Emergency Medicine Wins!!! More Residency Positions

[HemorrhagicShock]

Oh my godddddd. UC Davis is like 10 miles away. What a joke. The docs that train at programs like this should not be taken seriously when applying for jobs. What kind of crappy experience are they even getting here?

A quick google search highlights that this is a CMG residency as well (Vituity). I know they have a lot of contracts up in that area!

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[thegenius]

Did I just read that Kaiser is acquiring Geisinger recently? If so will this mean that Kaiser is quickly becoming a force in EM GME?

This is true (Kaiser buying Geisinger that is)

 

[alpinism]

The fact that Los Robles got approved is a complete joke.

The ED sees 40K in a town where a small 2 bed house costs over a million dollars.

The PD also literally just finished an education fellowship in 2018 and was the simulation director at Brooklyn Hospital.

 

[hopefulERdoc251]

Did I just read that Kaiser is acquiring Geisinger recently? If so will this mean that Kaiser is quickly becoming a force in EM GME?

My understanding is that it isn't a buyout. From people who work there, it's more an access to resources. Geisinger still retains it's name and will still function as it's own independent entity but has access to Kaiser resources for more of the outpatient stuff to increase access to care as it supposedly does on the west coast. But that's my understanding from topics w/ other people @ geisinger. The ERs aren't as much affected from my understanding (i.e, contracts are still under the geisinger name, paid the same as geisinger has previously provided etc)

EDIT: and truthfully, as a local from the area, they do see quite a lot of pathology and would be a good training institution (even moreso than the mothership in Danville that seems much less volume than GWV does). The 2 geisinger hospitals in NEPA each see almost 2x the volume that Danville does, and probably would see much more pathology in the actual ER compared to Danville, which is mostly a referral center that gets direct admits from hospitals in the surrounding areas rather than true volume thru the ER. But still don't think that there should be more residencies opening with the current state of EM

 

[EctopicFetus]

My understanding is that it isn't a buyout. From people who work there, it's more an access to resources. Geisinger still retains it's name and will still function as it's own independent entity but has access to Kaiser resources for more of the outpatient stuff to increase access to care as it supposedly does on the west coast. But that's my understanding from topics w/ other people @ geisinger. The ERs aren't as much affected from my understanding (i.e, contracts are still under the geisinger name, paid the same as geisinger has previously provided etc)

I thought geisinger is getting $5b. Kaiser will be the boss.

 

[hopefulERdoc251]

I thought geisinger is getting $5b. Kaiser will be the boss.

Right, and the thought is that will be distributed more through the outpatient setting. They have plenty of inpatient resources across all Geisinger hospitals but the actual access to primary care resources (PCPs, psych help) is piss poor and my *hope* is that most of that money gets funneled into outpatient resources that will actually help patients.

From residency friends who are at Kaiser institutions, some of their access is unparalleled (i.e, admit from home, you can get established w/ a PCP next day after d/c from the ER or inpatient settings). I'm hoping that's what the plan is for Geisinger. I also think that the point of it was to encroach on UPMC, LVHN and St. Luke's territory. UPMC is trying to get into the NEPA market and my understanding was that this is Geisinger's way to prevent that from happening. Ultimately I think this will help Geisinger expand west and south to the Lehigh Valley area. There had been talks for a while that Geisinger was going to buy St. Luke's as St. Luke's has allowed their employees to get access to Geisinger insurance plans. This will expedite that.

 

[EctopicFetus]

Kaiser is able to do this since they are also the insurer. I dont think they will have this scale in PA. Maybe im wrong, im not some expert at this but I am unsure it will work. Who knows. KP being a non profit isnt doing this cause they think they wont be making a “profit”.

 

[TooMuchResearch]

Maybe I should look at this from a different angle. What's the easiest way and minimum work required to open a residency? I'll get one up and running at our big house. Then we can stop hiring new docs and PAs and just start supervising residents. I'll never tell you if I'm joking.

 

[EctopicFetus]

Maybe I should look at this from a different angle. What's the easiest way and minimum work required to open a residency? I'll get one up and running at our big house. Then we can stop hiring new docs and PAs and just start supervising residents. I'll never tell you if I'm joking.

Thats the angle HCA has been looking at this. Plus long term benefit your employees are indoctrinated in your shenanigans and there is a steady stream of people for you to hire.

