Discuss Detroit » Archives - Beginning July 2006 » Accrediting Group Eyes DMC-WSU Squabble « Previous Next »
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Stecks77
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Username: Stecks77

Post Number: 37
Registered: 08-2006
Posted From: 129.9.163.106
Posted on Wednesday, September 06, 2006 - 1:35 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

If any of you have a subscription to Crains Detroit check out the article on the homepage called "Accrediting Group Eyes DMC-WSU Squabble."
http://www.crainsdetroit.com/a pps/pbcs.dll/frontpage

From what I can tell there has been very little coverage in the broader media regarding this dispute and a lack of resolution will have a large impact on the city, both economic and social.

I already know a number of medical students who whould like to work in the residency program at the DMC but are afraid its not going to exist so they may leave the city or the state entirely.

I have the text of the article but I didn't want to cut paste for copyright reasons. Sorry.
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Southwestmap
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Username: Southwestmap

Post Number: 568
Registered: 01-2005
Posted From: 70.229.231.102
Posted on Wednesday, September 06, 2006 - 2:22 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

I posted this comment on the Downtown Detroit development thread and am copying it here. I think you are very right that this is an important story.

I have friends who teach in the medical school. They believe that Mike Duggan has decimated the DMC and that within only a few years it will be nothing more than the equivilant of a community hospital system. The end of an era of great prestige, great research and great medicine in the heart of our city.

The DMC's alliance with WSU's med school was an important engine for travel into the region. Scientists, doctors and patients came from great distances, much as people travel to the Cleveland Heart Center, etc. Now we'll have- maybe- something like St. Joseph Mercy in its place.
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Wazootyman
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Username: Wazootyman

Post Number: 122
Registered: 02-2006
Posted From: 68.75.220.9
Posted on Wednesday, September 06, 2006 - 2:26 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Why exactly would a medical center that is so physically mixed within WSU allow itself to break off? I just can't understand the motivation on either side if this happens.

Also, I thought Mike Duggan was credited for making the DMC profitable again - what exactly has he done to "decimate" the center?
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Southwestmap
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Username: Southwestmap

Post Number: 569
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Posted From: 70.229.231.102
Posted on Wednesday, September 06, 2006 - 2:32 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

A long story succinctly presented in Crain's. I will say that Duggan, using codespeak, played the race card to weasel out of responsibility for dropping a prestigious residency (orthpedics)program that had a home at the DMC.
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Stecks77
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Post Number: 40
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Posted From: 129.9.163.106
Posted on Wednesday, September 06, 2006 - 2:36 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Duggan has done alot of cost cutting related to operations which was necessary but he has cut specialty areas such as orthopedics and I belive dermatology. From what I understand the ear, nose, and throat residency program is also in jeopardy among others.

This doesn't just mean the residents leave. The doctors and professors are also gone and the hospital does not have specialists in that area of expertise.

(Message edited by stecks77 on September 06, 2006)

(Message edited by stecks77 on September 06, 2006)
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Wazootyman
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Post Number: 123
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Posted From: 68.75.220.9
Posted on Wednesday, September 06, 2006 - 2:41 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

I'm going to read the article in Crain's tonight, but again, I just don't understand what possible benefit this would offer the DMC.
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Southwestmap
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Post Number: 570
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Posted From: 70.229.231.102
Posted on Wednesday, September 06, 2006 - 2:47 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Duggan terminated, unexpectedly, the orthopedic residency program, leaving(especially) third-year residents (as well as first and second-year) to find a new hospital somewhere, anywhere. This is career-damaging because residents must do a full three years in the same hospital. So the residents that he dumped have to start back over. As you can imagine, this raised a lot of concern with the national residency accrediting association. They are now asking hard questions about the DMC's intentions in the other specialty areas and they are getting facitious answers from Duggan.
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Stecks77
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Post Number: 41
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Posted From: 129.9.163.106
Posted on Wednesday, September 06, 2006 - 2:52 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

I thought I heard the dispute with the orthopedics doctors was over operating rooms? Availabilty? Times?

Southwestmap: did you hear anything like that?
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Ramcharger
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Username: Ramcharger

Post Number: 57
Registered: 05-2006
Posted From: 68.42.78.175
Posted on Wednesday, September 06, 2006 - 5:12 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Don’t residents sign a contract with their hospitals which would give them some legal recourse?
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659
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Username: 659

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Posted From: 68.73.204.233
Posted on Wednesday, September 06, 2006 - 5:58 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

i am a dermatology resident at WSU. the entire department of dermatology did indeed recently leave the DMC -- we are now affiliated with Oakwood Hospital. i'm not privy to the exact machinations of why we left but i can tell you what this means for DMC patients -- virtually no one to provide dermatology services to DMC pts, nobody to do inpatient consults as of Jan 1, no dermatology research, no academic department to draw interesting/challening patients to. if this happens in urology, ENT, ortho, etc then there will be no good reason for patients to come to the DMC anymore. our department is supposed to run an "indigent care" clinic once or twice a week at UHC but this will hardly meet the needs of patients.

there is talk that the DMC believes it does not get it's money's worth from supporting residency programs at WSU and is willing to eliminate it's academic affiliation. i don't know how any hospital system would willingly give up hundreds of doctors (residents) that work for just $40K a year.
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Bvos
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Post Number: 1939
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Posted From: 70.228.57.79
Posted on Wednesday, September 06, 2006 - 10:17 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

This will be a disaster for the DMC and for WSU. Just think of all the infrastructure that the WSU Med. School has built around the DMC. The Med. School has even been moving buildings to the medical campus at a great cost just for the purpose of being a stones throw from a hospital. Hopefully Duggan gets fired over this totally stupid idea.

