King/Drew To Close

[GeneralVeers]

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We just got word....from the LA Times. King/Drew failed CMS (though there were no complaints about the ER). That's basically the death knell for our residency. I don't have any more details at the moment. Needless to say, quite depressing. I may end up doing family medicine after all.

 

[wook]

GV:

You're kidding...right? If not, that s.cks!


Wook

 

[JackBauERfan]

We just got word....from the LA Times. King/Drew failed CMS (though there were no complaints about the ER). That's basically the death knell for our residency. I don't have any more details at the moment. Needless to say, quite depressing. I may end up doing family medicine after all.

if its true, i'm sorry! But I hope there are some programs that can help you guys out!

I'm about to google this though to check.

 

[Apollyon]

The RRC (and, a step up, the ACGME) encourages the rest of the community to absorb residents who lose their places due to no fault of their own. I would be VERY surprised if you didn't get a spot, and I would not be surprised if you and your colleagues stayed in the metro LA area, or at least California.

At the same time, you may indeed have to move somewhere far away. Still, you should not be left hung out to dry.

 

[waterski232002]

You can try to contact the University of Chicago... We absorbed 2 LSU EM residents after Katrina.

 

[Wahoo]

Here's an article confirming the demise of King/Drew:

Link to article in LA Times.

 

[wook]

Here's an article confirming the demise of King/Drew:

Link to article in LA Times.

GV:

Dang. Sorry dude/dudette.


Wook

 

[DrQuinn]

Dude. I got nuttin' but love for you. Let me know if I can do anything.

Q

 

[Hard24Get]

But it sounds like it would be a public health crisis if the King/Drew ED closes! God knows LA needs all the care it can get. Though I sure the King/Drew resident would be snatched up because of all their experience, I don't think we can afford to lose the ED. Surely it will be bought??? But if it is only privately funded, can there still be a residency program?

Very sorry about the trouble, General! 🙁

 

[SoCuteMD]

I'm SOOO sorry to hear that GV. Sending hugs your way!

 

[EctopicFetus]

damn sad to hear that..

 

[FoughtFyr]

GV,

Nothing but love for you brother. Sorry this is happening and I hope you come out of this $hit smelling like a rose.

I've got to ask, I know the ED was not the source of the problems, but how in heck was the staff that unprepared? I mean CMS sent in a group to help KD get ready. What, did the staff think they were kidding? I mean were they really just thinking that they could "get away" with business as usual? Were things really that bad? Give us the scoop...

- H

 

[GeneralVeers]

GV,

Nothing but love for you brother. Sorry this is happening and I hope you come out of this $hit smelling like a rose.

I've got to ask, I know the ED was not the source of the problems, but how in heck was the staff that unprepared? I mean CMS sent in a group to help KD get ready. What, did the staff think they were kidding? I mean were they really just thinking that they could "get away" with business as usual? Were things really that bad? Give us the scoop...

- H

I'm at a loss as to why we failed. Most of the reasons cited were for non-patient care issues. The few patient-care issues were nursing in origin. Our staff prepared for this for 16 months, with mock CMS interviews/inspections and coaching of all staff on how to answer questions. Essentially it comes down to lack of leadership and responsibility. The hospital was run like a socialist organization, rather than something which had to provide results. When the hospital opened in the 1970's they had the goal of hiring people from the "community". Unfortunately many they hired were unqualified and/or incompetent and stayed on for years. This philosophy in management persisted with our current administrators and the hierarchy. Essentially no employee could be fired for any reason, there were no incentives to do their jobs, and they could sit back and reap the benefits.

With the loss of CMS funding, the hospital loses 1/2 of it's 400 million dollar budget, which effectively means no budget to treat any patients. This is further compounded by the fact that the county wants the hospital to close because it costs too much money, and therefore will not cough up money to cover the loss of CMS.

The letter CMS sent to us states that patient care must end by November of this year. This creates huge problems in finding residency spots, especially for our seniors who only will have 6 months to go at that point.

 

[Lumberg]

PM heading your way

 

[deleted52758]

We just got word....from the LA Times. King/Drew failed CMS (though there were no complaints about the ER). That's basically the death knell for our residency. I don't have any more details at the moment. Needless to say, quite depressing. I may end up doing family medicine after all.

sorry to hear that. i've got much love for my fellow county residents. hang in there!

