'Homeless' Medical Residents Stranded After Program Loses Accreditation

Kathleen Doheny

April 23, 2021

Joel Pellot, MD, had never set up a GoFundMe campaign until this week. But when he learned that the neurosurgery residency program at the University of Puerto Rico was losing its accreditation, he knew that his fellow residents would need financial help to relocate to another program.

Pellot, who is finishing his sixth year of the 7-year residency program, is safe. He will graduate in June 2022, just as the accreditation status expires. But 10 of his colleagues will need to find other training programs and transfer to them in order to finish.

"These guys are part of my family," he says, citing the long hours spent together at the medical center.

Pellot set a goal of $42,000, which he has nearly reached. Donations have ranged from $5 to $2500. The funds won't cover all the relocation expenses, by a long shot, he says. Expenses will vary among the residents, depending on the distance to their new location and other factors. He hopes his campaign will help relieve some of their hardship.

In the longer term, Pellot fears that the loss of accreditation won't just upend the lives of the displaced residents. He says the lack of a training program could leave Puerto Rico with a shortage of physicians trained in neurosurgery.

"It is the only neurosurgery residency in Puerto Rico," he said. Neurosurgery requires the longest residency training of all medical or surgical specialties.

"On a daily basis, we usually have 30 or 40 consults," Pellot said. "Maybe we operate on three to five. It's a really busy service. When the other residents are gone, this is going to be a challenge," he says.

The ACGME Decision

According to the Accreditation Council for Graduate Medical Education (ACGME), the nonprofit body that evaluates and accredits medical residency programs, the Puerto Rico program had been continually accredited for years, but it was put on probation from 2018 to 2020. Now the ACGME has decided to withdraw accreditation, effective June 30, 2022.

"The ACGME, per policy, does not share information about accreditation decisions except between accredited programs and institutions," said Susan White, an ACGME spokesperson. Programs are free to share the information, she added.

According to Pellot, the program "made the changes the ACGME was requiring." It was hoped that full accreditation would have been restored by now. The ACGME ''usually gives a 2- to 3-year period so the program can upgrade and change what they require for accreditation [to be restored]," he said.

The official report from the ACGME is not yet available, Pellot said. He cited a lack of resources for the program, such as salaries for support staff, as a problem.

In a tweet posted April 20, the Financial Oversight and Management Board for Puerto Rico, which works to create economic growth and provide opportunity, called the loss of accreditation unacceptable. It stated that the board fully funded the Puerto Rico Medical Services Administration and approved requested funds, including $8 million for neurologic equipment and other needs. It called for a full analysis of the situation.

According to the American Association of Neurological Surgeons, the community of neurosurgeons is relatively small. About 3500 board-certified neurosurgeons practice in the United States. In 2018, 110 ACGME-accredited neurosurgery residency programs offered 225 positions. Residents are trained in all types of neurosurgery, including neurocritical care. After residency, physicians can receive further training in other areas, such as pediatric neurosurgery, spine, pain, neuro-oncology, or trauma, among others.

The administrators of the Puerto Rico program did not respond to requests for comment. However, the university's website notes that its Division of Neurological Surgery was started more than 30 years ago. It is the only neurosurgical academic provider in Puerto Rico. More than 1400 open procedures are performed each year.

As for Pellot, once he finishes residency training, he hopes to complete a fellowship elsewhere and then return to Puerto Rico, his birthplace, to practice.

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