USF is closing

[millerblade]

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Hi guys,

USF program in Tampa is closing in June forever. I'm one of those 11 unfortunate people who needs to relocate. I've been calling programs around the country trying to find a position for a couple month already. They generaly don't mind to take new residents BUT the problem is funding. Apparently USF took all money that where given for our education and redistributed it amoung other programs.
Yesterday we had a teleconference with one of RRC representatives regarding helping us . He said that RRC will approve new positions for us in any program BUT program needs to find funding for new residents.

Does anybody know about any possible positions available any time soon???
We are feeling really depressed and down right now.
👎
😡

 

[coprolalia]

That sucks, man. I'm sure there are more than a few sympathetic programs out there. And (maybe I was under the wrong impression, but...), I thought that GME funds were distributed on a total head-count within a GME program in a particular region through Medicaid on an annual basis. This would mean that only this year's distributions would've been sent to USF. Therefore, next year your funding would be restored at the level you are currently at in training (i.e., if you matched into a 4-year program, you would continue to receive federal funding, through Medicaid distribution, at for the number of years you had left in your GME training). Could be wrong.

Also, every other candidate this year should look at this example long and hard before choosing to go to a program that is on probation. There are a few out there, and it doesn't mean they are going to close, but they have major problems that need to be addressed.

Here they are:

PROGRAMS WITH A PROBATIONARY STATUS
Academic Year 2007-2008

Program Number / Name / Address / Specialty Director Accreditation Status Next Review Date


[0402111056] Louisiana State University (Shreveport) Program
Anesthesiology
Louisiana State University Health Sciences Center
1501 Kings Highway
PO Box 33932
Shreveport, LA 71130
Frank G. Zavisca, MD, PhD Probation

Effective: 3/22/2007 2/20/2008

[0402811078] University of Missouri-Columbia Program
Anesthesiology
University of Missouri-Columbia Hospital and Clini
3W27 Health Sciences Center
DC005.00
Columbia, MO 65212
Joel O. Johnson, MD, PhD Probation

Effective: 10/6/2005 10/17/2007

[0403511102] New York Methodist Hospital Program
Anesthesiology
Department of Anesthesiology
New York Methodist Hospital
506 Sixth Street
Brooklyn, NY 11215
Joel M. Yarmush, MD, MPA Probation

Effective: 9/28/2006 9/1/2008

[0403521105] New York Medical College at Westchester Medical Center Program
Anesthesiology
New York Medical College/Westchester Medical Center
Macy Pavilion West, Room 2389
Valhalla, NY 10595
Kathryn E. McGoldrick, MD Probation Under Appeal

Effective: 3/22/2007 3/1/2009

[0403531097] Brookdale University Hospital and Medical Center Program
Anesthesiology
Brookdale University Hospital and Medical Center
One Brookdale Plaza
Brooklyn, NY 11212
Adel R. Abadir, MD Probation

Effective: 10/6/2005 12/11/2007

[0405511163] West Virginia University Program
Anesthesiology
West Virginia University School of Medicine
1 Medical Center Drive
PO Box 8255
Morgantown, WV 26506
Richard Driver, MD, MS Probation

Effective: 10/6/2005 4/1/2008


http://www.acgme.org/adspublic/reports/pbProgs.asp

-copro

 

[deleted126335]

.

 

[millerblade]

Funding is an interesting topic. We asked RRC yesterday about it and they didn't really have an exact answer. I don't know GME funds are distributed - yearly or not. If it is yearly we shouldn't have any problems with relocation because we would have funds.

However, most PDs are asking on the phone- are you coming with funds

 

[InductionAgent]

Miller, what year are you?

 

[Coastie]

Sue USF for the money. Another option remains in that I'm sure the Tampa papers would love another good story about USF Anesthesiology. What led to the final demise, and what are the hospitals going to do without residents?

