When Mount Sinai Medical Center University Circle in Cleveland, Ohio announced on March 17 that is was filing for Chapter 11 bankruptcy reorganization and evolving into a community, nonteaching hospital by July 1, it was not good news for the orthopaedic department.
The announcement, made on Match Day, affected two incoming postgraduate year orthopaedic residents who had no position to come to and eight PGY2-5 orthopaedic residents who had to be placed in other programs by the July deadline.
"By occurring on Match Day, there were no longer any scramble positions open," explains William H. Seitz Jr., MD, chairman of the orthopaedic department. "And residents did not have a fallback in place to get their training."
But Dr. Seitz spurred into action to successfully find a match for all 10 residents. "I created a war room, called the Residency Review Commission (RRC) and faxed notices to every orthopaedic training program in the country," says Dr. Seitz.
The decision to move to a nonteaching hospital status also terminated seven other residency programs, affecting nearly 150 residents, including obstetrics and gynecology, emergency medicine, radiology, internal medicine, transitional, podiatry and dentistry.
The hospital's owner, Primary Health Systems, Inc. (PHS), expects to emerge from Chapter 11 as a nonprofit organization incorporated in Ohio under a new name to be determined by September. PHS's restructured organization will include Mount Sinai Medical Center University Circle, Mount Sinai Medical Center East in Richmond Heights, Mount Sinai Medical Campus in Beachwood, and Deaconess and Saint Michael Hospitals in Cleveland.
According to Beth A. Sweeney, the hospital's spokesperson, the decision was due to financial difficulty. "This change will eliminate extensive teaching-related expenses and allow those funds to be used for community operations," says Sweeney. "It will also put us on a level playing field with other nonprofits. We will now have access to the tax-exempt bond market and charitable contributions."
The hospital's decision to terminate the programs without a phase-in plan for residents was in violation of the Accreditation Council of Graduate Medical Education regulations. "We'd expect that once an institution appoints a resident, it would be appropriate for them to finish their residency program,"says Steven P. Nestler, PhD, executive director of the RRC's orthopaedic program. "The day the hospital announced they were closing the program, they were also telling the Match that they would take two new residents."
Dr. Seitz worked closely with the RRC and successfully matched all 10 residents in orthopaedic programs such as the University of Alabama at Birmingham, Harvard Medical School Program, Hospital for Special Surgery, Lenox Hill Hospital and others. The American Board of Orthopaedic Surgery waived requirements that the last two years of residency be done in the same program for the two residents going into PGY5.
Nestler noted St. Luke's Medical Center's orthopaedic residency program also was terminated on June 30, 1999. However, he said, "There was quite a bit of lead time and we were able to do the same thing for eight residents."
"We were on a track to do over 3,000 orthopaedic cases," says Dr. Seitz. "The orthopaedic department was basically keeping the hospital alive, the residency program was flourishing. We were producing as much research and publications and activity at the Academy meetings as bigger institutions around the country.
"The reality is, they can't run the hospital as efficiently without residents as they did before. It's really something that was not a well thought out, cost-effective management concept. When you have a resident, he's bright, young, eager and hard working and doesn't watch time clock. He recognizes there's a quid pro quo for education. You replace a resident with a nine-to-fiver and you now have three shifts working around the clock. There's really no comparison between what level of efficiency you get out of that replacement workforce."