Is a stagnation of residency spots coming?

[daru1]

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http://www.statesman.com/blogs/cont...008/01/31/bush_planning_91_billion_in_me.html

I posted this here because it will effect residencies around the country for the years to come, but mods, feel free to move this somewhere else -- I'm outside of posting in my home, Psychiatry 😛

Highlights:
Bush’s budget is expected to call for $83 billion in cuts to hospitals with the remainder coming from other health care providers. The hospital cuts would include:

A $15 billion across-the-board reduction in hospital payments


A $25 billion reduction in payments to hospitals that serve a disproportionately large number of low-income patients


$23 billion less for training hospitals


$20 billion less for hospital construction and equipment.


Wow. Just wow. Discuss.

 

[Faebinder]

I think it's about time residency stopped being funded by medicare. I think residents should be allowed the same privilages as mid levels and be able to bill for their services. That way everyone will see that residents bring in money to the institution and then we will see no more position cuts/stagnation.

 

[Doowai]

Wyomings residencies receive NO money from Medicare. And they are flush - pay high, and have a great savings - most residents are finishing residency with about $20 grand saved. When a teaching hospital wants a new 24 slice CT they get it. And absolutely no money from Medicare.

 

[deleted109597]

24 slice? Wow, must have a lot of new technology up there in Wyoming. Just the other day they got some Betamax players for the patients as well.

 

[Solideliquid]

24 slice? Wow, must have a lot of new technology up there in Wyoming. Just the other day they got some Betamax players for the patients as well.

(Yoda voice) This path leads to the darkside!!

 

[Rasengan]

Yet we send billions of dollars a year to Iraq, Saudi Arabia, and Israel who dont even need our money... thank god this tool and his cronies are going to be gone in a year.

On the flip side though, this is exactly what a socialized healthcare system would be like. The government would just take funding from treating your grandpa's colon cancer, stop his Avastin, and then give Pakistan a new fighter jet.

Gotta love opportunity cost.

http://www.statesman.com/blogs/cont...008/01/31/bush_planning_91_billion_in_me.html

I posted this here because it will effect residencies around the country for the years to come, but mods, feel free to move this somewhere else -- I'm outside of posting in my home, Psychiatry 😛

Highlights:
Bush’s budget is expected to call for $83 billion in cuts to hospitals with the remainder coming from other health care providers. The hospital cuts would include:

A $15 billion across-the-board reduction in hospital payments


A $25 billion reduction in payments to hospitals that serve a disproportionately large number of low-income patients


$23 billion less for training hospitals


$20 billion less for hospital construction and equipment.


Wow. Just wow. Discuss.

 

[tkim]

When a teaching hospital wants a new 24 slice CT they get it.

Hmmm, they must have the only 24-slice CT scanner in existence.

 

[daru1]

I just hope the Democrats have some backbone on this issue and it really is 'dead on arrival' to Congress.

 

[core0]

Hmmm, they must have the only 24-slice CT scanner in existence.

Its 3 eight slice CTs hooked together. It also does popcorn.

David Carpenter, PA-C

 

[daru1]

Thank you for the tangent. Can we move back towards discussion of the original topic?

 

[Doowai]

24 slice? Wow, must have a lot of new technology up there in Wyoming. Just the other day they got some Betamax players for the patients as well.

LOL.... okay I meant 64 slice.

 

[tkim]

Hopkins has a 256 slice scanner.

 

[Pir8DeacDoc]

I have a 1000 slice scanner in my basement. What's up now?



😀

 

[Faebinder]

My machines!!

[YOUTUBE]http://youtube.com/watch?v=IWVgYWHg8Nk[/YOUTUBE]

 

[DOCTORSAIB]

You guys are KILLING me with this CT "slicing" contest...

Minor slip of the tongue/finger on SDN and you're thrown to the wolves.

Tough crowd man.

 

[gng930]

My machines!!

[youtube]IWVgYWHg8Nk[/youtube]

Whose machines?

 

[tkim]

I have a 1000 slice scanner in my basement. What's up now?



😀

I know you're lying because it would have to be a 1024 slice scanner. Nice try.

 

[Faebinder]

Whose machines?

My Machines! MY MACHINES!! MY MY MY MACHINES

 

[Dr Serenity]

Got a portable 2048-slice CT scanner in my truck.

Folds up and fits into a briefcase. Runs off of 4 AAA batteries.

Beat that! 😛

 

[racerx]

Got a portable 2048-slice CT scanner in my truck.

Folds up and fits into a briefcase. Runs off of 4 AAA batteries.

Beat that! 😛

Bah! Portability is over-rated.

I have a 32,768 slice scanner, and you're all in it right now. So hold still, or you're getting sedated.

