Will new COM's be opening up new residencies?

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

Ogmora

Goldmember
10+ Year Member
Joined
Aug 20, 2012
Messages
239
Reaction score
73
Now that this merger has finally happened and when/if legislature for increased GME budgets passes, how will it affect (if at all) newer COM's (ACOM, CUSOM, LUCOM, MUCOM, etc.) in opening up more residency programs and positions?

Members don't see this ad.
 
Last edited:
  • Like
Reactions: 1 user
I think they will have to make sure they have quality places or they won't make it. I'm positive ACOM has nothing to worry about.. They use an awesome system.
 
Members don't see this ad :)
Now that this merger has finally happened and legislature for increased GME budgets have passed, how will it affect (if at all) newer COM's (ACOM, CUSOM, LUCOM, MUCOM, etc.) in opening up more residency programs and positions?

I dont think legislature has passed yet, not entirely sure though.

If not i doubt it will pass anytime before elections later this year. The house seems to dislike anything obama proposes.
 
I dont think legislature has passed yet, not entirely sure though.

If not i doubt it will pass anytime before elections later this year. The house seems to dislike anything obama proposes.

You're right. I refound the article that I read a few days ago and all it did was outline the proposal. Here I was thinking it had passed already...I guess it was just wishful thinking and inattention to detail.

Given that information, I'll need to rephrase my OP to "when/if legislature for increased GME budgets passes"
 
Last edited:
  • Like
Reactions: 1 user
You're right. I refound the article that I read a few days ago and all it did was outline the proposal. Here I was thinking it had passed already...I guess it was just wishful thinking and inattention to detail.

Given that information, I'll need to rephrase my OP to "when/if legislature for increased GME budgets passes"

I recall from my health policy class that only 2% of proposed bills actually make it through congress. That statistic has always given me a pessimistic outlook on proposed bills.
 
  • Like
Reactions: 1 user
I recall from my health policy class that only 2% of proposed bills actually make it through congress. That statistic has always given me a pessimistic outlook on proposed bills.

Schoolhouse Rock was always my source of information on policy making...2% is not promising at all.

That being said, I'm guessing it's not very likely that new residency programs will be opening?
 
Schoolhouse Rock was always my source of information on policy making...2% is not promising at all.

That being said, I'm guessing it's not very likely that new residency programs will be opening?
I would be glad at that. Nothing would be worse than over-expanding residency programs and creating a glut of highly trained professionals carrying huge debt.
 
  • Like
Reactions: 1 user
Liberty, Campbell and VCOM's are working together to open residencies in North Carolina, South Carolina, Virginia, and West Virginia with over 316 approved positions in their OMNEE group.

http://www.omnee.net/
 
  • Like
Reactions: 1 users
That's all great news, especially that CUSOM is able to open up so many positions. I hope they'll all be able to become ACGME accredited.

What about ACOM and MUCOM? ACOM has no press releases or information about pending residencies...I'm assuming that their partnership with AMEC and SAMC will make it easy to open up residency positions, but I can only speculate. (I have a vested interest in ACOM, in case you haven't noticed) And MUCOM seems to have a great relationship with the other med schools in the state, but I haven't heard anything about their GME plans.
 
Schoolhouse Rock was always my source of information on policy making...2% is not promising at all.

That being said, I'm guessing it's not very likely that new residency programs will be opening?

Well I still think residency programs will opening, but the funding would have to come from something other than medicare. My home state will be adding a few slots in family medicine (ACGME residency) and I believe the state government is funding it.
 
Well I still think residency programs will opening, but the funding would have to come from something other than medicare. My home state will be adding a few slots in family medicine (ACGME residency) and I believe the state government is funding it.

Ok, so I was under the impression that residencies were in short supply and that it would take federal funding to change that. If all it takes is state legislature (vs. national legislature) to open up new positions and programs, why is there so much talk about shortages? How long does it take to set up a program and why does it seem like an apparent crisis in GME?

