"Sorry, your residency program is closing"

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CodeBlu

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I realize this is an osteopathic postgrad issue... but this is still pretty unsettling.

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

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.
St. Barnabas Hospital
St. Barnabas has decided to end its radiology residency program. Image courtesy of St. Barnabas Hospital.

"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.
 
Yeah, its quite unfortunate... this happened to a program at Peninsula hospital and they were luckily able to place the residents, hopefully everything works out for them.
 
That is an absolutely **** move on the hospitals part, they should have let these kids finish and then transition slowly.

I'm sure there is more to the story, but no matter how you cut it, these residents sound Iike they got screwed big time.
 
Wow... Just wow.

How horrible it must be... Not even getting transferred.

Best of luck to those 11 residents...
 
Monkey: "Hey let's cut the radiology program."

CEO: "Why that sounds like a perfectly good suggestion Mr. Monkey. Here's a banana"

Monkey: "I pooped myself"
 
Why not wait until the current residents complete (and not renew the program by bringing in more residents after this year?) Or, why not transfer funds for the next however many years with the current residents so they can go somewhere they are wanted, then take funds after that to place towards IM?

Why shaft those you have promised 5 years of training and not even consider delaying your own hospital's ambitions?

This is ridiculous, and I think there should be discipline to this hospital system for pulling the rug out on these unfortunate residents.
 
and people wonder why the AOA has such a bad rap.
 
very disturbing, I'm surprised this is even legal. Could something like this happen at an allopathic program?
 
very disturbing, I'm surprised this is even legal. Could something like this happen at an allopathic program?

I've heard of allopathic residents losing their spots for hospital closure (see the recent closure of St. Vincent's in NY) but never for outright program termination. When this happens it seems like generally other programs are understanding and absorb the displaced residents.

Agree that it is a huge douche move to just close the program rather then stop accepting new applicants
 
very disturbing, I'm surprised this is even legal. Could something like this happen at an allopathic program?

Yes.

Just finished reading Panda Bear, MD's blog. Dr. Bear was in a Duke FM residency that abruptly shut down sometime in 06? 07?

Luckily for Dr. Bear, he transferred and matched into EM right before the program shut down. I think one of his blog posts has a pretty scathing review of his experience in Duke FM.

Edit: Here.
http://www.pandabearmd.com/2006/06/03/now-i-dont-feel-so-bad-about-leaving/

Edit2: FREIDA says Duke FM exists. I guess it was resurrected.
Duke University Hospital Program
Identifier: 120-36-21-222
Specialty: Family Medicine
 
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I've heard of allopathic residents losing their spots for hospital closure (see the recent closure of St. Vincent's in NY) but never for outright program termination. When this happens it seems like generally other programs are understanding and absorb the displaced residents.

Agree that it is a huge douche move to just close the program rather then stop accepting new applicants

A couple allopathic examples of programs closing off the top of my head:

#1:
This EM program in Los Angeles closed up shop abruptly in in 2006 and all of the residents were left on their own.

Article about the program:
http://journals.lww.com/em-news/Ful...dents_Scramble_for_Spots_as_CMS_Closes.2.aspx

SDN forum about it
http://forums.studentdoctor.net/showthread.php?t=344132

#2:
This EM program in Oklahoma abrupty got shut down by the ACGME in 2000:
http://www.ama-assn.org/amednews/2000/09/04/prsb0904.htm


Bottom line: For med students, it is not a bad idea to look at a hospital's relative financial position as well as if the program is on probation or not and when their next accreditation check is due. While rare, these things happen.
 
In ACGME residencies, even if your program is closed, you still have funding to complete the residency. The only issue is you need to find a program that's willing to accomidate you
 
My understanding was that the match agreement was a legally binding contract. If a resident can be held legally liable for dropping out of his residency program, how can the residency program not be liable for dropping its residents???

Do these residents have any grounds upon which to pursue legal action?
 
My understanding was that the match agreement was a legally binding contract. If a resident can be held legally liable for dropping out of his residency program, how can the residency program not be liable for dropping its residents???

Do these residents have any grounds upon which to pursue legal action?

You only sign a contract at any program for a year at a time so you are perfectly within your contractual rights to leave at the end of the year.
This is how some residents switch specialties even after matching to a categorical program.

