Doctors: LSU care redesign is wanting

Louisiana’s physicians are complaining about “the lack of detail and preparation” as LSU embarks on budget cuts that affect training programs for the state’s future physicians.

“We have created another tsunami or Hurricane Katrina-type condition in regard to graduate medical education in the state,” said Dr. Andy Blalock, the Louisiana State Medical Society president.

Blalock warned Monday that the state’s “best and brightest” current and future medical students and physicians in training would leave or not come at all amid the tumult.

LSU medical school statistics show that 70 percent of those who do their physician training in Louisiana continue to practice in the state. Each physician practice means $2 million to the state’s economy, Blalock said.

The 7,000-member state medical society is getting calls on a daily basis from physicians and a lot of “concerned” physicians in training and medical students, said Blalock, who as a Lafayette nephrologist specializes in kidney care.

The LSU system of 10 public hospitals is under Jindal administration orders to cut nearly $330 million as a result of a congressionally mandated reduction in federal Medicaid support coming to the state.

LSU’s approach to solving the financial problem is to move more care of the poor and uninsured, as well as more physician training, to private hospitals in what has been called a “health care redesign.”

Physician training is called graduate medical education.

While hospital bed and service cutbacks have been announced, arrangements have not been finalized with private sector hospitals to take on the physicians in training and medical students who would be displaced.

Commissioner of Administration Kristy Nichols said Monday it would be irresponsible not to take action now to address the sudden and unexpected federal funding drop.

“We will be aggressive and responsible at the same time and do something that is truly transformational as far as medical education,” Nichols said.

Blalock said the medical society held an emergency meeting of its board last week to discuss changes LSU is implementing and the impact on graduate medical education as well as care for the uninsured. LSU officials were invited, he said, but no one showed up.

LSU system President William Jenkins and Executive Vice President Frank Opelka said Monday they were unaware of the invitation.

Opelka, who is leading the health care restructuring, said the concerns are coming from “a small number of physicians in the state.”

“We are more than happy to meet with them,” Opelka said. “We think we have a really good plan for going into public-private partnerships ... that expands the graduate medical education experience. Change is difficult for everybody.”

Jenkins said he received a letter outlining medical society concerns to which he responded.

“I told them ... that we were equally concerned and trying to address the issue,” Jenkins said.

LSU health officials revealed last week a previously undisclosed potential $83 million hole in LSU’s medical schools budget as a result of hospital service cuts and downsizing.

The budgets of LSU medical schools in New Orleans and Shreveport rely on revenues generated from their relationships with the hospitals where hands-on training with faculty physician oversight occurs.

The $83 million shortfall “demonstrates that this time line is incredibly aggressive and our concern is it’s ultimately dangerous to GME,” Blalock said. “We need to be fully transparent and vet these so we don’t do permanent damage to the high quality medical education being offered.”

On Monday, Opelka said the $83 million number is overstated.

Opelka said the $53 million figure for the New Orleans medical school, which has relationships with LSU hospitals in south Louisiana, will be mitigated depending on how quickly contracts can be ironed out for GME activities at private hospitals. He said lost revenues are expected during a three year phase-in.

The $30 million figure associated with the three north Louisiana hospitals represents all funds flowing from the hospital operations to the medical school, Opelka said. He said the hospital cutback plan should have little impact there.

Nichols said the administration will dip into medical school reserve funds and coordinate with the private hospitals getting the medical education programs “to maximize financial arrangements.”

She said the administration would “mitigate losses” by considering all means of health care financing.

LSU has announced $150 million in cuts in its seven south Louisiana hospitals including reductions in inpatient, surgical, intensive care and emergency room beds as well as elimination of some services.

In its three hospitals in north Louisiana, another $60.9 million in budget cuts are being covered either by service reductions or one-time revenues.

Comments

1) Comment by Schmatzo - 31/10/2012

You know, it's always interesting to hear what a doctor thinks of himself and his peers. These folks need to stop worrying about what will happen to the "best and brightest", and focus on the patients who have to rely on a system through no choice of their own. Next time your sick, leave your Lexus at home and take the bus to the "Earl" or an LSU clinic. Sample some of the "best and the brightest" have to offer. You may come away with a slightly different impression. The average physician in training will may "order" a million dollars worth of useless tests and treatments by the time he completes his residency. (If you're lucky). If you took a hundred patients with the same acuity, and let MD's treat half of them, and ICU nurses with five years or more experience treat the other half, the nurses could likely achieve the same results if not better. There are a lot of excellent physicians out there, but not nearly as many as the public would think. Please accept my apologies if I offended any physicians, or members of the "best and brightest". Thank You.

