DMC, Wayne State lose neurosurgery training accreditation

A training program for neurosurgeons at the Detroit Medical Center has lost its accreditation, jeopardizing the reputation of the health system and its longtime academic partner, Wayne State University.

The Accreditation Council of Graduate Medical Education withdrew accreditation from the program earlier this month following a site visit on Sept. 18. Accreditation is set to end on June 30.

Wayne State University School of Medicine Dean Jack Sobel said the program would appeal. Neither the Council nor the program sponsor, DMC, would comment on how the program could restore its credentials or the specific causes.

"We are going to appeal together to recreate a teaching environment, with both sides participating, that will create an optimal teaching environment,” Sobel said.

The accreditation loss is a byproduct of the discordant partnership between WSU and the DMC, although Sobel said that was not the direct cause. That relationship has deteriorated sharply over the past several years, putting at risk the medical attention provided to high numbers of indigent and under-served residents in the nation's poorest metropolitan city.

Sobel said that Wayne State's top neurosurgical teaching faculty left the college to join DMC, which left them without the required teaching credentials to run the program.

"The failure of the residency is a failure of one or two teaching individuals. It's not a conflict between DMC and Wayne State," he said.

"This is an outlier," he said, adding that other residency programs are not at risk.

Loss of accreditation is rare, and rarer still for the seven-year residency programs in neurosurgery, with just 218 positions available nationally each year. They train physicians who perform brain and spine surgeries and treat patients with neurological disorders like stroke, Parkinson's or Alzheimer's disease. Doctors must exit accredited programs to be licensed in their specialty.

"These men and women are pretty stellar," said Atul Grover, executive vice president of the Association of American Medical Colleges. 

Neurosurgery is among the most competitive medical professions, and requires seven years of surgical residency following medical school. Neurosurgery residents contacted by The Detroit News declined to comment on the situation Thursday, but one described the situation as desperate.

"When I look at the characteristics of the average person who's matched with neurosurgery these days, they're not only exceptional clinicians with great academic credentials, they've done research, in many cases they have two degrees — these are really competitive people who are exceptional," Grover said.

Beyond the immediate impact, even a threatened loss of status can impact recruiting. Applicants rank their preferred choice of programs and go through a matching process to determine their placement, ensuring that the best applicants get their preferred programs. The DMC-Wayne program is unlikely to rank highly among top surgical candidates who fear it is risky.

The Council accredits 11,000 residency programs across the country. Accreditation was withdrawn from eight programs in 2019. It's not clear how or if accreditation can be restored; the Council would not comment on the Detroit program. 

The Council conducted site visits to the Detroit Medical Center's 65 residency programs on Sept. 18, and the eight residency programs sponsored by the Wayne State University Medical School on Oct. 18. 

The hundred-year relationship between Wayne State and the DMC was nearly severed last spring before they reached an agreement to continue. Both the university and the health system have sought partnerships with other institutions, with some success.

On Thursday, the two entities took turns contesting whether Wayne State was even affiliated with the program.

"The neurosurgery residency program at the Detroit Medical Center belongs solely to the DMC," the university said in a statement. "The Wayne State name is listed on the ACGME website because of a prior teaching affiliation agreement. That agreement ended a year ago when WSU neurosurgeons joined Tenet Physician Resources, or TPR. Since that time, Tenet has named the chair of the program and been responsible for all teaching."  

DMC spokesman Brian Taylor, however, said: "(Wayne State is) affiliated with the program. They're our academic partner." 

Wayne State still lists the individual residents on its website. Residents have WSU email addresses, and their photos and biographies are listed in the university’s directory of team members.

The website also informs prospective residents how to apply for the residency and and states “Neurosurgery applicants successfully matching to our program will complete all years of training in the Detroit Medical Center-sponsored training program.”

DMC could provide no information or documentation on the reason for the accreditation loss.

"(A)t this point, we have yet to receive detailed information outlining the reasons for the decision," Taylor told The News in an email. 

"It's unusual for a small specialty like this that's populated by people who are really exceptional surgeons to not be accredited," said Grover, of the Association of American Medical Colleges. 

The American Board of Neurological Surgery, which provides board certification for neurosurgeons, requires that candidates receive training through a program accredited by the Council.

According to Betsy Koehnen, chief administrative officer for the Board, residents unable to complete their seven years at an accredited institution will need to seek admission to an another program that is accredited to complete their training.  

"We only recognized trained individuals who graduate from an accredited program," Koehnen said. It’s unclear whether the residents in the program could depart for other programs, or how soon.

Grover, of the American Association of Medical Colleges, said the program's loss will reverberate throughout the field as medical graduates who hope for careers in neurosurgery compete for fewer available training slots. 

"You need all the doctors you can get, especially in a small, narrow specialty like neurosurgery," Grover said.

"There's probably only a hundred or so training programs in the entire country. So anything that effects the ability of an entire program to train people is likely to have an impact — not just on the local area but certainly regionally."

kbouffard@detroitnews.com

Twitter: @kbouffardDN