Increasing Complement

1. Increasing Complement Dan Kirse, MD, FAAP Professorand Vice-Chair Residency Program Director

3. Why do we increase resident complement? • Growing number of faculty

4. Why do we increase resident complement? • Growing number of faculty • Resident numbers have not changed

5. Why do we increase resident complement? • Growing number of faculty • Resident numbers have not changed • More clinical activities in the department

6. Why do we increase resident complement? • Growing number of faculty • Resident numbers have not changed • More clinical activities in the department • Our current residents are already overworked

7. Why do we increase resident complement? • Growing number of faculty • Resident numbers have not changed • More clinical activities in the department • Our current residents are already overworked • You are going to have to dig deeper than that

8. **Unable to get further historical information from Oto RRC

9. Recent NRMP Oto match data Year PGY1 slots 2006 264 2007 270 2008 273 2009 275 2010 280 2011 283

10. Temporary increase in complement • Must apply whenever a resident is greater than 3 months • out of phase • - extended sick time • - replacing a vacated resident position • - extended maternity leave • - complicated VISA resolution • - accept resident from troubled program (Katrina) • Process completed through WebAds • Similar documentation as permanent increase • Application considered by Exec. Director and head of RRC • (not dependent on waiting for bi-annual RRC meeting) • - *Probably less rigorous process than permanent increase

11. Timing of request for a permanent increase in complement In sync with RRC site visit - information included in PIF - **PIF approved by DIO - PIF forwarded to RRC prior to site visit - site visit occurs and site visitor includes info in report - request considered at next RRC bi-annual meeting Not in sync with RRC site visit - information submitted thru WebAds - **electronically forwarded to DIO for approval - forwarded to RRC for consideration at bi-annual meeting 2 major hurdles: internal approval from GMEC approval from RRC

16. Block diagram template

17. Clinical data update template *8 page document

18. Common wisdom says…. Prerequisites for a successful application: - long accreditation cycle (4-5 years)

19. Common wisdom says…. Prerequisites for a successful application: - long accreditation cycle (4-5 years) - (‘probation/warning’ status not eligible)

20. Common wisdom says…. Prerequisites for a successful application: - long accreditation cycle (4-5 years) - (‘probation/warning’ status not eligible) - adequate responses to citations

21. Common wisdom says…. Prerequisites for a successful application: - long accreditation cycle (4-5 years) - (‘probation/warning’ status not eligible) - adequate responses to citations - good Board pass rates

22. Common wisdom says…. Prerequisites for a successful application: - long accreditation cycle (4-5 years) - (‘probation/warning’ status not eligible) - adequate responses to citations - good Board pass rates - **squeaky clean case logs

23. Common wisdom says…. Prerequisites for a successful application: - long accreditation cycle (4-5 years) - (‘probation/warning’ status not eligible) - adequate responses to citations - good Board pass rates - **squeaky clean case logs - clean ACGME resident survey (no faculty oversight issues)

24. Common wisdom says…. Prerequisites for a successful application: - long accreditation cycle (4-5 years) - (‘probation/warning’ status not eligible) - adequate responses to citations - good Board pass rates - **squeaky clean case logs - clean ACGME resident survey (no faculty oversight issues) - this is the stuff you don’t have direct control of

25. Common wisdom says…. Prerequisites for a successful application: - long accreditation cycle (4-5 years) - (‘probation/warning’ status not eligible) - adequate responses to citations - good Board pass rates - **squeaky clean case logs - clean ACGME resident survey (no faculty oversight issues) - this is the stuff you don’t have direct control of The “Art” of a successful application

26. Common wisdom says…. Prerequisites for a successful application: - long accreditation cycle (4-5 years) - (‘probation/warning’ status not eligible) - adequate responses to citations - good Board pass rates - **squeaky clean case logs - clean ACGME resident survey (no faculty oversight issues) - this is the stuff you don’t have direct control of The “Art” of a successful application - creating a convincing educational rationale

27. “….and the survey says….”

28. Recent response to e-mail inquiry • ~15 responses • Most replies within ‘minutes’ of distribution • All but one response was from programs that • were successful in the process • One program denied twice in past 10 years • Interesting insights to follow…..

29. Scrutiny before the app. gets to the RRC • Limited availability of funds from GMEC to expand • (may get worse with further cuts at national level) • Some GMEC processes are rigorous and complex • - scrutinize op logs and educational rationale • - faculty expansion • - scholarly activities • - department’s importance in strategic mission of hospital • - competition with other departments within institution • for support from GMEC (ranking process) • - many applications never make it past this point

30. The ‘art’ of the successful application • Credible educational rationale for expansion • Cannot rely solely on high case logs or expanding faculty • Must not create image that current residents are overworked • and need help (don’t focus on ‘service’ component of needs) • Maintain proper ‘balance’ between service and education • Highlight long-term stability in key indicator case numbers • Examine local work force situation- need to show need for more • providers and historical evidence that residents stay local • Make convincing argument that “educational opportunities” • exist and are being developed that cannot be fully • utilized by current complement of residents

31. The ‘art’ of the successful application • “educational opportunities:” • New faculty starting new clinical service • ‘key’ surgical cases going uncovered by residents • Making case for lack of contact with faculty in clinic • New care facility coming online (VA, private hospital, etc) • Private practice rotation • Rotation based on core competency (QI rotation)

32. The ‘art’ of the successful application Convince the RRC that not only can you adequately train more residents than you currently have

33. The ‘art’ of the successful application Convince the RRC that not only can you adequately train more residents than you currently have …..but, also

34. The ‘art’ of the successful application Convince the RRC that not only can you adequately train more residents than you currently have …..but, also All of your residents would have a BETTER educational experience if you had more residents in your program (access to more and better educational opportunities)

35. The ‘art’ of the successful application Convince the RRC that not only can you adequately train more residents than you currently have …..but, also All of your residents would have a BETTER educational experience if you had more residents in your program (access to more and better educational opportunities) BE CREATIVE!!!