One thing that is not fully explored with regards to the residents--You mention that 9/15 residents wanted to leave. This likely included every resident from PGY1-3, as the ACGME guidelines stipulate that the last 2 years of general surgery residency must be completed at the same program. This would mean that the PGY 4-5 years would have to repeat years, extend their training, and lose out on millions of dollars over their careers in opportunity cost. These residents likely have loans that would continue to accrue interest during the extended training--some to the tune of $300k+ The real tragedy is-in addition to private equity pillaging a poor community of their safety net hospital- beating the altruism out of 15 general surgery trainees. Nothing takes the wind out of your sails like seeing the dysfunction of a hospital system like this first hand. It is an extreme risk to choose to serve at a safety net hospital. This is especially true for one with PE involved. Situations like this one incentivize physicians to run as far away from poor communities that need them most. The fact that dividends can be rendered when operating at a loss completely blows my mind.
Great points. I was surprised to read, in one of the lawsuit’s evidentiary exhibits, that one PGY-5 resident had already transferred (to a well-known program in the Midwest). The plaintiff’s attorneys offered this up as evidence that they weren’t preventing the residents from transferring (which the ACGME had accused them of doing). I’m not sure if that resident is planning to repeat their final years of training or not… when I commented on this on X, a couple of commenters asserted that there have been exceptions made to that policy.
Can you look at what’s happening with Steward healthcare in Massachusetts? The Boston Globe has some good articles explaining the situation at hospitals like Good Samaritan and St. Elizabeth’s
Thank you Dr. Carmody for the work that you do. You videos are very well done. I wanted to suggest that this format could be converted to a podcast easily and might increase your audience. People could more easily listen in the car, on a walk, etc. Just my 2c.
I have thought about it… I chose TH-cam when I got started with this stuff mainly because it was easy (enough) for me manage (and also because I sometimes have important visual aids). I might still try to explore putting it out as an audio-only podcast. It’s hard since I only have a certain amount of time to devote to this stuff.
@@sheriffofsodium There's some inside dealing as supposedly the CEO's wife is tied to the private equity company. They are also pushing for massive expansion of their cardiology program a la HCA. Very quickly moved them from top 10 to bottom 10 in my list for ranking.
This is very sad. I can tell you that training at a community program can make some of the best doctors if you want it to be, if the program wants it to be. I've seen this for myself and my co-residents/friends and we've all moved on too these "big name" programs for fellowships etc. and I can tell you many of the residents are not comparable in what you expect them to be able to do coming from a big program vs a community program. Oh well either way, private equity strikes again. I wish all these residents well, it's not an easy life. Thank you for this very informative and IMPORTANT video.
how is it legal to line your pockets to the tune of >$650m by saddling safety net community hospitals with debt while having them sell their biggest assets to be rented back to them? gross.
“You know, you and I want the same thing from health care. Rapid maximal extraction of wealth by any means necessary.” -Bartholomew Banks, Private Equity th-cam.com/video/a7-6zfg1PS4/w-d-xo.htmlsi=9WhI1kU1D6xOmFRj
Great video as always. I always found it funny that Mt. Sinai's medical school in NYC is named after Carl Icahn, a PE billionaire who wrote the playbook on corporate raiding and distressed asset extraction. Leonard Green & Partners should take note -- a $200m donation (of mostly dividend recap funds) is enough to stick you name on a medical school and establish some goodwill. Maybe in the future, you could look into doing a video on the dynamics of a GME program at a county hospital? I recently interviewed at an NY county hospital that was at a "near $180 million loss for 2023" and $560m in the red over the last five years. The program leadership seemed unconcerned about the risk of shutdown or major staffing issues affecting the program. The hospital leadership was even messier than I could imagine: a board led by an man appointed by the county executive, a CEO fired and replaced by the board's general counsel, and a culture of leadership changing with every election cycle. Residency applicants need to be on the lookout for signs that a program might be circling the drain, even if they look ok from a clinical standpoint.
That's crazy that the residents were encouraged to commit fraud to log cases. I can only imagine their lives: being on 12 hour shifts with nothing to do. Thanks Dr. Carmody!
