Discuss Detroit » Archives - Beginning January 2007 » Fighting words from Duggan re: WSU « Previous Next »
Fighting words from Duggan re: WSU - 1Crew126 11-16-06  11:27 am
  ClosedNew threads cannot be started on this page. The threads above are previous posts made to this thread.        

Top of pageBottom of page

313_doc
Member
Username: 313_doc

Post Number: 23
Registered: 09-2006
Posted on Thursday, November 16, 2006 - 2:05 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Are there any wheels left on this cart?

It’s interesting to see that the residents have retained council to secure their CMS funding if it comes down to that. As I said in an earlier post, it looks as if the AMA has looked into this so I’d be curious if there has been any legislation governing the transfer of these funds. If anything, these are federal government funds, and I would hope that they would slam Duggan if he tries anything funny.

I agree with the above posts and would point out that many of Duggan’s recent hires are being paid salaries far higher than their predecessors, namely in the orthopedic department, to cover services. If this whole disagreement was about $$$, then where is he getting this new funding. I know that there aren’t any residents left to help out with the work, but I agree that it’s only a matter of time before the books come back to bite Duggan and the DMC with their creative accounting.

While many of the residents, attendings and departments appear somewhat optimistic, there are rumblings that they need to start making plans and to try and contact those that will listen, i.e. board members and those in govt. for help. This is where it gets interesting because Jenny might no longer be able to reel in Duggan anymore. If there is anyone that can contain Duggan, they are keeping very quiet…
Top of pageBottom of page

Gistok
Member
Username: Gistok

Post Number: 3086
Registered: 08-2004
Posted on Thursday, November 16, 2006 - 2:20 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

I cannot see Duggan come out of this unblemished. This whole scenario has been cannon fodder for anyone who runs against him in the future for any political office. He'll spend most of any future campaign defending himself for his actions here.

There's too many "bodies" left in the wake for him to be able to "spin" his way out of this. He can talk all he wants about saving money for DMC... it's the human toll and suffering that people will understand, not bean counting.

Him coming out smelling like a Rose? If there's no agreement, I don't think so.
Top of pageBottom of page

Ash
Member
Username: Ash

Post Number: 12
Registered: 11-2006
Posted on Thursday, November 16, 2006 - 2:43 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

------------------------------ --------------------
because Jenny might no longer be able to reel in Duggan anymore. If there is anyone that can contain Duggan, they are keeping very quiet…
------------------------------ --------------------

Why wouldn't the governor be able slap some sense into this idiot? I would think and am afraid for that same reason, that Duggan and his band of lawyers might have looked real good into this CMS funding. If they were allowed to retain Ortho's funding, who can stop them from keeping that of the rest of the residencies?
Top of pageBottom of page

313_doc
Member
Username: 313_doc

Post Number: 24
Registered: 09-2006
Posted on Thursday, November 16, 2006 - 8:44 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

I stand corrected. The truth of the matter is Mike Duggan and the DMC control the CMS money. There is NO way to force their hand short of retroactive legislation from the federal level that would strip the hospital of the cash. The DMC will hold on to this money and will continue to receive it for the next 2-3 years until this cycle is done regardless of them training residents. The amount is based on the previous 3 year cap. Right now he has all the cards. He did his research.

Sorry folks…wish I had better news.
Top of pageBottom of page

Ccbatson
Member
Username: Ccbatson

Post Number: 5
Registered: 11-2006
Posted on Thursday, November 16, 2006 - 10:06 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

In response to the race question, I don't see it as having anything to do with that. It has to do with money and politics plain and simple. Look at the main players...Duggan, Mentzler...both wealthy caucasions (Duggan more wealthy than Mentzler), then look at the DMC and WSU board of directors...you may be surprised at what you find.

Duggan is going into this with his eyes wide open for the short term in terms of the CMS money. That gives him 3 years in which the 110 or so million per year coming in stays in the budget....guess how long his contract is....that's right, 3 years (are you surprised). He is gambling that he can recover this 110 million per year in the next 3 years.....a long shot by any oddsmakers' estimate. Furthermore, he almost certainly has an early exit strategy if it looks like he is going to lose this gamble in which the finger gets' pointed at WSU, and anyone one else that he sees as an opponent (politically, or otherwise). He is one shrewd SOB, you got to give him that...a perfect politician (G-d help us).
Top of pageBottom of page

313_doc
Member
Username: 313_doc

Post Number: 25
Registered: 09-2006
Posted on Thursday, November 16, 2006 - 10:23 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

I love hearing everyone talk about the governor or the boards stepping in to fix this. Hello people, if they haven’t done anything by now, I highly doubt that they are going to do anything in the near future. The only thing that I can see derailing Duggan (and Malone) is federal Medicare legislation that would be retroactive in nature to change the way that CMS funds are allocated. Basically it’s up to Stabenow and Levin and possibly the AMA with their PAC to force this from Washington. Seriously, for those who think that Jenny is going to step in and save the day…look it’s just not going to happen.

Well, at least I think that WSU will be remembered. I’m sure that the legislation that will eventually be created will be called the WSU clause or something like that.
Top of pageBottom of page

Yvette248
Member
Username: Yvette248

Post Number: 149
Registered: 10-2006
Posted on Thursday, November 16, 2006 - 10:35 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

The deadlines has passed. The accreditation board is here. They just called a state of emergency.

I'm sorry people, but the fat lady is singing.
Top of pageBottom of page

313_doc
Member
Username: 313_doc

Post Number: 26
Registered: 09-2006
Posted on Thursday, November 16, 2006 - 10:42 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Can someone explain to me what they mean by a state of emergency.

Is that like martial law? Is there going to be a curfew? Is there going to be a run on milk and bread in the stores?

We should all run for the hills and all get Beaumont doctors!
Top of pageBottom of page

Ccbatson
Member
Username: Ccbatson

Post Number: 6
Registered: 11-2006
Posted on Thursday, November 16, 2006 - 10:42 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

This is not the first time that the ACGME has shut down and relocated residents from a University program (although it is one of a very few). I am not confident that the government will make sweeping changes, and even less confident that they would do it retroactively to effect any change in this situation.
Top of pageBottom of page

Ccbatson
Member
Username: Ccbatson

Post Number: 7
Registered: 11-2006
Posted on Thursday, November 16, 2006 - 10:46 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

It is MSMS calling it a state of emergency. All it means (IMO) is that MSMS is speaking up (but not really doing anything) to be counted on the side of the victims (and it seems leaning towards WSU's position). It brings to mind Monty Pythons' Life of Brian where they are talking about taking action in political language illustrating their impotence.
Top of pageBottom of page

313_doc
Member
Username: 313_doc

Post Number: 27
Registered: 09-2006
Posted on Thursday, November 16, 2006 - 11:25 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

I too am important...er...impotent.

Honestly I think that there will be some legislation as the AMA alluded to in one of my earlier posts. There has to be or else dual sponsored residencies can take notice and pull the exact same thing. This was one of those loophole situations that Duggan totally exploited. I mean hey, I have to tip my hat to him doing all that research. Yes he’s pure evil, like the emperor in Star Wars, but he did his work. Now I wouldn’t want to change places with him or anyone else on that board. The karma will go around and eventually catch up to them, but it probably won’t be before ensuing s*!# storm that descends on the Detroit.

Hopefully the MSMS can have another meeting or forum to discuss matters, the med students that are paying attention can hold another rally, and Tom Malone can get some new rims on his Mercedes…and Mentzer can continue to stay the course. Good luck everyone, start getting your CVs together.

Sing it Carney Wilson!
Top of pageBottom of page

Fxfixer
Member
Username: Fxfixer

Post Number: 1
Registered: 11-2006
Posted on Thursday, November 16, 2006 - 11:36 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

I am also one of the former WSU/DMC ortho residents (along with 313_doc and femur).

To current residents....Now is the time to start calling potential programs for transfer. Get that CV and letters of recommendation in order. DO NOT WAIT for final word from your program directors or the medical school. Be proactive and start realizing that NO ONE will look out for your future except YOU.

When we went through this in the spring, countless leaders from the DMC and the university recommended that we wait until our fate was decided before contacting programs. In the end, we did ALL the footwork in getting our own spots.

Do NOT expect help from the DMC or WSU. Countless emails and pleas for help to former interim Dean Robert Frank and Dean Juzych (we nicknamed him "Useless") went unanswered.

With regard to funding...yes, our funding did not follow us and many programs initially willing to take us were subsequently unable due to their own lack of funding. My advice...focus your efforts on programs where money is not too much of an issue. If you look were the 24 ortho residents went, most were well-to-do programs were lack of CMS funding was not an issue.

Transferring programs is not easy...Imagine being a fourth year resident at a new place but being treated like an outsider...It feels like being an intern again. But in the end, you are in a better place with more stability and (most often) getting better training than you did at WSU/DMC.

Please remember all that is happening to you now when 1) election time comes and a certain Mr. Duggan is running for governer...and 2) when WSU Med school calls asking for donations...did they really look after your best interests?
Top of pageBottom of page

Fxfixer
Member
Username: Fxfixer

Post Number: 2
Registered: 11-2006
Posted on Thursday, November 16, 2006 - 11:55 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

BTW...when ortho closed at WSU/DMC, neither the medical center nor the university had the common courtesy to notify the residents.

You want to know how we found out about our fate?...We read about it in the Free Press:

http://www.udmercy.edu/news_ev ents/inthenews/April%2006/4-1- 06_DMC.pdf

Act now...don't wait for the Free Press or DetNews to tell you that your residency has been shut down.
Top of pageBottom of page

Ccbatson
Member
Username: Ccbatson

Post Number: 9
Registered: 11-2006
Posted on Friday, November 17, 2006 - 1:10 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

My G-d, awful does not begin to describe the sad state of affairs you guys were put through. Even worse, these are ortho residents, meaning top of the class, first string material. Now imagine the folks in other lesser competitive fields in greater numbers trying to relocate, without help.

Yes, in the end, you have to look after yourself, and these Ortho residents did an excellent job of it where not one ended up in a lesser program than the one that was pulled out from under them. But that is not the way it is supposed to be, when they were hired they signed a contract which the DMC/WSU simply ignored....isn't that illegal!!! Not only that, they STOLE from these residents their salaries for the next three years!!! Maybe the DMC and WSU will escape the legal ramifications by being the slimey lawyers that they are and playing the loopholes, but that is just plain criminal. It makes me so angry and frustrated reading about this that I don't know what to say other than good for you (the ortho residents), and *$&#** the DMC (and to a lesser extent, WSU for being too complacent).

You may be happy to know that I declined to donate this year as I usually do as a result of this nastiness (and may not return to the practice again).
Top of pageBottom of page

313_doc
Member
Username: 313_doc

Post Number: 28
Registered: 09-2006
Posted on Friday, November 17, 2006 - 1:18 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Amen brother.

Agreed with above. Trust no one, except your fellow residents. Keep your comments to each other as some attendings will be or are already starting to side with the DMC and word will get back to Duggan.

Look, Duggan controls the money and he will continue to receive it with or without you for the next 2-3 years. He holds all the cards and Mentzer holds none of them. Duggan will only put up offers that are favorable to the DMC and not WSU. Those who say that everything will be ok and that things will work out have been hanging out in front of DRH too long. Things didn’t work out in March and they aren’t going to work out in December. Just ask your attendings that claim to be in the know to tell you about the contract structure or the Troy building project and the retrospective MI certificate of need issues therein. Realize that they know just as much as you. The negotiations that continue are a farce and simply to appease the masses and the media.

If you look around carefully you will notice that some attendings and departments are already prepping the lifeboats. Your job is to get in one of them, with your fellow classmates. Look out for each other, as no one else will.