 

[Quimby2]

I was a bit suprised we lost it as well. However, not suprised we heard about it first via the LA Times; it's been our only sourse of "office memos" for the last three years.

Seems like it would be hard for the three local programs to absorb so many residents. Anybody out there go through this before?

 

[NinerNiner999]

Sorry to hear that General - I'm sure things will work out for the best (think about it, now you may have to work less shifts)...

 

[DrMom]

What rough news for all of you residents out there! I certainly hope that other programs will take you in.

 

[GeneralVeers]

I'd like to thank everyone for their support. A few people sent me e-mails regarding possible program openings.

If L.A. County cannot make a plan to place us within the next couple of weeks, we definitely may need to start placing people at other programs.

 

[RayF]

best of luck, man.. I'm sure a few months in another program isn't the worst thing that coulda happned: new networks, new opportunities, etc. so hope u not feeling too bad General.
The rumors had been spreading for a while, though. last year a 4th yr applying to the program told me exactly this was about to happn. dunno what his source was.. maybe the LA Times 🙁

 

[trkd]

GV, that is rough. I am really sorry to hear that. I hope you are able to work your way into another program without having to move house and home. Best of luck to you and all your collegues there.

 

[TysonCook]

PM your way GV

 

[Wackie]

Nothing to add but best wishes and good luck.

 

[castaway]

Hey GV,

I just sent you a PM.

 

[Jeff698]

Man, that really sucks for you.

I'm curious, though. Crappy fate for residents not withstanding, do you think anything short of the 'death penalty' would have solved things there in light of the existing culture?

Good luck, General. I'll be thinking hopeful thoughts for you and your buds.

Take care,
Jeff

 

[EctopicFetus]

dont forget about SAEM.org.. though i am sure your program will try to opne things up for you.

 

[GeneralVeers]

Here is an updated on the situation.

Our GME office contacted the ACGME regarding the recent "problems". ACGME will only allow training at JCAHO licensed facilities. Even though our facility lost JCAHO a couple of years ago, they had convinced ACGME that CMS accreditation was equivalent, which was accepted by the ACGME. Now that the hospital has lost CMS funding (which finishes in December) the ACGME says it can no longer be used for residency training purposes due to inadequate patient care standards.

This means that our primary (and only) EM training facility will be gone as of December. Currently there are no plans or agreements with other facilities to train us in EM.

There is the very remote possiblity that we could remain training at King if we could retain CMS funding. The only way to retain CMS funding would be if UCLA, or a private hospital group took over management of the hospital. If the new group has CMS funding at other facilities, it can be extended to temporarily cover King/Drew as well. This would be the best solution, however for such a thing to happen usually takes 6 months to a year to sort out (perhaps longer), yet we have only 3 months until our program is homeless.

Given all this, our GME and program still maintains they want the program to stay open in a "transitional period" after December. When asked about beginning the process of placing residents at other programs, they refuse to even consider it.

To me it seems that the people in charge are putting their needs and careers above the well-being of the residents. Thoughts anyone?

 

[Apollyon]

After Katrina, Charity vowed they would stay open, but Peter DeBlieux promised anyone that wanted to leave that he would support them - and he did. 4 took advantage.

Yours is a comparable situation, and your program should stand behind anyone who wants to bail now - after all, it is "aprés moi, le deluge". The handwriting is on the wall, but, instead of "mene, mene, tekel upharsin", not you, but the hospital has been weighed and found wanting.

 

[totalbodypain]

Here is an updated on the situation.

Our GME office contacted the ACGME regarding the recent "problems". ACGME will only allow training at JCAHO licensed facilities. Even though our facility lost JCAHO a couple of years ago, they had convinced ACGME that CMS accreditation was equivalent, which was accepted by the ACGME. Now that the hospital has lost CMS funding (which finishes in December) the ACGME says it can no longer be used for residency training purposes due to inadequate patient care standards.

This means that our primary (and only) EM training facility will be gone as of December. Currently there are no plans or agreements with other facilities to train us in EM.

There is the very remote possiblity that we could remain training at King if we could retain CMS funding. The only way to retain CMS funding would be if UCLA, or a private hospital group took over management of the hospital. If the new group has CMS funding at other facilities, it can be extended to temporarily cover King/Drew as well. This would be the best solution, however for such a thing to happen usually takes 6 months to a year to sort out (perhaps longer), yet we have only 3 months until our program is homeless.

