Louisville implosion

[Guest]

why did he fire 4 residents in 2 years, including a 6th year? Or is that false?

[Guest]

Can you provide proof? As far as I can tell they have a full roster of 14 residents with a 2/y program. Yes, 3 7s and only one 4. So as previously mentioned, one PGY4 apparently left. There are plenty of times when residents quit, so all I can say at this point is that they apparently lost a PGY4. Nothing too spectacular if no one else can provide intel

[Guest]

Good questions. A bit of history from the web and some speculation here....Niemat became Chair about 2016, brought in from Vanderbilt to stabilize a program that had a tumultuous split of the faculty in 2009 when most of the faculty went into private practice locally, just a block or two away at Norton Hospital. https://www.wave3.com/story/10059385/dis...ma-center/ "The surgeons say they were fired - but UofL says they quit March 1st, when the group announced a contract signed with Norton HealthCare, making it the group's primary employer." There were threats of lawsuits, etc. and only a small group of faculty was left at the University. This was all pre-Neimat and circa 2010-2015, the program was in a bit of chaos. The major faculty players had left to Norton, which is like a block or two away, and there was interim leadership. Truly, one would have anticipated some variable quality of residents who would have entered the program in those years prior to Neimat becoming chief. By 2018, within a couple of years of starting, Neimat seems to have made some progress on hiring new faculty. News releases https://www.lanereport.com/104304/2018/0...e-to-uofl/ show three new faculty hired by 2018 and they all still seem to be listed on the faculty page. One would assume that residents would be more attracted to the program recently as things stabilized. If there was a PGY-6 released at Lousiville it was likely to have been someone hired from those pre-Neimat years.

For the most part, the only reason a program would fire a late PGY resident would be one of two things....a real concern that the resident, now faced with more independent operating autonomy, was demonstrating a true lack of ability to synthesize the skills learned in the earlier PGY years. No program would take such a situation lightly, and it really comes down to whether the program thinks that person is safe. (We've seen in recent years what can happen when a resident with questionable skills graduates...see infamous news out of Texas) ...a second thing could be some sort of malfeasance, harassment, or things like that but that is unusual and probably not likely.

What about firings that occur in PGY 1-3 year? Same as above but there may be a lower threshold for the faculty to disengage. If the PD, with heavy input from the faculty, does not think a resident will be a safe surgeon in the long haul, it may be better to let them go early and let that resident move on to another speciality. We don't have the specific facts here so hard to say. But remember, the program is accountable to the ACGME and to the medical school...they can't just make resident firing decisions outside of established norms.

So what about messaging boards like this and the best way to get info in making a match decision. In general, do not trust these boards....preferably talk to the residents in the program you are interested in with a sample of input from all PGY levels. The residents will be able to tell you what their experience has been like, and give you a sense of the whether there is the mentorship, culture, lifestyle, and opportunity that you want. Generally, the happy residents aren't posting here on neurosurgeryhub....there is really no incentive for them to do so unless to combat a wildly inaccurate rumor...it is better to try to reach out to them directly.

Good luck to all in the match this year.

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(01-30-2022, 10:58 AM)Guest Wrote: Can you provide proof? As far as I can tell they have a full roster of 14 residents with a 2/y program. Yes, 3 7s and only one 4. So as previously mentioned, one PGY4 apparently left. There are plenty of times when residents quit, so all I can say at this point is that they apparently lost a PGY4. Nothing too spectacular if no one else can provide intel

Another good point...sometimes people just choose a different specialty as well.

[Not clinical faculty]

(01-29-2022, 10:38 PM)Guest Wrote: https://kycir.org/2016/08/23/u-of-l-prof...s-program/

Since I know more about this program than most commenters, I do want to point out that this googled article from 2016 is about a research faculty member from the KY Spinal Cord Injury Research Center, not a clinical faculty member associated with the residency program. 

Additionally - Nauta and Neimat are smirking and evil?!!! Come on.

[Guest]

(02-02-2022, 03:49 PM)Not clinical faculty Wrote:

(01-29-2022, 10:38 PM)Guest Wrote: https://kycir.org/2016/08/23/u-of-l-prof...s-program/

Since I know more about this program than most commenters, I do want to point out that this googled article from 2016 is about a research faculty member from the KY Spinal Cord Injury Research Center, not a clinical faculty member associated with the residency program. 

Additionally - Nauta and Neimat are smirking and evil?!!! Come on.

since you know a lot, can you tell us about the program? Is it good or bad? Pls let us know. Thank you

[Guest]

(01-30-2022, 11:37 AM)Guest Wrote: Good questions.  A bit of history from the web and some speculation here....Niemat became Chair about 2016, brought in from Vanderbilt to stabilize a program that had a tumultuous split of the faculty in 2009 when most of the faculty went into private practice locally, just a block or two away at Norton Hospital.  https://www.wave3.com/story/10059385/dis...ma-center/  "The surgeons say they were fired - but UofL says they quit March 1st, when the group announced a contract signed with Norton HealthCare, making it the group's primary employer."   There were threats of lawsuits, etc. and only a small group of faculty was left at the University.  This was all pre-Neimat and circa 2010-2015, the program was in a bit of chaos.  The major faculty players had left to Norton, which is like a block or two away, and there was interim leadership.  Truly, one would have anticipated some variable quality of residents who would have entered the program in those years prior to Neimat becoming chief.   By 2018, within a couple of years of starting, Neimat seems to have made some progress on hiring new faculty.  News releases https://www.lanereport.com/104304/2018/0...e-to-uofl/ show three new faculty hired by 2018 and they all still seem to be listed on the faculty page.   One would assume that residents would be more attracted to the program recently as things stabilized.   If there was a PGY-6 released at Lousiville it was likely to have been someone hired from those pre-Neimat years.