Hi guys,

USF program in Tampa is closing in June forever. I'm one of those 11 unfortunate people who needs to relocate. I've been calling programs around the country trying to find a position for a couple month already. They generaly don't mind to take new residents BUT the problem is funding. Apparently USF took all money that where given for our education and redistributed it amoung other programs.
Yesterday we had a teleconference with one of RRC representatives regarding helping us . He said that RRC will approve new positions for us in any program BUT program needs to find funding for new residents.

Does anybody know about any possible positions available any time soon???
We are feeling really depressed and down right now.
👎
😡

 

[deleted126335]

.

 

[coprolalia]

Just double-check and make sure you know how disbursements are sent to the institution. Again, (I believe) it goes something like this: GME office supplies total number of residents in program per academic year, Medicaid receives and reviews that number against ACGME allocation, and lump sum for the year is disbursed to institution to cover GME costs (e.g., individual resident stipend, maintaining training, reimbursement for Medicare/Medicaid cases resident participates in without billing gov't, etc.).

I agree, though, that no matter how you slice it there is a big chunk of money that is left-over from THIS year that you should be entitled to. Problem is, if you involve a lawyer, especially if working on a contingency fee basis, they are going to want a cut of that money if recovered (up to 33-40% of it!). So, I would exhaust the appropriate academic channels within the ACGME first. Unless, they drag their feet... And, check your contract to see if there is anything specifically mentioned about funding/stipend you're getting in regards to this.

You are right. If they are closing the program, at the very least it is extremely bad form (and greedy) for them to keep the money, especially if they are no longer providing you training. But, there may be some big legal loophole that you don't know about and it may actually take longer to "get your money back" in the courts than it would to just move onto another program. Starting legal proceedings likewise is going to chew up a lot of your time, even if you do it as a class-action (with all your colleagues together). I'm sure that the institution doesn't want the publicity, though. So, you could always go the avenue of calling the local newspaper or television outlet as well. Just make sure you absolutely have all your facts straight before you do anything like that.

Just my (additional) $0.02.

-copro

 

[toughlife]

Sue USF for the money. Another option remains in that I'm sure the Tampa papers would love another good story about USF Anesthesiology. What led to the final demise, and what are the hospitals going to do without residents?

They likely already have their replacements. They are called CRNAs.

 

[CremeSickle]

Listen

I would be VERY careful about lawsuits and defamatory remarks or actions that lead to them. I understand that people will be angry, upset and feel cheated, but believe me, if you were to get real vocal publically vs them while your still looking to get another residency... you wont find one.

Noone wants a student troublemaker. They dont care if you are right or wrong.

The key to internship, rotations and residency is to keep your head down, work hard and stay below the radar.

 

[coprolalia]

Noone wants a student troublemaker. They dont care if you are right or wrong.

Well, first off, they are not students, they are resident physicians.

Secondly, while I agree that you shouldn't burn bridges, you still have to pick and choose your battles. I'll state it again so it's clear: make sure you have all of your facts straight before you do anything. But, sooner or later, you have to stand up for yourself on the issues that matter. And, this issue matters.

Remember the whistle-blower at Hopkins a few years ago (re: the resident work hours)? He was supposed to be able to do this confidentially, but he was found it. What happened to him? Well, he left Hopkins (under pressure and perceived inability to get a fair shake after what happened) and completed his general internal medicine residency at Washington University.

What's the point of my story? Sometimes "going public" is hard and puts you at great personal risk. But, when you are getting bent over and treated like a farm animal, it is the noble and courageous thing to do. You send a message (the one Hopkins got... as well as every other residency program in the country) that you can't do whatever you want to residents and disregard the rules. Your sentiment, CremeSickle, is actually what leads to resident abuse and the perception by some programs that they can do whatever they want because the residents are too afraid to stand up for themselves. Occassionally, someone is brave enough to challenge this. I applaud those who do, and remind programs that we are professionals as well as future colleagues and shepherds of our profession, something they have been known to forget on occasion.

I hope it works out for the displaced USF residents.

-copro

 

[Coastie]

Yeah, my buddies tell me that USF's management is very, very, very relaxed with its CRNAs.

I don't know if that's true or not.

They likely already have their replacements. They are called CRNAs.

