Emory - What is going on with Grady?

I'm a 4th year student who rotated there......Everything in this article is so true. This is such a sad situation! I would argue that the environment at Grady is starting to compromise training, more specifically.... many of the inadequacies just slow the day down and take away from the other facets of orthopedic training, don't get me wrong.... the education/attendings are great, however the Grady environment really adds unnecessary stress that impedes necessary education. This is something I have been struggling back and forth with, while trying to decide on my rank list. Now, with that being said I don't the think that Grady will ever close, I suspect that if worse comes to worse the surrounding private hospitals will bail out Grady...that option would be much more cost effective that the unspeakable alternative.

Having been a casual observer on this forum, I'd like to (for the first time) give my input as this thread hits home. I'm the program director at Emory and would certainly invite any of our residents to also post on this thread for their unbiased input.

To begin with, the NY Times article is correct in many ways and clearly flawed in others. Yes, Grady is a county hospital with its share of flaws and lack of resources. However, Grady continues to be one of the best places in the country to train. Having said that, approximately 35% of our residency training actually happens at Grady.

Furthermore, the article is dated. As many of you know, the governance of Grady recently changed (after the article was written) assuring an influx of funding from philanthropy and the private sector. This will essentially insure Grady's survival and it certainly will mean a better Grady than we currently have. In addition, the Georgia legislature just went into session. Very hot on the agenda is funding for a trauma network. I am certain that this will be approved and we should certainly have the decision within the next couple of weeks.

I would add that training at a place like Grady is not for everyone. It is certainly not an "easy" place to train. However, I don't know of any institution in the country where you can get the surgical autonomy with adequate and close supervision and the breadth of pathology that you would see at Grady. Clearly I'm biased about this but I insist that a place like Grady allows surgical experiences unmatched at institutions that don't have a county-type hospital.

Sorry about the verbose response. In short, Grady is not closing and is certainly not in any imminent danger of shutting its doors. That is simply not possible. In fact, Grady should become an even better place to train with a better business model.

I feel compelled to respond to the above post as well. I am one of the new attendings at Grady. I graduated from this program in 2005 and after fellowship and one year of private practice, returned to Emory. I guess I am qualified to comment from both the perspective of a recent resident, as well as attending.

A few observations. Anyone who has rotated or trained at a large county hospital/trauma center can relay many stories of hospital inefficiency. In this way, Grady is no different than Parkland, Charity, the Med, the old Cook County, Bellevue, etc. If you want digitized xray, the lab/line team, and fresh-cut flowers in the lobby, you are likely to be disappointed. However, if a steady stream of badly injured patients with complex orthopedic problems and your direct participation in their care (including surgical) is something you want, Grady could be the place. Having trained in more private settings with greater efficiency and better ancillary help, I know that the trade-off for these conveniences is education and autonomy. I would argue the hands-on training obtained at Grady is a perfect complement to the private, tertiary experience seen at other hospitals during your Emory career. I would also take issue with the thought that the autonomy is unsupervised (as brought up in the article) as we now have 5 full-time attendings at Grady, all with fellowship training (joints, sports, hand, spine, and of course, trauma). For example, yesterday, as a service, we operated on 2 acetabulums (plated), 3 tibias (2 of which were segmental and open-all rodded), 1 supracondylar femur (locked plating), as well as, one 4 lb desmoid tumor from the posterior thigh (excised) and several ankles and wrists in the outpatient room. All cases were staffed by an attending, working very closely with the resident primary surgeon. I would further argue that if anything, things are better here now in terms of efficiency and equipment than when I trained here.

Secondly, I signed my contract to come here in August of 2007-right in the middle of the media frenzy about the financial hardships of the hospital. Now, I work for Emory, not Grady, so I have a safety net. However, I have never believed the hospital would close. The media coverage, has been, to a large degree, very helpful. There are things that need to be addressed and changes that need to be made. I think these will be addressed in time with the additional resources that are coming soon. Public opinion of the hospital may have suffered in the short-term, but changes needed for the long-term sustainability of the hospital have been set in motion. I feel very comfortable with my position here and with the state of the orthopedic program.

As a current resident in Emory's program, I'd like to shed more light on the Grady situation. Drs. Oskouei and Kimmerly have already written statements clarifying the medical-legal dynamics as Grady transitions to a non-for-profit organization. This undoubtedly will benefit the system as a whole, including the resident educational experience, and will fortify its position central to the healthcare of ALL of Georgia and even the Southeast Region.

As anyone who has trained at Grady (including rotators) knows, it certainly is a place where inefficiency too often is the norm. This does indeed place extra "work" on the residents. But not at one point have I thought the shortcomings of Grady are adversely affecting my educational experience. For example, I would be naive to say that it wouldn't be a better place with a digital x-ray machine, easily accesible equipment and better-trained ancillary staff. I would also be just as naive to think there are many (if any) hospitals in this country where I would see the same volume of high acuity orthopedic injuries from start to finish. We see the patients from the very initial presentation in the trauma bay and are directly involved in their surgical care, starting as interns. After having never seen a tibial nail as a medical student, my chief resident (with the attending scrubbed) walked me through a tibial nail my first week of my intern year. I'm more than willing to chase down hard copies of films and collect splint supplies at the cost of losing thirty minutes of sleep, so I can be the primary surgeon (even at 4:00 am) as a rookie. Few, if any, of Grady's shortcomings could be found in a "country club" hospital but (based on my experiences with my away-rotations and 17 interviews) there aren't many places that would provide me with the operative experience I have here at Grady.

Orthocane -- I hope this blurb addressed your concerns.

Pacman -- Thank you for showing interest in our program by rotating here. I understand why you feel the inadequacies of Grady add stress to our lives as residents. They certainly do at times. But what is not true is that it is impeding our educational experience. That's a bold statement for you to claim, and I'm unclear as to how you came to this conclusion. Either way, best of luck in your search for the "best" training program for YOU. Every place you'll encounter has its own strengths and weaknesses and it's up to you to decide what you can and can't deal with. So please, in the future, refrain from making unfounded comments about our program (unless you really think we as residents are getting sub-par training, and then that's a whole other issue...)