the mess in akron

Sunday, April 9, 2017

The road to the Final Four culminates in a national holiday and it is also an opportunity for many to consider the plight of the student athlete. While their skill allows coaches and colleges to make millions, the players do not share in the bounty and very few will go on to play professionally. A student athlete is bound by the many rules and regulations of the NCAA and often has little recourse should the coach leave, the school be placed on probation or any myriad other issue that might arise.

But it’s not only college athletes who may fall victim to arbitrary rules that are more about money than equity. Consider the situation of emergency medicine residents training at the Summa Health System in Akron, Ohio. Their training program has been placed on probation by the Accreditation Council for Graduate Medical Education (ACGME) and may lose its accreditation on July 1. The residents in the program could transfer to another hospital or university program but unless they are granted their released by Summa, their new employer won’t get paid to teach them and likely would not open up a spot on their “roster.”

Some background about how medical education works. After graduating from medical school, newly minted doctors continue their postgraduate training as residents at teaching hospitals. Depending upon the specialty, that training can last three to seven years or more. Like an apprenticeship, as the doctors gather more experience in caring for patient, they are given more responsibility and less supervision until at the end of their training, they can care for patients independently. In addition to seeing patients, the hospitals are required to have teaching physicians who are responsible for lectures and research to expand the new docs’ knowledge base beyond what was taught in medical school. Medicare funds those residency teaching programs, including resident salaries and hospital expenses associated with their teaching, from the professors to the office support staff. And to be funded, a teaching program needs to be accredited by the ACGME.

The Mess in Akron

In Akron, Summa, a major teaching hospital, underwent an unusual change in their emergency department on January 1. The incumbent group of emergency doctors who had practiced there for 40 years was replaced by another. It wasn’t about the quality of patient care; it was about a contract coming due, a dispute over money and who would be paid what. The hospital announced a hastily arranged bidding process to find a new group of ER doctors, with a request for proposal due on December 29. The incumbent local group was not chosen and a new national company was awarded the contract that began on January 1. Normally, there is a transition period that lasts 3-4 months so that there is minimal disruption to patient care. In Akron, Summa arranged for a new set of docs to start 48 hours after the contract was awarded. Unfortunately for the emergency residents who were caught in the crossfire, the new group did not hit the ground running when it came to teaching and providing academic structure and supervision. On February 8, the ACGME placed the residency program on probation.

In the world of the NCAA, players have little option when a coach leaves or the college changes its promise to a student athlete. The education opportunity may remain, but the opportunity to play or compete may be lost. Perhaps a worse situation now exists for the emergency medicine resident trainees in Akron. There is no guarantee that their program will regain accreditation and if that accreditation does not occur, those same doctors will not be able to take their board exams so that they can call themselves specialists. Training has to occur in an approved, accredited program to count. And yet, if they try to find another place to train, there may not be funds to allow that to happen, because the hospital can, in effect, block the transfer. It sounds a lot like a student athlete wanting to transfer to another college but can’t because they were being blocked by their coach.

Medical students often begin their journey filled with optimism. As they progress through four years of medical school and then more years of postgrad training, it takes a lot of work and emotional capital to maintain a level minimum level of altruism. For those caught in the Akron mess, it is a sad reminder that too often money takes precedence over common sense, and while it’s hard to consider physician as victim, perhaps this might be one time when it is true.

Reference:Annals of Emergency Medicine April 2017

 

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