Start to get letters of recommendation together from faculty that you know well, it doesn’t have to be the chairman and ask them if they have any insight into their previous training sites or if they know anyone. Put the word out amongst your friends, alumni and on web boards to see if there are any vacancies or programs that could take on extra people. There are 900 of you so you’ll need to spread out some.

Forget about the funding issue and focus on getting a 6-month extension to finish out the academic year. 6 months out of a 3-year residency is 1/6 of the time and I don’t know how the various boards would shine on transferring or finishing early. In my opinion, I think that you would have a better chance with the lawsuit to finish out the year than to recover your CMS funds.

Go to the ACGME website and go to Residency Review Committee section and find out who your executive director is, likely a PhD and is in charge of a few specialties, and start a dialogue with them regarding transfers. They are the ones that will gather info and facilitate communication between you, your specialty committee and prospective transfer sites. Word of caution though – elect ONE person in your department to act as the liaison between the residents and the executive director. It will be better for everyone if messages go through this one person, instead of 100 voices each with their own issues. You will be heard, it’s just a courtesy for this person on the other end who is probably already dealing with placing the UCLA King/Drew residents right now.

Stay together and help each other out. Hold open discussions about transfers and help those that have special needs about location, or family etc. Everyone can’t go to Ford or Beaumont just because they own a house…We all do. There are other places out there and while it sucks to learn a new system, you will likely graduate better for it.


Mentzer and Frank will likely address you after the fact, but will continue to try and assure you of the stability right now. I mean maybe their delusion should be commended, it’s just misdirected. Both of them weren’t quite ready for prime time.

For those of you at CHM, you should ask Dr. Tom Malone just how he feels about this and how he sleeps at night. Realize that he’s the lone MD on the DMC board, a voice of reason, or an insight into how to take the structure down. Thank him for me.

Duggan…enough said.

And now without further delay…some emails from the past (some names have been removed so that they’re not further drug through the mud).


(in reference to our CMS funding from a former attending)

RE: The DMC will not be releasing CMS 'slots' to pay for your future education elsewhere

I learned of much confusion on the part of
>you residents about a critical issue.
>
>This is the fact:
>
>"The DMC will not be releasing CMS 'slots'
>to accepting Programs to pay for
>your future education elsewhere."
>
>I thought you all understood this.
>I thought I communicated this at the Monday 3/20 meeting.
>I thought Malone confirmed this at the Monday 3/20 meeting.
>
>I know some residents knew this before the Monday 3/20 meeting.
>
>
>
>I welcome discussion on this issue--
>
>its morality, appropriateness, practicality, effects, etc--
>
>as long as the discussants realize that
>the discussion will not change the fact.


(a note from Tom Malone regarding a meeting about the proposed DMC ortho program – note the line about not doing anything to “block” us and giving us support)

A number of the orthopaedic surgeons and I will be hosting a meeting to
answer these questions Monday night.

The short answer is that we would like the residents to stay and will
encourage them to do so with what we believe is a strong program. But
if residents look at our plan and then decide it's in their best
interest to transfer, DMC will not do anything to try to block them.

In your e-mail, you ask if we know how hard it is to create a new
residency. Your question reflects a misunderstanding of what we are
doing.

DMC is not proposing to create a new program or a new residency. ACGME
policies specifically allow for the accreditation of a new sponsoring
institution when the teaching faculty is fundamentally changed.

In the past, the sponsoring institution has been a joint venture by DMC
and WSU. DMC's accreditation application asks that DMC be named as the
sponsoring institution for the existing residency. If DMC's proposal is
accepted, the current orthopaedic residency program would continue
operating after July 1st, but under DMC leadership.

On Monday night, we're going to outline a plan we believe can get RRC
approval in time to allow the residency program to continue
uninterrupted. Instead of making major life decisions based on
second-hand rumors, we wanted the residents to have a chance to hear our
plans directly and then decide for themselves what is in each person's
best interest.

The one message the RRC has delivered clearly is that their actions will
be heavily influenced by the residents' desires. If a large number want
to stay, I'm confident the RRC will expedite the review. If most are
tired of this and just want to leave, I expect the RRC will support that
decision.

As Chief Medical Officer, all I can do at this point is try to get you
all the facts and then support the individual decision each resident
makes.

Best Wishes,

Thomas A. Malone, MD, MBA
Executive Vice President and Chief Medical Officer
Detroit Medical Center

________________________

Peace out and good luck!
Top of pageBottom of page

Ash
Member
Username: Ash

Post Number: 13
Registered: 11-2006
Posted on Friday, November 17, 2006 - 8:38 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

313_doc, femur and fxfixer - My sincere thanks to all of you from the bottom of my heart. I am a resident here and my dept. leadership is telling us that they will help us with the placement. But I am going to get my letters and CV organized and start emailing PDs.

Once again - thanks a lot and sorry about what happened to you and your family, especially if you had bought a house in this godforsaken MI economy.
We were expecting ACGME to pull the plug on us today but they have postponed the decision till early Dec. I can not wait that long. Hell with WSU and DMC. We, the residents, need to dig ourselves out of this mess.
Top of pageBottom of page

Crew
Member
Username: Crew

Post Number: 1068
Registered: 02-2004
Posted on Friday, November 17, 2006 - 8:40 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

I looks like the media is just starting to pick up on this story and realizing how big of an impact it will have on the entire region.
Top of pageBottom of page

Fxfixer
Member
Username: Fxfixer

Post Number: 3
Registered: 11-2006
Posted on Friday, November 17, 2006 - 8:53 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

More advice...

Please remember that your co-residents now at the DMC are your friends for life. You will need to sit down and discuss at length the wishes of each member of your residency class. Respect each other and put yourselves in each other's shoes. As stated above, there are limited local spots...not everyone will be able to stay in metro detroit. As a group, the ortho residents realized that some of our classmates had wives who were also residents at the DMC (and their programs continued after ortho closed), some had kids, and a variety of other personal reasons. I believe that these resients should have priority in applying for local spots. Those with weaker ties to Detroit should expect to transfer cities.

Owning a house in Detroit (esp in this market) is tough. Almost all the ortho residents owned houses and many of us still own them despite being in another city. Consider renting it out while you finish your residency elsewhere. In the current housing market, most of us had to settle for a loss on the house or decided to keep it and rent it in hopes of a shorter term brighter future in the housing market.

Transfering residencies will be expensive. We were fortunate that our department helped by funding our interviews at potential hospitals. Moving expenses were limited to $2000. This is NOT enough and you should adjust your budgets NOW to absorb the greater cost of moving. Look into loans (to add to your already astounding med school loans). The DMC did NOT give us any financial help and you should not expect it.

Once you have acquired a new spot, get your licensing ASAP. This, too will be expensive. Most importantly, it is time consuming.

That is all I can think of right now. Above all, remember that you as residents did not deserve this. You must stick together. We likened our situation to a bad divorce in which the parents could not work out child custody. In the end, we ended up in foster-care.

Also, be professional with your patients now. I realize you are stressed about this, but patient care should not be affected by what is happening to you. They do not need to hear about all the rumblings going on. Remember, in the end, the city of Detroit patients will be the biggest losers in this all.

Good Luck and please do not hesitate to ask questions.
Top of pageBottom of page

Lig_res
Member
Username: Lig_res

Post Number: 15
Registered: 10-2006
Posted on Friday, November 17, 2006 - 9:17 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Folks do any of you have an idea of what would happen to ophtamology department. Also since the contract is expiring Dec 31 will the residents allowed to be there till june 30
Top of pageBottom of page

Ash
Member
Username: Ash

Post Number: 14
Registered: 11-2006
Posted on Friday, November 17, 2006 - 10:21 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

It is probably all over.

http://freep.com/apps/pbcs.dll /article?AID=2006611170336

DMC is furthering it's agenda for it's own residencies and fellowships w/o WSU.
Top of pageBottom of page

Stecks77
Member
Username: Stecks77

Post Number: 188
Registered: 08-2006
Posted on Friday, November 17, 2006 - 10:30 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

This could be devastating?

Stubborn a-holes can't get their crap together when so much else is on the line. This area cannot afford this.

Granholm needs to get involved for crying out loud. Of course fresh off the victory she doesn't have anything to lose.

(Message edited by stecks77 on November 17, 2006)
Top of pageBottom of page

Thrice
Member
Username: Thrice

Post Number: 99
Registered: 08-2005
Posted on Friday, November 17, 2006 - 2:41 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

As of 2:25 today.

Dear Colleagues,

On Nov. 14, the Accreditation Council for Graduate Medical Education conducted an on-site institutional review of GME programs sponsored jointly by Wayne State University and the Detroit Medical Center. Wayne’s sole objective during this institutional site visit was to promote continued accreditation of those GME programs that remain under joint WSU/DMC sponsorship.



Early this year the DMC created five exceptions to our tradition of jointly sponsored residency programs when it abruptly severed its relationship with the School of Medicine’s Department of Orthopaedic Surgery; and radically reduced financial support for dermatology, family medicine, otolaryngology, and urology. These DMC actions terminated the Orthopaedics Residency Program; and rendered it impossible to maintain the educational quality of programs in dermatology, family medicine, otolaryngology, and urology. As a direct result of these DMC actions, Wayne expanded its relationships with Oakwood Healthcare, Inc. and Crittenton Hospital Medical Center, which have independently partnered with us to continue these residency programs under Wayne’s institutional sponsorship. The enthusiastic support of Oakwood and Crittenton has preserved the School of Medicine’s ability to provide a comprehensive array of educational programs.



Nearly 65 GME programs remain under joint WSU/DMC sponsorship. Wayne is steadfastly committed to continuing these programs under joint WSU/DMC sponsorship. Our position will not change. Further, Wayne shall oppose any proposal by the DMC or its hospitals to further dilute our partnership.



Wayne and the University Physician Group have been negotiating in good faith with the DMC since May 2006, toward renewal of the agreements that support the teaching services of our faculty physicians. I was therefore deeply dismayed to learn that during active negotiations, and while our ACGME evaluator was still on campus, the DMC launched a strategy to terminate all programs remaining under joint sponsorship, and attempted to intimidate School of Medicine clinical department chairs into joining its pursuit of programs sponsored solely by the DMC. This action by the DMC is inconsistent with good faith negotiations and places our jointly sponsored programs at great peril. School of Medicine clinical department chairs have gone on record strongly opposing this action; the WSU/DMC Resident Council likewise opposes this action.



Wayne and School of Medicine leadership have honored the confidentiality of negotiations. Our silence in the media must not be interpreted as any wavering from our unmitigated support of joint WSU/DMC sponsorship of remaining graduate medical education programs. We passionately support our School of Medicine clinical department chairs and the WSU/DMC Resident Council.



The Wayne and University Physician Group teams are committed to reaching agreements that will be in the best interests of the many constituencies to whom we are responsible. We remain committed to:



* Continuing our valued relationship with the DMC;
* Expanding our presence in the city of Detroit;
* Educating our students and training our residents and fellows in the best possible teaching environments;
* Recruiting and retaining outstanding physicians to teach our students and serve our community;
* Upholding our mission of delivering the highest quality patient care supported by education and research; and
* Providing compassionate care to the region’s uninsured and underinsured.

Sincerely,

Robert M. Mentzer, Jr., MD
Dean, School of Medicine
Senior Advisor to the President
for Medical Affairs
Wayne State University
Top of pageBottom of page

313_doc
Member
Username: 313_doc

Post Number: 29
Registered: 09-2006
Posted on Friday, November 17, 2006 - 4:03 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Boy, I feel a lot better after reading that letter. I feel safe inside. I feel like Mentzer has a firm grasp on...NOTHING!

