Whoa! Tulane Anesthesia Residency Goes Private!

[jetproppilot]

WOW.

Don't even know where to start.

Just got a call from the head of my group, Frank Rosinia, that the company I work for just landed the anesthesia contract for Tulane University.



Lets back up a bit.

As most of you know, I spent my first eight years in private practice in a "real" private practice model....where I was hired, did some time, became partner. And enjoyed 6.5 years of having a real voice in the practice, enjoyed the people I worked with, and enjoyed looking for used-pickup-trucks to cart all the cash I was making to the bank.

Family reasons carted me back to New Orleans in March 04, when I accepted the Chief position at a hospital here.

My colleagues and I in the cuppla years I was there concentrated on efficiency, turnover times, CRNA attrition (hospital had a hard time retaining employees), and patient/surgeon satisfaction.

We accomplished our goals.

Problem was I had a personality conflict with the Chief Medical Officer of the hospital.

He viewed me as a Chief who didnt bite into his theories on how to run a department.

I viewed him as a micromanaging politician who 1)didnt know a thing about anesthesia 2)expected me to perform administrative duties that I wasnt given resources to carry out 3)a dude who was supposed to be a physician alliance, but was just another administrative robot.

SO after hurricane Katrina, a reorganization occurred.

Parrish Anesthesia got the contract at my hospital.

I wasn't invited back to my hospital.

I was ready to high-tail it back to my original-lucrative gig, but had trouble pulling the trigger because of family issues.

About 5 anesthesiologists left Parish disgruntled, and went to Tulane.

I called a cuppla of them. Heard their beefs.

Frank literally called me many, many times encouraging me to stay....albeit at another Parish hospital.

I was skeptical of the AMC model. I protested. Was frustrated

Despite all this,I took the job at my current professional home.

And was pleasantly surprised, as my blogs have described.

Good salary. 9 weeks vacation. Nice hospital, devoid of political undertones.

And the most important of all,

NO EMPTY PROMISES.

I'm happy.

So today I get the phone call from Frank Rosinia.

He's the new Chair of Tulane. Parish Anesthesia has the contract.

A year ago, before I'd had the opportunity to work for this company, I wouldda scorned.

Today, after working here for a year-and-change,

I'm Giddy.

One of the biggest deficiencies I see in residency education is how residents are trained the academic medicine way, which is far different from the way private practice anesthesiologists perform....day in and day out.

Future Tulane anesthesia residents will be trained like a private practice anesthesiologist.

This is, like, MAJORLY FU&KING BIG.

Tulane has the chance to revolutionize residency education.

Bring it outta the mantras of academia, into the forefront.. where procedural times, efficiency, surgeon satisfaction are more important than they are at current day academic institutions.

The opportunity to eliminate academic myths from resident education.

The opportunity to eliminate the obstructionalistic viewpoint concerning "do I do the case or not?" of academic anesthesia.

WOW.

This model has been tried (USF).

Unsuccessfully.

I'm confident that won't happen at Tulane.

Rosinia isnt interested in using residents as stool-sitters, like what happened at USF.

He's interested in training residents to be technical gurus. bottom line is if you can't do the procedures deftly in this biz, you're behind the eight ball when you start your practice.

He's interested in training residents to be perioperative physicians.

Deft in OR management, clinical decision making, perioperative knowledge so said-clinical-decisions are sound.

So like I said,

WOW.

My company is gonna be at Tulane.

And outta personal experience, I can personally vouch for Rosinia. He's never screwed me. Never given me an empty promise. He actually helped me. Guided me with persistency to my current gig. Helped me with getting off here and there for parent-teacher conferences. Helped me with vacation times.

I told Rosinia that Tulane couldntve made a better choice. Dudes deft at our trade, and has a genuine character that I've personally worked with for over a year now.

In summary, Dudes never been anything but up front with me.

Tulane is soon to be a place turning out dudes deft at the trade.....right outta the starting blocks.

Hell, I may even be residency director someday.....that'd be a kick, huh?

---

Members don't see this ad.

 

[Winged Scapula]

Very interesting turn of events (having been peripherally aware of the story you told above)!

 

[Bertelman]

Congrats! That sounds like a great opportunity. I have a few years yet to make my decision, but I've always wanted to be able to mix the perks of PP with the ability of teaching new docs. Hope I can find a gig like that some day.

