Avoid Walter Reed Neurology

[MSUCOM2003]

This is sort of an extension of the previous popular post titled "Avoid Military Medicine." Many of the comments he makes are very true. In addition, I'd like to point out the deficiencies in the Neurology Dept at Walter Reed:

1. Resident Review Commitee (a part of the ACGME) accredited the program for 2 years (the average National Capital Consortium Program received 4 years). They cited poor learning opportunities secondary to being on call, post call or burdened by, and I paraphrase here, large amounts of scut.

2. Malignant faculty who treat residents like children. No joke, a staff once said, "Pete and Re-peat go to the lake and Pete falls in. What are you left with," in response to a second error made by a resident. This same faculty half-jokingly threatened UCMJ charges when a resident beat him on the run portion of the APFT.

3. Faculty who pay lip service to things like the 80 hour work week rule, being on time for meetings & MR, but they themselves are often the worst offenders.

4. A hospital that deserves to be trashed in a few years and moved to Bethesda. The computers crash often, the Information Tech dept rarely helps out, the clerks and support staff are rude, the ER truly sucks, I just got efficient with using ICDB and they're switching to CHCS II, another inefficient and worthless system I'm sure.

I don't have the time to continue pointing out stuff. I'd be happy to talk with anyone considering coming to this awful place off-line.

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[Mirror Form]

This is sort of an extension of the previous popular post titled "Avoid Military Medicine." Many of the comments he makes are very true. In addition, I'd like to point out the deficiencies in the Neurology Dept at Walter Reed:

1. Resident Review Commitee (a part of the ACGME) accredited the program for 2 years (the average National Capital Consortium Program received 4 years). They cited poor learning opportunities secondary to being on call, post call or burdened by, and I paraphrase here, large amounts of scut.

2. Malignant faculty who treat residents like children. No joke, a staff once said, "Pete and Re-peat go to the lake and Pete falls in. What are you left with," in response to a second error made by a resident. This same faculty half-jokingly threatened UCMJ charges when a resident beat him on the run portion of the APFT.

3. Faculty who pay lip service to things like the 80 hour work week rule, being on time for meetings & MR, but they themselves are often the worst offenders.

4. A hospital that deserves to be trashed in a few years and moved to Bethesda. The computers crash often, the Information Tech dept rarely helps out, the clerks and support staff are rude, the ER truly sucks, I just got efficient with using ICDB and they're switching to CHCS II, another inefficient and worthless system I'm sure.

I don't have the time to continue pointing out stuff. I'd be happy to talk with anyone considering coming to this awful place off-line.

At least walter reed is to some extent a real hospital.

 

[delicatefade]

Where are you?

 

[Mirror Form]

Where are you?

For now I value my anonymity.

 

[USAFdoc]

This is sort of an extension of the previous popular post titled "Avoid Military Medicine." Many of the comments he makes are very true. In addition, I'd like to point out the deficiencies in the Neurology Dept at Walter Reed:

1. Resident Review Commitee (a part of the ACGME) accredited the program for 2 years (the average National Capital Consortium Program received 4 years). They cited poor learning opportunities secondary to being on call, post call or burdened by, and I paraphrase here, large amounts of scut.

2. Malignant faculty who treat residents like children. No joke, a staff once said, "Pete and Re-peat go to the lake and Pete falls in. What are you left with," in response to a second error made by a resident. This same faculty half-jokingly threatened UCMJ charges when a resident beat him on the run portion of the APFT.

3. Faculty who pay lip service to things like the 80 hour work week rule, being on time for meetings & MR, but they themselves are often the worst offenders.

4. A hospital that deserves to be trashed in a few years and moved to Bethesda. The computers crash often, the Information Tech dept rarely helps out, the clerks and support staff are rude, the ER truly sucks, I just got efficient with using ICDB and they're switching to CHCS II, another inefficient and worthless system I'm sure.

I don't have the time to continue pointing out stuff. I'd be happy to talk with anyone considering coming to this awful place off-line.

There are many stories, similar to the above, that I have experienced first hand, and heard from other military doctors secondhand. what I would like to do here is my take on why the extreme negative attitude that some docs feel towards their military medicine life.

I feel much of it is because of who WE ARE as people. As a physician, we did not reach this point in our lives because we have poor work ethics, are not team players, etc.

