Citation

Roberts LW. Acad. Med. 2020; 95(4): 485-487.

Copyright

(Copyright © 2020, Association of American Medical Colleges, Publisher Lippincott Williams and Wilkins)

DOI

10.1097/ACM.0000000000003151

PMID

32209842

Abstract

Hahnemann University Hospital closed last summer. A very large medical training institution with more than 150 years of service to the public, the loss was felt by patients, learners, faculty, staff, and neighboring communities. Other academic hospitals have folded before and a number have shut down since, but Hahnemann’s is the first closure of a major urban teaching hospital in the United States.1 Few observers would argue that the process was handled well: communication was inadequate, transition planning insufficient, and the timing unthoughtful at best. The integrity of academic medicine itself was deeply affected; many hundreds of resident physicians, fellows, and health professions students who had placed their faith and their futures in the hands of the academic hospital found their needs and expectations subordinated to other interests.

The Hahnemann closure followed a well-recognized, apparently legal path in the business world: long-standing deficit leading to acquisition and merger (in 1993), unsustainable losses followed by bankruptcy (in 1998), another sale (in 2018), continuing deficit, and then the decision to close (in 2019).2 Ethically, though, the rapid closure of the academic hospital was difficult to accept because Hahnemann had cared for the ill of Philadelphia for more than a century and a half and was considered a critical safety net hospital for decades.2 Moreover, the hospital was owned by a resource-intensive company with a problematic history,3 and the company separated the hospital from its land while declaring bankruptcy to attain real estate profits. Furthermore, Judge Kevin Ross of the U.S. Bankruptcy Court for the District of Delaware ruled that residency slots may be sold as assets without the consent of the Centers for Medicare and Medicaid Services.2,4 Tangibly, the abrupt and insensitive manner of the closure displaced and hurt vulnerable and voiceless people—people who deeply matter to us in the field of academic medicine.

Whether resident and fellow positions can be sold, as if physicians-in-training were mere objects rather than our cherished mentees and early-career colleagues, is now a matter for the courts. The Centers for Medicaid and Medicare Services, along with professional societies across the country, have thus far blocked the unprecedented sale ...

Language: en