Saturday, July 29, 2006
Dr. Stobo responds to GME/Navigant question 7/28
Response: Recommendation 18 reads: “Limit the total number of residents to those with outside funding sources.”
The only significant external source of funding for graduate medical education (GME) costs is Medicare. However, Medicare has established “caps,” or limits on the number of residents it is willing to fund. For UTMB, the Medicare cap is 497 residents. In 2005, UTMB had 563 residents. We fall short of being fully reimbursed for what it costs us to train our residents. Adding to the direct cost of “extra” resident positions, the university must also support additional faculty to help train and supervise those residents, must treat a proscribed number of patient conditions to provide sufficient clinical experience (many of those patients are unfunded), and incurs additional administrative costs. Navigant estimated that our total unfunded costs associated with GME amounted to $26.4 million, a large amount for UTMB to absorb.
UTMB, through a committee specifically charged to explore this issue, is currently considering the consultant’s recommendation to reduce the number of residents to the Medicare cap, which is what one typically sees at other academic health institutions. The recommendation has not been accepted yet.
Downsizing the number of residents is a complicated and somewhat long-term process that would need to be undertaken carefully and strategically. It would need to be achieved over several years by reducing the number of new residents coming to UTMB rather than reducing the number of residents already here.
http://www.utmb.edu/president/FIP/FAQs.htm
LRN comment: looks like the difference is about 66 slots, which is quite a bit different than the 118 slots currently circulating the rumor mill. Let's hope the downsizing applied to GME is closer to the 66 cap/gap in the MCR funding.
Friday, July 28, 2006
FAQ - continuity OB
In order to be eligible to count the delivery as a continuity delivery, you MUST have:
1. seen the patient for two or more prenatal visits AND
2. either perform the SVD or assisted in the C/section (scrub in) AND
3. see the patient post-partum
Duty hour exceptions are allowed for continuity deliveries.
You may count up to 10 C/sections (that you at least scrubbed in for) toward your total requirement of 40 deliveries.
If an R1 or R2 is supervised by an R3 for the delivery, both may count the delivery toward their 40. If the continuity requirements are met for both residents, then both can also count them toward the continuity requirement of 10.
Tuesday, July 25, 2006
R2 Advisor meetings due
This will be our first month to use our new online portfolio for documenting the meetings!! You don't have to chase down that paper form any longer. But please make sure you have set the appropriate permissions for your Advisor in the portfolio prior to the meeting. Also please set them for me, as I will need to be able to display the pertinent sections for the Quarterly Review.
Heads-up to the R3's: your Advisor meetings are due in August, so please get those scheduled.
Thanks, everyone!
Saturday, July 22, 2006




We had a great time at the party! I'm glad so many people were able to make it. If you missed it, you missed some of the best BBQ brisket in TX! My Dad really knows how to do it. Everyone ate well, we had lots of kids and a wonderful time. In addition to our new R1 class, I was really happy Lorena S., who will join our next class, and her husband were able to make it as well. Andy took advantage of his last FMR party opportunity too, as he will be
graduating at the end of next block. David came as soon as he handed off the call pager to the night float resident. All in all, it seemed each class was well represented.
We missed Hanan and Saleh, who had a tragedy in their family this past week. Please keep them in your thoughts and prayers and let's all do what we can to help them in the coming days.
Most of us had our first opportunity to meet Dr. Weaver's newly-adopted son, from Perm, Russia. It's good to see our family growing, and he is a perfect addition. There were a few new children in the new R1 class too.
Linda is talking about having end-of-rotation 2 at her house, so I'll let her keep us posted about the plans for that. Dr. Thompson also wants to have a party soon at her house and end-of-rotation 3 might be a really nice time of year for that, with her house on the water and opportunities to fish off the deck.
Thanks for coming everyone. I enjoyed having you at my home and the opportunity to spend some casual and fun time with you all.
Friday, July 14, 2006
Strolling Through the Match
I still can't believe it's almost that time already.
Let me review some of the "top tips"...
Load your documents to ERAS early.
Be sure your letters of recommendation are appropriate to the programs where you're applying. For example, if you're applying to both Pedi and FM, make sure you send the correct letters to the program. It's very bad form to send a FM PD a letter that says, "I'm so pleased to recommend X to you for your Pedi program..."!! It's also not very cool for the letters to be generic. They should indicate that the person writing it knows which specialty you're applying for. The letters should come from practicing physicians, not residents or fellows. Letters from community physicians are encouraged. Some programs prefer to see that you've waived your right to review the letters before they're uploaded.
