Hospital Closure and COVID-19 Pandemic: A Resident’s Journal

Emuejevoke Chuba, MD
PGY-2 Anesthesiology Resident
Temple University Hospital, Philadelphia

Friday, March 16, 2018, to some was just a regular workday, but to the 4th year U.S medical students and international medical graduates (IMGs) aspiring to work in the United States of America, it was a special day. It was Match day. As an international medical graduate who went through different interview processes in various parts of the country, I was eager to see where I was going to call home for the next four years. The email finally came; it was Drexel University Hospital/Hahnemann University Hospital, Philadelphia. I was finally leaving New York City – the "city that never sleeps,” which had been home to me ever since I relocated to the USA, to the "city of brotherly love."

Four months into my intern year, the hospital acquired a new owner. I was not sure if this was good or bad. However, most of the more senior attendings saw this as a welcome development, as they were concerned about the hospital’s solvency under the previous owner. We had various meetings with the new leaders who shared some innovations to be implemented. Every resident, including me, was excited about the change coming to the hospital. Little did we know what they had up their sleeves. I woke up one cold morning in April 2019 to the news that the hospital was laying off 175 workers. According to the CEO, the hospital was losing too much money and was going bankrupt. Small groups of people were seen on every floor and clinic, discussing the fate of residents and fellows if the hospital were to eventually close. The tension was palpable. A few weeks later, work seemed to go back to normal. And then to our utmost surprise, the hospital filed for bankruptcy on Wednesday, June 26, 2019, leaving stranded over 500 physicians in training. Residents had a series of meetings with the department leadership, graduate medical education, and the Accreditation Council for Graduate Medical Education (ACGME). Although we rallied alongside other hospital workers calling on the government and the public to save the hospital, our efforts yielded no changes. My colleagues and I had to search for a new program to continue our training. In my research on the process of hospital closure, "Orphaned residents," "displaced residents," "CME funding," were some of the recurring phrases in most articles.

To date, the Hahnemann University Hospital (HUH) closure is the largest teaching hospital and graduate medical education closure in US history.1 In addition to the disruption of the lives of physicians in training, the closure of a large urban medical has a profound impact on the community it serves. Patients experience a breach in continuity of care, misplacement of medical records, and longer commutes to access health care.2 Because HUH was located in the center of city of Philadelphia, it provided care to an underserved community, and its closure had the double effect of leaving many patients stranded and overburdening other already stretched hospitals in the city.

I applied to programs with the emails featuring the subject line "displaced Hahnemann resident" as I went through the arduous process of securing a residency spot all over again. I was stressed physically, financially, and mentally. Thoughts of losing my residency training weighed me down all day. If the bankruptcy court had released funds allocated to trainees, it would have been easier to gain admission to a receiving program. But as a foreign graduate on a visa, I had been given a 30-day ultimatum to get a training position or go back to my country. Amid this dilemma, I received a call from my current program director, offering me a spot. I felt supported as she allayed my fears and assured me of my position in the program. On August 1st, 2019, I signed a contract letter to continue my training at Temple University Hospital. Once more, "the city of brotherly love" had decided to show me love.

I quickly settled into my new program with the support of the program's leadership, faculties, and residents. Six months into my first year of anesthesia residency (CA-1), I was impressed by how many skills I had acquired, having done a couple of organ transplants, neurosurgical, obstetrics, urological, and ambulatory cases. This drove me to set a higher goal for the next six months. The year 2020 started with so many hopes until mid-January when news of the novel coronavirus from China started making waves. Initially, there was no cause for alarm until America recorded its first case, and within a short period COVID-19 was declared a pandemic. Elective cases were canceled, schedules were changed to accommodate providing care for COVID-19 patients, and some rotations had to be canceled.

As a healthcare provider, I was faced with the challenge of providing maximum care to these patients without getting infected. However, with proper donning and doffing of protective personal equipment, there is a reduced risk of contracting the coronavirus from infected patients.3 This gave me some assurance. Additionally, the daily loss of my patients, informing their relatives who had no opportunity to visit prior to their death, self-isolation after direct patient contact and stigmatization from my neighbors contributed largely to mental and emotional stress. I lived each day overwhelmed with fear and anxiety and on multiple occasions, was awakened by memories of events that occurred earlier at the hospital. I was able to unload my feelings through our various departmental meetings and sessions of meditation and debrief, all aimed at creating a safe space to communicate our fears. These practices were part of the recommendations following the 2003 SARS outbreak and the recent COVID-19 pandemic where health care workers developed post-traumatic stress disorder.4,5 

In all of this, I can confidently say I have acquired some life skills from the hospital closure and the coronavirus pandemic experience. Some of these lessons include resilience, leadership, adaptability, and optimism. I recently joked that every year of my training thus far has been associated with a significant event. Now I live each day wondering which significant events will take place in the remaining two years of my residency – maybe a few, maybe none. Time will tell.


  1. Berns, J. S., Coull, S., Paskin, D., Spevetz, A., Boyer, W. C. Reflections on a Crisis in Graduate Medical Education: The Closure of Hahnemann University Hospital, Academic Medicine. Journal of the Association of American Medical Colleges. 2020; 95 (4): 499-502
  2. Romeo, D., Kwan, Amy., Nestler, Sue., Cohen, N. Impact of the Closure of a Large Urban Medical Center: A Quantitative Assessment (Part II). Journal of Community Health. 2012; 37 (5): 995-1005.
  3. Heinzerling, A., Stuchey, M.J., Scheuer, T., Xu, K., Perkins, K.M., Ressenger, H., Magill, S., Verani, J.R., Jain, S., Acosta, M., Epson, E. Transmission of COVID-19 to health care personnel during exposures to a hospitalized patient-Solano County, California, February 2020. Centre for Disease Control and Prevention. Morbidity and Mortality Weekly Report. 2020; 69
  4. Torales, J., O’Higgins, M., Castaldelli-Maia, J. M., & Ventriglio, A. The outbreak of COVID-19 coronavirus and its impact on global mental health. International Journal of Social Psychiatry. 2020.
  5. Greenberg, N., Docherty, M., Gnanapragasam, S., Wessely, S. Managing mental health challenges faced by healthcare workers during covid-19 pandemic. BMJ. 2020;368:m1211 doi: 10.1136/bmj.m1211
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