For the most part, the only reason a program would fire a late PGY resident would be one of two things....a real concern that the resident, now faced with more independent operating autonomy, was demonstrating a true lack of ability to synthesize the skills learned in the earlier PGY years.  No program would take such a situation lightly, and it really comes down to whether the program thinks that person is safe.  (We've seen in recent years what can happen when a resident with questionable skills graduates...see infamous news out of Texas) ...a second thing could be some sort of malfeasance, harassment, or things like that but that is unusual and probably not likely.  

What about firings that occur in PGY 1-3 year?  Same as above but there may be a lower threshold for the faculty to disengage.  If the PD, with heavy input from the faculty, does not think a resident will be a safe surgeon in the long haul, it may be better to let them go early and let that resident move on to another speciality.  We don't have the specific facts here so hard to say.   But remember, the program is accountable to the ACGME and to the medical school...they can't just make resident firing decisions outside of established norms.

So what about messaging boards like this and the best way to get info in making a match decision.   In general, do not trust these boards....preferably talk to the residents in the program you are interested in with a sample of input from all PGY levels.  The residents will be able to tell you what their experience has been like, and give you a sense of the whether there is the mentorship, culture, lifestyle, and opportunity that you want.  Generally, the happy residents aren't posting here on neurosurgeryhub....there is really no incentive for them to do so unless to combat a wildly inaccurate rumor...it is better to try to reach out to them directly.

Good luck to all in the match this year.

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(01-30-2022, 10:58 AM)Guest Wrote: Can you provide proof? As far as I can tell they have a full roster of 14 residents with a 2/y program. Yes, 3 7s and only one 4. So as previously mentioned, one PGY4 apparently left. There are plenty of times when residents quit, so all I can say at this point is that they apparently lost a PGY4. Nothing too spectacular if no one else can provide intel

Another good point...sometimes people just choose a different specialty as well.

I have experience with Louisville and am happy to share what I know because AFAIK the program is unjustly getting flamed by either randos or people with bones to pick.

First off, the above post is an accurate and good summary of what happened at the program before Neimat got there, which was a huge hurdle for the program to overcome. In addition, Jewish Hospital (previously privately run) had an absolute dumpster fire of a situation and was threatening to close the doors, before being acquired by the University of Louisville. This is where a bunch of the private spine and functional was run, and it was threatening to be a huge problem. The problem has since resolved and seems to be fine now.

Secondly, there have been two residents who have left. One was from Australia and was in the PGY-4 class, another was initially in something like the PGY-7 class (got there in 2015/2016) but (according to what residents at Louisville told me) was held back multiple years due to faculty's lack of confidence in them. I would only be able to speculate what happened to cause them to leave, which I wont do.

The faculty of Louisville has changed significantly for the better in the last few years. The one malignant faculty (according to residents and students) has left, and the ones that have come aboard (Williams, Ding, Seig, Abecassis) are all well-trained, smart, genuinely nice, and could realistically help the program recover from it's several setbacks and capitalize on it's solid (relatively speaking) case volume.

The Louisville case mix is solid with a large volume of spine (Boyake is pretty well known for doing some cool complex spine stuff), good amount of trauma (lol @whoever said USC level), vascular, and functional, and a reasonable amount of skull base (with Williams, Ding, and Abecassis actively looking to increase this).

Regarding Neimat's character, I have personally never met a surgeon (much less a neurosurgeon) who is as nice to patients, staff, students, or residents. I refuse to take any comment seriously which depicts him as acting malicious or unfair, and think that he has done a great job at a program/place that has been gotten more than it's fair share of unfortunate events. He is also very loyal to his residents and is very well connected.

Overall, would recommend Louisville to anyone who is happy at a Louisville-sized city, wants to have a solid operative experience with a good opportunity for research (I mean look at Sharma, Khattar, and Alhourani and tell me that they don't have a good pub list), and a pretty impressive track record for fellowship placements (grad 2 years ago neurovascular at UW, grad 1 year ago functional at Vandy, one of the PGY-6 to neurovascular at Buffalo)

[Guest]

Anybody know what their relationship with the Leatherman spine group is like? Sounds like the ortho residents may rotate with them but neurosurgery does or something. Obviously thats a strong ortho spine fellowship with Glassman at the helm so seems like a good opportunity

[Guest]

The relationship has been adversarial at best primarily due to insecurities of the neurosurgery department.

[Guest]

https://www2.mbc.ca.gov/BreezePDL/docume...432121.DID

[Guest]

^^ outrageous what they did to him. I read the report. So obvious they were out to get him.