At least Duggan is delusional as to his version of a medical institution or what he can do with all his money. Mentzer, on the other hand, can't see reality. No amount of negotiating or discussion is going to change the contract structure or the fact that Duggan is holding about $80 million dollars a year for the near future. And the other thing, Duggan's realized now that he doesn't have to share it. A good captain would recognize defeat, plan accordingly and take care of his troops. Poor Mentzer is going to continue to believe that he can win and his troops are going to get decimated. It's time for plan B if you have one. For the residents, it's time to get out.


To Dr. Mentzer or Dr. Frank, would the last one of you who leaves DRH please shut the lights off. Thanks.
Top of pageBottom of page

Ash
Member
Username: Ash

Post Number: 15
Registered: 11-2006
Posted on Friday, November 17, 2006 - 4:06 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

------
Folks do any of you have an idea of what would happen to ophtamology department. Also since the contract is expiring Dec 31 will the residents allowed to be there till june 30
------

After I heard that Duggan threatened the chairs to take up a positions with DMC, even the shred of hope I had in completing the academic year here at DMC is now gone. I can not understand what his immediate game plan going to be - dont you think extending the contract till june 07 will give him the time to implement his "transition plan" and ours? The unanimous rejection of DMC's residencies and fellowships, by the resident council and all the chairs is not going change Duggan's course. He's made up his mind long time back.
Top of pageBottom of page

Cassie1717
Member
Username: Cassie1717

Post Number: 50
Registered: 04-2005
Posted on Friday, November 17, 2006 - 8:04 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Email from Mike to the DMC employees, sent this afternoon

Dear DMC Employees:
Given recent articles in the press, this is a good time to communicate directly to employees what is happening in the WSU negotiations and to outline the principles on which DMC is acting. Those principles have driven the success of the entire DMC community in achieving our financial turnaround and are continuing to work.

I want to thank all DMC employees for the way you have continued to handle the stress of this period while still delivering wonderful patient care. I just marvel at the fact that our patient volume this month is running ahead of last November. Overall profitability is well ahead of budget and 2006 will be DMC's best year financially since 1997.

Several hospitals are having an excellent year, but the turnaround at Sinai-Grace within the last 6 months has been nothing short of remarkable. We're doing a lot of things right under very difficult circumstances.

The DMC management team approaches every decision focused on one overriding mission: how do we protect our hospitals financially so we can make sure the DMC safety net will be here for years to come. I don't care how much orchestrated criticism I get, I will not agree to any contract with WSU that jeopardizes the future of Receiving, Hutzel,
Sinai-Grace, or any DMC hospital and the DMC Board feels exactly the same way. The safety net is what is at stake here.

I wrote you in October that WSU had already abandoned its historic DMC partnership by moving medical services to Oakwood and buying a massive building in Troy. Since then, the picture has become even more clear. The total budget for the Troy development to be split between the WSU doctors and Oakwood now surpasses $60 million - enough to build a small hospital.

Last week, WSU advised us that it had applied for 6 new residencies to be solely sponsored by WSU without DMC to be located at suburban hospitals. WSU further advised us that it had unilaterally decided to end 4 current WSU/DMC residencies: ENT, Urology, Family Medicine, and Dermatology. As a result, the DMC team has started working to convert the residencies to DMC residencies because it is the only way to stop WSU from continuing to kill off the WSU/DMC joint Detroit residencies and starting new WSU suburban residencies in their place.
While we have differences with the WSU administration, I have the greatest respect for the faculty physicians now training our residents. Under DMC sponsorship of residencies, it is my intention to contract with those same faculty to continue the training program. I just don't want WSU to be able to cancel the programs and move them elsewhere.

We are nearing the end of the Governor's mediation process and we will see what results. It appears only outside intervention will solve this problem - whether it's the Governor, the Mayor, or a court. But our safety net hospitals will not survive if DMC caves into the WSU pressure, agrees to pay WSU $80 million to work at DMC Hospitals, and at
the same time allows WSU to join Oak wood in building a competing suburban network to attract the same patients.

The DMC Board remains committed to its historic mission of operating a Detroit campus of specialty hospitals that support this community's safety net. We're going to figure out how to resolve this one way or another.

Until then, please continue to do your best to set aside the distractions and continue to deliver the kind of care DMC patients have come to expect.
Mike

Cassie's note: The departments WSU is seeking sole programs for are urology, dermatology, ENT, family medicine, & orthopedics, the ones Duggan said he and the DMC wouldn't support earlier this year. He doesn't know which end is up.
Top of pageBottom of page

Ash
Member
Username: Ash

Post Number: 16
Registered: 11-2006
Posted on Friday, November 17, 2006 - 8:43 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

----
Last week, WSU advised us that it had applied for 6 new residencies to be solely sponsored by WSU without DMC to be located at suburban hospitals. WSU further advised us that it had unilaterally decided to end 4 current WSU/DMC residencies: ENT, Urology, Family Medicine, and Dermatology.
----

This is hypocrisy at a ridiculous level. The 6 new residencies being sponsored by Oakwood and WSU - ENT, Urol, FM, Derm, CT and Ortho were the ones that he wanted to dissolve in the first place. Is he plain crazy? This finger pointing is childish and costing our lives.

----
As a result, the DMC team has started working to convert the residencies to DMC residencies because it is the only way to stop WSU from continuing to kill off the WSU/DMC joint Detroit residencies and starting new WSU suburban residencies in their place.
While we have differences with the WSU administration, I have the greatest respect for the faculty physicians now training our residents. Under DMC sponsorship of residencies, it is my intention to contract with those same faculty to continue the training program. I just don't want WSU to be able to cancel the programs and move them elsewhere.
----

Is he daydreaming? The faculty and residents have unanimously rejected his sponsor. Damn it, why can't Mentzer see what seems to be obvious to all of us - it is all over folks.
Top of pageBottom of page

Ccbatson
Member
Username: Ccbatson

Post Number: 10
Registered: 11-2006
Posted on Friday, November 17, 2006 - 9:28 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

No more illusions of a amicable agreement or contract exist any longer. All that remains is for the ACGME to say yea or nay to acreditation...and it is most likely nay. Man the lifeboats everyone (residents and WSU faculty) and G-d speed. To the DMC/Mike Duggan, you will have deserved what you get, but your victims do not.
Top of pageBottom of page

313_doc
Member
Username: 313_doc

Post Number: 31
Registered: 09-2006
Posted on Friday, November 17, 2006 - 9:28 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Realize that when Duggan wanted to “create” his new DMC residencies, he basically told the department heads that they would either come over to his side, or he would do to them what he did to the orthopedics.

I honestly don’t know though who Duggan is trying to rally or impress with his diatribe. Is there any resident, attending, community member or patient transporter that thinks that Duggan is actually doing a good job. He’s says one thing to one group of people and something else to another. Does he really think that everyone doesn’t know what’s going on?
Top of pageBottom of page

313_doc
Member
Username: 313_doc

Post Number: 32
Registered: 09-2006
Posted on Friday, November 17, 2006 - 9:39 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Ccbatson...do you have a klaxon to sound?

The only question is whether there will be a 6 month extension to get the residents to finish up the year. There are a lot of residents who would be 6 months short of finishing who have jobs or fellowships lined up. They stand to lose the most of the residents and it is for that reason that there needs to be the extension for them to finish out. I honestly think that a lawsuit would stand merit in this situation because it will impact multiple people in their employment and this is an easier concept for jury to understand than the complex CMS legislation. If they aren't going to grant the extension, then I would sue for lost wages...as in the last year of your career earnings, because that's what would be lost.
Top of pageBottom of page

Femur
Member
Username: Femur

Post Number: 8
Registered: 10-2006
Posted on Friday, November 17, 2006 - 10:07 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

If you haven't taken step 3 yet, take it soon. Then send the paperwork for the license to the state board where you are moving. In MI you don't need a permanent license while in residency, but keep in mind that there are states where you cannot be a resident without having a full state license. I can tell you that I got my state license a week after July 1st, 2006 and I did not get paid for that week. So get to it now.

And I couldn't agree more with fxfixer: take good care of your patients, but it doesn't hurt to let them know of what's going on.

Also make sure you let all the DMC supporting staff know that Duggan is the reason why you are leaving DMC, or Michigan, and he is the reason why they will lose their jobs soon as well. They all need to hear about this. They are the people who vote for Granholm and her pal Duggan every 4 years. Maybe they can be convinced to recall her (maybe that's Mentzer's hope as well :-):-)
Top of pageBottom of page

Femur
Member
Username: Femur

Post Number: 9
Registered: 10-2006
Posted on Friday, November 17, 2006 - 10:36 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

That email from Tom Malone was to questions we had raised about whether DMC was going to help or get in the way of resident relocation should the residency close.

Below is an email from one of the ortho attendings that went and got hired from DMC. Very warm and fuzzy guy, but he figured he was better off with Duggan.
__________________


Dr XXXXXXXXXXXXXXXXXXXXXXXXXXXXX:

I think I can answer your questions.
The DMC will not do anything to prevent or impede your moving.
However, I am not recommending to DMC that they pay relocation costs.

I understand the accreditation process intimately,
and it is not yet so late as to make accreditation impossible, only
difficult.
I wrote the DMC proposal.
Some of the rumored errors in the initial PIF
were actual errors on my part;
some were wholly fictional errors,
invented by faculty who prefer to have no Program
instead of a Program they do not profit from.
The DMC PIF has been revised and corrected.

I am sorry I have been out of town and out of touch for a few days.
I am back now, please call me or page me to discuss.

The DMC values Orthopaedic residents very highly.
The disagreement between UO and DMC was deep and serious.
I don't want to go into all the details here and now, but I will if
you call.
Top of pageBottom of page

Ccbatson
Member
Username: Ccbatson

Post Number: 11
Registered: 11-2006
Posted on Saturday, November 18, 2006 - 1:22 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Absolutely sue them, and not just one suit for the short term, but many suits including future earnings. Unfortunately, this is a costly venture, and recently, or soon to be out of work residents can't afford the attorneys' fees, but those with attorneys as family, or close friends may be able to recruit some assistance, and maybe some attorneys will adopt the cause and lend a hand at an affordable rate (I know, fat chance if it isn't a family member, but you never know, maybe the publicity wil attract someone).
Top of pageBottom of page

Crew
Member
Username: Crew

Post Number: 1072
Registered: 02-2004
Posted on Saturday, November 18, 2006 - 7:18 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

When I read Duggan's e-mail from 11/17, I couldn't believe it. He's blaming WSU for moving residencies to the suburbs when he's the one who kicked those same programs out of the DMC. If order for Wayne State to maintain a comprehensive educational experience, the Dean needs all 19 clinical departments to maintain fully functional residency programs. I'm glad I'm not the only one who thinks Duggan is more than a little nutty. It's all politics and power with this guy. He won't stop until he controls the Medical School.
Top of pageBottom of page

Ccbatson
Member
Username: Ccbatson

Post Number: 14
Registered: 11-2006
Posted on Saturday, November 18, 2006 - 11:04 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

I don't think he intends to control the medical school. Rather to wound, or kill it eliminating the competition. Nice guy, huh? I am sure Ma and Pa Duggan are proud of their little boy....just sickening.
Top of pageBottom of page

Thrice
Member
Username: Thrice

Post Number: 100
Registered: 08-2005
Posted on Saturday, November 18, 2006 - 1:34 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Crew you are absolutely right.

The thing that duggan bitches about in every letter, the troy center, is his own fault.

I have the pleasure of having Dr. Crissman (the former dean) of WSU as a small group leader for a class. He took about an hour of class time the other day to explain the situation. The great hypocrisy is this:

Original WSU wanted to place the center on John R across from the DMC. They had a grant plus other funds totaling over 10 million. Duggan told them flat out no.