No, many of us did what it took, and became military physicians because we are extremely hard workers, we demand excellence from ourselves, and we love our country. This leads to an extreme amount of frustration at being placed in a military health care system that we have virtually no control over. We know first hand how NOT-excellent, how NOT efficient, and how NOT to treat people this whole thing is. Up to this point in many of our lives, we had at least some control to ensure the product we put out (grades, research etc) was excellent. We also were surrounded somewhat by people who wanted us to be there and succeed. That is FAR FROM the truth in terms of what is happening in our military clinics, run by people who at times could care less for morale, who at other times, have no training or experience on how to run a large high output clinic in good times let alone in bad times. As stated, the majority of what I saw in military medicine was a POOR designed health care system with the WRONG people in the WRONG leadership positions with the WRONG decisions being made, by METRICS that were WRONG. Not that I am expecting perfection here, but the current situation is not even in the ballpark.
Since I first discovered this site about 6 months ago, it has been very, very rare to see any doc that has an overall good impression of what is going on. I know those med students and residents already in the pipeline do not want to read about how bad it is, but I think they need to know, and they need to start using their chain of command now, with all the other residents/med student on board, to bring up these issues and demand change; both for their future, the future care of our pateints, and the future of military medicine as well.

 

[bustbones26]

OK first off, not many choices in the army, if you don't want NCC, you have MAdigan, that's it!!

Second off Sledge, I know where you are at and let me tell you, I did a month of medicine there last year as an MS-4 and wanted to go jump off a bridge afterwards. EXTREMELY malignant faculty!! Treated all IM residents like $hit and as if they were to stupid to be born. If I had done IM, I'd have ranked WBAMC before them, no joke!! To be honest, the whole reason I switched to neuro was because I spent a month of medicine there and felt too stupid to buy a stick of gum or pump gasoline afterward. Man, that was a mistake, it took me more IM rotations to realize that the place was just full of maligant idiots.

To be honest, I actually felt sorry for the residents there because they actually were not dumb, they did good work, but were treated like a$$, so they always felt inadequate.

 

[militarymd]

That's how I felt when I was a resident at Bethesda (anesthesia) in the mid 90's...until I did away rotations and did a civilian fellowship....then I realized that my view of the world was skewed.

 

[island doc]

Perhaps the reason the staff faculty physicians at these institutions have created such malignant environments as the result of their dysfunctional behaviors, is because they too are miserable and unhappy people, and are therefore making life miserable for everyone else. Perhaps they too wish they were elsewhere.

 

[RichL025]

For now I value my anonymity. I'll tell you where once I get out of this $h*thole.

Anonymity?

Geez, unless Sledge is your real name, you're already anonymous and telling us what medcen you're constantly bitching about isn't going to OUT you.

No offense, but this is getting a little suspicious.

 

[MoosePilot]

Anonymity?

Geez, unless Sledge is your real name, you're already anonymous and telling us what medcen you're constantly bitching about isn't going to OUT you.

No offense, but this is getting a little suspicious.

Relax. He's put significantly more information about himself out in his long time posting. He worries someone might put it together and give him a bad eval or something. I can understand that. I've relaxed my anonymity over time, as I thought I had less at stake.

He's a long time poster and not someone to be suspicious about.

 

[Mirror Form]

Anonymity?

Geez, unless Sledge is your real name, you're already anonymous and telling us what medcen you're constantly bitching about isn't going to OUT you.

No offense, but this is getting a little suspicious.

You obviously don't know much about the size of the various med cens. There aren't that many interns. Although I really don't care if you believe me or not.

 

[s42brown]

I'm going to guess it is the lower right corner of the USA. I have never been to this place but I think I could be right.

 

[Homunculus]

Anonymity?

Geez, unless Sledge is your real name, you're already anonymous and telling us what medcen you're constantly bitching about isn't going to OUT you.

No offense, but this is getting a little suspicious.

he's legit. trust me.

--your friendly neighborhood admin power caveman

 

[RichL025]

You obviously don't know much about the size of the various med cens. There aren't that many interns. Although I really don't care if you believe me or not.

Well, since I'm IN one of them right now, and just LEFT another one, you're statement above is wrong.