Given all this, our GME and program still maintains they want the program to stay open in a "transitional period" after December. When asked about beginning the process of placing residents at other programs, they refuse to even consider it.

To me it seems that the people in charge are putting their needs and careers above the well-being of the residents. Thoughts anyone?

While waiting till they are putting the chains on the door to give a thought to your future may be seen as spontaneous and spunky, I would just call it stupid and shortsighted. To use another analogy; Don't be the last rat off a sinking ship. Leave that job to the administrators and management that have run the place into the ground. I think it is safe to say thier judgment has been less than stellar up to this point....👎

 

[Jeff698]

Thoughts anyone?

As painful as it may be, I think waiting around for your administration (with, let's face it, a less than stellar track record) to figure out a way to 'protect' you would be rather, um, er, oh hell, I can't even think of the right word.

Punch out now. Start browsing SAEM, hit up the EMRA residency fair in New Orleans if you can make it, email program directors near and far.

Your fate is yours and no one else's. I'd do everything I could to bail before you end up unemployed and have to waste a year. If your PD has a problem with that, then he is clearly not thinking of your best interests. If he gets wadded about you wanting to leave, that'd be an incredibly strong hint that you need to bail even faster.

You're in a crappy situation. I truly wish you the best of luck.

Take care,
Jeff

 

[Apollyon]

I shall reiterate, though - I am highly confident that all displaced residents that want a spot will find one somewhere.

As Jeff said - now is the time to pull the plug. Good luck - it CAN be done!

 

[BKN]

Here is an updated on the situation.

Our GME office contacted the ACGME regarding the recent "problems". ACGME will only allow training at JCAHO licensed facilities. Even though our facility lost JCAHO a couple of years ago, they had convinced ACGME that CMS accreditation was equivalent, which was accepted by the ACGME. Now that the hospital has lost CMS funding (which finishes in December) the ACGME says it can no longer be used for residency training purposes due to inadequate patient care standards.

This means that our primary (and only) EM training facility will be gone as of December. Currently there are no plans or agreements with other facilities to train us in EM.

There is the very remote possiblity that we could remain training at King if we could retain CMS funding. The only way to retain CMS funding would be if UCLA, or a private hospital group took over management of the hospital. If the new group has CMS funding at other facilities, it can be extended to temporarily cover King/Drew as well. This would be the best solution, however for such a thing to happen usually takes 6 months to a year to sort out (perhaps longer), yet we have only 3 months until our program is homeless.

Given all this, our GME and program still maintains they want the program to stay open in a "transitional period" after December. When asked about beginning the process of placing residents at other programs, they refuse to even consider it.

To me it seems that the people in charge are putting their needs and careers above the well-being of the residents. Thoughts anyone?

General,

In this kind of disaster, the leaders often try to save the ship. I suspect that they are doing this in good faith. Whatever the good intentions or otherwise of your bosses, they are no longer in control of the situation. If CMS says no patient care after December, the hospital will likely be bankrupt by the end of January. Thus a "transitional period" seems unlikely to me.

The RRC is likely to encourage other programs (for example all of those in LA) to take some of you in. Usually in this situation, a temporary increase in resident authorization can be approved. That begs the question however as to who pays the salary. It would be nice to think that the county would transfer you to the other hospitals, but since money was a major root of the problem, I wouldn't hold your breath.

I agree with Ap, Jeff, and pain, it's time to look out for number one.

 

[GeneralVeers]

Thanks for the help everyone, especially BKN. There's one hitch though. I just found out that our program director is not allowing anyone out of their contracts. They're afraid that everyone will leave, and that it will kill the residency outright. Looking for a job is futile, since we can't breach our contracts. This means everyone is stuck on board the titanic until July.

 

[Jeff698]

I just found out that our program director is not allowing anyone out of their contracts. They're afraid that everyone will leave, and that it will kill the residency outright. Looking for a job is futile, since we can't breach our contracts. This means everyone is stuck on board the titanic until July.

OMG! 😱

I've got news for your PD. Not having residents is not what is killing the residency. It's not having a freaking hospital! If the hospital really closes, the program is already dead. Seems like he needs one of Feb's demotivational posters.