They started looking at other options and found the troy location.

Duggan is now using this as in excuse to get rid of the residency programs.

He wants the contract money so that they look like they are making money, when in fact after a few years they will be much worse off. And at which point he will probably be long gone.
Top of pageBottom of page

Ash
Member
Username: Ash

Post Number: 17
Registered: 11-2006
Posted on Saturday, November 18, 2006 - 5:58 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Hi guys - If accreditation is immediately withdrawn, isn't it very difficult to place all the residents and fellows w/o any major interruption to their training? On the other hand, even if ACGME retains the accreditation till July 2007, will Duggan agree to ACGME's request and keep the residents and faculty till July 2007?

Isnt it going to be extremely difficult to find positions in the middle of the academic year when CMS slots dont follow us?
Top of pageBottom of page

313_doc
Member
Username: 313_doc

Post Number: 33
Registered: 09-2006
Posted on Saturday, November 18, 2006 - 7:08 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

It’s difficult to say what will happen exactly. With the last contract extension, they at least let orthopedics finish out the year by giving them a 3 month extension. It is unclear if they will give the other departments a 6-month extension to finish out their contracts. However, remember that you have a contract, meaning at least you get paid, until June 30th, 2007. Now whether or not you will get training remains to be seen.

I don’t think you guys should waste your time with trying to get the CMS funds. I would leave that to Senators Levin and Stabenow. I would think that they might have some issues with $300 million dollars of federal monies going to line the coffers of the DMC without residents and likely deviating from their actual mission statement. I would like to see Duggan, Malone and co. in trouble on the federal level. Look, Granholm and Kwame aren’t going to do anything.

What I would concentrate on is making sure you get the last 6 months of this year so the seniors can graduate. For those of you who aren’t in your last year and have to transfer and/or repeat a year due to board requirements I would sue the DMC for lost wages, and possibly pain and suffering. As to the lost wages, realize that you will be missing out on your LAST year’s salary, i.e. how much you would have made in your last year in practice. Some quick math (avg. salary ~200,000 x 400 juniors needing to repeat a year) = $80 million dollars. That is something that is a lot easier to understand than that complex Medicare laws. It is a case you guys could win, and then some. Good luck.

(Message edited by 313_doc on November 18, 2006)
Top of pageBottom of page

Ccbatson
Member
Username: Ccbatson

Post Number: 15
Registered: 11-2006
Posted on Saturday, November 18, 2006 - 11:37 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Winning that kind of a suit would be wonderful, and you probably do have a good case. But don't kid yourselves either, the DMC is not going to roll over and surrender easily, and they know there way around a courtroom (and apparently the law as well). It would be a tough and very expensive fight, regardless of how strong the case may be.
Top of pageBottom of page

Ccbatson
Member
Username: Ccbatson

Post Number: 17
Registered: 11-2006
Posted on Saturday, November 18, 2006 - 11:46 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Another question comes to mind. Per Mike Duggan, the DMC is in the black and doing well right now (I don't believe it for a second given that they are world class book cookers). However, I read that the DMC recently took a 30 million dollar advance from the Wayne county uninsured/underinsured fund. Why the apparent inconsistency? More book cooking? Are we missing something?
Top of pageBottom of page

313_doc
Member
Username: 313_doc

Post Number: 34
Registered: 09-2006
Posted on Sunday, November 19, 2006 - 12:16 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

I’m not an attorney, but I was assuming that the case for lost wages would be in a civil court with a jury who would be able to see the merits of the issues. It seems that to try and recover the CMS funds would be a ruling or interpretation on federal law. I know that Duggan was a prosecutor and he probably has some good lawyers in his stable, but I also realized that there are some other bada$$ attorneys out there with a special place in their heart for Duggan. In his previous jobs he managed to piss off a lot of lawyers who would now like to put him in his place.

As for the accounting, I think it would be interesting to have an impartial third party audit of the books. I would love to see their creative bookkeeping. Do the taxpayers have a right to see the books if he was using public funds to pay the bills?
Top of pageBottom of page

Ccbatson
Member
Username: Ccbatson

Post Number: 19
Registered: 11-2006
Posted on Sunday, November 19, 2006 - 2:28 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Ironically, prior to his position with the DMC, Duggan and Granholm were very critical of the book keeping under Arthur Porter. They required and set up oversight as a condition for the 50 million dollar bail out received by the DMC at that time. Shortly thereafter, out goes Porter, and in comes Duggan. Since that time I have not heard word one from anyone (Granholm in particular) raising questions about accounting practices. The oversight was set up by Granholm (meaning in cahoots with Duggan) so we now have the inmates running the asylum. Pure political corruption at its' finest. Had Granholm lost, things would have been much different from Duggans' perspective, and it seems awfully coincidental that Duggan accelerated his conquests right after the election. It may not be far fetched to say that Granholms victory was the nail in the coffin for the victims of this debacle.
Top of pageBottom of page

Ash
Member
Username: Ash

Post Number: 19
Registered: 11-2006
Posted on Sunday, November 19, 2006 - 11:46 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

This information is posted already under another thread in this message board.

I found the following information and to my surprise it seems to say that the adopting hospitals can apply for FTE adjustment, if they are under the caps. In addition, the hospital that closed its program(s) must submit the FTE reduction statement to its fiscal intermediary within the same 60-day timeframe.

"
This policy follows the existing regulations at 42 Code of Federal Regulations (CFR) 413.79(h) concerning closed hospitals and closed programs, and is intended to provide a temporary adjustment to the FTE caps of a hospital that trains displaced residents only so long as those residents are "displaced." That is, as long as the original program in which the resident trained remains closed (whether because the hospital itself is permanently closed or because the specific residency training program is closed), the adopting hospital can count the displaced FTE residents for Medicare payment purposes by virtue of a temporary FTE cap adjustment.
"

The first link below has the most relevant information.

http://questions.cms.hhs.gov/c gi-bin/cmshhs.cfg/php/enduser/ std_adp.php?p_faqid=5696&p_cre ated=1126804397&p_sid=Qb6-63ni &p_accessibility=0&p_lva=&p_sp =cF9zcmNoPTEmcF9zb3J0X2J5PSZwX 2dyaWRzb3J0PSZwX3Jvd19jbnQ9MSZ wX3Byb2RzPTAmcF9jYXRzPSZwX3B2P SZwX2N2PSZwX3NlYXJjaF90eXBlPWF uc3dlcnMuc2VhcmNoX25sJnBfcGFnZ T0xJnBfc2VhcmNoX3RleHQ9NTY5Ng**&p_li=&p_topview=1

http://www.cms.hhs.gov/AcuteIn patientPPS/Downloads/CMS-1531- IFC.pdf
Top of pageBottom of page

313_doc
Member
Username: 313_doc

Post Number: 36
Registered: 09-2006
Posted on Sunday, November 19, 2006 - 11:52 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

It’s also coincidental that at the last “negotiations” in March, a 9-month extension was given…except for orthopedics. Everyone involved was puzzled as to why it was 9 months and not 15, to get the contract to the end of the academic year, not the calendar year. We saw that the contract was going to expire during the holidays, and everyone figured that they would just grant another 6-month extension to get to June. However, the astute people then noticed that the 9-month contract just swept this problem under the rug until AFTER the election. Everyone put this issue on the back burner during the voting and nobody was the wiser. It was also believed that during March, Granholm pressured Irv Reid to agree to this extension. I don’t think it takes much coaxing by a governor to convince the president of a public university to do something. She didn’t want this to rear its ugly head during her campaign. It’s bad enough that the big three are in a slump and the economy has tanked. But, I’m sure she didn’t want to have to have to explain why one of cronies was destroying the medical safety net for one of her biggest constituencies.

To Ash and others, the rumor mill from a few residency directors is that you would likely be able to finish out the year. Now, what I said earlier about lost wages still rings true if you are a senior or someone who would have to repeat a year due to transferring. This is your career that has just bee torqued and it is a direct impact on your future. Good luck and feel free to ask questions.


A recall would be so nice...
Top of pageBottom of page

Ash
Member
Username: Ash

Post Number: 20
Registered: 11-2006
Posted on Sunday, November 19, 2006 - 12:32 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

313 - Our PD from the beginning had always maintained that we will be allowed to complete our academic year. I wonder if behind all the political posturing, there is an understanding for a 6 months incremental contract renewal.

I really wish and hope that the rumor turns out true. Having to move mid academic year w/o the CMS slots is a double whammy.

313 - Suppose ACGME extends accreditation, w/o Duggan's blessing, how can we continue here till June? There is also the bigger issue of retaining the faculty till June next year. A mass exodus of the faculty can not be ruled out.
Top of pageBottom of page

Ccbatson
Member
Username: Ccbatson

Post Number: 21
Registered: 11-2006
Posted on Sunday, November 19, 2006 - 6:26 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

It would be very fishy and a sign of weakness for the ACGME to extend accreditation after issueing their ultimatum/deadline, now allowed to pass, and describing the academic environment down there as "a toxic environment". I can't imagine that they did their review at the DMC last week and found it to be a wonderful and stable place for residents. Especially while Duggan was lurking about trying to extort the faculty right under their (the ACGME's)noses.

Unfortunately Ash, many such assurances were given to the Ortho residents prior to their programs' abrupt closure and theft of their funding. You can't trust anyone here even if they mean well, it may not be in saids program directors' power to deliver on any such promises....they too may be out on the street on very short notice, if they show some character and refuse to sell their souls to the dev...I mean Mike Duggan.
Top of pageBottom of page

Ccbatson
Member
Username: Ccbatson

Post Number: 23
Registered: 11-2006
Posted on Monday, November 20, 2006 - 10:56 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Rumor on the other related thread allude to the DMC seeking other university partners. Te posited answer was that it was/is with MSU. This stems from the fact that MSU medical students (not residents..I don't think) rotate at DMC Huron Valley Hospital. If MSU would affiliate for little or no cost to the DMC, of course the DMC would welcome that. They would be getting the university affiliation reputation boost without having to pay for it. Less clear is why MSU would want to do that.
Top of pageBottom of page

Yvette248
Member
Username: Yvette248

Post Number: 167
Registered: 10-2006
Posted on Monday, November 20, 2006 - 11:04 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

DMC is way too far from MSU for that to be practical. I guess the following Free Press story gets to the bottom line (literally) of what is really going on.

"Duggan wants DMC trimmed to a half-dozen, high-end medical practices, from sports medicine to cardiology, that build more admissions for the struggling health system's bottom line."

(Message edited by yvette248 on November 20, 2006)
Top of pageBottom of page

Femur
Member
Username: Femur

Post Number: 10
Registered: 10-2006
Posted on Monday, November 20, 2006 - 11:34 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

After splitting from Baylor, Methodist signed an affiliation agreement with Cornell from New York. Weird stuff, but true.
Top of pageBottom of page

Ccbatson
Member
Username: Ccbatson

Post Number: 24
Registered: 11-2006
Posted on Monday, November 20, 2006 - 11:53 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

If it is cheap, or free for the DMC, and MSU is willing, they will go for it. HFH was affiliated with UofM for a while, and then Case Western (in Cleveland) for a couple of years.
Top of pageBottom of page

Ccbatson
Member
Username: Ccbatson

Post Number: 26
Registered: 11-2006
Posted on Tuesday, November 21, 2006 - 12:09 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Sports Medicine builds hospital admissions? Did he really say that? Outpatient surgery at most. If that is a true quote, either he mispoke, or a law degree imparts no knowledge of Medicine on any level...wait a minute....I might be on to something here.
Top of pageBottom of page

Femur
Member
Username: Femur

Post Number: 11
Registered: 10-2006
Posted on Tuesday, November 21, 2006 - 12:16 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

"Duggan wants DMC trimmed to a half-dozen, high-end medical practices, from sports medicine to cardiology, that build more admissions for the struggling health system's bottom line."