 

[TooMuchResearch]

Thats the angle HCA has been looking at this. Plus long term benefit your employees are indoctrinated in your shenanigans and there is a steady stream of people for you to hire.

Honestly with our volume and acuity, we might be able to offer better training than a number of these new programs.

 

[EctopicFetus]

Honestly with our volume and acuity, we might be able to offer better training than a number of these new programs.

Some of them are a literal joke so im not surprised.

 

[HemorrhagicShock]

Honestly with our volume and acuity, we might be able to offer better training than a number of these new programs.

This is the same calculus that intrepid administrator-type physicians made prior to starting their own residencies. Fast forward 5 years and here we are. If you can't beat 'em, join 'em... right?

 

[southerndoc]

Honestly with our volume and acuity, we might be able to offer better training than a number of these new programs.

I think there should be a minimum volume before a residency can be approved. Sites with <50,000 patients/year should be required to be owned/operated by a university with a medical school before they could be approved. Those with >50,000 could be independent.

 

[EctopicFetus]

I think there should be a minimum volume before a residency can be approved. Sites with <50,000 patients/year should be required to be owned/operated by a university with a medical school before they could be approved. Those with >50,000 could be independent.

I dont think the universities should be treated special. They have shown a push to buy rinky dink hospitals using their academic status but they run them much like for profit businesses.

I think you have to have a certain number of patients per resident. I would suggest 3000 patients per resident. So if you want a 3 year program and 8 residents per class that would be 24x3. 72000 volume ED. This seems reasonable. The concept of a resident run department needs to be abolished. It has become a money making scheme and not an educational endeavor.

 

[Apollyon]

I dont think the universities should be treated special. They have shown a push to buy rinky dink hospitals using their academic status but they run them much like for profit businesses.

I think you have to have a certain number of patients per resident. I would suggest 3000 patients per resident. So if you want a 3 year program and 8 residents per class that would be 24x3. 72000 volume ED. This seems reasonable. The concept of a resident run department needs to be abolished. It has become a money making scheme and not an educational endeavor.

But there is a number. Unfortunately, at this second, I don't recall it. It's in the RRC listing, though.

 

[GatorCHOMPions]

But there is a number. Unfortunately, at this second, I don't recall it. It's in the RRC listing, though.

https://www.acgme.org/globalassets/pfassets/programrequirements/110_emergencymedicine_2023.pdf

Pages 7-8 of the document: min 30k volume at main site, and any rotation greater than 4 months must have min 30k. Also must have 3% or 1200 critically injured patients per year, whichever is highest.

Quite the low bar, unfortunately. And this says it is updated to reflect revised common program requirements as of July 1 2023!

 

[Moose A Moose]

I said it before and I'll say it again. Dermatology will be the next to fall.

Good. What a sham.

 

[emergentmd]

Government paid, warm bodies willing to work 80+hrs wk with medical licenses who will take the worse aspects of medicine including overnight call/inhouse pager call/indigent pts/metrics/charting/scut work/discharge summaries who rarely complains.

This will not stop, will get worse, all residencies eventually will get affected.

 

[EctopicFetus]

The standards for EM are ridiculous. 30k volume ED. .what a joke regardless of acuity and does that cap the number of residents or is that the cap for having a residency all together.

 

[Socrates25]

I don't get it. Aren't most of these new residency programs privately funded? Medicare funding is capped by Congress so I dont see Medicare putting up all these extra millions of dollars for new residency slots. Or did I miss something and Congress upped Medicare funds for residency?

 

[VA Hopeful Dr]

I don't get it. Aren't most of these new residency programs privately funded? Medicare funding is capped by Congress so I dont see Medicare putting up all these extra millions of dollars for new residency slots. Or did I miss something and Congress upped Medicare funds for residency?

New programs can get funding. Existing programs mostly can't if they expand.

 

[FlaminHotER]

The standards for EM are ridiculous. 30k volume ED. .what a joke regardless of acuity and does that cap the number of residents or is that the cap for having a residency all together.

It’s horrendous

 

[thegenius]

But there is a number. Unfortunately, at this second, I don't recall it. It's in the RRC listing, though.

That is correct. There may not be an absolute number but there are surrogate numbers. Can't have a residency where the ER sees 10,000/year and you have 8 residents.

I read the RRC while interviewing for residency and I think it's one of the reasons why I got into residency where I did, I think I impressed the department head