Recently, I walked by the shuttered Hahnemann University Hospital and noticed graffiti painted above the doors that had welcomed the poorest and sickest patients in the city for more than 170 years. I could not shake the overwhelming feeling of abandonment that emanated from the spray paint.
In January 2018, Hahnemann was purchased by American Academic Health System (a newly formed for-profit subsidiary of Paladin Healthcare, based in El Segundo, California). In June 2019, with little warning, the company announced that the hospital would close in less than three months. This left patients scrambling to find doctors, practices, and hospitals where they could get urgent and necessary care, including chemotherapy. It also left staff, nurses, physicians, and others looking for employment. Patients and employees felt truly abandoned.
Appropriately, the abandonment of the underserved patient community for whom Hahnemann previously cared has been a focus of the city's response. Many local hospitals have stepped up to give Philadelphians places to receive care. But another vulnerable population has also been abandoned and left powerless while the bankruptcy process unfolds: the young doctors who had chosen to complete their medical training at this once-proud safety net institution.
The future of medicine lies in the hands of the young doctors who are just starting their careers. The path to practicing medicine is long, challenging, and expensive. After at least eight years of schooling (four years of undergraduate studies followed by four years of medical school), young doctors are required to complete an internship and residency (at least three years but often more than five) for postgraduate training. This has been the subject of many popular TV series. Through this process, these trainees sacrifice their personal lives and immerse themselves into their studies and preparation. Along the way, they accumulate a student debt that averages $200,000.
The residents who came to Hahnemann committed to training at a hospital that was not glamorous and had limited resources. They came to learn how to heal the poor, navigate the challenges of a medically underserved community, and deliver high-quality and cost-effective care. Most importantly, they put their future in the hands of the hospital. The skills they hoped to learn from senior physicians would impact their entire careers.
These young doctors never thought that, in addition to entrusting their training to Hahnemann, they would be placing their careers in the hands of a for-profit enterprise that valued profits over all else.
Since their purchase of Hahnemann, American Academic Health Systems subscribed to a management style resembling what was seen on “The Apprentice,” firing and hiring five CEOs in rapid succession. By January 2019, the company recognized the value of the real estate and systematically and quietly dismantled the hospital over the course of the subsequent six months.
When the owners announced that the hospital was to close, more than 570 medical trainees were left scrambling to find hospitals that would take them — the largest displacement of trainees in our country’s history. The term that is used to describe these trainees is “orphan.” Their futures for which they had worked so hard and sacrificed so much were now in jeopardy. Thankfully almost all of the trainees found safe landing spots across the country to complete their training.
The owners of the hospital added insult to injury to their abandonment by violating their contractual obligation to pay for trainee tail malpractice insurance. Without having their time at Hahnemann insured since the change of ownership, more than 980 trainees are open to significant liability, will have trouble obtaining credentials to practice at most hospitals, and may be ineligible for state medical licensure in at least 18 states. The cost of purchasing malpractice insurance on their own is prohibitive and could be more than $70,000 per individual.
The decisions about how funds from the bankruptcy will be distributed are being fleshed out in court. There, a cadre of attorneys representing corporations, multiple creditors, and employed physicians deliberate the merits of their debt.
Our trainees were left without an organization that can represent their best interests, though the American Medical Association is arranging legal representation for them in the court proceedings. In the meantime, their fates are in limbo and there is no clear path to remedy the situation. They were abandoned.
This cannot and must not happen. Not only does this disaster jeopardize their immediate futures, but it will undoubtedly influence their choice of where and how they practice. With added debt and disenfranchisement, this group of young doctorswho had a strong chance and desire to stay in Philadelphia, is much more likely to practice in more affluent communities where there are no shortages of qualified and well-trained physicians.
The spray paint above the doors of Hahnemann has recently dried. Just as the house of medicine has united to embrace the abandoned patients in Philadelphia, we are hopeful that organizations and individuals who value the future of medicine will rally to support these young doctors who have been abandoned by American Academic Health System.
David J. Aizenberg, M.D., is the former program director for internal medicine residency at Drexel University, for which Hahnemann was the primary teaching hospital. A version of this piece originally appeared in MedPage Today.