Yeah, right. What happened to the "safety net"? You can't be the safety net health system if you have only a half dozen departments that make you money.

I remember Duggan in that one meeting with us saying that he wanted "more sports" from the ortho department. He actually said that the mission of orthopedics ought to be prevention of ACL injuries in teenagers, but that idiocy deserves no comment, I'm repeating it here just for entertainment value.

Anyway, the fact is that sports medicine generates almost zero admissions. With rare exceptions, patients with ACL reconstructions and the such go home the same day. Sports-trained orthopods work in surgicenter type settings, far away from county type hospitals, which is what DMC is. Lifestyle is a big attraction to that sub-specialty, so good luck recruiting them to work at Receiving. I guess you can pay a sports medicine doc enough to go work at a place like DMC, but then you wouldn't be making any money off of him...

Most likely Duggan wants to have sports medicine for marketing purposes. He wants to say that he is taking care of NBA athletes and so on. But that again tends to get in the way of his "safety net" mission. I'm not sure whether they understand that at the DMC. I think that they are spending way too much money on gimmicks at that place. One million dollars for those stupid "robots", which are essentially a laptop with 4 wheels, a camera, a microphone, and a lot of extra plastic. Or when they sent those thick marketing publications, $30 each, to their own residents, claiming, for instance, that the minimally invasive total joint replacement surgery was invented by Ference at Grace.
Top of pageBottom of page

Cassie1717
Member
Username: Cassie1717

Post Number: 51
Registered: 04-2005
Posted on Tuesday, November 21, 2006 - 10:36 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Granholm joins talks in WSU, DMC fight
Dingell warns of health care disruptions if no settlement

November 21, 2006

BY PATRICIA ANSTETT and KORTNEY STRINGER
http://freep.com/apps/pbcs.dll /article?AID=/20061121/BUSINES S06/611210322
As pressure builds for a resolution, Gov. Jennifer Granholm joined talks for the first time Monday and pressed for a settlement in the contract dispute between the Detroit Medical Center and Wayne State University's School of Medicine.

Granholm met periodically throughout the day with both parties at the George W. Romney Building in Lansing, according to press secretary Liz Boyd. She has told her handpicked mediator that the sides must meet round-the-clock to reach an agreement -- even if she has to serve them Thanksgiving dinner.

The two sides, whose disagreement threatens to end nearly 70 medical residency programs they jointly operate, have been at loggerheads over doctor compensation and other issues.

The outcome of the talks could have broad implications for Michigan's health care system, which depends on a steady flow of highly trained physicians from the residency programs.

There was no word of a settlement by Monday evening.

Granholm's involvement came as a powerful Michigan congressman predicted that if there isn't a settlement, there will be severe disruptions in care for more than 3,500 metro Detroit veterans seen annually at Detroit's John Dingell VA Medical Center.

It would cost the federal government at least $13 million more a year if veterans were sent to other hospitals for care, U.S. Rep. John Dingell, D-Mich., the hospital's namesake, told the Free Press.

More than 200 WSU faculty and 60 medical residents provide care at the VA Medical Center, which has 108 hospital beds and 109 nursing home beds. Dingell said the failure of the two groups to settle their differences was "very concerning."

"At this point, it is important for the two sides to continue negotiating with the governor's top mediator and come to an agreement acceptable to both parties," Dingell said in a statement. "Failure of them to achieve an agreement will have a severe impact on medical services at the Detroit Veterans hospital."

Dr. Basim Dubaybo, chief of medicine at the Dingell Center, predicted severe disruptions in outpatient, surgery and nursing home care if the center loses WSU care. Some patients would have to be sent to the Veterans Affairs' Ann Arbor facility; the rest would go to metro Detroit hospitals, he said.

"We need to bring people together to resolve this," Dubaybo said.

Dubaybo and Dingell joined a chorus of community voices building since Friday and demanding resolution of the bitterly stalled discussions between Detroit's two longest-standing health partners.

Friday, WSU President Irvin Reid sent an e-mail to 10,000 Wayne State employees imploring the sides to reach an agreement.

Other statements, in what is becoming a war of e-mails, were issued late last week by DMC chief Mike Duggan, WSU medical school dean Robert Mentzer, 17 WSU department chairs and the WSU residents' medical council.

Without resolution, Michigan's future supply of new physicians will dwindle, and its emerging business research climate will be irreparably marred, Reid and others say.

WSU provides 30% of Michigan's physician workforce and has pumped $137 million a year in research into cancer treatment, hypertension, maternal and infant care, and diabetes, Reid's e-mail said.

Mediator David Fink, an attorney Granholm picked for the negotiations, said Friday he planned daily negotiations until an agreement is reached.

Partners for a century through predecessor institutions, the DMC and WSU are deadlocked over an $80-million physician contract that expires Dec. 31.

Duggan wants DMC trimmed to a half-dozen, high-end medical practices, from sports medicine to cardiology, that build more admissions for the struggling health system's bottom line.

He has told a half-dozen WSU departments, from family practice to pathology, that he no longer needs them and hopes to outsource their work to private doctor groups, according to interviews with more than a half-dozen key physician leaders.

Duggan charges that the WSU faculty physicians are erecting a massive outpatient health center, with two operating rooms and 100 doctor offices, in Troy.

The WSU physicians, in response, call Duggan's strategy irresponsible and accuse him of abandoning poor Detroiters for corporate and better-insured patients.

They say they wanted to build a patient-friendly, easily accessible, patient center downtown but purchased the Troy facility with Dearborn's Oakwood Health System only after Duggan rejected their proposal.

Contact PATRICIA ANSTETT at 313-222-5021 or panstett@freepress.com and KORTNEY STRINGER at 313-223-4479 or

kstringer@freepress.com.
Top of pageBottom of page

Ccbatson
Member
Username: Ccbatson

Post Number: 27
Registered: 11-2006
Posted on Tuesday, November 21, 2006 - 12:18 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

The principal parties (Duggan and Mentzer)appear to be, if anything, further apart as opposed to closer to a contract. A lot of the doom and gloom is a little overplayed IMO. The DMC and WSU will not shut down immediatly even in the worst case scenario. They will, however, limp away wounded, and the DMC may die a slow death over time (~5 years or so). HFH, St John, and others are still functioning (and making profits) in the city...they may not want to absorb the overflow of uninsured, but could and would if forced. Remember also that todays' DMC is a mere fraction of what it was just ten years ago in terms of volume (in other words, the exodus is already well underway).

Those robots are hilarious...my take on it was that the message being sent was that we don't have any clinicians that want to physically set foot at the hospital, so the best we can do is give you a long distance Doctor. Academic Physicians see a very low volume relative to the real world, so it is not as if they are so overworked that they need these robots in order to handle the workload. A big, and very funny, joke, IMO.
Top of pageBottom of page

313_doc
Member
Username: 313_doc

Post Number: 37
Registered: 09-2006
Posted on Tuesday, November 21, 2006 - 8:03 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Since nobody seems to be able to control the powers that be. Maybe we should consider the powers that be. The DMC board can effectively relieve Duggan of his powers. Since they didn’t do their job, maybe we should let them know. To my knowledge, the DMC board is made up of various individuals in the community from all walks of life and with their own businesses and ventures and lives. I think it would be great if someone published a list of the members of the DMC board, then they couldn’t hide in the shadows making money, while Mike and Tom did all the dirty work. I’m sure there are respected community members that would rather not have their name associated with what will be one of the greatest meltdowns in healthcare. Basically this is going to go down in the books as what not to do and an example as to why certain laws and regulations will be instituted. I’d love to boycott someone’s bakery or paint store because of what they did…and then to make things better, tell the people that are waiting in front of DRH waiting for nonexistent care where these board members work so they could ask them personally why they did this. Just my $0.02.

As for Granholm, one word…Recall.
Top of pageBottom of page

Cassie1717
Member
Username: Cassie1717

Post Number: 52
Registered: 04-2005
Posted on Tuesday, November 21, 2006 - 8:06 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

313_doc, how do you propose getting ahold of the names of the Board members?
Top of pageBottom of page

313_doc
Member
Username: 313_doc

Post Number: 38
Registered: 09-2006
Posted on Tuesday, November 21, 2006 - 8:11 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Isn't this public knowledge?
Top of pageBottom of page

Ccbatson
Member
Username: Ccbatson

Post Number: 28
Registered: 11-2006
Posted on Tuesday, November 21, 2006 - 9:49 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

In the past, board members have not let their identities be known by and large. A few have (Stemple, and Malone), I can see why in light of the recent turn of events as it is not something to be proud of. Most certainly, the board has, and is, endorsing Duggans' actions. However, if the pressure gets to high/the heat gets turned up, they may very well throw him on the scrap heap (after paying out the rest of his newly inked 3 year contract...the sneaky bastard).
Top of pageBottom of page

Ccbatson
Member
Username: Ccbatson

Post Number: 31
Registered: 11-2006
Posted on Tuesday, November 21, 2006 - 11:34 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Hey, let's hold David Fink to his word (I know, don't hold your breath, this is after all a trial attorney and politician) on continuing negotiations until a settlement is reached....what if, as it is increasingly more likely, that never happens? I hope he doesn't have any other plans in mind.
Top of pageBottom of page

Crew
Member
Username: Crew

Post Number: 1082
Registered: 02-2004
Posted on Wednesday, November 22, 2006 - 11:42 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Sounds like a deal has been inked. News conference today at 2:00. We'll see how the ACGME reacts.
Top of pageBottom of page

Cassie1717
Member
Username: Cassie1717

Post Number: 53
Registered: 04-2005
Posted on Wednesday, November 22, 2006 - 11:52 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Settlement reached between DMC-Wayne State, governor says
By PATRICIA ANSTETT

November 22, 2006

An agreement has been reached in the dispute between the Detroit Medical Center and Wayne State University’s School of medicine, the governor’s office said Wednesday.

Gov. Jennifer M. Granholm and representatives from DMC and WSU will hold a press conference in Detroit at 2 p.m. today to announce an agreement, her office said.
Contact PATRICIA ANSTETT at 313-222-5021 or panstett@freepress.com.

http://www.freep.com/apps/pbcs .dll/article?AID=/20061122/NEW S99/61122014
Top of pageBottom of page

Yvette248
Member
Username: Yvette248

Post Number: 184
Registered: 10-2006
Posted on Wednesday, November 22, 2006 - 12:08 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Wow! I can't believe it!