Can you create a brief video as a guide on how residents can more thoroughly vet through residency programs and hospitals that have a shady history like this?
What a mess. IIRC you'd talked about this on "X" or I read a piece on it so was familiar with the situation. Thanks for detailed explanation! The "secret sauce" of PE is pretty simple.
some decades ago private equity became the ire of emergency medicine. they were buying out departments and seems they figured out why not just buy the entire hospital. then insurance companies got worse trying to deny every payment if they could. the director of an ED where i worked spent more time battling for reimbursement than he did seeing patients. private equity gave us special training as i recall, one of the most interesting ones was if Na or K was 1 point above or 1 point below normal lab range we had to add hypo or hyper to the diagnosis list even though prior the thought was not significantly raised or lowered.
Great video as always Sheriff. But please please please get a windshield for your mic. Or at least set the mic at a 45-degree angle from the path of your breath. Those popping P's are killing your sound quality.
Thank you for watching - and for the kind words. Please share with others, too - my whole point in making this stuff is to try to get other people talking and thinking about some of these problems.
I'd like to propose another winner(s) - future residents who know fairly early in their training that their program isnt up to par, can contact ACGME and expect to receive some sort of respite. Im sure ACGME also learned something from this event & I agree with you that they made the right choice, even if the optics didnt work out in their favor.
Fantastic explanation Hats off to you sir Should(sadly) be a movie( horror). Why isnt this a deeper national story. How does this trauma center survive???
I go to medical school at one of the Philadelphia schools and knew someone who knew someone who was actually in this program. The reason I heard for the shutdown was because the were not meeting their case requirements or case load for residency. This is complete hearsay and should be taken as such. I applied and interviewed for the Transitional Year program and they assured us that their program has no accreditation issues and i believe them- I will likely match at a higher choice for my intern year but the PD was very nice and seemed like a decent place for TY at least.
It may be just hearsay - but it is consistent with what Prospect/Crozer’s attorneys acknowledge in their lawsuit, and in their attached correspondence with the ACGME. (One exhibit even acknowledges the concern that residents were double-logging cases using both the MRN and the FIN.) I believe it’s also true that none of the other programs have had accreditation issues. Prospect/Crozer brought that up in the suit, also.
“I bought this hospital so I could increase its value as quickly as possible using brutal austerity and authoritarianism so that I can then sell it to the next private equity company for more money.” -Barty Banks th-cam.com/video/I2q3Ow1Ijjg/w-d-xo.htmlsi=T1Ximj5vF4ZneNyh
USMLE can introduce different types of questions in the exam: for example: "multiple correct answer type questions" where different options are correct but your answer to the entire question is not correct unless you mark all the correct responses.. or can introduce "integer type questions" where whole numbers from 0 to 9 are the answers and one has to approximate to the closest integer to mark the correct response. or introduce "match the following' type questions, or introduce negative marking to the incorrect responses. These are the strategies that are used in one of the toughest exams in India- IIT JEE to get admission into the prestigious IITs.
Thank you for documenting what is going on in graduate medical education.
Thank you for taking time to watch my stuff.
One thing that is not fully explored with regards to the residents--You mention that 9/15 residents wanted to leave. This likely included every resident from PGY1-3, as the ACGME guidelines stipulate that the last 2 years of general surgery residency must be completed at the same program. This would mean that the PGY 4-5 years would have to repeat years, extend their training, and lose out on millions of dollars over their careers in opportunity cost. These residents likely have loans that would continue to accrue interest during the extended training--some to the tune of $300k+
The real tragedy is-in addition to private equity pillaging a poor community of their safety net hospital- beating the altruism out of 15 general surgery trainees. Nothing takes the wind out of your sails like seeing the dysfunction of a hospital system like this first hand. It is an extreme risk to choose to serve at a safety net hospital. This is especially true for one with PE involved. Situations like this one incentivize physicians to run as far away from poor communities that need them most.
The fact that dividends can be rendered when operating at a loss completely blows my mind.
