Perspectives on the Acute Care Continuum

The Acute Care Continuum is the integration of urgent, emergent, inpatient and post-discharge care of patients with acute medical conditions. 

Strengthening Our Residency in the Community

5/8/2013 5:13:54 PM | 0 comments

According to the Association of American Medical Colleges (AAMC), the United States will face a shortage of 90,000 physicians by 2020 and 130,000 by 2025. And making it more difficult to climb out of this hole, the federal government is reducing Graduate Medical Education (GME) funding, both in the general budget and in sequestration cuts. As a result, the AAMC is pushing for Congress to lift the cap on Medicare-funded residency training programs which was adopted as part of the Balanced Budget Act of 1997. Last month, two bills were introduced to address the shortage. The House’s Training Tomorrow’s Doctors Today Act and the Senate’s Resident Physician Shortage Reduction Act of 2013 would phase in 15,000 residency positions over five years.

Kaweah Delta Medical Center, the hospital where I practice, has invested in starting its own GME department with the addition of residency programs in emergency medicine (EM), family practice, psychiatry, general surgery and transitional year training. This is a win-win on many levels for everyone involved. It will benefit the doctors accepted to the program, the hospital, my physician group, and the entire community.

As the person entrusted with developing this new EM residency program, I have been delighted with the flood of excellent candidates applying to our program. One reason for the spate of applicants is that competition for residency placements is growing throughout the country. The National Resident Matching Program reports that the number of applicants for residencies already exceeds the available positions (pdf).

Another potential reason for our popularity is that we are located in a rural area of California, which as Barbara Katz points out can be a much less popular destination for physicians. However, only a few residencies in EM exist in California, and of those, many are four year programs. By contrast, we are a three year program, and many EM residents prefer three year programs. They often joke that the difference between a three year program and a four year program is about $200,000. If they want an additional year of training they often favor short fellowship programs, through which they can gain additional credentialing. Because of these advantages, we are able to recruit the best and the brightest young doctors to our program.

Those residents who are fortunate enough to match with Kaweah Delta’s new EM residency program will receive excellent training. Our institution has enough high acuity and ED volume for twice the number of residents we are currently accredited for, which means that trainees will have no shortage of exposure to multiple types of patient pathology. In addition, because this hospital is new to the world of GME, our residents will not be fighting over procedures in the trauma bay with other residents. In this program we will be sure that residents get an opportunity to learn without being exploited as inexpensive labor. We will closely monitor duty hours and eliminate marathon shifts in accordance with ACGME regulations. On one full morning each week we will emphasize this ideal of “education over service” by keeping Thursday morning as “protected educational time” for EM residents in training.

Besides creating a great training opportunity for new physicians, the residency program will also furnish advantages to the hospital. Residents will provide in-house coverage and also increase the number of physicians available to treat patients. Furthermore, supervising and teaching the trainees will be stimulating for our attending physicians. Being a hospital with residency training programs will increase our prestige and will help in physician recruitment. We expect that our efforts to educate and graduate outstanding residents will put this hospital ahead of the competition when the time comes to hire these residents.

This residency program has benefits for my physician group, too. This is our first experience in starting an allopathic residency program, and it will give us experience that will be helpful in setting up others. This program will open up recruiting for my physician group, as many of the already vetted and graduating residents will have the opportunity to join our group. The new EM residency program at Kaweah Delta is both a needed residency program to help meet the physician shortage, and an opportunity for both the future of my physician group and for this local community.

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