Waco Va Hospital Case Study
The Expansion of a Residency Program in the Waco VA Hospital
By expanding the residency program already in place, the amount of patients seen could well cover the amount of people needing care.
Cost
The addition of 5 faculty would incur an additional $900,000 for salary. However, residents are only paid around $65,000 and work upwards of 80 hours a week. So the total cost for the addition of 50 residents would be around $3.25 million, however Medicare appropriates funds to help educate residents. In total, however, the cost per resident would be closer to $100,000, if technology, teaching materials, and other non-salary expenses (Moore). With the addition of faculty, addition or repurposing of rooms would need to occur so the faculty would …show more content…
be able to have offices and the medical libraries could be expanded. A general estimate of $7 million can be given to the repurposing and remodeling of the hospital rooms, however this can be more or less depending on the extensiveness of the remodel.
In 2008, “the Medicare program paid an estimated $2.7 billion for direct graduate medical education and $5.74 billion for indirect medical education.” (AHA 3) For each resident, $76,000 from the Direct Graduate Medical Education (DGME) fund is appropriated and $38,000 from the Indirect Medical Education (IME) fund is appropriated. (Moore) These funds would cover most of the expenses incurred with taking on residents and it covers half of the salary for director and assistant directors and supports the faculty teachers. In addition to Medicare funding, faculty members that participate in research could be awarded funding from the NIH. Last year, “National Institute awarded teaching hospital faculty $2.2 billion in research funding” (AHA 1). However, only 25.9% of costs have to do with wages (Koenig 118). Taking that into account, the addition of the proposed number of residents combined with all other costs would actually be closer to $13 million. The benefits of a teaching hospital are not just seen in the hospital, but in the community as well.
Teaching Hospitals are major economic engines in their communities, generating business, employment and tax revenue. Teaching Hospitals directly employ 2.7 million people and are often the largest employer in their communities. Businesses operating in other sectors benefit from the direct expenditure of hospitals and their staff (AHA 2). Every dollar spent by a member medical school or teaching hospital indirectly generates an additional $1.30 when it is “re-spent” on other businesses or individuals, resulting in a total impact of $2.30 per dollar spent (AHA …show more content…
2).
Time To become a teaching hospital, there are several things that must happen before a hospital can open their doors to residents. To be an accredited teaching hospital, CTVHCS must go through the Accreditation Council for Graduate Medical Education (ACGME) and file paperwork to be reviewed. But before any of that can happen, faculty must be hired including a program director, associate program directors, and teaching physicians. The number of faculty hired corresponds with the number of residents allowed in. With the current 115 residents, there should be 3 associate directors and 8 faculties and a program director, however expanding by 50 residents would require adding 2 more associate directors and 3 more faculties (About CTVHCS). To hire professionals, the process would include them applying or headhunting for qualified candidates, interviewing, selecting the individuals, allowing them time to leave their previous job and relocate here, going through the necessary paperwork, and going through all the routine initiation protocols such as fingerprinting, background checks, more paperwork, giving them time to transfer over their accreditations and necessary paperwork for insurance agencies so that they will be able to treat patients and insurance companies will cover it. This can take anywhere from under a month to nearly 6 months. Offices for the added faculty would need to be added whether built on or repurposed from other rooms. The remodel of these rooms would be an estimate of 6 months to finish.
Once the faculty are hired, the year’s graduating medical students will have to apply to programs the beginning of their senior year and Match Day is 3rd Friday of March. Match Day is when Medical Students are sorted into their respective programs in Hospitals. “Matching to a residency program is a very involved process that lasts nearly a year.” Students begin researching possible residencies the previous May and apply in September (The Match). They enter into the hospitals in July. However, these elements with students, faculty, and facilities can occur simultaneously, so total time would be around a year for full implement.
Availability of Resources
The most difficult resource will be finding faculty for the residents. If an additional 50 residents were added, two more associate directors would need to be hired as well as 3 more faculty members. In the chart below, it is outlined how much of each would be needed depending on the number of residents in the program (Moore 7-8).
Residents Associate Directors
80-119 3
120-159 4
>159 5
Residents Core Faculty
106-120 8
121-135 9
136-150 10
151-165 11
166-180 12
>180 13
There would, also be a need for space for the expansion. This would mean either a loss of hospital rooms to become faculty offices, or they would need to expand the hospital requiring land. Each of these potential problems would require funds and time to allow proper resources to be allocated.
Sustainability
With the addition of spots in the residency program, more physicians will be trained each year, and that will in turn create a more available workforce for the hospitals to pull from to find individuals that would be a fit in their programs. This solution would be sustainable as long as funding was there, if Medicare or Veterans’ Affairs withdrew any funding there would need to be cutbacks on the size of the class, however it would still be a teaching hospital and still have all the materials to return to their original class size.