 

[CremeSickle]

Hey Cop

I understand what you are saying but to all the people who make the decisions we are still considered students and are treated as such. Your arguing semantics with me.

I also understand about standing up for yourself. However, if there is one thing i have learned it is that when you are not in a position of power (residents certainly are not) and you speak up you get screwed. Your example about hopkins is perfect. I bet if you asked that guy if it was worth it he would say no. He lost resident time, had to move, start somewhere new and where everyone knew he was a "tattle tale".

Standing up for yourself has to be weighted against the risk vs benefit of it. Even if you have all of your ducks in a row it may still not be worth it in the end.

Let me give you an example.

A resident in my local area was frustrated when they were told that they would HAVE to stay for overtime because of staffing issues whenever the attending deemed it needed. Turned out this was "needed" every 2-3 days for 4-6 hours while the attending went home.

This person complained to the chief and was told "too bad". They decided to lodge an official complaint in writing and did so. Never had to stay for overtime again. Over the next 6 months however, this resident seemed to take an "academic beating" from a number of the attendings and one even called them a "cry baby tattletale ***** not fit for medicine". How nice eh?

Needless to say this resident left before the evals got any worse and they were kicked out. While totally in the right, being a sacrificial lamb isn't always worth it. When asked if they would do it again they said absolutely not.

So, will fighting or suing change the fact that USF residency program is closing and you need to find another place? No. Could it very well blacklist you at other programs? Yes.

Little to gain and alot of hassle to endure.

Only you know if its worth it for you.

Well, first off, they are not students, they are resident physicians.

Secondly, while I agree that you shouldn't burn bridges, you still have to pick and choose your battles. I'll state it again so it's clear: make sure you have all of your facts straight before you do anything. But, sooner or later, you have to stand up for yourself on the issues that matter. And, this issue matters.

Remember the whistle-blower at Hopkins a few years ago (re: the resident work hours)? He was supposed to be able to do this confidentially, but he was found it. What happened to him? Well, he left Hopkins (under pressure and perceived inability to get a fair shake after what happened) and completed his general internal medicine residency at Washington University.

What's the point of my story? Sometimes "going public" is hard and puts you at great personal risk. But, when you are getting bent over and treated like a farm animal, it is the noble and courageous thing to do. You send a message (the one Hopkins got... as well as every other residency program in the country) that you can't do whatever you want to residents and disregard the rules. Your sentiment, CremeSickle, is actually what leads to resident abuse and the perception by some programs that they can do whatever they want because the residents are too afraid to stand up for themselves. Occassionally, someone is brave enough to challenge this. I applaud those who do, and remind programs that we are professionals as well as future colleagues and shepherds of our profession, something they have been known to forget on occasion.

I hope it works out for the displaced USF residents.

-copro

 

[coprolalia]

I understand what you are saying but to all the people who make the decisions we are still considered students and are treated as such.

Not at my program. And, I feel sorry for you if this is truly a reflection of how you are treated at yours.

I also understand about standing up for yourself. However, if there is one thing i have learned it is that when you are not in a position of power (residents certainly are not) and you speak up you get screwed.

Creme, they've already been completely screwed. The program closed and USF (purportedly) kept their money! Forget about the fact that they are "not in a position of power". That was already proven. Everything has been taken away from them.

Likewise, there is a difference between lodging a reasonable complaint and (what could be perceived as) unreasonable complaining. That's all people really care about when you bring up issues: is it reasonable or not. I would hope that the people training you on how to be an anesthesiologist are also training you on how to have a spine. Otherwise, when you finish you are just going to be another order-taker technician, and that's NOT what we need more of in our profession. What we need are more diplomats, in every sense of that word.

The fact is, no program is likely going to take these displaced residents without funding. What more do they have to lose? I actually think other programs would look favorably upon them trying to get their money back, if this is how it plays out.

