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Residents Rally For Resolution,
Mediator Appointed
By PAUL NATINSKY
As the
Accreditation Council for Graduate Medical Education travels to
Detroit for its Nov. 14 site visit, WSU/DMC residents and fellows
are busy preparing themselves for potential disruptions to their
education – and the pitfalls could be perilous.
Risks range
from the personal to the professional to catastrophic damage to the
region’s health care system, WSU/DMC Resident Council President Paul
Bozyk, MD, told a gathering of attorneys and WCMSSM physicians at
the medical society’s headquarters Nov. 9.
Per an Oct. 25
letter from the ACGME, if the accrediting body finds the residency
programs unstable and/or feasible contingency plans lacking for
current residents, “the Sponsoring institution’s accreditation
status will be in jeopardy.”
In addition to
personal, financial and psychological costs to residents, Dr. Bozyk
said there are questions about the ability to relocate fellowships
and residencies, and particularly, there is uncertainty about where
the dollars attached to those programs end up.
Dr. Bozyk said
residents chose Detroit and the WSU/DMC program for a reason. If
residencies at WSU/DMC close, residents might have to accept
positions in programs that don’t offer the same case mix or academic
environment that is offered at WSU/DMC. There is also the matter of
money that flows through the residencies. “Relocation without cap
dollars for so many would make it exceedingly difficult to find
programs of comparable caliber,” he said.
The
difficulties don’t stop there. The city of Detroit, Southeast
Michigan and the state would face consequences including a
disruption of continuity of care, treatment for 25 percent of the
state’s Medicaid patients and 40 percent of Detroit’s primary care
patients.
The roots of
the current crisis trace a long joint history involving both Wayne
State University and DMC. The DMC has concerns about market share
and its bottom line as well as its reputation for clinical
excellence. WSU cites maintaining academic excellence and receiving
a fair contract among its top concerns.
DMC
administration has objected to residency programs under the WSU/DMC
umbrella partnering with other hospitals and taking business away
from DMC. WSU has pushed for partnerships with multiple health
systems as part of a stated effort to meet its residents’ needs in
cases where, in its view, the DMC can’t provide the appropriate
clinical experience.
The issues
involved are myriad and underpinned to a certain extent by disputes
about where federal money coming into the joint program is ending
up.
During his
presentation, Dr. Bozyk showed a slide from WSU Medical School Dean
Robert Mentzer, MD’s Nov. 1 presentation to board members from both
WSU and the DMC. The slide contained a bar graph showing decreased
funding to WSU. Text accompanying slides from the presentation
indicated that federal and state disproportionate share (DSH)
reimbursement to the DMC has increased annually, while DMC
pass-through DSH payments to WSU faculty physicians over the same
period have remained unchanged.
Further,
according to the Dean’s presentation, DMC eliminated $5.8 million in
recruitment and joint program development funding in 2004 as part of
an overall $8 million reduction to contracts.
In an Oct. 9
e-mail to DMC employees, CEO Mike Duggan stated, “The 700 WSU
physicians and employees now earn in excess of $200 million a year
from DMC: $80 million paid directly by DMC and another $120 million
in physician fees earned at DMC hospitals. It remains one of the
largest, if not the largest, financial packages received by any
medical school practice group from any hospital system in America.”
At the time of
Dr. Bozyk’s presentation, he was not optimistic that the sides would
come together without outside intervention; the same issues kept
resurfacing. But later that day local attorney David Fink was
appointed as mediator at the recommendation of Gov. Jennifer
Granholm. (see Dr. Bozyk’s update letter in this edition.)
Dr. Bozyk
emphasized that the focus of the negotiations should remain health
care and education. He said he was considerably more optimistic
about the sides reaching an agreement once he learned of the
mediator.
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