DOCTORS ' LOUNGE
( continued from page 27 ) letics , or music , make very good surgical residents . They were always a point ahead with me . The impressive new facilities around the city for college athletics have really changed many things for the city , and for women ’ s sports , especially , changes for the better . Jurich was creative and a very positive influence for most of his tour .
Every city struggles to help the homeless , but we must do better . Addiction and mental illness are the key contributors to homelessness . When I came to Louisville in 1971 , Central State Hospital in Anchorage had thousands of patients . They lost this home when the policy changed to “ community housing ,” which too often meant the street . The best I was able to do as Public Health Commissioner for the State was to obtain some 10-day hospitalizations funded by Medicaid for addiction management under physician supervision , such as at UofL Health - Peace Hospital . President Neeli Bendapudi has kept UofL Health Mary & Elizabeth and UofL Health - Peace Hospital alive . Which UofL Health -Peace Hospital is perennially rated in the top ten percent of occupancy for inpatient psych hospitals , for its size . It ’ s very valuable to us .
Thanks be for all those empty ICU beds at UofL Health Jewish when COVID-19 came to town . It is a real long-term problem but the federal government ’ s support for COVID-19 inpatient treatment and its promptness of payment has made a big thing possible . The heart of the Medical Center needs to stay downtown , and I think the idea of UofL being in charge is only 40 years overdue .
Tom Miller , leads a very effective and responsive team from University Hospital , and what has morphed into UofL Health . His TV ads for us are very positive and helpful .
The past year of protests and events related to racial injustice has affected downtown profoundly . I am not wise enough , and this is not the place to debate solutions , but we are dealing with the loss of trust on all sides in race relations . Woodford Porter Sr ., who chaired the Board of Trustees at UofL three times , and Harriett were my closest friends for many years , both are gone now , and I miss them so . We always talked about how we must listen to one another better . A unique and valuable leader at ULH has been Christopher 2X . I do not know him well , but his work is vital to us . His role in helping the Hospital with the terrible problem of gun trauma and violence has been vitally important to us . Statistics show that the majority of gunshot wound victims are Black . 1 Mr . 2X has worked with Brian Harbrecht , MD , in the ER and with our trauma teams , as effectively as anyone possibly could . The issue is great and the solution is still not at all clear . Overall , getting guns out of the hands of the mentally ill would be a huge step forward in reducing gun violence . Our ICU nurses are triple-stressed , dealing with deaths from gunshot wounds , COVID-19 and all the other trauma patients . It is rough , with no end yet in sight .
Q2 . How has surgery - its teaching , its practices - changed since 1971 ?
A2 . Zoom was surprisingly good for interviewing applicants to match here in surgery and is about 90 % as good as “ in person .” UofL always looks better to visitors in person : our faculty shines ,
Room 9 impresses , they so enjoy meeting the current residents and getting the straight scoop . You can ’ t do all that with Zoom . But Zoom saved the applicants approximately $ 10,000 each in avoiding interview costs on top of their student debt ! The Department still gets 1,000 applicants for ten spots , their exam grade scores etc . cut that pool down to about 200 , then the faculty pores over the 200 and cuts the interviewees down to 100 . Kelly McMasters , MD , has been remarkably effective at this and so many other things .
In the same vein , COVID-19 pushed the USMLE Part 1 into a pass / fail system and that is utterly useless now for selection of House Officers . The pressure is heavily on medical students now to ace the Part 2 exam . They get only one chance now to rise to the top . The USMLE people may have meant well , but it ’ s going to backfire on the students .
The students planning to interview now are facing tougher odds than ever : right now , the US is producing about 2,000 more medical student graduates every year than we have intern slots for . 2,000 ! In America we ’ ve opened 12-13 new medical schools over the past decade and our school , like others , has increased class sizes . Some programs are preferentially taking candidates with advanced degrees , the proven test-takers . In the interview process , many domestic senior students are competing against those who have already obtained advanced degrees , sometimes overseas . Whether they can hold a scalpel or talk to a patient is still another question . These medical students often also have crushing debt . The first solution to the number of residency slots is inevitably going to force Medicare to fund more PG1 slots ; very few people realize that Medicare fundamentally carries the freight in residency salary and benefits . There has always been a problem with educational debt , and I could tell stories about that all day or all night . Interestingly , some clever people in the last decade or so have realized that if one trains in a non-profit hospital , which many are , and then accepts employment in a medical school or teaching hospital , one can often get tremendous federal help with paying down one ’ s debt . Several advanced residents here have done this successfully and this , alongside the military option , have been the only real solutions to a difficult financial scenario so far .
In-training surgical case numbers since the onset of COVID-19 have been way down . Based on operative experience , a previous fifth year chief is really only a barely fourth year , in terms of experience , now . In the cities hit the hardest , elective surgeries were canceled for months in many places . That ’ s a huge issue for surgery everywhere . Chris Ellison ’ s 2021 Journal of the American College of Surgeons paper showed that operative experience was down by 50 % on the east and west coasts , and down about 30-odd % in mid-America . With all the debt that trainees carry , all the time invested in education , the classes coming up behind them , simply lengthening training is just kicking the can down the road . We cannot stop the clock and the American Board of Surgery and the Residency Review Committee have done good jobs in trying to keep the standards up . I do not think there is a good answer ; one cannot stop the patients or plug the pipeline . The practice partners will need to take the future surgeons under their wing now more than ever .
28 LOUISVILLE MEDICINE