 1070."

On 6/11/10, "the Maricopa County Hospital NICU had exactly 2 babies. Good Sam was at 20% of capacity. NICU nurses are being fired at every hospital in Maricopa County that has an NICU and the docs will not be far behind.
My guess, is that over the next 12 months, there will be an exodus of 10-15% of all physicians here in the state of AZ, as there is that much less work."

My comment: There are multiple residency programs at Maricopa Medical Center: http://www.mihs.org/mededucation/index.html
I can't help but wonder how many of these programs may have to close in light of the drastic drops in patient census,

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[McGillGrad]

It is my understanding that the illegals usually paid in cash to avoid any immigration issues.

 

[Jet915]

These hospitals are probably saving a ton of money because I doubt most of these illegals were paying anything.

 

[McGillGrad]

These hospitals are probably saving a ton of money because I doubt most of these illegals were paying anything.

Following your logic, why would the hospitals fire employees if they are saving money?

 

[JaggerPlate]

Following your logic, why would the hospitals fire employees if they are saving money?

To save even more money? Getting rid of people who didn't pay for services (they didn't pay cash, they simply used the ER and didn't pay at all) = x amount of money. Getting rid of the staff that was necessary to handle all these people = y amount of money. A. They don't need the staff now, and B. They can save x + y by cutting the staff as well.

 

[whyrms]

Following your logic, why would the hospitals fire employees if they are saving money?

I think they have to fire the employees first, then they'll save money.

Here's how it works; they have to hire people to care for people who won't pay. It's like hiring people who does nothing, because these employees contribute no net income to the hospital. So now that the patients who were paying nothing leave. The hospital can now cut down on the number of employees who were not making any money for the hospital, thus saving the hospital money.

 

[Apollyon]

It is my understanding that the illegals usually paid in cash to avoid any immigration issues.

These hospitals are probably saving a ton of money because I doubt most of these illegals were paying anything.

In South Carolina, if not drunk, the illegals paid in cash - they could get an itemized charge at DC, and would just start peeling 20s and 100s off the roll. The thinking was "collections --> immigration --> deportation".

Drunk? People saying they forgot or didn't know their own names. Idiots transcend cultures.

 

[McGillGrad]

I think they have to fire the employees first, then they'll save money.

Here's how it works; they have to hire people to care for people who won't pay. It's like hiring people who does nothing, because these employees contribute no net income to the hospital. So now that the patients who were paying nothing leave. The hospital can now cut down on the number of employees who were not making any money for the hospital, thus saving the hospital money.

Not sure if you've ever run a business, but you don't hire more people if you do not increase revenue. It doesn't work that way.

 

[JaggerPlate]

In South Carolina, if not drunk, the illegals paid in cash - they could get an itemized charge at DC, and would just start peeling 20s and 100s off the roll. The thinking was "collections --> immigration --> deportation".

Drunk? People saying they forgot or didn't know their own names. Idiots transcend cultures.

Worked in an ER in So Cal for 2 years ... for us it was illegals -> receive care -> leave.

 

[tno77]

When will they pass this law in NY?

 

[Doctor D]

It is a little bit funny how you guys throw around the word illegal like they are some kind of nagging cockroach. They are people and alot of them are better humans than many Americans. The idea that they don't pay and overuse services is not true in the research. In fact, they tend to use services less. How about answering the OP's question instead of starting an immigration debate.

 

[chocomorsel]

It is my understanding that the illegals usually paid in cash to avoid any immigration issues.

Ha ha ha. Funniest statement I've read here in a while. Are you kidding me? If I remember correctly you are from Canada where you guys don't have nearly the illegal immigrant issue we do here.

Your understanding is wrong. Most times they pay nada. And there's nothing we can do but help them. The money that covers them comes from taxpayers. Some pay a little bit of cash but most pay nada. Healthcare without insurance is prohibitively expensive here in the U.S and these people can't afford it. Heck most Americans can't afford it without health insurance.

 

[chocomorsel]

Following your logic, why would the hospitals fire employees if they are saving money?