This will also decimate Midtown and all of the condos going up there.
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Wazootyman
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Post Number: 124
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Posted From: 68.75.220.9
Posted on Thursday, September 07, 2006 - 8:00 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

I think these are all reasons why it would never happen, but maybe I'm just an optimist.
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Stecks77
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Post Number: 44
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Posted From: 129.9.163.233
Posted on Thursday, September 07, 2006 - 8:56 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Thanks for chiming in 659. I was hoping a resident would offer more direct insight into the situation.
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Southwestmap
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Username: Southwestmap

Post Number: 576
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Posted From: 70.229.231.102
Posted on Thursday, September 07, 2006 - 9:44 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

659: I'm pretty sure that orthopedics is already gone. Eliminating that residency program was the beginning of this "squabble."
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Thrice
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Username: Thrice

Post Number: 93
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Posted From: 207.91.250.131
Posted on Thursday, September 07, 2006 - 3:53 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

I’m a second year at WSU-SOM who has been following this for the past year. I hope to do my residency in the metro area and I have already purchased a condo here. I’ll give you my biased opinion of that matter, for what its worth.

Duggan is a lawyer first and foremost, and not a doctor. He is currently stuck between a rock and a hard place with the DMC losing money, while providing 200 million per year in uncompensated care. Right now, he is looking at a dollar total bottom line and I think he has made the following decision:

The DMC can provide cheaper care in some areas by dropping certain academic factuality and training programs and replacing them with non-academic doctors.

Duggan thinks that he can provide services for cheaper, not utilizing the resident system. While this is HIGHLY debatable, even if it were true it wouldn’t save a lot of money. One reason to cut the academic programs is the possibility of providing less care that is uncompensated, but that’s my own personal conjecture.

My question is does the DMC really think it can attract quality doctors with out the incentives of academics? With no research? No teaching? Highly unlikely with other health care systems near by, that can probably pay more, Docs come to the DMC to research (they get over 60 million a year in NIH funding) or to learn, in is residency training programs. With out these factors there is no real draw to work at the DMC, hopefully mike will realize this before to late.

The main sticking point for the SOM is they want an over arching contract for all the residency programs. If programs continue to be cut one by one, the other programs will have less recourse (I,E. less striking power) after a few have been eliminated. The DMC wants to contract each program with an individual contract. There is no need for this unless they plan to re-new/not renew in order to cut select programs. They will probably try to cut the smaller programs that lose more money, while keeping the larger ones, (IM, Gen surg)

Added to the debate is that the SOM has been expanding its program sizes (according to recommendation by the associate of American medical colleges) which the DMC can no longer accommodate and has been expanding into other health systems to share the burden of students. I think the DMC sees this as a slap in the face, when it really comes down to logistics.

Why this is bad for everyone:
1) Wayne loses prestige (very important in recruiting students). Any disruption of the residency programs severely impairs the perceived quality of the program (and of the entire SOM). Already this year ortho did not recruit a new class. It will take this program many years to recover from this insult and be able to recruit high quality students again.

2) DMC loses the main reason good doctors come there; to practice and teach. They are provided a place to do research which out that….. what is the attraction?

Anyway, that’s how I see the problem.
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Cassie1717
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Username: Cassie1717

Post Number: 43
Registered: 04-2005
Posted From: 64.12.116.204
Posted on Thursday, September 07, 2006 - 8:03 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Who can fire Duggan and when can this be done?
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659
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Username: 659

Post Number: 2
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Posted From: 68.73.204.233
Posted on Thursday, September 07, 2006 - 8:29 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

if duggan wants to make money, cutting subspecialties doesn't make sense. with a little investment, dermatology could have made the DMC a ton of money b/c of all the billable procedures we do. nobody ever made any money off of an internal medicine department b/c our health care system totally undervalues primary care. that's why med students want to go into dermatology and not family practice.

i realize that there have been rumors of the demise of the DMC for years now. while this may not be the death of the DMC (it certainly won't be the end of Karmanos and Children's) i think it is very likely that Receiving Hospital may be a very different place in the near future.
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Thrice
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Post Number: 94
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Posted From: 207.91.250.131
Posted on Thursday, September 07, 2006 - 8:40 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

659: its just easier to cut the smaller programs....

How many residents in your derm program? 2 maybe 5 a year tops?

I.M. has 30-40 per year. Big difference.

Plus billable procedures must be paid. That is a huge problem at the DMC, like I said, they give away 200 MILLION per year in care.
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659
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Username: 659

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Posted From: 68.73.204.233
Posted on Thursday, September 07, 2006 - 8:57 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

99% of the patients i saw at the DMC over the last few months were insured so their insurance covered their biopsies so we were paid for those procedures. uninsured people rarely come to dermatology (b/c skin problems don't make you that sick) and if they do and they need a biopsy they usually refuse it b/c they don't want to pay.

there are only 4 residents a year in my program but there are also only 3 full time attendings compared to what must be hundreds of medicine attendings.
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Thrice
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Post Number: 95
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Posted From: 207.91.250.131
Posted on Thursday, September 07, 2006 - 9:08 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

I’m not saying it makes sense, but I think the DMC thinks it is more profitable to cut the smaller programs. Why go after ortho and derm? I heard possibly optho to? They must have higher overhead or something.
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659
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Username: 659

Post Number: 4
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Posted From: 68.73.204.233
Posted on Thursday, September 07, 2006 - 9:29 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

in any case, duggan needs to fill everyone (employees, residents, patients) in on his long term plans b/c as it stands right now there are a lot of people who are beginning to worry about how the changes to the DMC are going to affect them.
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River_rat
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Username: River_rat

Post Number: 211
Registered: 02-2006
Posted From: 71.246.214.35
Posted on Friday, September 08, 2006 - 9:43 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Sorry 659, but a tube of clobetasol replaces 75% of the dermatologists on the planet and the reason you saw paying patients in Derm at DNC is that you are all interested in cosmetic derm now.