Whether or not the Hopkins med guy was the sacraficial lamb isn't paramount; the point is all programs got the message that the ACGME wasn't going to play games and screw around with hours. They meant business. It might not have been worth it personally to him in the long run, but he proved the point and all residents have benefitted in no small way from it. We should be thanking him for his courage, whether he was a willing martyr or not. The difference here is that USF has (purportedly) screwed these residents even harder, and they don't even have a residency to lose anymore, and likely no new ones to gain without funding.

Totally different scenarios. The more you give away as an individual and a professional, the less you should be surprised when it's subsequently taken from you.

-copro

 

[CremeSickle]

Cop

I think you have changed my mind.

Well written.

 

[toughlife]

Not at my program. And, I feel sorry for you if this is truly a reflection of how you are treated at yours.



Creme, they've already been completely screwed. The program closed and USF (purportedly) kept their money! Forget about the fact that they are "not in a position of power". That was already proven. Everything has been taken away from them.

Likewise, there is a difference between lodging a reasonable complaint and (what could be perceived as) unreasonable complaining. That's all people really care about when you bring up issues: is it reasonable or not. I would hope that the people training you on how to be an anesthesiologist are also training you on how to have a spine. Otherwise, when you finish you are just going to be another order-taker technician, and that's NOT what we need more of in our profession. What we need are more diplomats, in every sense of that word.

The fact is, no program is likely going to take these displaced residents without funding. What more do they have to lose? I actually think other programs would look favorably upon them trying to get their money back, if this is how it plays out.

Whether or not the Hopkins med guy was the sacraficial lamb isn't paramount; the point is all programs got the message that the ACGME wasn't going to play games and screw around with hours. They meant business. It might not have been worth it personally to him in the long run, but he proved the point and all residents have benefitted in no small way from it. We should be thanking him for his courage, whether he was a willing martyr or not. The difference here is that USF has (purportedly) screwed these residents even harder, and they don't even have a residency to lose anymore, and likely no new ones to gain without funding.

Totally different scenarios. The more you give away as an individual and a professional, the less you should be surprised when it's subsequently taken from you.
-copro

These are words to live by.

 

[toughlife]

The closure of yet another anesthesiology residency program is an example of where academic anesthesiology is headed.

It is no surprise to see this happening and it will continue. Listen folks, the motivation to teach residents has been removed by AANA lobby and this is the end result. Programs doing a crappy job teaching residents, caring more about teaching SRNAs and using CRNAs is not an act of fate.

This is what the competition has been thinking about when they decided to financially drown anesthesiology via the anesthesia teaching attending reimbursement rule. If you take away the financial incentive to teach us, AND provide one to work with CRNAs, the # of residents will be less and less every year until no more residents are trained. At that point, anesthesiology will become a nursing job and the AANA wishes will have crystallized.


That is the future unless we do something to reverse the unfair teaching rule.

 

[halflife94]

toughlife you are so right. Even as a student rotator you can tell that srna/crna/aa education was placed ahead of the residents.

 

[coprolalia]

toughlife you are so right. Even as a student rotator you can tell that srna/crna/aa education was placed ahead of the residents.

Just out of curiousity, where did you observe this?

It has been my experience that SRNAs are taught exclusively by CRNAs, and the level (depth and breadth) of training is far different.

-copro

 

[shomama]

what other programs have recently closed?

 

[Faebinder]

If I were you guys, I'd write a letter to the ASA and tell them they need to make sure that the insane Medicare understands that you are able to supervise 2 or even 3 residents in 3 rooms at the same time, just like you are able to do so for an CRNA. Anesthesiology is not Surgery and you do not need to be present at all time in the room to teach the resident. Once the money is fixed, the residency will be fixed and proper teaching will happen. Until then, anesthesiologist will look for CRNAs to supervise.

 

[coprolalia]

If I were you guys, I'd write a letter to the ASA and tell them they need to make sure that the insane Medicare understands that you are able to supervise 2 or even 3 residents in 3 rooms at the same time, just like you are able to do so for an CRNA. Anesthesiology is not Surgery and you do not need to be present at all time in the room to teach the resident. Once the money is fixed, the residency will be fixed and proper teaching will happen. Until then, anesthesiologist will look for CRNAs to supervise.