We can all learn from your life story, Jet. I've always thought that the people who persevere, bust their a$$ will eventually get the perfect gig dropped into their lap. Just keep plugging away, and eventually you will find the dream.

 

[militarymd]

ummm...maybe I should be applying for a Louisiana license.

 

[deleted50478]

From what I heard Parish isn't taking over Tulane. Frank Rosinia is leaving Parish Anesthesia Management to become chief at Tulane, presumably pending RRC & GME committee approval. Also presumably, he will continue his financial ties to Parish Anesthesia through the Parish Management Consultants wing of the business. You seem to think this is great for resident education. You may be right. There are probably differing points of view too. If, as I heard, the anesthesiologists continue to work for HCA not Parish, I guess this won't affect you. I guess we'll see when the rumors become reality. Tulane faculty, residents, and CRNAs may be comforted somewhat by your opinion though many of them worked for Parish before and may have made up their minds already. Very interesting turn of events though... I hope things do turn out well over there.

 

[jetproppilot]

From what I heard Parish isn't taking over Tulane. Frank Rosinia is leaving Parish Anesthesia Management to become chief at Tulane, presumably pending RRC & GME committee approval. Also presumably, he will continue his financial ties to Parish Anesthesia through the Parish Management Consultants wing of the business. You seem to think this is great for resident education. You may be right. There are probably differing points of view too. I guess we'll see when the rumors become reality. Tulane faculty, residents, and CRNAs may be comforted somewhat by your opinion though many of them worked for Parish before and may have made up their minds already. Very interesting turn of evens though... I hope things do turn out well over there.

Certainly.

Thanks for your post.

I'm not known for being politically correct, as most of you know.....which isnt always good for me.

But its honest, which is what I strive for. I'd rather be honest than politically correct.

Inner peace issues, but thats an entirely different thread.

So if I had a bad feeling about this I'd certainly post that.

My feeling is that this could start a revolution in resident education.

Rosinia has the knowledge, clinical deftness, political eloquence, and balls to step up to the mike with micatin when necessary to accomplish this.

 

[Noyac]

Dude, I'd be there with you in a minute if I could snowboard and mtnbike after work in N.O.

 

[jetproppilot]

Dude, I'd be there with you in a minute if I could snowboard and mtnbike after work in N.O.

WAKEBOARDING, DUDE, WAKEBOARDING!!

And if we get a good storm, you can do it in front of your house!!!

 

[bonesmd]

It sounds like it is going to be an interesting time for anesthesia in nola soon between Alan Kaye likely getting the LSU program up and running and the changes at Tulane. Keep us updated, Jet.

 

[TX515]

I'm interested. Congratulations Jet.

 

[Coastie]

How does LSU and Tulane coming back online affect training at the Oschner Clinic? I heard that since Katrina they have really solidified their base and expanded quite a bit.

 

[deleted50478]

How does LSU and Tulane coming back online affect training at the Oschner Clinic? I heard that since Katrina they have really solidified their base and expanded quite a bit.

LSU and Tulane have virtually no impact on training at Ochsner. Ochsner residents train almost entirely at the Ochsner mother ship with one month at University/CharityNorth and another at Chabert. Tulane residents also don't rotate at LSU or Ochsner hospitals so an LSU program wouldn't impact them either. The only significant impact of LSU opening is possible loss of the trauma rotation and competition for local jobs after residency.

 

[Termwean]

Man......I thought they were going to start LSU gas for a few yrs now. I went to all the anesthesia interest group meetings, heard what they had to say........but it just never materializes into a program.

 

[deleted50478]

Man......I thought they were going to start LSU gas for a few yrs now. I went to all the anesthesia interest group meetings, heard what they had to say........but it just never materializes into a program.

Yes, but they had a site visit this year. It's beyond the same old rumors now. From what I hear, they'll find out in the next few weeks whether they've been approved or not. That's the rumor anyway...

 

[Tenesma]

i am betting that it ends up being like USF.... you can't mix private practice and academic medicine - it just doesn't work without the residents being turned into scut monkeys...

good luck, and i hope that you can prove me wrong

 

[jetproppilot]

Yes, but they had a site visit this year. It's beyond the same old rumors now. From what I hear, they'll find out in the next few weeks whether they've been approved or not. That's the rumor anyway...

