Hi folks,
This week The Washington Post published a story about the state of the residency programs at Howard University College of Medicine. It seems that every residency program except General Surgery is either on probation or slated to be eliminated. OB-Gyn folded during my third year. I was actually doing my OB-Gyn clerkship when the residency program was cancelled. The first and second year residents had to scramble to find programs for the upcoming year. The third-years were given the option of attending another year but graduating from a program that was not accreditated. Most of the third-year residents opted to leave.
The chairman of the department called my group of students together over lunch and told us about the residency situation. He is a nationally known OB-Gyn who has published many papers and scholarly works. He said that the “politics” of Howard did not allow him to implement many of the changes that he wanted to implement. He had been in the program only nine months before he left. He advised us to thoroughly research the residency programs that we would apply to so that we might have an idea if the programs would exist long enough for us to finish residency.
The Howard Surgery residency program came through the accrediation process with no deficiencies and has received a 5-year approval. They had a 100% rating, the only one in the city! Radiology, emergency medicine, pediatrics and pulmonary medicine are on probation and slated to be closed if changes are not implemented before the next review.
OB-Gyn, and Family Practice have had their accreditation withdrawn but still have residents. All are FMGs who are despirate to stay in this country. ( My very excellent Family Practice preceptor had one of the current OB-Gyn residents rotating with him while I was on his service.) She might have been an MD but he did not allow her to see patients without him being present in the exam room. I saw all of my patients independently and presented them to him. He would either follow up on my suggestions or modify them.
I would invite you all to read the story in Monday’s Post which is on the web at http://www.washingtonpost.com It contains some useful information. While I have the greatest respect and admiration for the Department of Surgery at Howard University College of Medicine because they have strived to present the best teaching and training while fighting the politics, I am very happy to be moving on to another hospital for my residency. UVA also has a 5-year approval and 100% rating. 
Hey Nat,
I read that piece on the Metro and was thinking of you–I'm glad you posted this. It really surprised me to read that there was such a systemic problem at Howard, b/c it seems to me that they've got so much going for them–lots of history, a big city, etc, etc. Reading between the lines of the Post story it seemed like mistreatment of residents was part of the reason that Howard's programs were getting this discipline. Is that true? And more generally, what kind of changes would have allowed them not to have this happen?
cheers
SF/DC Joe
| Quote (joewright @ May 01 2002,12:58) |
| Hey Nat, I read that piece on the Metro and was thinking of you--I'm glad you posted this. It really surprised me to read that there was such a systemic problem at Howard, b/c it seems to me that they've got so much going for them--lots of history, a big city, etc, etc. Reading between the lines of the Post story it seemed like mistreatment of residents was part of the reason that Howard's programs were getting this discipline. Is that true? And more generally, what kind of changes would have allowed them not to have this happen? cheers SF/DC Joe |
Hi there,
Keep in mind that it is not just Howard that is suffering these systemic problems. Yale's Surgery Residency Program is under probation as is the University of Maryland. Hopkin's surgery program was able to get past the probation because of clever reporting. It is a pretty malignant surgical residency program.
What happens is that programs believe that the only way to train residents is to work them into the ground. In peds for example, residents have to see patients in clinic on their day off. If you have to come into the office and see patients, is that a day off? When do the residents have time to read? The answer is that they do not have time to read.
University of Maryland is working to get more help for residents in the form of mid-level practictioners to take cases that don't have much of a teaching value such as appys and gall bladders. The mid-levels will also take care of much of the scut.
University of Virginia has already implemented dedicated conference and teaching times, mid-level practictioners to do scut and total days off. They also added more lounge space and upgraded the call rooms for privacy, quiet and comfort. There is a brand new gym on site and other things that make on-call a little better. If an attending schedules a surgery during conference time, he or she won't have residents to assist. They might get a PA or NP but they won't get a resident. Support services are excellent so you don't have to push patients to radiology or start IVs when you need to be studying.
Resident abuse abounds at locales that tend to hire foreign medical graduates. Many of these people are so bent on getting into this country and the "so-called good life" that they will allow anything to go on. I remember a professor at GW who would make his Chinese graduate students clean his yard and pool. No American graduate student would do this! The same kinds of things happen to foreign medical grads. (The medicine department has no American grads this year at Howard.)
