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NYC hospital leaves DO residents high and dry

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north55th

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http://www.auntminnie.com/index.aspx?sec=sup&sub=res&pag=dis&ItemID=102467&wf=5307

NY hospital to shutter radiology residency program
By Eric Barnes, AuntMinnie.com staff writer

February 13, 2013 -- A New York City hospital on Monday moved to terminate its radiology residency program, leaving 11 residents without a program or funding to continue beyond the current program year ending June 30. Funding for the program is being shifted to pay for more spots for primary care residents.

In a February 11 letter to radiology residents, St. Barnabas Hospital Senior Vice President Keith Wolf said the institution had decided to end its osteopathic radiology residency program, and that it would not renew any resident contracts beyond June 30.

"The hospital will assist the affected residents in their endeavors to continue their education," Wolf wrote in the letter, a copy of which was obtained by AuntMinnie.com.

Hospital spokesperson Steven Carter told AuntMinnie.com that the hospital has decided to reallocate the money from radiology to fund new residencies in primary care, with an eye toward the anticipated need for more primary care physicians going forward, especially in the hospital's core area of the Bronx.

Under the Patient Protection and Affordable Care Act (PPACA), more people are expected to become insured and to seek primary medical care, driving the need for more primary care physicians. At St. Barnabas, the decision was based more on the perceived need to reallocate resources than to save money, Carter said.

"Although financial implications were considered when making the decision, we were very motivated by the desire to place more training slots into areas where the healthcare focus is these days, such as primary care," Carter wrote in an email. "This decision was not based on any real or perceived oversaturation of radiologists in the market. We will move the slots to other programs to support the shift in healthcare, especially in the Bronx, where primary care is a significant need."

The decision to shut the program will not affect any graduating residents, but it will affect 11 residents currently in the program: three postgraduate year 1 (PGY-1) residents (interns), three PGY-2 residents, three PGY-3 residents, and two PGY-4 residents.

The hospital in January discussed the possibility of closing the program with a representative of the Committee of Interns and Residents, a national union representing residents and interns, and also briefly discussed it at a meeting on January 29 before sending out the formal notice on February 11, Carter said.

High and dry

But residents have complained, both on the AuntMinnie.com Residents Forum and by telephone, that the hospital has left them high and dry -- and perhaps even unemployable, because it declined to transfer the funding to another residency program that could potentially pick them up, committing the money instead to other residency subspecialties within the hospital.

"If we're not receiving our funding, we're in a bind because what hospital is going to take us without our funding?" said third-year resident Dr. Nirav Shelat in an interview with AuntMinnie.com. "They would have to pay not only our salary, but our malpractice and all of that, so it just seems unreasonable."

Part of the money earmarked for residencies comes from the federal government, and residency programs that are ending typically transfer funds to other schools that are willing to accept the residents so they can complete their education. In this case, however, St. Barnabas chose to keep the money and repurpose the funds "one for one," to new residency slots in primary care.

"The money is being shifted to another specialty, so it's not like the hospital is taking the money and pocketing it," Carter said. "If a hospital closes and a resident is discontinued there, as I understand it, it becomes sort of an orphan spot that the new hospital can now assume. So if you had eight radiology residents and they went to a different hospital, they would bring with them a spot, and the money would be there for it, but that's only if the hospital closes. So it's really shifting the [funds] to what the hospital thinks is a more important need, which is primary care."

This won't help the residents whose program is being terminated, he acknowledged, but he said the hospital will do what it can to help place the residents in new programs. The New York Colleges of Osteopathic Medicine Educational Consortium (NYCOMEC), accredited by the American Osteopathic Association (AOA) to oversee osteopathic residencies in the state, also said it will do what it can to help find new programs for the residents. But for now the situation looks grim.

"We signed on to our residency program thinking that five years from now we would be radiologists, and now, to have the rug pulled out from under us -- we're all stunned, and we don't know what our next steps are," Shelat said. "They told us that we're not going to get our funding, and that's what shocked us all the most. Why would a hospital take on a radiology resident's salary at $60,000 a year plus malpractice and the cost to train him?"

"It's unfortunate, but the money doesn't come with them," Carter said.
 
Terrible.

I hope NYCOM can assist these residents just as it did for all the residents that were displaced when Peninsula Hospital Center closed down in Far Rockaway, NY last year.