The DMC/WSU squabbles have been going on since the inception of the DMC. The original disputes were between the Harper - Grace - Women's Hospital groups and the new DMC. The WSU professor docs were intent on moving the long term docs out. Detroit had a great medical reputation for years with names like Benson and Dodrill but then as DMC came into being the demographics of the city and medicine changed.

Other facilities, the ever present Henry Ford Hosp., the greatly expanding Beaumont, etc. became more central to the population and were of equal or better quality. In addition, the city lost about 800,000 people and the real need for the DMC (which was always political) became less and less important.

Duggan is a very competent financial guy and if DMC is to survive, it needs a leader who will make the tough decisions such as Duggan is doing. The politicos are still in the saddle and what will happen (other than the little guy getting ......) is anyone's guess. But everyone knows DMC is in real trouble financially.

DMC is a huge employer and downsizing it will be another nail in the coffin.

river rat
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Stecks77
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Username: Stecks77

Post Number: 46
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Posted From: 129.9.163.106
Posted on Friday, September 08, 2006 - 9:53 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Doesn't Henry Ford Hospital and Beaumont deal with less uninsured patients?

Isn't the DMC primarily in trouble because it treats uninsured patients?

Although it technically isn't, the DMC is a public hospital based upon patient demographics.

That is a pretty big difference, no?
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Crew
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Username: Crew

Post Number: 1028
Registered: 02-2004
Posted From: 146.9.52.18
Posted on Friday, September 08, 2006 - 9:56 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

There is certainly room for futher consolidation in this industry.
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Southwestmap
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Username: Southwestmap

Post Number: 579
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Posted From: 70.229.231.102
Posted on Friday, September 08, 2006 - 10:05 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

I believe that the biggest concern is that the DMC's reputation is as teaching hospital, a research hospital where great work is being done. Beaumont doesn't have that claim to fame.

These elements are being lost because Duggan thought he could bully the Med School and he lost.

In the end, what was a Mayo Clinic, a Cleveland Clinic in Detroit - a prestigious medical research center - is being dismantled.
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Cassie1717
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Username: Cassie1717

Post Number: 44
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Posted From: 64.12.116.204
Posted on Friday, September 08, 2006 - 1:03 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

I can't tell you how many times I've had patients transferred to me at the DMC from U of M, Beaumont, and Henry Ford, mainly because the cases were "too hard" for them to handle. We canNOT lose the DMC's relationship with WSU SOM.
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River_rat
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Post Number: 213
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Posted From: 68.166.44.44
Posted on Friday, September 08, 2006 - 4:52 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Please, with all due respect, DMC is not a Mayo or Cleveland Clinic. The political problems are the nexus of the matter. The largely indigent and uninsured population of the central city needs DMC and DMC needs funding to continue operations in the face of "no-pay" patients. Who and how they will pay is the question. Duggan is simply making monetary decisions to survive. Not every hospital and med school needs a dermatology residency, or an orthopedic residency for that matter.

To set the record straight, the care at the two institutions mentioned by Cassie1717 can manage any medical problem known and to imply or state that a case is "to hard" for them is absurd.

More than anything DMC needs to downsize to fit the new population and find funds to pay for their care. If it doesn't, then the care won't be there.

None of the discussion addresses the real problem which is funding medical care for a very, very expensive group in America. The poor.
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Cassie1717
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Username: Cassie1717

Post Number: 45
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Posted From: 205.188.116.137
Posted on Friday, September 08, 2006 - 8:54 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

"I'm sorry, we just can't manage that type here" is quoted from AA and "Send that patient to Hutzel, they don't have insurance" was personally witnessed at HFH. Never happens, River_rat, never. If the DMC were to go under, they'd have to pick up the uninsured slack.
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River_rat
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Username: River_rat

Post Number: 217
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Posted From: 71.246.214.35
Posted on Friday, September 08, 2006 - 9:34 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Cassie1717,

I won't disagree with your statement as reworded now, but no transfers occur because of an lack of medical capability, only a lack of ability to withstand uncompensated care.

river rat appreciates clarification
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Zephyrprocess
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Username: Zephyrprocess

Post Number: 11
Registered: 08-2006
Posted From: 69.241.250.214
Posted on Saturday, September 09, 2006 - 2:05 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

River_rat opined: "Not every hospital and med school needs ... an orthopedic residency for that matter."