That's not really the issue, and this basically already happens (they can actually supervise 2 residents). The issue is reimbursement. If an attending supervises two residents (in two separate rooms), Medicare/Medicaid (and many insurances companies following suite) only reimburse 1/2 of the fee for the anesthetic. This is unlike surgical fees, where an attending surgeon can supervise two resident cases at the same time in two different rooms and still get full reimbursement for each case they do.

Anesthesiologists are not "present all the time in the room to teach the resident" during a case, and neither are they in the room with the SRNA. What does happen is the SRNA is usually paired with a CRNA (at least at our institution), and since that CRNA can only be assigned to one room he/she spends all his/her time in the room with the SRNA being "supervised". Regardless, the attending anesthesiologist still has to sign the chart and overall "supervise" the case.

Just out of curiousity, where are you a fellow and in what type of training program?

-copro

 

[Faebinder]

That's not really the issue, and this basically already happens (they can actually supervise 2 residents). The issue is reimbursement. If an attending supervises two residents (in two separate rooms), Medicare/Medicaid (and many insurances companies following suite) only reimburse 1/2 of the fee for the anesthetic. This is unlike surgical fees, where an attending surgeon can supervise two resident cases at the same time in two different rooms and still get full reimbursement for each case they do.

Anesthesiologists are not "present all the time in the room to teach the resident" during a case, and neither are they in the room with the SRNA. What does happen is the SRNA is usually paired with a CRNA (at least at our institution), and since that CRNA can only be assigned to one room he/she spends all his/her time in the room with the SRNA being "supervised". Regardless, the attending anesthesiologist still has to sign the chart and overall "supervise" the case.

Just out of curiousity, where are you a fellow and in what type of training program?

-copro

This is not true... especially in USF. Believe me I know.. A lot of crack down is happening on this. You can pair rooms with private insurance and medicare but medicare wont pay when an attending is running two medicare rooms, and private insurances are trying to follow this lead. I know little of anesthesia reimburisement but I know surgical reimburisement too well.

I'm Colorectal.

 

[amyl]

someone please correct me if i am wrong. currently the supervision rule is one anesthesiologist to four crna's and one anesthesiologist to two residents. i think this is what has to change. at a residency program I recently visited, the question of residents moonlighting after hours instead of being replaced at 5ish with crna's, came up and was quickly squashed. I questioned why, as the residents would likely work for less than the crna's... but of course, they can ultimately run more rooms and thus rake in more money per dollar spent as 1 anesthesiologist and 4 crna's are less expensive than 2 anesthesiologists and 4 residents... and not just for moonlighting, the incentive to train more residents is gone when they can just hire and teach crna's for less and get more of them for the same money. all day long they can run four rooms with crna's and only two with residents and thus double their income per anesthesiologist.
all this sends the faulty message crnas know more than residents. this may be true of ca-1's coming off a year of medicine and peds but in my limited experience, ca2's are as ready as any crna to run their own case. maybe a graduated supervision rule would work? 1 to 2 for ca-1's, 1 to 4 for ca-2s, etc....just thinking.... maybe there should be a cutoff on ITEs to allow less supervision...
its not just anesthesiology though. while on my ER rotation there was an opportunity to do an LP, which I had never done, and the ER doc, whom i actually really liked and respected, let the PA do it as she had never done one before either. kinda seemed wrong to me....

 

[CremeSickle]

Tough

Really, you sound like a broken record. Where is your proof?

USF isnt closing because of or related to teaching rules, CRNAs etc. They closed because of poor management and residents getting ****ty training.

This article was written LAST year:

Panel to USF: Close school of anesthesia

Inspectors say the program, already on probation, isn't doing enough for students. But school officials say things are improving.

By LISA GREENE
Published May 11, 2006
TAMPA - The troubled program for training anesthesiologists at the University of South Florida should be shut down, inspectors for a national accrediting group have recommended.