I can't believe what a jerk he's is being. Screw him. I'd start looking anyway. He can try to hold you to your contract all he wants but when he can't keep his end of that contract (i.e. at least have a hospital to train you in) there's no way he can get away with this nonsense.

Good luck!
Jeff

 

[docB]

A contract is a two way street. The residency may be breeching the contract by not providing you with an ACGME approved program. I suspect that if the institution founders they will not be able to hold you to those contracts. This sounds like a delaying tactic. They want you all to sit tight while they work it out.

 

[GeneralVeers]

A contract is a two way street. The residency may be breeching the contract by not providing you with an ACGME approved program. I suspect that if the institution founders they will not be able to hold you to those contracts. This sounds like a delaying tactic. They want you all to sit tight while they work it out.

Yes, this is exactly the strategy.

 

[NinerNiner999]

I would ask (collectively if need be) for your residency program to provide you with a written letter stating you will be provided a training facility and continuation of your training for the remainder of your intended residency (up to three years, or whatever you have left). Add specifically that this training will lead to ABEM and NBME eligibility for certification as an EP. Give them 30 days to respond in writing with this statement. Inform them that if they are unable to provide you with a stable training environment to continue your ACGME-approved training within the allotted time, you will actively seek a position elsewhere. This request for notification should be sent to them in writing, return receipt.

That being said, I would begin to seek positions elsewhere with a goal of starting in January. Programs may be more receptive to accepting new residents in 6-month intervals. As was mentioned before, it is difficult to uphold a contract for training when there is no ability to train. If they cannot provide a training location or a pathway for you to meet your goals, your contract if effectively null and void...

 

[BKN]

Thanks for the help everyone, especially BKN. There's one hitch though. I just found out that our program director is not allowing anyone out of their contracts. They're afraid that everyone will leave, and that it will kill the residency outright. Looking for a job is futile, since we can't breach our contracts. This means everyone is stuck on board the titanic until July.

So you breach your contract? Do you think they'll sue? Bad PR and you don't have any money anyway. The few times we've had somebody leave, we just said "Don't let the door etc."😉

Niner's suggestions have merit, but I'm not sure that the RRC will approve partial year credit, It's usually done one year at a time if there will be a transfer. So I'm suspect that if you bailed mid year you'd increase your tarining time by 1/2 year since you would have to start EM2 over. That balanced against the possibiilty that King will be able to get you to the end of the training year.

😡 Good luck.

 

[NinerNiner999]

Well stated as always, BKN. Our program has, in the past, offered residency six months into the year, with the expectation you will stay six months after everyone else has left...

 

[NinerNiner999]

Well stated as always, BKN. Our program has, in the past, offered residency six months into the year, with the expectation you will stay six months after everyone else has left...

 

[GeneralVeers]

So you breach your contract? Do you think they'll sue? Bad PR and you don't have any money anyway. The few times we've had somebody leave, we just said "Don't let the door etc."😉

Niner's suggestions have merit, but I'm not sure that the RRC will approve partial year credit, It's usually done one year at a time if there will be a transfer. So I'm suspect that if you bailed mid year you'd increase your tarining time by 1/2 year since you would have to start EM2 over. That balanced against the possibiilty that King will be able to get you to the end of the training year.

😡 Good luck.

Nice to know about the 1 year interval. I was unaware that RRC didn't allow transfers mid year with ability to keep the partial year. I guess that means we're definitely stuck here until July, or the RRC pulls the plug and places us.

If the RRC shuts us down and places us midway through the year, will they let us keep the partial year credit?

 

[BKN]

Nice to know about the 1 year interval. I was unaware that RRC didn't allow transfers mid year with ability to keep the partial year. I guess that means we're definitely stuck here until July, or the RRC pulls the plug and places us.

If the RRC shuts us down and places us midway through the year, will they let us keep the partial year credit?

Not sure (nor am I completely sure about my last post). Normally to transfer between programs the losing PD must provide the gaining PD with a complete listing of rotations done. The gaining PD must then fit them into his program format and from there develop what the resident has yet to do. We usually have some warning and time if it's an end of year transfer.

words of wisdom from the special requirements:

Resident Transfers
To determine the appropriate level of education for a resident who is
transferring from another residency program, the program director must
receive written verification of the previous educational experiences and a
statement regarding the performance evaluation of the transferring resident,
including an assessment of competence in the six core areas described in the
Program Requirements, prior to acceptance into the program. A program
director is required to provide verification of residency education for any
residents who may leave the program prior to completion of their education.

