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Students learn hard lessons about matching in turbulent times

From the May 1999 ACP-ASIM Observer, copyright © 1999 by the American College of Physicians-American Society of Internal Medicine.

On Match day, 24 medical students opened envelopes that revealed they would be residents at Mt. Sinai Medical Center in Cleveland. The only problem was that the hospital had gone bankrupt the preceding day.

As part of its Chapter 11 reorganization, all teaching and residency contracts and affiliations with University Hospitals and Case Western Reserve University School of Medicine will be phased out by June 30.

"No one knows what is going to happen to these kids," said Henry J. Schultz, FACP, president of the Association of Program Directors in Internal Medicine (APDIM). APDIM has urged its members through electronic mailing lists and its Web site to consider these students for any open positions.

Nine of the 24 medical students had matched in Mt. Sinai's internal medicine programs. In addition, 27 second- and third-year internal medicine residents were left high and dry by the news. A spokeswoman for Mt. Sinai said that about half the hospital's residents had found replacement positions by early April.

For medical students trying to choose a training program, these are turbulent times. The situation in Cleveland may be the most dramatic example, but students around the country seem to understand that they need to pay almost as much attention to the economics of training programs they were considering as to their academics.

"I think students are getting more and more sophisticated in trying to gather some information about the stability of the program and the hospital," said Lisa B. Wallenstein, internal medicine chair and program director at Albert Einstein Health Care Network in Philadelphia. During interviews this year, she said, applicants commonly asked about the hospital's finances and the Philadelphia health care marketplace.

"A lot of medical schools around the country have been through some version of a merger or other change," Dr. Wallenstein said. "There's not really a city that has been immune, and the students are aware of what happens when nurses are laid off and beds are closed."

These issues may have contributed to the trouble that some well-regarded internal medicine programs had filling their positions through this year's Match. In Philadelphia, for instance, some Thomas Jefferson University internal medicine faculty speculate that a health system-insurance company dispute that affected business at the residents' clinics this winter may have turned some applicants off from the program. A few slots went unfilled there. The University of Pennsylvania's internal medicine residency program also was unable to fill all its positions through the Match this year, leading some to wonder whether Philadelphia's experience with the bankruptcy of Allegheny Health System made some students wary of moving to the city.

"It doesn't take more than one program a year to close and have the trainees have to scurry to find a position to make people skittish," Dr. Wallenstein said. "It really has to do with perceptions of the marketplace. ... That is just not the kind of a sold foundation that [residency applicants] are looking for."

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