I spoke with Alan Kaye yesterday.

He's supposed to know something Monday or Tuesday.

 

[cubs3canes]

Ochsner will probably never lose the trauma rotation at Charity/University, because they are not doing hearts at Charity and the new LSU program (if it is approved) will probably need to come to Ochsner to do some cases.

Also, LSU still will have one of the largest SRNA schools in the country. This means case competition.

Remember the Tulane residents still go to Texas Heart for CV.

Congrats Jet. I really think this will make the Tulane program more like the Ochsner program. Very clinical..this is a good thing.

The main question is, will they be hiring in three years and will the salary and lifestyle be as good as parish with the benefits of academics and teaching?

Cubs

 

[SleepIsGood]

I dont think this is a new concept. Residencies that are not part of a 'university' are pretty much run by private practice attendings. There turnover and other 'private practice' qualities are emphasized.

 

[OB1🤙]

This is pretty awesome, especially given the recent events at Tulane (i.e. Gitlin making big promises to the residents before the RRC eval, then backing off on them afterward, then bailing to Miami). I've always had a stupid grudge against Gitlin ever since he supervised an interscalene block on me my MS1 year (shoulder scope), in which the resident somehow nicked my EJ and I bled everywhere.

If I was graduating this year, this might have been a huge incentive to stay. As it was, I had to flee for the mountains and ocean.

Enjoy the new position. If Susie is still at Tulane, take her to Harrah's with you and supplement your paycheck by relieving her of hers. God does that lady suck at poker...

 

[jetproppilot]

This is pretty awesome, especially given the recent events at Tulane (i.e. Gitlin making big promises to the residents before the RRC eval, then backing off on them afterward, then bailing to Miami). I've always had a stupid grudge against Gitlin ever since he supervised an interscalene block on me my MS1 year (shoulder scope), in which the resident somehow nicked my EJ and I bled everywhere.

If I was graduating this year, this might have been a huge incentive to stay. As it was, I had to flee for the mountains and ocean.

Enjoy the new position. If Susie is still at Tulane, take her to Harrah's with you and supplement your paycheck by relieving her of hers. God does that lady suck at poker...

Yikes!

BTW, I'm staying at my current hospital.

What happens in the future we'll have to wait and see.

Exciting nonetheless.

 

[amyl]

Jet, I loved NOLA but have some constructive criticism re: tulane. the program seemed pretty disorganized, they were vague about the case numbers and the call schedule, moonlighting and other stats....they didn't seem to have a clear ideal about the kind of person they wanted as a resident...although they seemed more interested in people from new orleans. I was invited for an interview, then got kind of a why are you here kind of vibe. laid back is cool but they were almost pathologically laidback and laissez-faire. i think there is LOTS of potential there, I hope you can make something great of it. structure and direction. good luck.

 

[Faebinder]

Mmmm.. i'm skeptical. Then again, given USF history, I suppose I should give Tulane the benefit of the doubt. We'll see if the money wins over resident education or not. Best of luck.

 

[jetproppilot]

Jet, I loved NOLA but have some constructive criticism re: tulane. the program seemed pretty disorganized, they were vague about the case numbers and the call schedule, moonlighting and other stats....they didn't seem to have a clear ideal about the kind of person they wanted as a resident...although they seemed more interested in people from new orleans. I was invited for an interview, then got kind of a why are you here kind of vibe. laid back is cool but they were almost pathologically laidback and laissez-faire. i think there is LOTS of potential there, I hope you can make something great of it. structure and direction. good luck.

Thanks for the post.

I have alotta faith in Rosinia, He's not a dude that says stuff, then sits back on hind quarters. Quite the opposite.

Last week he relayed some details about a meeting at my gig he went to....

I recognized his ability to get his point across and get things done without pissing the administrators off...thats a gift.

Know what his primary objective is at ALL times?

Contract renewal.

Thats a dude with foresight.

Anyway, back to your experience at Tulane, yeah it went downhill.

I interviewed there in 1991 for matriculation in 1992 and had a completely different experience.

I was coming from Da U....had never even been to Louisiana..felt welcome at Tulane...had a great interview experience....

.....had a great residency experience (as good've an experience you can have have during residency)

Hopefully things can return to what I remember amicably speaking.