Because they don't have enough patients to take care of so therefore not going to pay some nurses to sit around gossiping and watching soaps. I think they will likely be saving some serious dough myself.

 

[JaggerPlate]

They are people and alot of them are better humans than many Americans.

Totally relevant to the conversation. Thanks.

 

[chocomorsel]

It is a little bit funny how you guys throw around the word illegal like they are some kind of nagging cockroach. They are people and alot of them are better humans than many Americans. The idea that they don't pay and overuse services is not true in the research. In fact, they tend to use services less. How about answering the OP's question instead of starting an immigration debate.

They may not over use the services, but when they need the services they know they will not be turned away and will not have to pay if they can't afford it. Or chose not to pay. But it's not just illegal immigrants who do this, it's poor people, and middle class people who can't afford or don't have health insurance for whatever reason. But as taxpayers we do get a little pertubed that we are paying sky-rocketting insurance fees while some people pay nada.

 

[Apollyon]

It is a little bit funny how you guys throw around the word illegal like they are some kind of nagging cockroach. They are people and alot of them are better humans than many Americans. The idea that they don't pay and overuse services is not true in the research. In fact, they tend to use services less. How about answering the OP's question instead of starting an immigration debate.

If you are still a med student, you fall right into what has been discussed, at times, often on SDN - that med students are communists.

Time will tell if you continue to sail on the distaff side, or progress to the middle or right.

 

[whyrms]

Not sure if you've ever run a business, but you don't hire more people if you do not increase revenue. It doesn't work that way.

So you're saying that they wouldn't have hired those employees in the first place if they were not making a profit?
I was under the impression that these are public hospital and that they staff their hospital not on profit margin but rather to meet demands. If they had 80 babies being born that year regardless if the parents were paying or not, they will still need to hire enough nurses/physicians to take care of those 80 babies. That's what i'm assuming. If that's the case then yes, they should make a profit by cutting back employees. If that's not how it works then, I'm making an ass our of u and me.

 

[obpgy1]

With the new Arizona law illegal aliens are leaving Arizona.


My comment: There are multiple residency programs at Maricopa Medical Center: http://www.mihs.org/mededucation/index.html
I can't help but wonder how many of these programs may have to close in light of the drastic drops in patient census,

It will be interesting to see what will happen. I believe Maricopa's OB program has recently increased in terms of the incoming intern class. Usually though, OB numbers at programs are sufficient and the GYN numbers are a bit lacking so they may be able to take a hit.

The lack of NICU patients make me think that MFM will be hit worse than others.

My guess is that after 2-3 years of tracking procedures/deliveries etc they may decrease their residency size by a few positions.

 

[McGillGrad]

Ha ha ha. Funniest statement I've read here in a while. Are you kidding me? If I remember correctly you are from Canada where you guys don't have nearly the illegal immigrant issue we do here.

Your understanding is wrong. Most times they pay nada. And there's nothing we can do but help them. The money that covers them comes from taxpayers. Some pay a little bit of cash but most pay nada. Healthcare without insurance is prohibitively expensive here in the U.S and these people can't afford it. Heck most Americans can't afford it without health insurance.

This info is directly from a person that works in the ED, in the south, who is responsible for collecting money from patients. Unless residents collect payment from patients, you would know less than the person who I am citing. Who, btw, is sitting right next to me.

 

[McGillGrad]

So you're saying that they wouldn't have hired those employees in the first place if they were not making a profit?
I was under the impression that these are public hospital and that they staff their hospital not on profit margin but rather to meet demands. If they had 80 babies being born that year regardless if the parents were paying or not, they will still need to hire enough nurses/physicians to take care of those 80 babies. That's what i'm assuming. If that's the case then yes, they should make a profit by cutting back employees. If that's not how it works then, I'm making an ass our of u and me.

Hospitals run on a budget. They are allocated funds for staff. There is no magical money tree to pay for more staff, unless the budget allows for it.

If no one was paying, no new staff would be hired.

