After months of speculation, residents at Drexel University/Hahnemann University Hospital learned in July that, as of July 29, 2019, they have to finish their residencies elsewhere.

On June 26, 2019, the California-based investment firm that owned the Philadelphia hospital filed for bankruptcy and abruptly announced the hospital would close. The question was, when?

In the weeks after notice of the impending closure, residents were left with no shortage of uncertainty. In mid-July, Matt Abrishamian, MD, didn’t know whether he would need to move by the end of the month. Or maybe it would be early September. He didn’t know for certain whether, or when, the funding he had as a resident would travel with him as he sought out a new program to complete his third and final year. He didn’t know if he would be licensed in time to train in a new state. Dr. Abrishamian was looking into transferring to an emergency medicine program at the University of California, Irvine.

“This is uncharted territory, and there is a lot of uncertainty,” said Dr. Abrishamian. “You don’t want any gaps in your training because it can affect your licensing and getting through boards. It’s been a lot of waiting and unclear answers, mainly because something like this hasn’t happened at this magnitude and size.”

Search for Information and Answers

According to The Philadelphia Inquirer, in a Philadelphia Court of Common Pleas lawsuit against Hahnemann and its owners, Drexel University called the closure “the largest orphaning of medical residents in the history of the United States.”¹
There are 570 residents currently employed at Hahnemann, and 45 of them are in emergency medicine.

Some foreign medical residents on J-1 visas could face deportation if they fail to secure new accredited residency positions within 30 days of the hospital’s closure.² The hospital’s owners—American Academic Health System LLC (AAHS), an affiliate of Paladin Healthcare—announced Hahnemann would close on Sept. 6, 2019, though as of July 16, its plan had not yet been approved.

The signs were there for months, said third-year emergency medicine resident Liz Calhoun, MD. “They’ve been cutting corners where they could—the quality of supplies has decreased, they stopped repairing elevators and buildings,” Dr. Calhoun said. “There’s been evidence that it’s been on rapid decline.”

In April 2019, Hahnemann’s financial troubles became apparent when owners cut 175 jobs. According to the Inquirer, the company sent letters to incoming residents to assure them their positions were not in jeopardy.

But residents say they were otherwise largely kept in the dark.

“We had been hearing about it in the news, and a lot of faculty weren’t that concerned. They said that it’s a major hospital and it would be impossible for it to fold in a matter of months,” said Dr. Abrishamian. “I got notice of the closure through group chat, and it’s all been secondhand information from the news.”
In a letter to colleagues, Drexel’s president, John Fry, wrote: “We have been preparing for some months for this unfortunate outcome, even as we did everything possible … to prevent the closure of Hahnemann, which has a long and storied history with the College of Medicine, and with the city of Philadelphia.”

Residents have been scrambling to find new placements, a process complicated by uncertainty over when their funding will be released, which many of the programs accepting transferring residents would require. (The hospital has since announced a timeline for releasing the funding.) Some new residents had only just arrived in Philadelphia when the hospital announced its closure. On July 24, Hahnemann announced that it will be releasing the residents’ funding, with plans for all funding to be released Aug. 6.³ Residents will continue to be paid until Aug. 25 or until they start at a new residency program.

Support from Colleagues in Medicine

Residents say they have received a tremendous amount of support from program faculty, professional organizations, and other area hospitals, including Thomas Jefferson University Hospital and Temple University Hospital, which have agreed—like other area institutions—to take on as many of Hahnemann’s residents as they can.

“The emergency medicine resident community stands united and we applaud the ongoing work of multiple organizations including the AAMC (Association of American Medical Colleges), ACGME (Accreditation Council for Graduate Medical Education), AMA (American Medical Association), CORD (Council of Residency Directors in Emergency Medicine), and ECFMG (Educational Commission for Foreign Medical Graduates),” wrote Hannah Hughes, MD, MBA, President-Elect of the Emergency Medicine Residents’ Association (EMRA), in a statement for ACEP Now. “EMRA has reached out to the Drexel EM community to offer our full support as the program and trainees find a solution to continue their commitment to education and patient care. We stand ready to assist in any way, shape, or form.”

