New HCA/NAPA Anesthesia Residency in Austin

[cowbydoc]

I got this email for the program director gig at a new HCA funded residency in Austin. Did the ABA learn nothing from EM?!?! Please if you have time call the ABA. This is ridiculous. We need to protect our specialty.

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[Howard888]

Dell medical school in Austin doesn’t even have a residency and they have a stand alone pedi hospital, level 1 trauma….and is actually a medical school.

How does the anesthesia residency go to a for profit hospital system and Napa vs an actual medical school????

Cheap workforce to make money off of. What an embarrassment

 

[CubsDynasty]

NAPA&HCA is the Kayne&Kim of set ups

 

[sevo00]

How can we contact aba to let them know how we fell about this. This is not ok

 

[cowbydoc]

The ABA contact number is 866-999-7501. I was told to talk with the credentialing people. They didn’t answer so I left a message. I will be calling again.
Some stats from EM: 2023 match had an 81.6% fill. Residency positions at for profit hospitals had a 50% higher rate of not filling than at not for profit hospitals. The number of EM residencies expanded from 160 to 265 from 2013 to 2020! There is a projected surplus of almost 8,000 ER physicians by the year 2030.
We can’t let our field become EM. These for profit entities could care less about training. They want cheap labor. That’s it.

 

[sevo00]

Also the ACGMEs job to make sure these new training sites have adequate training. I doubt a lot of these new for profit sites have adequate training

 

[addoncase]

Does the aba even care?
Don’t they likely already know about it?

 

[pgg]

Does the aba even care?
Don’t they likely already know about it?

The ABA is too busy being late grading their new, unnecessary, and poor quality cardiac exam. Even if they weren't this isn't really their lane.

The ASA is the entity that should care and lobby against this, but they're mostly useless. But who knows - CRNAs probably want fewer anesthesiologists, so maybe the ASA will get involved to stop this.

 

[cowbydoc]

I called the ASA first and they referred me to the ABA. They said that the ABA are the ones that certify residencies so they are the ones who we would need to speak with.

 

[DolphinVA]

There's soon to be another, in Houston. HCA Medical Center+Clear Lake/USAP but veiled under the new University of Houston program.

 

[Dr. Anonymouss]

I called the ASA first and they referred me to the ABA. They said that the ABA are the ones that certify residencies so they are the ones who we would need to speak with.

Can we create a petition to sign? The ABA serves anesthesiologists so we should let them know what the anesthesiologists think about this...

 

[nimbus]

I wonder how many slots they will have. The new Tampa program will have 12/yr.

 

[addoncase]

The ABA is too busy being late grading their new, unnecessary, and poor quality cardiac exam. Even if they weren't this isn't really their lane.

The ASA is the entity that should care and lobby against this, but they're mostly useless. But who knows - CRNAs probably want fewer anesthesiologists, so maybe the ASA will get involved to stop this.

The aba certifies you not the asa
The programs tell the aba you are ok to leave residency and move on
Asa, I agree they should be doing much more

Can we create a petition to sign? The ABA serves anesthesiologists so we should let them know what the anesthesiologists think about this...

While I agree, I get the general
Sentiment is that no one organization to care?

Last I heard the only thing that came up was the state of Indiana of all places banning mid levels from promoting themselves and misleading the public saying they are physicians

 

[pgg]

The aba certifies you not the asa

We're arguing pointless semantics here but the ABA has nothing to do with residency programs, their opening, closing, accreditation, number of residents, the quality of their training, or whether more/fewer anesthesiologists are good or bad for the profession or society.

They're not going to refuse to test and certify candidates who come to them from an accredited residency program with cash in hand. They're just not. Totally barking up the wrong tree here. But call them if you like.

 

[nimbus]

For both the ASA and the ABA, more anesthesiologists=more revenue. It’s that simple.

 

[Dr. Rude]

The organization that you should direct your comments to is the ACGME.


ACGME Mission:
The mission of the ACGME is to improve health care and population health by assessing and enhancing the quality of resident and fellow physicians' education through advancements in accreditation and education.


