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UT Southwestern response to Dallas Morning News on 07/09/10

UT Southwestern response to Dallas Morning News on 07/09/10

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UT Southwestern’s written response to questions from The Dallas Morning News
UT Southwestern’s written response to questions from The Dallas Morning News

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Published by: The Dallas Morning News on Jul 30, 2010
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 UT Southwestern Responses to Dallas Morning News
July 9, 2010
Overview
UT Southwestern (UTSW) encloses its responses to the 12 questions posed by the DallasMorning News (DMN) on Friday, July 2, 2010, concerning resident physician training andclinical care provided by UT Southwestern. We have focused specific comments on surgicalservices and training because of the apparent particular interest in these issues. However, wewish to emphasize that the underlying principles and approaches are similar for all clinicaldisciplines. The responses are necessarily lengthy, due to the inherent complexity of graduatemedical education. Moreover, several of the presumptions embedded in the questions are simplywrong, and we wish to correct those as thoroughly as possible, so that the DMN has an accuratebasis for any story it may wish to write. To ensure that the answers are understood in the broadercontext of academic medical centers and medical training in general - and UT Southwestern inparticular - UT Southwestern would like to emphasize the following points before turning to thequestions:
As one of the leading academic medical centers in the country, UT Southwestern is deeplycommitted not only to its missions of education, patient care, and research, but also to thefundamental value to patients and society of the integration and interdependence of thesethree activities. This integration is a defining characteristic to every one of the most highlyranked and widely respected medical schools and hospitals in the country.
Graduate medical education (GME) - the three to eight years of residency and fellowshiptraining that follows medical school graduation - is overseen by national bodies, mostimportantly the Accreditation Council for Graduate Medical Education (ACGME), whichsets the national standards for residency programs in a given specialty and conducts regularreviews of such GME programs.
It is also worth noting that the number of GME program positions supported by Medicarewas capped at the 1996 level as part of the Balanced Budget Act of 1997, i.e. when what isnow University Hospital-St. Paul was still a community hospital and had not yet beenacquired by UT Southwestern, which is the principle reason why there are fewer GME
 
July 9, 2010 Page 2
program positions at University Hospital-St. Paul, compared to Parkland Memorial Hospital(Parkland).
With the welfare of patients as the foremost priority, the essence of all residency programs isto provide graduated supervision to resident physicians as they progress through theresidency program, with the goal of producing physicians fully ready to independentlyperform their chosen specialty.
Against this backdrop, UT Southwestern Medical School sponsors 95 residency andfellowship programs and has prepared, at least in part, more than half of the physicians whocurrently practice in North Texas.
UT Southwestern-sponsored residency training programs are stringently scrutinized by theACGME. We note that UT Southwestern operated hospitals also fulfill all requirements of The Joint Commission, the national accreditation organization for hospitals.
UT Southwestern adheres to ACGME standards irrespective of whether residents areassigned to rotations in UT Southwestern owned and operated hospitals and clinics, or to UTSouthwestern affiliated hospitals, including Parkland, Children’s Medical Center, the NorthDallas Veteran’s Administration Medical Center, and other private hospitals in North Texas.
The philosophy underlying residency training is best summarized in the ACGME’s ownwords about its common program requirements:“Developing the skills, knowledge, and attitudes leading to proficiency in all thedomains of clinical competency requires the resident physician to assumepersonal responsibility for the care of individual patients. For the resident, theessential learning activity is interaction with patients under the guidance andsupervision of faculty who give value, context, and meaning to those interactions.As residents gain experience and demonstrated growth in their ability to care forpatients, they assume roles that permit them to exercise those skills with greaterindependence. This concept – graded and progressive responsibility – is one of the core tenets of American graduate medical education. Supervision in thesetting of graduate medical education has the goals of assuring the provision of safe and effective care to the individual patient; assuring the development of theskills, knowledge, and attitudes in the resident required to enter the unsupervisedpractice of medicine; and establishing a foundation for continued professionalgrowth.”
 
July 9, 2010 Page 3
UT Southwestern’s responses to the DMN’s questions will focus on the UT SouthwesternGeneral Surgery Residency Program, given the DMNs particular interest in this area. Wenote at the outset that this program adheres to the ACGME’s graduate medical educationphilosophy and program requirements so effectively that at its last accreditation review(2007), it was given full continued accreditation without citations and assigned a 5-yearreview cycle (the longest review cycle granted by the ACGME Surgical Residency ReviewCommittee).
A number of the DMN questions are based on a report that is now 6 years old, and evenwhen it was first issued had serious limitations. That report was prepared by HealthManagement Associates (HMA), a proprietary consulting and hospital management firmhired by Parkland. HMA reported that over a six-month period its consultants interactedwith “more than 250 governmental officials, health care and business leaders, civic andadvocacy group representatives, doctors, patients, and other front line clinical andadministrative staff.” However, the HMA representatives had very little interaction with UTSouthwestern administration and leadership and lacked significant input for the assessment.As a result, when the report was issued, UT Southwestern found that it was flawed and at thattime expressed in writing its disagreement and concern regarding the quality of the dataconsidered by HMA and the accuracy of the resulting conclusions and recommendations.UT Southwestern is equally concerned today that the DMN would find such a dated anddiscredited report relevant in 2010, especially given the many changes that have occurred inthe landscape of health care delivery nationally and at both UT Southwestern and Parkland inthe intervening years.
To address a central underlying premise of a number of the questions posed, we want to stateunequivocally that UT Southwestern does not support two standards of patient care andembraces the same approach to care provided at Parkland and the University Hospitals.
There is a distinction, however, in how patients access care at Parkland versus the UTSouthwestern operated hospitals. The great majority of Parkland inpatients are admittedthrough the Parkland emergency department. Relatively few Parkland inpatients arrive withestablished relationships with faculty physicians, and they are therefore assigned to UTSouthwestern physicians upon admission. In marked contrast, the great majority of inpatients at University Hospital- Zale Lipshy and University Hospital-St. Paul have anestablished relationship with faculty physicians prior to admission. However those patientswho do present to the University Hospital-St. Paul emergency department without a priorphysician relationship are assigned to a faculty physician similar to the procedure atParkland. (University Hospital-Zale Lipshy does not operate an emergency department.)Just as at Parkland, faculty physicians care for patients at the University Hospitals inconjunction with resident physicians – although for the historical reasons noted above, there

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