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Residents complained before loss of accreditation, UNM says

UNM Hospital. (Journal file)

Copyright © 2019 Albuquerque Journal

When the University of New Mexico School of Medicine lost its neurosurgery residency program accreditation earlier this year, a school official pointed to a spate of faculty departures as one of the causes. But an uprising from residents in the program was also a major factor, UNM acknowledged last week.

Budding brain surgeons in the residency program banded together in 2018 and sent a letter of grievances about their program to the medical school’s accrediting agency.

Fallout from that letter factored into the removal of the chair of the Department of Neurosurgery, multiple system and cultural changes within the institution and ultimately the withdrawal of the accreditation of the neurosurgery residency program.

The Accreditation Council for Graduate Medical Education has informed UNM’s School of Medicine that the program will lose its accreditation in June, and university officials said it will take several years to get it back. That is forcing eight resident physicians to leave for other hospitals, UNM Health Sciences Center officials have said.

UNM’s plans to regrow its neurosurgery department, and additional details about how the medical school lost its accreditation of the neurosurgery training program – including that it started with a letter from the residents – were discussed during a UNM Board of Regents Health Sciences Center Committee meeting on Monday.

In August 2018, the ACGME provided UNM medical officials with a letter written by its neurosurgery residents, which they sent directly to the accrediting council, according to a presentation to the regents committee on Monday. The letter described concerns the residents had with their program and at least some of those concerns were corroborated by the ACGME in its August 2019 findings, including that the education program lacked structure and that residents, to some extent, were being mistreated, according to the presentation.

“That letter, when we became aware of it, did raise concerns,” Dr. Michael Richards, the vice chancellor of clinical affairs at UNM Health System, said in an interview. “The residents did write a letter to the ACGME … with their concerns about the balance of service to education and the access to a broad range of cases as opposed to just lots of emergencies and trauma cases and the availability of the attendings. Those were the issues that were raised that triggered (action by the UNM health officials).”

UNM denied a request from the Journal for a copy of the letter, saying that it didn’t have the document, despite the representation to the contrary made in the presentation.

Mark Rudi, a UNM Hospital spokesman, said in an email that UNM doesn’t have the letter.

“The letter was sent by the residents directly to the ACGME. We were notified by the ACGME that they received a letter from the residents. The ACGME did not provide us with a copy of the letter,” Rudi said.

The ACGME declined to provide the Journal with a copy.

Efforts to reach the neurosurgery residents were unsuccessful.

Complaints

Richards said the concerns voiced in the residents’ letter included their duty hours. ACGME has several work-hour rules for residents, which include that they not average more than 80 hours of work per week, he said. The residents also complained about the types of cases that they were receiving during their residency.

“We see a lot of trauma … because of the kind of institution we are: a Level 1 Trauma Center,” Richards said. “Some of their concerns were that they were not getting as many kinds of cases that were not related to trauma.”

Richards said HSC officials quickly made changes after receiving a copy of the residents’ letter.

The same month that UNM received a copy of the letter, Dr. Howard Yonas, the chair of the Department of Neurosurgery, agreed to retire at the end of the year.

“I wouldn’t say that was the only issue” that led to his retirement, Richards said. “As part of the overall comprehensive response plan there were lots of changes within the department. And Dr. Yonas retired and we changed the program director of the residency program. We started the search for the new chair. All of those were things that were really important steps and demonstrate the response of the organization, building the right team and addressing all of the issues.”

Dr. Joanna Fair, the associate dean of graduate medical education, said during Monday’s subcommittee meeting that the hospital also worked to change the culture so residents would feel comfortable raising concerns to HSC officials, and not necessarily go straight to the accrediting agency.

For example, the hospital has brought in a wellness director for sessions with faculty and residents. They now require more frequent meetings, at least monthly, between the program director and residents, according to the presentation.

University health officials also say they have created a culture of accurate reporting of work hours for doctors doing their residency, according to the presentation.

Those were among the changes the HSC has put in place in recent months. But the timing of the changes with evaluations by the accrediting agency was difficult to manage, Richards said.

In December 2018, the accrediting agency did a residency site visit and two months later put the program on probation. In June 2019, there was a follow-up site visit and the ACGME withdrew the program’s accreditation two months later.

Richards said that as UNM was hosting the accrediting agency, they were moving around personnel and making systemic changes to try to address the residents’ concerns.

“The time period from when we became aware of the issues to when the action plan could be implemented fully and then demonstrate sustainability … was so compressed that you really can’t completely implement and demonstrate sustainability on the action plan items” before the accreditation was withdrawn, Richards said.

No appeal

Dr. Paul Roth, the chancellor of UNM Health Sciences and the dean of the medical school, said UNM has decided not to appeal the loss of the neurosurgery residency program’s accreditation. Instead, it will work to earn reaccreditation, which will probably take two to three years, according to university documents.

There were a total of 15 “citations” in the neurosurgery program’s most recent report from the ACGME. UNM’s School of Medicine is one of two hospitals in the country losing the accreditation of its neurosurgery program in June, according to the ACGME’s website. The other program is at Detroit Medical Center/Wayne State University.

As a result of the loss of accreditation, University of New Mexico Hospital is going to lose its neurosurgery resident doctors. Richards said that eight of the physicians, who had between one and six years left of their residencies, will be placed at other training hospitals. UNM will continue to pay their salaries even after they leave for other programs. Richards said that those eight physicians will have landed at new programs by the end of 2019. Two other residents will complete their training by the time the medical school loses its accreditation in June.

In the immediate future, UNM plans to double the number of neurosurgeons on staff by March. They have also hired 23 advanced practice providers to the staff to handle the workload of the departing residents.

There are currently six brain surgeons at UNMH. Dr. Meic Schmidt has been announced as the next chair of neurosurgery. He will start early next year and is bringing with him two brain surgeons. The hospital is also hiring one more neurosurgeon and is finalizing a contract with an outside firm that will provide the hospital with three hospital-based neurosurgeons, Richards said.

He said the hospital will not lose its designation as the state’s only Level 1 Trauma Center, which requires that neurosurgeon services are always available but doesn’t require that the hospital have a neurosurgery training program.

“We remain absolutely committed to being able to provide these essential neurological services to the community,” he said.

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