Id love to chime in on this little issue. I have a decent understanding of the events that have already played out and I find it interesting that some of this is finally starting to show its head in the papers.
It seems that the two sides did not work out an agreement by October 1st and thus will have to tell the RRC that they just cant agree to anything. This happened on a smaller scale on March 31st when the DMC decided not to negotiate with the orthopedics department and only offered a 9-month contract extension for the other 18 departments.
I cannot begin to relay the amount of misunderstanding on the DMC, specifically Mike Duggans part, as well as the lack of effective leadership in the medical school. The way that these two sides are running, they are destined not to reach an agreement and the ACMGE will step in and shut the programs down.
I think that what everyone must realize, which is probably a hard concept to really grasp and understand, is that the ACGME/RRCs role is NOT to make sure that underinsured areas have adequate medical coverage through graduate medical education. The role of this governing body is to regulate and ensure adequate quality graduate medical education for residents and fellows. If conditions are deemed toxic or substandard then it is the role of this body to act accordingly and place the programs on probation or to shut them down and then place the residents or fellows into qualified training programs. If, by these actions the ACGME/RRC transfers the effective workforce out of an underinsured area in the name of education, then one must realize that is the fault of the training site (i.e. DMC and WSU) for allowing this to happen. Residents and fellows rank/match into their programs to train at based on educational and geographical reasons, not because they are choosing to work in an underserved area. It is only the byproduct of this education that is the labor that helps out the community. Basically, just remember who to assign blame to when this all goes down and try not to get caught up in the social cards that the politicians will play, and are already playing. The 900 residents and fellows are here to be educated and they have all worked very hard to get to this point and it would be unfair to each and everyone of them to simply keep them working in a poor educational environment in the name of the underinsured.
A few little tidbits about the DMC and WSU
The DMC effectively hired its own cardiology department with non-WSU physicians so that they could better dictate the role of that department.
The ENT residency is no longer affiliated with the DMC
Derm is as described in a previous post.
Rumors are that the Urology department is on its way out as well.
The orthopedic department (University Orthopedics) was actually fired originally on October 31st effective date, but after Mike Duggan and Tom Malone failed to secure the services of any orthopedic surgeons in the area to cover the DMC hospitals (essentially without residents) they had to re-hire that faculty group, until they could find someone to take the call and cover the cases.
The DMC did not release the CMS funding from the government (~$150.000-200,000 per year per resident) to go with the 24 junior orthopedic residents to help them find their new training sites, effectively restricting their possible choices to programs with adequate funds, and usually not very local
What the DMC is doing with this ~$6 million dollars is anyones guess (24 junior residents + 8 graduating seniors).
The DMC tried to start their own orthopedic residency prior to the March 31st deadline, however their program was blatantly filled with misrepresentations and empty promises such that the majority of the junior residents voted against this program, and the only ones who voted for it was due to local family issues. It was viewed as a desperation attempt by the DMC to preserve the orthopedic workforce with little guarantees of educational merit. Effectively, the ultimate head of the program would be Mike Duggan. Those who wish to disagree are misinformed. Mike Duggan has little understanding of medical issues as in a meeting with the orthopedic residents, he stated that they should be learning how to treat adolescent ACL injuries (as his daughter had one) and taking care of professional athletes, something that adds little benefit to resident education.
In a previous article, Duggan is quoted as saying that if he cannot negotiate a contract with WSU that he would take the money ($88-90 million) and pay the nations top specialists to work for the DMC. He fails to realize that this money is CMS funding from the government that is tied to resident education. Most/All of the programs there are dual sponsored (50:50) between WSU and DMC. One side cannon simply pull up anchor and ditch their partner and take the money and the residents. This misunderstanding led Duggan to try to take over the orthopedics residency with the known consequences. If he tried this with the other 18 departments it is likely the ACGME/RRC would act as they did before and deem this a toxic environment and shut down the residencies.
Both the DMC and WSU are applying for new orthopedic residencies currently. This is probably the most troubling to the previous residents. Both sides had ample opportunities to work out an agreement and because of their inactions; the closure of the previous program caused a huge disruption to 24 peoples personal and professional lives
something that is often left out of the papers. One should also not forget the status of the remaining 8 residents, who were forced to stay on at WSU/DMC to finish out their training because of board requirements to be in their final 2 years in one site. Their year now is anything but good.
Through the relocation of the 24 residents, the medical school did little to help them with their transfers.
Bottom line:
Mike Duggan is very responsible for what is going and he should be to blame when things start going downhill.
Tom Malone (Chief Medical Officer of the DMC) is Duggans right hand man and should not fall without blame.
Dr. Robert Frank (previous Interim Dean of WSU School of Medicine) had no leadership qualities and was bullied by Mike Duggan the DMC board and is a big reason why things have progressed this far.
Dr. Robert Mentzer (current Dean of WSU School of Medicine) came on board in early March of 2006 and seems to have the attitude that he didnt know things were this bad when he started. Hard to believe that a CT transplant surgeon didnt do his homework before starting. In his brief tenure with an orthopedic department he never addressed the residents to tell them the status of negotiations or to tell them that their program had closed or offer his support during this time.
Irving Reid (President of WSU). It is rumored that he was pressured to agree with the DMC offer of a 9 month extension for the 18 departments (minus orthopedics) by Gov. Granholm so that coverage would continue in Detroit past the November elections and that the possible maelstrom of a DMC closure would not come into play during her campaign.
What Ive put forth is true to my understanding of the situation unless I stated it was rumor. Let me know what you think. Keep an open mind and dont be swayed by the misinformed.
