Helping Congress Stop the GME Funding Cuts -- UPDATE
The Centers for Medicare and Medicaid Services (CMS) is set to implement radical changes to completely eliminate funding for GME in all teaching hospitals and additional cuts that will hit public hospitals.
But the voices of CIR doctors have been echoing in the halls of Congress.
Thanks to stories like these, Congress is taking action to place a moratorium on the proposed Medicaid cuts and stand up for the indispensible care you provided.
Read these stories, and then add your own. Explain that, as a resident, you are indispensable front-line providers of care on the floors, in the units, in the clinics, and in the E.R.s of your hospital.
I am a second-year Internal Medicine resident. I see everything.
My day begins often before the sun rises. I've finished pre-rounds, rounds, social-work rounds, discharge planning rounds, teaching rounds, twenty-four patients, three admissions–and it's not even noon.
I can sum up the worthiness of the work I do by means of a recent patient encounter. Mr. Jones (not his real name) was admitted for respiratory failure and ended up on a ventilator. He was only 33. He was morbidly obese and had bad lung disease from sleep apnea. Now he was in the intensive care unit for pneumonia. As our team of physicians cared for this stranger, who lacked a primary care physician, we began our plans for his future. Remove the breathing and feeding tubes, then take care of his hypertension and newly diagnosed heart disease, prepare for rehab and possibly a discharge home after. This all worked out–he was in luck. And he now had a primary care physician: me. Since then we've worked hand-in-hand, and he is well on his way to recovery and substantial weight loss.
Dr. Jack Braha
Maimonides Medical Center
Brooklyn, NY
I have a 10 year-old patient with dermatomyositis, which can flare to the point of debilitation–he can't walk, he can't go to school, he can't even lift his hands over his head. His mother has rheumatoid arthritis and so also has limitations on her movement. Together, they live on $200 a month at most from her disability, renting space in someone's garage. When he first presented with his illness, he was uninsured and went to several private emergency rooms but was only given treatment for his pain without any diagnostic work-up.
I believe he failed the wallet biopsy.
When he came to us, he was in renal failure and miserable, with a full-body rash and unable to move. I feel truly fortunate that we were able to run the tests we needed, get his muscle biopsy, and take the time to make a diagnosis and appropriately stabilize this patient's disease without worrying about who was going to pay for it. He ended up needing rheumatology sub-specialist care and long-term inpatient rehabilitation because of his disease, for which we needed to transfer him to Children's Hospital of LA. Unfortunately, this transfer was delayed for weeks as CHLA would not accept him until our financial services staff figured out how to get him covered by Medi-Cal.
What would have happened to this patient's chronic disease if he were not able to get Medi-Cal, and if the already-miserable rate of reimbursement was not available to fund residents, who were his primary care-takers, made his diagnosis, stabilized him over the course of 2 months and are still responsible for his long-term follow-up? I imagine he'd still be bouncing around between private emergency rooms, getting stop-gap measures but not the continuity of care needed to keep him going to school, growing and developing like every child should have the opportunity to do.
Dr. Melissa Cowell
LA County + USC Medical Center
Los Angeles, CA
I am currently an OB/GYN physician at The Brooklyn Hospital Center in NYC, and I completed one year of trauma general surgery at Lutheran Medical Center, also located in Brooklyn, NY. I spend most of my time helping patients who arrive at my hospital in need of medical care but do not have any means of insurance or payment. I believe that health comes first, and if a person is in need, I don't feel that they should suffer because they cannot afford to cover the fees applicable to their health coverage.
During my year of trauma surgery, I have come across hundreds of patients who came to my hospital practically "dead on arrival," and my team of physicians responded to these patients and spent hours and hours trying to revive them and stabilize them so they could live another day. I have helped a wide range of patients, including those who were homeless and had not even a single penny in their pockets, as well as prosperous individuals who were able to afford health insurance. I have saved lives of NYC police officers and NYC firefighters when they were brought into my hospital as a Level I emergency.
