October 30, 2019

Dean's Message: The impact of residents and fellows at UAB

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Resident physicians play an immensely important role at every academic medical center in the country, and UAB is no exception. In the U.S., residencies are largely funded through Medicare. However, in 1997 the Balanced Budget Act placed a cap on the number of residencies it was willing to fund per teaching hospital based on calculations through December 1996. UAB Hospital’s number of federally-funded residency positions is based on the number of FTEs included in the Medicare Cost Report filed in 1996. What does that mean exactly? For one, it means that it has been fairly difficult for teaching hospitals to expand the number of Graduate Medical Education (GME) positions that they can provide. In order to grow, the institution has to find a way to make up the difference in cost. This is part of the reason that we are facing a physician shortage throughout the country.

Here at UAB Hospital, we’re the largest training site in the state and one of the largest in the Southeast with 96 different residency and fellowship programs. Leadership at UAB Medicine has recognized that in order to grow the number of doctors in our state (and retain them), we have to increase the size of our programs. Therefore, we have annually made that investment and currently fund more than 200 additional residency and fellowship positions over our 1996 cap at a cost of about $13.6million to our academic medical center. While covering the funding gap we face is no small feat, it is imperative that we do so. Fortunately, we also partner with our affiliated hospitals for additional GME funding, including the Birmingham Veterans Administration Medical Center and Children’s Hospital of Alabama, among others.

The truth is that without residents and fellows, we would not be able to serve the number of patients we see on a daily basis. Our training physicians are true participants in the care of our patients, and they bring with them a wealth of knowledge, energy, empathy and dedication. They clearly impact the workforce in Birmingham, the state, as well as the Deep South. They provide a cadre of talent that allows us to put physicians and sub-specialists in more locations throughout the state, and that also means more spots for physicians who’ve trained at UAB. On top of that, these residencies provide a venue for attracting individuals to Alabama who might not have otherwise moved here if not for the elite training opportunities they’ve found through UAB. They bring an influx of talent—around 200-300 people each year—many of whom come to us from out-of-state as highly educated and trained individuals.

Our goal is for our resident pool to reflect the population they take care of because data is clear that care is improved when patients are treated by individuals who look like them, but we still have some work to do. Twenty-five to thirty percent of our state’s population are underrepresented in medicine minorities. Currently, that is fairly far from the number of resident physicians in our programs from those particular groups, but we are dedicated to ensuring we increase that number until it’s more reflective of our state. Creation of our strategic GME diversity plan began in May of 2017 and was finalized in January of 2018. At the beginning of this year, Dr. Latesha Elopre was named director of Diversity and Inclusion for GME and was charged with leading our efforts. Dr. Elopre, along with several other UAB leaders such as Dr. Craig Hoesley, Dr. Alice Goepfert, and Dr. Mona Fouad and the Office for Diversity and Inclusion, have been instrumental in evaluating and evolving our recruitment processes. I am extremely pleased with the progress they have already made and will continue to make.

Before closing, I’d like to take a moment to personally thank all of our 1,000+ residents and fellows. You are absolutely integral to our enterprise, and we deeply appreciate the commitment that you bring to UAB.