 

[whyrms]

Hospitals run on a budget. They are allocated funds for staff. There is no magical money tree to pay for more staff, unless the budget allows for it.

If no one was paying, no new staff would be hired.

If it's a public hospital, then tax dollars will be use to hire more staff. These tax dollars comes from legal residents (and a very small percentage from non-legal, such as sale tax). So now that the illegal residents are leaving, the hospital won't have to waste so much tax money. So yeah, anything else you want to add?

 

[McGillGrad]

If it's a public hospital, then tax dollars will be use to hire more staff. These tax dollars comes from legal residents (and a very small percentage from non-legal, such as sale tax). So now that the illegal residents are leaving, the hospital won't have to waste so much tax money. So yeah, anything else you want to add?

Edit: No point in going any further with this...if you don't know how businesses run, then I can't help you.

 

[whyrms]

Edit: No point in going any further with this...if you don't know how businesses run, then I can't help you.

Anyway, thanks for trying.

 

[exPCM]

It will be interesting to see what will happen. I believe Maricopa's OB program has recently increased in terms of the incoming intern class. Usually though, OB numbers at programs are sufficient and the GYN numbers are a bit lacking so they may be able to take a hit.

The lack of NICU patients make me think that MFM will be hit worse than others.

My guess is that after 2-3 years of tracking procedures/deliveries etc they may decrease their residency size by a few positions.

Good points.

Once again, since you might need a refresher on how ALL businesses work...

Hospitals run on a budget. They are allocated funds for staff. There is no magical money tree to pay for more staff, unless the budget allows for it.

Public or private, the budget is allocated according to paying patients.

This is not a free clinic.

You are off the mark.
Hospitals, governments, and businesses all have budgets and many of them run deficits and have to borrow money to cover the deficits. Some even end up going bankrupt. Hospitals which receive government funding often try to get taxes raised to increase funding to cover indigent care.
There is a magic money tree: the US Bureau of Engraving And Printing has the printing presses

 

[McGillGrad]

I have a master's in finance but lack of ability/interest in conveying it to laymen.

Believe what you want. Tax dollars are magical fruit. There is no accountability in public hospitals.

Good points.




You are off the mark.
Hospitals, governments, and businesses all have budgets and many of them run deficits and have to borrow money to cover the deficits. Some even end up going bankrupt. Hospitals which receive government funding often try to get taxes raised to increase funding to cover indigent care.
There is a magic money tree: the US Bureau of Engraving And Printing has the printing presses

 

[exPCM]

I have a master's in finance but lack of ability/interest in conveying it to laymen.

Believe what you want. Tax dollars are magical fruit. There is no accountability in public hospitals.

Maricopa County Hospital loses $2 million weekly on uncompensated care due largely to illegal immigrants.
http://www.blogforarizona.com/blog/labor/
Really it should not be so hard for you to understand.

 

[McGillGrad]

Are you really citing an anti-immigration blog as proof of hospital losses? Politicians lie, FYI. Just in case you didn't know. I do not see anything besides a politician's word to back up your claims.

I understand hard facts. If you could provide some, that would be helpful.

Maricopa County Hospital loses $2 million weekly on uncompensated care due largely to illegal immigrants.
http://www.blogforarizona.com/blog/labor/
Really it should not be so hard for you to understand.

 

[Jet915]

Wow, didn't know I was going to stir up so much debate. This law is good for Arizona monetary wise, unfortunately, all these illegals will move to Cali, New Mexico or Texas and make their situations worse.

 

[exPCM]

Are you really citing an anti-immigration blog as proof of hospital losses? Politicians lie, FYI. Just in case you didn't know. I do not see anything besides a politician's word to back up your claims.

I understand hard facts. If you could provide some, that would be helpful.