In a stinging letter dated May 2, the inspectors said USF isn't doing enough to support the program for training residents. The strongest criticisms were aimed at the unusual agreement USF made last fall with a private anesthesiology group to teach residents at Tampa General Hospital.

That change was designed to lift the program out of probation, where it has been since March 2004. But many faculty members don't have teaching experience, do too little scholarly research and provide too little supervision of residents in some instances, reviewers said.

Residents, who learned of the recommendation Wednesday, are scared they will get into trouble for complaining, and faculty members aren't concerned about residents' "well-being and working environment,'' reviewers said.

But USF medical school leaders say that the program already has made significant improvements since the national group put it on probation two years ago and that many of the letter's complaints aren't accurate.

USF plans to make more changes and fight to keep the program running, the medical school dean said.

"The bottom line is, the committee has given us an incredible opportunity to revamp our anesthesiology program and build a state-of-the-art one, and that's what we're working to do,'' said Dr. Stephen Klasko, medical school dean and vice president of USF Health.

If the Accreditation Council for Graduate Medical Education follows the recommendation, the program would lose accreditation in July 2008.

Such moves are rare. Last year, ACGME reviewed about 4,200 of more than 8,000 programs. Of those, 54 were put on probation and 20 lost accreditation.

Residencies give more specialized training to doctors who have completed medical school. USF's four-year program has about 45 residents and 10 interns, or first-year students.

It's considered a fundamental part of any medical school and losing it would be a blow to the Medical College's prestige.

Klasko said the problems cited by inspectors in 2004 have been fixed. Inspectors said at the time that some residents lacked supervision at Tampa General.

Klasko, who joined USF in fall 2004 with the program already on probation, made the controversial arrangement with the private practice group, Florida Gulf-to-Bay Anesthesiology Associates, a year ago.

That ended USF's anesthesiology practice at Tampa General, and residents were suddenly being taught by doctors they had been competing against. But Klasko defended the change Wednesday, saying the competition between the two medical practices didn't help residents either.

USF has to consider less traditional arrangements because, unlike many medical schools, it doesn't own its own teaching hospital, he said.

USF has until July 1 to appeal. The question is whether to object to the letter, which was based on findings in September 2005, or to submit a new program, said Dr. Peter Fabri, USF's associate dean of graduate medical education.

"This program has been on a phenomenal trajectory for the past 12 months,'' Fabri said. "The problem is one of timing. Most of the items in that letter are not substantially accurate. ... The real question is, how do we demonstrate to all concerned that this is a high-quality anesthesiology program?''

For example, the letter said only 54 percent of USF anesthesiology residents passed certifying exams from 2000 to 2004. That's true, said Dr. Enrico Camporesi, the new anesthesiology department director. But in 2005, the pass rate rose to 90 percent.

Camporesi, who was meeting Wednesday evening with residents, said he wants to reassure them that he welcomes criticism, and that he has talked to faculty members about openness.

"I will defend the right to have multiple opinions,'' he said.

Reviewers said "faculty intimidation of residents has occurred.'' Fabri said there was an incident two years ago involving someone who left USF.

The report also said the program director defers too many decisions to Dr. Devanand Mangar, the well-known anesthesiologist who directs the private group. Mangar couldn't be reached late Wednesday.

It is unclear what changes USF intends to make. Klasko plans to negotiate with Tampa General and other hospitals in the next few weeks. USF is willing to invest more in the anesthesiology program, but Klasko said that money needs to go for doctors with academic credentials, not doctors who only treat patients.

"Whatever model we come up with is going to have a significantly increased academic component,'' he said.

Tampa General president and CEO Ron Hytoff said in a statement that he supports USF giving more information to ACGME, and that patient care won't be affected.

Ultimately, Klasko said, the changes ACGME wants will go beyond anesthesiology. The group is pushing to make all residency programs focus more on how residents learn, he said, not just how many babies they deliver or procedures they perform.

