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The Acquisition of a Community General Surgery Residency Program by a University Residency Program in New England - Planning, Execution and Early Lessons Learned
*John J Tackett1, Walter E Longo1, *Geoffrey Nadzam1, *Rosemarie L Fisher2, *Ania Shea1, Robert Udelsman1, *Peter S. Yoo1
1Yale University School of Medicine-Department of Surgery, New Haven, CT;2Yale University School of Medicine-Department of Medicine, New Haven, CT
Objective
In 2012, Yale New-Haven Hospital, a 962-bed tertiary referral hospital and the flagship training hospital of the Yale Surgical Residency, acquired the Hospital of St. Raphael (HSR), a 406-bed community hospital and its general surgery program. As a result, two disparate surgical residencies were combined. This paper describes the early experience of combining these programs.
Design
Survey
Setting
Academic Tertiary Hospital
Other Participants
Surgical Residency Program
Intervention
None
Main Outcome Measure
Combination of two residencies
Results
After the acquisition, the total number of categorical and preliminary general surgery residents increased from 69 to 90. Planning took place on three levels: regulatory, clinical, and cultural. Regulatory compliance with ACGME/RRC guidelines was considered prospectively. Relevant regulatory variances were obtained in advance. Sites affiliated with the smaller program were eliminated. Rotation assignments were made without distinction between the residents' program of matriculation. Clinical differences including case complexity and volume, electronic medical records, and service to education balance were considered. Cultural differences included research experience, interest in tertiary specialties, and projected career paths. Specific efforts were made regarding career counseling and team building to engender compatibility and cohesiveness. Flexible use of non-clinical lab years continued to be an important buffer for fluctuations in resident complement.
Conclusions
Given the unstable finances of US healthcare, the acquisition of hospitals and combination of residencies is increasing. Acquisition of a community hospital by a tertiary university program has both benefits and drawbacks. Benefits include a balanced, heterogeneous case mix and scheduling flexibility. Drawbacks include dilution of complex index cases and potential for decreased camaraderie. Forethought, flexibility, and delineation of expectations are essential to the successful combination of two disparate residency programs.
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