Am I mistaken that GME is really in limited supply?
 
Members don't see this ad :)
Ok, so I was under the impression that residencies were in short supply and that it would take federal funding to change that. If all it takes is state legislature (vs. national legislature) to open up new positions and programs, why is there so much talk about shortages? How long does it take to set up a program and why does it seem like an apparent crisis in GME?

Am I mistaken that GME is really in limited supply?


GME is "frozen" in that every single hospital that has any residents right now can no longer add any more (except through some creative money movement, but that is more akin to swapping residents between programs). So for 95% of all hospitals out there they fall into one of two categories 1) they already have residents and are forbidden from every expanding to get more or 2) they have no interest in ever having residents and won't add them even if you ask nicely.

The 5% (the number is used for demonstration: no clue if its 3%, 0.5%, 7%. Its small) are composed of either 1) hospitals that want residents but no one has ever asked to host a program yet or 2) pediatrics or rural FM programs.

When you look at new residenies you should really look at what they are opening since it has to fall into one of those two categories. If you see a bunch of different residencies popping up at the same place, then its a hospital that never had residents before. You should ask "why". Some places the answer is simply "no one approached them to host residents before, but its a perfectly fine place to train" at other places the answer is "they really arent that good of a fit for a residency program and this could be a bit dicey to force one in there." On the other hand, there are federal exceptions to the residency freeze for any *rural* FM progam and all pediatric programs are exempt from the freeze. So you can see FM opening anywhere that can be defined as rural and peds can open just about anywhere it wants.

But lets take it back to reality again, the huge and overwhelming percent of hospitals are barred from ever expanding their resident training until the federal government budges on funding. Most of these new residencies are part of a mixed bag. Some of them are legit places that should be training residents but never had until now, and a good amount of them are the schools sort of thrusting residency programs onto hospitals that are really under-equipped for the training demands, thus why they werent scooped up earlier.

So no. The "state" is not setting up residencies through any of its laws. Its more accurate to say its brokering them. Its guiding the process along so that the new ones are less likely to be in the 'overwhelmed and underprepared' end of the mixed bag that new residencies are.
 
You are awesome DocEspana. It's always a pleasure to hear your opinion on things and this definitely clears up most of my confusion in the matter.

With the merger going through, am I correct in assuming that those "not a good fit for residency" hospitals will account for a much smaller portion of the new residencies (if any open up), since the ACGME has stricter rules for accreditation of GME than the AOA had?

My primary concern is about ACOM, who has a well established clinical rotation program, yet maybe only 1 residency program at their clinical sites. Correct me if I'm wrong, but you're saying that the easiest way a new program will open up at any of these sites (and will become ACGME accredited) is with the passing federal legislation which will thaw the freeze placed on expanding GME?

Now from what I hear, there are a number of hospitals, who have never been approached before, that are interested in starting residency programs within AL and are affiliated with their clinical rotation sites. Assuming they are "perfectly fine to train at" (how would one determine this?) and they don't qualify as an exception to the freeze, how and when would they begin to accept residents?

Because this is all speculative, putting all other issues regarding new schools aside, does attending a school that lacks residencies affiliated with their core rotation sites warrant any type of major concern? Especially when the probability of passing new federal legislation is unlikely? (I may be entirely wrong and ill advised, but I assumed that many people do their residencies at or near the hospitals where they did their clinicals and that those looking to go elsewhere did away elective rotations.)

GME is "frozen" in that every single hospital that has any residents right now can no longer add any more (except through some creative money movement, but that is more akin to swapping residents between programs). So for 95% of all hospitals out there they fall into one of two categories 1) they already have residents and are forbidden from every expanding to get more or 2) they have no interest in ever having residents and won't add them even if you ask nicely.

The 5% (the number is used for demonstration: no clue if its 3%, 0.5%, 7%. Its small) are composed of either 1) hospitals that want residents but no one has ever asked to host a program yet or 2) pediatrics or rural FM programs.