Great points. I was surprised to read, in one of the lawsuit’s evidentiary exhibits, that one PGY-5 resident had already transferred (to a well-known program in the Midwest). The plaintiff’s attorneys offered this up as evidence that they weren’t preventing the residents from transferring (which the ACGME had accused them of doing). I’m not sure if that resident is planning to repeat their final years of training or not… when I commented on this on X, a couple of commenters asserted that there have been exceptions made to that policy.
The new audio setup sounds great! Thank you for the interesting breakdown - what a crazy situation for those residents to be in.
Better but still some issues probably with the mic (bass).
Thanks so much for taking the time to research and read and put this together!
Can you look at what’s happening with Steward healthcare in Massachusetts? The Boston Globe has some good articles explaining the situation at hospitals like Good Samaritan and St. Elizabeth’s
Thanks for making this content. As a premed this is good information to know. I feel so bad for those residents, they deserved better.
Thank you for watching.
Thank you Dr. Carmody for the work that you do. You videos are very well done. I wanted to suggest that this format could be converted to a podcast easily and might increase your audience. People could more easily listen in the car, on a walk, etc. Just my 2c.
I have thought about it… I chose TH-cam when I got started with this stuff mainly because it was easy (enough) for me manage (and also because I sometimes have important visual aids). I might still try to explore putting it out as an audio-only podcast. It’s hard since I only have a certain amount of time to devote to this stuff.
Keep your eye out on Summa Health in Akron, Ohio....they were just bought out a few weeks, if not days, before rank lists were due this cycle by PE
Ruh roh.
@@sheriffofsodium There's some inside dealing as supposedly the CEO's wife is tied to the private equity company. They are also pushing for massive expansion of their cardiology program a la HCA.
Very quickly moved them from top 10 to bottom 10 in my list for ranking.
This is very sad. I can tell you that training at a community program can make some of the best doctors if you want it to be, if the program wants it to be. I've seen this for myself and my co-residents/friends and we've all moved on too these "big name" programs for fellowships etc. and I can tell you many of the residents are not comparable in what you expect them to be able to do coming from a big program vs a community program.
Oh well either way, private equity strikes again. I wish all these residents well, it's not an easy life.
Thank you for this very informative and IMPORTANT video.
how is it legal to line your pockets to the tune of >$650m by saddling safety net community hospitals with debt while having them sell their biggest assets to be rented back to them? gross.
“You know, you and I want the same thing from health care. Rapid maximal extraction of wealth by any means necessary.”
-Bartholomew Banks, Private Equity
th-cam.com/video/a7-6zfg1PS4/w-d-xo.htmlsi=9WhI1kU1D6xOmFRj
Because when the penalty is financial the only crime is being poor
The answer always leads back to unrestricted capitalism
@@sheriffofsodiumprivate equity needs to move on to other profitable opportunities like fire departments or libraries
Great video as always. I always found it funny that Mt. Sinai's medical school in NYC is named after Carl Icahn, a PE billionaire who wrote the playbook on corporate raiding and distressed asset extraction. Leonard Green & Partners should take note -- a $200m donation (of mostly dividend recap funds) is enough to stick you name on a medical school and establish some goodwill.
Maybe in the future, you could look into doing a video on the dynamics of a GME program at a county hospital? I recently interviewed at an NY county hospital that was at a "near $180 million loss for 2023" and $560m in the red over the last five years. The program leadership seemed unconcerned about the risk of shutdown or major staffing issues affecting the program. The hospital leadership was even messier than I could imagine: a board led by an man appointed by the county executive, a CEO fired and replaced by the board's general counsel, and a culture of leadership changing with every election cycle.
Residency applicants need to be on the lookout for signs that a program might be circling the drain, even if they look ok from a clinical standpoint.
Great points. I got a question that’s sort of along those lines… I may work it in to a Mailbag in the future.
Great video always enjoy the podcasts.
Thank you for taking the time to watch.
Awesome explanation. Thank you for sharing.
That's crazy that the residents were encouraged to commit fraud to log cases. I can only imagine their lives: being on 12 hour shifts with nothing to do. Thanks Dr. Carmody!
