The resident physicians at Nashville General will have to find somewhere else to finish their training if the hospital is downsized to a collection of outpatient services. An announcement last month that relocated Meharry Medical College's third- and fourth-year students did not affect medical residents — but related changes at Nashville General would.
Meharry made a surprise decision to pull students from the hospital on its own campus, citing how slow business has gotten at the city-run safety-net facility. That transition does not include the 118 young doctors who've graduated from medical school but are tethered to Meharry for their residency years. According to the school, 52 of them work at Nashville General.
The uncertainty comes because the city is now considering an end to inpatient care, which is required for residents to get the necessary experience. And residency slots are already highly competitive.
Residents have been discouraged from talking to the media. But Meharry president James Hildreth says he’s told them not to worry about their budding careers.
"All of them will be able to conclude their training with us, either by being placed in local hospitals or one of our 18 affiliated hospitals that we currently have," Hildreth said. "So none of the residents that we currently have at Meharry are going to have to leave to finish their training."
It's possible that residents could also eventually move to Tristar Southern Hills Medical Center, where Meharry's medical students will soon be learning. But the HCA hospital has never hosted residents and would have to get approval from federal authorities. HCA Tristar would not confirm whether it has applied for the necessary permission.
As for the future of Nashville General, Meharry residents currently handle much of the frontline care. If they depart along with medical students, it would be just one more staffing obstacle for the financially strained facility. But CEO Joseph Webb says he'll manage.
"I've been CEO of hospitals that were not index teaching hospitals. I've been CEO of hospitals that had no residents. I could easily function either way," Webb said.
But in some ways, Webb rejects the premise. His bigger concern is shielding the financially teetering hospital from being pared down to the point that residents might have to leave. So he's raising red flags. He contends reducing services beyond a certain point could cost the city even more. He says the emergency room feeds the inpatient care which drives folks into outpatient care — like an ecosystem.
"All we're doing is saying if you really want to take a look at the cost factor, then let us at least propose to you — before we go completely down this path — how you can actually benefit to a larger degree than just cutting off a portion and exacerbating your cost and the health disparities," he said.
Meharry's Hildreth has organized a working group to find a realistic path forward for the hospital. But they may have to act quickly. Nashville General expects to run out of operating funds Jan. 30. And while it's likely to get an additional subsidy from the Metro Council, Mayor Barry has indicated that she doesn't want to go another year under the current business model.