One possible interpretation of their mission: More docs is in the interest of population health. The fact that some those docs are less well trained than previous generations is a cost that we should accept in the name of increasing numbers of practitioners. In addition, lowering the cost of anesthesia services by increasing supply is in the best interest of population health. I submit that on how one chooses to interpret their mission that they are doing their job.

 

[<(^_^)>]

Realistically for profit hospitals and private equity groups should not be allowed to “educate” new residents. The profit incentive is there, and will never not be there. Education will be a distant secondary concern and I expect you may see 75-80 hour low case complexity residencies sprout up soon. They will fill, as there’s always going to be someone desperate for a slot, and as a result patient care will suffer.

As others mentioned there are other possible sites for residencies that don’t yet have residencies and while it might be nice if we all made neurosurgery money by restricting any new residencies I do think a realistic goal is ensuring the quality of residencies are maintained.

 

[aneftp]

The ABA contact number is 866-999-7501. I was told to talk with the credentialing people. They didn’t answer so I left a message. I will be calling again.
Some stats from EM: 2023 match had an 81.6% fill. Residency positions at for profit hospitals had a 50% higher rate of not filling than at not for profit hospitals. The number of EM residencies expanded from 160 to 265 from 2013 to 2020! There is a projected surplus of almost 8,000 ER physicians by the year 2030.
We can’t let our field become EM. These for profit entities could care less about training. They want cheap labor. That’s it.

The problem is not EM docs or residency slots. The problem is arnp and even IM and FP working for less money.

When u rate adjust crnas working hours and days worked and less weeknights and weekends. Crnas really Average 400k a year for similar work an MD makes at 465k (the national average based on real 40 hours and no call docs slots) assuming 8-10 weeks off. So the spread difference when adjusting for similar hours and availability with crna and anesthesiologist is very little in the overall scheme of things.

Arnp take around 130-150k. FP may take 275k. EM docs take around 350-400k. For similar hours. A much bitter difference

 

[CubsDynasty]

At the end of the day I don't think any of the governing organizations truly care that much about the quality of the graduates. SRNA programs are popping up left and right, doesn't really matter how good the clinical training sites are or whether its academic or AMC run. Look at the recent COVID class of CRNA grads who barely got OR time because they were deployed to the ICUs for much of their training. Physician, CRNA, AA they all just want as many people as possible.

 

[Dr. Anonymouss]

At the end of the day I don't think any of the governing organizations truly care that much about the quality of the graduates. SRNA programs are popping up left and right, doesn't really matter how good the clinical training sites are or whether its academic or AMC run. Look at the recent COVID class of CRNA grads who barely got OR time because they were deployed to the ICUs for much of their training. Physician, CRNA, AA they all just want as many people as possible.

Thats what is sad. Quality is going down so that quantity can go up. We all know that quantity = more $. Who puts these people in positions of power. We need new leadership

 

[Coffee PRN]

The anesthesia market will probably cool off heavily in ~5 years once all these new grads+new CRNtAs hit the market

 

[sevo00]

Just got a private message from a NAPA anesthesia residnet who wishes to remain anonymous. Their residency primary consists of doing cataracts and preoping for CRNAs. The SRNAs are primarily given all the learning cases. This is absolutely ridiculous and needs to be brought up to the ASA and ACGME. This is piss poor training just for the PE firm to get cheap labor to staff rooms. Anyone have contact for the ACGME? I will email and call them personally. Also would like to complain to NAPA

 

[Shimmy8]

Plus you know those docs want nothing to do with teaching residents.

 

[sevo00]

Just got a private message from a NAPA anesthesia residnet who wishes to remain anonymous. Their residency primary consists of doing cataracts and preoping for CRNAs. The SRNAs are primarily given all the learning cases. This is absolutely ridiculous and needs to be brought up to the ASA and ACGME. This is piss poor training just for the PE firm to get cheap labor to staff rooms. Anyone have contact for the ACGME? I will email and call them personally. Also would like to complain to NAPA

Btw this is regarding the nuvance health program in Connecticut

 

[Test Boy]

Just got a private message from a NAPA anesthesia residnet who wishes to remain anonymous. Their residency primary consists of doing cataracts and preoping for CRNAs. The SRNAs are primarily given all the learning cases. This is absolutely ridiculous and needs to be brought up to the ASA and ACGME. This is piss poor training just for the PE firm to get cheap labor to staff rooms. Anyone have contact for the ACGME? I will email and call them personally. Also would like to complain to NAPA

Yeah, I’m upset just reading this but what are you gonna say to NAPA? They are a for profit organization and will do whatever they can to maximize their profits. It’s never a good thing whenever an AMC takes over a residency program.

