The emergency medicine residency program operated by Summa Health System at Akron General Hospital for at least 35 years faces closure July 1 if an appeal of its failed Jan. 24 accreditation survey by the Accreditation Council for Graduate Medical Education is unsuccessful.
ACGME assessed the program after an abrupt change Jan. 1 in emergency department staffing from the longtime group Summa Emergency Associates to US Acute Care Solutions in Canton, OH. The change in staffing required the new program to provide a director, associate director, and 10 faculty — one for every three residents in the program — with academic teaching and research credentials. The program has until July 1 to provide ACGME with a plan to correct the deficiencies.
ACGME will rescind the residency's accreditation if those faults are not remedied, and many published and broadcast reports noted that one of those was that the new residency director, Scott Felten, MD, did not have the proper experience to lead the program. That point is disputed by Summa. “We were disappointed by ACGME's decision, and are in the process of appealing that decision,” said Mike Bernstein, the system director of corporate communications for Summa Health, in an email.
“USACS faculty meet or exceed all necessary requirements for an ACGME-accredited emergency medicine program. In fact, Dr. Felten has more than four years of experience as a core faculty member in ACGME-accredited emergency medicine residency programs. We have full faith and confidence in our emergency department team from USACS — a partnership in emergency medicine staffing that is here to stay — and will continue working with them to ensure our residents continue to receive excellent training,” he said.
During contract negotiations late last year between Summa Health and the previous emergency physician group, Summa Emergency Associates, Jeff Wright, MD, the president of the group, said the first draft contained a major cut in funding for graduate medical education. He estimated it would have taken the 10 core faculty down to five, half that required by ACGME.
Asked about Dr. Wright's comment and Summa's commitment to saving the residency, Mr. Bernstein said, “As always, Summa Health remains committed to medical education, and we will advocate for the best interests of our residents, patients, and physicians through appropriate channels.”
Appealing the Decision
Marty Richmond, the director of corporate communications for USACS, backed up Mr. Bernstein's statement. “The physicians of USACS working at Summa are all residency-trained, board-certified emergency medicine physicians. USACS manages nine other residency programs, and is capable of running this program at the same high level it's been run for years. Our physicians, including the program director [Dr. Felten], meet the qualifications to serve as core faculty. USACS disagrees with the ACGME findings, and is working with Summa to appeal this decision,” he said.
The many published and broadcast reports quoting those who attended a Summa meeting reporting the ACGME findings said ACGME found that Dr. Felten did not have the proper qualifications. At one point after the visit by ACGME, however, Mr. Richmond said ACGME had approved Dr. Felten in the role of new residency director. Summa did not clarify the matter in requests from Emergency Medicine News.
ACGME does not release the results of its surveys, ceding that decision to the hospital or the residency. USACS deferred to Summa Health to release the report, but Mr. Bernstein said Summa would not distribute the survey results. Questions from Emergency Medicine News about Dr. Felten's qualifications, why Summa was pulled from the emergency medicine match, and whether the new residency faculty are qualified were not answered by Summa Health.
A Jan. 5 statement from USACS said Dr. Felten had most recently “served as residency director for USACS. In this role, he worked with the residents and residency programs at all nine USACS graduate medical education facilities. Dr. Felten joined USACS in 2008 and worked clinically at St. Francis Hospital in Tulsa, Oklahoma, and in the Mercy Health System in Cincinnati.
“Previously, Dr. Felten served as an assistant professor of Emergency Medicine at the University of Oklahoma in Tulsa. Before that, he was a member of the Emergency Department staff at Akron General Medical Center and later served as the medical clerkship director, associate program director, and medical director of the Akron General Medical Center Emergency Department in Stow, Ohio,” USACS said.
A program director must continue in his position for a length of time that ensures leadership and program stability, according to the ACGME requirements. He must have experience in the specialty and documented educational and administrative experience acceptable to the ACGME review committee. The director's certification in the specialty must be current, and he must have at least three years' experience as a core faculty member in an ACGME-accredited emergency medicine program. The director must also oversee the quality of the didactic and clinical education at all sites that are part of the program, ACGME said. He should be clinically active but must not work more than 20 hours per week or 960 clinical hours per year.
ACGME requires faculty to devote time to the educational program to fulfill supervisory and teaching responsibilities in each of ACGME-designated competency areas. They must take part in organized clinical discussion, rounds, journal clubs, and conferences that are part of the residency program. Some should demonstrate scholarship by obtaining peer-reviewed funding, publication of original research, or review articles in peer-reviewed journals or chapters in textbooks or other scholarly activities designated in the ACGME rules. (http://bit.ly/ACGMEResidency.)
Dr. Felten, in a communication to potential residents obtained by Emergency Medicine News, said if Summa Health's appeal fails, the “sponsoring institution” will be placed on probation. “If we are not successful with our appeal, our accreditation for our EM residency program will be withdrawn effective July 1, 2017. All of our current third-year residents will graduate unaffected, but if this stands, we will need to transfer our first- and second-year residents to other institutions to complete their residency training.” He said Summa has hired a consulting firm to help with the appeal.
Dr. Felten added that he withdrew the emergency medicine program from the match this year, and said he hoped that the appeal will be decided in a timely fashion to allow the residency program to take part in the Supplemental Offer and Acceptance Program.
In the wake of an uproar over the change in emergency department staffing and a vote of no confidence, Summa Health's former president and CEO Tom Malone, MD, resigned in late January, and the board named Clifford Deveny, MD, as his interim replacement, effective March 13. Dr. Deveny had worked in the Akron system for approximately 20 years previously.
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