Residents: You guys can email David Broder @ [email protected]
He is the President of NYCOMEC and Associate Dean at NYCOM. Hopefully he can help.

Good luck.
 
damnnnnnnnnnn

i was ACTUALLLY very interested in this program! ha!
is the rest of the hospital is good shape
?anyone know
 
damnnnnnnnnnn

i was ACTUALLLY very interested in this program! ha!
is the rest of the hospital is good shape
?anyone know

i am rotating there now and seems like the EM program is in the strongest demand there as well as the EM/IM program
 
There are stories like this all the time unfortunately. It's why I advise everyone to take USMLE I and II and shoot for an ACGME residency.

I mean, obviously both the DO and MD worlds are real big on primary care as a talking point right now, but I would expect a big hospital to be more self-serving than to just up and drop a residency because someone suggested they need more primary care spots.
 
Good point. There has to be something else going on here....hmmmmm....paging DocEspana!
 
Good point. There has to be something else going on here....hmmmmm....paging DocEspana!

The story is they are swapping out the private radiology group that was running the residency program for a teleradiology group. Ergo they had to shut down the residency program to allow that change.

The incredibly dick move part of it was holding on to the funding instead of letting the radiology residents take it with them. INCREDIBLY messed up.
 
The story is they are swapping out the private radiology group that was running the residency program for a teleradiology group. Ergo they had to shut down the residency program to allow that change.

The incredibly dick move part of it was holding on to the funding instead of letting the radiology residents take it with them. INCREDIBLY messed up.

Absolutely agree...incredibly messed up to hold onto that funding.

Note to self: Stay away from St. Barnabas while considering residencies...
 
Was that residency open in the 2013 match? Like did someone match there for radiology on Monday?
 
The story is they are swapping out the private radiology group that was running the residency program for a teleradiology group. Ergo they had to shut down the residency program to allow that change.

The incredibly dick move part of it was holding on to the funding instead of letting the radiology residents take it with them. INCREDIBLY messed up.

Hmm... then they are not technically closing down their radiology department? Just trimming costs by utilizing telemedicine? So sad. Is this what patient interaction has boiled down to?
It's incredibly messed up, indeed. Very shady.
 
So bad..really feel for these residents. Does everyone think they will be able to find a place eventually to continue their training?
 
I mean, obviously both the DO and MD worlds are real big on primary care as a talking point right now, but I would expect a big hospital to be more self-serving than to just up and drop a residency because someone suggested they need more primary care spots.

AOA does not guarantee placement into a residency position within the same field should a program close or PD resign. ACGME guarantees placement within the same field for residents in good standing. This is a huge concern considering a majority of AOA programs are based at smaller community hospitals with smaller departments less adaptive to rapid change.
 
AOA does not guarantee placement into a residency position within the same field should a program close or PD resign. ACGME guarantees placement within the same field for residents in good standing. This is a huge concern considering a majority of AOA programs are based at smaller community hospitals with smaller departments less adaptive to rapid change.

while this is 100% true, and i do not for a second wish to downplay the legitimate point you make.... the AOA has seen programs close and has placed residents into the same field successfully in all cases that I have heard of. They just don't guarantee it.

Good point. There has to be something else going on here....hmmmmm....paging DocEspana!

haha. I heard this as background noise just today. Im honestly not sure what the "full" story is. I'm actually at a program right now that just closed its ACGME IM program down (or rather, will be closing it next year) and the AOA end of the program (its sort of dual accredited. Two programs share a main hospital but have different secondary hospitals) is expanding to fill *some* of the lost spots. The reason in that case is because the "other" hospital in the ACGME end is the "mother" hospital, and it has new ownership who wishes to eliminate waste. The IM residents dont represent enough of a work force to be pro-profit over a few (much more efficient) attendings, and getting more residents is not an option due to ACGME constraints. So they are simply dissolving the program and seeing if an attending-run service will run cheaper due to efficiency over the less efficient residents who are profit generators just by the merit of existing.

Is this what is happening in St Barney? No clue. but its the trend you're seeing a lot.
 
ACGME guarantees placement within the same field for residents in good standing.