Personal statement - draft it NOW, and then put it away for a few days. Get it back out and reread it. Have two or three other people read it and give suggestions. Run spell checker. Check your document after you upload it. Sometimes ERAS does weird formatting things and you'll want to correct those. If you had some stumble in medical school or took a leave of absence, the personal statement is the place to address that. Hopefully you will be able to say what you learned from that experience and put a positive spin on it. Don't lecture to us about what is Family Medicine... we already know. We do, however, like to hear any personal experiences you may have had that influenced you to choose FM.
Choosing programs - don't forget, if you will be moving with family that your family has to be happy there too. If they're not happy, you're not going to be either. The consensus among the PDs is that the most important thing is that you like the people you will be working with... that you get a good feeling from the faculty and residents you meet and feel comfortable in the environment. What you get out of residency is a whole lot about what YOU put into it and less so about details of the program. Remember, the accreditation process makes sure all the programs have the minimums. That said, if you have special interests... THAT is worth considering. Make sure the programs you're looking at can meet those needs.
Interview - be on time and be professional. Dress nice. Be on your best behavior. Turn off your cell phone or leave it in the car. Ask questions every time you get an opportunity, even if you've already asked the same question of someone else that day. At the very least, you'll get a different perspective. Most programs have residents involved in the interview process. Often, it is a more casual atmosphere such as a lunch or dinner. Remember that this too is part of the interview process. Being able to work in a team and get along with a group is a huge part of residency, and we'll be looking for clues about you during the group activities. Although more casual, they ARE a part of the interview process. Review your notes about the program the night before the interview. If you are knowledgeable about the basics, it shows real interest in the program and that's important to us.
Don't interview with your top pick first. Do a "practice interview" or two with programs you think are probably lower on your list.
Special needs - if you're couples matching or have a spouse who will need a certain kind of job, there will times it is appropriate to ask for that sort of information. Please do, because it's likely we can help you. We can set you up with a realtor, make sure you get to see the public school system, or whatever you need.
Most importantly, be yourself. Don't put on a show to be what you think the program wants. Obviously, you do want to put forward your best image, but don't try to be something you're not. Chances are, you're going to just know when the fit is right.
Talk to as many 1st and 2nd year residents currently in the program as you can. These are the people you will spend the most time with over the next 3 years of your life.
Good luck! We look forward to seeing you over the coming months.
Thursday, July 13, 2006
Keeping up with Navigant
The plan regarding FMC support staff (nursing and administrative, OSA, etc.) has not yet been made public. I know that Lynda and Cheryl are currently working on it.
No further word on the recommended GME cuts... Hopefully, we will hear soon because we are beginning plans already for recruiting season. At this point, I remain hopeful that the impact to the FMR will be none or at least very small.
For those of you following from out of town, I'm including some links to articles in the Galveston Daily News.
July 13 July 10 July 8 July 6
Tuesday, July 11, 2006
kudos to Ron
Wednesday, July 05, 2006
End of Rotation 1 Party
Mark the party on your calendars! Watch your email for directions and more details.
*****
In other news, I'm happy to welcome Oscar to the group and say the new class is now all present! This was a record year for getting in-training permits, visas, and all other necessary paperwork done! A big thank you goes out to all the incoming residents and to the FMR staff for being prompt and efficient with all of that. No easy task. Good work!
*****
Check out the progress Darren Burns has made on our snazzy new electronic resident portfolio! Major portions are now activated and available through the FMR homepage. HUGE thank you to Darren and Ron Williams for your work on that! Residents - please look at your access permissions page and grant permission to your Advisor for the appropriate sections.
Thursday, June 29, 2006
PD out of office 7/3 and 7/4
Wednesday, June 28, 2006
Navigant update
To the best of my knowledge, there will be no staff cuts in the administrative staff upstairs. It is anticipated that there will be a small reduction in downstairs/clinic staff but I do not yet have details regarding that.
Navigant recommendations included the convening of a Task Force consisting of UTMB people to further study the residency and fellowship programs and make further recommendations regarding those. I do not yet know who will be on that Task Force or what their timeline will be. My personal speculation is that we will know something near the end of the calendar year. The Dean has given her word that all current residents and fellows would have the opportunity to complete their training program according to the current expectations for progress and promotion.
From my perspective, the FMR will continue to move forward on our improvement projects, working toward a program of excellence as has been our goal for the past two years. We've made a lot of progress toward the excellence criteria and hope to realize the achievement of some longer term goals in this new academic year. I anticipate no dramatic impact to our program at this point from the Navigant recommendations.
The Chiefs are updated weekly and they are, as am I, willing and available to answer any questions you may have or respond to concerns related to the Navigant report.