When you look at new residenies you should really look at what they are opening since it has to fall into one of those two categories. If you see a bunch of different residencies popping up at the same place, then its a hospital that never had residents before. You should ask "why". Some places the answer is simply "no one approached them to host residents before, but its a perfectly fine place to train" at other places the answer is "they really arent that good of a fit for a residency program and this could be a bit dicey to force one in there." On the other hand, there are federal exceptions to the residency freeze for any *rural* FM progam and all pediatric programs are exempt from the freeze. So you can see FM opening anywhere that can be defined as rural and peds can open just about anywhere it wants.

But lets take it back to reality again, the huge and overwhelming percent of hospitals are barred from ever expanding their resident training until the federal government budges on funding. Most of these new residencies are part of a mixed bag. Some of them are legit places that should be training residents but never had until now, and a good amount of them are the schools sort of thrusting residency programs onto hospitals that are really under-equipped for the training demands, thus why they werent scooped up earlier.

So no. The "state" is not setting up residencies through any of its laws. Its more accurate to say its brokering them. Its guiding the process along so that the new ones are less likely to be in the 'overwhelmed and underprepared' end of the mixed bag that new residencies are.
 
You are awesome DocEspana. It's always a pleasure to hear your opinion on things and this definitely clears up most of my confusion in the matter.

With the merger going through, am I correct in assuming that those "not a good fit for residency" hospitals will account for a much smaller portion of the new residencies (if any open up), since the ACGME has stricter rules for accreditation of GME than the AOA had?

Its pretty inaccurate to say its stricter. Its just different. I would personally agree that it sets more specific hurdles to jump over, but saying that the ACGME rules are stricter is oversimplifying to the point of potentially sending the wrong message. ACGME rules simply are more restrictive as to what can and cannot be there (not that they are any harder to obtain.... theyre not. They're much more specific and you design the program to those specifications.)

My primary concern is about ACOM, who has a well established clinical rotation program, yet maybe only 1 residency program at their clinical sites. Correct me if I'm wrong, but you're saying that the easiest way a new program will open up at any of these sites (and will become ACGME accredited) is with the passing federal legislation which will thaw the freeze placed on expanding GME?

If they have even a single residency program there the *only* way they add more residents is to either add peds residency or to change the laws. If they have residents, then they are locked unless they wish to pay the residents out of their own pockets. (They wont)

Now from what I hear, there are a number of hospitals, who have never been approached before, that are interested in starting residency programs within AL and are affiliated with their clinical rotation sites. Assuming they are "perfectly fine to train at" (how would one determine this?) and they don't qualify as an exception to the freeze, how and when would they begin to accept residents?

being qualified enough is a judgement call. There isnt someone grading residencies, though that would be an interesting job. This is a judgement call that certain places dont have the a) resources b) teaching staff c) variety of rare pathology d) patient load to support resident programs and offer a robust education.

But if a group of hospitals wanted to go and enroll their first residents they need to apply to the federal government. At the moment the OPTI system (a post-graduate education "oversight" system run by each osteopathic school) helps such hospitals get themselves ready for federal application. They apply to the government for funding for x y and z residency and the government inspects them for criteria a, b, c and d (as seen above) and decides how many residents they can take on in total, and in which fields they are allowed to place them. This process takes years (talking 3-5 years here) from initial desire to get residents to first entering class.

Because this is all speculative, putting all other issues regarding new schools aside, does attending a school that lacks residencies affiliated with their core rotation sites warrant any type of major concern? Especially when the probability of passing new federal legislation is unlikely? (I may be entirely wrong and ill advised, but I assumed that many people do their residencies at or near the hospitals where they did their clinicals and that those looking to go elsewhere did away elective rotations.)

If your school doesnt have residencies affiliated with it you are at a very marginal disadvantage. You would probably notice it, but you'd probably assign *too much* value to it. It has less value than you'd think. From the point of view of future residencies, you do electives at places you want to go to and often you dont even need to rotate at the places you want to match to, as long as you rotate as similar places and have good LoRs from it.