 

[mlw03]

this thread's really gone by the wayside. in any case, faebinder, i think your idea is great, although i wonder how it would work in ancillary fields like anesthesia, path, and radiology where an attending still has to sign off on most everything the resident does. i'm a path person, and i know you'd never get a surgeon to operate based on a resident signing something out on their own. i can just imagine the patient dying and then the family suing and having the original pathology read by an expert as something that wouldn't have required surgery.

and doowai, i just searched the NRMP directory and found only 2 residnecy programs in WY - 2 FM programs with a total of 9 spots. so not really an option for most of us.

 

[Llenroc]

You guys are KILLING me with this CT "slicing" contest...

Minor slip of the tongue/finger on SDN and you're thrown to the wolves.

Tough crowd man.

I dunno. I didn't think a typo was all that funny. Maybe people are easily amused here. 😕

 

[daru1]

Like I said before, thanks for hijacking my thread.

 

[NotAProgDirector]

Wyomings residencies receive NO money from Medicare. And they are flush - pay high, and have a great savings - most residents are finishing residency with about $20 grand saved. When a teaching hospital wants a new 24 slice CT they get it. And absolutely no money from Medicare.

Are you sure about this? There is no one place where payments to residencies are listed. However, this study about FP residencies in the WWAMI system looked at revenue and expenses directly related to residents. This study included what appears to be a single Wyoming program (although Univ of Wyoming sponsors the only two programs in the state, so this might actually include both campuses). From the study:

Overall, the total revenue per resident, excluding
Medicaid GME, increased for 11 of 12 programs, averaging
15.3%, to $222,106. The program experiencing a
decrease reported significantly less net patient revenue
per resident.

This suggests that they take Medicare money.

I think it's about time residency stopped being funded by medicare. I think residents should be allowed the same privilages as mid levels and be able to bill for their services. That way everyone will see that residents bring in money to the institution and then we will see no more position cuts/stagnation.

I hate to say it, but this won't really fix anything I think. Right now, most things that residents do are billed to medicare. It's just that they get billed under a faculty name, or is included as part of DRG payments. For example, I'm in clinic with 3-4 residents. All the patients they see gets billed to me. However, I can't see any of my own patients, so I don't generate any bills of my own. If residents billed directly to medicare, then I wouldn't get any "financial / RVU credit" for backing up residents -- in fact I would be "punished" for doing so because of lower productivity numbers. Faculty would stop backing up residents. Looked at another way, the hospital is already billing for what you do under someone else's name. If that billing switches to you, the whole system makes no more money. It does make it more transparent where the money is coming from, but as I mentioned you might find that no faculty member can "afford" to work with you any more.

BTW, you might find the link above interesting. Paper describes revenues and expenses of residents directly, something I know you find interesting.

 

[Faebinder]

Are you sure about this? There is no one place where payments to residencies are listed. However, this study about FP residencies in the WWAMI system looked at revenue and expenses directly related to residents. This study included what appears to be a single Wyoming program (although Univ of Wyoming sponsors the only two programs in the state, so this might actually include both campuses). From the study:



This suggests that they take Medicare money.



I hate to say it, but this won't really fix anything I think. Right now, most things that residents do are billed to medicare. It's just that they get billed under a faculty name, or is included as part of DRG payments. For example, I'm in clinic with 3-4 residents. All the patients they see gets billed to me. However, I can't see any of my own patients, so I don't generate any bills of my own. If residents billed directly to medicare, then I wouldn't get any "financial / RVU credit" for backing up residents -- in fact I would be "punished" for doing so because of lower productivity numbers. Faculty would stop backing up residents. Looked at another way, the hospital is already billing for what you do under someone else's name. If that billing switches to you, the whole system makes no more money. It does make it more transparent where the money is coming from, but as I mentioned you might find that no faculty member can "afford" to work with you any more.

BTW, you might find the link above interesting. Paper describes revenues and expenses of residents directly, something I know you find interesting.

Thanks for the great article. The paper is pretty detailed though expenses are not detailed out which leaves a lot to be fought over.

My idea is that residents get paid directly and they pay their sponsering institution. It becomes a true teach-work model. I get paid when I bill... and I get billed for the teaching services of the attending/institution running my show. What better way to teach a resident the importance/details of money management as a medical business? Some fellows of private institutions sorta do that already.

 

[DOCTORSAIB]

I dunno. I didn't think a typo was all that funny. Maybe people are easily amused here. 😕

Or some of us take things too seriously. Or your undies are too tight..😕

Boss, I was amused at the way people responded not so much the typo itself.

 

[Annette]

I don't think the teaching hospitals will drop residency spots- they rely very heavily on cheap labor. They'll probably drop salaries/benefits instead.

The 24 slices are spred over the state, so it takes awhile to be scanned!