(I bet Devos would have never been able to pull THIS off. Go Jenny!)
Top of pageBottom of page

Ash
Member
Username: Ash

Post Number: 21
Registered: 11-2006
Posted on Wednesday, November 22, 2006 - 12:20 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Devos would have fired Duggan and would not have let the situation come to it's current state. We will see what compromises did WSU have to make to ink a deal and what impact would those compromises have on the retention of the faculty. ACGME still has the final word here, although I doubt ACGME will pull the plug on us now. It may if the faculty exodus continues unabated.
Top of pageBottom of page

Sharmaal
Member
Username: Sharmaal

Post Number: 958
Registered: 09-2004
Posted on Wednesday, November 22, 2006 - 12:25 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Talk about Giving Thanks. Let's just hope these trials and tribulations will help this partnership grow stronger in the years to come.
Top of pageBottom of page

Yvette248
Member
Username: Yvette248

Post Number: 187
Registered: 10-2006
Posted on Wednesday, November 22, 2006 - 12:28 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Quote: "Devos would have fired Duggan"

I'm sorry, just how does a governor have the power to "fire" a CEO of a hospital? Logical answers people, please!!!
Top of pageBottom of page

Ccbatson
Member
Username: Ccbatson

Post Number: 34
Registered: 11-2006
Posted on Wednesday, November 22, 2006 - 4:42 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Don't give Granholm too much credit, she and others were just responding to political pressure put on them by....us (and those like us). If it were not for that pressure, I am confident that Granholm would have stayed out of it and let her like minded pal Duggan destroy WSU and the DMC. While Devos probably would not have done much, had Granholm not been elected, Duggan would have been in a weaker position and this would likely have been resolved or abandoned sooner than it was. Amazing how slippery politicians can turn a failed evil plot into an accomplishment...absolutely sickening, and I, for one, don't buy it for a second...neither should you. Attempted robbery on a large scale should be prosecuted, not lauded as a victory when they decide that they can't get away with it and abort the plan.
Top of pageBottom of page

Femur
Member
Username: Femur

Post Number: 12
Registered: 10-2006
Posted on Thursday, November 23, 2006 - 1:43 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Well, good luck to all residents at WSU. Hopefully your residencies will be over before the next cycle of negotiations. Happy Thanksgiving.
Top of pageBottom of page

Ccbatson
Member
Username: Ccbatson

Post Number: 44
Registered: 11-2006
Posted on Thursday, November 23, 2006 - 9:34 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Even more hopefully, the current administration at the DMC will be gone, and a more forward thinking leader will takeover so that the DMC and WSU can rebuild their reputation and attract quality students, faculty, and residents.
Top of pageBottom of page

Crew
Member
Username: Crew

Post Number: 1085
Registered: 02-2004
Posted on Saturday, November 25, 2006 - 7:43 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

As I stated before, my personal opinion is that there will be further consolidation in the healthcare industry in this state. The DMC may not even exist in its present form when this new contract expires.
Top of pageBottom of page

Yvette248
Member
Username: Yvette248

Post Number: 197
Registered: 10-2006
Posted on Saturday, November 25, 2006 - 10:20 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

"Amazing how slippery politicians can turn a failed evil plot into an accomplishment...."


Yep. And if she would have not done anything, you would have b*tched and complained about that also. So, if it's all the same to you, I will keep applauding positive outcomes.
Top of pageBottom of page

Ccbatson
Member
Username: Ccbatson

Post Number: 47
Registered: 11-2006
Posted on Saturday, November 25, 2006 - 4:41 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Doing something when forced by growing political pressure is nothing to be proud of, or praised for. Think of an analagy where someone is plotting a bank robbery, the plan is under way and appears to be running afoul and somebody aborts the plan. Should they get a reward? Absolutely not!! It is still a crime, called attempted robbery....same thing (regardless of how one tries to rationalize it).
Top of pageBottom of page

Ccbatson
Member
Username: Ccbatson

Post Number: 48
Registered: 11-2006
Posted on Saturday, November 25, 2006 - 4:51 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

"If she had not done anything, you would have b*tched and complained about that also" Darn right I would...that is called Robbery (versus attempted robbery). Duggan (and to a lesser extent Granholm, by complacence and collusion...choosing an old chum of Duggans' as the "unbiased moderator"..give me a break) had chosen to do the wrong thing from the beginning of this averted disaster. The only way to partially redeem themselves would be to cease and desist, ADMIT responsibility/guilt, apologize sincerely, and pay reparations for the damage done to the injured parties if possible. They have neither admitted responsibility, or offered reparations, so they are not forgiven.
Top of pageBottom of page

Southwestmap
Member
Username: Southwestmap

Post Number: 633
Registered: 01-2005
Posted on Tuesday, November 28, 2006 - 11:12 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Thought I'd add this post from Nolan Findlay's blog:

"The rest of the DMC/WSU story.

When the Detroit Medical Center and Wayne State University's medical school last week settled their bitter dispute over the contract that binds them together, Gov. Jennifer Granholm and DMC Chief Executive Mike Duggan took the stage to lavish praise on David Fink, the governor's appointed mediator.

An aggrieved Duggan even suggested that The Detroit News owed an apology to Fink for expressing the widely held skepticism that he may not be an unbiased middle man. Fink, Granholm and Duggan were all part of the old Wayne County political machine under the late Ed McNamara.

The deal, Duggan claimed, vindicated Fink.

But as we suspected, there was more to the story.

The deal actually came together after representatives from the Detroit Regional Chamber and Detroit Renaissance paid a visit to the governor to express their strong desire that the dispute be settled fairly, and quickly. There was also rumbling in the business community that if Duggan took down Wayne's medical school, he could kiss his future political ambitions goodbye.

The business guys brought in Congressman Joe Schwarz, the Republican from Battle Creek who is a practicing physician and Wayne State medical school graduate, to make some phone calls. He did. And the deal got done.

Perhaps Fink was brilliant at the negotiating table. But I'd bet the arm twisting from the business folks went a long way toward getting the contract settled."
Top of pageBottom of page

Ccbatson
Member
Username: Ccbatson

Post Number: 49
Registered: 11-2006
Posted on Tuesday, November 28, 2006 - 9:38 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

My G-d.....if that is an accurate depiction, Duggan, Granholm, and Fink were dragged screaming and kicking to this settlement. This means that their intents were the opposite of the terms of the final agreement (or, in other words, to have the split between WSU and the DMC become final). The shocking part (well, not really, as they are all lawyers, liberals, and politicians, so what should we expect?)is that they spin things 180 degrees as if it was their doing and that they should receive the credit. What they should get is fired (Duggan, and Fink) and recalled (Granholm) and they should be happy with that, because their intent was nothing short of grand larceny.
Top of pageBottom of page

Ortho313
Member
Username: Ortho313

Post Number: 1
Registered: 10-2006
Posted on Thursday, December 07, 2006 - 9:39 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Did anyone go to the dean's public meeting yesterday?
The fall out of this is funny. The media portrays the new financial incentives in the contract for WSU physician quality control and length of stay as one of the most interesting elements of the deal.
I would disagree.
This deal explicitly marks the beginning of the end of this relationship. There is as much division in this deal as there is union. A university without hospitals and a hospital with no independent educational mission (find a mission statement that describes DMC education outside of WSU - I can't) have already begun dividing the residencies. There is no reason for this to happen unless it is just the beginning - not the outcome I'd expect from two smiling people shaking hands on the front page of the paper, celebrating their partnership (Duggan and Reed).
I guess it is up to the ACGME. Today's papers makes no mention of how the now seperate programs were received by the ACGME. I don't know how they will respond to a hospital system that is deciding to DROP a medical school to teach pediatric residents or to a university willing to let another program go.

(Message edited by ortho313 on December 07, 2006)
Top of pageBottom of page

Ccbatson
Member
Username: Ccbatson

Post Number: 50
Registered: 11-2006
Posted on Friday, December 08, 2006 - 10:35 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

I don't tink it is nearly as bad as that. My spin is that this is the best that could be salvaged from the damage done by Duggan's now ill fated megalomaniacal plan. Reading between the lines, Duggan has had his ears pinned back (long overdue), and is left doing damage control in what remains of his tenure (which, at nearly 3 more years is 3 years too long).

Ortho was already lost, as was Derm, Family practice, and ENT (I may be forgetting something) so, they were "allowed", to continue in their pursuit of other sponsors. Apart from these programs, by contract, all remaining residencies proceed as joint WSU/DMC programs. Hobbled by horrible PR (it will be years before first, second, third....you get the point....string candidates, with any common sense or judgement, apply to these programs.

Good work Duggan (and the DMC board) you even failed in your unwitting attempt to kill WSU SOM and the DMC. I can only imagine what the future holds in these incompetent hands. Thank G-d I have the luxury of watching from a distance having long since unhitched my wagon from that dying horse (I say put them all out and start over anew....the positive potential is huge, but not with these dimwitted dinosaurs).
Top of pageBottom of page

Zephyrprocess
Member
Username: Zephyrprocess

Post Number: 171
Registered: 08-2006
Posted on Saturday, December 09, 2006 - 2:16 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)


quote:

Ortho was already lost, as was Derm, Family practice, and ENT (I may be forgetting something) so, they were "allowed", to continue in their pursuit of other sponsors.




Urology was among those kicked out, and Cardiothoracic surgery didn't have sufficient caseload downtown to be accredited.


quote:

Apart from these programs, by contract, all remaining residencies proceed as joint WSU/DMC programs.




Pediatrics is now sole-sponsored by the DMC
Top of pageBottom of page

Crew
Member
Username: Crew

Post Number: 1091
Registered: 02-2004
Posted on Saturday, December 09, 2006 - 11:24 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

The Internal Medicine Residency at Sinai-Grace will become, like Peds, a sole-DMC sponsored program. Internal Medicine on the downtown campus will continue as a joint sponsored program.
Top of pageBottom of page

Ccbatson
Member
Username: Ccbatson

Post Number: 51
Registered: 11-2006
Posted on Saturday, December 09, 2006 - 11:51 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Interesting nuances.....so, in summary Ortho, Derm, Family practice, ENT, and Urology from earlier disputes, CVS by way of lack of cases was lost (without a replacement) which is....puzzling and inexcusable that this result could not have been averted, and SGH IM and Childrens/Peds splintered off by kissing up to Duggan prior to the settlement (the phrase "scabs" comes to mind).

9 programs in all, and I bet that the programs that started anew with non DMC partners will ultimately fare better than both the salvaged jointly sponsored programs and the new solely DMC residencies. Why? The DMC under Duggan just narrowly avoided self destruction and still has all of the negative financial and business dynamics that got them in trouble in the first place.
Top of pageBottom of page

Ortho313
Member
Username: Ortho313

Post Number: 2
Registered: 10-2006
Posted on Sunday, December 10, 2006 - 2:32 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

I'm not sure how much of which department's split was a dispute.
Ortho - clearly
ENT - I heard rumblings that too many cases were being done outside of DMC - surgeons taking call but little else downtown.
Family Practice - screwed. They followed DMC recs yrs ago to move off campus as satellite referers to DMC and downtown - huge endeavor - then were no longer wanted by DMC particularly since so little done on campus. Told that the move was part of past administration dealings - didn't matter that they were essentially loyal.
Urology - no idea
Derm - had problems on its own
CVS - ironic - turning Hutzel into cardiac hospital is a common rumor to help build DMC as procedure oriented high-reimbursing specialty mecca.

The mostly no longer wanted specialties are largely cancer based practices (ENT, uro, derm) and that was thought to be another reason DMC lost interest in them.

So peds, SGH-IM, and the proposed new ortho program will be university-free.

We'll have to see if these splits are the beginning or the end of more to come.

Further, I like how for one institution it is reaching out; for another abandonment.

http://detnews.com/apps/pbcs.d ll/article?AID=/20061115/METRO 03/611150330&SearchID=73265551 114954
Top of pageBottom of page

Ccbatson
Member
Username: Ccbatson

Post Number: 52
Registered: 11-2006
Posted on Sunday, December 10, 2006 - 10:21 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

I think the new contract will snuff further changes along these lines for the duration of the contract at least (3 years). Ortho313's assesment is pretty much spot on. I would add one further, less tangible, factor...the apparent profound stupidity of the DMC. In every instance, rational people are astounded at the decisions made by the DMC....not by the eventual and inevitable failures that result (if someone decides to jump in front of a fast moving car, the injuries are not surprising). It seems that the DMC could turn a goose lying golden eggs into a liability. Given this point of reference, the past, present, and future failures make a lot more sense (at least they do to me)
Top of pageBottom of page

Ccbatson
Member
Username: Ccbatson

Post Number: 53
Registered: 11-2006
Posted on Sunday, December 10, 2006 - 10:29 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

I am not sure that i would agree with the statement that the unwanted programs are cancer based.

