Hurricane Katrina puts fate of residents in question

Radiology departments around the country are ready and willing to take in residents and fellows displaced by Hurricane Katrina. As the flood waters recede, however, it seems that residency programs in the New Orleans area will remain intact in some form.

Three teaching hospitals affected by Katrina - the Ochsner Clinic Foundation, Tulane University, and Louisiana State University in New Orleans - have all decided to keep their combined 58 residents in the area.

Ochsner's New Orleans campus did not flood and remained open throughout the catastrophe, according to its Web site. The outpatient volumes should shift away from New Orleans, but the clinic is not closing or contracting any programs.

Most likely, residents will be sent to Baton Rouge or other outlying facilities, said Dr. Stephen R. Baker, president-elect of the Society of Chairmen in Academic Radiology Departments (SCARD).

"Radiology chair Dr. Ed Bluth told me that if it isn't going to work out, he'll get back to me," Baker said.

Tulane has temporarily set up camp in Houston with the assistance of the Alliance of South Texas Academic Health Centers, which includes Baylor College of Medicine, Texas A&M University, the University of Texas Medical Branch at Galveston, and the University of Texas Medical School at Houston.

LSU has regrouped in Shreveport and Baton Rouge. Both LSU and Tulane expect classes to resume by Sept. 26 and residents to be placed by Oct. 1.

As the Gulf Coast disaster unfolded, Baker galvanized the movement to prepare for alternative placements in case residency programs in Katrina's path could not continue.

"I had two goals: to ensure that residents' continuity was maintained and to preserve intact existing programs if the program director was able to secure an acceptable site to continue graduate education," he said.

Baker first called Dr. Kay Vydareny, chair of the Residency Review Committee (RRC) for diagnostic radiology. She spoke informally to a few leaders, including Dr. Robert Hattery, executive director of the American Board of Radiology. Everyone understood the dire situation and the potential disruption to residents' education. Baker was given approval to appeal for help.

Along with SCARD president Dr. Donald P. Harrington and Dr. Spencer B. Gay, president of the Association of Program Directors in Radiology (APDR), Baker sent a letter to all program directors asking if they'd be willing to take on at least one displaced resident. The response was overwhelming.

The second phone call he received was from Dr. Lawrence Stein, who had already convened a meeting of all the program directors of the 16 Canadian residency programs. Each one had agreed to take on residents if the need arose.

Baker also heard from Tulane's program director and radiology chair Dr. Harold Neitzschzman. After seeing to the safety of patients and staff, he had to be rescued from the hospital rooftop by helicopter.

Most people were terrific, Baker said. But some expressed reservations about paying for displaced residents, and one person insisted on only high-quality residents.

"Human nature revealed itself to me along its spectrum," he said.

Transferring residents is not an easy process. There is much red tape involved. But in this extreme situation, many government agencies and medical associations responded with promises of an expedited process.

The Centers for Medicare and Medicaid Services announced that teaching hospitals would not be penalized for exceeding their Medicare resident caps if they took on displaced residents.

The Accreditation Council for Graduate Medical Education (ACGME) and the RRC must approve of all transfers. According to a Sept. 8 update on the ACGME Web site, however, program directors have the authority and responsibility to arrange and approve temporary or permanent transfers for resident/fellow education as needed.

Program directors must determine whether they will be able to provide the necessary elements for residency/fellowship education, including adequate patient volume, appropriate faculty supervision, attention to safety, and duty hours in conformance with ACGME requirements. They must report their final plans to their respective RRC executive director by Oct. 1.

"My first approach to this was that we ought to ask the program directors what help they would like, rather than try to take things out of their hands," Gay said. "Our role is to provide support when asked, to be there when ready. If and when they do need help, we will be there for them."

The APDR had been ready to become a clearinghouse for the list of institutions that were willing to take on displaced residents. Several residents decided to take matters into their own hands and place themselves into other programs. Baker encountered five such instances and intervened in all of them.

"You can't jump the program if it's not the will of the program director," he said.

For more information from the Diagnostic Imaging archives:

We have seen the future of radiology and it looks good - very good

Administrators wrestle with new challenges and skill sets

Informatics takes spotlight in radiology teaching tasks