Tips from the Trenches about Adding or Growing GME Perspectives from UTHSCSA from the roll out of four new GME programs in South Texas – Robert J. Nolan MD and the San Antonio GME Team

Essentials for the GME naïve hospital A firm understanding of the benefits and limitations of “cap – building” -- knowledgeable legal consultation Which entity will be the Sponsoring Institution (SI) If the hospital is not the SI – a robust and clearly delineated understanding of the roles of the SI and the participating hospital(s)

CMS DGME and IME funds do not begin to flow until after the residents are in place Loss-leader annual funding for startup: DIO salary/benefits Program Director(s) salary/benefits Program Coordinator(s) salary/benefits Core faculty support Resident salaries/benefits for initial start up year or two

One-time Non-personnel costs Hospital renovations – call rooms, conference rooms, offices for residents/faculty Clinic renovations/lease – Family Medical Center Faculty recruitment Faculty development Consultation/Legal fees ACGME application fees

Challenges for GME programs at naïve hospitals All hospital politics are local The belief among community practitioners that “understand” residency training Compensation issues: practitioner salaries vs. academic salaries Diversity and complexity of patient populations at community hospitals Availability of required procedures

Facilitating new GME programs at naïve hospitals Faculty Development – teaching skills, assessment, evidence-based practice, team skills Scholarship – presentations, publications, peer-reviewed extra-mural funding, etc. Professional Development – Nurses, Lab Technicians, OR and L&D personnel, etc. Quality Improvement and Patient Safety activities – ACGME Clinical Learning Environment Review

Why develop new GME programs at naïve hospitals? Potential Return on Investment: Better quality of care Increased complexity of care (tertiary) Recruitment of nationally recognized physicians Increased referral rates (from graduates and as a result of new service lines) Reduction in recruitment costs via retention of graduates Care of the underserved and community service projects Market differentiation – increase in public opinion, perceived value and prestige