Answers to Some Questions that Brookdale Residents Are Asking about the Residency Program Reductions and Potential Program Closures
On November 2, 2011, the Committee of Interns and Residents/SEIU, learned about the financial perils that Brookdale Hospital is confronting and the potential reduction in some of the Brookdale residency programs. CIR has been working hard to find out everything we can and in turn to provide the residents at Brookdale with timely and accurate information. Here are answers to some questions that have come up so far.
1. Has the decision been made to close the Brookdale ACGME residency programs?
We have not been informed of any possible program closures yet.
We have been informed, however, that Brookdale is considering program reductions in all the other departments, namely Anesthesia, Surgery, Internal Medicine, Psychiatry and Pediatrics. At this point it is not clear how those reductions will happen. So far the only programs that seem to be unaffected are Urology and Dental.
The ACGME rules state that when Brookdale as the “sponsoring institution” decides to close a residency program, it must inform the residents as early as possible. CIR will continue to monitor the situation closely and tell you whatever we learn when we learn it.
2. What is the process for deciding if residency programs are going to be downsized or closed?
From what we understand, Brookdale has retained the consulting firm Health First to evaluate the efficiency of Brookdale’s operations, a part of which is evaluating the size and scope of the residency programs and fellowship. The firm has submitted an approach to the hospital and the affected departments for dealing with the issues at hand, and the chairs of those departments have been given the opportunity to submit responses and possibly suggesting other models of achieving the savings the hospital is seeking as an alternative. These reports are due before the end of the month. After that happens, the consulting firm will take the alternate proposals under advisement and submit final recommendations to the hospital’s leadership.
CIR has made a formal request for a copy of the proposals and approaches that are being considered as well as a seat at the table.
3. If the decision is made to close programs or reduce the size , when would they close?
The information that CIR has received does not indicate any movement by Brookdale to make changes to the residency programs prior to July 1, 2012.
4. Can a hospital close or reduce the size of residency programs before June 30, 2012?
Yes. But it would be much better for all concerned—if the programs have to close—that they close no earlier than June 30, 2012. CIR will be emphasizing this point to Brookdale and all other stakeholders.
5. Can a program, together with its residents, be moved entirely to a new hospital so that I won’t have to look for a position on my own?
Theoretically, it is possible, but it is very unlikely. Don’t count on it.
6. What does it mean to be a “displaced” (“orphaned”) resident? And will I become a “displaced” resident if my program is reduced?
A “displaced resident” is defined as a resident who was training at a hospital up to the point that the program completely closed. Federal money for the displaced resident slot can be transferred to a receiving program. If your program is downsized, you do not become a displaced resident.
7. I am in a transitional program and have been accepted into a categorical position starting July 1. Am I eligible for “displaced resident” (“orphan”) status for my categorical position?
No. If a resident has a contract for a categorical position that starts July 1 and the program closes on June 30th or before, “displaced resident” status is unavailable.
8. Will the Residency Review Committee (RRC) for my specialty help me find a new position?
No. The RRCs are not in the business of finding new placements for residents displaced by program closures or reductions. They will not provide any assistance.
9. Will CIR help me find a new position?
To a limited degree. CIR is a labor union that does collective bargaining for 13,000 residents at numerous hospitals around the country; unfortunately, we are not set up to act as a resident placement service. Nonetheless, in the event of residency program closures or reductions at Brookdale, CIR will contact programs in all CIR hospitals to ask if they can take on more residents and then share their responses with Brookdale residents. After that it will be up to each resident to take steps to secure a placement for him or herself at any of these hospitals.
10. Is Brookdale responsible for finding new positions for all the residents who lose their position by the potential program closures or program reductions?
ACGME requires Brookdale to have a written policy that addresses program closure. Nonetheless, it is in your best interest to take personal responsibility for finding a new position for yourself. You should speak with your program director. Your program is in the best position to give you advice and assistance. You should use all available sources and networks at your personal disposal.
As for program reductions, the CIR contract says: “An incumbent Resident shall not be prevented from completing his/her residency program because of the Hospitals’ decision, for budgetary reasons or to reduce the number of residents in the program. (…) The Hospital shall use its best efforts to place incumbent residents whose positions are affected.”
11. If we are displaced by program closure, won’t we be forced to compete for the same few PGY 2 and higher PGY residency slots that open up each year around the country?
Not exactly. When residency programs completely close, other programs may request temporary residency slots that one or more displaced residents take to complete their training. All programs need to be mindful of not diluting the training experience of their existing residents by adding too many new slots and have to get formal approval from their RRC before adding any new slots.