Pros
• Patients receive treatment from highly qualified physicians with access to most advanced technology and equipment (Wexler 40)
• Patients with complex, unusual, or difficult diagnosis usually benefit from the presence of acknowledged medical experts and more comprehensive resources available at these facilities (Wexler 40)
• Teaching Hospitals serve as centers of research and innovation, helping to develop new treatments and cures. (AHA 1)
• National Institute awarded teaching hospital faculty $2.2 billion in research funding. (AHA 1)
• Teaching hospitals provide important non-hospital services that benefit patients and their communities such as health screenings and support groups (AHA 2)
• Teaching Hospitals are major economic engines in their communities, generating business, employment and tax revenue. Teaching Hospitals directly employ 2.7 million people and are often the largest employer in their communities. Businesses operating in other sectors benefit from the direct expenditure of hospitals and their staff. (AHA 2)
• Every dollar spent by a member medical school or teaching hospital indirectly generates an additional $1.30 when it is “re-spent” on other businesses or individuals, resulting in a total impact of $2.30 per dollar spent. (AHA 2)
• Under the Medicare Program, teaching hospitals receive additional payments to offset the added costs associated with training and support of medical residents. (AHA 3)
• In FY 2008, the Medicare program paid an estimated $2.7 billion for direct graduate medical education and $5.74 billion for indirect medical education.
(AHA 3)
• You Know Who the Good Physicians Are and You Can Keep Them (Moore)
• Huge Savings in Recruitment (Moore)
• Average Cost Per Placement Is $25,000/Physician (Moore)
• Staff High Frequency Clinical Areas with Inexpensive Faculty (Moore)
• Expand Primary Care Access Without Investing in Established (i.e., Expensive) Physicians (Moore) Cons
• Inconvenience and invasion of privacy that may result from multiple examinations performed by residents and students (Wexler 40)
• Some teaching hospitals have reputations for being impersonal (Wexler 40)
• In addition to residents’ salaries and benefits, teaching hospitals must pay for faculty, faculty offices, classroom space, and comprehensive medical libraries and advanced, highly sophisticated technological equipment to support their residency programs. (AHA 3)
• Hospitals are being challenged by evolving patient needs and shifts in where care is delivered; increasing pressure on already-stretched resources; Medicare residency caps that may constrain their ability to train new physicians; and payment changes that limit their ability to offer state-of-the-art clinical and educational experiences (AHA
4)
By expanding the residency program already in place, the amount of patients seen could well cover the amount of people needing care.
Cost
The addition of 5 faculty would incur an additional $900,000 for salary. However, residents are only paid around $65,000 and work upwards of 80 hours a week. So the total cost for the addition of 50 residents would be around $3.25 million, however Medicare appropriates funds to help educate residents. In total, however, the cost per resident would be closer to $100,000, if technology, teaching materials, and other non-salary expenses (Moore). With the addition of faculty, addition or repurposing of rooms would need to occur so the faculty would …show more content…
be able to have offices and the medical libraries could be expanded. A general estimate of $7 million can be given to the repurposing and remodeling of the hospital rooms, however this can be more or less depending on the extensiveness of the remodel.
In 2008, “the Medicare program paid an estimated $2.7 billion for direct graduate medical education and $5.74 billion for indirect medical education.” (AHA 3) For each resident, $76,000 from the Direct Graduate Medical Education (DGME) fund is appropriated and $38,000 from the Indirect Medical Education (IME) fund is appropriated. (Moore) These funds would cover most of the expenses incurred with taking on residents and it covers half of the salary for director and assistant directors and supports the faculty teachers. In addition to Medicare funding, faculty members that participate in research could be awarded funding from the NIH. Last year, “National Institute awarded teaching hospital faculty $2.2 billion in research funding” (AHA 1). However, only 25.9% of costs have to do with wages (Koenig 118). Taking that into account, the addition of the proposed number of residents combined with all other costs would actually be closer to $13 million. The benefits of a teaching hospital are not just seen in the hospital, but in the community as well.
Teaching Hospitals are major economic engines in their communities, generating business, employment and tax revenue. Teaching Hospitals directly employ 2.7 million people and are often the largest employer in their communities. Businesses operating in other sectors benefit from the direct expenditure of hospitals and their staff (AHA 2). Every dollar spent by a member medical school or teaching hospital indirectly generates an additional $1.30 when it is “re-spent” on other businesses or individuals, resulting in a total impact of $2.30 per dollar spent (AHA …show more content…
2).