Also, I'm not sure pursuing legal action against a hospital's army of attorneys on retainer will be very fruitful. Except maybe as a very expensive and time-consuming measure to assuage one's hurt feelings.
 
My understanding was that the match agreement was a legally binding contract. If a resident can be held legally liable for dropping out of his residency program, how can the residency program not be liable for dropping its residents???

Do these residents have any grounds upon which to pursue legal action?

The contract only legally binds you show to show up for the first 90 days I believe. After that you can legally quit and still be allowed to register with the NRMP (though good luck getting a nice letter from the program you screwed over). The contract does not say the program must complete your training. It does suck for those residents though. I don't understand why the funds are not attached to a particular individual.
 
Monkey: "Hey let's cut the radiology program."

CEO: "Why that sounds like a perfectly good suggestion Mr. Monkey. Here's a banana"

Monkey: "I pooped myself"

I think that is probably a fairly accurate representation of what actually happened.

What a horrible institution to pull a stunt like this, I would never want to go there for residency.
 
If there is any justice in the world, the CEO will hit his head and get an epidural.... which gets missed by the new teleradiology service. Jusy sayin'.
 
Wow...

Just stop accepting new residents and let them finish, Why leave them high and dry? The funding would be moved to primary care as each resident finishes. There should be laws against this.
 
Monkey: "Hey let's cut the radiology program."

CEO: "Why that sounds like a perfectly good suggestion Mr. Monkey. Here's a banana"

Monkey: "I pooped myself"

The monkey being a politician somewhere who schemed up this idea to increase primary care spots for the new healthcare changes. Bet you anything it started with a politician no the CEO and I bet that's why it has to be NOW instead of just letting the current crew finish out their training.

In a situation where the resident loses a spot through no fault of their own, program closure or this kind of restructuring, the funding should stay with the resident to help them secure a new spot. How clueless are the administrators about this? I would never screw with someone's future like that.
 
very disturbing, I'm surprised this is even legal. Could something like this happen at an allopathic program?

No.

At least not in a way that leaves the residents high and dry. ACGME guarantees they'll find you a transfer spot if a program closes. Pretty much all of the above examples were crappy situations, but the residents themselves did find spots to finish their training.
 
Wow, what a sh*tty move. So the AOA won't guarantee them a transfer spot while the ACGME would?
 
I'd get those other 10 residents and toilet paper the **** out of that hospital. They should have just phased out the program.
 
From what I've been told, any ACGME residents that are forced from their position due to the shutdown of a program will be placed at another residency program in their region. A couple of the New York programs I interviewed at (gen surg) had taken on extra residents due to the closing of a different program in the northeast. It seems the ACGME does ensure that there are places and pay for all residents.
 
I wonder if this decision was made in consideration of "the whole person".
 
I wonder if this decision was made in consideration of "the whole person".

Obviously not. They performed a holistic review of the hospital's whole wallet instead. They thought it would be holistic-er that way.
 
How do we make a resident union across specialties to p protect us against crap like this. Those poor residents are all alone in this.
 
This is correct. ACGME does not guarantee you'll find or get a spot, nor is there any requirement that it be in the same geographical area.

Right. But in a field like radiology, in the allo world there would be many many more potential open spots available for these folks to land on their feet. This is part of the gamble of the competitive fields in the osteo only programs -- you perhaps have a better shot at getting such a spot without the allo competition, but there isn't the same kind of safe landing if it goes up in smoke.
 
This is correct. ACGME does not guarantee you'll find or get a spot, nor is there any requirement that it be in the same geographical area.

I've never heard of an allo program closing or losing accreditation where the residents didn't all get spots at least offered to them.
 
I just to want shed some light on what's being said regarding this closure. I was one of the 4 incoming radiology residents affected by the Saint Vincent's Manhattan closure back in 2010. I learned the hard way that being an orphaned resident (aka having funding go with you) is a HUGE deal. Since I was at the end of my intern year in medicine and hadn't actually started my radiology residency at Saint V's, I was told by my future program director, the GME of the med school that sponsored the program, the NRMP, and the radiology RRC that since I wouldn't be considered an orphaned resident so I'd have no funding. This only applied to the 4 allopathic grads who hadn't started yet. The current residents in the program at that time (as I understand it) had a much easier time finding a spot since their funding would be able to be transferred. I contacted nearly every residency program across the country and while they were sympathetic to my situation, nearly all told me that there was nothing they could do about it to help out.
 