Perhaps not. If you expect to run a pre-eminent Level 1 trauma center, though, having residents to take call certainly makes a difference.
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Gargoyle
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Username: Gargoyle

Post Number: 25
Registered: 04-2006
Posted From: 24.192.189.109
Posted on Saturday, September 09, 2006 - 1:07 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

You're right there, Zephyrprocess. No ortho people on-site at 3 am when the freeway rollover crashes come into the ER means that DRH's Level 1 trauma designation could be in jeopardy. That's not all the DMC has lost recently. Three physicians who specialized in neurointerventional radiology have been lost to politicking, poor salaries, and lack of modern equipment. Three years ago the DMC could offer patients the very latest treatment for strokes in progress and ruptured brain aneurysms. Sadly, that is no longer true.
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River_rat
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Post Number: 218
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Posted From: 71.246.214.35
Posted on Sunday, September 10, 2006 - 10:07 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Diggelicious,

I make it a rule that I do not respond to personal attacks, but what particular statement or group of statements do you take such umbrage?

river rat
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659
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Username: 659

Post Number: 5
Registered: 08-2006
Posted From: 68.255.162.93
Posted on Sunday, September 10, 2006 - 11:39 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

"i do not respond to personal attacks"

+

"a tube of clobetasol replaces 75% of dermatologists on the planet"

+

"you are all interested in cosmetic derm now"

=

uninformed hypocrite

i'm sorry i won't have the pleasure of reading river_rat's response to my personal attack
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River_rat
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Username: River_rat

Post Number: 219
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Posted From: 71.246.214.35
Posted on Sunday, September 10, 2006 - 11:20 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

659,

Do you disagree with the value of clobetasol?

+

"you" does not refer to the singular you, but the plural you of the great ascent of clinical dermatology of the last decade (e.i. - botox, laser skin rejuvenation, fillers such as Restylane, Sculptra, collagen and the used of retinoic acid and hydroquinones).

I apologize if my comments were taken to be personal to you (singular).

river rat
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Innercitydoc
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Username: Innercitydoc

Post Number: 1
Registered: 09-2006
Posted From: 146.9.104.82
Posted on Monday, September 11, 2006 - 2:03 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

I've been lurking on this site for quite a while and thought I would give some input on the situation. I'm a medical student at Wayne and it is my understanding that one of the main reasons between the Duggan and Desilva, the ortho chair, was because Duggan wanted the program to be based upon the sports teams here in Detroit and Faculty wasn't having it b/c the urban community wouldn't benefit. I've also heard that the replacement orthopod is being paid something to the tune of a million dollars a year to basically be on call every night with the help the 5th year residents who had to stay put at the DMC. Has anyone heard otherwise?
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Ddmoore54
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Username: Ddmoore54

Post Number: 313
Registered: 07-2004
Posted From: 69.242.213.242
Posted on Monday, September 11, 2006 - 4:29 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

"I believe that the biggest concern is that the DMC's reputation is as teaching hospital, a research hospital where great work is being done. Beaumont doesn't have that claim to fame. "

Beaumont may not be a university affiliated hospital, but it's b.s. to say that "great work isn't being done there." The vast majority of Beaumont's residency programs are regarded much more highly than those at the DMC.

Why aren't WSU grads applying to the DMC anymore? Because the vast majority of the infrastructure is completely run down, dirty, and down right nasty. Not to mention the ancillary staff which is sub-par at best and an administration that seems to have no appreciation for its physicians.
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Cassie1717
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Username: Cassie1717

Post Number: 46
Registered: 04-2005
Posted From: 64.12.116.204
Posted on Monday, September 11, 2006 - 4:59 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

But DDMoore, at the DMC you treat CHF & research it, at the Beau, you read about it & do some research on it. Like going to medical school in AA ;-)
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Crew
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Username: Crew

Post Number: 1029
Registered: 02-2004
Posted From: 146.9.52.68
Posted on Tuesday, September 12, 2006 - 8:47 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Definately a very different experieince in Wayne County. It will be very interesting to see how things work out in the next few months. The landscape could look very different.
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Buick_mckane
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Username: Buick_mckane

Post Number: 95
Registered: 02-2004
Posted From: 12.75.40.250
Posted on Tuesday, September 12, 2006 - 9:49 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Every brick that Duggan is taking out of the DMC's foundation is being picked up by Henry Ford. It's like "hey, thanks". Everything the Medical Center is doing is like a gift to HFHS.

I've worked at both and there was absolutely no research being done in my department at DMC. The equivalent department at Ford is doing tons of research and they're securing new grants all the time. Ford Hospital is the real local version of Mayo or Cedars-Sinai.
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Southwestmap
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Username: Southwestmap

Post Number: 580
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Posted From: 70.229.231.102
Posted on Tuesday, September 12, 2006 - 10:11 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

I wish that the publishers of the local dailies would start covering this story.
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Crew
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Username: Crew

Post Number: 1030
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Posted From: 146.9.52.68
Posted on Tuesday, September 12, 2006 - 10:16 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

I don't think the daily newspapers or the public in general appreciate what a big effect this story can have on the quality of life in not only Detroit but all of southeastern Michigan.
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River_rat
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Username: River_rat

Post Number: 220
Registered: 02-2006
Posted From: 68.166.44.44
Posted on Tuesday, September 12, 2006 - 1:20 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Earlier on the thread,

the real need for the DMC (which was always political) became less and less important.

The entire operation / existance / future of DMC is not about medicine. It is about politics; anything any one of us says on this thread is of little matter. Politics in Detroit spell a bad future for anything it touches. As always, the little guys get .......
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Zephyrprocess
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Username: Zephyrprocess

Post Number: 16
Registered: 08-2006
Posted From: 69.241.250.214
Posted on Tuesday, September 12, 2006 - 6:04 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

The "political need" for DMC is not simply a question of maintaining some kind of urban prestige.

