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Letters to the Editor

“Orphan” Status: Inadequate Protection for Abandoned Residents

Adler, Cameron MD

Author Information
doi: 10.1097/ACM.0000000000003166
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To the Editor:

The closure of Hahnemann University Hospital in Pennsylvania has shed light on a terrifying reality of medical training: when a residency program shutters, its residents become “orphans,” and they have few protections. Current policy regarding program or sponsoring institution closures is inadequate and may be unenforceable.1,2 In the case of Hahnemann University Hospital, the residents had not been released from their contracts as of September 2019, nearly 3 months after notification of impending closure. They were told as late as April 2019 that their residency positions were not in jeopardy and their funding may be sold to a sponsoring institution that does not have the capacity or approval to train them all.3,4 Despite this, the residents have little recourse.

When a program or sponsoring institution is at risk for closure for financial reasons, there are currently no regulations regarding notification or release of trainees.5 Sponsoring institutions should be required to keep their trainees informed on financial health and stability of the institution. Institutions should also be required to contractually release their trainees in a timely manner, as the trainees cannot finalize new training opportunities prior to release from their contracts with clearly delineated funding sources.

Additionally, trainees should be made aware of the funding source for their position before programs are at risk of closure. Some residency programs are completely funded by Centers for Medicare and Medicaid Services (CMS), some are partially funded, and some receive no CMS funding. Prior to any risk of closure, the sponsoring institution should clearly outline each trainee’s funding source and what funding would transfer with them if they are “orphaned.”

In the case of a closure, we must also consider the level of financial and civil responsibility the sponsoring institution and their parent institutions should have. Many residents will have to break leases, uproot families, or even be at risk of deportation due to the closure of their sponsoring institution or residency program.3,6

Current policy for program or sponsoring institution closure is lacking and does not protect trainees. Closure must be regulated, and the trainee protections must be enforceable. As hospital systems continue to merge and consolidate, we must be prepared for future sponsoring institution closures and ensure that affected residents can continue their education as seamlessly as possible.

Cameron Adler, MD
Fourth-year resident, Department of Diagnostic Radiology, Mayo Clinic, Phoenix, Arizona;; ORCID:


1. Redford G. What happens when a teaching hospital closes? AAMC News. Published 2019. Accessed December 16, 2019.
2. Church S. Hospital doctors’ training at risk in Drexel sale, court told. Bloomberg. Published July 19,2019. Accessed December 16, 2019.
3. Brubaker H. Hahnemann University Hospital closure upends career paths for 570 doctors-in-training. The Philadelphia Inquirer. Published July 3,2019. Accessed December 16, 2019.
4. McCoy CR. Just 30 patients remain at Hahnemann University Hospital, residents tell judge. The Philadelphia Inquirer. Published July 19,2019. Accessed December 16, 2019>.
5. Accreditation Council for Graduate Medical Education. ACGME Institutional Requirements. Updated 2018. Accessed December 16, 2019.
6. Schaefer MA. For some Hahnemann medical residents, there’s an added stress: Potential deportation. The Philadelphia Inquirer. Published July 15,2019. Accessed December 16, 2019.
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