Hahnemann/Drexel Radiation Oncology

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Does anyone know anything about the Drexel/Hahnemann Radiation Oncology program, and whether or not it lost its accreditation. What does this mean for the program?
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Seldon1985 said:
You can go to the ACGME Public website to see info about specific programs:

https://www.acgme.org/ads/Public/Pr...rams/Search?stateId=39&specialtyId=98&orgCode

I don't know what this means exactly, but under accreditation status, it says: Accreditation Withdrawn
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It means exactly what it says. Drexel has lost its acgme accreditation. Not sure how that affects current and future matched residents to that program but given that the effective date is end of June 2014, that probably means this and next year's class will complete while everyone else will need to figure things out fast. This probably isn't coming as a shocker as I think they've been on probation the last few years

Obviously, no one should be matching there this year ;)
 
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medgator said:
It means exactly what it says. Drexel has lost its acgme accreditation. Not sure how that affects current and future matched residents to that program but given that the effective date is end of June 2014, that probably means this and next year's class will complete while everyone else will need to figure things out fast. This probably isn't coming as a shocker as I think they've been on probation the last few years

Obviously, no one should be matching there this year ;)
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Bummer, was hoping thats not what it was.
 
wagy27 said:
ND, as an alumni, any info, is this a temporary hiccup, or are they shutting things down for good?
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It's hard to say. I know Dr. Brady and the current chair are fighting this with big law guns, but difficult to predict if they will be victorious over the ACGME.

Very sad. Hahnemann is one of the oldest radonc programs in the country. Rich in history and has produced many leaders in the field. Very clinically strong program and, despite the obstacles in past years, recent grads have all obtained great jobs. Despite not being a "top" program, 75% of grads in the last 4 years have gone into academics. The tutelage of Luther Brady has been a strong bonus of the program. While it's certainly not a research powerhouse, I would put the clinical experience toe to toe with any program in the country with a good mix of 50% of time spent at the academic site (Hahnemann) and the other 50% at a very busy private hospital (Abington..which also is a teaching hospital, but more of a community setting).

There were two main reasons for the probation status: 1) not enough linacs at the primary site (requirement of two and Hahnemann only has one) and 2) not enough faculty at the primary site (requirement is four, they only have 3).

The program is unique in that residents are spread among two teaching hospitals. Typically there are 2 residents at Hahnemann and 2 up at Abington with the 5th resident either on electives or research. There are plenty of attendings between the two hospitals, but there are not four attendings at one hospital. Abington has 3 linacs, Hahnemann only one. So a couple of years ago Abington was made the "primary site" in order to satisfy the linac requirement. However, the 4 faculty at one site requirement..which is an arbitrary rule plucked out of the sky IMO..has not been able to be satisfied because the numbers don't require a fourth faculty at Abington nor at Hahnemann.

Anyway, kind of a shame in my opinion that nitpicky rules like this can shut a program down when they have no bearing on the overall quality of the residency training.
 
lazers said:
I (and the ACGME) don't understand why a program would start a residency when they can't even have 4 attendings at their primary site. In my opinion 4 or 5 attendings is not enough to start a training program. This is a word of caution to all medical students looking into applying to programs with only 4 attendings at their primary site. If only one attending leaves their program can be put on probation or be shut down.
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He did say it was one of the oldest programs - presumably they had more attendings when it was started. Anyhow, if there are only 2 residents at that site at a given time, 3 attendings should be enough. The ACGME could view it as a slippery slope, opening the door for other programs to hang onto their residencies with minimal equipment and staff, potentially compromising education.
 
lazers said:
I (and the ACGME) don't understand why a program would start a residency when they can't even have 4 attendings at their primary site. In my opinion 4 or 5 attendings is not enough to start a training program. This is a word of caution to all medical students looking into applying to programs with only 4 attendings at their primary site. If only one attending leaves their program can be put on probation or be shut down.
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In smaller community/academic programs this is not uncommon and imo speaks nothing for the training experience. Residents often travel to the same outside site as their attending and this a setup often seen in private practice where you see patients at multiple sites.

Theoretically, there would be 4 attendings at the primary site but not all attendings are there all days
 
Do all 4 attendings need to be at the site as their primary site? For instance, could it be possible to have one of the Drexel attendings spend a half day in clinic at Abington, making it technically 4 attendings?
 
lazers said:
I believe the bigger problem is that you need more than 4 or 5 attendings to train under. You learn specific skills from each and that number is too few.
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Interesting view. I tend to think your most valuable education comes not from your attending, but from your patients that you see and what you put into each patient encounter. How hard you work, how much you read, etc.