You can be damn certain that HFHS, St. John, and to a lesser extent Beaumont (because of geography) have a clear and vested interest in keeping the DMC's indigent and under/uninsured patients AWAY from their doors. They'll all gladly support enough subsidies from Lansing or wherever to keep DMC going to absorb the losses anyone would incur caring for that patient population.
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River_rat
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Post Number: 224
Registered: 02-2006
Posted From: 71.246.214.35
Posted on Tuesday, September 12, 2006 - 9:07 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

My point exactly Zephyrprocess. The 'raison d'etre' for DMC is your point and numerous others, but to enumerate them would offend more people than I already have on this thread.

the river rat was at the DMC in the early days and the politics of it have always been raw and rough.
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Southwestmap
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Username: Southwestmap

Post Number: 582
Registered: 01-2005
Posted From: 70.229.231.102
Posted on Wednesday, September 13, 2006 - 9:34 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

I do agree that there has been a political/turf component to DMC management for years. The DMC has been some kind of curious mayoral fiefdom. For years, and through several mayoral administrations, mayors moved many personas non grata from city offices and dumped them at the DMC to help them save their faces.

Also, at the DMC, administrative hiring is obsessively AA. I guess that the City watches it very closely.
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Swansong
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Posted on Thursday, September 21, 2006 - 5:45 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

The immediate gain to the Duggan at the DMC was a short term bonanza of $90 million a year from the DMC-SOM/WSU conract. That $90 million is keeping the DMC afloat but the gains are short term. The SOM research component was an intangible for the DMC. Its loss will be reflected in the range of cases that were only referred because of the availablity of academic expertise but will now no longer receive diagnosis and consequently, medical care at the DMC. These cases were predominantly good payors
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Zephyrprocess
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Posted on Thursday, September 21, 2006 - 10:45 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Swansong--welcome.

DMC is not realizing a $90 million annual savings; only a couple departments from the School of Medicine have been squeezed out so far (most prominently Orthopaedic Surgery, see above). The remaining departments continue to operate under contract extensions with the DMC, the latest running through the end of the calendar year.
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Thrice
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Posted on Saturday, September 23, 2006 - 2:35 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Det news picked it up:

http://www.detnews.com/apps/pb cs.dll/article?AID=/20060923/S CHOOLS/609230402
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Innercitydoc
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Posted on Saturday, September 23, 2006 - 3:24 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

From dean Mentzer on Monday:

This is an update on Wayne State University/Detroit Medical Center contract negotiations.

Yesterday I forwarded two proposed companion contracts to the Detroit Medical Center for signature: the Wayne State University Teaching Agreement and the University Physician Group Professional Services Agreement. The proposed terms and financial arrangements are essentially the same as what the DMC offered in February 2006, with the addition of some DMC-initiated incremental support targeted to select School of Medicine clinical departments.

I believe these contract documents address all mutual concerns and that there remain no barriers to bringing negotiations to closure next week. Simultaneous execution of both contracts will enable WSU and the DMC to report favorably to the Accreditation Council for Graduate Medical Education by the October 1 deadline imposed upon us by the ACGME.

I wrote to you in July that I am personally committed to defining the scope and terms of our next contracts by September 30 to ensure continuity of programs within the scope of our longstanding WSU/DMC partnership; I am hopeful that Mike Duggan shares a desire to conclude negotiations, and focus our attention on the educational scope of the upcoming November 14 ACGME site visit.

As I have affirmed on many occasions, the School of Medicine’s partnership with the DMC and our commitment to the city of Detroit are central components of our mission, and will remain so. I look forward to continuing a rich and robust relationship with the DMC to fulfill our obligations to our patients and students.

I will keep you posted on progress.

Robert M. Mentzer, Jr., MD
Dean, School of Medicine
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313_doc
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Posted on Sunday, October 01, 2006 - 11:12 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

I’d love to chime in on this little “issue.” I have a decent understanding of the events that have already played out and I find it interesting that some of this is finally starting to show its head in the papers.

It seems that the two sides did not work out an agreement by October 1st and thus will have to tell the RRC that they just can’t agree to anything. This happened on a smaller scale on March 31st when the DMC decided not to negotiate with the orthopedics department and only offered a 9-month contract extension for the other 18 departments.

I cannot begin to relay the amount of misunderstanding on the DMC, specifically Mike Duggan’s part, as well as the lack of effective leadership in the medical school. The way that these two sides are running, they are destined not to reach an agreement and the ACMGE will step in and shut the programs down.

I think that what everyone must realize, which is probably a hard concept to really grasp and understand, is that the ACGME/RRC’s role is NOT to make sure that underinsured areas have adequate medical coverage through graduate medical education. The role of this governing body is to regulate and ensure adequate quality graduate medical education for residents and fellows. If conditions are deemed “toxic” or substandard then it is the role of this body to act accordingly and place the programs on probation or to shut them down and then place the residents or fellows into qualified training programs. If, by these actions the ACGME/RRC transfers the effective workforce out of an underinsured area in the name of education, then one must realize that is the fault of the training site (i.e. DMC and WSU) for allowing this to happen. Residents and fellows rank/match into their programs to train at based on educational and geographical reasons, not because they are choosing to work in an underserved area. It is only the byproduct of this education that is the labor that helps out the community. Basically, just remember who to assign blame to when this all goes down and try not to get caught up in the social cards that the politicians will play, and are already playing. The 900 residents and fellows are here to be educated and they have all worked very hard to get to this point and it would be unfair to each and everyone of them to simply keep them working in a poor educational environment in the name of the underinsured.

