Medical license mess for doctor-trainees means high anxiety for Pa. hospitals

Pennsylvania's new online system for licensing doctors-in-training — the residents who are the backbone of staffs at many hospitals — was supposed to streamline and speed up the annual process.

But eight weeks in, the electronic system has been such a mess that only about 17 percent of the state's 9,600 trainees have gotten the credential, according to state data. Without it, they can't practice and study medicine.

Now, some big hospitals across the state are worried about facing staffing shortages on July 1, the start of the work year for residents.

"No question patient care would be compromised if any more than a small number are not licensed," said physician Jeffrey S. Berns, the University of Pennsylvania's associate dean for graduate medical education. "It would be chaotic."

The Pennsylvania Department of State, which provides administrative support to the Board of Medicine, which licenses physicians, acknowledged a rocky rollout of the new online process, which was formerly done by U.S. mail. But glitches have been fixed, and with more workers getting more overtime, the department is now processing 1,400 residents' applications a week, said Ian Harlow, commissioner of professional and occupational affairs.

"I understand where the hospitals are coming from," he said. "But I'm confident we can get them done in time."

The crunch highlights the importance of a segment of the medical workforce that patients may not appreciate. Residents, who are concentrated in teaching hospitals, make up 20 percent of Pennsylvania's doctors, medical college data show. Each spring during their three to eight years of on-the-job training, they must submit an application and extensive documentation to get licensed. 

Although many residents are too preoccupied to notice the problem, some are keenly aware. Tanner Walsh, who is finishing her pediatric residency at Crozer-Keystone Health System, helps with managing her fellow trainees. That includes explaining why they urgently need to go online and make sure their license application is submitted.

"For a brand-new intern [first-year resident], who doesn't even know where the bathroom is in the hospital, this is just an overwhelming amount of information," she said.

Erik Blutinger, a third-year emergency medicine resident at Penn, just returned from a one-month clinical program in South Africa that took more than a year to arrange.

"That would be impossible to do now with the current process because of the delays in licensing," he said.

Harlow, at the Department of State, said the department is sensitive to the fact that residents' careers and livelihoods are at stake. For example, applications of overseas residents are getting high-priority processing because they can't get their visas until they have their licenses.

"I'm not saying there weren't problems," Harlow said, "but I feel like we've been responsive."

The could-be crisis reflects missteps by the state, residency program coordinators said. While they praised the state's goal of joining the digital age, they said the mid-March debut of the system came with little warning, no advance training, and software full of bugs.

Neonatologist Stephen Higgins, who oversees residency programs at Crozer-Keystone Health System, has been sounding alarms for several weeks. Of Crozer's 125 new and renewing trainees, less than 10 percent had licenses by Friday.

"I'm worried that on July 1, there might be a lack of residents to help cover these hospitals," Higgins said. "Am I crying 'the sky is falling?' If we anticipate a health-care crisis, we can't wait for the crisis to say something."

The University of Pittsburgh Medical Center, the state's biggest residency program with 1,800 trainees, also had fewer than 10 percent licensed this week.

"We are in the same boat as the Philadelphia-area institutions," said Samantha Cascone, UPMC's director of operations for graduate medical education. "Really, all Pennsylvania institutions that have trainees are facing these same concerns. We're all worried."

The State Department said a total of about 1,600 trainee licenses had been issued by Thursday. An additional 530 applications had been kicked back to residents because of "discrepancies" — anything from a name change to no proof of completing mandated opioid education.

The old licensing process also was prone to delays. But residency program coordinators acted as a safety net, prodding residents with reminders, reviewing their paperwork before submitting it to the state for them, even filling out their applications.

"The ability to do that was taken away," said Susan Coull, associate director for medical education at Temple University Hospital, where less than 10 percent of 550 residents had gotten their licenses by this week.

Echoed Berns at Penn, "Part of the anxiety is the lack of control."

The online system requires hospitals to upload spreadsheets with identifying data about their residents. Then the state creates individual accounts and emails each resident to log in and complete the application.

Initially, the state gave the hospitals little guidance beyond emailing instruction manuals for doing the uploads. When whole spreadsheets' worth of uploaded data were rejected for no apparent reason, the residency coordinators were flummoxed and frustrated.

"The state ended up doing a training webinar, but not until they were inundated with questions," Temple's Coull said.

One big flaw discovered in the software: it spurned zip codes or Social Security numbers that started with zeros. It also didn't recognize some medical specialty codes, and was persnickety about things like hyphens and periods.

"I think the people slogging it out at the state are doing the best they can," UPMC's Cascone said. "But the decision to roll it out when and how they did was not helpful."