Enough other posters seem to think you're on the level, though, so I'll extend the benefit of the doubt (not that you need it from me or anything)

I still think it's...... petty....... to constantly complain about a particular place, and drop hints, but then refuse to name that place.

Even in the smaller medcen (Madigan) I'm at now, there's 2-3 residents per each year level in each program (the smaller ones at least), so unless "sledge" happens to be your known nickname, your anonymity is still preserved.

 

[bustbones26]

I was posted negative feedback about a program on a site like this in complete anomity. It took them about 6 hours to figure out is was me. Sledge may not be happen where he is at, but he aint stupid either. Being were he was, I know for a fact that ppl there would make his life miserable if they even thought he might have said something bad about the place.

Truth is, the army is small. As an MS4, it actaully is your duty to go out to these placed and judge for yourself. So the moral is, go to the medcens and learn for yourself.

 

[USAFdoc]

I was posted negative feedback about a program on a site like this in complete anomity. It took them about 6 hours to figure out is was me. Sledge may not be happen where he is at, but he aint stupid either. Being were he was, I know for a fact that ppl there would make his life miserable if they even thought he might have said something bad about the place.

Truth is, the army is small. As an MS4, it actaully is your duty to go out to these placed and judge for yourself. So the moral is, go to the medcens and learn for yourself.

exactly; if somebody doesn't beleive what the people are saying about a place (or in my case, the near entirety of USAF primary care) just go visit yourself, but make sure you speak with the "front line docs, not the commander etc....2 different stories).

 

[UncleRico]

I am an active duty AF resident and I am personally familiar with several AF residency programs. I know many of the program directors well and I have had numerous conversations with them regarding AF GME. The common theme that inevitably comes out of these conversations is that AF medicine does not have the patient population to provide the volume and diversity of teaching cases necessary to maintain quality graduate medical education. Continuous deployments of the teaching staff and the high number of AF physicians getting out provide additional strain on the system. Most residency programs use smoke and mirrors to squeak by the RRC inspection to maintain accreditation. Also, research is a joke at most military residencies, so you are really shooting yourself in the foot if you hope to get into academics via military medicine.

It is becoming more and more clear that AF GME is subpar compared to the typical large university residency programs. This is an extremely important fact for prospective medical students to be aware of, because the quality of one's residency training may be the single most important component of medical education. The AF should get out of GME, because everyone loses when the system is broken: residents get poor training and this obviously results in poor care for the troops and dependents.

I know most of you considering whether or not to join the military don't even yet know what "GME" means, but take my advice and avoid military medicine. As your career progresses, you will be grateful that you did.

 

[island doc]

Listen to Uncle Rico and avoid Uncle Sam.

 

[RichL025]

Also, research is a joke at most military residencies, so you are really shooting yourself in the foot if you hope to get into academics via military medicine.

but take my advice and avoid military medicine. As your career progresses, you will be grateful that you did.

You did well in the first part of your post explaining your background and your knowledge of USAF medicine. I think I would take issue, however, with your sliding into making generalizations about the rest of the services.

I'm thinking this was unintentional? Or do you extend the same to Army GME?

 

[Mirror Form]

You did well in the first part of your post explaining your background and your knowledge of USAF medicine. I think I would take issue, however, with your sliding into making generalizations about the rest of the services.

I'm thinking this was unintentional? Or do you extend the same to Army GME?

It certainly extends to Army GME. RRC frequently harrasses some military residency programs (but definitely not all), including army, about patient numbers b/c they tend to be on the low end of the spectrum, and sometimes are quite questionable. I'm surprised that anybody who's been to multiple army hospitals finds that suprising. Granted, like the civilian world, it definitely depends on which med cen you're stationed, and what type of residency you're doing. For example, ortho certainly isn't hurting for patients anywhere right now. Whereas, some gen surg programs are seriously struggling for numbers.

As far as research goes, you're definitely not going to be working with too many world reknowned academics in the military since many docs get out after their commitment is up. Whereas, most university based civilian residency programs have some older more famous people.

 

[RichL025]

Sledge,

Sorry, I don't buy it. WHATEVER Medcen you are at (and all this cloak and dagger is, as I said earlier, a little suspicious) may have problems, I'll allow - since I have not rotated at all of them (and I've been a little curious about how Ike & Beaumont get enough cases).

