Rifram09 said:
For the docs: is there something TCU and/or wealthy TCU supporters should do to help generate residency positions in FW? For example, could a wealthy donor gift a large sum to an existing hospital in FW to create new residency slots? Is that how it typically works? If not, how does it usually work.
Thanks!
Residency, or GME, positions are typically funded by government dollars through medicare. A cap on funded positions was put in place in the mid to late 90's, so that the number of positions each program had funded was frozen at the cap. Because some teaching hospitals utilize residents heavily, many went over the cap by funding the positions themselves out of operational dollars. The deciding factor tends to be figuring out if they could get NP's or PA's or staff physicians to do the work normally done by residents at a comparable price. Many factors go into this decision since there are built in inefficiencies when you deal with residents in training. The natural course is that they do their training and move on, so the hospital is constantly dealing with new and inexperienced young doctors. The new ones tend to order more unnecessary tests and those costs are bore by the hospital (and patients?). A certain part of the direct and indirect costs paid by the medicare money that funds those training positions are earmarked for the hospital to cover some of those inefficiencies.
When hospitals go over their medicare caps, they must bear all of the hidden costs themselves, so determining the value versus costs of residency training in those situations has been an ongoing study and it varies greatly by specialty. Residents get paid very little if you look at it on a per hour basis, since many work 80 hours a week. Replacing one resident, in certain situations, may require hiring two persons (NP's, PA's, CRNA's etc). However, because residents rotate on other specialties/services/hospitals that the other providers do not, the ratio and costs can be very challenging to figure, and is often just a best guess. I mentioned that new residents can be very inefficient, however, residents who are in a 4 or 5 year program are generally excellent by the time they are in the 3rd through 5th year, and often even in their 2nd year. So, those residents provide outstanding resources for patient care at very little cost. Other things such as benefits have to be factored in for each group.
Funding a mid size or large residency program can be very costly. Getting government funding for a new residency program is likely challenging. Funding it completely from the private sector would be a high cost as well. Another monetary source is the VA. Many med schools and residency programs collaborate with a VA hospital in order to defray some of the costs, since the VA will fund a percentage of the residency programs in exchange for the services of the residents in the care of their veterans. Other examples include collaborations with other hospitals. For example, UTMB Galveston collaborates with the Texas Dept of Corrections as well as the Shriner's Burn Hospital.
It has recently been estimated that each resident (in our area of the country; salaries are generally higher in CA and NY, for instance) has an annual cost of ~$75K after salary and benefits have been factored in. So, for a private entity to fund a residency program of modest size, say 50 residents per year, it would require an annual contribution of $3.75 million. Assume that the teaching hospital or VA partner would pay a large portion of that for clinical services covered. So, I am not sure what costs would be left over that would require funding. The funding would have to be renewable for the health of the residency programs with their accreditation bodies. In addition, they would need to make sure willing faculty are in place to teach the residents (the experience a trainee gets in a large teaching hospital will be vastly different than the experience they receive in a small community hospital).
I have written all of this to say, I really don't know how much it would take in funding to make it worth it to a hospital to undertake this type of endeavor if they had not previously been doing that.
Bring on the TL/DR