Monday, June 26, 2006
To the new class of FM interns
This is a hard year. You will learn more this year than at any other time in your professional life, with the possible exception of your first year in practice.
Remember that you are NOT a pediatrician, obstetrician, intensivist or surgeon! You will never know as much as they do about their fields. And you don’t need to. That’s not your job.
At the end of this year, your pediatric and internal medicine colleagues will not be competent to deliver a baby. You will. Your OB colleagues will not have a clue about what to do with a sick newborn or a young woman with chest pain. You will know. You will be able to manage a patient’s diabetes AND their hypertension AND their skin cancer. You will know which patient with a headache needs a CT scan and which one needs to learn about stress reduction. You will care for everyone in a family, from newborn to geriatric. You will understand how their history and family and community impact their health. None of your colleagues in other disciplines will be able to do all of that.
Try to remember some of this as you feel stressed and poorly prepared in your intern rotations. You are an intern and you are learning. Every one of us has been there. At the end of this year, you will be more prepared than the interns of any other field. It will seem like eternity and then suddenly the first year will be over. You will be amazed how much you’ve learned.
Welcome. We’re glad to have you here. It’s going to be an exciting and rewarding year.
Sunday, June 25, 2006
Happy and sad times
Well, we did it. We had to let them graduate... but we sure will miss them! It was a great night of celebration of accomplishments and sad goodbyes. This class holds a special place in my heart because they were the first that I was primarily responsible for selecting and recruiting as a new Program Director. I'm very proud of them and all they've accomplished. What a talented group of young people!
The UTMB-FM Faculty of the Year for 2006 is Dr. Cecilia Romero. Dr. Romero has served UTMB, the Family Medicine Residency and Pre-Doc programs and so many other organizations in more ways than I can possibly name. The FMR will especially miss her contributions to our Community Medicine curriculum and as a valued and trusted resident mentor. Dr. Romero will retire in September and she too will be missed. See the video of Dr. Romero's award presentation.
Outgoing Chief Residents Clint Watson, M.D. and Huelen Smith, M.D. with Administrative Associate Louis Johnston announce award recipients.

Staff Appreciation Award recipient, Rosie Vincent
I won't list all the award recipients and graduates individually here because we will have a section of the website devoted to the details, so check the photo album in a few days. Thank you to the FMR Staff who did so much to make this a great night. Thank you to the residents of the Class of 2006, who have worked so hard and made us all so proud of them.
Congratulations, Residents of the Class of 2006!!
Friday, June 23, 2006
Congratulations, Angela
We're cheering for you, Angela, and wishing the best!
Kudos to Clarence and Jerome
Wednesday, June 21, 2006
UTMB Update
Dr. Stobo's public statement as posted on the UTMB website
Specifics regarding how Family Medicine and the FM Residency program in particular will be affected are not yet available. Dr. Thompson expects to receive some of that information this morning and I will post an update when I know more.
A general meeting for the Program Directors is scheduled next Tuesday. My meeting with Drs. Blackwell and LeBlanc follows on Wednesday morning.
To the best of my knowledge, I do not expect any current residents to be directly affected. This includes our incoming class.
Tuesday, June 20, 2006
Program Directors' Workshop
This project was funded by our current HRSA Residency Training Grant and begins to look at the issue of reliability of various measures of competency used in our program to assess residents.
The results were well received and should be useful to many Family Medicine programs. We anticipate submission for publication in the near future.
Thanks for the great work, Mike!
Tuesday, June 13, 2006
Dr. Kunchar's fellowship graduation
Monday, June 12, 2006
Match 2007
We will be having our first Recruiting Team meeting mid to late July, exact date TBA.
I anticipate our process will be much the same as last year, with interviews scheduled on Monday and Wednesday mornings, from mid-October through early February.
Stay tuned for announcement of the Recruiting Team meeting date/time...
Thursday, June 08, 2006
Update on PD
On Monday, I received a referral of a 3y/o girl for adoption from Russia. I will be making two trips to Russia to complete the adoption. The first will be about 10 days and the second 3 weeks. I plan to take maternity leave upon return from trip 2. In total, my second absence will be about 6 weeks.
I AM returning to work and the PD position after my leave. I do not anticipate any significant disruption in Residency. Dr. Shepherd, Ron Williams, Linda Hubbell and the remainder of the Residency team are well prepared to lead the program during my absence. I don't yet have any specific travel plans as I am awaiting my travel invitation from Russia. This could happen at any time and I will most likely get 2 - 4 weeks notice.
If you'd like to see a photo of my angel, there is one on my office door. :-)
I will post updates on specific plans as they become available.