Thank you for watching.
You are out here doing the work. If you are watching this: like and comment. Get eyes on this.
I really appreciate you watching - and spreading the word.
This is going to be Summa Health in a few years after VC General Catalyst purchased them.
Can you create a brief video as a guide on how residents can more thoroughly vet through residency programs and hospitals that have a shady history like this?
What a mess. IIRC you'd talked about this on "X" or I read a piece on it so was familiar with the situation. Thanks for detailed explanation!
The "secret sauce" of PE is pretty simple.
I'm struggling to see any industry in which Private Equity comes in and leaves it in a better state when they came in
some decades ago private equity became the ire of emergency medicine. they were buying out departments and seems they figured out why not just buy the entire hospital. then insurance companies got worse trying to deny every payment if they could. the director of an ED where i worked spent more time battling for reimbursement than he did seeing patients. private equity gave us special training as i recall, one of the most interesting ones was if Na or K was 1 point above or 1 point below normal lab range we had to add hypo or hyper to the diagnosis list even though prior the thought was not significantly raised or lowered.
Great video as always Sheriff. But please please please get a windshield for your mic. Or at least set the mic at a 45-degree angle from the path of your breath. Those popping P's are killing your sound quality.
I love these videos. Major changes need to be implemented to the US healthcare system.
Thank you for watching - and for the kind words. Please share with others, too - my whole point in making this stuff is to try to get other people talking and thinking about some of these problems.
I'd like to propose another winner(s) - future residents who know fairly early in their training that their program isnt up to par, can contact ACGME and expect to receive some sort of respite. Im sure ACGME also learned something from this event & I agree with you that they made the right choice, even if the optics didnt work out in their favor.
Fantastic explanation
Hats off to you sir
Should(sadly) be a movie( horror).
Why isnt this a deeper national story.
How does this trauma center survive???
I go to medical school at one of the Philadelphia schools and knew someone who knew someone who was actually in this program. The reason I heard for the shutdown was because the were not meeting their case requirements or case load for residency. This is complete hearsay and should be taken as such.
I applied and interviewed for the Transitional Year program and they assured us that their program has no accreditation issues and i believe them- I will likely match at a higher choice for my intern year but the PD was very nice and seemed like a decent place for TY at least.
It may be just hearsay - but it is consistent with what Prospect/Crozer’s attorneys acknowledge in their lawsuit, and in their attached correspondence with the ACGME. (One exhibit even acknowledges the concern that residents were double-logging cases using both the MRN and the FIN.)
I believe it’s also true that none of the other programs have had accreditation issues. Prospect/Crozer brought that up in the suit, also.
Bartholomew Banks is a quality reference 😂
“I bought this hospital so I could increase its value as quickly as possible using brutal austerity and authoritarianism so that I can then sell it to the next private equity company for more money.” -Barty Banks
th-cam.com/video/I2q3Ow1Ijjg/w-d-xo.htmlsi=T1Ximj5vF4ZneNyh
Sometimes I think greed will destroy many things in the US.
I think you’re probably right.
Very elaborate
New microphone sounds good
Interesting!
USMLE can introduce different types of questions in the exam: for example: "multiple correct answer type questions" where different options are correct but your answer to the entire question is not correct unless you mark all the correct responses.. or can introduce "integer type questions" where whole numbers from 0 to 9 are the answers and one has to approximate to the closest integer to mark the correct response. or introduce "match the following' type questions, or introduce negative marking to the incorrect responses. These are the strategies that are used in one of the toughest exams in India- IIT JEE to get admission into the prestigious IITs.
I think you got the wrong video bro
Will Marshfield Clinic be closing next year?
I honestly don’t know. But I have seen their name in Becker’s headlines a few times for closing various locations/services.
Bartholemew banks! love the lit review and the @gloucomenflecken reference
“You know what he does during his bowel movements?”
“No…”
“He operates.”
th-cam.com/video/I2q3Ow1Ijjg/w-d-xo.htmlsi=HxDOLisOdfbPlesH