 

[Faebinder]

someone please correct me if i am wrong. currently the supervision rule is one anesthesiologist to four crna's and one anesthesiologist to two residents. i think this is what has to change. at a residency program I recently visited, the question of residents moonlighting after hours instead of being replaced at 5ish with crna's, came up and was quickly squashed. I questioned why, as the residents would likely work for less than the crna's... but of course, they can ultimately run more rooms and thus rake in more money per dollar spent as 1 anesthesiologist and 4 crna's are less expensive than 2 anesthesiologists and 4 residents... and not just for moonlighting, the incentive to train more residents is gone when they can just hire and teach crna's for less and get more of them for the same money. all day long they can run four rooms with crna's and only two with residents and thus double their income per anesthesiologist.
all this sends the faulty message crnas know more than residents. this may be true of ca-1's coming off a year of medicine and peds but in my limited experience, ca2's are as ready as any crna to run their own case. maybe a graduated supervision rule would work? 1 to 2 for ca-1's, 1 to 4 for ca-2s, etc....just thinking.... maybe there should be a cutoff on ITEs to allow less supervision...
its not just anesthesiology though. while on my ER rotation there was an opportunity to do an LP, which I had never done, and the ER doc, whom i actually really liked and respected, let the PA do it as she had never done one before either. kinda seemed wrong to me....

👍

Cant think of a solution for this.. If you mess with that ratio then you mess with the teaching quality. Might not be important for simple cases but you do want the attending to pay attention to you for complicated cardiac cases, neuro cases etc. Reimburisement should be different for a resident/attending run surgery than a CRNA/attending run room. The first one is technically of higher quality considering the level of attention done by the attending.

 

[FuzzyBK]

someone please correct me if i am wrong. currently the supervision rule is one anesthesiologist to four crna's and one anesthesiologist to two residents. i think this is what has to change. at a residency program I recently visited, the question of residents moonlighting after hours instead of being replaced at 5ish with crna's, came up and was quickly squashed. I questioned why, as the residents would likely work for less than the crna's... but of course, they can ultimately run more rooms and thus rake in more money per dollar spent as 1 anesthesiologist and 4 crna's are less expensive than 2 anesthesiologists and 4 residents... and not just for moonlighting, the incentive to train more residents is gone when they can just hire and teach crna's for less and get more of them for the same money. all day long they can run four rooms with crna's and only two with residents and thus double their income per anesthesiologist.
all this sends the faulty message crnas know more than residents. this may be true of ca-1's coming off a year of medicine and peds but in my limited experience, ca2's are as ready as any crna to run their own case. maybe a graduated supervision rule would work? 1 to 2 for ca-1's, 1 to 4 for ca-2s, etc....just thinking.... maybe there should be a cutoff on ITEs to allow less supervision...
its not just anesthesiology though. while on my ER rotation there was an opportunity to do an LP, which I had never done, and the ER doc, whom i actually really liked and respected, let the PA do it as she had never done one before either. kinda seemed wrong to me....

okay, I'll correct you (sort of). there is no "rule." the staff where you are could supervise four residents if they wanted, but they won't get reimbursed. Why pay you to work when they can make money off of CRNA's as has been mentioned numerous times across numerous threads. Economically SRNA's are a windfall. They are actually paying the institution to come sit in the OR and help out. Compare that to residents whom actually "have" to be paid to the same job. (varies by institution, since some won't let SRNA's in rooms by themselves)

 

[toughlife]

Just out of curiousity, where did you observe this?

It has been my experience that SRNAs are taught exclusively by CRNAs, and the level (depth and breadth) of training is far different.

-copro

The CRNAs teaching SRNAs were at some point taught by an anesthesia attending. I know this for a fact.

 

[toughlife]

Tough

Really, you sound like a broken record. Where is your proof?

USF isnt closing because of or related to teaching rules, CRNAs etc. They closed because of poor management and residents getting ****ty training.

This article was written LAST year:

And could you tell me where the incentive is from this private practice group to teach residents when they know the reimbursement they will get from medicare is only half than if they supervise CRNAs?

Can you tell me whether now that CMS has decided to up anesthesia reimbursement by 32% there will be more or less of an incentive to do so?

Follow the money and you will have the answer to the problem.