A few little tidbits about the DMC and WSU…

The DMC effectively hired its own cardiology department with non-WSU physicians so that they could better dictate the role of that department.

The ENT residency is no longer affiliated with the DMC

Derm is as described in a previous post.

Rumors are that the Urology department is on its way out as well.

The orthopedic department (University Orthopedics) was actually fired originally on October 31st effective date, but after Mike Duggan and Tom Malone failed to secure the services of any orthopedic surgeons in the area to cover the DMC hospitals (essentially without residents) they had to “re-hire” that faculty group, until they could find someone to take the call and cover the cases.

The DMC did not release the CMS funding from the government (~$150.000-200,000 per year per resident) to go with the 24 junior orthopedic residents to help them find their new training sites, effectively restricting their possible choices to programs with adequate funds, and usually not very local…What the DMC is doing with this ~$6 million dollars is anyone’s guess (24 junior residents + 8 graduating seniors).

The DMC tried to start their own orthopedic residency prior to the March 31st deadline, however their program was blatantly filled with misrepresentations and empty promises such that the majority of the junior residents voted against this program, and the only ones who voted for it was due to local family issues. It was viewed as a desperation attempt by the DMC to preserve the orthopedic workforce with little guarantees of educational merit. Effectively, the ultimate head of the program would be Mike Duggan. Those who wish to disagree are misinformed. Mike Duggan has little understanding of medical issues as in a meeting with the orthopedic residents, he stated that they should be learning how to treat adolescent ACL injuries (as his daughter had one) and taking care of professional athletes, something that adds little benefit to resident education.

In a previous article, Duggan is quoted as saying that if he cannot negotiate a contract with WSU that he would take the money ($88-90 million) and pay the nation’s top specialists to work for the DMC. He fails to realize that this money is CMS funding from the government that is tied to resident education. Most/All of the programs there are dual sponsored (50:50) between WSU and DMC. One side cannon simply pull up anchor and ditch their partner and take the money and the residents. This misunderstanding led Duggan to try to take over the orthopedics residency with the known consequences. If he tried this with the other 18 departments it is likely the ACGME/RRC would act as they did before and deem this a “toxic” environment and shut down the residencies.

Both the DMC and WSU are applying for new orthopedic residencies currently. This is probably the most troubling to the previous residents. Both sides had ample opportunities to work out an agreement and because of their inactions; the closure of the previous program caused a huge disruption to 24 people’s personal and professional lives…something that is often left out of the papers. One should also not forget the status of the remaining 8 residents, who were forced to stay on at WSU/DMC to finish out their training because of board requirements to be in their final 2 years in one site. Their year now is anything but good.

Through the relocation of the 24 residents, the medical school did little to help them with their transfers.

Bottom line:

Mike Duggan is very responsible for what is going and he should be to blame when things start going downhill.

Tom Malone (Chief Medical Officer of the DMC) is Duggan’s right hand man and should not fall without blame.

Dr. Robert Frank (previous Interim Dean of WSU School of Medicine) had no leadership qualities and was bullied by Mike Duggan the DMC board and is a big reason why things have progressed this far.

Dr. Robert Mentzer (current Dean of WSU School of Medicine) came on board in early March of 2006 and seems to have the attitude that he “didn’t know things were this bad” when he started. Hard to believe that a CT transplant surgeon didn’t do his homework before starting. In his brief tenure with an orthopedic department he never addressed the residents to tell them the status of negotiations or to tell them that their program had closed or offer his support during this time.

Irving Reid (President of WSU). It is rumored that he was pressured to agree with the DMC offer of a 9 month extension for the 18 departments (minus orthopedics) by Gov. Granholm so that coverage would continue in Detroit past the November elections and that the possible maelstrom of a DMC closure would not come into play during her campaign.

What I’ve put forth is true to my understanding of the situation unless I stated it was rumor. Let me know what you think. Keep an open mind and don’t be swayed by the misinformed.
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Zephyrprocess
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Posted on Sunday, October 01, 2006 - 11:40 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

313_doc wrote: "It seems that the two sides did not work out an agreement by October 1st and thus will have to tell the RRC that they just can’t agree to anything."

Several days ago, the two sides submitted a joint letter to the ACGME reporting that good faith negotiations were in progress and would continue until agreement.
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313_doc
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Posted on Monday, October 02, 2006 - 12:23 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Zephyr, I might have taken the blurb in the Detroit News the wrong way, but I'm just too used to both sides talking about "good faith" negotations and they really don't go anywhere and really don't seem to be in good faith.

http://www.detnews.com/apps/pb cs.dll/article?AID=/20060930/M ETRO/609300335&SearchID=732586 296672

The ACGME has given deadlines before and they need to in fairness to the residents so that they can prepare for any changes in their training. Good faith negotiations is what WSU/DMC want to show the RRC, but unless there is an agreement it is no different than before.
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Zephyrprocess
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Posted on Monday, October 02, 2006 - 12:32 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

313_doc, I didn't mean to suggest I was rebutting; I hope I'm adding some factual specifics about how they were handing the ACGME 10/1 deadline.
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Crew
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Posted on Monday, October 02, 2006 - 8:23 am:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

Just to clarify, the ACGME's Oct 1 deadline was for the DMC and WSU to reach a contract agreement. The joint letter that was sent to the ACGME just states that contract negotiations are on going. So, unless an agreement was reached over the weekend, DMC and the university missed that deadline.
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313_doc
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Posted on Tuesday, October 10, 2006 - 8:04 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

I don't have time to really comment on this lovely piece of propaganda, but I hope that someone who is really up to date on the negotiations can poke some holes in this rally 'round the oak tree statement. I almost want to call this a desperation call to try and get the support of all the ancillary staff by playing up the social and job cards.