 

[GasPerspectives]

It doesn't help that the ASA advertises exactly how much residency slots save hospitals "... the cost per hour of clinical coverage for residents was $29.14, whereas paying nurse anesthetists to work overtime was $181.12 per hour of clinical coverage and paying nurse anesthetists to take on extra shifts was $255.31 per hour of clinical coverage... over three years, the addition of three residency positions resulted in a cost savings of between $440,000 and $730,000 for the first year, $840,000 and $1.4 million for the second year, and $1.2 million and $1.9 million for the third year..." .

Source

 

[sevo00]

Btw this is regarding the nuvance health program in Connecticut

Correction it’s the nuvance health program in Poughkeepsie, NY

 

[GravelRider]

Just got a private message from a NAPA anesthesia residnet who wishes to remain anonymous. Their residency primary consists of doing cataracts and preoping for CRNAs. The SRNAs are primarily given all the learning cases. This is absolutely ridiculous and needs to be brought up to the ASA and ACGME. This is piss poor training just for the PE firm to get cheap labor to staff rooms. Anyone have contact for the ACGME? I will email and call them personally. Also would like to complain to NAPA

That resident and every resident in that program should be messaging the ACGME on a daily basis. For all of its warts, the ACGME has taken action against programs in the past.

 

[Dr. Rude]

That resident and every resident in that program should be messaging the ACGME on a daily basis. For all of its warts, the ACGME has taken action against programs in the past.

except that they are all worried about maintaining their anonymity, retaliation, concerns about the program being decertified and them being SOL. being labeled a whistleblower, etc., etc., the real world.

 

[Hoya11]

Correction it’s the nuvance health program in Poughkeepsie, NY

what is nuvance? the residency program?

 

[sevo00]

what is nuvance? the residency program?

Nuvance is name of the health system

 

[Hoya11]

what is nuvance? the residency program?

nuvance staffs a few small hospitals in my area, its a little guy in between multiple bigger entities

they have their own anesthesia group for most of their locations but for some of the more rural locations they inherited napa

they are not a malignant entity but a desperate one'

im confused as to how they are tied to austin tx residency program

 

[sevo00]

except that they are all worried about maintaining their anonymity, retaliation, concerns about the program being decertified and them being SOL. being labeled a whistleblower, etc., etc., the real world.

Apparently they had contacted the acgme and when the acgme came for a site visit everyone was basically forced to lie out of fear of retaliation

 

[Dr. Rude]

Apparently they had contacted the acgme and when the acgme came for a site visit everyone was basically forced to lie out of fear of retaliation

 

[nimbus]

Just got a private message from a NAPA anesthesia residnet who wishes to remain anonymous. Their residency primary consists of doing cataracts and preoping for CRNAs. The SRNAs are primarily given all the learning cases. This is absolutely ridiculous and needs to be brought up to the ASA and ACGME. This is piss poor training just for the PE firm to get cheap labor to staff rooms. Anyone have contact for the ACGME? I will email and call them personally. Also would like to complain to NAPA

Okay but do they get to give the eyedrops?

 

[Bertelman]

Also would like to complain to NAPA

lol. You’d have better luck talking to a brick wall.

I can vouch for how they treat their contracted employees. Can’t imagine what they think of residents.

 

[GravelRider]

Apparently they had contacted the acgme and when the acgme came for a site visit everyone was basically forced to lie out of fear of retaliation

Come on. It’s 2024. Whistleblowing or whatever you want to call it is the easiest thing in the world now. Everyone carries a recorder in their pocket. How would they force people to lie? Who is going to retaliate?