​

 

[Flopotomist]

Not sure (nor am I completely sure about my last post). Normally to transfer between programs the losing PD must provide the gaining PD with a complete listing of rotations done. The gaining PD must then fit them into his program format and from there develop what the resident has yet to do. We usually have some warning and time if it's an end of year transfer.

words of wisdom from the special requirements:

Resident Transfers
To determine the appropriate level of education for a resident who is
transferring from another residency program, the program director must
receive written verification of the previous educational experiences and a
statement regarding the performance evaluation of the transferring resident,
including an assessment of competence in the six core areas described in the
Program Requirements, prior to acceptance into the program. A program
director is required to provide verification of residency education for any
residents who may leave the program prior to completion of their education.

​

that last line seems like it may help GV if his PD decides to try to play hardball. Good luck GV!

 

[NinerNiner999]

From what I've heard, you can negotiate a residency transfer at any time in the academic year so long as the requirements and terms are agreed upon in advance by all parties. BKN would know better then I....

 

[BKN]

From what I've heard, you can negotiate a residency transfer at any time in the academic year so long as the requirements and terms are agreed upon in advance by all parties. BKN would know better then I....

Perhaps I don't, now that I went back and looked at the verbiage.

 

[GeneralVeers]

Perhaps I don't, now that I went back and looked at the verbiage.

This will be an interesting thing to figure out. If I get in contact with one of the programs with an open PGY-2 spot, I'll ask them to explain how much of the partial year will transfer.

 

[beyond all hope]

I know a lot of people who transferred midyear who didn't lose any time (including at least one that transferred out of King). Since it's within the same speciality, this shouldn't be a problem.

There are a lot of programs who want to expand but were unable to do so because of RRC restrictions, which will certainly be relieved in order to help King residents find new spots. What happened previously when surgery lost its accreditation three years ago will certainly happen for EM now: residencies will open up new spots for you. Also remember that King-Drew has hundreds of alumni, and many in academic posts.

Agree with previous poster: send a letter ASAP stating your need for a stable residency program or you will consider your contract null and void.

Start contacting residencies that you're interested in right away and scope out your opportunities. No one would blame you for looking for greener pastures at this unfortunate juncture.

 

[SIANNI]

Sorry to hear about this. That is a tough break and very unfortunate for everyone, especially the people who live in the neighborhood. Is it true that the program is obligated to find all the residents a spot in another program? What happens to G.Surg and OB and Int Med and everyone else? Where can they go? What if they need to stay in one city due to family issues? This whole thing sounds just awful.

 

[GeneralVeers]

Sorry to hear about this. That is a tough break and very unfortunate for everyone, especially the people who live in the neighborhood. Is it true that the program is obligated to find all the residents a spot in another program? What happens to G.Surg and OB and Int Med and everyone else? Where can they go? What if they need to stay in one city due to family issues? This whole thing sounds just awful.

It is awful, and rather unprecedented for this many residencies to close (we have 18). It's on the order of a Katrina disaster in terms of relocating residents, and the human cost in terms of decrease in patient care may be just as bad as Katrina.

On a brighter note, the L.A. Times suggests that County is negotiating with Harbour-UCLA to take over the hospital. This would give us CMS approval, regain our training site, and improve the hospital organization as well as resident education. I really hope they can work something out in the next couple of weeks, even if it's just a tentative agreement.

 

[bulgethetwine]

It is awful, and rather unprecedented for this many residencies to close (we have 18). It's on the order of a Katrina disaster in terms of relocating residents, and the human cost in terms of decrease in patient care may be just as bad as Katrina.

On a brighter note, the L.A. Times suggests that County is negotiating with Harbour-UCLA to take over the hospital. This would give us CMS approval, regain our training site, and improve the hospital organization as well as resident education. I really hope they can work something out in the next couple of weeks, even if it's just a tentative agreement.

I think the "6-month" credit issue is related to someone transferring from a different specialty. i.e., no matter how congruent your rotations if you came from, say, IM, you're only going to get 6 months credit for your previous IM work toward your new residency in EM.

For someone going from one EM program to another, you get full credit for time served provided your new PD can tweak your rotations such that you still qualify all the required rotas.