Resident unions help with attempting to eliminate resident abuse. The American Board of Surgery has come down very hard on residency programs that abuse residents. While General Surgery is never going to be a 9-5 specialty, it doesn't have to be abusive. Howard, Mayo and other top programs have eliminated the abuse and sided more on attempting to upgrade teaching and learning.
I put this information out for those who are going into third and fourth year with decisions to be made on choosing good residency programs to apply to. You have to do some solid research beyond what you read on the program website or what you read in US News and World Report.
Does having the residency programs on probation affect the medical school? Not very much because the program of instruction is already set. Howard is still a great place to go to medical school. Other than General Surgery, I am not sure that I would apply there for residency.
Thanks, Nat! Great reading at 2 AM when Emily (our 2 week old daughter) wouldn't go to sleep. I'm thinking these sleepless nights are good prep for med school and residency!
Nat,
Your topic is of specific interest to me, considering I am in the throes of researching this very topic. Is there a database, web site or resource I can tap into to see if the programs I am looking into are on probation or heading that way? Even though you did not mention anesthesia anywhere, I do know that anesthesia is one of the rougher residencies and some of the programs/universities you mentioned are among the anesthesia programs I am researching.
Thanks in advance for your advice!
| Quote (OldManDave @ May 03 2002,10:27) |
| Nat, Your topic is of specific interest to me, considering I am in the throes of researching this very topic. Is there a database, web site or resource I can tap into to see if the programs I am looking into are on probation or heading that way? Even though you did not mention anesthesia anywhere, I do know that anesthesia is one of the rougher residencies and some of the programs/universities you mentioned are among the anesthesia programs I am researching. Thanks in advance for your advice! |
Hey Dave,
The website for the accrediting organization is From there, you can get specific requirements for maintaing proper graduate medical education. There is a list of programs that are on probation. I believe that AMSA has this list but it comes from ACGME (Accreditation Council of Graduate Medical Education). The ACGME webpage was my starting point for choosing residencies to appy to.
Some programs have clever ways of getting past the regulations but you need to clearly know them before you interview. The more you know, the better you can ask questions.
Website is http://www.acgme.org
When you go to the website, look under "Search for accredited programs". The programs are listed by specialty. You will find some basic program requirements, when the next site visit will occur etc. You can also pull down information such as the education requirements for each specialty from other areas on the site. You need to look up this information as you apply for residency. The worst thing that can happen is to have a residency program yanked from under you. Before you apply,visit this website. When you are interviewing, use the information on this website to make sure that you know as much as possible before you rank a program. Ask questions! Department chairs should be able to explain probation status and what they are doing to fix the situation. If not, don't rank that program.
Programs with good "reputations" can end up on probation but reputation alone is not good enough to risk your post-graduate training. You need to look for the words "Continued Full Accreditation" next to your program. If those words are not there, think "Red Flag".
and on another aspect - what are your thoughts about the environment for medical students doing clinical rotations at a school where the residency program in an area is on probation - e.g. if OB/GYN is on probation at Med-U, what would the OB/GYN rotation be like? would it be impacted by the eflux of residents?
should the status of residency programs associated with a medical school be remotely considered in application to that school as a medical student ? I know there is no connection to the quality of yrs 1&2, but what about 3&4 ?
Lisa
| Quote (LisaS @ May 03 2002,16:23) |
| and on another aspect - what are your thoughts about the environment for medical students doing clinical rotations at a school where the residency program in an area is on probation - e.g. if OB/GYN is on probation at Med-U, what would the OB/GYN rotation be like? would it be impacted by the eflux of residents? should the status of residency programs associated with a medical school be remotely considered in application to that school as a medical student ? I know there is no connection to the quality of yrs 1&2, but what about 3&4 ? Lisa |
Hi there,
If your school wants to remain accredited, they arrange for you to do your OB-Gyn rotation elsewhere. In our case, it was at one of the Johns Hopkins affiliated hospitals. We actually turned out to have a better OB-Gyn experience now than when we had the department. That was a result of having a former department chairman who was more interested in making sure the medical students were taken care of even if he couldn't keep the residency program going with all of the in-fighting.
The Yale General Surgery Program is on probation and scheduled to be sacked for next year unless something drastic is done. While the General Surgery Program is having trouble, the medical school is not. I suspect that the leadership of the medical school and surgery will get things fixed so that Yale Surgery will continue.
