0403residencyaudTracy Vardeman of Northeast Georgia Health System talks about the challenges of creating a medical residency program.
Should Northeast Georgia Medical Center become a training ground for new physicians?
The hospital is considering establishing a medical residency program, but officials say they’ll have to think carefully before making such a commitment in time and money.
"There are still a lot of questions to be asked," said Tracy Vardeman, vice president of strategic planning for Northeast Georgia Health System. "Training (graduate) medical students is a substantial shift in what we do each and every day in this organization."
Last year, the Georgia Board for Physician Workforce received $500,000 from the General Assembly to explore creating a medical residency program at the Gainesville hospital and two Athens hospitals, St. Mary’s and Athens Regional Medical Center.
Using about $120,000 of that money, the three hospitals hired Boston-based ECG Management Consultants to do a preliminary study. That report was completed in January.
"The phase one study looked at the overwhelming need for physicians," said Vardeman. "Now we’re looking at whether we should go to phase two of the study."
The second report would examine the practical issues of creating a residency program, such as financial feasibility and the logistical challenges of three institutions working together.
It’s not even clear at this point where the resident physicians would come from. The Medical College of Georgia is planning to start a branch campus at the University of Georgia, possibly as early as next year. But Brenau University is also looking at starting a medical school in Gainesville.
In either case, students would attend medical school for four years, and then would need to work at a hospital for three to seven years as they hone their clinical skills.
Most newly graduated physicians in Georgia do their residencies in Atlanta or Augusta, the cities where the state’s existing medical schools are located.
Having residency programs in Gainesville and Athens could bring more physicians to those smaller cities, which will need hundreds more doctors as the area’s population grows.
"The single strongest determining factor of where you practice in the future is where you did your residency," said Ben Robinson, director of the Georgia Board for Physician Workforce.
He said unlike the decision to build a new hospital, Georgia has no "certificate of need" requirement for residency programs; any hospital is free to create one. But there are two enormous hurdles to overcome: accreditation and funding.
Robinson said every program needs to meet the requirements of the national Accrediting Council for Graduate Medical Education, because doctors who don’t go through an accredited program are not eligible for board certification.
"Residency programs are heavily regulated, because of the potential harm that medical professionals can cause if they aren’t properly trained," Robinson said.
He said a hospital can choose to just have a single residency program, or it can have multiple programs in a variety of specialties.
"It can be as simple or as complicated as you want to make it," he said.
The most difficult question, however, will be figuring out how to pay for it. Training each resident can cost more than $100,000 a year. Robinson said funding can come from a variety of sources, including Medicare, the Veterans Administration, state government, medical schools and the hospitals themselves.
"Medicare is the largest source," he said.
But that funding may begin to dry up as Medicare approaches its own fiscal crisis.
Complicating the issue further, for Gainesville and Athens, is that three different hospital systems would be sharing responsibility.
"There are additional challenges to this approach," Robinson said. "It is doable. But a consortium is not a common model."
He said he only knows of a handful of other programs around the country that are operated by a consortium of hospitals.
"It requires good communication between the organizations," he said, noting that dividing up the funding could be especially tricky. "Medicare dollars go to each hospital, so how do you direct the flow of money?"
On the other hand, Robinson thinks the residency proposal is worth considering.
"These programs certainly are expensive," he said. "But there’s tremendous potential benefit. For patients, it’s mostly positive. These (new) physicians have the most up-to-date training. They know all the new science."
Robinson said if the three hospitals are willing to work together, a residency program could be started from scratch within a relatively short time frame.
"Reasonably, they could have this in place by 2012," he said.