I'm just a MS-4, admittedly. But at this stage, I have the skills to evaluate programs using the larger metrics - although I admit the finer upsides & downsides may not yet be apparent to me. That disclaimer aside, the two medcens I am most fmailiar with (from spending several months at each) are Madigan & Walter Reed.

At BOTH of them the residents do a fair bit of operating. How much in comparison to other, civilian programs? Dunno, but someone here a few weeks ago posted the "minimum" number of cases a resident is supposed to have (by ABS standards, I believe) to graduate , and I can assure you that both programs far exceed the minimum.

As far as research goes, you're definitely not going to be working with too many famous reknowned academics in the military since many docs get out after their commitment is up.

Look, once again, I'm not going to cry "BULL$HIT" because I don't know where YOU are at, and the details of your program. But the above just illustrates that you haven't looked at the other medcens - at Madigan here we have a passel of old surgeons with a wealth of experience (who are jokingly referred to as the "jedi council"). No, none of them is named Debakey, but how many hopsitals that people do residencies in DO?

Are Walter Reed and Madigan in the top ten of "prestigious research" hopsitals in the country? Probably not, but considering the wide range of academic & community programs there are out there, I wouldn't be surprised to find that we're center-of-mass, and in fact above-average in certian fields.

We don't have a Debakey, but we _do_ have staff that have alot of articles after their names. I was going to cut and paste a pubmed search of our chief of vascular, but I wasn't sure it would be proper to put his name here (although I guess I just gave you enough info to figure out who he is...) but the pubmed search under his name turned up pages and pages of citations for him. (ping me off-line if you want his name to duplicate my search)

Not only that, but he loves teaching students & residents, also (how many of the world-reknowned academics have THAT accolade?)

So, once again, I'm sorry you're stuck in such a miserable, second-rate program that you don't even feel comfortable naming. But do NOT extend your generalization to all of army surgery GME.

 

[Mirror Form]

Sledge,

Sorry, I don't buy it. WHATEVER Medcen you are at (and all this cloak and dagger is, as I said earlier, a little suspicious) may have problems, I'll allow - since I have not rotated at all of them (and I've been a little curious about how Ike & Beaumont get enough cases).

I've personally witnessed more then one army residency program not getting enough patients. Like the civilian world, those programs are in the minority. However, your chances of being at such a program are probably higher in the army then in the civilian world. I've rotated at Walter Reed and the programs there all seem very good. So if you're confident that you'll match there then you have nothing to worry about.

Look, once again, I'm not going to cry "BULL$HIT" because I don't know where YOU are at, and the details of your program. But the above just illustrates that you haven't looked at the other medcens - at Madigan here we have a passel of old surgeons with a wealth of experience (who are jokingly referred to as the "jedi council"). No, none of them is named Debakey, but how many hopsitals that people do residencies in DO?

Are Walter Reed and Madigan in the top ten of "prestigious research" hopsitals in the country? Probably not, but considering the wide range of academic & community programs there are out there, I wouldn't be surprised to find that we're center-of-mass, and in fact above-average in certian fields.

We don't have a Debakey, but we _do_ have staff that have alot of articles after their names. I was going to cut and paste a pubmed search of our chief of vascular, but I wasn't sure it would be proper to put his name here (although I guess I just gave you enough info to figure out who he is...) but the pubmed search under his name turned up pages and pages of citations for him. (ping me off-line if you want his name to duplicate my search)

Not only that, but he loves teaching students & residents, also (how many of the world-reknowned academics have THAT accolade?)

So, once again, I'm sorry you're stuck in such a miserable, second-rate program that you don't even feel comfortable naming. But do NOT extend your generalization to all of army surgery GME.

I think you got the wrong impression from me about my comments on research. There are plenty of research oppurtunities in the army and there are plenty of attendings who do a lot of research. However, it can really help in a lot of fields to be able to do some work with someone who is nationally known. You chances of that happening are lower in the military b/c a lot of the famous people are older and if they were ever in the military have long since gotten out. Many civilian programs (obviously not all) have a couple older people that have had more time to make a name for themselves in their field.

 

[mitchconnie]

I'm just a MS-4, admittedly. But at this stage, I have the skills to evaluate programs using the larger metrics - although I admit the finer upsides & downsides may not yet be apparent to me. That disclaimer aside, the two medcens I am most fmailiar with (from spending several months at each) are Madigan & Walter Reed.

