Residency Expansion frustration...

[347932]

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I've been trying to get the residency here expanded for a loooooong time.

We have one resident for three spots and can only get one resident every three years. Not one resident per year. It boggles why, so I decided to start looking deeper.

I spent hours talking to the powers that be at the Medical School and they've said its just not in the cards for unknown reasons.

I recently had a meeting with the VP of the hospital system that sponsors the current residency and they told me that their focus is not in Podiatry for the near future (10-15 years). They would rather focus on the "bigger" residencies (General Surgery, PM&R). Even though they have to shell out the first year of expansion money they get all of it back and then make +85% every year there after.

I've approach the other hospital system in the area to develop a residency, and have had meetings canceled out by the CEO on three separate occasions.

I'm frustrated and have to lay low for awhile, as in my community, trying to stir things up like that turns too many heads.

I wanted to let everyone know that the effort in this regard is being made. Its just not as easy as it should be.

 

[misskittyPA]

It would be helpful if you would share a little more information. It would be unfortunate for a student to accidently end up at this hospital or in this city that is apparently not very podiatry friendly.

Help potential students, what city/state are you in?

 

[347932]

It would be helpful if you would share a little more information. It would be unfortunate for a student to accidently end up at this hospital or in this city that is apparently not very podiatry friendly.

Help potential students, what city/state are you in?

The city is VERY podiatry friendly, but residency doesn't really have to do with that when hospital systems are involved. All they see is dollar signs.

 

[347932]

Just curious but why would you try to convince a hospital to expand a residency program all by yourself? Why didn't you bring this issue to the attention of the APMA? I remember reading that you used to be involved with the organization. Don't you have some old buddies you can call up to assist you with this situation? I don't think any podiatrist could single handedly persuade a hospital to "see the light" and expand their current podiatry residency program.

The APMA has been extra ordinarily helpful. Every residency started with one or a small group of Pods wanted to teach. If the CEO of the hospital system is not interested the APMA can't change his mind.

Podiatrist have been single handedly doing this for a very long time.

 

[dtrack22]

Is there any opposition from orthos in the hospital?

I ask because a single individual (MD) talked a northwest hospital board into shutting down a PS&M 36 recently.

The money issue is valid when a program is starting from scratch. Does a hospital CEO really want to foot the bill for a resident (or 2-3) for 3 years until they are finally remunerated? But I'm with you thinking it shouldn't be a concern in a hospital system that already sponsors a PS&M resident.

Interesting

 

[347932]

Is there any opposition from orthos in the hospital?

I ask because a single individual (MD) talked a northwest hospital board into shutting down a PS&M 36 recently.

The money issue is valid when a program is starting from scratch. Does a hospital CEO really want to foot the bill for a resident (or 2-3) for 3 years until they are finally remunerated? But I'm with you thinking it shouldn't be a concern in a hospital system that already sponsors a PS&M resident.

Interesting

No Ortho residency there, and our resident rotates with the Ortho trauma guys. They welcome us, as we help them with the foot/ankle stuff.

 

[GiftedPoster22]

Not having a pod residency means nothing to the care of the patients in the area.

It's simply for the egos and convienience of the local pods that will use them to do their work.

At this time hospitals have to be very careful what things they take on economically. Residency is a good thing as long as everything works... but if the program has issues it can cost the hospital money... a lot of money.

If medicare regulations regarding the paperwork of the programs...are not met, the hospital will be paying money back and it can be millions of dollars if they have lots of residents.

The hospital has bigger economic ideas. A pod residency isn't worth their time. Think about how many resources would be required and the time needed to invest. They would rather do it on other programs with larger pay offs and it makes sense to me.

 

[krabmas]

Not having a pod residency means nothing to the care of the patients in the area.

It's simply for the egos and convienience of the local pods that will use them to do their work.

At this time hospitals have to be very careful what things they take on economically. Residency is a good thing as long as everything works... but if the program has issues it can cost the hospital money... a lot of money.

If medicare regulations regarding the paperwork of the programs...are not met, the hospital will be paying money back and it can be millions of dollars if they have lots of residents.

The hospital has bigger economic ideas. A pod residency isn't worth their time. Think about how many resources would be required and the time needed to invest. They would rather do it on other programs with larger pay offs and it makes sense to me.

pod residencies actually bring more $$$ to the hospital than most gen surg, ortho, Imed... residencies. The other residencies' pt base is trauma, sick, un-insured pts. Pods do more elective cases. If the residents are there the local pods are more likely to want to do cases there and bring their inpatients there to "use" the residents. the residents benefit too.

 

[347932]

Not having a pod residency means nothing to the care of the patients in the area.

It's simply for the egos and convienience of the local pods that will use them to do their work.

At this time hospitals have to be very careful what things they take on economically. Residency is a good thing as long as everything works... but if the program has issues it can cost the hospital money... a lot of money.

If medicare regulations regarding the paperwork of the programs...are not met, the hospital will be paying money back and it can be millions of dollars if they have lots of residents.

The hospital has bigger economic ideas. A pod residency isn't worth their time. Think about how many resources would be required and the time needed to invest. They would rather do it on other programs with larger pay offs and it makes sense to me.