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I just want to set the record straight on what's being said regarding this closure. I was one of the 4 incoming radiology residents affected by the Saint Vincent's Manhattan closure back in 2010. I learned the hard way that being an orphaned resident (aka having funding go with you) is a HUGE deal. Since I was at the end of my intern year in medicine and hadn't actually started my radiology residency at Saint V's, I was told by my future program director, the GME of the med school that sponsored the program, the NRMP, and the radiology RRC that since I wouldn't be considered an orphaned resident so I'd have no funding. This only applied to the 4 allopathic grads who hadn't started yet. The current residents in the program at that time (as I understand it) had a much easier time finding a spot since their funding would be able to be transferred. I contacted nearly every residency program across the country and while they were sympathetic to my situation, nearly all told me that there was nothing they could do about it to help out.

It sounds like you weren't able to secure another rads spot after Saint Vincent's closed, so what did you end up doing? Did you apply for another match?

Sent from my Nexus 7 using Tapatalk HD
 
I was told by the NRMP that they don't enforce a hospital's "financial matters". Since Saint Vincent's was shutting down due to bankruptcy, they'd do nothing to hold them to the match contract. They told me that they'd waive my NRMP fee (so generous on their part) for going through the scramble that year. The problem was I'd have to sit out a year if I did that. I gave it a shot and come scramble day, there were a total of 6 unfilled spots in radiology. I tried to call, email, fax those programs but their phones were busy all day. I never got a reply from any of them. So at that point, I had to hope for an unexpected opening 3 months before the start of residency although it was unlikely that an incoming resident would drop out so late in the game. I had offers from academic Neurology and Anesthesia programs MUCH closer to home through the scramble, but I ultimately turned those down because radiology is what I wanted to do no matter how far from home.

My radiology adviser from med school was the one person who really came through for me. She made phone calls all across New York and New England. There was one program that was interested in adding a spot for just that year (and as I understand it putting them over the cap thereby paying out of their pocket for me). I flew out there while on my wards rotation, spent a few hours with them, and signed on the dotted line. It turned out to be a blessing for me...I went from being the "outsider" to chief resident. So the morals of the story are that residency is a very abusive system (but we have to pay our dues I guess) and that hospitals/CEOs/higher ups don't give a damn about you at the end of the day...they'll screw you over at the drop of a hat. But persistence does pay off, and calling/emailing/badgering enough people is bound to get someone to listen to your situation.
 
I'm really glad it worked out for you. =)

I was told by the NRMP that they don't enforce a hospital's "financial matters". Since Saint Vincent's was shutting down due to bankruptcy, they'd do nothing to hold them to the match contract. They told me that they'd waive my NRMP fee (so generous on their part) for going through the scramble that year. The problem was I'd have to sit out a year if I did that. I gave it a shot and come scramble day, there were a total of 6 unfilled spots in radiology. I tried to call, email, fax those programs but their phones were busy all day. I never got a reply from any of them. So at that point, I had to hope for an unexpected opening 3 months before the start of residency although it was unlikely that an incoming resident would drop out so late in the game. I had offers from academic Neurology and Anesthesia programs MUCH closer to home through the scramble, but I ultimately turned those down because radiology is what I wanted to do no matter how far from home.

My radiology adviser from med school was the one person who really came through for me. She made phone calls all across New York and New England. There was one program that was interested in adding a spot for just that year (and as I understand it putting them over the cap thereby paying out of their pocket for me). I flew out there while on my wards rotation, spent a few hours with them, and signed on the dotted line. It turned out to be a blessing for me...I went from being the "outsider" to chief resident. So the morals of the story are that residency is a very abusive system (but we have to pay our dues I guess) and that hospitals/CEOs/higher ups don't give a damn about you at the end of the day...they'll screw you over at the drop of a hat. But persistence does pay off, and calling/emailing/badgering enough people is bound to get someone to listen to your situation.
 