We don't have a Debakey, but we _do_ have staff that have alot of articles after their names. I was going to cut and paste a pubmed search of our chief of vascular, but I wasn't sure it would be proper to put his name here (although I guess I just gave you enough info to figure out who he is...) but the pubmed search under his name turned up pages and pages of citations for him. (ping me off-line if you want his name to duplicate my search)

You have a very valid point the Madigan and WRAMC have some solid GME that is likely to remain viable for years to come. But I think these programs (and maybe the BAMC/Wilford Hall merger) are the only places in the DoD with the volume to sustain quality GME. Unfortunately, the army also maintains GME at Tripler, Beaumont, Eisenhower, etc. and the AF is saddled with Wright-Pat, Keesler, and Travis AFB. The surgical case volume at these smaller places is clearly marginal—Uncle Rico’s “smoke and mirrors” comment is right on target.

I think your perspective of military GME/research programs as an MS4 is valid, but limited. Consider Vascular Surgery at Madigan, which you mentioned. As you stated, the chief there is a great guy and an outstanding teacher. But he is not on the editorial board of any major journal in the field, has not participated in any major randomized trials, carries no NIH funding and is not a player on the national Vascular Surgery scene. You won’t be getting into vascular fellowship at Mass. General based on his recommendation.

His CV and the Pub Med search you refer to may be impressive to an MS4, but take a look at what the citations are—a lot of case reports and small retrospective series done by his residents and accumulated over decades. Look at which journals they are in (Is “Military Medicine” even peer-reviewed?) Count the number of first authorships in the Journal of Vascular Surgery, the only real high-impact journal in our field—zero. How many endovascular device trials is Madigan involved with?—zero. How many randomized multicenter trials?—zero.

Case reports and retrospective series are great (and basically all that I have in my CV), but they are not to be confused with big-time research. To my knowledge, no military surgeons are involved in any big multicenter randomized studies or any major device trials, and we have no major players on the national basic-science scene. Military surgeons who trumpet their 6-case series of blast injuries from Iraq as ground-breaking research just look silly.

I agree with you that there are isolated pockets of good clinical surgical training in the DoD, but lets not pretend that the Army, AF, or Navy have anything close to a major university hospital.

This is no knock on madigan vascular surgery or its chief--they do good work. But what seems like a big deal in the tiny world of military medicine, is probably very small-time on the outside.

 

[RichL025]

You have a very valid point the Madigan and WRAMC have some solid GME that is likely to remain viable for years to come. But I think these programs (and maybe the BAMC/Wilford Hall merger) are the only places in the DoD with the volume to sustain quality GME. Unfortunately, the army also maintains GME at Tripler, Beaumont, Eisenhower, etc. and the AF is saddled with Wright-Pat, Keesler, and Travis AFB. The surgical case volume at these smaller places is clearly marginal—Uncle Rico’s “smoke and mirrors” comment is right on target.

Well, I certainly can't speak for the Air Force, and have heard enough grumblings to suspect the concerns are valid.

To the list of DoD places with enough volume I think you can add Tripler, also - unless I was blatantly lied to (a possibility, I concede <g>) - they are considering expanding the number of residents because of the sheer volume of cases they have exposure to - not at Tripler, but at their affiliated hospitals. I have no idea about the quality & availability of teaching staff, just the case numbers.

As for the CV of that vascular surgeon (who we are carefully keeping nameless) - no, he does not sit on the boards of any major journals, nor does he have cites in J vasc surg. What he DOES have (and the 2 army GME programs I am familiar with) is a record of placing people who want vascular fellowships (or any fellowship) in the specialties they want.

Hope that wasn't overly twisted grammar - what I meant was, while I concede that the army is not a powerhouse of top-tier reasearch, it manages to consistently place residents into fellowhips - civilian fellowships. Not Mass General (although I don't know if anyone wanted to go there), but decent places where they get a good number of procedures (just talked to my former chief res now in a vascular fellowhip).

Not glamorous or prestigous, but solid.

