Editor's note: A previous version of this story ran on the Daily Lobo's website. That story was taken down and rewritten for clarity.
The University of New Mexico Hospital (UNMH) neurosurgical residency training program has been canceled due to a lack of mentorship for the residents, according to Executive Vice President and Chancellor for UNM Health Sciences Paul Roth.
Residents are physicians who have finished medical school and are receiving training in a specialized area, such as neurosurgery. They practice medicine under the supervision of a senior physician registered in their specialty.
The UNMH accreditation period officially ends in the summer of 2020. However, six of the eight neurosurgery residents have already left for other hospitals because they're scheduled to finish their seven-year program after the accreditation period ends. Only two will remain at UNMH, as they will be able to finish their program before summer 2020.
A UNMH employee in the department of neurosurgery said the department received notification that they lost their accreditation from the Accreditation Council for Graduate Medical Education (ACGME) in August. The employee requested anonymity citing concerns of retaliation because UNMH employees are required to sign an agreement stating that they will not talk to the media.
"Residents are being forced to leave. The University (UNM, not the hospital) is bound to pay their salary until they graduate — the other schools (that they transfer to will) get free help," the neurosurgery employee said.
Roth, who also serves as the dean of the School of Medicine, held a town hall in September where he addressed how UNMH reached this point.
He said the neurosurgical residency program lost accreditation in part because of "the way in which the residents were being treated — there was inadequate supervision and there was very poor mentoring going on."
A letter from the ACGME Office of Complaints, dated August of 2018, said the program was notified about multiple potential ACGME requirement violations a year before the accreditation was pulled.
A "diminishing caseload resulting in a decline in operative experience" was one of the seven allegations listed in the ACGME letter.
The letter alleged that residents were "consistently taken out of the operating room to perform basic service-related tasks that are typically performed by nurse practitioners and physician assistants" wrote Keisha Billups, the ACGME Office of Complaints Associate.
According to Billups, the complainants alleged the specified tasks were assigned to residents because there was "inadequate non-physician clinical staffing" that was needed to support the program.
"It is alleged that when residents have raised concerns or offered feedback in attempts to improve the program, the program has failed to respond, refused to discuss the concerns or created policies that appear to punish residents," Billups said. "It is also alleged that the department chair often threatens to dismiss residents from the program."
The ACGME letter went on to explain that there was also no "pediatric neurosurgeon, no fellowship-trained spine surgeon and no functional/epilepsy surgeon" on staff to provide the mentorship that the residents needed to become skilled themselves.
According to UNM Health Sciences Center public affairs official Alex Sanchez, the neurosurgical department is already working to resolve these issues. After more than five months without a chair, UNMH announced last week that Dr. Meic Schmidt has accepted UNMH’s offer and will be arriving in four months after he's released from his current contract.
Losing the residency program raised questions about the Level 1 Trauma Center status of the hospital. Level 1 trauma centers provide the highest level of care to acutely injured patients of all ages. New Mexico currently only has one — UNMH.
The next closest Level 1 Trauma Centers are in Lubbock, TX or Flagstaff, AZ — both are approximately 325 miles from Albuquerque or a two and a half-hour helicopter ride away.
According to an email to the Daily Lobo from Dan Hamilton, the public information associate for the American College of Surgeons (ACS) — the group that sets the Trauma Center standards — "neurotrauma care must be continuously available for all TBI (traumatic brain injury) and spinal cord injury patients and must be present and respond within 30 minutes based on institutional-specific criteria."
"Neurosurgical evaluation may be done by a neurosurgery resident at any level or neurosurgery APP (Advanced Practice Provider) as long as the patient was initially evaluated by an EM (Emergency Medicine) physician or trauma surgeon," Hamilton wrote. "There must be documented communication with the attending neurosurgeon."
Hamilton said "many Level I trauma centers do not have or utilize neurosurgical residents in providing coverage" and thus having a residency program is not a requirement for Level 1 Trauma Center status.
However, a UNMH employee in the department of neurosurgery explained that though AAP (Advanced Practice Provider) nurses can, in theory, be scheduled to provide the care that the neurosurgical residents have been providing at UNMH, that option is expensive.
Sanchez, the UNMH public information officer, said, "The Level 1 trauma status is not impacted. There is no requirement to have a residency program for the trauma designation. There is a requirement that you have a neurosurgeon available 24/7. We have that and will continue to have that coverage."
Roth said UNMH will seek re-accreditation "as soon as we possibly can" and explained that they will be conferring with national advisors about whether or not they should attempt to appeal the decision.
"Minimally, if we don’t go forward with an appeal, it might take us 2 or 3 years to regain accreditation," Roth said. He added that they are working with the current faculty so that they will remain in place despite no longer having a training program.
When asked for comment, the New Mexico Governor’s Public Informations Officer Nora Sackett said, "The loss of the neurosurgery residency program accreditation is extremely troubling (to Governor Lujan Grisham)."
Lissa Knudsen is a beat reporter at the Daily Lobo. She can be reached at email@example.com or on Twitter @lissaknudsen
Megan Holmen is the news editor at the Daily Lobo. She can be contacted at firstname.lastname@example.org or on Twitter @megan_holmen