Is it possible to start a residency in a private practice?

[tacobellforlife]

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As the title says, I was looking at new Dermatology programs and recently saw that a private practice in Michigan, Dermatology and Cosmetic Center PLLC Program, opened a residency program. Asking Google and ChatGPT it states that a private practice can not start a residency program as it needs to be part of ACGME approval.

However, the program is also listed on the ACGME website. Residents also rotate through a near by hospital facility known as Hurly Medical Center, but looking at their ACGME data it does not list Dermatology as one of the residency programs offered; nor is Dermatology offered as a residency program on the main hospital GME website.

I am just curious as to how this works? Is this the beginning of new training occurring in a private practice setting?

 

[ThoracicGuy]

Not that this answers your question, but trusting any answer from ChatGPT is wrong. Those things put out garbage with real answers. Don't trust it.

 

[GoSpursGo]

They probably jumped through the hoops to get ACGME approval. They may not be a GOOD program, but as given the competitive nature of dermatology you would presumably prefer training there over going unmatched

 

[NotAProgDirector]

There's nothing stopping any small outfit -- whether private practice, a rural based clinic, HMO, or whatever -- from starting a residency program. If they are to be the Sponsoring Institution, then they just need to follow both the ACGME Institutional Requirements and the program requirements. The institutional requirements will include a need for a DIO -- but for a sponsor with a single residency program the PD is usually the DIO also. They will need a GMEC (not a big deal), and otherwise need to make sure that they meet all the requirements. If there's a program requirement that the residents/fellows have inpatient experience -- then that site needs to have an affiliation with a hospital for that. In this case, they will need both inpatient derm care, and dermatopathology experience - which looks like has been set up.

The problem that they can run into is funding. Residencies are paid by CMS via the Medicare cost report. But I doubt this small PP submits a Medicare Cost Report, and their IME payments would basically be zero. I expect they are not planning on getting any funding, and are just planning on paying for it out of operational funds. if they can expand their clinic patient numbers because of the residents, likely will easily pay for itself.

 

[gutonc]

There are LOTS of surgery fellowships that operate like this. No reason something like derm (which is 98.7% outpatient) can't do the same. Jump through the hoops, figure out a way to pay them and there you go.

 

[comp1]

Sure, lots of different types of organizations start residencies. It's quite a lot of work for the PD and other attendings (which isn't remunerated by itself) and isn't necessarily net profitable unless you have Medicare funding as described above or some significant grants. There are private companies who run businesses specifically to help organizations meet the ACGME requirements to set up residencies, but it's definitely not easy.

 

[AlbinoHawk DO]

I saw a fellowship where the hospital hired a private group to run it

There always loopholes

 

[LucidSplash]

The surgeons that trained me were an academic private practice, multi-surgical specialty group. Not hospital employed. Level 1 trauma included. The neurosurgeons were a separate group but also private practice, although they didn’t have residents or fellows. Which mean the trauma residents got to put in the ICPs. Private practice can look different than the commonly held ideal.

 

[Apollyon]

I don't see any issue with this, if they have the volume. This would be for "money" specialties, like derm and ortho (like the Steadman clinic - they have fellowships), because they could pay for it, even without government cash infused.

 

[dozitgetchahi]

There are LOTS of surgery fellowships that operate like this. No reason something like derm (which is 98.7% outpatient) can't do the same. Jump through the hoops, figure out a way to pay them and there you go.

There are several (previously) osteopathic derm programs like this that already exist. Iirc most osteopathic derm programs basically were established in random private practices. And some of these programs still exist after the DO/MD merger.

 

[AlbinoHawk DO]

There are several (previously) osteopathic derm programs like this that already exist. Iirc most osteopathic derm programs basically were established in random private practices. And some of these programs still exist after the DO/MD merger.

I think there are MD fellowships in Ophthalmology where this is the case. It's an old-school apprenticeship model

 

[tacobellforlife]

I think there are MD fellowships in Ophthalmology where this is the case. It's an old-school apprenticeship model

I think some of the Ophthamology residencies are still held in private practice centers, no? I guess I should've realized that before making the post. Usually see posts about "X Eye Center" and it turns out to be at a private clinic or so.

 

[eyeeye_captain]

I think some of the Ophthamology residencies are still held in private practice centers, no? I guess I should've realized that before making the post. Usually see posts about "X Eye Center" and it turns out to be at a private clinic or so.

TL;DR yes for ophtho fellowships, no for residency.

I’m pretty sure every residency has at least a hospital affiliation, even the small ones. Some programs do send residents to private offices, especially if most of their faculty are part time or they are lacking in a subspecialty.

For some reason, ophtho fellowships outside of some plastics (ASOPRS) are not regulated by the ACGME. (Fun fact: that means there’s limited oversight and programs could theoretically pay you whatever they want while having you bill as an attending.) There is AUPO recognition, but it’s not required or regulatory. In retina there are some fully private fellowships, maybe the best of which at least used to be TRI St. Louis. There are a good number of privademic places like RGW, Cincinnati, Rush, Minnesota, Wills, and UAB (x2). The first 4 of the hybrid list have sold to private equity, so it’s kind of like the dangers of an HCA residency. There are some really sketchy private 1 year plastics/aesthetics fellowships. There are a range of quite good to sketchy private cataract/refractive/anterior segment spots. So all in all, a big spectrum with some really good places and some weak ones.

 

[Dral]

if they can expand their clinic patient numbers because of the residents, likely will easily pay for itself.

Where I am, I can more than double my billable encounters working with three residents vs just seeing patients on my own. I can oversee four or even 5 residents if we hustle, but I think there is an ACGME regulation about only supervising three at a time (maybe it's a recommendation. I'm not really sure).

Attending salary - salary of three residents = lots left over.

Of course that's a very simplified equation. There is added overhead, more nurse/MA and staff salaries, etc. However, I'm sure there is still some left over after all that.

Other than the oversaturated urban areas, getting the pt census up is likely not going to a problem for Derm. Even if this would be mainly to increase money coming into the practice, one could always argue that more patients are getting Derm care than if the residency wasn't running.

 

[Smurfette]

TL;DR yes for ophtho fellowships, no for residency.

I’m pretty sure every residency has at least a hospital affiliation, even the small ones. Some programs do send residents to private offices, especially if most of their faculty are part time or they are lacking in a subspecialty.

For some reason, ophtho fellowships outside of some plastics (ASOPRS) are not regulated by the ACGME. (Fun fact: that means there’s limited oversight and programs could theoretically pay you whatever they want while having you bill as an attending.) There is AUPO recognition, but it’s not required or regulatory. In retina there are some fully private fellowships, maybe the best of which at least used to be TRI St. Louis. There are a good number of privademic places like RGW, Cincinnati, Rush, Minnesota, Wills, and UAB (x2). The first 4 of the hybrid list have sold to private equity, so it’s kind of like the dangers of an HCA residency. There are some really sketchy private 1 year plastics/aesthetics fellowships. There are a range of quite good to sketchy private cataract/refractive/anterior segment spots. So all in all, a big spectrum with some really good places and some weak ones.

Some of the GS fellowships are the same (not ACGME regulated). So if you want an academic powerhouse or simply to get volume/exposure to later go into PP, you can find something that fits your goal.