LOL, you haven't the foggiest idea of what you speak.

 

[dpmgrad]

I agree with krabmas that Podiatry residency programs do bring hospital more money.

I am not sure why your hospital administrators are not receptive about expanding more positions. Perhaps, you can ask other administrators such as CMO or other residency program directors as to why the hospital administrators are not receptive to Podiatry residency program expansion.

It is possible that the administrator may think that the number of positions for the Podiatry program may be capped. Podiatry residency program positions are not capped by Medicare, unlike the allopathic residency programs. The family practice residency program at my institution have been trying to expand positions, but can not do so because they have reached their cap for number of positions.

 

[347932]

I agree with krabmas that Podiatry residency programs do bring hospital more money.

I am not sure why your hospital administrators are not receptive about expanding more positions. Perhaps, you can ask other administrators such as CMO or other residency program directors as to why the hospital administrators are not receptive to Podiatry residency program expansion.

It is possible that the administrator may think that the number of positions for the Podiatry program may be capped. Podiatry residency program positions are not capped by Medicare, unlike the allopathic residency programs. The family practice residency program at my institution have been trying to expand positions, but can not do so because they have reached their cap for number of positions.

I met with the CFO, the President of the Medical Staff and they both clearly indicated that they are aware of all the details pertaining to the intricacies of podiatry residencies, but have no interest in expansion. I think there are political powers at work here after doing some more research. Some of the attendings and even the Director have not made things smooth for the medical school. I just don't know...

 

[Podfather]

I met with the CFO, the President of the Medical Staff and they both clearly indicated that they are aware of all the details pertaining to the intricacies of podiatry residencies, but have no interest in expansion. I think there are political powers at work here after doing some more research. Some of the attendings and even the Director have not made things smooth for the medical school. I just don't know...

All of the previous points made are essentially correct but the reasons for not wanting or expanding a program are multifactorial. Financially there is a huge outlay by the hospital that takes years to recoup (this includes expansion). There is a push now due to the expected shortage of primary care physicians to care for 35 miilion entry patients in a few years to do anything possible to increase these positions first. Politically, issues with orthopedics are essentially the same or worse than 10 years ago. Even at our hospital with friendly orthopedists who work with the residents and refer occasionally to me, behind the scenes, they are sometimes tepid. If the hospital is trying to recruit a new ortho group they want to de-emphasize podiatry's presence, especially if the group has a foot orthopod. Also there is a huge push now by AMA/AOA to take back medicine. They are in complete panic mode with the new DNP degree and nurses being called "doctor" and independently treating patients (remember the 35 million mentioned above). They are now lumping them with all non-MD/DO practitioners and trying to push for physician control or supervision for all non MDs/DOs "to protect the public" (HA HA). Rhetoric from the 1980s is back and new BS such as "I don't care if they are 3 year trained and RRA certified, their residencies and boards are not approved by our organizations therefore we argue they are not competent".

Sooooooo, as I have found over the years decisions regarding podiatry are often made viscerally and without logic or thought. It is often more about timing than one's arguments. Keep plugging; the timing often makes the window open for a very brief time.

 

[skiz knot]

pod residencies actually bring more $$$ to the hospital than most gen surg, ortho, Imed... residencies. The other residencies' pt base is trauma, sick, un-insured pts. Pods do more elective cases. If the residents are there the local pods are more likely to want to do cases there and bring their inpatients there to "use" the residents. the residents benefit too.

??? Ortho person trolling the pod forums...

Sure ortho sees trauma but we also see insured, elective cases in joints, sports, foot and ankle, hand, spine... I'm willing to bet overall insurance reimbursements for the ortho cases are significantly higher than those for podiatry (I'm not trying to make any argument that ortho cases are more important/valuable, just a fact based on current reimbursements).

 

[Podfather]

??? Ortho person trolling the pod forums...

Sure ortho sees trauma but we also see insured, elective cases in joints, sports, foot and ankle, hand, spine... I'm willing to bet overall insurance reimbursements for the ortho cases are significantly higher than those for podiatry (I'm not trying to make any argument that ortho cases are more important/valuable, just a fact based on current reimbursements).

As vice chair of surgery at my hospital and having been an investor in a surgical center I have seen reimbursement data. Orthopedics is one of the better reimbursers (better does not necessarily mean always profitable) than many surgical specialties. However, Podiatric cases are close if not equal and these are the reasons why these 2 specialties are sought out for physician owned entities. Profit drops on joint replacement surgery in ortho and hospitals can take significant hits depending on the rates negotiated with insurers. The same holds true for DPMs who say throw on a frame with an implantable bone stimulater, various expensive orthobiologics, and maybe all of this over a nail. The newest plates, staples, implants and screws can be significantly more expensive than reliable older implants. Hospitals track all of this data and can tell if you are a profit center or not.

Ever wonder why a surgeon uses say a Synthes screw at thir investor center vs some new fixation at the hospital? Add to it that some surgeons take their best insurance to their investment center and Medicaid to the hospital and one can see why decisions sometimes are made not to have a DPM residency, or to recruit a new orthopedist, podiatrist, or other surgeon to their hospital to compete against someone who is on staff. Hospitals are not always angels either and have their own issues that can be addressed in another post.