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Doctors Hospital at Renaissance's four residency program directors are John Michael Breen, Eron. G. Manusov, Charles M. Richart, and Michelle Cordoba-Kissee.

EDINBURG, RGV – Doctors Hospital at Renaissance has asked visiting members of Congress to help change the law so the Rio Grande Valley can secure more residency slots at its teaching hospitals.

Currently, there is a cap on how much funding the Centers for Medicare and Medicaid Services (CMS) can provide for residency programs and how many programs can be funded.

“At the moment, CMS works with hospitals to help fund residency programs. There are no more residency slots that CMS will pay for unless you are a new hospital. If you are a new hospital you only five years to build the residency and then you are cut off again,” said DHR CEO Israel Rocha, in an exclusive interview with the Rio Grande Guardian.

“There are some hospitals in other parts of the country that have empty slots that are not being funded but they hold on to the number of slots they have even though they are not using them. What we would like to do is have CMS either create new slots so that everyone can have more doctors or reshuffle the ones that are not being used into sort of a lottery and then let everyone compete for them.”

Rocha said redistributing the residency slots is vital if the UT-Rio Grande Valley School of Medicine is to prosper. “Congress will have to fix this. We have some great opportunities because we (the Valley) are growing and we are a new hospital. We can take advantage of this, but, thinking long term, into the future, we definitely want the opportunity to have more residency programs.”

Rocha gave his interview to the Rio Grande Guardian immediately following a power point presentation made to a handful of members of Congress at the Edinburg Conference Center at Renaissance. The meeting was hosted by U.S. Rep. Filemon Vela, D-Brownsville. In attendance were Manny Vela, CEO of Valley Baptist Health System in Harlingen, which is a teaching hospital, and Dr. Guy Bailey, president of UT-RGV.

“We are very honored to have partnered with UTRGV and UTPA in the transition for a graduate medical education program,” Rocha said, at the beginning of his presentation to the members of Congress. “Our hospital became a major teaching hospital this year. Together with Valley Baptist Health System we comprise a majority of the residency programs that will help launch the new UTRGV medical school.”

Rocha pointed out that this year, DHR opened up four residency programs that have already matched students. “They will be setting foot on campus in July, 2015. We have family medicine, general surgery, obstetrics and gynecology, and internal medicine. All four programs underwent a rigorous review process in order to receive accreditation this past fall, in 2014. The first 25 of 80 students in those components were approved.”

Rocha said DHR is “very proud” to have achieved accreditation for its first four residency programs so quickly. “We have been wanting a medical school for a long time and so we did not let any grass grow under our feet. We got started to make sure the medical school got there from ideation to hiring the program core faculty to submitting the PIF (program information form) to getting accreditation was all less than 12 months. It was a very heavy exercise and we are very honored to have been able to do it.”

Rocha said DHR would not have been able to secure accreditation without the support of the community and Dr. Bailey and his staff at UTRGV. “It was a comprehensive effort. You need the residency programs to hire the directors, to get the faculty, to get the medical school started. It was a great team effort and we were very excited. The ACGME (Accreditation Council for Graduate Medical Education) told us it was the fastest they had seen any institution do it in the United States. So, we were very happy to have done it and get full accreditation.”

Rocha then told the members of Congress what DHR has in store for this year – more residency programs. “This year we are working to get preventative medicine, pediatrics, a one year transitional program, as well as urology accreditation. So, we will be adding four more residency programs that are in pursuit of hiring their program directors. We are very excited about that.”

The one new residency program DHR is most excited about, Rocha said, is preventative medicine because there are so few of them around the country. “It is a new trend, one that specializes, a hybrid between family medicine, internal medicine and a specialized policy program that looks at how you can really change and bend the cost curve nationally. Because we are a huge area for diabetes and obesity we thought that investing in preventative medicine residency and bringing those talents here to our community was very important. We are very excited about this and have been working with top programs around the country to help create this one. We are very excited to have this partnership and collaboration and they are coming together to do very nicely.”

Rocha said thus far over 500 students from around the country have come to visit DHR with a view to signing on for a residency. “For a new residency program we are very excited that combined, over all the residencies, we have had over 3,500 applicants for less than 25 slots. It was highly competitive. The students scored an average 98th percentile on their United States Medical Licensing Examination. He said the first students arrive in July, 2015. “Overall we will have over 200 residents on our campus and over ten residency and fellowship programs over the next five years,” Rocha predicted.

Rocha then made his pitch for members of Congress to help on addressing the CMS cap.

“Our hospital being a new hospital, we have five years to get our cap in order to get the CMS funding. Please revisit how graduate medical education is paid around the country and look at creating more slots so we have more opportunities. We always say, you can build medical schools but if you do not have the residencies to go there they will not stay in your community – so they (residency programs) are the end means to get the doctors in the community you need. We encourage everybody to support funding and expansion of the graduate medical education cap so we can bring more programs.”

Rocha said the CMS cap on spending on residency programs is a national issue. He cited the example of DHR hiring a pediatric neurosurgeon. “The competition was tough. They graduate ten (pediatric neurosurgeons) in the United States every year and yet 15 retire every year. So, you are seeing that shortage in those specialists when we have our population increasing. So, we have some problems in getting the high specialists that we need to help cure our country. Just as there is a race and need for primary care medicine, there is an equal need for those specialist physicians who handle complicated disease and diagnosis and they are, unfortunately, not graduating at the frequency that we need to take care of our community.”

Rocha acknowledged that national leaders are looking for” great solutions” on the shortage of specialists issue and that the Affordable Care Act has a provision that allows nurses to do more and doctors to do more. “At the end of the day you still do need that cardiac surgeon, you still need that pediatric neurosurgeon, you still need that specialist to be able to push medicine, to push discovery.”

The Association of American Medical Colleges argues that resident limits are impeding teaching hospitals’ educational mission. The AAMC argues that the Balanced Budget Refinement Act of 1999 has imposed “significant limitations on the ability of teaching hospitals and medical schools that sponsor and conduct graduate medical education programs to respond to the needs of the communities they serve.” Over time, the AAMC states, the current policy will “impede the continued development of the educational mission at many teaching institutions.”

In a policy statement, the AAMC said Medicare reimbursement for additional residents and/or new residency programs at teaching hospitals are needed for a variety of reasons, including:

* Rapid population growth in some areas of the United States. The current limits constrain the ability of hospitals and medical schools that sponsor graduate medical education programs to increase the magnitude of residency training activity to help assure adequate and appropriate numbers of physicians within that geographic area.
* Shortages in certain medical specialties. It is not uncommon for shortages to arise in certain specialty areas of medicine due to changes in medicine, technology and practice. In these instances, some areas of the country may have a shortage of training positions for these specialties due to the dynamics of the medical marketplace and the longitudinal development of teaching programs.
* Development of new specialties. Medicine is evolving at a very rapid pace. Driven in large part by the rapid increases in new knowledge arising from research and other activity at medical schools, pharmaceutical firms, technology firms, and research institutes, there is a need to continually consider the development of new specialties. These new specialties provide the leadership to assure that these new capabilities are available to the public. Staff of the Accreditation Council for Graduate Medical Education (ACGME) have noted that the current resident limits are impeding even preliminary discussions about the establishment of new residency programs.