This program is in the most populated area of the country. If it got shut down, the ACGME could grant area programs a few more spots to absorb the residents. They would not be left stranded and the other programs would probably be happy to have the labor.

In the age of social media and ubiquitous recording devices, you would have to be either really insane or really dumb to threaten retaliation and “force” residents to lie (commit fraud if the program is not meeting certain educational requirements). I truly do not understand people who put up with situations like this when there are multiple ways out…whether it’s a job or something like this.

 

[Dr. Anonymouss]

Come on. It’s 2024. Whistleblowing or whatever you want to call it is the easiest thing in the world now. Everyone carries a recorder in their pocket. How would they force people to lie? Who is going to retaliate?

This program is in the most populated area of the country. If it got shut down, the ACGME could grant area programs a few more spots to absorb the residents. They would not be left stranded and the other programs would probably be happy to have the labor.

In the age of social media and ubiquitous recording devices, you would have to be either really insane or really dumb to threaten retaliation and “force” residents to lie (commit fraud if the program is not meeting certain educational requirements). I truly do not understand people who put up with situations like this when there are multiple ways out…whether it’s a job or something like this.

I totally agree, but from the residents perspective what happens to them? Like clearly this program isn’t fit to be a program. On one side I get it, the education isn’t up to par with standards and this is no way to train competent anesthesiologists…. But at the same time, these individuals spent a lot of time and money to get to this point in their lives. This program was deemed acceptable according to the ABA even though it clearly isn’t. So what happens to the residents?

 

[sevo00]

Come on. It’s 2024. Whistleblowing or whatever you want to call it is the easiest thing in the world now. Everyone carries a recorder in their pocket. How would they force people to lie? Who is going to retaliate?

This program is in the most populated area of the country. If it got shut down, the ACGME could grant area programs a few more spots to absorb the residents. They would not be left stranded and the other programs would probably be happy to have the labor.

In the age of social media and ubiquitous recording devices, you would have to be either really insane or really dumb to threaten retaliation and “force” residents to lie (commit fraud if the program is not meeting certain educational requirements). I truly do not understand people who put up with situations like this when there are multiple ways out…whether it’s a job or something like this.

Don’t shoot the messenger. I am just telling you what I was told. But put yourself in their shoes, I know when I was a residnet I also was afraid to speak up out of fear of being punished. I had student loans to pay and no other skills at that point outside of medicine

 

[addoncase]

They ABA is busy recruiting and making arrangements for the American board of EM to use their AIM center (osce will now also be part of EM boards in two years)


Where will the Certifying Exam take place? The Certifying Exam will take place
at the AIME Center in Raleigh, North Carolina. This is a professional assessment center
created by the American Board of Anesthesiology for high-stakes assessments for
board certification. The in-person format will allow ABEM to offer a high-quality
assessment that upholds the highest standards in the specialty. Multiple exam
administrations will take place each year, which will allow candidates more flexibility in
scheduling.

 

[kidthor]

Come on. It’s 2024. Whistleblowing or whatever you want to call it is the easiest thing in the world now. Everyone carries a recorder in their pocket. How would they force people to lie? Who is going to retaliate?

I’ve seen many whistleblowers get completely railroaded by their employers, including now. It’s not an easy thing to do, especially for residents who are at the bottom end of power imbalance. Also the acgme won’t accept a formal complaint unless it’s signed by a named person - anonymous complaints go to their ombudsman who basically does nothing.

The ACGME is a very ineffective organization from what I’ve seen. It wants to keep programs accredited at all costs and has very little incentive to act on even credible information.

Also carrying a recorder in your pocket is not always a great idea. Where I am in CA it’s illegal to record someone without their consent, and most employers have a recording policy. So you record someone then your employer states that you committed a policy violation and says they’ll fire you for cause - plus the recording is debatably not admissible in court.

All this is to say that whistleblowing is not an easy task, even for people who are clearly right.

 

[pgg]

That resident and every resident in that program should be messaging the ACGME on a daily basis. For all of its warts, the ACGME has taken action against programs in the past.