Howard is taking some drastic measures even now with so many residency programs on probation. I know that they will fix their deficiences since their backs are to the wall. It is just a shame that it had to come to this. Many residency directors just refused to believe that their programs could fold. Time for reality check. With the AMA solidly behind limiting resident hours and cutting back on FMGs in programs, many programs are going to have to put out major money to attract American grads in order to continue.
Hi there,
ACGME (Accreditation Council for Graduate Medical Education) had revoked the accreditation of Howard University’s residency training programs in Pediatrics and Emergency Medicine. The text of the article that appeared in June 15th Washington Post:
2 Howard U. Programs Lose Accreditation
Hospital Appealing Monitoring Agency’s Ruling on Emergency, Pediatric Services
By Avram Goldstein
Washington Post Staff Writer
Saturday, June 15, 2002; Page A08
The agency that supervises the nation’s graduate medical education system has revoked the accreditation of residency programs in emergency medicine and pediatrics at Howard University Hospital.
If the rulings by the Accreditation Council for Graduate Medical Education withstand appeals by Howard, the number of resident physicians treating emergency patients and children at the hospital on Georgia Avenue NW will drop sharply beginning July 1, 2003, and fall to zero a year later.
Hospitals cannot employ residents in unaccredited programs.
Without the 66 residents working in the emergency and pediatric departments, the hospital would have to reorganize and find attending physicians to replace them. Howard has one of the city’s busier emergency rooms.
Officials from the Chicago-based accreditation council said confidentiality rules preclude them from detailing what led to their actions, but they said the revocations could not come without years of warnings.
Howard officials, including university President H. Patrick Swygert, declined to comment. In a written statement issued late yesterday, the hospital said it is appealing the rulings and addressing the accreditors’ criticism.
“We are confident that the accreditation for these programs will be restored,” the unsigned statement said. "Our goal remains the full and unqualified re-accreditation of these programs."
The appeal schedule calls for a February decision.
Residents are new physicians in postgraduate training in their chosen specialties. They generally work long hours treating patients under the supervision of attending physicians.
Hospitals pay residents relatively low salaries – typically $40,000 a year – while collecting millions in special training fees from Medicare and Medicaid.
Accreditation standards cover all aspects of residency training, including teaching methods, working conditions, scrutiny of patient deaths and evaluation of residents.
Howard has 350 residents in 25 specialty training programs, and a disproportionate number of those programs have been flagged by the accreditation council.
In addition to emergency medicine and pediatrics, the council has placed Howard’s anesthesiology, family practice, pathology, radiation oncology and urology departments on probation and given the pulmonary disease program the functional equivalent of probation.
Moreover, Howard’s management of all 25 of its programs has been labeled “unfavorable” by the council – a finding that blocks Howard from launching any new or replacement residency program.
A Howard professor with knowledge of Howard officials’ thinking, who spoke on condition of anonymity, said the university has hired consultants to fix long-standing residency program problems and help pursue the appeals. Officials are preparing for the worst in case the appeals fail, the professor said.
“You’ve got to always have a contingency plan, and they’ve shifted into that mode,” the professor said.
Another Howard professor who spoke on condition of anonymity said the council should not have acted so strongly against the emergency and pediatrics programs because it destabilizes a black medical institution when fewer than 4 percent of the nation’s doctors are black.
Few white physicians show much interest in treating patients in African American neighborhoods, so the action is insensitive, said the second professor, who is black.
David Leach, the council’s executive director, rejected that argument.
“We refuse to accept the idea of lowering standards because they don’t have resources,” Leach said. "The message behind that is that the indigent of this country really don’t deserve first-rate care, so let’s develop two standards."
Newton Osborne, a Howard professor who has worked with or overseen obstetrics and gynecology residency programs at four teaching hospitals, including Howard’s until several years ago, said the fault lies with Howard’s medical chiefs.
“I had personal run-ins with them while I was chairman because I felt they were not doing what they had to do to protect the health and limb of the patients,” he said. "Whenever I sent reports about things that were poorly managed, they would sit there for months and years."
Osborne said Howard’s leaders assumed that they were immune from council discipline by virtue of the facility being one of only three predominantly black teaching hospitals in the nation.
"I guess the position of the other people is, ‘If [the leaders] are not worried, why should we be?’ " Osborne said.