Time To become a teaching hospital, there are several things that must happen before a hospital can open their doors to residents. To be an accredited teaching hospital, CTVHCS must go through the Accreditation Council for Graduate Medical Education (ACGME) and file paperwork to be reviewed. But before any of that can happen, faculty must be hired including a program director, associate program directors, and teaching physicians. The number of faculty hired corresponds with the number of residents allowed in. With the current 115 residents, there should be 3 associate directors and 8 faculties and a program director, however expanding by 50 residents would require adding 2 more associate directors and 3 more faculties (About CTVHCS). To hire professionals, the process would include them applying or headhunting for qualified candidates, interviewing, selecting the individuals, allowing them time to leave their previous job and relocate here, going through the necessary paperwork, and going through all the routine initiation protocols such as fingerprinting, background checks, more paperwork, giving them time to transfer over their accreditations and necessary paperwork for insurance agencies so that they will be able to treat patients and insurance companies will cover it. This can take anywhere from under a month to nearly 6 months. Offices for the added faculty would need to be added whether built on or repurposed from other rooms. The remodel of these rooms would be an estimate of 6 months to finish.
Once the faculty are hired, the year’s graduating medical students will have to apply to programs the beginning of their senior year and Match Day is 3rd Friday of March. Match Day is when Medical Students are sorted into their respective programs in Hospitals. “Matching to a residency program is a very involved process that lasts nearly a year.” Students begin researching possible residencies the previous May and apply in September (The Match). They enter into the hospitals in July. However, these elements with students, faculty, and facilities can occur simultaneously, so total time would be around a year for full implement.
Availability of Resources
The most difficult resource will be finding faculty for the residents. If an additional 50 residents were added, two more associate directors would need to be hired as well as 3 more faculty members. In the chart below, it is outlined how much of each would be needed depending on the number of residents in the program (Moore 7-8).
Residents Associate Directors
80-119 3
120-159 4
>159 5
Residents Core Faculty
106-120 8
121-135 9
136-150 10
151-165 11
166-180 12
>180 13
There would, also be a need for space for the expansion. This would mean either a loss of hospital rooms to become faculty offices, or they would need to expand the hospital requiring land. Each of these potential problems would require funds and time to allow proper resources to be allocated.
Sustainability
With the addition of spots in the residency program, more physicians will be trained each year, and that will in turn create a more available workforce for the hospitals to pull from to find individuals that would be a fit in their programs. This solution would be sustainable as long as funding was there, if Medicare or Veterans’ Affairs withdrew any funding there would need to be cutbacks on the size of the class, however it would still be a teaching hospital and still have all the materials to return to their original class size.
Pros
• Patients receive treatment from highly qualified physicians with access to most advanced technology and equipment (Wexler 40)
• Patients with complex, unusual, or difficult diagnosis usually benefit from the presence of acknowledged medical experts and more comprehensive resources available at these facilities (Wexler 40)
• Teaching Hospitals serve as centers of research and innovation, helping to develop new treatments and cures. (AHA 1)
• National Institute awarded teaching hospital faculty $2.2 billion in research funding. (AHA 1)
• Teaching hospitals provide important non-hospital services that benefit patients and their communities such as health screenings and support groups (AHA 2)
• Teaching Hospitals are major economic engines in their communities, generating business, employment and tax revenue. Teaching Hospitals directly employ 2.7 million people and are often the largest employer in their communities. Businesses operating in other sectors benefit from the direct expenditure of hospitals and their staff. (AHA 2)
• Every dollar spent by a member medical school or teaching hospital indirectly generates an additional $1.30 when it is “re-spent” on other businesses or individuals, resulting in a total impact of $2.30 per dollar spent. (AHA 2)
• Under the Medicare Program, teaching hospitals receive additional payments to offset the added costs associated with training and support of medical residents. (AHA 3)
• In FY 2008, the Medicare program paid an estimated $2.7 billion for direct graduate medical education and $5.74 billion for indirect medical education.
(AHA 3)
• You Know Who the Good Physicians Are and You Can Keep Them (Moore)
• Huge Savings in Recruitment (Moore)
• Average Cost Per Placement Is $25,000/Physician (Moore)
• Staff High Frequency Clinical Areas with Inexpensive Faculty (Moore)
• Expand Primary Care Access Without Investing in Established (i.e., Expensive) Physicians (Moore) Cons
• Inconvenience and invasion of privacy that may result from multiple examinations performed by residents and students (Wexler 40)
• Some teaching hospitals have reputations for being impersonal (Wexler 40)
• In addition to residents’ salaries and benefits, teaching hospitals must pay for faculty, faculty offices, classroom space, and comprehensive medical libraries and advanced, highly sophisticated technological equipment to support their residency programs. (AHA 3)
• Hospitals are being challenged by evolving patient needs and shifts in where care is delivered; increasing pressure on already-stretched resources; Medicare residency caps that may constrain their ability to train new physicians; and payment changes that limit their ability to offer state-of-the-art clinical and educational experiences (AHA
4)