What happens to medical residents when a hospital closes?
When New York City’s St. Vincent’s Hospital closed on April 30, 2010, ending what the New York Times called a “long struggle to stay afloat despite millions of dollars of debt,” it left a swath of Manhattan without a hospital.
The first priority, of course, was to figure out how the community served by the hospital would meet its health care needs. But at least as important, argue the authors of a new paper in the American Journal of Medicine, is to
consider the people who once served the hospital. When a hospital shuts down, what happens to one of its largest work forces, its house staff? For these young doctors who have not yet completed their medical education but are in the last chapter of their training, what lies ahead?
At St. Vincent’s, that meant 253 residents and 104 fellows — in fact, the “largest closure of a house staff program in the history of Graduate Medical Education in the United States,” according to the paper. The residents learned of the closing a month before it was scheduled:
Although the odds seemed to be stacked against them, the residents had one significant advantage: Because Medicare provides reimbursement funding for each resident, the house staff provides financial incentive to any hospital that is in need of labor. So when a program closes, each enrolled resident is placed under “orphan” status and the money that was originally allotted for the resident can be transferred to the new hospital. The money is available to the receiving program for each year that is needed to complete the residency.
Although this served the majority of residents well, it placed others in a tougher situation, particularly those who had matched at St Vincent’s for neurology, anesthesiology, and radiology starting in July 2010, but were at a different program for their preliminary or transitional year at the time the hospital closed. Because they had not yet started training at the St Vincent’s program in which they matched, they were not considered orphans. Therefore, no funding was available for these residents.
However, when St Vincent’s Hospital finally closed its doors, all but 2 residents and all the fellows were offered positions at other training program.
Most of those were able to start in their new programs right away, on May 3.
Perhaps it’s not surprising that a graduate education system with more than 116,000 spots, at more than 9,000 programs accredited by the Accreditation Council on Graduate Medical Education, found room for a few hundred residents and fellows.