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Q&A
H+H staffing changes and the roles of physicians and residents
0:34:14
·
7 min
Dr. Mitch Katz explains recent changes in H+H staffing, particularly regarding physicians and residents, and discusses the roles of residents in teaching hospitals.
- The apparent decrease in physician positions is due to a shift from city payroll to affiliate payroll, not an actual reduction in doctors.
- Residents play important roles in teaching hospitals, but their responsibilities are distinct from attending physicians.
- Dr. Katz emphasizes the importance of proper supervision and competency determination for residents.
- The discussion touches on patient preferences for attending physicians versus residents and the balance between learning and service in medical education.
Mercedes Narcisse
0:34:14
Headcount.
0:34:15
H and H overall headcount has increased by fourteen ninety three positions when comparing the second quarter of fiscal twenty twenty five with the fourth quarter of twenty twenty four.
0:34:26
This increase is reflected in every category with the most positions for registered nurse, which you answer some part of it, tech specialists and residents.
0:34:37
However, the number of residents has increased by one hundred and 30 while the number of physicians has decreased by six positions.
0:34:49
Are residents being asked to cover the work typically done by physicians?
0:34:54
Has HNH received complaints from patients who expected to consult a physician and were instead directed to a resident?
Dr. Mitch Katz
0:35:03
So thank you for asking because it gives me a chance to to clarify.
0:35:08
And there there are many, issues always with health and hospital budgets.
0:35:13
So the budget you see, when it comes to headcount are those people who were on the city payroll.
0:35:21
But the vast majority of our doctors are not on the city payroll.
0:35:25
The vast majority of our doctors are hired through affiliates, either, NYU, Mount Sinai, or Pagni.
0:35:35
And so those don't appear in your budget.
0:35:39
So and and in particular, there have been, movements of some city previously, physician positions to PAGNI because it works better in our system.
0:35:52
So I don't want people to think that there has been a decrease in doctors.
0:35:56
There has not been a decrease in doctors.
0:35:58
There is no decrease.
0:35:59
Those positions just move to the affiliate rather than being Move.
0:36:04
Direct city employment.
0:36:06
Residents, as you know, are are a very important part of health and hospitals and a very important part of our system.
0:36:14
Mhmm.
0:36:14
The resident role is distinct from the attending doctor role, but they are physicians.
0:36:21
After the first year, you become a licensed physician.
0:36:25
So but they a large part of their residency is meant for learning how to become an attending physician.
0:36:34
So, you know, I don't I don't see it, you know, should do we ask a resident to do an attending doctor job?
0:36:41
No.
0:36:42
But in all teaching hospitals, residents play important roles and that's medicine, right, remains primarily an apprenticeship.
0:36:53
That's the model that that that medicine has always been.
0:36:57
You learn and you provide service, and you provide service to learn.
0:37:03
I don't think that people would be very good doctors if they only went in the classroom and read from books.
0:37:11
Most of what you learn, whether you're a doctor or a nurse or a physician assistant, you learn by caring for people.
0:37:20
That's how you learn.
0:37:21
Now it all has to be appropriately supervised, Right?
0:37:26
That doesn't mean you just go out there and nobody is checking to make sure it's correct.
0:37:31
But it but residents absolutely perform important clinical jobs, but not the job of an attending.
Mercedes Narcisse
0:37:40
But patients still want to see a physician, their attending physician, not the resident.
Dr. Mitch Katz
0:37:48
Right.
0:37:49
They would
Jeanmarie Fitch
0:37:49
see So
Mercedes Narcisse
0:37:49
do they have a lot of complaint around that?
Dr. Mitch Katz
0:37:51
I wouldn't say a lot.
0:37:52
I mean, I know the issue you mean.
0:37:54
I mean, I was true thirty five years ago when I was a resident too.
0:37:58
I mean, it's, you know, I mean, the the best I mean, one of one of my favorite stories was when I was on a oncology floor, it must have been in the eighties, and the family insisted that the IV only be put in by the attending.
0:38:23
And, of course, the attending tried and failed three times because god knows when the last time the attending Sure.
0:38:31
Was asked to put in an IV.
0:38:34
And I was the the second year resident, and so I went and put in the IV, which, of course, I had no trouble because I was a second year resident.
0:38:43
That's all I ever did was draw bloods and put in IVs.
0:38:47
And the family then brought me this large, you know, gift and insisted that I I'd be the only one allowed to take care of the patient because of the success in putting in the IV.
0:38:59
So so, I mean, the issue always exists and, you know, I would tell anyone, you know, if they have a serious medical problem, you know, they and they're at a teaching hospital, they should absolutely ask to speak to the attending.
0:39:12
But I think teaching hospitals work well when everybody does their job.
Noelle Peñas
0:39:17
Mhmm.
Dr. Mitch Katz
0:39:18
And that that's the best model.
Mercedes Narcisse
0:39:20
I will be in agreement, definitely.
0:39:22
But I'm still having, like, what the, like, residents are the residents covering their attending physician for things that physicians the attending physician normally do?
Dr. Mitch Katz
0:39:36
No.
0:39:37
A resident does the things that a resident Do.
0:39:40
Should do.
0:39:40
Yeah.
0:39:40
And it but again, you know, it's important to understand some of the distinctions.
0:39:45
For example, a central line can only be put in by a resident after a resident has been supervised, putting in several lines successfully.
0:39:57
So I think for a central line it's 10.
0:40:01
So 10 times the resident is observed by an attending putting in the line.
0:40:07
If 10 times the resident successfully puts in the line, resident is then certified to put in central lines.
0:40:14
The next the eleventh time, they wouldn't not be an attending there because you have supervised appropriately the person.
0:40:22
So, you know, what we believe in is that every skill, and it's the same thing in nursing, right?
0:40:27
Every skill should be taught.
0:40:31
Competency should be determined.
0:40:32
You should have a standard of what determines competency.
0:40:36
People should have to fulfill it.
0:40:38
Mhmm.
0:40:38
But once they've fulfilled it, they're allowed to do it.
0:40:41
But they're not allowed to do it if they haven't fulfilled it.
Mercedes Narcisse
0:40:44
Mhmm.
0:40:44
As you're explaining the putting the line, guess what?
0:40:48
I most oncology patient at Elmer's used to look for me Yes.
0:40:51
Because I'm afraid of needles, so I have to make sure that I'm good at it.
Lincoln Restler
0:40:55
See?
Mercedes Narcisse
0:40:55
So but we still want the the residents not to be overwhelmed as well.
0:41:00
So that's where I'm getting it.
0:41:02
Understood.
0:41:03
Alright.
0:41:05
How does H and H plan to increase the physician's headcount?
0:41:09
Does H and H have a target headcount for physician?
0:41:12
You said there is no decrease.
0:41:14
Am I correct?
Dr. Mitch Katz
0:41:14
There is no decrease.
0:41:15
Right.
0:41:15
The the positions that you highlighted just moved from the Citi payroll to the affiliate payroll.
Mercedes Narcisse
0:41:22
Okay.
0:41:23
So thank you for that.
0:41:26
Habena was who has joined me.
0:41:28
Oh, council member Rivera just joined us.
0:41:34
Before I get to state budget, I have book Margarita Webb book powers.
0:41:50
No?
0:41:51
So Marmarita, you have a question before I get to move on to the budget?