Resident dermatology funding

[Rzrbker]

GME/resident funding issues continue to become increasingly problematic across the board (especially in dermatology). Dermatology is particularly at risk as hospitals fund the majority of resident lines in various medical specialties and they do not see much value in supporting dermatology given it's predominantly an outpatient specialty. There's even talk of changing residency funding including decreasing resident pay, possibly eliminating paid resident positions, and looking to alternative sources of funding (resident clinics that generate revenue directly for their position, industry sponsored, etc).

I just wanted to get some informal feedback on how the different residency programs fund their dermatology positions.

1) Do you know or are you aware of how each position at your residency program is funded?
2) If so, how are they funded? Hospital lines, private sources, generated from clinic revenue, unrestricted educational grants (from pharma, etc)?

Our program is a mixture of hospital funded (several hospitals, including VA, contribute to positions), and positions through university (partially through clinic revenue).

Please contribute if you're able to. Thanks.

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[DermViser]

GME/resident funding issues continue to become increasingly problematic across the board (especially in dermatology). Dermatology is particularly at risk as hospitals fund the majority of resident lines in various medical specialties and they do not see much value in supporting dermatology given it's predominantly an outpatient specialty. There's even talk of changing residency funding including decreasing resident pay, possibly eliminating paid resident positions, and looking to alternative sources of funding (resident clinics that generate revenue directly for their position, industry sponsored, etc).

I just wanted to get some informal feedback on how the different residency programs fund their dermatology positions.

1) Do you know or are you aware of how each position at your residency program is funded?
2) If so, how are they funded? Hospital lines, private sources, generated from clinic revenue, unrestricted educational grants (from pharma, etc)?

Our program is a mixture of hospital funded (several hospitals, including VA, contribute to positions), and positions through university (partially through clinic revenue).

Please contribute if you're able to. Thanks.

Nearly all residency positions are paid the way you state, either by the hospital/institution itself, or thru Medicare. I'm sure there are some residency positions that are privately funded as well (Pharma, etc.) or by one's home country (Saudi Arabia) but this is the minority. It has been floated around for residents in higher paying specialties to pay for residency training like what happens in Dentistry, but I think there would be a huge uproar and we haven't gotten to that point yet.

Dermatology is definitely in the cross hairs when it comes to reimbursement cuts and when it comes to cutting residency positions relative to primary care. Hospitals tend to not like Derm bc their main source of revenue is inpatient care. Derms are also harder to control bc they can always set up shop on their own.

The administration believes that doctors, specifically specialists, are paid way too much. It's the main example used when it comes to people who believe that medical care involves too much procedures. When even the architect of Romneycare and Obamacare, Jonathan Gruber uses the elementary argument of dermatologists vs. primary care, to appeal to emotional sentiment of college students, we're in trouble: http://stream.nts.wustl.edu/R131004001/

 

[doc MD]

GME/resident funding issues continue to become increasingly problematic across the board (especially in dermatology). Dermatology is particularly at risk as hospitals fund the majority of resident lines in various medical specialties and they do not see much value in supporting dermatology given it's predominantly an outpatient specialty. There's even talk of changing residency funding including decreasing resident pay, possibly eliminating paid resident positions, and looking to alternative sources of funding (resident clinics that generate revenue directly for their position, industry sponsored, etc).

I just wanted to get some informal feedback on how the different residency programs fund their dermatology positions.

1) Do you know or are you aware of how each position at your residency program is funded?
2) If so, how are they funded? Hospital lines, private sources, generated from clinic revenue, unrestricted educational grants (from pharma, etc)?

Our program is a mixture of hospital funded (several hospitals, including VA, contribute to positions), and positions through university (partially through clinic revenue).

Please contribute if you're able to. Thanks.

75% of our positions are funding by the VA, the rest by a mixture of 3 clinics (university, county, private).

I do not see them cutting out derm. They can talk all they want about wanting to cut procedures and 'outpatient' specialties. The fact remains they are an integral part of medicine and would be a ridiculous if they did... especially since hospitals should not just have inpatient services, they should have outpatient services.

 

[DermViser]

75% of our positions are funding by the VA, the rest by a mixture of 3 clinics (university, county, private).

I do not see them cutting out derm. They can talk all they want about wanting to cut procedures and 'outpatient' specialties. The fact remains they are an integral part of medicine and would be a ridiculous if they did... especially since hospitals should not just have inpatient services, they should have outpatient services.

75% funded by the VA!!?? Wow.

I think though it's a calculation on the part of the hospital CEO. As a hospital CEO which would you send an extra residency position on:

1) Internal Medicine
2) Dermatology
3) Ortho

Most likely every hospital CEO will pick #3, based on reimbursement for RVUs.

 

[ckdgusdl88]

From what I understand, the very fact that hospital CEOs do not want more residents is the major reason for constricted supply of dermatologists.

 

[doc MD]

From what I understand, the very fact that hospital CEOs do not want more residents is the major reason for constricted supply of dermatologists.

that concept can be apply to all residents; and maybe more so to derm than to other specialties. Education takes time which could have been better spent with making money. CMS pays hospitals for the 'education' time but the margins on that and the amount of $ on RVU that can be made seeing patients is 0 or negative, making the whole idea of an academic center a thing of the past.

 

[DermViser]

that concept can be apply to all residents; and maybe more so to derm than to other specialties. Education takes time which could have been better spent with making money. CMS pays hospitals for the 'education' time but the margins on that and the amount of $ on RVU that can be made seeing patients is 0 or negative, making the whole idea of an academic center a thing of the past.

The way I've heard it said is that education is an unfunded mandate. Most hospitals lose money, that being said there are some ****ty teaching hospitals that wouldn't survive without residents.