Come on. It’s 2024. Whistleblowing or whatever you want to call it is the easiest thing in the world now.

It's not just open or hidden retaliation that dissuades residents from complaining to the ACGME about stuff like this, or work hour violations, or anything else.

It's the realization that action taken against their program can impact their ability to finish residency on time and get a job on time and move on with their lives. Nobody wants to graduate from a program on probation, or have to find a new program mid-residency if the program gets shut down, or rely on references from faculty or a program director who get slapped by ACGME. If indeed a slap actually happens.

There are a million ways to retaliate against residents, openly, subtly, and silently just with weaker or less enthusiastic recs for fellowship or jobs.

We all know this to be true. It's not unreasonable for residents in these situations keep their heads down and grind out the residency and move on with their lives.

 

[GassYous]

Correction it’s the nuvance health program in Poughkeepsie, NY

Wow all that and you have to live in Poughkeepsie

 

[Dr. Anonymouss]

It's not just open or hidden retaliation that dissuades residents from complaining to the ACGME about stuff like this, or work hour violations, or anything else.

It's the realization that action taken against their program can impact their ability to finish residency on time and get a job on time and move on with their lives. Nobody wants to graduate from a program on probation, or have to find a new program mid-residency if the program gets shut down, or rely on references from faculty or a program director who get slapped by ACGME. If indeed a slap actually happens.

There are a million ways to retaliate against residents, openly, subtly, and silently just with weaker or less enthusiastic recs for fellowship or jobs.

We all know this to be true. It's not unreasonable for residents in these situations keep their heads down and grind out the residency and move on with their lives.

Exactly, but to allow this to continue is not only an injustice to the future residents that attend these programs, but also patients who expect their anesthesiologists to have the best training and education.

 

[GassYous]

I’ve seen many whistleblowers get completely railroaded by their employers, including now. It’s not an easy thing to do, especially for residents who are at the bottom end of power imbalance. Also the acgme won’t accept a formal complaint unless it’s signed by a named person - anonymous complaints go to their ombudsman who basically does nothing.

The ACGME is a very ineffective organization from what I’ve seen. It wants to keep programs accredited at all costs and has very little incentive to act on even credible information.

Also carrying a recorder in your pocket is not always a great idea. Where I am in CA it’s illegal to record someone without their consent, and most employers have a recording policy. So you record someone then your employer states that you committed a policy violation and says they’ll fire you for cause - plus the recording is debatably not admissible in court.

All this is to say that whistleblowing is not an easy task, even for people who are clearly right.

I don't agree, my program had a negative review mostly related to hours and teaching and the program made some real changes

 

[addoncase]

I don't agree, my program had a negative review mostly related to hours and teaching and the program made some real changes

Sounds like my former program too

 

[Dr. Rude]

Exactly, but to allow this to continue is not only an injustice to the future residents that attend these programs, but also patients who expect their anesthesiologists to have the best training and education.

Cost of doing business. Gotta take the bad with the "good". It's a value decision, etc.etc.,

 

[Dr. Rude]

I don't like it either. See my post 16 for the rationale behind it.

 

[Robotic Wis-Hipple]

Plus you know those docs want nothing to do with teaching residents.

Most PP folks went into PP for a reason. They don’t want to be teaching naive/ignorant residents during 20min Chole’s etc.

The way I see it, and what is the real danger here is HCA is playing the long game, using a residency to build a future hireable hospital employed workforce. Hospitals are trying to go in house for this but PP guys tend to expect more $$$ than they want to offer. But if they can convince a captive audience to sign on they’ll kick out all the PP guys.

 

[nimbus]

Most PP folks went into PP for a reason. They don’t want to be teaching naive/ignorant residents during 20min Chole’s etc.

The way I see it, and what is the real danger here is HCA is playing the long game, using a residency to build a future hireable hospital employed workforce. Hospitals are trying to go in house for this but PP guys tend to expect more $$$ than they want to offer. But if they can convince a captive audience to sign on they’ll kick out all the PP guys.

Same reason Kaiser opened a no tuition medical school in Pasadena. They see the need to grown their own doctors. Definitely a long game.