You apparently operate under some belief that hospitals have a "budget" and can't lose money.
Here are a few sites to try and open your eyes:
$1B bankruptcy looms for St. Vincent's
http://www.crainsnewyork.com/article/20100413/FREE/100419959
Queens Residents Protest Hospital Closures
http://blogs.wsj.com/bankruptcy/2009/02/11/queens-residents-protest-hospital-closures/
Bankrupt hospital serving Hispanic immigrants closing
http://network.nshp.org/profiles/blogs/bankrupt-hospital-serving
City, Owner Clash Over Fate Of D.C. Hospital
http://blogs.wsj.com/bankruptcy/2010/05/06/city-owner-clash-over-fate-of-dc-hospital/
Hospitals see string of bankruptcies in recent weeks

Read more: Hospitals see string of bankruptcies in recent weeks - FierceHealthFinance - Health Finance, Healthcare Finance http://www.fiercehealthfinance.com/...uptcies-recent-weeks/2008-09-24#ixzz0qv2wWKo9
Subscribe: http://www.fiercehealthfinance.com/...-Tynt-FierceHealthFinance-FierceHealthFinance
http://www.fiercehealthfinance.com/story/hospitals-see-string-bankruptcies-recent-weeks/2008-09-24
Dealing out blame for hospital closings
http://blog.nj.com/njv_guest_blog/2008/02/dealing_out_blame_for_hospital.html

I could go on for hours but the point is you might want to do some homework on EMTALA and the finances of hospitals.
The burden of uncompensated care is growing, closing many emergency departments, decreasing community resources and threatening the ability of emergency departments to care for all patients.

http://www.acep.org/pressroom.aspx?id=25936
Between 1988 and 1996, ED patient visits rose from
81.3 to 93.1 million, an increase of 14%. During the same
period, the number of EDs decreased from 5,210 to 4,740,
with ED closures outstripping the rate of facility closures by
28%.
The potential impact on trauma care when safety net
facilities fail was dramatized in 1995-1996, when Los
Angeles County/University of Southern California Medical
Center came within days of closure before a $186 million
bailout in federal funds
http://www.acep.org/WorkArea/DownloadAsset.aspx?id=8976

If you are just somebody who wants to argue for the sake of arguing then the facts are probably irrelevant.

 

[exPCM]

I think a potentially more interesting observation is how significantly the OB usage has dropped following the bill. Coincidence? Or do illegal immigrants really comprise the majority of OB usage? Also potentially important to note, both of these hospitals are located near South Phoenix, a very poor neighborhood.

In Arizona, at the Maricopa County Medical Center, an anchor baby is born every three hours. Two out of three births are to illegal aliens, 2,900 each year. It’s a huge part of the $28 million overall spent treating illegal aliens at just one hospital."
http://www.arizona-education.org/ar...amps-school-lunch-programs-and-free-education
Here is another article I found after a quick search:
Parkland Heath & Hospital System was founded in 1894 as the county's public hospital. It is the primary teaching hospital for the University of Texas Southwestern Medical Center. It is also the busiest maternity hospital in the US and second busiest in the world. Parkland is dedicated to the health and well-being of individuals and communities entrusted to its care.
http://itunes.apple.com/us/podcast/parkland-health-hospital-system/id250345652

Since Parkland opened in 1895, it has served Dallas' indigent population, which often includes uninsured minority and immigrant residents.

A recent patient survey indicated that 70 percent of the women who gave birth at Parkland in the first three months of 2006 were illegal immigrants, hospital officials said.

These Hispanic women had been having their babies at Parkland without much attention until the recent debate over illegal immigration. Critics have questioned the ease with which illegal immigrants are delivering their babies at U.S. hospitals – at taxpayers' expense.
In 2004, the hospital spent $70.7 million delivering 15,938 babies but ended the year with a $7.9 million surplus in obstetrics.

The positive bottom line resulted from a hefty infusion of Medicaid funds, about $34.5 million, to cover the delivery costs for the undocumented women. Dallas County taxpayers also kicked in $31.3 million, or about 40 percent of the total obstetrics costs, and the federal government paid an additional $9.5 million to make up for the hospital's high percentage of patients on Medicaid, the state-federal insurance program for the poor.