This is not true. The ACGME doesn't guarantee anything. The ACGME does work with any program that is closing to try to help place residents. They will approve programs for temporary increases in their resident complements to absorb displaced residents. They have a web based system that allows programs to find new homes for displaced residents, especially in emergency situations like natural disasters. They also require that all GME offices have a Program Closure Policy / Plan. But there is no guarantee of further training, same field or not. They can help, quite a bit.

The funding issue is complicated. When a whole institution shuts down, the funding slots get reallocated to accepting programs. When a program shuts down in a controlled manner, they usually stop accepting residents and "finish out" those in the pipeline. When a program shuts down suddenly like this, they can decide not to reallocate the slots. It's a disaster for the residents. In an allopathic program, the ACGME would likely lean heavily on the GME office.
 
What makes it more difficult for the radiology residents is the limited number of AOA Diagnostic Radiology programs available that they may seek transfer. Including St Barnabas, there are only 15 AOA programs. With the closure of St Barnabas (and with them keeping the allocated funds), if these residents want to continue in radiology, they have to find a AOA program willing to take them, and absorb the cost of the additional resident. Unless the ACGME and American Board of Radiology makes an exception, they are not eligible for ACGME programs (unless they want to start over) since none of their training was under the auspice of the acgme. Terrible thing to happen, and for the hospital to make the situation worse by keeping the funding instead of allowing it to follow the residents. Even if they want to create a new primary care residency, it will take a few years to reach full complement. And I hope the AOA will be stepping in to help out as much as possible. They owe it to their "members" to move heaven and earth to help these residents out.

Actions mean more than words. I wonder if they will have difficulty recruiting residents (and even faculty) in the future, given their actions.
 
is there any legal recourse for this kind of switcheroo by a hospital?
 
What makes it more difficult for the radiology residents is the limited number of AOA Diagnostic Radiology programs available that they may seek transfer. Including St Barnabas, there are only 15 AOA programs. With the closure of St Barnabas (and with them keeping the allocated funds), if these residents want to continue in radiology, they have to find a AOA program willing to take them, and absorb the cost of the additional resident. Unless the ACGME and American Board of Radiology makes an exception, they are not eligible for ACGME programs (unless they want to start over) since none of their training was under the auspice of the acgme. Terrible thing to happen, and for the hospital to make the situation worse by keeping the funding instead of allowing it to follow the residents. Even if they want to create a new primary care residency, it will take a few years to reach full complement. And I hope the AOA will be stepping in to help out as much as possible. They owe it to their "members" to move heaven and earth to help these residents out.

Actions mean more than words. I wonder if they will have difficulty recruiting residents (and even faculty) in the future, given their actions.

👍 agreed. this must be the Barnabas residents' worst nightmare.
 
Even if they want to create a new primary care residency, it will take a few years to reach full complement.

This is the part that makes the least sense to me. You want to reallocate to FP, fine, but it's not like you're going to have to pay third year FP residents during the first couple years. Stop accepting new residents to the Radiology program, start up the FP program, and then phase one in without phasing the other out. Wait a couple years first, but they owe it to the residents to help them finish the training they promised.
 
This is the part that makes the least sense to me. You want to reallocate to FP, fine, but it's not like you're going to have to pay third year FP residents during the first couple years. Stop accepting new residents to the Radiology program, start up the FP program, and then phase one in without phasing the other out. Wait a couple years first, but they owe it to the residents to help them finish the training they promised.

most new programs dont "phase in" like a new medical school might. New programs tend to open with most (likely not all) spots filled for all PGY years. They snipe residents from other programs who want to move to a certain geographical area to do so.
 
So...America will be deprived of some mediocre radiologists from the most overrated osteopathic teaching hospital?

<flamesuit on>
 
New programs tend to open with most (likely not all) spots filled for all PGY years. They snipe residents from other programs who want to move to a certain geographical area to do so.

I know we're at the same school.

And this tactic sounds... familiar, ie NJRMEC. And this is just the beginning!
 
I know we're at the same school.

And this tactic sounds... familiar, ie NJRMEC. And this is just the beginning!

Correct. We all went to bed one day and when we woke up njrmec had lots of residents. I also got to see a new aoa obgyn program hunt for residents when I was on obgyn. A few of the residents showed me that they all got an email invite to leave their program and come to a new opening one if they wanted to be in that area. People at all pgy years except chief got that email over a 48 hour period.

From those two examples (and some other anecdotes others have relayed to me) filljng all the pgy at once is the nnorm.
 
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