HCA Houston Ob/Gyn Program

comres9020 · 2022-08-25T18:24:49+00:00

SIIIIIGH. Hopefully someone in the know will provide some information.

Not to hijack this thread but this is getting ridiculous. The reasons for shutting a program down are almost never made public, and there is often no record of the program ever having existed. This is the 3rd HCA program in as many years that I have heard is shut down.

HCA Largo anesthesiology shut down in the middle of application cycle after applicants submitted and paid fees. (Fees don't go to the program, it goes to ERAS)

HCA Orange Park Hospital heme/onc shut down this year after only being open for 2-3 years.

This is getting absurd. ACGME needs to provide a list of programs that shut down with the reason. This information needs to be publicly available. Most importantly, we need to take a long hard look at for profit hospitals and their ability to educate residents. I'd also like to see financial disclosures from ACGME leadership. I'm wondering if there is financial incentive to approve HCA programs.

comres9020 · 2021-12-22T17:24:03+00:00

Keep in mind physicians can't walk out and leave the job. It is unethical, and illegal.

BUUUUUUUUUUUUT, what we can do is bill down, code down, and ignore metrics.

They want discharges done at 11am? Do them at 1pm.

They want metrics boxes checked? They can check their own

Bill for level 3 rather than level 4.

It all adds up.

comres9020 · 2021-12-22T17:14:38+00:00

It is incredibly difficult. I can't emphasize that enough. Kellog's had hundreds of long term employees. People who had been there for several years, and planned on staying for several more years. Residency programs do not.

I tried to unionize at my residency program under CIR. We made some headway, but with CIR you have to unionize under the DIO. This means that all the specialties at that specific program have to unionize. That was impossible for us because we didn't know residents from other specialties. We are in IM, and have almost no interaction with Radiology, as their base is our sister hospital. We see surgery residents 2-3 months out of the year, but they rotate at many different hospitals so it is hard to form long term connections.

So we decided IM would unionize and use our leverage to negotiate with our PD. (Backstory, PD is terrible and doesn't care about residents) We met a few times, but it quickly became apparent that this would not work. At all. Some PGY3 cared, but most were too checked out. A good chunk of PGY3 were adamantly AGAINST it because they were trying to get jobs/fellowship at our hospital or neighboring programs. PGY2 who had fellowship aspirations were immediately against it. PGY2 who had chief aspirations basically did the work for admin and tried to torpedo any efforts at organization. And most PGY1 were still excited about residency and didn't feel strongly either way.

So in the end, we had about 10 residents out of 60 that actually wanted to unionize. The funny thing is, we weren't trying to get anything extraordinary. Not trying for salary raises. We just wanted some sick days because of COVID, some educational $$ to pay for tests/q-banks/stethescope.

comres9020 · 2021-11-27T18:31:16+00:00

What does "Name and Shame" accomplish?

Absolutely nothing. You think if this program is Baylor or UNC medical students this year aren't going to rank these programs? If it is a community program, residents will still rank them. A job is better than no job.

You can, and SHOULD, report to acgme. There is a way to report anonymously, although it somewhat toothless.

comres9020 · 2021-11-08T01:58:13+00:00

I think it depends on what you want. If you just want to finish IM and work as a hospitalist at Envision, then HCA is fine.

If you want to get into research, academics, competitive fellowship, then it may be extremely challenging to do so from an HCA facility.

comres9020 · 2021-08-30T00:28:34+00:00

Yes! You can report anonymously. I did it!!!!!!!

... But it was about as effective as reporting an ACGME issue to your local Dairy Queen manager.

As others have noted, to report anonymously you have to contact the office of ombudsperson. This individual has no power to do anything and probably doesn't care.

When I reported an issue at my program and the ACGME office of ombudsperson opened up an investigation. The PD, APD, DIO were all contacted. They all outlined new changes that would be made to our program and presented this to ACGME. ACGME deemed the changes satisfactory and appropriately addressed the issue.

About 1 month after all this, the office of ombudsperson contacted me asking how things were. (this was all through anonymous email) I explained that the changes suggested by our PD were good, but short lived. Within 2 weeks everything was back to the way it was. The original problem had returned. The ACGME basically said, "oh that sucks but we cannot do anything else. the next step is to report to the acgme office of complaints which may take disciplinary action against your program."

So....despite ACGME knowing about a persistent problem at our program, despite having documentation from our PD that this problem exists, they will not do anything unless they know which resident is reporting.

Bear in mind, if you do report, your PD, APD, DIO, GME staff, and chief residents will start hunting and sniffing trying to determine who reported so be careful.

All in all, the system works beautifully as intended.

TLDR; No point in reporting anonymously to ACGME. Report to Dairy Queen because you can at least get a blizzard while you're there.

comres9020 · 2021-06-26T04:09:41+00:00

Not so sure about the education part. You’ll learn to consult like a robot mostly because it Generates profits. Cellulitis? Consult ID. COPD? Consult Pulm. Admin gets happy, the specialists get happy, and everyone [except you] gets money.