Gloria Corona, 31, was back at the prenatal clinic for the first time in four years, convinced that she was pregnant with her third child but wanting to find out for sure. Her boys, 4 and 5 years old, were born at Parkland.

Speaking through a translator, Mrs. Corona expressed gratitude for the Parkland staff having taught her to stay away from alcohol, to eat vegetables and fruits and to drink lots of water during her pregnancies.

She also was grateful that Parkland charged her nothing for the first two deliveries. In her native Mexico, she would have had to pay $200 for a hospital delivery, the equivalent of four to six weeks' pay there, because she had no health insurance, she said.
http://www.dallasnews.com/sharedcontent/dws/news/localnews/stories/061206dnmetmoms.d9b9669.html
http://www.snopes.com/politics/immigration/parkland.asp

 

[rock_climber]

Edit: No point in going any further with this...if you don't know how businesses run, then I can't help you.

:troll: Seriously, read McGillGrad's other posts. "Stir the pot" would be an understatement for this dude.

No reason to engage him, he is much smarter than all of us. remember:
1) he's from Canada
2) he went to McGill and graduated
3) he got a 242 on Step 1
4) he has serious disdain for any M4 who does not study/work at 100% up to, on, and after match day
4) he has a friend who works at a hospital and is sitting next to him.

 

[chocomorsel]

This info is directly from a person that works in the ED, in the south, who is responsible for collecting money from patients. Unless residents collect payment from patients, you would know less than the person who I am citing. Who, btw, is sitting right next to me.

I don't have first hand info here. The info I have is from surgeons that I work with who say that they hardly collect any money from their surgeries when the patients are uninsured and/or illegal. In other words "private pay" patients who can't be covered by the government. Maybe they are able to pay minor ER fees, but when they need something really dire like surgery/inpatient care, they usually can't afford it and therefore don't pay it. I mean healthcare is crazy expensive here. Most of us can't afford it without insurance so I doubt an immigrant worker can.

 

[chocomorsel]

:troll: Seriously, read McGillGrad's other posts. "Stir the pot" would be an understatement for this dude.

No reason to engage him, he is much smarter than all of us. remember:
1) he's from Canada
2) he went to McGill and graduated
3) he got a 242 on Step 1
4) he has serious disdain for any M4 who does not study/work at 100% up to, on, and after match day
4) he has a friend who works at a hospital and is sitting next to him.

Love this post. Hilarious.

 

[Apollyon]

Maybe they are able to pay minor ER fees

"Minor ER fee"? Do you know what is a "facility charge"? That's just for showing up. It's about $500 if you just register then walk out.

A run of the mill ED bill can be $1200-$2000.

 

[kjode1]

I wouldn't jump to your conclusions. The prediction of 10-15% of docs leaving is WAY off. There is a big shortage of docs in phoenix - its one of the reasons salaries are so high here. This shortage is great for trainees, and for those looking for work here.

For the record, neither Maricopa nor Banner Good Sam have made ANY cuts to resident staffing, nor have they closed ANY programs. The nursing reductions were planned long before SB1070 due to the financial crisis (as a California doc, you are probably having the same thing). there is no evidence at all to tie this to SB1070 - especially since that is not even in effect yet!

1070 is a terrible bill. But lets not start making conclusions without evidence.

With the new Arizona law illegal aliens are leaving Arizona.
http://www.nydailynews.com/news/nat...new_immigration_law_takes_effect_in_july.html

The effect on hospitals is now being seen:
From a colleague on Sermo:
"1400 OB/Ped/NICU nurses layed off
AZ SB 1070, the Arizona law recently passed which makes it a state crime "as well as a Federal crime" to be here illegally, has already started to make it's self felt. The two major hospitals in Phoenix which deal with large numbers of illegals aliens, Maricopa Medical Center and Good Samaritan, announced to their staff that there would be large layoffs of all personel, including nurses, that are in areas of the hospital that have heavy utilization of services by Illegal aliens. This has centered primarily around OB, the NICU at both hospitals. According to my sources, the number of OB patients at both facilities has plummeted since the passage of AZ SB 1070."