© 2002 The Washington Post Company
It is a pretty scary situation for some of my classmates who have matched into these programs because they might have to find other residency training programs. As I have said in previous posts, the medical school and the medical student teaching programs are not affected by this ruling, just the residency programs. Some residency programs such as General Surgery have received no deficiencies and are fully accredited for the next 5 years. Surgery has even added more teaching attendings who are really top notch. Still it is disheartening that this ruling has to take place but there are some serious management problems with the Hospital that need to be addressed. It may take this kind of ruling for those problems to be addressed.
"Another Howard professor who spoke on condition of anonymity said the council should not have acted so strongly against the emergency and pediatrics programs because it destabilizes a black medical institution when fewer than 4 percent of the nation’s doctors are black.
Few white physicians show much interest in treating patients in African American neighborhoods, so the action is insensitive, said the second professor, who is black."
What kind of crap is this? I thought “separate but equal” was inherently unequal according to the US Supreme Court.
Unless they have specific and compelling evidence, throwing the race card out on the table and implying discrimination just made me lose all respect for the anonymous professor. If the prevailing attitude is like his/hers, its no wonder they are having problems with residencies there.
| Quote (MD/PhD slave @ July 23 2002 10:02 am) |
| "Another Howard professor who spoke on condition of anonymity said the council should not have acted so strongly against the emergency and pediatrics programs because it destabilizes a black medical institution when fewer than 4 percent of the nation's doctors are black. Few white physicians show much interest in treating patients in African American neighborhoods, so the action is insensitive, said the second professor, who is black." What kind of crap is this? I thought "separate but equal" was inherently unequal according to the US Supreme Court. Unless they have specific and compelling evidence, throwing the race card out on the table and implying discrimination just made me lose all respect for the anonymous professor. If the prevailing attitude is like his/hers, its no wonder they are having problems with residencies there. |
Hello there,
It is very interesting that you perceived one quote from an anonymous professor quoted in newspaper article as the "prevailing attitude" at Howard. As a graduate of that medical school and having completed clinical rotation in pediatics, radiology and emergency medicine (the departments that are on probation and slated for closure) I would say that the "prevailing attitude" is to get the management of the hospital sensitive to the needs of physicians in training so that residency programs may not be lost. Last year, over 500 people submitted applications to the emergency medicine program for 5 slots. Every slot at Howard filled in the match. Last year, every graduate of the E-medicine residency had no less than 20 job offers. If the training and teaching were so poor, why would people be seeking slots there? Why would graduates the program have so many job offers?
The rebuttal of this one professor's comment was well stated in the article and sums up the "prevailing attude" of the departments in question and the Howard University College of Medicine. The problems need to be addressed and are serious. Howard is a strong institution with very talented clinicians and professors. They will get through this crisis just as they have stood for 140 years and excelled.
Would I apply to and attend Howard University College of Medicine today? Yes and I am very proud to counted among the alumni of this medical college along with the likes of Edward Cornwell, III, Chairman of Trauma Surgery at Johns Hopkins University and Avram Cooperman, world renowned Pancreatic and Hepatobiliary surgeon and editor of Surgical Clinics of North America. It may fall to us, the alumni, to make sure that Howard gets these departments back on track and that the residency programs remain as strong as General Surgery. We are more than equal to the task and are providing input and support for the people who are working on this situation.
njb,
please read my post again. I said "IF the prevailing attitude is like his/hers…"
I have no knowledge of Howard’s med school or residency programs. I was talking specifically about the comments of the anonymous professor.
My interpretation of the remarks by the anonomous professor was different than yours, MD/PhD.
"…the council should not have acted so strongly against the (ER) and (peds) programs because it destabilizes a black medical institution when fewer than 4 percent of the nation’s doctors are black."
The action was “insensitive” because "…few white physicians show interest in treating patients in African American neighborhoods."
So, nowhere is the suggestion - or the implication - that the rulings were the result of discrimination.
What he is saying is that important and compelling reasons exist to look to assure the success of black institutions of medical training and care.
As one reason, he directly cites the provision of patient care to underserved populations. Then, in characterizing injury to programs designed in part to increase numbers of black physicians as a bad thing, he indirectly refers to a second reason: the continuation of efforts aimed at compensating for ongoing societal and cultural barriers to minority acheivement in this country.
In other words, this didn’t happen to Howard because it is a Black institution. Rather - because Howard is a Black institution - additional critical objectives are being fulfilled, which demands that extra consideration be given before implementation of actions which might threaten their existence.
