When a Residency Program Shuts Down: Advice from Three (Previously) Displaced Residents

WHEN A RESIDENCY PROGRAM SHUTS DOWN

By Aaron R. Kuzel, DO, MBA

Background

Hilary Davenport

Jordan Miller

Hilary Davenport, DO, is currently at PGY-3 resident at the University of Louisville and will be starting an ultrasound fellowship at The Ohio State University Wexner School of Medicine in July. Dr. Davenport was a PGY-2 emergency resident at Hahnemann University Hospital prior to its closure August 16, 2019. Jordan Miller, DO, is the chief resident at Summa Health. Dr. Miller was a PGY-1 emergency medicine resident at Adena Health System in Chillicothe, Ohio prior to its loss of accreditation in 2020. Scott Poland, MD, is the emergency medicine ultrasound director and core faculty at Summa Health. Dr. Poland was a PGY-3 emergency resident at Summa Health prior to its closure in 2017.

Imagine, you are at the height of your residency. For four years you’ve dreamed of nothing but being able to practice emergency medicine at this residency. You’ve developed new relationships, have a new home, and you’re thriving and coming into your own as an emergency medicine physician. Suddenly, the rug is pulled out from under you, and you find yourself scrambling to find a new job, a new home, and calling every contact in your phone trying to find somewhere to complete your residency. This is a nightmare scenario for any resident; however, for these three emergency medicine physicians —Drs. Davenport, Miller, and Poland — it became a horrible reality. These residents were involved in the closure of Hahnemann University Hospital, Summa Health’s contract dispute and closure, and Adena Health’s accreditation loss. Yet despite these challenges, these three physicians overcame this adversity and are thriving in their careers as emergency physicians. Here they share their experience and insight on coping through career setbacks and their advice for other residents who may share similar experiences.

Dr. Poland: I went through the stages of grief: Initially denial, then anger, bargaining, depression, and eventually acceptance. Dr. Miller: Initially I was devastated and didn’t know exactly what to think. I had to excuse myself from the room and went into the hallway to start sobbing. Dr. Davenport: I was actually on a plane on my way to vacation when I woke up from a nap to over 400 text messages and “group me” messages. I found out sitting on a window seat of a plane! I was in shock, and a slurry of cuss words came to my mind — specifically ones that started with the letter “F.” I had a panic attack with nowhere to go and I couldn’t contact anyone. Of course, my natural instinct was to wonder, “What could be the worst possible outcome?” All I could think about was It had taken me so long to get to this point in my career, and it was all crashing down around me.

How did this experience impact your overall life?

Dr. Poland: It was an unexpected bump in the road, but overall I have still been able to accomplish my personal and life goals. Dr. Miller: Initially my program closure was devastating. I had recently bought a house, which put a lot of stress on my family. For about 10 months I was extremely angry about the situation and went through all the stages of grief until I finally accepted my new life. Ultimately my program closure opened new doors that wouldn’t have been possible otherwise. Dr. Davenport: Through this experience I have learned a lot about malpractice insurance, what it’s like to work at a multitude of hospitals, and how to make friends quickly. The good news for my social life is that it meant I got to move closer to my then boyfriend, now fiancé. But I will say that I miss Philadelphia and my coresidents from Drexel EVERY. SINGLE. DAY. We were such a close-knit group of people. They were my family and I still think of them that way. I’m not sure if I became a better physician by going to a different program, and the world may never know, but I think it did change how I practice medicine. I have now worked with and learned from double or triple the number of attendings during residency.

Did the closure of your program have an impact on your career trajectory?

Dr. Poland: At the time I felt devastated and unsure of my future. In retrospect, I look at it as a beneficial time of adversity. It allowed me to see multiple ways of practicing that I may not have otherwise seen. It made me aware of the challenges and current culture that emergency medicine is facing. Dr. Miller: I went from a small community center to a large level one trauma center. I always wanted to be a community doctor and had thought about fellowship as an intern, but I wasn’t at a big program. I also really didn’t enjoy the idea of being in a big city and it’s still sometimes very stressful for me to be in a large city. It did, however, give me the opportunity to see a larger volume of critically ill patients and ultimately was the reason I decided to apply and match to fellowship for critical care. Dr. Davenport: I matched in an ultrasound fellowship at Ohio State and go, to move to Columbus to be with my fiancé. I’m not sure if any of that would have happened if I had stayed in Philadelphia. I think the goals of my career would have been the same. The plan was always to apply for an ultrasound fellowship— it just depended on where I was.

What was the hardest adjustment you had to make because of the closure?

Dr. Poland: I was fortunate to relocate at the beginning of my third year which meant I had all of my off-service intern year rotations done and had gained experience in the emergency department already. Dr. Miller: I didn’t realize how difficult that would be for me to live in a big city. It was also extremely difficult for me to essentially feel like I was an intern again while going into my third year of residency. Dr. Davenport: Each hospital and residency program has a different culture, and I would say that was the hardest adjustment. I came from a program where everyone was really close knit and all of the classes hung out with each other. I had a very hard time feeling like I fit in at my new hospital. Not only was I learning an entire new hospital system, I also felt like I had to “prove” myself to my fellow residents, attendings, nurses, and other staff. Everyone wondered who I was and it was very difficult at first. Trying to make friends and learning a new hospital system were the most difficult.

