Helping Medical Trainees Understand the Financial Health of Training Institutions

To the Editor: Philadelphia Academic Health System, LLC, which operated Hahnemann University Hospital in Philadelphia, filed for bankruptcy on June 30, 2019, just after the hospital onboarded 135 interns and residents and 40 fellows for the next academic year.1 Most of these physicians made a commitment to Hahnemann through the National Residency Matching Program and believed that Hahnemann had made a reciprocal commitment to them. Instead, these 175 new trainees and nearly 400 others who expected to be continuing their training at Hahnemann had their lives thrown into turmoil. For at least a year before the bankruptcy announcement, the hospital’s declining fiscal health was apparent. Unfortunately, most resources for assessing the financial health of hospitals can only be found in state-specific databases or require paid subscriptions.2–4 These are not readily accessible to medical students applying for internships and residents applying for fellowships. Additionally, most of these individuals are unlikely to be able to meaningfully interpret such data and identify hospitals or health systems in financial peril. The closure of Hahnemann and the displacement of over 500 residents and fellows, many of whom had just moved to the Philadelphia area, signed leases, and had medical school and other debt to pay, should serve as a wake-up call to the broader medical education community. Residents and fellows should not matriculate into financially weak institutions unaware of the peril their new training site poses to their professional development, personal lives, careers, and finances. A simple, uniform system for grading or otherwise identifying the financial strength or weakness of such institutions, as it relates to graduate medical education (GME), should be developed. It would be a great service to the GME community if the Association of American Medical Colleges, national hospital organizations, medical schools, Accreditation Council for Graduate Medical Education, or others would use this recent devastating hospital closure to stimulate development of readily available, easily understood resources to help students and residents discern the financial health of institutions they are considering for training. The public has access to information about the quality of care provided by hospitals. For those making, and expecting, a commitment for their GME training, access to concise and accurate information about the financial health of their training institutions is also vital

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