 

[island doc]

Isn't this something of a moot point, academics and research that is, military medicine never has been and never will be about research or even about pure academics for that matter. If an individual desires a career in academics/research, military medicine is probably not for them. On a little different note, how many military medical centers or individuals have been named by US News and World Report as the best in any particular field? How many military medical centers have been named as a "Top 100" hospital?

 

[bustbones26]

Well, I certainly can't speak for the Air Force, and have heard enough grumblings to suspect the concerns are valid.

To the list of DoD places with enough volume I think you can add Tripler, also - unless I was blatantly lied to (a possibility, I concede <g>) - they are considering expanding the number of residents because of the sheer volume of cases they have exposure to - not at Tripler, but at their affiliated hospitals. I have no idea about the quality & availability of teaching staff, just the case numbers.

As for the CV of that vascular surgeon (who we are carefully keeping nameless) - no, he does not sit on the boards of any major journals, nor does he have cites in J vasc surg. What he DOES have (and the 2 army GME programs I am familiar with) is a record of placing people who want vascular fellowships (or any fellowship) in the specialties they want.

Hope that wasn't overly twisted grammar - what I meant was, while I concede that the army is not a powerhouse of top-tier reasearch, it manages to consistently place residents into fellowhips - civilian fellowships. Not Mass General (although I don't know if anyone wanted to go there), but decent places where they get a good number of procedures (just talked to my former chief res now in a vascular fellowhip).

Not glamorous or prestigous, but solid.

Now lets imagine for a moment that you are a director of a fellowship program. And one day, this applicant from an army program comes to interview and says, "oh by the way, the army will pay me to do this fellowship, i.e., you get a "free" fellow". Do you think that might have something to do with residents getting placed into fellowships? Not knowcking you statement, just making this point.

 

[mitchconnie]

What he DOES have (and the 2 army GME programs I am familiar with) is a record of placing people who want vascular fellowships

Over the past several years, 10-20% of vascular fellowship slots have gone unmatched. Any American grad with a pulse can get in--let alone one who carries his own funding.

 

[bogatyr]

Isn't this something of a moot point, academics and research that is, military medicine never has been and never will be about research or even about pure academics for that matter. If an individual desires a career in academics/research, military medicine is probably not for them. On a little different note, how many military medical centers or individuals have been named by US News and World Report as the best in any particular field? How many military medical centers have been named as a "Top 100" hospital?

The military does have a rich history of research- Walter Reed, William Beaumont, and the use of antibiotics in WWII come to mind. I think military medicine should be about research, for example the development of the new hemostasis promoting bandages or non-blood oxygen carrying compounds. Many of the innovations that are brought about by battlefield necessity end up being quite useful in the civilian world. There is no reason why the military shouldn't have strong career research scientist/physicians, other than all the other reasons discussed in this forum why people leave the military.

 

[Homunculus]

how many military medical centers or individuals have been named by US News and World Report as the best in any particular field? How many military medical centers have been named as a "Top 100" hospital?

the military and VA system doesn't participate in the "top 100" hospital stuff put out by US News and such. I have no doubt they would be in the top 100, seeing as I've actually worked at some of the top 100 and Walter Reed stacks up well with most of them. Granted, WRAMC is one of the military's quaternary facilities and *should* be that high, but to say that not being on the top 100 list shows they are substandard isn't accurate.

http://www.usnews.com/usnews/health/best-hospitals/methodology.htm

--your friendly neighborhood it ain't *that* bad caveman

 

[bobbyseal]

Now lets imagine for a moment that you are a director of a fellowship program. And one day, this applicant from an army program comes to interview and says, "oh by the way, the army will pay me to do this fellowship, i.e., you get a "free" fellow". Do you think that might have something to do with residents getting placed into fellowships? Not knowcking you statement, just making this point.

This argument is invalid. Medicare pays resident and fellowship salaries. The hospital doesn't pay for our salaries. So, telling a PD that he doesn't have to pay for you matters little.

Feel free to do a fellowship on the military dime. I know uncle sam will be happy about having a fellowship trained doc locked in for another 2+ years at a market undervalued price.

 

[Mirror Form]

This argument is invalid. Medicare pays resident and fellowship salaries. The hospital doesn't pay for our salaries. So, telling a PD that he doesn't have to pay for you matters little.

Actually, you're wrong on this issue. Most fellowships DO NOT receive funding from medicaire. As such, having a fellow who's salary and health benefits are being paid for by the military is very attractive. Many military personal can literally "walk in" to prestigious fellowships b/c of this.