 

[toughlife]

okay, I'll correct you (sort of). there is no "rule." the staff where you are could supervise four residents if they wanted, but they won't get reimbursed. Why pay you to work when they can make money off of CRNA's as has been mentioned numerous times across numerous threads. Economically SRNA's are a windfall. They are actually paying the institution to come sit in the OR and help out. Compare that to residents whom actually "have" to be paid to the same job. (varies by institution, since some won't let SRNA's in rooms by themselves)

But residents are paid through medicare funds which would not be available if there was no residency program.

You are right though, SRNAs are a windfall to a teaching program.

 

[CremeSickle]

Well

The incentive is that not all pts will be medicare patients and they will have a pool of residents from which to hire that they have trained in "their way".

Well of course the residents dont get reimbursed as much as a CRNA would, they are not finish their education yet and the CRNAs are. Like it or not, that is how it is.

CMS increase in reimbursement works for everyone, CRNA, MD/DO, and attendings supervising either. Its a win for everyone.

And could you tell me where the incentive is from this private practice group to teach residents when they know the reimbursement they will get from medicare is only half than if they supervise CRNAs?

Can you tell me whether now that CMS has decided to up anesthesia reimbursement by 32% there will be more or less of an incentive to do so?

Follow the money and you will have the answer to the problem.

 

[dionysios]

There are programs that hold spots outside the match and have funding available. You need to be persistant with other programs and talk to some of the remaining good and supportive attendings at USF to help you with connections. Just call every program across the US and sell yourself. I went to USF for med school and I know the situation at hand with the program. Dont rely on the RRC or GME office to do anything. The residents are going to have to do everything if they want the spots elsewhere. PM me if you want to know of some other programs with possible spots.

 

[bigeyedfish]

Do all the residents have to relocate at a closing program? I heard a rumor that only pgy1's are required to relocate and the CA1-2 would have the option of finishing training.

 

[epidural man]

Sue USF for the money. Another option remains in that I'm sure the Tampa papers would love another good story about USF Anesthesiology. What led to the final demise, and what are the hospitals going to do without residents?

Do note SUE or do anything crazy like that. Residencies/fellowships/internships close all the time for what ever reason.

I, for one, like the idea of an anesthesiology residency closing. This means less anesthesiologists trained and more job security for the rest of us. Why do you think Radiation Oncologists get payed $1mil/yr or so? Because they only train around 5 people (maybe a little more 🙂) a year.

I don't think you will have ANY problem finding a spot. A lot of academic programs at large institutions will easily have room for you.

 

[OldManDave]

Man, does that stink to high-heaven! You have my sympathy as relocating mid-way thru the game can't anything really beneficial, unless your program's education/training quality is what prompted the closure.

I would certainly check with Dartmouth, my alma mater. It is an excellent program in a way-cool location (if you like winter & out-of-doors activities - no nightlife here at all) & we/they seem to pick up folks in mid-cycle upon occasion.

Best of luck to you in your search!

 

[Swaydaa]

Ohio State will usually pick up an off cycle resident

 

[toughlife]

Do note SUE or do anything crazy like that. Residencies/fellowships/internships close all the time for what ever reason.

I, for one, like the idea of an anesthesiology residency closing. This means less anesthesiologists trained and more job security for the rest of us. Why do you think Radiation Oncologists get payed $1mil/yr or so? Because they only train around 5 people (maybe a little more 🙂) a year.
I don't think you will have ANY problem finding a spot. A lot of academic programs at large institutions will easily have room for you.

The problem with your logic is that you are assuming no one else can do anesthesia. The rad onc studs are secure because they are not stupid enough to teach their craft to anyone else.

 

[BIS40]

In the beginning, someone posted programs on probation.....just wanted to say as a recent grad of Westchester medical center/NYMC that the appeal is already processed.............probation was mainly because of poor board pass rate, and last year two people didnt sign up out of seven, and the five that took the written all passed (5/5) so the presumption is the appeal will go through and probation will be lifted.

Good luck everyone!