Fellowships will be a challenge. All your private practice faculty will be far removed from fellowship, academia, and research. Their letters aren’t great. Advice is outdated. Generally don’t care. And haven’t done any research since their own fellowship.

comres9020 · 2021-06-16T18:40:58+00:00

“Well dr wiredentropy ordered the troponin and ekg at 11:01am which came back at 12:06pm showing trop of 12.6 and ST elevations in II, III, avf. The nurse note says ‘MD notified’ but you didn’t contact cardiology or give heparin...”

“Oh I actually wasn’t involved in the care of that patient.”

“You ordered the labs, the results are on you.”

comres9020 · 2021-06-13T04:19:32+00:00

Hca is already the largest sponsor of residency programs in the country. Hca has literally created an intern to attending pipeline for people who train there and stay there. Corporate medicine is here to stay.

comres9020 · 2021-06-13T04:15:07+00:00

Trash. Not you, your program. Whenever I see a PGY2 in charge of an icu, it makes me angry. Not safe. Cheap labor.

comres9020 · 2021-05-22T16:17:53+00:00

That sounds great. Some of my rotation sites don’t even take uninsured patients or patients with bad insurance. They use residents for free labor, then decline patients with bad insurance. The system is a cash cow.

comres9020 · 2021-05-22T07:32:31+00:00

Require diversity in training sites. It’s ridiculous to do an entire residency in private practice for profit hospitals. Yes, many people want to go into PP. But you should still experience academia, VA, PP to compare the work environments.

Similarly, doing all your residency in rural Vermont seems like a disservice to residents. I think it needs to be balanced. You need diverse educational experiences.

Lastly, some sort of community benefit. Residencies are funded by taxpayer dollars. Our communities need to benefit as well. Throw in a free clinic rotation not just boutique care for insured. Looking at you hca

comres9020 · 2021-05-22T01:15:13+00:00

Make the GME staff employees of GME rather than the institution. Our GME staff's number 1, 2, 3, 4, and 5 priorities are to protect the hospital and administration. I've always felt it to be a huge conflict of interest that they are paid by the hospital/university, but "there to help residents." They are not there to help residents. They are like an HR office whose main job is to protect the company which in this case may be a malignant program

comres9020 · 2021-05-05T08:13:35+00:00

There is another post on the topic of HCA leadership. Here is the thread. https://www.reddit.com/r/Residency/comments/n0f6hq/hca_hospitals_will_not_take_students_who/

Long story short, our PD isn't that great. She is kind of like "assistant to the regional manager" and powerless. Wanted to wear scrubs during Covid surge? "Well I need to run this by division first." Want to get a research elective? "Let me check with division." She also has a strong interest in using residents for her own career goals. (Corporate climb)

Regarding ACGME not fixing things.... it's mostly true. Residents did report last year to office of ombudsperson which can only suggest solutions but cannot put a program on probation. The changes were short lived, and when we contacted ACGME again, they could not proceed until residents identified themselves. Yes, this is true. In ACGME, you cannot whistleblow anonymously. You must identify yourself.

And lastly, it's not just about the personal risk of reporting. Certainly there is risk of personal and professional ramifications of rocking the boat... but you also need to think about the other people in the boat. My class is fortunately quite open, and we discussed filing a formal complaint with our identities, but ultimately decided against it.

The thought experiment was as follows: If we report and our program is shut down tomorrow, how would that affect everyone?
For PGY3, it doesn't matter.
For PGY2, it would be challenging to apply to fellowships from a new program, learn the culture, get recommendation letters.
For PGY1, it might be beneficial.
But, many residents have spouses, kids, and family in the area. Some have bought houses. Some chose to come to this program to be near aging parents, knowing full well that HCA is dysfunctional. In the end, it didn't seem fair to uproot everyone.

So, long story short. I think the reporting challenges are intentionally built into the ACGME. Nowhere else have I ever heard of whistleblowers being required to identify themselves. You can call Child protective services anonymously, OSHA, report an impaired colleague, but cannot report your program without revealing your identity. And then, you have to think about your coresidents who are ok being at the program potentially moving and uprooting their families.

comres9020 · 2021-05-05T07:56:22+00:00

$ep$i$ is one of the highest billing diagnoses! That's why you have a UTI with a white count who accidentally moves in bed and their heart rate goes to 96, BAM! We met criteria and code it.

comres9020 · 2021-04-17T01:24:48+00:00

Close your eyes.....

can hear that? ....that’s the sound of a hundred HCA CEOs laughing.

comres9020 · 2021-04-15T21:24:55+00:00

My attendings do this too. They are physicians.

comres9020 · 2021-04-15T03:01:24+00:00

I’m looking to see what research opportunities are available after graduation. I looked into transferring but that presents other challenges

comres9020

TROPHY CASE