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It’s not often a hospital administrator suggests that federal and state sources should reimburse the hospital for less money.

But that’s exactly what Rich Morrison, senior vice president of government and regulatory affairs of Florida Hospital is suggesting when it comes to the cost of residency programs.

Right now, the typical residency costs about $180,000, Morrison said. It’s difficult to tell how much the hospital actually spends in services, but it’s generally less than the 25 percent of the total that Morrison believes hospitals should be spending.

“It’s just recognizing the reality,” he said. “Where’s the money going to come from? It shows that the hospital is really committed to training more doctors in the area.”

That’s exactly why Florida Hospital has decided to fully fund six new residencies in Emergency Medicine at its Orlando hospital beginning in July 2008 even without guarantees that it will receive any state or federal funding.

Already roughly 400 graduates have applied.

The hospital plans to add six more residencies each year until topping out at 18 with or without outside resources.

So far, the spending proposal Morrison envisions that splits graduate medical education costs at 75 percent for government and 25 percent from the hospital is in its preliminary phase. Morrison spoke to some members of the Florida congressional delegation who asked for more detail.

“With current state budget woes, it will be a tougher discussion,” he said.
The new Emergency Medicine Residency Program, announced in December, comes just a month after Florida State University researchers released a study on the looming physician shortage. The study, which represents the largest set of information ever collected about Florida’s physician workforce, said that 13 percent of physicians in Florida plan to “leave or significantly reduce their practice within the next five years.”

Emergency departments are already seeing the effects of a shortage, said Dr. Dale Birenbaum, program director of the Florida Emergency Physicians, a group of about 100 doctors who staff eight Florida Hospitals. Birenbaum will also be the program director for the new residency in Orlando.

“There’s no question that in Florida compared to more densely populated states there has been a lack of specialists,” Birenbaum said. “Their lack of availability makes it tough to take care for patients.”

Birenbuam believes that Florida suffers in recruiting physicians for a combination of reasons. Some are due to the low reimbursement rates under Medicare. Another reason has to do with the infrastructure of medical schools.
“Orlando is one of the largest metro areas that didn’t have a college with a medical school associated with it,” Birenbaum said. “That’s why the programs that will develop at the University of Central Florida in 2009 to accept first year medical school students will help create that infrastructure for training doctors in the state.”

Right now, the emergency medicine physician group Birenbaum heads has trouble recruiting. “We’re always in a constant state of looking for doctors we’d like to have work with us,” he admitted.

As the amount of people with health insurance declines, emergency departments increasingly become sources of primary care, which means emergency physicians are called on to serve a whole host of needs they weren’t originally trained for. In future residencies, the curriculum will need to be adjusted.

“The ED doctor gets called on to do more and more,” Morrison said. “We think its incumbent on us to be on the forefront of that curriculum.”

The new residency comes just at the right time, he said, adding “the greatest steps a hospital can do are support graduate medical education and residencies.”
Florida Hospital created a new residency last year in General Surgery. In a couple of years, it plans to open another residency in Internal Medicine.

“We feel that by increasing the infrastructure and training, we’ll help support the clinical care of patients by not only helping to produce more doctors that will likely stay in the region, but also increasing the quality of care patients receive,” Morrison said.



February 2008

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