Editor's Forum

Hahnemann Closure: The Worst GME Debacle in U.S. History

It's time for every medical student, resident, and practicing physician to stand up against ongoing threats to GME funding. The devastating closure of Hahnemann University Hospital in Philadelphia shows why.

In late June, Philadelphia’s Hahnemann University Hospital, the main teaching hospital for Drexel University, declared bankruptcy and announced plans to cease all patient care operations by September. The abrupt statement came just days ahead of a new academic year for the 570+ residents and fellows training in Hahnemann’s 36 graduate medical education (GME) programs.1 

The closure has not only abandoned patients in need, but also forced the largest stranding of medical residents in U.S. history.2 

Chaos and confusion have followed. Based on previous program closures, it was assumed the trainees would be released from their contracts and tasked to secure positions for themselves elsewhere. In an outpouring of support, programs in the Philadelphia area and throughout the country began developing plans to accommodate the soon-to-be displaced trainees. The ACGME invoked its Extraordinary Circumstances Policy3 and the Education Commission for Foreign Medical Graduates began posting updates to help trainees navigate J1 visa challenges.4

But then Hahnemann announced plans to transfer its GME funding to neighboring Tower Health, a community health system with only a fraction of the medical specialties and positions held by Hahnemann.5 This prompted court filings by the AAMC, ECFMG, and ACGME.6 Yet a bankruptcy judge ruled in mid-July that Hahnemann can, indeed, sell its residency and fellowship slots to the highest bidder – regardless of whether that institution is capable of completing the training of the actual doctors currently filling those slots.

This has sparked immediate outrage in the medical education community.

When a GME program closes, Medicare regulations and ACGME guidelines provide a framework for hospitals to proceed in terms of placing trainees. Usually, displaced trainees are permitted to temporarily transfer their Medicare funding to other hospitals for the duration of their remaining training. If the receiving institution intends to keep that position and its associated funding past the transferred resident’s training, a section of the Affordable Care Act allows for the permanent transfer of GME funding via a competitive redistribution process.

Before any of that can happen for the Drexel residents, however, their contracts and Medicare funding must be released by Hahnemann. Yet that funding instead is being sold off in a bidding process – keeping hundreds of trainees in limbo even as the hospital closure creates a health care crisis for Philadelphia’s underserved communities.5

Court filings continue, with no clear resolution in sight as of press time. Crystal clear, however, is the need for every medical student, resident, and practicing physician to engage in advocacy to protect not only patients but also the house of medicine itself from ongoing threats to GME. Residency slots must not be treated as a commodity, and corporate money games cannot be allowed to supersede crucial medical education and patient care.

Editor's note: Please continue reading for EMRA's official statement on the Hahnemann University Hospital closure.


References
1. Residencies and Fellowships. Hahnemann University Hospital. Accessed July 18, 2019.
2. Orlowski J. What residents need to know about the Hahnemann University Hospital closure. AAMC News. July 18, 2019.
3. Hahnemann University Hospital Closure – Update: ACGME Activities Relating to Hospital Closure. Accreditation Council for Graduate Medical Education. Accessed July 18, 2019.
4. Hahnemann Closure: Information on GME Funding Hahnemann Residents and Fellows. Educational Commission for Foreign Medical Graduates. Accessed July 18, 2019.
5. Fiore K. Hundreds of Trainees in Limbo as Philadelphia Hospital Closes. MedPage Today. July 15, 2019.
6. Center City Healthcare, LLC Bankruptcy Court Docket Sheet; District of Delaware. Docketbird. Accessed July 18, 2019.

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