Good and bad. Probably need a correction in number of open radiology spots. Problem is if demand for radiology picks up again and there are no radiologists, other fields will start to encroach into our turf, ie, nonradiology, EM trained claiming to be emergency radiologists... Whatevs
 
http://connect.jefferson.edu/s/1399/index.aspx?sid=1399&gid=2&pgid=1077

"Institutions can expand internal medicine, pediatrics and family medicine residency programs by ceasing to pay residents in more competitive programs like dermatology, orthopaedic surgery and radiology. They could use federal funds that previously supported the competitive programs to pay for new primary care positions and could start charging residents in the more competitive programs tuition," Nasca says. "
 
113 love your avi LOLOLOL glad to see some ratchet in the ranks. Definitely a TJ fan.
 
http://connect.jefferson.edu/s/1399/index.aspx?sid=1399&gid=2&pgid=1077

“Institutions can expand internal medicine, pediatrics and family medicine residency programs by ceasing to pay residents in more competitive programs like dermatology, orthopaedic surgery and radiology. They could use federal funds that previously supported the competitive programs to pay for new primary care positions and could start charging residents in the more competitive programs tuition,” Nasca says. "

Wow. Sounds like a great idea....:rolleyes. What better way to force most the intelligent people out of medicine.
 
http://connect.jefferson.edu/s/1399/index.aspx?sid=1399&gid=2&pgid=1077

"Institutions can expand internal medicine, pediatrics and family medicine residency programs by ceasing to pay residents in more competitive programs like dermatology, orthopaedic surgery and radiology. They could use federal funds that previously supported the competitive programs to pay for new primary care positions and could start charging residents in the more competitive programs tuition," Nasca says. "

This will certainly not end well.


Wow. Sounds like a great idea....:rolleyes. What better way to force most the intelligent people out of medicine.

If you CHARGE people to be residents, well, it will basically make the competitive specialties inaccessible to the vast majority of medical students. Imagine being 300K in debt out of med school, and taking on even more debt to get through 5 years of Radiology. And don't forget compound interest!




I don't know how this will end. All I know is that it's a really a bad time to be an IMG. Hopefully US MD students like us will fare better, so we aren't all forced into FP.
 
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http://connect.jefferson.edu/s/1399/index.aspx?sid=1399&gid=2&pgid=1077

“Institutions can expand internal medicine, pediatrics and family medicine residency programs by ceasing to pay residents in more competitive programs like dermatology, orthopaedic surgery and radiology. They could use federal funds that previously supported the competitive programs to pay for new primary care positions and could start charging residents in the more competitive programs tuition,” Nasca says. "

I've heard of asking people to work hard for free and calling it an "internship" because they're exploitative and greedy. But charging people to work long hours and do your dirty work would be a new low.
 
I've heard of asking people to work hard for free and calling it an "internship" because they're exploitative and greedy. But charging people to work long hours and do your dirty work would be a new low.

That's putting it a lot more politely than what I'm thinking right now.
 
I've heard of asking people to work hard for free and calling it an "internship" because they're exploitative and greedy. But charging people to work long hours and do your dirty work would be a new low.

It's not possible on the MD side--the ACGME requires residents to be paid in order for the program to be accredited. I think having residents work for free has been known to happen I DO residencies though.
 
It's not possible on the MD side--the ACGME requires residents to be paid in order for the program to be accredited. I think having residents work for free has been known to happen I DO residencies though.

Yeah that's a quote from the CEO of the ACGME so I wouldn't bet on this, anything can change.
 
So basically the plan is to make the best specialties available only to the rich. Just what this country needs.
 
So basically the plan is to make the best specialties available only to the rich....

I'm not sure "best specialties" is accurate.

But the plan is very short sighted. And with the history of indentured servitude in this country, I can think of a thousand legal problems with a plan where you expect people to work five years for zero pay, let alone pay for it. The Fed just decided residents were employees not trainees for purposes of FICA, so imagine now suggesting that you want to charge people for five years for their employment. On top of an existing loan burden. It's just a silly idea. people in charge who suggest this kind of poorly thought out solution are really the problem.

An equally dumb plan involving risk shifting would just be to just force everyone who already earned a decent salary in medicine to then only be allowed to work for resident salaries and give the rest to primary care salaries, or else retire. At least we'd get some of the old out of touch guys with silly ideas out of residency governance.
 
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