On 6/11/10, "the Maricopa County Hospital NICU had exactly 2 babies. Good Sam was at 20% of capacity. NICU nurses are being fired at every hospital in Maricopa County that has an NICU and the docs will not be far behind.
My guess, is that over the next 12 months, there will be an exodus of 10-15% of all physicians here in the state of AZ, as there is that much less work."

My comment: There are multiple residency programs at Maricopa Medical Center: http://www.mihs.org/mededucation/index.html
I can't help but wonder how many of these programs may have to close in light of the drastic drops in patient census,

 

[kjode1]

As a doc who actually works at Maricopa, I can very honestly say that we do not ask who is illegal. Not sure where these numbers could come from.

 

[McGillGrad]

:troll: Seriously, read McGillGrad's other posts. "Stir the pot" would be an understatement for this dude.

No reason to engage him, he is much smarter than all of us. remember:
1) he's from Canada
2) he went to McGill and graduated
3) he got a 242 on Step 1
4) he has serious disdain for any M4 who does not study/work at 100% up to, on, and after match day
4) he has a friend who works at a hospital and is sitting next to him.

243, actually.

 

[chocomorsel]

"Minor ER fee"? Do you know what is a "facility charge"? That's just for showing up. It's about $500 if you just register then walk out.

A run of the mill ED bill can be $1200-$2000.

Much more minor than the 10's of thousands that could easily accumulate being an inpatients. Yes, it's a lot of money, but it sure beats 1-4k/day of inpatient services. That's what I meant.

 

[Coastie]

Edit: No point in going any further with this...if you don't know how businesses run, then I can't help you.

Please, oh pretty please impart your wisdom. Did your carribbean school have a special economics of medicine class through which you can educate us all?

 

[Coastie]

It is my understanding that the illegals usually paid in cash to avoid any immigration issues.

 

[Coastie]

Following your logic, why would the hospitals fire employees if they are saving money?

Dude, they have non paying patients..who are leaving.

Therefore, they are saving money on supplies that the illegals would be using.

Now it's time to get rid of another cost: staff.

Good for those hospitals. I hope Arizona gets a little break after the pillaging of its treasury by illegals.

 

[McGillGrad]

You sure do like to laugh a lot. So jolly.

 

[JaggerPlate]

McGill ... you went to the Caribbean?? Didn't know that.

 

[McGillGrad]

McGill ... you went to the Caribbean?? Didn't know that.

Yeah, I started at a Carib school. Best time of my life! I transferred to a LCME school after step 1. I don't advertise where, although there are only 5-7 or so that take transfers...and even less that take Canadians.

 

[whyrms]

Yeah, I started at a Carib school. Best time of my life! I transferred to a LCME school after step 1. I don't advertise where, although there are only 5-7 or so that take transfers...and even less that take Canadians.

Off topic, but is that you in your avatar? is that the character from The Tick? or is that some sort of Pokemon.

 

[McGillGrad]

Off topic, but is that you in your avatar? is that the character from The Tick? or is that some sort of Pokemon.

It's Henchman #21 from the Venture Bros, as portrayed by some dude at a Comic Convention...lol

 

[Llenroc]

You are one ******ed mother ****er.

 

[J-Rad]

Personal attacks, as a method of argument, or otherwise, are not welcome here. Posters may now feel free to return to the original topic of the thread.

 

[notinkansas]

It is a little bit funny how you guys throw around the word illegal like they are some kind of nagging cockroach. They are people and alot of them are better humans than many Americans. The idea that they don't pay and overuse services is not true in the research. In fact, they tend to use services less. How about answering the OP's question instead of starting an immigration debate.

The use of the word ILLEGAL is used CORRECTLY to describe a person who is in the US IN VIOLATION OF OUR IMMIGRATION LAW.


Try pulling that in France. Or Mexico...which, by the way, has stricter immigration laws than Arizona does.


Would you mind citing the reference for your research to back up your claim ? I would like to read it.