Friday 17 February 2012

When a medical residency program loses accreditation

Guardian of resident affairs
ACGME is the watchdog that ensures that programs across the nation stick to standards that are set forth for graduate medical education programs. There are duty hour rules; there are work rules, teaching rules and compliance rules. It is a detailed framework that programs follow to prevent exploitation of residents.

The genesis 
The origin of the duty-hour work rules comes from a case in New York where an allegedly overworked resident was responsible for the death of a patient, Zion Libby. New York State Department of Health Code, Section 405, [Libby Zion law], is a regulation that limits the amount of resident physicians' work in New York State hospitals to roughly 80 hours per week. In July 2003, the Accreditation Council for Graduate Medical Education (ACGME) adopted similar regulations for all accredited medical training institutions in the United States.

Although there was conflicting evidence about the cause of her death, it is thought to have been caused by serotonin syndrome from the drug interaction between the phenelzine she was taking prior to her hospital visit, and the Demerol administered by a resident. You can read more about this case here 

 New york times did a article last year regarding this phenomenon of over worked residents, called ‘phantom menace of sleep-deprived doctors’

 Work hour rules are but one of the many factors that programs across the country have to comply. Back in 2002, ACGME revoked the accreditation of residency programs in emergency medicine and pediatrics at Howard University Hospital. In 2003, Internal medicine program at Johns Hopkins' lost its accreditation for several violations, including the work hour rule.

The hospitals have recourse to appeal the citations while on probation. This is a time frame (usually 6-9 months) that have been given to the program to put in place corrective measures and fix the issues they were cited for. If at the end of probationary period, program is not able to take care of the problems to ACGMEs satisfaction, it stands to lose official recognition.

Effects of the loss
There are several ramifications to loss of accreditation, hospital loses support from federal grants, reimbursement from Medicaid for residency training will be lost and most importantly the program cannot have residents to train. Hospital then has to have attending replace the residents. Some residents are transferred to other programs. However, because there are no ‘vacant’ residency spots to begin with (no programs go unfilled – prematch, match, scramble, SOAP – all ensure that there are no vacancies), these residents are let go.

Since the stakes for the hospital are higher than just lost opportunity for training and education of physicians, the programs and hospital usually end up fixing or temporizing the issues they were cited for.  However, be careful when considering programs that are on probation and have had issues with accreditation. Use this information to arrange your rank order list.

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