Local program directors came together on July 17 to offer residents a citywide interview day “to offset the stress of interviewing,” said Dr. Calhoun, who, with her husband, owns a home in the area and is hoping to stay in the region, although she is also considering the best next step for her career.

On July 10, Hahnemann, Drexel, and Tower Health announced a letter of intent to transfer the majority of Hahnemann/Drexel’s residency and fellowship programs to Tower Health. But while that may help new interns and future emergency medicine residents, Dr. Calhoun said Tower Health does not currently have the capacity to train senior residents. Drexel referred questions regarding resident displacement to AAHS, who did not respond to questions via email or telephone.

According to EMRA, there are more than 2,500 annual emergency medical residency spots in the United States, and abrupt residency closures are uncommon. However, said Dr. Hughes, there have been a few closures of ACGME-accredited programs in recent years due to natural disasters (Hurricane Katrina), hospital bankruptcy, and failed contract negotiations.⁴

Loss of Critical Part of Community

Hahnemann University Hospital was established in 1848 as the Homeopathic Medical College of Philadelphia and later renamed. It merged with several other medical schools, and, in 1998, Tenet Healthcare acquired Hahnemann. Shortly after, Drexel took over management of the academic institution. In early 2018, AAHS purchased Hahnemann and nearby St. Christopher’s Hospital for Children from Tenet.

“Hahnemann has been a staple of the community for so long, and even though for 20 or 30 years the hospital has been on shaky ground, no one ever imagined it would close and certainly not on a 30-day or 60-day time frame,” said Dr. Calhoun.

Despite the September closure date, Hahnemann—considered a safety-net hospital for the area—stopped admitting patients through the emergency department on July 17 and planned to operate effectively as an urgent care center, open only to noncritical cases.

The closure will also send ripple effects through other regional hospitals at which Hahnemann/Drexel residents worked. For instance, Dr. Calhoun said that residents staff overnight shifts at the emergency departments and intensive care units of community hospitals in the Mercy Health system and that, with residents leaving, those hospitals will be scrambling for solutions.

Seeing the decline at Hahnemann has also been challenging, she said. “We have white boards with services that are no longer available. We’re just not seeing as many ambulances. There is no longer trauma or stroke or STEMI, no labor and delivery services, no elective OR cases … There are still sick patients who walk themselves through the door but certainly at a decreased volume and decreased acuity from several weeks ago.”

But she and her colleagues are trying to take it all in stride. “In emergency medicine, you need to be able to handle whatever’s thrown at you and keep a level head,” Dr. Calhoun said. “We were taught resilience early on, so hopefully we are stronger in the end, but we still have a difficult couple of weeks ahead.”

References

1. Brubaker H. Hahnemann University Hospital closure upends career paths for 570 doctors-in-training. Philadelphia Inquirer. July 3, 2019. Available at: https://www.inquirer.com/business/hahnemann-university-hospital-residents-lose-training-grounds-20190703.html. Accessed July 24, 2019.
2. Schaefer MA. For some Hahnemann medical residents, there’s an added stress: potential deportation. Philadelphia Inquirer. July 15, 2019. Available at: https://www.inquirer.com/health/hahnemann-j-1-visa-foreign-residents-medical-doctors-deported-20190715.html. Accessed July 24, 2019.
3. Brubaker H. Hahnemann starts releasing stranded residents; St. Chris auction could see competitive bidding. Philadelphia Inquirer. July 24, 2019. Available at: https://www.inquirer.com/business/hahnemann-university-hospital-releases-residents-20190724.html. Accessed July 25, 2019.
4. Berger E. A contract expires, an emergency medicine residency stands on the brink. Ann Emerg Med. 2017;69(4):A20-A23.