First, in the real world anyway, ENT, Derm, Peds, IM, Urology, CVS, and Family Practice are at most partially "cancer based". Somewhat moreso in a Universtiy and urban setting...but not to the exclusion of noncancer related activities.

Second, as evidenced by Karmanos, and elsewhere, Cancer based specialties are strong revenue generating services. Why would the DMC be disinterested? (disregard the fact that they themselves are terminally stupid).
Top of pageBottom of page

Ortho313
Member
Username: Ortho313

Post Number: 3
Registered: 10-2006
Posted on Monday, December 11, 2006 - 10:45 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Don't know. Karmanos is now independent. Most of the work ENT and uro did downtown was cancer related - or so I was told by some people in ENT. I do not know if it is/was part of a vision for the hospital center to get a way from those 2 cancer-based surgical subspecialites.

Peds Onc is traditionally one of the most profitable departments in the hospital system - no change there - still CHM/DMC.
Top of pageBottom of page

Ccbatson
Member
Username: Ccbatson

Post Number: 54
Registered: 11-2006
Posted on Tuesday, December 12, 2006 - 9:55 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

In general, you can follow the money to the true answer. Profitable services=keepers, losers=throw them overboard. However, I don't think it is a matter of the fields being unprofitable (ortho, Derm, ENT, CVS, and Urology??? in the private world, they do very nicely), it is a matter of these individual departments failing plus economic/political issues.

If the DMC were smart (and if my aunt had testicles....), they would have maintained the Physicians in these fields that were drawing patients as opposed to firing them all and making bitter enemies of their biggest benefactors (back in the late 90s). Alas, another in a very long line of DMC mistakes/failures.
Top of pageBottom of page

Ash
Member
Username: Ash

Post Number: 23
Registered: 11-2006
Posted on Wednesday, December 13, 2006 - 3:01 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

The latest victim is the Cardiology dept I hear. DMC is forging ahead with it's own heart center, and some of the faculties have already jumped ship. They may not have enough faculties to continue the fellowship. Hiring new faculties is proving to be very difficult, since most of the candidates want to know what happens after the contract expires 3.5 years from now. Did anyone hear any latest announcement from DMC regarding their new heart center? What's the scoop on that?
Top of pageBottom of page

Ccbatson
Member
Username: Ccbatson

Post Number: 55
Registered: 11-2006
Posted on Thursday, December 14, 2006 - 2:07 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Hmmmm...wouldn't that be in violation of the new contract? Unless this had developed before the agreement, or was exempted. If it were exempted, it should have been listed in the press releases as such.

If true, it is yet another example of what should be a success...turning into failure. What quality cardiologists with established practices and reputations would come to join the DMC? Unless the DMC pays them a fortune (and even then, it would only be temporary) what they will attract will be subpar at best.
Top of pageBottom of page

Ortho313
Member
Username: Ortho313

Post Number: 5
Registered: 10-2006
Posted on Thursday, December 14, 2006 - 10:38 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

++What quality cardiologists with established practices and reputations would come to join the DMC? Unless the DMC pays them a fortune (and even then, it would only be temporary) what they will attract will be subpar at best.

Someone in the area willing to take a chance for a promotion and a raise. If it fails, they can probably go back to or easily find a job in the area without relocating, etc. (MI is at a MD deficit) At worst, you are a well-paid hired gun for a few years. When the system implodes in 3 yrs, you leave (like the current leadership will have done shortly before you). Chuck O'Brien already stepped down and the ink is still wet on the new contract.

The DMC has money now. They are collecting DSH dollars and CMS funds on every lost residency spot (with no residents to pay, insure, educate, etc) for a few years. They are spending their way out of trouble: athletic coverage and more importantly billboard rites, advertising campaign, rebuilt ortho dept with all new staff, building cardiology center/hospital, CHM to Macomb county. The 2 above revenue sources will start thinning in about 2-3yrs: no further CMS money for residents lost, looks like they are moving away from being the Medicaid dumping ground for SE MI - should decrease DSH $$'s. They will then be trying to turn a profit on the new services they are building now. Whatever business comes with having your name plastered over the Joe, etc. Whatever cardiology generates (insurance companies and other specialty lobbyists tend to find a way for such narrow reimbursement utopias like this to level off and spread the wealth), whatever Macomb generates for CHM. The race is on. Safe money says the expenses of today do not materialize into the gains of 2009. MI is still toward the bottom of Medicare reimbursement nationwide. The big 3 still set the pace for the MI blues to stay below the national averages for reimbursement.
Top of pageBottom of page

Ccbatson
Member
Username: Ccbatson

Post Number: 56
Registered: 11-2006
Posted on Thursday, December 14, 2006 - 11:59 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Sounds OK on paper, but without substance to back it up, it falls flat. "someone in the area will take a chance".....I don't disagree, but that somebody is not going to be a top shelf successful clinician, rather, a lesser caliber physician, or a new Physician doing some resume' building (that is, if that don't have something better than the "DMC" to use as a stepping stone) like they do at HFH.

"Rebuilding" is a good descriptor. This implies that they once had something, lost it, and are trying to regain what was lost. If the loss was by no fault of their own, then they might have a chance, however, as is the case here, if the loss was a result of their own stupidity (which has not changed), then they are doomed.

They have some money as a result of the residency debacles, but look at their recent financial history.

In the plus column...2000; downsizing and firing overpayed (debatable) Physicians, 2003; selling off assets including nursing homes, practices, and clinics, 2004; the 50 million dollar bailout, 2003; Karmanos buys out and rents space at Harper.

In the negative column....1997; buying Sinai for 75million, and most importantly an ongoing budget deficit in the range of 75-100 million a year as a result of bad debt and lost volume/revenue.

Contrary to what we are being told, even though the budget is balanced on very flimsy paper, it is only as a result of these temporary one time influxes, and extremely creative book keeping (put mildly, more accurately described as criminal/fraudulent). The bad debt is reduced with the decreased volume, but the revenue is not going up.

Now, that is my doom and gloom assessment. On a positive note, the potential is huge for the DMC. They have a monopoly (that they nearly threw away) on academic medicine in the area, a solid infrastrucure, plenty of capacity for clinical and research activities, and a rich history.

The solution?? Start over from the top down with quality, experienced, business minded leadership. Get rid of everyone else, and swiftly...Duggan, the active/voting board members, and the department heads. You can't replace the leadership and leave an entrenched, fat, political monster at the head of all of these departments to foil the new leadership. Harsh and impersonal?? Yes indeed. Absolutely necessary when facing disaster and collapse?? Also true.
Top of pageBottom of page

Ortho313
Member
Username: Ortho313

Post Number: 6
Registered: 10-2006
Posted on Friday, December 15, 2006 - 11:27 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

I agree with you. Your first paragraph is a tricky one though.

Most physicians will admit that they (MD's) are not good at formally evaluating quality of care by other MD's. Even worse on acting on it. Insurance companies are going to try with objective outcome measures. It will not be just. The best guy in town gets the most complicated cases and probably spends the most resources with the most complications though giving patients their best shot at a good outcome. On paper, he is not so hot. Lots of complications, long hospital stays, high cost. In reality he is just answering a need for the community. Its tricky. I guess my point is that no one will know or really have any way of knowing if their new DMC doctor is any good - well unless, of course, if Emery King says so.

It will be a mess in 2-3 yrs when the short term funds are out and the new high-paid MD's are looking for the same or more $$ to renew their contracts. The money won't be there and the support for their programs and ideas will go the way of the robots the DMC had running around the hospitals - the now really expensive coat hangers forgotten and not missed.

I'm with you - this borderline fraudulent financial resurrection is as transparent as it is going to be short lived.
Top of pageBottom of page

Ccbatson
Member
Username: Ccbatson

Post Number: 57
Registered: 11-2006
Posted on Saturday, December 16, 2006 - 12:01 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Interesting analysis. My response is that the quality of a Physician is not quantifiable...no test, no measure can provide this answer. However, in my opinion and experience, most Physicians, and many patients, have a very keen and accurate sense of who is an average, below average, above average, or exceptional clinician. Not without exception of course, but even Physicians that aren't so wonderful themselves, seem to use the same high caliber Docs when they, or their family members are in need.

The Hour magazine survey would be a wonderful tool based on this principle, but, unfortunately, it is not for many reasons. Political forces, self interest, vested interests, and poor sampling of a relatively small population render the list inconsistent and useless. Illustrative, and humorous, is the common occurance where someone appears on the list one year and not the next. What happened? Did they lose their touch? Go over to the darkside? Become disabled? have a bad year? Makes you wonder, doesn't it?
Top of pageBottom of page

Ortho313
Member
Username: Ortho313

Post Number: 8
Registered: 10-2006
Posted on Tuesday, December 19, 2006 - 9:11 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

The DMC is accepting applications for their new ortho residency. They are telling staff they have a 80% chance of approval for '07, 100% for '08. They chose not to tie themselves to the failed program - it apparently is now only the Wayne State program. The DMC must have made a very favorable impression on the ACGME visitor - that is what they have told several department chairs.

------------------------------ ----------------
The Wayne State University Orthopaedic residency program transferred out 24 residents and graduated 8 more on June 30, 2006. The Wayne program is finishing the education of the last PG-5 class, then will close.

The Detroit Medical Center and Providence Hospital (the institutional sponsors of the Wayne program) have joined together to hire faculty and provide funds for research and education in a new Orthopaedic residency program.

The DMC / Providence program will have 5 training sites:

1. Detroit Receiving Hospital has hired 3 fellowship-educated Ortho traumatologists and is looking for 2 more.
2. Childrens Hospital of Michigan has hired one pediatric Ortho and is lookinh for 2 more.
3. Michigan Orthopaedic Specialty Hospital has contracted with 3 sports Orthopaedists who take care of several of the pro teams.
4. Sinai-Grace has its faculty intact and will provide experience in a large Medicaid clinic.
5. Providence didn't lose any faculty and will teach spine, more sports, and arthroplasty.
6. Providence Hospital has agreed to build and DMC has agreed to pay for operations of an Orthopaedeic research laboratory.
The program has an agreement with the largest hand surgery practice in Michigan to teach hand surgery.

The ACGME will NOTIFY the program on January 15, 2007 whether we will be granted accreditation for July 1, 2007. At this date, we are not offering interviews, but we are accepting applications by email. If you want an application blank, email me at <+++++++++++>.

If we are granted accreditation, will will enroll a PG-1 class and maybe even a PG-2 class for residents who have already done a surgery internship.
Top of pageBottom of page

Ccbatson
Member
Username: Ccbatson

Post Number: 58
Registered: 11-2006
Posted on Tuesday, December 19, 2006 - 10:47 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Since the cat is out of the bag, a few details that I am aware of..... 2 camps are applying; Oakwood under Desilva (the former DMC/WSU chairman), and Silberg (from Oakwood), and then the aforementioned Providence/DMC group largely led by Providence orthopods (Markel and Higginbotham at the lead).

I have heard that the ACGME is very anti Desilva laying blame for the earlier loss of his program at his feet. Representatives have so much as said that they did not want him (Desilva) to have a program. By default, Providence/DMC will likely get the nod.

In the same vein as the ACGME's animosity towards Desilva, so to should Duggan's involvement concern them. Hopefully, (please listen somebody) Duggan will make his exit sooner rather than later, and rid this new/promising program of the Spectre of doom that is the DMC/Duggan.
Top of pageBottom of page

Ortho313
Member
Username: Ortho313

Post Number: 9
Registered: 10-2006
Posted on Thursday, December 21, 2006 - 12:10 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Not sure how ACGME could consider either proposal.