WITH THAT SAID: if your base rotations are all at places without robust residency programs present you put your *education* at a significant disadvantage. People can talk all they want about how going to places with small or no resident presence is an advantage and you get more time with attendings. Those people are completely delusional. Residents are a *massive* boost to your education in the 3rd and 4th year. They are constantly reading, they have plenty of time to baby sit you and run through stuff with you. You get education and they get education (that you sit in on). They are usually a marker of a service busy enough that it *needs* residents, which means that there is more for the student to see. They often want to pass off procedures to you, attendings would rather do it themself. And they are your window to clinical research opportunties since they need to do research but rarely have the time, so your assistance is vital to them.
 
  • Like
Reactions: 5 users
Good information here, especially to students considering applying to these newer schools. Thanks!
 
So much great info, Doc. Thanks for taking the time to respond, this is beyond helpful.

Its pretty inaccurate to say its stricter. Its just different. I would personally agree that it sets more specific hurdles to jump over, but saying that the ACGME rules are stricter is oversimplifying to the point of potentially sending the wrong message. ACGME rules simply are more restrictive as to what can and cannot be there (not that they are any harder to obtain.... theyre not. They're much more specific and you design the program to those specifications.)



If they have even a single residency program there the *only* way they add more residents is to either add peds residency or to change the laws. If they have residents, then they are locked unless they wish to pay the residents out of their own pockets. (They wont)



being qualified enough is a judgement call. There isnt someone grading residencies, though that would be an interesting job. This is a judgement call that certain places dont have the a) resources b) teaching staff c) variety of rare pathology d) patient load to support resident programs and offer a robust education.

But if a group of hospitals wanted to go and enroll their first residents they need to apply to the federal government. At the moment the OPTI system (a post-graduate education "oversight" system run by each osteopathic school) helps such hospitals get themselves ready for federal application. They apply to the government for funding for x y and z residency and the government inspects them for criteria a, b, c and d (as seen above) and decides how many residents they can take on in total, and in which fields they are allowed to place them. This process takes years (talking 3-5 years here) from initial desire to get residents to first entering class.



If your school doesnt have residencies affiliated with it you are at a very marginal disadvantage. You would probably notice it, but you'd probably assign *too much* value to it. It has less value than you'd think. From the point of view of future residencies, you do electives at places you want to go to and often you dont even need to rotate at the places you want to match to, as long as you rotate as similar places and have good LoRs from it.

WITH THAT SAID: if your base rotations are all at places without robust residency programs present you put your *education* at a significant disadvantage. People can talk all they want about how going to places with small or no resident presence is an advantage and you get more time with attendings. Those people are completely delusional. Residents are a *massive* boost to your education in the 3rd and 4th year. They are constantly reading, they have plenty of time to baby sit you and run through stuff with you. You get education and they get education (that you sit in on). They are usually a marker of a service busy enough that it *needs* residents, which means that there is more for the student to see. They often want to pass off procedures to you, attendings would rather do it themself. And they are your window to clinical research opportunties since they need to do research but rarely have the time, so your assistance is vital to them.
 
Anyone wanna post cliffs?
 
Anyone wanna post cliffs?

Definitely worth reading all of what DocEspana said.

If I tried to summarize it would probably be longer than what he wrote.
 
If you don't mind me asking, what did you end up applying for this year, Docespana?
 
If you don't mind me asking, what did you end up applying for this year, Docespana?

Applied to be your new daddy.

I'll reveal when the ACGME results come out. I didnt want to sign a contract outside of the match and felt my odds in the match provided for better opportunities. Thats the only concrete info I have so far.
 
Yep DocEspana is right, the family residency program I was talking about was in a rural area. I was not too sure of the details of its set up, so it was great to hear from DocEspana about how it works for family and pediatrics.
 
Top