12. Why would another program temporarily add a residency slot?
First, residents provide an economical labor pool for hospital medical services. But there’s another financial incentive at work in this situation. Generally, each residency slot is supported by federal money. When a program closes, each resident is deemed a “displaced resident” (or “orphan”) and federal money for the displaced residents’ slots can be transferred to receiving programs. Federal money for the displaced slots are available to the receiving program only long enough for each displaced resident in the receiving program to complete their residency.
Two examples: A Medicine resident entering her PGY 2 year would have funding for 2 years, to cover her remaining PGY 2 and PGY 3 years. A Surgery resident entering his PGY 2 year would have funding for 4 years, to cover his remaining PGY 2, 3, 4 and 5 years.
13. Does the receiving program of displaced residents qualify automatically for the transferred federal funds for my residency slot from the first day I work there?
Not exactly. First, the original program has to close completely. So if your program closes on June 30, 2012, and you enter the new program later, on July 1, 2012, the new program can receive the transferred funds for your residency slot for the period beginning July 1, 2012. Second, both the closing program and the receiving program have the affirmative obligation to make applications to the federal government within 60 days of the program closure date.
14. If I leave before the program closes, am I entitled to “displaced resident” status?
No. A “displaced resident” is defined as a resident who was training at a hospital up to the point that the program completely closed. If you discontinue your training at Brookdale prior to your program closing, you are not considered a “displaced resident.” Nonetheless, if you are leaving to transfer to an open residency slot in a new program, then your problem is solved and the issue of “displaced resident” status is irrelevant.
15. Would fellows also be able to get “displaced resident” (“orphan”) status?
If the fellowship is ACGME-accredited, yes; if it is not, no. ACGME-accredited fellowships are subspecialty residencies and are supported by federal funding for residencies. If a fellow is in a program when it closes, then that fellow will be eligible for “displaced resident” status. But if a resident has a contract for a fellowship that starts July 1, 2012 and the program closes on June 30, “displaced resident” status is unavailable.
The hospital has maintained, due to fellowship affiliations with SUNY Downstate, that the earliest reductions or discontinuation of fellowship programs wouldn’t be until July 1, 2013.
16. Do residents who are in H-1B status have any additional issues to consider?
Yes. In order to remain in the United States, residents in H-1B status cannot have any time gap – not even one day – between the date they finish at the closing program and the date they start at the receiving program. Residents in H-1B status cannot start work before a new H-1B petition has been filed by the receiving program. Residents in H-1B status must get accepted by a receiving program sufficiently in advance of the closure of their existing program to allow time for a new H-1B petition to be filed before they begin work at the receiving program.
17. What additional issues are there for residents in J1 status to consider?
Like residents in H-1B status, residents in J-1 status cannot have any time gap between the date they finish at the closing program and the date they start at the new program. Before they start at the new program, they must have applied for and received approval from the Educational Commission for Foreign Medical Graduates (ECFMG) for the new program. ECFMG takes about four weeks to process an application. Therefore, it is essential to secure a position in a new program sufficiently in advance to allow time for the ECFMG approval to be issued before the conclusion of your residency work at Brookdale.
18. Will I get paid time off from my residency program to go to interviews?
Not at this time. We intend to discuss with Brookdale. The CIR contract provides for 20 vacation days for residents each year. While we understand that essential medical services need to be covered, we believe Brookdale should take a liberal attitude toward allowing residents to schedule their remaining vacation time to go to interviews and we will discuss this with them as well.
19. Will Brookdale pay for my travel expenses when I go to interviews?
Not at this time. CIR intends to raise this issue with Brookdale, along with payment for other expenses, such as moving expenses, incurred due to any program closures.
20. I live in Brookdale housing. What will happen to my housing if my program is closed or reduced?
CIR will commence what is called impact bargaining on a myriad of issues affecting residents who will be displaced or losing their spot due to program reductions as soon as those decisions are made. CIR would be seeking a potential resolution that could include an extension to your housing right to use Brookdale housing during a transitionary period.
21. What will happen to our CIR contract/collective bargaining agreement if Brookdale is acquired by another hospital?
Any hospital that acquires Brookdale could voluntarily agree to be bound by the collective bargaining agreement currently in place. If the hospital acquiring Brookdale does not agree to be bound by the current agreement, it would have to negotiate with CIR prior to making any unilateral changes to the terms and conditions of your employment, like salary and benefits.
If you have more questions, please contact the CIR Organizer, Marsha Niemeijer, at mniemeijer@cirseiu.org.
