Emergency Medicine Residents Oppose the Sale of Graduate Medical Education Slots

Authors: Dhimitri Nikolla, DO, Hannah R. Hughes, MD MBA, Allison Beaulieu, MD, Haig Aintablian, MD, Nehal Naik, MD


On June 30, 2019, Philadelphia Academic Health System, LLC filed for Chapter 11 bankruptcy, which left 570 residents and fellows in training at Hahnemann University Hospital scrambling for new sites to work and train.1-2,9 On Sept. 5, 2019, the sale of Hahnemann’s Graduate Medical Education (GME) slots for $55 million was approved by U.S. Bankruptcy Judge Kevin Gross despite disapproval by the Centers for Medicare and Medicaid Services (CMS), which considered it illegal.3 After an appeal by CMS, on Sept. 16, 2019, a federal judge temporarily stopped the sale of Hahnemann’s GME slots.4

Having residents and fellows on staff at an institution is a privilege, not a commodity. GME slots are scarce because of the 1997 cap on Medicare support; however, residents and fellows play a critical role in the care of underserved patients.5-8 The care residents and fellows provide is billed for by their institution. However, the primary responsibility of residents and fellows is to train in their chosen specialty to learn to practice independently, not generate revenue. Though GME slots are linked to their institutions and may be transferred in the event of a change in hospital ownership, they are not an asset to be sold. ​

Our organizations oppose the commoditization of GME slots and commend the efforts of CMS to halt the sale of Hahnemann’s residency and fellowship slots.


  1. Closure FAQs for the Community. Hahneman University Hospital. Available at: https://www.hahnemannhospital.com/SitePages/Closure%20FAQs%20for%20the%20Community.aspx. Accessed: November 22, 2019.
  2. Fiore K. Hundreds of Trainees in Limbo as Philadelphia Hospital Closes – 570 residents, fellows scramble to find new jobs. Medpage Today. Available at: https://www.medpagetoday.com/hospitalbasedmedicine/graduatemedicaleducation/81023. Accessed: November 22, 2019.
  3. Brubaker H. Hahnemann residency program sale approved by bankruptcy judge in controversial decision. The Philadelphia Inquirer. Available at: https://www.inquirer.com/business/health/hahnemann-bankruptcy-residency-sale-judge-approves-cms-20190905.html. Accessed: November 22, 2019.
  4. Feldman N. Judge puts freeze on sale of Hahnemann residency program — for now. Whyy.org. Available at: https://whyy.org/articles/judge-puts-freeze-on-sale-of-hahnemann-residency-program-for-now/. Accessed: November 22, 2019.
  5. The Role of GME Funding in Addressing the Physician Shortage. AAMC. Available at: https://www.aamc.org/news-insights/gme. Accessed: December 4, 2019.
  6. Serwint JR, Thoma KA, Dabrow SM, et al. Comparing patients seen in pediatric resident continuity clinics and national ambulatory medical care survey practices: a study from the continuity research network. Pediatrics. 2006;118(3):e849-e858.
  7. Moy E, Valente E Jr, Levin RJ, Griner PF. Academic medical centers and the care of underserved populations. Acad Med. 1996;71(12):1370-1377.
  8. Chen C, Chen F, Mullan F. Teaching health centers: a new paradigm in graduate medical education. Acad Med. 2012;87(12):1752-1756.
  9. Daniels L. A medical resident’s eulogy for Hahnemann Hospital. WHYY.org. Available at: https://whyy.org/articles/a-medical-residents-eulogy-for-hahnemann-hospital/

Approved February 11, 2020.