I won't argue that a large program with thriving didactics, etc makes it easier to obtain clinical knowledge. But it does not guarantee it. We've all encountered physicians who trained with the best and brightest yet lack the clinical acumen to effectively treat a T1 prostate. We've all also probably encountered docs who trained at mid or lower tier programs who rise as superstars in the field.

At the end of the day, of course you should match at the best program possible. But everyone has their own definition of what kind of program would be best for them. Your definition would mean that 20 or 30 programs in the country are I'll-equipped to train residents effecitively and I'm willing to bet that folks who trained at smaller programs would disagree with that assertion. Big programs certainly have their benefits. But so do small ones, just different virtues IMO.
 
lazers said:
I (and the ACGME) don't understand why a program would start a residency when they can't even have 4 attendings at their primary site. In my opinion 4 or 5 attendings is not enough to start a training program. This is a word of caution to all medical students looking into applying to programs with only 4 attendings at their primary site. If only one attending leaves their program can be put on probation or be shut down.
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As a side note, these rules about number of faculty and number of linacs were established in 2009..thereafter Drexel was placed on probation because we happened to have a site visit that year. It had been a successful program for decades prior to that, albeit a small program. The "primary site," is just ACGME lingo on paper. Many programs rotate residents through multiple locations. In Drexel's case, there just aren't 4 at any one site. But plenty throughout the system and more clinical diversity than a lot of programs. I saw quite a few T20 head and neck and GYN cases at Hahnemann, then the typical T1 breast service at our community location. One downside to some of the top programs is you often don't get that kind if experience. Some of the cases I saw you would think you were in an underdeveloped country or something. And lots of hands-on experience. We were the ones doing the procedures, etc.

Anyway, I can't defend my program very well as its being shut down. But like I said, I think it's a real shame.
 
I also think 4+ full-time attendings at a primary site is a very reasonable minimum. There's a reason we train under "professors." These docs teaching residents aren't supposed to be merely sufficient as generalists. You need to have enough attendings for at least a moderate degree of specialization to support adequate education. There will be variable quality within attendings at any program, but you wanna train somewhere that has staff docs that are viewed at least by their institutional colleagues as site-specific experts.
This is true in any field. I look at our radiology colleagues. They do rotations in breast, neuro, ENT, body, interventional, ultrasound, MSK, etc under attendings who only specialize in these areas, despite the fact most of the grads do private practice. You wanna learn from specialists in order to ultimately be a good generalist.
 
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Whatever the rules, I do feel bad for the current and future residents. I can't imagine how stressful it is for them. The good news is that there are quite a few other programs in Philadelphia that may be able to get a temporary increase in the number of residents (Penn, Jefferson, Fox Chase).

On another note, there has been a serious increase in the number of residency spots due to new programs being opened-- maybe shutting down some programs will keep the number of residency spots stable.
 
wagy27 said:
Agreed, I think its a big problem moving forward. Problem is that the people with power to control this are the same ones that benefit from full time resident coverage.
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What will it take to change this? As someone who may enter the workforce in this field in the next 7ish years I have to say that it worries me that it could become oversaturated. I know this is happening in other fields of medicine, but how can leadership be convinced to stop allowing the continued expansion of residency slots?
 
lazers said:
The problem is that theyre a source for cheap labor and the ACGME doesnt see the plight of future grads having a hard time finding jobs.
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I've spoken with one of the higher-ups in the ABR a couple of years ago about this exact point. They essentially cannot look at job market/outlook when decided on expanding, contracting, or opening up new programs. It's supposed to be an objective decision based upon the program's application and the ABR guidelines. Another terrible case in point here is what has happened to the field of Nuclear Medicine. Also run by the ABR, Nuc Meds have a terrible job outlook and many try to get into other residencies after Nuc Meds residency. Still, you have some programs that continue to expand despite such a poor jobs outlook because on paper, that residency program could adequately "train" more residents. One thought is that the Feds allow us to police our own field in terms of the number of training spots available. in turn however, they don't want us to limit those spots so much that we can demand much higher prices and longer wait times due to the small number of practitioners (for us, its always better to be on the higher demand and lower supply end of the curve). However, blindly adding new programs/spots with just enough faculty or a limited breadth of cases in-house, I hope, isn't the answer...
 