Without further delay...I give you Mike Duggan...



October 9, 2006



Dear DMC Employees



With the recent newspaper articles, I’m getting questions daily from DMC employees about the Wayne State contract. Let me try to tell you directly what’s going on and what’s at stake.



The financial situation at the DMC has stabilized. 2006 will be the third straight year in the black, something DMC hasn’t accomplished since the 1980’s. Things are going to be tight for us until the Michigan economy improves, but we’ve come a long way in a short period of time.



The DMC Board leadership and I have tried hard with three different Deans in the last two years to get an agreement with WSU. WSU tries to cover with innocent sounding terms like “diversifying” and “suburban strategy”, but the cold truth is WSU has already abandoned its historic DMC partnership. WSU is aggressively building a fleet of lifeboats, establishing numerous suburban hospital contracts so their doctors can one day jump ship and float off into a sea of better payer mix, taking their insured patients with them. Most WSU doctors seem to find this plan distasteful, but it is being pushed with full force by the WSU administration.



At the end of the day, DMC’s decision comes down to this choice:



Do we side with the WSU administration demanding huge payments from DMC while they build new programs at other hospitals who want to take our patients?



Or, do we side with all those doctors, nurses, aides, techs, transport workers, administrators, and other staff who are 100% loyal to the DMC and whose jobs could be lost if the WSU doctors took DMC market share away to their new partners at Oakwood and Providence?



To me, it’s not a difficult choice. I have never in my life been treated with the warmth and kindness that I have received from DMC employees the last few years. I couldn’t be more pleased that the DMC Board just extended my contract three more years through 2009, because the work here is far from done. My proudest accomplishment is the fact DMC stopped the annual cycle of layoffs and instead has actually hired 3,000 new employees in the last three years. We can’t afford a WSU contract that jeopardizes those jobs.



When I came to the DMC, I didn’t come as an experienced hospital administrator, but as a lifelong Detroiter who understood two principles about our region that would determine whether DMC would survive:



1) If people have a choice between the same service either downtown or near their home, they will choose to stay near home; and

2) If the service provided downtown is truly unique, people will pour in by the thousands from 50 miles or more.



My first e-mail to employees in 2004 shocked some when I told you I wanted to scrap my predecessor's plan to close Detroit hospitals. I wrote of the great success of the Fox Theatre, UD High School, the casinos, Joe Louis Arena, and Greektown. I truly believed we could save our own great institutions by building unique programs to bring patients back to Detroit. The DMC employees supported this vision with tremendous energy as we cleaned up the appearance of our campus, improved hospital services, and recruited key doctors.



Those who were here in late 2004 will remember how patients responded, pouring back onto our central campus in such numbers that our parking structures were overwhelmed and we had cars backed up into the streets and parked on sidewalks. It was a remarkable turnaround and showed that you don’t need to build new hospitals in Novi to attract patients. But you do have to offer a level of care patients can’t get in Novi.



Many employees don’t understand the DMC/WSU contractual relationship, but in principle, it’s pretty simple. The original partnership between DMC and WSU was formed in 1980 by visionaries who truly understood how to get patients to come Downtown.



The partnership involved 4 major commitments DMC made to WSU doctors:



1) WSU received one of the largest financial payments of any medical school in America

2) Exclusive right to positions of medical leadership in all downtown hospitals

3) Exclusive right to provide many hospital services at all DMC hospitals (ER, Radiology, Anesthesiology, etc.)

4) A partnership that allowed WSU to run 69 residency training programs at DMC.



It was a lot to give up, but what DMC got in exchange was a commitment of loyalty that WSU would build a great and unique academic medical center at DMC. While the relationship had many contentious issues, those fundamental principles survived essentially intact for 25 years, until WSU embarked on its recent suburban strategy.



What does that contract mean to WSU today? The 700 WSU physicians and their practice groups and employees now earn in excess of $200 million a year from DMC: $80 million paid directly by DMC and another $120 million in physician fees earned at DMC hospitals. It remains one of the largest, if not the largest, financial packages received by any medical school practice group from any hospital system in America. And DMC has offered to increase that amount in each of the next three years.



WSU keeps claiming DMC is exaggerating the risk from WSU’s competing programs, so judge for yourself. WSU’s suburban strategy is only in its infancy, yet here are proposals WSU either already has proposed or actually concluded:



1) A joint surgery center with Oakwood just 3 miles from DMC’s MIOSH hospital;

2) New teaching and clinical partnerships with Crittenton and Providence

3) The purchase of a massive office building in Troy—the former Saturn World Headquarters—to be the center of the WSU Medical practice. The Saturn Building is larger than all the space occupied by WSU doctors at DMC today.

4) A comprehensive affiliation with Oakwood to provide a range of specialty services. Oakwood is already promoting itself in the suburbs as the place to get Wayne State specialty services without having to go downtown.

5) The Dean’s office promised Oakwood that pediatricians from Children’s would run Oakwood’s pediatrics unit. Children’s today is the dominant hospital in the Dearborn market, getting more than 50% of the pediatric hospital admissions. Children’s would stand to lose significant patient volume if Oakwood is able to tell Dearborn parents they have the same doctors as Children’s.



