Rethinking a decision that had sparked fear and anger among its radiology residents when it was announced last month, St. Barnabas Hospital in New York City has reversed course on a planned closure of its radiology residency program, vowing to keep it going for at least another year.
Meanwhile, details are beginning to emerge on the rationale behind the hospital's initial decision to close the residency program. Behind the scenes at St. Barnabas, teleradiology has been seen as an increasingly attractive and cheaper alternative to renewing the coverage contract with the current group, which has reportedly been unwilling to offer consistent overnight coverage onsite, sources told AuntMinnie.com.
And in a related development, a new osteopathic radiology residency program in the same New York borough may soon be established, regardless of the ultimate fate of the St. Barnabas radiology residency program.
For now, anyway, June 2014 is the earliest date the hospital's residency program will be terminated -- and, in fact, it may not end at all, the hospital told AuntMinnie.com.
Residents initially didn't take the news of the closure well, and after speaking with them and their union, the Committee of Interns and Residents (CIR), about the upheaval a program cancellation in less than four months would unleash, the hospital decided "it was only fair to give them more notice," St. Barnabas spokesman Steven Clark said in an interview.
As for extending the program beyond 2014, "they'll make a decision later on," he said, "but right now the plan is to continue at least through June 2014."
However, even if the program does continue through next June, most current residents will still be left without a program before they can complete their fourth year of residency and a final fifth year of internship.
Without a paddle
The decision to halt the sizeable program left several of the hospital's first- through third-year residents with nowhere to turn, AuntMinnie.com reported on February 13.
The new extension will allow fourth-year residents and interns to complete their training by June 2014. The funds that were to be shifted into new primary-care slots will stay, for one more year at least, in radiology.
"This is not what the hospital's game plan was, but after talking to the residents, they felt they wanted to do what was right for them, so they extended it even though the hospital knows it's going to cost money," Clark said.
But third-year resident Dr. Nirav Shelat told AuntMinnie.com that a one-year extension will cover only two additional residents who are slated to complete their training by June 2014, leaving nine others -- including himself -- still unable to complete their training if the program ends.
"I'm still stuck, and we still have not received anything in writing" about an extension of the residency program, Shelat said. "They have told us kind of verbally that this is something they're planning on, but with everything that's going on, I won't feel comfortable about anything unless I have something in writing."
Some are satisfied with the extension, but others aren't benefiting, Clark acknowledged. "Some are happy, especially those who were nearing the end, because obviously that's a class that will get to finish now," he said. "But others still feel betwixt and between, and they'd like some guarantee that they can either finish their training or an opportunity to move their money with them, which is not going to happen."
Previous residency programs that ended before residents could finish have sometimes released the federal money that accompanies the residency slots to the residents' new institutions, effectively funding the completion of their studies elsewhere. But not in this case: The St. Barnabas money would stay with the hospital to be funneled into new primary-care residencies, Clark said.
"If the hospital gave these slots away, as some of these residents are asking, it would cost about $1.5 million annually until the last of the residents graduated from another hospital," Clark said.
Teleradiology on ice
The whole idea of scrapping the residency program started when the hospital decided it could get more value for its radiology dollar by not renewing a contract with an incumbent radiology provider, Healthcare Radiology and Diagnostic Systems. The contract has since been extended in light of the decision to keep the residency program going, Clark said.
It's not that there were problems with this group of seven radiologists, but teleradiology seemed to offer several advantages, including night coverage, which has been an issue at the hospital.
"As I understand it, it's the residents who read the images overnight," Clark confirmed in an email to AuntMinnie.com.
The idea was that teleradiology "would save a good deal in costs and also that it would improve the quality of care," Clark said. "Having the ability to have board-certified radiologists available day and night to read images plays to the patient quality advantages of teleradiology."
Healthcare Radiology and Diagnostic Systems did not immediately respond to calls and an email seeking comment.
Finally, the hospital thinks that keeping up with the need for more primary-care doctors under the Patient Protection and Affordable Care Act will require "putting some residency slots in primary care and take them away from radiology," Clark said.
For now, the decision has been made to extend the incumbent group's contract for one year. "If they had gone to teleradiology, there would not have been a residency program because the new group didn't want a residency program," he added.
New residency program
If all else fails, St. Barnabas residents may eventually be able to take their experience up the road to Northern Brooklyn and a brand new osteopathic residency program at Wyckoff Heights Medical Center.
The center is developing a new osteopathic radiology residency program in conjunction with the New York Colleges of Osteopathic Medicine Educational Consortium (NYCOMEC). Dr. David Broder, president of the consortium, told AuntMinnie.com that the new residency application is very much related to the possible closure of the St. Barnabas program.
Upon hearing that the St. Barnabas program might be ending, "we said we would be interested in considering and trying to start a new [American Osteopathic Association (AOA)-approved] radiology residency program," Broder said. Of course, setting up such a program takes months, and although it could be in place by July 1 of this year, "that would be the short end" of the time frame, he said.
Approval is a multistep process: Once the residency application is approved by NYCOMEC, it's sent on to the AOA, which reviews the application in conjunction with the American Osteopathic College of Radiology, he said.
"They may decide to send a site inspector to check the program, and then a council of the AOA would vote, based on the counsel of the radiology college, on whether the program was approved or not," Broder said.
How many residency slots are envisioned? "It's still in the preliminary stages right now, but I think they were looking at around 12," Broder said. "But that's not a final number."