BraggPeak said:
On another note, there has been a serious increase in the number of residency spots due to new programs being opened-- maybe shutting down some programs will keep the number of residency spots stable.
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sobored said:
I know this is happening in other fields of medicine, but how can leadership be convinced to stop allowing the continued expansion of residency slots?
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The problem is, you have a recent study like this:

http://jco.ascopubs.org/content/early/2010/10/27/JCO.2010.31.2520.abstract

with people forgetting about the actual hard data from not even a couple of decades ago....

http://www.redjournal.org/article/S0360-3016(98)00476-3/abstract
 
medgator said:
The problem is, you have a recent study like this:

http://jco.ascopubs.org/content/early/2010/10/27/JCO.2010.31.2520.abstract

with people forgetting about the actual hard data from not even a couple of decades ago....

http://www.redjournal.org/article/S0360-3016(98)00476-3/abstract
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"Upon graduation, a significant number of residents and fellows were either unemployed or involuntarily underemployed" (second paper).

I don't know how you reconcile this finding with the JCO paper findings. I guess it all comes down to geographic preference being the limiting factor - apparently most of the people who couldn't find jobs (back in 1995) were looking only in specific areas.
 
Disagree completely with the ACGME.
Why 4? Why not 6? Why not 3?

If the guys and gals at MCP/Drexel were passing their boards and not harming people, why the arbitrary number?

The absolute smartest person in medicine that I know, and possibly the most broadly knowledgeable in our field, graduated from this program. The medical oncologists asked him about the most recent chemo literature. The surgeons defer to him when considering other options.

If a resident were to train only under his tutelage with no other attendings, they would be one of the top graduating residents in the country. I have no doubt. Not that they would be have a broad understanding of how people practice, but they'd know how to practice radiation oncology with evidence and competence. He would demand to eat their tortilla chips when at chipotle, but that is neither here nor there.

Let's not confuse quality with quantity. The ACGME is just another overly regulating, underly functional body that does nothing to improve the care of patients, and does everything to make people want to quit academic medicine.

If this number is so optimal, someone please show me that Drexel (which has been operating at low capacity for a while now) has lousy resident outcomes? This field drives me nuts.
 
It's so true that self motivation is much more important in training than equipment/professors. However, Hahnemann University Hospital did not have a RadOnc Department that one could say was adequate by today's standards.
It's a terrible sitiuation for their current 4 residents who are really nice people. Wish them the best of luck in securing a spot.
 
seper said:
It's so true that self motivation is much more important in training than equipment/professors. However, Hahnemann University Hospital did not have a RadOnc Department that one could say was adequate by today's standards.
It's a terrible sitiuation for their current 4 residents who are really nice people. Wish them the best of luck in securing a spot.
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Hmm. There are actually five residents, not four. And yes, they are all excellent people.

I don't know what you mean by "today's standards." Hahnemann certainly was not drowning in technology, but provided excellent clinical training. So we only had one Siemens linac and an HDR afterloader. But I'll guarantee we performed more GYN brachy than most. We took care of the all the uninsured pediatric patients who were refused the fancy technology on the other side of town..if anyone was on the aircraft carrier in San Diego (ASTRO), they heard me go off on this in front of a couple thousand proton party attenders about my 18 month old with no insurance with bilateral Rb and I called every proton center in the country, none would take her.

So yah, we had inferior technology, but I'll guaran-damn-tee you we saw cases that most residents at top programs never see. That patient with the neglected breast or H&N cancer for a couple years doesn't fit the right profile for most top centers..but I'll argue makes for pretty good clinical education, and that was our norm at the downtown site. Did we have morning conference everyday and excellent faculty-led didactics on a regular basis? No. But outside of the top tier bubble..that experience is actually kind of rare IMO. I think the bulk of residents out there have a daily experience similar to what I experienced - show up for work, take care of really sick people, go home and try to cram some useful information about tomorrow's patients into your tired brain. Suffer through radbio and physics weekly lectures. Prepare for resident-led didactics. This board is littered with folks with an experience more akin to that of a larger program with unlimited resources, so I understand it colors your thinking and your comments.

However, small programs like Drexel make up about a third or more of all radonc residency programs. I am an attending at an academic program now that is actually smaller than Drexel was overall but provides excellent training to 4 residents. The Chief resident before me at Drexel is on staff at a top ten program and the Chief resident before that is on staff also at a large academic program. My co-resident (who founded one of the largest nonprofits in radiation oncology as a resident) obtained one of the more sought-after private practice gigs that was available. If our training was inferior by any standard, I guess it did not shine through in the job hunting process or in the board examination process (so far anyway..to be continued in less than 2 weeks!).