And hopefully Rosinia takes this huge opportunity and turns it into a place that turns out rokkstar anesthesiologists.

 

[tulanesres]

Remember the Tulane residents still go to Texas Heart for CV.

Not anymore.
Well... it's kind of back and forth on that one.

 

[Gern Blansten]

I dont think this is a new concept. Residencies that are not part of a 'university' are pretty much run by private practice attendings. There turnover and other 'private practice' qualities are emphasized.

Not a new concept at all. There are a plethora of different models out there including what Jet has described. Many hybrids between academic and private exist, but the ACGME / RRC will put some requirements in place that will create some challenges for the purely private practice group that wishes to have a residency program(research/publications etc).
Each residency program has its strengths and weaknesses that have to be looked at. How good a residency program is is in the eye of the beholder. I hope that the Tulane program and Jet are wildly successful, but I suspect that there will be unforeseen hurdles that need to be jumped as they make that transition.

 

[tulanesres]

Hawaiian Bruin, I think you are way off base. Gitlin took a work-horse program pre-Katrina and turned it into a resident-centered program with a great quality of life and an improved focus on education.

Amyl, case numbers have increased steadily over the last 2 years, so it might be a tough question to answer. Quality is more important anyway. It's hard to believe that anyone would be vague about the call schedule. More likely they told you want it was and you thought it was too good to be true. It couldn't be more straight-forward. I'm not sure how they seemed more interested in people from New Orleans, but that is also incorrect. I don't think any of the incoming residents for the last two years have been from New Orleans. I don't know what pathologically laidback means, but you may be right there.?

 

[OB1🤙]

Hawaiian Bruin, I think you are way off base. Gitlin took a work-horse program pre-Katrina and turned it into a resident-centered program with a great quality of life and an improved focus on education.

If things remain this way, great. I had heard that things were fantastic for the time leading up to the RRC accreditation, and that afterward, things sort of fell apart. I heard a LOT of grumbling after the RRC left. If your experience was different- hey, you're the one still there, not me, and I'll defer to your firsthand knowledge. I do give Gitlin credit for salvaging the program from the ashes of Katrina, that was no easy feat. He does deserve kudos for that.

The changes as far as call (Qmonth) and cherry picking the best teaching cases for residents sounded great at the time. If those changes remain, fantastic.

I also agree with amyl that the way the program had structured the interview day for candidates was a huge mess, made the place look completely disorganized, and did not speak to the potential quality of the program. It was, for lack of a better word, unprofessional (although lunch at Palace Cafe is always a good thing). That NEEDS to change for the future if the goal is to attract good residents from outside the school, because first impressions go a long way on the interview trail. The interview day was a huge cluster#^ck, plain and simple.

Regardless, it sounds like changes are coming to Tulane, and I hope the program continues to evolve and improve.

Roll Wave.

 

[fantastic]

Gitlin took a work-horse program pre-Katrina and turned it into a resident-centered program with a great quality of life and an improved focus on education.....

I had heard that things were fantastic for the time leading up to the RRC accreditation, and that afterward, things sort of fell apart.....>>>>>>>>>>>

To some extent,... YOU ARE BOTH RIGHT!

But Gitlin in less than one year is already 2 chairmans ago,

SO,

no point REHASHING in detail other than to say,

YOU ARE BOTH RIGHT!

 

[OB1🤙]

So I think all this got away from the point of Jet's OP, which was-

Tulane will be training residents in the private practice model, not the academic model, and that this will be a profound and pretty novel departure from the norm.

I'm interested in what specific differences there will be on a day to day, case by case basis.

And I'm interested in how we in the rest of Academia USA can get exposed to these differences (outside of perusing this site), and if there are ways to get our residencies to at least pay lip service to them, outside of putting us in the eye room and getting practice with high turnover that way.

 

[tulanesres]

Gitlin took a work-horse program pre-Katrina and turned it into a resident-centered program with a great quality of life and an improved focus on education.....

I had heard that things were fantastic for the time leading up to the RRC accreditation, and that afterward, things sort of fell apart.....>>>>>>>>>>>

To some extent,... YOU ARE BOTH RIGHT!

But Gitlin in less than one year is already 2 chairmans ago,

SO,

no point REHASHING in detail other than to say,

YOU ARE BOTH RIGHT!