2) Comment by retiredinbrla - 31/10/2012

Docintraining, thanks for telling TommyRucker the facts. I agree with you 100%.

3) Comment by Docintraining - 30/10/2012

TommyRucker. As a current physician in training in the LSU system, I want to point out that you have no clue what you're talking about. While Louisiana is the only state to operate a charity system, you don't realize that we graduate some of the best physicians in the country. LSU residency programs are among the most highly sought after positions in the country because graduating doctors know that they can come to Louisiana and be more than adequately trained. And more than 75% of physicians stay within 50 miles of where they train. Often in these states that operate a private-public model, physicians are forced to enter fellowships because they cannot handle the rigors of their specialty. NOT in Louisiana! Also, I'd like to point out that the people that advocate the public-private model of healthcare are also the first to not want a resident ( or doctor in training) to be involved in their care. While I don't disagree that the system that we have may not be the most efficient system, the fact is that we put out the most competent doctors in the country. I don't know about you, but when my health is on the line, I want the best physician around to take care of me. While the poor/indigent patients may pay the initial price in these budget cuts, years down the road we will all pay the price.

4) Comment by IMVOR - 30/10/2012

How is it that those (including the gov) who wanted the government out of their lives, claimed states rights, and rebelled against accepting federal stimulus money and expanded Medicaid as well as private insurance exchanges provided for in the ACA, are blaming the federal government for the budget hole the state now finds itself in? It would seem that the much-touted effort to attract business to Louisiana will be thwarted by a wrecked education and health care system. Louisianans are their own worst enemies, and they seem, overall, to be satisfied with that. How else can one explain doing the same stupid things over and over for 200 years? The result of this latest assault on the health system will no doubt be the same as it has always been. Those who want health care and education will move elsewhere and those who can't move or don't care simply will do without. We seem to have (with a few exceptions) politicians who are either nut jobs or utterly spineless. These are the people Louisianans elect and not only tolerate but actively support. Louisiana's problems are what they are because Louisiana has no will to do any different.

5) Comment by Being_Stupid - 30/10/2012

Being a doctor is not that difficult. Why does it require 10 years of medical school to become a doctor? Back in the late 1800s when I was born it was a lot easier to become a doctor. You simply worked as an apprentice for another doctor for about two to three years, observed and practiced under their direction, and then WHAMO! you were a doctor. But Now-a-days it is ridiculous all the hoops, money, and wasted years of youth one must jump through to become a doctor, and that is only if you are granted admission to medical school. Medical care could be a lot more affordable and available if it wasn't for all these universities and government intervention. This isn't rocket science, it is medicine. No big deal.

6) Comment by TommyRucker - 30/10/2012

I don't buy into the argument that physicians will not be adequately trained in this state by following the model that EVERY OTHER state follows in their training. No other state has the charity hospital network like Louisiana and it has become to costly and to inefficient and unless the fed 'money cow' wants to fork over the money to keep it operating then Louisiana has not choice but to DO WHAT EVERY OTHER STATE DOES and shift physician training to the private sector or away from this charity system. This is a bogus argument and the state medical society needs to be ashamed to make it. The real reason that doctors are upset is that THEY are going to have to get more involved in the care of many poor patients. They are already involved in such care, it is just going to increase and with the increase comes many problems of which fair payment for services may be the least. There are great increase in liability costs and many of these patients require a lot more attention and time. These patients also usually have more complicated problems and are in many cases only seen in an advanced stage of a medical problem. This is what happens when the economy is going bad and we can thank our socialists friends for it. We cannot afford the continuation of an expensive and inefficient charity system. If you want it, then get ready to pay and pay BIG. The quality of medical education in Louisiana is a false issue and one being used by political types rather than a previously well respected group of physicians who focused on the TRUTH and the greater good of our state.

7) Comment by Stephen - 30/10/2012

Nichols has already wrecked the foster care system. This will be exposed over the next couple of years. Now, she is turning her sights on the medical schools, hospitals, and the rest of us. We will all be impacted as she runs future doctors out of the state.

8) Comment by Ruby - 30/10/2012

What in the world does Kristy Nichols know about the education of future physicans? What qualifications does she have to make any statements regarding this important matter? This will be an unmitigated disaster for the future of health care in our state.

9) Comment by Pakistani - 30/10/2012

Pakistani boy knows nothing about healthcare. This is going to turn out to be a diaster. All for his personal gain and his hope to be off the hook by January 2013.