As to securing spots, the current residents actually could not be in a better position if the program does end up closing. They will have a funded spot and the ACGME will allow programs to absorb them above and beyond their approved number of residents, making them an attractive commodity.

Anyway, enough from me.
 
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Point taken. I didn't mean to suggest that top programs never see those types of patients..but that if you compare a day in the clinic at Hahnemann to a day somewhere else, well, it's certainly overall a different experience. I'm not saying better..just defending that the clinical training was certainly not inferior in my opinion to anywhere else.
 
I just wanted to reply to this post and even created an SDN account to do so... Congratulations - you made me sign up to another social network...

As the chief resident at Drexel/Hahnemann, I'm surprised by some comments. Everyone is entitled to an opinion, and this is probably the forum to do that.

Having said that, I would like to caution people from making assumptions about OUR program without having any idea about OUR program. Having a single citation doesn't make for a bad program - and in my mind, it certainly is no grounds for closure. I would challenge anyone whose residency program is flawless to throw the first stone.

As for myself, I'm proud to be a Hahnemann/Drexel grad with a great job lined up (actually I had my job lined up for nearly a year now - signed on July 2nd, 2012). The faculty has been very supportive of everyone here, and it is the reason why graduates from Drexel/Hahnemann have a superb alumni satisfaction, and continue to go on to do great things.

I will see you all around - and if you ask me to defend MY program, I'll do that any day of the week...
 
iamradonc said:
I just wanted to reply to this post and even created an SDN account to do so... Congratulations - you made me sign up to another social network...

As the chief resident at Drexel/Hahnemann, I'm surprised by some comments. Everyone is entitled to an opinion, and this is probably the forum to do that.

Having said that, I would like to caution people from making assumptions about OUR program without having any idea about OUR program. Having a single citation doesn't make for a bad program - and in my mind, it certainly is no grounds for closure. I would challenge anyone whose residency program is flawless to throw the first stone.

As for myself, I'm proud to be a Hahnemann/Drexel grad with a great job lined up (actually I had my job lined up for nearly a year now - signed on July 2nd, 2012). The faculty has been very supportive of everyone here, and it is the reason why graduates from Drexel/Hahnemann have a superb alumni satisfaction, and continue to go on to do great things.

I will see you all around - and if you ask me to defend MY program, I'll do that any day of the week...
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:thumbup::thumbup::thumbup:
 
iamradonc said:
Having said that, I would like to caution people from making assumptions about OUR program without having any idea about OUR program. Having a single citation doesn't make for a bad program - and in my mind, it certainly is no grounds for closure. I would challenge anyone whose residency program is flawless to throw the first stone. .
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Per the link in the second post of this thread,drexel has been on probationary status since 10/2008. That's all related to that single citation?
 
iamradonc said:
As the chief resident at Drexel/Hahnemann

I will see you all around - and if you ask me to defend MY program, I'll do that any day of the week...
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Great! Could you please answer the op's question?

Random Gamma said:
Does anyone know anything about the Drexel/Hahnemann Radiation Oncology program, and whether or not it lost its accreditation. What does this mean for the program?
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medgator said:
Per the link in the second post of this thread,drexel has been on probationary status since 10/2008. That's all related to that single citation?
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The closure of the program is indeed due to the single citation related to the required 4 faculty at one site issue. In 2008 there was also a citation for only 1 linac at the primary site (a new requirement). The machine issue was addressed by changing the "primary site" to Abington Hospital, where residents were already spending 50% of their training anyway...this was a change on paper essentially with zero change to the program itself and only done because Abington has 3 linacs and HUH only one. The ACGME was happy with that. Again, illustrating how completely stupid some of these requirements are for smaller programs. One little tweak on paper and you go from a citation worthy of closure to completely within the realm of acceptability.

However, in the end, the faculty issue is the one citation that the program has not been able to address. Neither of those hospitals require 4 faculty. There are 6 clinical faculty throughout the system that residents rotate with, always in a 1:1 ratio..there just aren't 4 at the primary site.
 