Yeah Dude!!!

 

[Bertelman]

Tulane will be training residents in the private practice model, not the academic model, and that this will be a profound and pretty novel departure from the norm.

I'm interested in what specific differences there will be on a day to day, case by case basis.

I imagine it will be good exposure for the residents to be involved with PP gas attendings. I'm not sure how well they will learn the quick turnover, though, as they are still victims of an academic surgery dept., training residents and letting students close.

 

[deleted21609]

"There is really a group of dedicated and invested faculties who are making differences in my carrier"...HELL YEAH DUDE!!

there are always faculties that one resident likes better than the others

 

[FLK 1]

As a former Tulane anesthesia resident who left after Katrina, I sincerely hope that the department is back on track. The department looks quite a bit different now, but the faculty who stayed or came back are all excellent. I personally think that the old leadership was more than happy to run a work-horse program when ACGME accreditation wasn’t at stake. Still, they kept the program afloat in its darkest hour, so I guess that has to count for something. Best of luck to the new chair.

 

[fantastic]

"There is really a group of dedicated and invested faculties who are making differences in my carrier"...HELL YEAH DUDE!!

What do you mean by that??



-won dae too sum say

 

[amyl]

Hawaiian Bruin, I think you are way off base. Gitlin took a work-horse program pre-Katrina and turned it into a resident-centered program with a great quality of life and an improved focus on education.

Amyl, case numbers have increased steadily over the last 2 years, so it might be a tough question to answer. Quality is more important anyway. It's hard to believe that anyone would be vague about the call schedule. More likely they told you want it was and you thought it was too good to be true. It couldn't be more straight-forward. I'm not sure how they seemed more interested in people from New Orleans, but that is also incorrect. I don't think any of the incoming residents for the last two years have been from New Orleans. I don't know what pathologically laidback means, but you may be right there.?

no offense meant at all...was seriously constructive criticism as I really did like tulane. I guess by pathologically laidback I meant I got the feeling while I was there that no one was that interested in the interviews or interviewees...kind of like an after thought -- just a feeling. the residents i met seemed happy but not enthusiastic. just the vibe i got -- which some people may like but i am a little too high strung i guess.

 

[tulanesres]

no offense meant at all...was seriously constructive criticism as I really did like tulane. I guess by pathologically laidback I meant I got the feeling while I was there that no one was that interested in the interviews or interviewees...kind of like an after thought -- just a feeling. the residents i met seemed happy but not enthusiastic. just the vibe i got -- which some people may like but i am a little too high strung i guess.

No problem. interview day needs to be improved.
the experience working there and interviewing weren't similar at all, but as an interviewee it's all you have to go on and should be better.
constructive criticism is good.
separate from that, if people are enthusiastic every day, they are probably either fake or on drugs or both. or maybe in a cult?

 

[painkiller]

It is what it is...

Just get the tube in...

they steal our pastries...

you must anticipate the unanticipated difficult airway...

do you know how many hours the average anesthesia resident works?

some studies say...

whats up party people...

i might pass out if i dont have my sugar this morning...

starting a preop fellowship in 2009...

tulane anesthesia rocks!!!!

HELL YEAH DUDE!!!!!!!!

 

[painkiller]

 

[Bertelman]

It is what it is...

Just get the tube in...

they steal our pastries...

you must anticipate the unanticipated difficult airway...

do you know how many hours the average anesthesia resident works?

some studies say...

whats up party people...

i might pass out if i dont have my sugar this morning...

starting a preop fellowship in 2009...

tulane anesthesia rocks!!!!

HELL YEAH DUDE!!!!!!!!

put down your fourth cup of coffee, dude.

 

[Mman]

One of the biggest deficiencies I see in residency education is how residents are trained the academic medicine way, which is far different from the way private practice anesthesiologists perform....day in and day out.

Future Tulane anesthesia residents will be trained like a private practice anesthesiologist.

This is, like, MAJORLY FU&KING BIG.

Tulane has the chance to revolutionize residency education.

Bring it outta the mantras of academia, into the forefront.. where procedural times, efficiency, surgeon satisfaction are more important than they are at current day academic institutions.

The opportunity to eliminate academic myths from resident education.

The opportunity to eliminate the obstructionalistic viewpoint concerning "do I do the case or not?" of academic anesthesia.