Are we exaggerating in being concerned? Could DMC jobs or hospitals be at risk if WSU kept making these kinds of deals with our competitors for the next three years?



Now, here’s the really astonishing part. In its last written proposal 2 weeks ago, WSU demanded a new 3 year contract with all the same services and preferential contracts at DMC hospitals they have today. Then, WSU wanted an $8 million annual increase in contract payments from DMC. And then WSU demanded the total freedom to keep making all these partnerships with the other hospitals. They are demanding that DMC finance its own demise and they pretend to the rest of the world like they can’t understand why the DMC Board and I won’t just sign it.



Here’s the good news: the DMC management team is about the most talented group of people I’ve ever been around. They’re working 18 hour days developing contingency plans and we’re gaining confidence that DMC is going to come out of this stronger than we are today. We know this isn’t nearly as difficult a crisis as we faced in 2004.



Our plans are being developed based on the same principles that got us out of bankruptcy in 2004. If a group’s proposal builds a unique medical program at DMC, we will strongly back it. If a group’s proposal is designed to take DMC’s money while they build programs at our competitors, we will reject it and we’ll work to replace them with a group that will build uniquely at DMC.



Interestingly, the process is having the unexpected benefit of naturally sorting out the gripers and malcontents who are choosing to leave on their own. There will be a lot of pain and anxiety during the transition and DMC will probably look quite a bit different than it does today. At the end of the day, I really believe we will be stronger because we’re going to have a medical staff that truly wants to be here. And that really would be priceless.



It’s 1:00 AM Monday and this is probably too long already. I’ll do a separate piece on the residency issues shortly.



Mike
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Innercitydoc
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Posted on Tuesday, October 10, 2006 - 10:28 pm:   Edit PostDelete Post   Move Post (Moderator/Admin Only)

From Dean Menzter today:

Dear Colleagues,



Since the first of this month, I have received many questions about the status of the School of Medicine’s negotiations with the Detroit Medical Center. I am writing to provide you with a brief update on our continued talks, and to invite you to join me for a session on Tues., Oct. 17 at 5:00 p.m. in Scott Hall’s Blue Auditorium to answer your questions, face to face.



As you are aware, the Accreditation Council on Graduate Medical Education (ACGME) will be conducting an on-site institutional review of our GME programs on Nov. 14. The ACGME knows that the contract supporting the joint graduate medical education programs expires on Dec. 31, 2006, and has not yet been renewed. The immediate and rightful concerns of the ACGME are the stability of our training programs and the well being of the residents and fellows for whom we share responsibility.



On Oct. 1, the School of Medicine and the DMC notified the ACGME that good faith negotiations were underway and would continue until an agreement was reached. Wayne State University and the School of Medicine remain committed to continuing good faith negotiations to ensure the continuity of programs sited at our downtown home, and within the scope of our longstanding affiliation with the DMC.



As I have affirmed on many occasions, the School’s commitment to the city of Detroit and its partnership with the DMC are central to our mission, and will remain so. Although the School of Medicine relies upon longstanding and essential partnerships with numerous healthcare institutions to train one of the nation’s largest medical school classes, our education, research, and clinical care programs are inextricably linked to the city of Detroit and its unique demographics.



WSU’s more than 700 faculty physicians are responsible for approximately 65 percent of DMC’s revenues, and deliver about 80 percent of all care delivered to the DMC’s uninsured and underinsured patients. About 30 percent of all practicing physicians in Michigan received all or part of their medical training at WSU/DMC. Of the city of Detroit’s 690 primary care physicians, 350, or 40 percent, are WSU/DMC resident physicians-in-training.



Detroit is the School of Medicine’s home: WSU has committed to capital investment of $200 million over the next five years in two new facilities on its downtown campus — the Richard J. Mazurek, M.D. Medical Education Commons and a new state-of-the-science multidisciplinary research building that will house the University’s evolving Center for Clinical and Translational Science. In fact, these facilities will be catalysts for centering regional education; and clinical translational research activities at our downtown site.



As you may know, the School’s student body is the most diverse in the nation; we graduate more African-American and Arab-American physicians than any of our 125 peer United States medical schools, and rank among the top five for training African-American physicians who go on to become university faculty. Our interdisciplinary research programs are targeted to the diverse metropolitan population that we serve and are recognized as national models of excellence. These programs include cancer, maternal and child health, and healthcare disparities, and are the foundation of the Barbara Ann Karmanos Cancer Institute and the WSU Center for African-American Urban Health. The School and the DMC collaborate on these and many other programs.



In summary, I assure you that Wayne State University and its School of Medicine are steadfastly committed to each of the following:



Continuing our valued relationship with the DMC;
Expanding our presence in the city of Detroit;
Upholding our mission of delivering the highest quality patient care supported by education and research;
Educating our students and training our residents and fellows in the best possible teaching environments;
Recruiting and retaining leading physicians to teach our students and serve our community;
Providing care to the region’s uninsured and underinsured

As talks with the DMC continue to evolve, it is important that you are updated with accurate information. To that end, I will be hosting a forum on Tues., Oct. 17 at 5:00 p.m. in Scott Hall’s Blue Auditorium. Please join me then for a briefing, followed by a question and answer session.



I look forward to seeing you on Oct. 17.



Sincerely,



Robert M. Mentzer, Jr., MD

Dean, School of Medicine

Senior Advisor to the President for Medical Affairs

Wayne State University




I plan on attending this seminar and addressing many of the issues that have been brought up on this forum. I encourage others to attend as well.

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