January 23, 2004

VUMC residents will return from Saint Thomas

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Johannie Resto, left, interprets the questions of Nurse Practitioner Mark Young to Maria Torres, center, before her son, George, has a procedure. Photo by Dana Johnson

VUMC residents will return from Saint Thomas

Last week it was announced that Vanderbilt will discontinue its academic affiliation with Saint Thomas Hospital effective July 2005. Vanderbilt has sent residents for training rotations in medicine and surgery at Saint Thomas since the late 1970s. VUMC residents working and training at Saint Thomas will be reassigned within Vanderbilt. Currently 35 of the 780 VUMC residents are assigned rotations at Saint Thomas.

“Our educational resources at VUMC have been strengthened remarkably over the years, lessening our need to send our students and residents to other sites,” said Dr. Steven G. Gabbe, dean of the School of Medicine. Speaking Tuesday afternoon at a VUSM town hall meeting, Gabbe said that, since the beginning of the relationship with Saint Thomas, the number of medical undergraduates at Vanderbilt has remained stable (at roughly 400) while the faculty has grown from approximately 500 to more than 1,300. Patient volume has also risen steadily: in just the past five years, outpatient visits are up roughly 40 percent and surgical cases are up approximately 27 percent. Gabbe said that, considering the expanded training opportunities posed by the greatly increased faculty presence and patient volumes at Vanderbilt, and considering the educational impact of VUMC’s advanced clinical informatics capabilities, “We think the very best place for you to train is right here.”

The relationship with Saint Thomas has entailed substantial additional costs for VUMC since last July when, in the interest of patient safety and resident quality of life, the Accreditation Council for Graduate Medical Education began limiting residents to an 80-hour work week. Vanderbilt began to employ nurse practitioners and physician assistants to do work previously performed by residents. While Vanderbilt physicians-in-training make between $38,000 (first year) and $50,000 (tenth-year fellows), these nurses and assistants command annual salaries of about $70,000.

According to the Association of American Medical Colleges, the average cost for academic medical centers resulting from the new work requirements is $3.8 million per year. In the fiscal year that ends in June, Vanderbilt estimates its costs due to the rule at $2.8 million, rising to $4 million next year.

Sending residents to Saint Thomas had suddenly become much more expensive for Vanderbilt. Gabbe said VUMC Vice-Chancellor Harry R. Jacobson asked Saint Thomas to help with these costs. When Saint Thomas replied that it was unable to do so, Vanderbilt proposed a list of alternative exchanges but was again turned down. “Their response was disappointing,” Gabbe said. “We gave them every opportunity, but the response appeared to reflect a diminished regard for our relationship. … We felt we had no decision other than to end the association.” In all, the negotiations lasted about six months. On Dec. 30, Vanderbilt issued a notice of termination in 18 months as provided under the contract.

Gabbe emphasized the excellent educational programs provided for students and residents at the Veterans Administration Hospital and through the Meharry-Vanderbilt Alliance. He said he considers opportunities to participate in community health care settings to be valuable for Vanderbilt students and residents, and that VUMC is making arrangements to expand these opportunities. “We are not going to do anything that might compromise your education,” Gabbe told the students.

Gabbe said VUMC termination of resident rotations at Saint Thomas will not prevent medical students from studying with faculty preceptors at Saint Thomas, and, at this time, there is no reason to believe it will affect the five VUMC resident slots in obstetrics and gynecology at Baptist Hospital (which is owned by Saint Thomas Health Services).