Hahnemann University Hospital’s imminent closure will lead to an array of hardships for people in our city. Patients are being displaced, Philadelphia’s emergency care resources are strained, employees are losing their jobs, and pregnant women must find another place to receive prenatal care and deliver their babies.
Though these are critical transitions, we are fortunate that the Philadelphia health-care economy is large and robust, and that other institutions are prepared to care for patients and absorb employees in need of jobs. However, another group that is less visible to the public — the more than 500 physician trainees who work at the hospital — also faces profound upheaval.
Fortunately, closure of a large teaching hospital such as Hahnemann is rare. But because it is rare, and the rules governing transfer of medical residents and fellows from one program to another are unclear, the plans are prompting a chaotic scramble with little precedent. An estimated one in six physicians in the United States undergo some form of medical training in Philadelphia. With this many young doctors adrift at such a crucial point in their education, Hahnemann’s closure has real consequences for the future of patient care across the nation.
Graduate medical training programs must be able to meet stringent and specific training requirements set by the Accreditation Council for Graduate Medical Education (ACGME). Hahnemann’s owners have failed to ensure that these physicians will have the opportunity to get the training they are there to receive. Residents there should be released from any contractual obligations as quickly as possible to avoid any further disruption to their professional development and their lives.
Many of these young people arrived just weeks ago to take up residence in Philadelphia and begin their graduate medical education at Hahnemann. They have signed leases, must make car payments, and, importantly, are taking their first steps to begin paying off student debt. Many have families to support. International medical graduates on visas may be at risk of needing to leave the United States in as little as 30 days.
Now, they must desperately try to find an opportunity to continue their training. Residency and fellowship program directors at Hahnemann, who are talented medical educators, have gone into overdrive — with assistance from leaders at other academic medical centers in the region — to help each of their trainees find a new opportunity to complete the education that has been at least 17 years in the making already.
Medical residents and fellows work round the clock to care for patients in hospitals across the nation. They span from those who have just graduated from medical school to those who have already spent four to eight years practicing and are now receiving highly specialized training in fields from cardiac surgery to oncology.
While these doctors provide valuable clinical care for health systems, residents and fellows are not primarily workers. They are in training to become fully credentialed physicians in their fields. The programs are attached to teaching hospitals, not medical schools. Hospitals receive additional payments from the Center for Medicare and Medicaid Services (CMS) to support their education and subsidize their salaries. For these reasons, residency positions are highly sought-after by health systems.
As Hahnemann announced its closure, rumors quickly circulated about deals to move entire residency programs en bloc to another institution. But just as patients have autonomy and can select where else to seek care as Hahnemann closes, so too must these residents and fellows have a say in where they complete their training.
In fact, the freedom to transfer upon closure of their training hospital to another of their choosing — not one dictated by others at the closing institution — is a fundamental right assured by the ACGME. The organization has already issued guidance to ensure an orderly, fair placement of Hahnemann’s residents. A latticework of informational websites and email chains offering leads and contacts at neighboring institutions has sprung up to lend a hand as residents scramble to make plans.
We are committed to assisting as many of these young physicians as a possible, and to working with our colleagues across the city, or elsewhere, to provide the training that Hahnemann’s residents have worked so hard to earn. There are real victims in this collapse: patients, employees, and trainees. The autonomy of all of them must be taken into account by leaders and institutions in this region as we work together to absorb the fallout from Hahnemann’s failure.