Both refused the offer by ACGME AFTER ortho drop dead date last year to salvage something. WSU president clearly stated at that point the message/impact of the closure was more important than anything that could be saved.

WSU clearly used this to springboard move to Oakwood.

DMC chose not to release CMS funds to departing residents' accepting programs. Told residents that they get what they deserve for not agreeing to dump WSU - i.e. no funding transfer.

Both sides seem more interested in showing up the other than an actual educational program. I thought the point of working at Oakwood was to be in the area without the hastles/beauracracy of educational orthopaedics. Otherwise wouldn't those people be in one of the academic systems in the area already? I guess if your president/board/whoever wants billboards that read "academic medical center" you don't have much of a choice.
Top of pageBottom of page

Ccbatson
Member
Username: Ccbatson

Post Number: 59
Registered: 11-2006
Posted on Thursday, December 21, 2006 - 10:34 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

I think the ACGME wants to see one of the nations largest single campus medical education systems have a full complement of GME/residency programs. If true, even if it is clearly suboptimal (as you point out very clearly), they (the ACGME) will overlook deficiencies to get the ball rolling and hope things turn out well in the long run.
Top of pageBottom of page

Ortho313
Member
Username: Ortho313

Post Number: 10
Registered: 10-2006
Posted on Friday, December 22, 2006 - 9:33 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Which medical education system is that?

The DMC is not a medical education system. They are a hospital system that has shown minimal interest in forming or developing training programs independent of WSU prior to this year. Further, they are not interested in a full compliment of GME programs (derm, family, ENT, etc).

WSU has no clinical resources of their own - and no interest in them. They obviously don't care that people declaring their new DMC residency superior to the previous WSU/DMC one are simultaneously trumpeting themselves as WSU professors. Shouldn't there be enough pride in the WSU med school to put an end to that? Are those titles really so sacred they cannot be removed... or surgeons literally advertising to be WSU professors despite no one in the med school acknowledging giving a position.

Nevada (Las Vegas), INOVA in northern VA, and Tampa are 3 large centers I can think of that run level 1 trauma and do not have an ortho residency yet have other GME programs. They rely on PA's or rotators. 2 of those are clearly in rapidly growing populations too. The only population growth here is in the unemployment column.

Though I give minimal if any value to mission statements, the ACGME one is cut and pasted below:

-----------------

ACGME Mission, Vision and Values

Mission Statement
We improve health care by assessing and advancing the quality of resident physicians' education through accreditation.

Vision Statement
Exemplary accreditation

ACGME Values are manifest through:

Accountability
Processes and results that are:
Open and Transparent
Responsive to the educational community and the health of the public
Reliable, valid and consistent

Excellence
Accreditation that is:
Efficient and Effective
Outcomes-based
Improvement-oriented
Innovative

Professionalism
Actions that are:
Respectful and Collaborative
Responsive
Ethical
Fair

-----------------

The ACGME would do possibly irrepairable damage to their credibility if they compromised their mission - particularly their definition of professionalism - and accredited either application. How would they justify it to the programs who willingly took in residents without the funding? Several of those programs are applying for more residents. Reward the bickering parties (WSU and/or DMC) with a new paid work force or the programs that accepted displaced residents, no questions asked, without the money that the above institution wanted for itself - and now without the resident salary/benefits/etc to pay? If only more programs could have closed - maybe there would be enough surplus to but the Lions or put up more antagonistic billboards like the one in Royal Oak questioning WBH's ability to treat kids.
Top of pageBottom of page

Ccbatson
Member
Username: Ccbatson

Post Number: 60
Registered: 11-2006
Posted on Friday, December 22, 2006 - 9:35 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

As with most mission statements, they are simply window dressing and hardly worth the paper they are written on (sad, but true).

I agree with your assertions as to the way things ought to be, and are supposed to be. However, the real world doesn't often work that way. Ulterior motives, political in fighting, favoritism, nepotism, and prejudice all enter the picture, more so as the subject matter is more politically charged.

Detroit differs from just about every other major city in that it has only one medical school, WSU. This is why I believe that many parties treat WSU and the DMC differently, and this may include the ACGME. I also agree that the aforementioned "medical education system" is not much of a system at all...but, again, whatever it is, it is all that there is covering Medical school and GME under one "roof".

What they (the ACGME) ultimately decide to do remains to be seen. Once it is said and done, then we can assess whether or not the ACGME is upholding its' mission, or not. I put my money on the latter possibility (unfortunately).

A free market system would allow for the ideal situation that you describe, and we would all benefit from. Unfortunately, we don't have this in our publicly subsidized education system, or, for that matter, any government program. A true, yet unrealistic, solution would be to privatize, and downsize government. However, neither functioning political party is interested in doing this (although Republicans are closer...but not close enough). Libertarians go too far, and are impotent anyway, so, we are stuck for the moment with our broken system. Pushing for more of a free market approach is our best hope, and that is what we should all be doing (IMO, of course).
Top of pageBottom of page

Ortho313
Member
Username: Ortho313

Post Number: 11
Registered: 10-2006
Posted on Sunday, December 24, 2006 - 1:15 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Against all evidence of the past year+, I hold out hope that at least 1 institution (ACGME) can remain uninfluenced enough to see that education and even patient care are the last things these bickering sides care about.

Further, in 2-4yrs if/when the wheels fall off someone of stature in the ACGME/RRC will have to justify how less than 2 years from the start of this debacle, they handed another set(s) of individuals (students -> residents) to either DMC or WSU and their program directors who have, to date, oversaw/participated in 2 ortho program closures (old SGH program and now combined DMC/WSU). It is not as if the writing is not on the wall for either proposal to fail. That has been well described in this thread.

Many seemed surprised by how overt the ACGME has been in their disinterest in the effect on the medical students. There are already administrative/governing bodies in place to protect the interests of medical students. It is clearly not within the ACGME's jurisdiction. Thus, WSU/DMC is no different than HFHS, St. John's, or any other GME program in the region. The fact that there is a medical school next door to the DMC main campus should be of no concern to them. They have hinted at that; I hope they act on it on January 15.
Top of pageBottom of page

Ccbatson
Member
Username: Ccbatson

Post Number: 61
Registered: 11-2006
Posted on Sunday, December 24, 2006 - 4:18 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

I still agree in principle with the ideals you set forth.

Unfortunately.....unless, they change directions late in the game, the ACGME appears to be behaving as the political animal that it is.

Less cost, less work, and less headache for them drives their action (rather, inaction). The MO seems to be make the easy decisions taking the path of least resistance, and cover it up later with spin. We will see what direction they choose to take.
Top of pageBottom of page

Ortho313
Member
Username: Ortho313

Post Number: 12
Registered: 10-2006
Posted on Thursday, December 28, 2006 - 11:30 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

I'll try to hold on to some hope, but the more I read, the more your prediction (DMC accreditation) seems likely.

I do not see how denying the applications would be more work or headache. I could see the opposite. If they approve it, the DMC will likely continue applying for new residencies. They have already contacted urology to sway them from WSU/Oakwood to exclusive DMC - despite the published descriptions of the contract and its 6 month cooling off period. Approving neither program may buy the ACGME some real time and effort; dissuading the submission of dual applications (WSU/Oakwood & DMC) for most every other program. I do not believe a 6 month cooling off or 3 year contract will slow that down regardless of what the paper reports the terms to be. Hopefully the prospect of losing respect (and possibly participation) from physician/educators if they approve either application will not go unnoticed by the ACGME/RRC.
Top of pageBottom of page

Ccbatson
Member
Username: Ccbatson

Post Number: 62
Registered: 11-2006
Posted on Thursday, December 28, 2006 - 1:19 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

A denial would likely mean appeals, lawyers, media coverage, and general fighting/debate that would cost time and money. As I think the ACGME would want to endorse a replacement program for the one that was lost, this means that the "work" involved in approval would be no more than what would occur regardless of an initial denial to someone.

Furthermore, if they want to be done with the issue and also have an excuse to deny other applications (ie Oakwood with DeSilva, for whom it is rumored the ACGME bears significant animosity), they would be able to do so by saying that the need has been filled.

The DMC is going to apply for whatever they are going to apply for regardless of a denial of one application to the ACGME. If anything, they (the DMC) would accelerate their efforts to overcome the denial. Remember, Duggan is a politician...if politicians know anything, it is that if you fail, try again, and again, until you succeed (an entirely disgusting process, IMO).

A fictitious example; A law allowing Medicare price fixing is proposed, and voted down...the very next opportunity, what is proposed? That's right, a bill advocating Medicare price fixing, and so on, until it is passed (or ad infinitum).

I said this was a fictitious analagy...but not really in that Medicare already does price fix, however, the changes in reimbursements and rules in specific have to be approved or denied (as in the thrice denied Physician reimbursement cuts).

Even worse, this cyclic process costs both sides time and money. Medicare to support the bill, and the AMA (and others) to oppose it. Guess who pays the governments' tab?? Yep....us, the taxpayers.....see what I mean by disgusting?

Anyway, I am rambling, so....
Top of pageBottom of page

Ortho313
Member
Username: Ortho313

Post Number: 13
Registered: 10-2006
Posted on Friday, January 12, 2007 - 5:30 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

1/15 is ACGME decision day.

Safe money says DMC - yes. "Old boys network" ties too strong that past and present don't matter:
1. 2 failed programs already
2. Already have sports fellowship on probation
3. Harper hospital president used academic files to get prev residents wives cell #'s to contact them is regards to the residents position on proposed DMC plan. **Classy**
4. "*u** the residents, they get what they deserve" from new program member to justify no fund transfer.
5. Members of new program with history of not wanting resident involvement - still on proposal.
6. Members of new program openly and consistently criticize business ethic and how it affects patient selection and patient care by the hand group.
7. Pediatrics, now sole DMC, already getting the squeeze after dumping WSU - promises of funding research lab off site laughable when CHM recent developments considered.
8. Promise to expand CHM ortho staff from 1 to 4 has not changed in 9+ months... not holding breath on that one.
9. There is no contract with WSU despite November reports. The November saviour was not an actual contract agreement, but more a list of possible terms and really just a public sideshow. No stability in system as advertised.
10. Rotation director of new proposal with history of openly criticizing substance abuse issues of other members of new program, particularly at educational functions. Would refer to loss of respect developing for the abuser by underlings. Objections to that notion never heard, still. Rumblings such issues also affected ability to perform while on call.

Safe money say WSU - no. Well, 1 out of 2 ain't bad.

(Message edited by Ortho313 on January 12, 2007)

(Message edited by Ortho313 on January 12, 2007)
Top of pageBottom of page

Ccbatson
Member
Username: Ccbatson

Post Number: 63
Registered: 11-2006
Posted on Saturday, January 13, 2007 - 12:20 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Isn't it sickening? Either the people making the decision are hopelessly ignorant, or they are knowingly turning a blind eye.

Either possibility is bad, but the second one is flat out depressing. Who are these people? How did they attain their positions? Elected representatives? Elected by whom? not me. Or are they appointed cronies of??? other appointed cronies??

Politics stink in almost every form, but when these folks are responsible for medical education, and ultimately, patient care on a national level (ie who educates future clinicians, and how).

We need to expose this corruption and revamp the system. How, and to what? I would support a democratic process whereby candidates apply, or are nominated, and then voted on by all of the members of the parent organization (AMA, specialty board members, and all certified members). Each candidate publishes a one page profile and position paper, then voting members vote on one candidate. I know, never going to happen, but....it can't hurt to dream.

Add Your Message Here
Posting is currently disabled in this topic. Contact your discussion moderator for more information.