I'm currently a resident where anyone would qualify it as heavily academic by any definition. But I think I get quite a bit of training in the areas you describe as more important in private practice, which is where I plan to end up. Every single day I work to get faster and better at my technical skills. I can count on one hand the number cases in my room that have been cancelled for anesthesia reasons in 2 years (stopping at McDs for lunch on the way to your 3:00 pm surgery probably wasn't a good idea). I'm always getting pointers on how to make things run smoother and more efficiently.


I still have a ways to go, but I'd imagine that the day I finish I will be able to walk into any private practice setting in the country and crank out cases safely and efficiently.

 

[LostTommyGuns]

I still have a ways to go, but I'd imagine that the day I finish I will be able to walk into any private practice setting in the country and crank out cases safely and efficiently.

Probably - but having seen programs where residents are trained under a "private practice" environment I can easily say that it is a better resident lifestyle and when everyone is on the same page - particularly the Anes attendings (who often push the surgical attendings), you get a better feel for the real circumstances.

In other news - I remember that fateful day when my favorite Hawaiian bled all over himself in an amusing versed induced stupor and was told (as blood coursed down his arm ) "don't worry about that blood, everything's going fine" by a particular dept chair... heh heh.

 

[OB1🤙]

In other news - I remember that fateful day when my favorite Hawaiian bled all over himself in an amusing versed induced stupor and was told (as blood coursed down his arm ) "don't worry about that blood, everything's going fine" by a particular dept chair... heh heh.

I learned that day that Versed is a hell of a drug.

And all that was still before they tried to exsanguinate me for the second time of the day through the R AC PIV. Crikey, I must have lost almost half a unit just in the holding area, those bastards.

 

[excalibur]

I learned that day that Versed is a hell of a drug.

And all that was still before they tried to exsanguinate me for the second time of the day through the R AC PIV. Crikey, I must have lost almost half a unit just in the holding area, those bastards.

HB, did u ever get sensation back in the axillary distribution from that injury?

 

[OB1🤙]

HB, did u ever get sensation back in the axillary distribution from that injury?

I did, thankfully- it took about a year, maybe a year and a half. That sucked.

 

[jetproppilot]

I did, thankfully- it took about a year, maybe a year and a half. That sucked.

HEY FORMER NEW ORLEANS SACLESS POKER PLAYING DUDES.....GET A ROOM, WOULDJA?? YOU TOTALLY HIJACKED MY THREAD WITH YOUR B.S. !!!!!!!"

lol:)

uhhhhhhh.......just kidding.

carry on.

 

[OB1🤙]

Dude, look at my post #29 up there, I tried to redirect this thread back to the point of your OP.

But since nobody bit, we had us a good talk about how Tulane anesthesia tried to cure my shoulder by phlebotomy and permanent sensory paresis.

 

[halflife94]

So did anyone hear anything about LSU-NO?

 

[deleted50478]

So did anyone hear anything about LSU-NO?

Ask again in two weeks.

 

[jetproppilot]

So did anyone hear anything about LSU-NO?

Alan heard from the board.....they said they needed to have a few more questions answered before making final decision and that another site visit was not necessary.

Whatever that means.

 

[SleepDocLA]

The OP obviously knows very little of the way Frank operates. Frank is out for Frank. He will screw anyone and everyone to get what he wants. His actions serve one purpose and one purpose only....helping Frank.

I knew him as a resident. He was out for #1 then. When he came back from Mass Gen. he was only worse. When he wanted to be chairman at Ochsner and did not get what he wanted he pouted and left town only to return several months later to join Parish. Guess he failed to get his way in Colorado too!

Watch out Tulane....you have brought in a monster. Why did those five docs leave Parish and go to TUMC last year......Frank Rosinia. Anyone who gets in Frank's way will be crucified and then run out of the department. His ethics are questionable at best.

What amazes me is that the department had a great leader and a great person in Chuck Fox. He ran the department when Git was there. He was who the residents turned to. He was really the one who held it together after Katrina. He was the logical and sensible choice for Chairman.

So as I sit on the sidelines of New Orleans and watch....I can't help but wonder how long it will take before Tulane, HCA, the faculty and residents realize they have been sold a bill of goods. Frank and Parish Management will screw them all.