Now that I am covering the Labor and Delivery Unit at The Brooklyn Hospital Center, I come across many patients who need prenatal care and don't have insurance to pay for it, as well as those who arrive in active labor and those who come in with unstable vital signs and need emergent surgery to save not only their lives, but the lives of their babies.
I am the front line of care for my patients when they come into my hospital and need my help.
Dr. Bassam Rimawi
The Brooklyn Hospital Center
Brooklyn, NY
I am now on obstetrics rotation. The residents at our hospital provide primary care to most of the laboring women who present to our hospital. For many, it is the first time they have had insurance in their lives, with Medi-Cal insurance providing for the antenatal period. Most of these patients are seen in our resident clinic for their prenatal care. In a way, residents' patients are some of the most difficult. Challenging social situations, scant resources, and cultural and language barriers abound.
But as I sit now following a 30 hour shift with about 1 hour of sleep mixed in, I'm reflecting on these patients and these years of my training. I know as a fact that my hospital and hospitals across the nation would collapse without residents providing front-line care to patients like ours. It is not just community hospitals that depend on resident-provided care, but also the gigantic academic centers in which I went to medical school, where residents are no less than churning engine of the hospital. Everything would stop without them.
Dr. Nicole Mohlman
Santa Rosa Sutter Medical Center
Santa Rosa, CA
I am a pediatrics resident in one of New York City's public hospitals. All of my patients would be uninsured if not for Medicaid programs.
My patients are children and U.S. Citizens, many of them children of illegal immigrants. As U.S. Citizens, they have all the rights that I do.
The Bronx has one of the highest rates of asthma in the country. In fact, almost half of all children in the Bronx have asthma to some degree. We tend to think of asthma as a mild illness that responds to albuterol–the classic "asthma pump" that asthmatics carry with them. However, I have seen the other side of this illness. Last spring, a 10-year-old boy arrived at the E.R. DOA (Dead on Arrival) from an asthma attack.
As residents, we have our own patients for whom we care. I work alone in the hospital every night. Without residents, our pediatrics service would simply not function. As a native Spanish speaker, I provide an essential service to patients whose parents do not speak English. Without these services, our patients' parents would not be properly educated in their care, and these children could die from conditions that are as treatable as asthma.
Dr. Michael Ginsberg
Jacobi Medical Center
Bronx, NY
I would like to share with you a patient that I took care of one and a half years ago. He was a middle-aged man from Mexico who had migrated to the United States several years prior. His family is in Mexico, and he works as a bus boy. He shares an apartment with some friends, and he has no insurance. He came to the ER because of abdominal pain, nausea and vomiting. Upon arrival to the ER, he had fever and a very loud heart murmur. In the initial work-up, we were thinking he only has UTI or acute pyelonephritis (kidney infection). We started him on intravenous antibiotics. We did imaging studies to confirm this, and we found out that he has an infarction of his right kidney, spleen and lungs. An echocardiogram or cardiac US revealed a vegetation in one of his heart valves. My patient had infective endocarditis, and the vegetation found in his heart valve had embolized or traveled to his other organs.
My team started him on intravenous antibiotics targeted to the organism that grew in his cultures. We had to give the IV antibiotics for 4 weeks, and he had to stay in the hospital the whole time because he did not have any insurance. He was unable to work for that month, and he was afraid that he might lose his job and his apartment because of what happened to him. There were times that he wanted just to sign out and leave, but we were able to convince him how serious his condition was and thus he stayed in the hospital. Consequences from his infection if not treated are heart block, stroke, heart failure, abscess in his heart valve, perforation and rupture of the heart valve, which would require replacement of the affected valve. My patient had this very severe infection that, if not treated aggressively, could have led to his demise. He remained stable during the rest of his hospital stay, and he was discharged after receiving a month's course of IV antibiotics. My team has saved my patient's life.
Imagine what he would have gone through if GME funding was drastically cut in my hospital. Imagine also all the lives that we can save if Medicaid's GME funding for teaching hospitals is supported by the Congress.
Our patients' health is our priority, and their safety and lives are our concern.
Dr. Michele Granada
Metropolitan Hospital Center
New York, NY