I, for one, would have no qualms in hoping that this did indeed represent the ‘prevailing attitude’ of my institution, and would stand in full support of a faculty member making such a statement.
And as Natalie wisely points out, working toward administrative recognition of “…the needs of physicians in training so that residency programs not be lost…” absolutely MUST BE the important shared goal of everyone involved: hospital administration, faculty, students, residents, AND the ACGME.
Cheers!
I don’t think “insensitive” was a jusidicious use of the word. He is right when he says it hurts inner city health care situations, but they weren’t targeting Howard Med because it serves a predominantly black population. They got it because the admin situation stinks and needs to be revamped.
It will now that people have been put on notice.
the implication however, is that there should be “separate but equal” standards for Howard vs other schools. The people at Howard didnt believe in “separate but equal” standards in the 1950s… why do they believe in it now?
Howard is a unique place, I just dont feel that their best interests are served by lowering their standards for residency accreditation, and playing by a different set of rules than those that exist for other institutions.
Hmmm…
I guess I just don’t perceive any concept of ‘separate but equal’ being asked for or applied here. If anything, this guy seems to be saying, let’s NOT do things equal this time gang, but for very compelling reasons.
It’s done all the time.
Mr. Stockbroker breaks federal law and robs people of huge amounts of personal worth. BUT he’s supporting his family, is an active member of the community, yada yada, …so we’ll give him probation instead of jailtime.
Coach Football is caught red-handed in violation of recruitment rules, BUT he’s got a winning team, brings in huge dollars for the university, yada yada, …so let’s fine him some nominal amount of cash, let him keep coaching and finish out the season.
Mr. Upstanding Citizen’s son is caught breaking and entering…we won’t charge him this time, Sir.
Father Priest is caught - numerous times - molesting children…transfer him to a new district, please.
Giving offenders a break because of the belief that irreparable harm might result, and that the person, department, institution or situation are otherwise salvagable and have important contributions to offer, is by all means not a new concept. It’s just never been equally applied in this country.
An important point here is, as Natalie pointed out, that Howard is accomplishing exemplary work in physician training. The ACGME violations resulting in probation are violations of new mandates regarding resident work hours. VERY few programs are in compliance with these mandates as of yet. Mine certainly isn’t.
Regards!
So you dont see any downside at all to having different standards for each institution? The ACGME would be worthless.
I don’t see the ACGME putting my program on probation, probably in part because of the national shortage of surgeons. The ACGME routinely uses discretion in implementation of its corrective measures. This should be no exception.
It would be short-sighted and detrimental to eliminate public health programs which are fundementally useful, unless the violations are egregious in nature and override the good work being realized by keeping the program in place.
The answer is to find working solutions. A heavy-handed approach is one way of realizing the goal of compliance with ACGME mandates. This professor is - wisely - urging caution so that meaningful work and outcomes are not lost in the effort to rapidly effect change in one small area of resident training.
Hi folks,
Some of the Howard residency programs are on probation because of poor management resulting in problems that are affecting the training of residents in those programs. University of Maryland’s General Surgery program is on probation for too many resident working hours. Yale’s General Surgery department has lost accreditation for the same reason that some of Howard’s residency programs are on probation, i.e. poor management.
Howard’s Internal Medicine, Psychiatry, General Surgery, Neurology, Cardiology, Rheumatology, Physical Medicine & Rehab, Endocrinology, Hematology and Nephrology Departments are not on probation and are nationally ranked. These departments are excellently managed and are very competitive in terms of applications and appliants to post-graduate training there.
I don’t think that probation status for those programs at Howard had anything to do with racial discrimination and I know that the new residency director for Emergency Medicine is setting some pretty high standards for getting his department off probation. He doesn’t see anything “racial” about getting the hospital to provide what his residents need in terms of educational opportunities.
President Swygert is not a novice nor a “lightweight” when it comes to the running of a University. He has made Howard into a mecca for academic excellence. I have complete confidence that these residency programs will not be scrapped especially Emergency Medicine.
I was the original poster of the newspaper article because I knew that some folks need to be aware of the probationary status of residency programs before they apply; just as I was aware of these matters when I was interviewing for residency. It is very sad for those folks who entered the departments at Howard, Yale and University of Maryland because you have no assurance that your residency department will be there as you go through your training.
As I stated in previous posts, the state of residencies does not affect the education of medical students. Howard University College of Medicine just came through LCME examination with flying colors and is fully accreditated.