Were there any positives to the experience as you reflect back on that time?

Dr. Poland: The opportunity to train under three cohorts of emergency medicine providers. I was able to see that residents can be trained under small groups, larger groups, and hospitalemployed physicians. It was also great to meet all of the new residents and make new friendships. Dr. Miller: It made me a more resilient person in many aspects of my life, not just in medicine. I’ve also met some of the most amazing friends I’ve ever had in my life, which I wouldn’t have done if I hadn’t gone through this experience. Dr. Davenport: The biggest positive of all was more social than anything. I moved much closer to my then boyfriend, now fiancé. If I still lived in Philadelphia, I’m not sure if our relationship would be as strong as it is now. Another positive is that I feel very independent. The University of Louisville values the autonomy they give to residents, so I have been able to moonlight at other emergency departments in the city and have really grown as an emergency physician. I feel much more confident in my skills and my ability to carry multiple patients at a time. I’ve also been able to teach interns and medical students more at the University of Louisville, which helped me decide I wanted to continue my career in academics.

Do you have any advice for finding a new program? Did your program director and/or the Accreditation Council for Graduate Medical Education (ACGME) help place you?

Dr. Poland: Reach out to the programs you were interested in when first applying to residency. Analyze what factors are important to you and evaluate the programs based on that criteria. For me geography and location were an important factor. My old and new program directors both offered to assist but I had a lack of trust at the time and decided to pursue my own offers. The ACGME unfortunately takes a hands-off approach and only decides on program accreditation. Dr. Miller: I met my current program director at a lecture about the American Board of Emergency Medicine (ABEM) and told him about my situation. My old program director helped me look into programs that I felt would be a good fit for me. Ultimately it was a combination of effort from multiple people to get me to my new program. Dr. Davenport: The cold honest truth: just start emailing the program directors of the programs that you interviewed at. That was the first step I took. When I found out about the news I immediately reached out to a longtime friend/ boss. Every day, the ACGME would release new residency programs that were willing to take “orphaned” residents. It was a list that would say how many residents (per PGY year) they would take and then you would have to contact them. It sounds easy but it was not. Before they would accept you there were interviews and they would need to see your application. Imagine doing all of this while still working your normal residency shifts. I was working in the MICU doing q4 call while trying to manage this. There isn’t a book of rules; you just wing it the entire time.

We also did “speed dating” interviews with all of the programs in and near Philadelphia. It was the weirdest feeling competing with your friends for a spot at another program. You sat down with associate program directors, program directors, and chairs for 10 minutes to answer interview type questions and then you would find out two days later if they liked you enough to want you at their program.

It was the devastating watching Drexel attendings as they saw this happening. For them it was as if they were losing their children. Our program directors helped as much as possible. If we found a program that we liked they would provide that program with our information, but as I said, there were no rules and it was an “every man for himself mentality.”

Did your opinion on emergency medicine change throughout this process?

Dr. Poland: It reaffirmed for me that emergency medicine is a large family willing to help those in need; however my personal experience opened my eyes to the enormous amount of business in medicine. Dr. Miller: Yes. I didn’t realize how small the community was and how willing people were to help. I was trying not to fall apart for months while going through this process and felt like I had an amazing support system to help me come to terms with my situation. Dr. Davenport: This process had nothing to do with my love for emergency medicine, which was ingrained in me since I was a scribe 10 years ago. I still think it is a great specialty. I think the experience just changed the way I think of hospital systems and residencies in general.

How do you think our national organizations should intervene to prevent this from happening?

Dr. Poland: First, by having high standards that emergency residencies are expected to uphold; second, by having guidelines for preventing untimely contract disputes and hospital closures; third, by encouraging the gradual closing of underperforming programs to prevent relocation of residents. Finally, by facilitating relocation discussions, interviewing, and financial assistance for those residents facing the challenge of relocation. Dr. Miller: This is a hard question to answer but I think if a program shuts down, maybe let all the residents finish? My seniors were allowed to graduate. It was only the interns who were displaced. Also, relocation shouldn’t financially be on the resident. It cost me thousands of dollars I didn’t have to move, interview, and make a down payment on a house. Plus, I couldn’t sell my house for months because of the COVID pandemic. There has to be a better way. Dr. Davenport: I think it is the duty of national organizations to take an active role in assuming ownership for displaced residents and ensuring they achieve their goals in emergency medicine. Further, I believe that national organizations should take a firm stance in evaluating residencies that are started by “for-profit” or private equity institutions. Those programs that view residents as cheap labor and do not prioritize their educational needs should be removed. I believe it is the duty of our national organizations to protect residents and ensure that residents are not treated as commodities, but rather as future board-certified emergency physicians. Hahnemann was a clear example of when a for-profit entity chooses profit over patients and future physicians, physicians, nurses, and staff. I think our organizational bodies can 100 percent prevent these types of tragedies from happening.

ABOUT THE AUTHOR: Dr. Kuzel is an emergency medicine resident at the University of Louisville School of Medicine. He is the associate editor of the RAMS Section of SAEM Pulse and is a member-at-large on the SAEM RAMS Board.