A Cautionary Tale: The 2019 Orphaning of Hahnemann's Graduate Medical Trainees.

Hahnemann University Hospital provided care for Philadelphians starting in 1848, but its recent history has been riddled with financial turmoil that culminated in its rapid closure in summer 2019. As the hospital shuttered its doors to patients, it also orphaned 583 medical trainees. This crisis exposed vulnerabilities in graduate medical education (GME). In a firsthand account of the situation that developed in Philadelphia and reached academic institutions across the country, the authors reflect on lessons learned that may help leaders at other institutions mitigate the inevitable difficulties that arise when academic hospitals close. These lessons pertain to handling panic and administrative burdens in the aftermath of closure, the importance of well-defined processes, a clear understanding of GME funding, and strategies for placement of trainees that minimize disruption of their education.

Common Complaints of the Hands and Feet.

Primary care providers frequently care for complaints of the hands and feet. Here, the author describes the typical presentations of hand osteoarthritis, carpal tunnel syndrome, ganglion cysts, plantar fasciitis, onychomycosis, and Morton neuroma. Useful physical examination techniques are described. The history and physical examination are usually sufficient to diagnose these conditions without the need for more advanced testing. All of these conditions have evidence-based therapy that can be initiated by the primary care provider. These treatments as well as reasons to refer to a specialist are reviewed.

The Graduate Medical Education (GME) Gold Rush: GME Slots and Funding as a Financial Asset.

The unprecedented displacement of more than 550 trainees that occurred because of the closure of Hahnemann University Hospital has demonstrated that the medical education community, Centers for Medicare and Medicaid Services, and the Accreditation Council for Graduate Medical Education were unprepared for a graduate medical education (GME) crisis of this scale. The authors offer a first-hand perspective of the chaotic environment that ensued following the announcement of the hospital's closure and of the challenges faced by trainees and program leadership looking to ensure trainees found a landing program that was a good fit for them. The authors review the complexity of GME funding and how the owners of Hahnemann University Hospital leveraged this in an attempt to offset debt. The lessons learned from the authors' experience can help inform the medical education community's response to this type of crisis in the future.