The 570 residents who started their programs just more than a week ago at Hahnemann University Hospital in Philadelphia, Pennsylvania, are scrambling to find new positions in light of the announced closing of the hospital.

After more than 170 years, the hospital's website states that Hahnemann will gradually close on or before September 6.

"This was a difficult but necessary decision due to financial difficulties," Hahnemann officials said. "The hospital cannot continue to lose millions of dollars each month and remain in business."

The hospital did not respond to Medscape Medical News' request for comment.

There is still one option under consideration for those stranded: An email was sent to Hahnemann residents and fellows Wednesday about a tentative deal to transfer residents and fellows to hospitals in the Tower Health system around Philadelphia.

"I want you to be among the first to know that Hahnemann University Hospital and Tower Health have entered into a letter of intent to transfer the majority of the residency and fellowship programs at Hahnemann and Drexel University to Tower Health. Under the letter of intent, Tower Health will assume responsibility for your continued training while giving you preferred placement in one of Tower Health's six hospitals, many of which are in close proximity to Hahnemann," Ron Dreskin, chief executive officer of Philadelphia Academic Health System, said in a statement.

But the deal, according to the Philadelphia Inquirer, is still subject to approval by US Bankruptcy Court. Hahnemann and its parent company, American Academic Health System, are due in court Thursday, the newspaper reports.

"Free Choice"

And deal or no deal, the residents and fellows still have their own decisions to make.

"All parties involved recognize that you have free choice regarding where to complete your training," Dreskin said in the statement.

Residents, who had just started their programs on July 1, have begun looking for other spots. But that has been complicated because each resident's funding is tied to Hahnemann and residents must be released so they can get "orphan" status, which would allow the funding to follow them to the new position.

As of Tuesday, those releases had not been made, but Dreskin said in his statement, "Hahnemann will begin releasing any program participants who wish to complete their training elsewhere, upon confirmation of the [Medicare reimbursement funding] cap value for every participant in the training program."

Other groups are also working to help those left in the lurch. The Accreditation Council for Graduate Medical Education (ACGME) wrote in a memo on July 2: "The ACGME has invoked its Extraordinary Circumstances Policy (ACGME Policies and Procedures, Section 21.00). The ACGME facilitates accreditation considerations that make it possible for residents and fellows to transfer to other programs."

However, it added, "The ACGME is not directly involved in resident or fellow placement or decisions related to funding. Residents and fellows should contact their program director and/or designated institutional official (DIO) with any questions about the transfer process."

One of those affected is Thomas Sibert, MD, who had just started his third year as an internal medicine resident at Hahnemann. Now, instead of focusing on finding a fellowship, he must simultaneously find another residency as well.

"The people we are counting on for recommendations are themselves also looking for jobs," he told Medscape Medical News. "The attendings have been endlessly supportive. They've been working for the fellows at the same time they're working for their residents interested in fellowships and looking for their own jobs."

He described some of the worries the residents are facing.

Many have signed full-year leases for housing and some landlords have been unwilling to break them, he said. Because the areas near Philadelphia can only at this point — depending upon pending solutions — take a percentage of the displaced, others will need to move across the country and some states will require getting a new medical license with potentially months of background checks.

The consequences are especially severe for interns, Sibert said.

"They are going to enter their new hospitals with very little clinical exposure because the number of patients and the resources at Hahnemann have been so severely reduced," he said.

In addition, Sibert's research "is just dead," he said, and others' research has been torpedoed as well as data gathering has been interrupted and principal investigators and attendings are scattering.

Patients are hit particularly hard by the closing, he noted, especially those with very specific and acute needs.

"We have one of the largest HIV clinics in the city attached to us. We have groups of patients with solid organ transplants, including kidney and liver, who are now potentially going to have to find new institutions," he said.

Meanwhile, physical resources are rapidly being removed from clinics.

"Doctors have been writing notes to update plans of care and people have come in as part of the liquidation to take away their computers," Sibert said.

Programs all over the country have reached out on social media letting the residents know about potential openings.

"This Is Almost Unheard of"

Ana Lourenco, MD, had been on the job as Brown University's new residency program director in Providence, Rhode Island, for one day when she got the news that Hahnemann would close.

Brown quickly started the process of seeking approval from GME to add residency spots. They got two spots in radiology approved and immediately the responses flowed in from displaced residents, she said. There's still work to be done in the hospitals' GME offices to transfer their approved federal funding, she said.

Adding such spots is difficult and rare.

"This is almost unheard of," Lourenco told Medscape Medical News. She said she can remember residents transferred after Hurricane Katrina in 2005 but the circumstances have to be on that scale.

As for Hahnemann's other physicians, most "will remain in their practices," the hospital said on the website. "Hospital officials will be working with local healthcare providers to help place many of our employees in new jobs."

Thomas Sibert's mother, Karen Sibert, MD, associate clinical professor at University of California Los Angeles' anesthesiology department, feels the Hahnemann loss on a personal and professional level.

"This is the biggest situation of its kind in American history," she told Medscape Medical News. "There's never been a mass displacement of this magnitude. And no one ever thought that Hahnemann would close."

She pointed out that international residents will likely have even more trouble navigating the closure and sorting out visa requirements, and families will be uprooted.

"People have jobs and spouses and their kids are in schools; they're settled. There's no way Philadelphia can take 570 residents into all the area hospitals. It will be a financial hardship for so many of them," Karen Sibert said.

She posted on Twitter that residency programs across the nation have a responsibility to get involved in finding spots for the displaced residents.

She said she received an email from David Aizuss, MD, president of the California Medical Association, saying that the association will reach out to the University of California to find places for residents.

But sites "aren't really offering spots until they know how much (funding) is coming and when it's coming. It's truly a mess. The scale of this is unbelievable to those of us in this field," she said.

Laurenco and Thomas and Karen Sibert have disclosed no relevant financial relationships.

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