 

[militarymd]

depends on the fellowship....ones that have ACGME recognition with a board to follow should be funded. As a ccm fellow in anesthesia, being military funded meant zero to the programs.

 

[FliteSurgn]

Actually, you're wrong on this issue. Most fellowships DO NOT receive funding from medicaire. As such, having a fellow who's salary and health benefits are being paid for by the military is very attractive. Many military personal can literally "walk in" to prestigious fellowships b/c of this.

Most fellowships do receive funding from Medicare, but they receive 50% less than they would for an "initial" trainee. Medicare limits full GME payments to the initial training period (3 years for IM or FP, 4 years for OB, etc). After that time (or after 5 years, whichever comes first), they pay 50% of what they would've paid during the initial period. The former being considered 1.0 FTE (full-time equivalent) and the latter 0.5 FTE.

The actual amount that a hospital receives per FTE varies due to a lot of factors, but it's a crude estimate to say that Medicare pays about 30-50% of the costs associated with training an initial trainee.

 

[bustbones26]

The point is, no matter where the funding comes from the PD does not need to worry about it, if your military, they know they have the funding to support you. And yes, you are right, it will extend your payback time, but that is the joy of military medicine

 

[bobbyseal]

Most fellowships do receive funding from Medicare, but they receive 50% less than they would for an "initial" trainee. Medicare limits full GME payments to the initial training period (3 years for IM or FP, 4 years for OB, etc). After that time (or after 5 years, whichever comes first), they pay 50% of what they would've paid during the initial period. The former being considered 1.0 FTE (full-time equivalent) and the latter 0.5 FTE.

The actual amount that a hospital receives per FTE varies due to a lot of factors, but it's a crude estimate to say that Medicare pays about 30-50% of the costs associated with training an initial trainee.

I heard that my hospital gets approx $100-150K per year per resident from medicare. We obviously don't get that much in salary.

 

[FliteSurgn]

I heard that my hospital gets approx $100-150K per year per resident from medicare. We obviously don't get that much in salary.

Was that from a reliable source or was it just a rumor you heard? I doubt that there are many people at the hospital that have any idea what the REAL amount that your particular hospital receives from Medicare on a per resident basis. The amount that any particular hospital gets per resident is a complex computation that has a lot of variables asociated with it. Most of this deals with the volume of Medicare patients. Hospitals that rely heavily on Medicare patients will obviously get more in Medicare funds while hospitals (children's hospitals for example) get almost no Medicare funds...although this disparity has been addressed somewhat in recent legislation. Furthermore, your salary isn't the only cost associated with your training. There's insurance, malpractice, residency accreditation, administrative expenses, paying teaching staff, etc. Rest assured that Medicare is not financing 100% of GME nor is the hospital making money from Medicare on the training of residents.

 

[RichL025]

nor is the hospital making money from Medicare on the training of residents.

Which brings up a great point.... why do they do it? Oh, I'm not asking about those tha have big, high-powered academic programs, cause all those famous surgeons need a steady supply of bottle-washers *ooops* I meant assistants...

But why would smaller community hospitals ever run residency programs if it were a loosing proposition? Espescially in today's tight dollar days? You can't bank "prestige"....

 

[Mirror Form]

Which brings up a great point.... why do they do it? Oh, I'm not asking about those tha have big, high-powered academic programs, cause all those famous surgeons need a steady supply of bottle-washers *ooops* I meant assistants...

But why would smaller community hospitals ever run residency programs if it were a loosing proposition? Espescially in today's tight dollar days? You can't bank "prestige"....

Yeah, I think you're right in that most hospitals do make at least some money off of residency programs. Although it's illegal to bill for work done my residents, they do save time in the clinic and also get a lot of work done for the hospital. For example, you'd have to pay a surgeon a lot more to be first call then you would to make him 4th call after the intern, junior resident, and chief resident. Also, while residents do slow down the operations, they save the hospital from having to hire surgical PA's.

 

[bustbones26]

For those doubting the 100-150K per resident keep in mind how much it cost a hospital to give you healthcare insurance, pay your malpractice insurance, pay for your meals while on call, and any other benefits they offer to you: educational allowances, etc.