I think most people here are convinced that your program seems to train superb clinicians. The problem with lowering some of these requirements is that they may be a couple of dozen places with minimal infrastructure and personnel who might apply for opening a residency program. They can't technically be denied if they meet all their requirements and we will have proliferation of sub-par programs. While I agree that the metric that matters the most is clinical training, we have to have some reasonable requirements and we can't have requirements changed on a case-by-case basis. Unfortunately, while it may hurt one good program, it may end up protecting trainees from many mediocre programs. If Abington has 3 linacs, isn't there enough volume to support 4 faculty members there?
 
beemer said:
I think most people here are convinced that your program seems to train superb clinicians. The problem with lowering some of these requirements is that they may be a couple of dozen places with minimal infrastructure and personnel who might apply for opening a residency program. They can't technically be denied if they meet all their requirements and we will have proliferation of sub-par programs. While I agree that the metric that matters the most is clinical training, we have to have some reasonable requirements and we can't have requirements changed on a case-by-case basis. Unfortunately, while it may hurt one good program, it may end up protecting trainees from many mediocre programs. If Abington has 3 linacs, isn't there enough volume to support 4 faculty members there?
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I totally agree with you and think these are reasonable metrics going forward. But to apply them retrospectively to a program that has been in successful operation for over 4 decades, well, that's where I part ways with the ACGME. I think that our program should have been grandfathered..but have no problem establishing certain metrics like this going forward.

As for Abington..it's a very busy private practice. It's a community hospital with many residency programs, but the Abington practice itself is private practice, so adding faculty is up to their group of 3. They routinely have at least 70+ patients under treatment. So yes, if it was a strictly academic place it probably would have 4 or more faculty, but I don't see them moving in that direction personally. So it likely will be the dagger in the heart unless the ACGME stance softens (also doubtful).
 
napoleondynamite said:
I totally agree with you and think these are reasonable metrics going forward. But to apply them retrospectively to a program that has been in successful operation for over 4 decades, well, that's where I part ways with the ACGME. I think that our program should have been grandfathered..but have no problem establishing certain metrics like this going forward.
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I think a danger there would be if programs that were in their prime at one point start to peter out, the "grandfathering" might allow things to get much worse without any type of intervention.

Perhaps a better methodology would be the look at things in a "gestalt" kind of way. Instead of having a single requirement, have a checklist/point system where clinical load, variety of cases and overall faculty:resident ratio also play a role rather than hanging the decision to close a program on a single metric.
 
If this job posting from today (5/31) is any indication, Drexel may be planning to continue to fight to maintain their program.

http://careers.astro.org/jobs/5445021

Interestingly, under the "Notes" section of the posting, "education of residents" is listed as an area of responsibility.
 
laserbeams said:
If this job posting from today (5/31) is any indication, Drexel may be planning to continue to fight to maintain their program.

http://careers.astro.org/jobs/5445021

Interestingly, under the "Notes" section of the posting, "education of residents" is listed as an area of responsibility.
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I hope theyve released their residents because it is almost June and if this program hasnt released their residents these folks wont have a job come July.
 
With so many programs opening up I'm kind of glad the ACGME is closing the crappy ones personally. Why would we want colleagues out there treating people who obviously won't know what they are doing because they trained somewhere that couldn't meet bare minimum standards. Seems like a no brainer to me. :rolleyes:
 
radoncdreamer said:
With so many programs opening up I'm kind of glad the ACGME is closing the crappy ones personally. Why would we want colleagues out there treating people who obviously won't know what they are doing because they trained somewhere that couldn't meet bare minimum standards. Seems like a no brainer to me. :rolleyes:
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Thank you for joining this site so that you could post this invaluable contribution. Your posting not only provides deep insight, but evidence of a keen understanding of the issues at Drexel. I assume you are an 'insider' with the ACGME and covertly peppering us with this information.
 
radoncdreamer said:
With so many programs opening up I'm kind of glad the ACGME is closing the crappy ones personally. Why would we want colleagues out there treating people who obviously won't know what they are doing because they trained somewhere that couldn't meet bare minimum standards. Seems like a no brainer to me. :rolleyes:
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radiaterMike said:
Thank you for joining this site so that you could post this invaluable contribution. Your posting not only provides deep insight, but evidence of a keen understanding of the issues at Drexel. I assume you are an 'insider' with the ACGME and covertly peppering us with this information.
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LOL. And stop wasting good usernames. Grow some cojones and post with your own ID.
 
Yeah what's the angle with this place
 
News! Nice, Christiana is a great RadOnc Department.
 
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