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A national nonprofit that accredits graduate medical education programs has placed Roger Williams Medical Center on probation.

The 220-bed teaching hospital in Providence, R.I. has been operating its residency programs under “probationary accreditation” since July 8, according to documents posted on the website of the Accreditation Council for Graduate Medical Education (ACGME). The council does not publicly disclose the reasons behind its accreditation decisions, a spokeswoman said in an email.

Roger Williams currently has 57 doctors fresh out of medical school who are enrolled in its residency programs, according to the ACGME. The Providence hospital has a clinical affiliation with Boston University School of Medicine, and the university’s graduates frequently do rotations in internal medical and surgery at the Providence hospital, a spokeswoman for the university confirmed in an email. 

Hospital residency programs provide on-the-job training for doctors fresh out of medical school and a cheap source of skilled labor to fill hospitals’ coverage gaps. During the coronavirus pandemic, residents at Roger Williams have been working side-by-side medical staff in hospital emergency rooms as well as intensive care units. 

Dr. Vincent Armenio, director of the internal medicine residency program and chairman of dermatology at Roger Williams, said that the hospital’s probationary accreditation was “triggered” by the accreditation council’s decision to close the dermatology program after learning that its residents were no longer training at Roger Williams.

The decision to move the dermatology residents out of the hospital for training. Aremnio said, was supposed to be “a bridge” until Roger Williams could get the program back on its feet. The dermatology program for years has been plagued by staffing problems, he said, running through seven directors in the past seven years. When Armenio took over as chairman of dermatology in 2017, he said, to ensure that the residents received proper training he arranged for them to train through Brown Dermatology, a member of Lifespan, the state’s largest health-care network. Most of the training, he said, took place at Lifespan’s three hospitals: Rhode Island Hospital, Hasbro Children’s Hospital and The Miriam Hospital.

 “My attempt was to save the program for Roger Williams and to be a Roger Williams-based program,’’ Armenio said. In the meantime, “I had to think of the individual resident.”

He said six of this year’s seven dermatology residents are training at Brown Dermatology; one enrolled in a program near his home in Ohio.

Roger Williams is operated by ChaterCare Health Partners, a local arm of Prospect Medical Holdings Inc., a California-based for-profit company. 

People familiar with the accreditation process say that it’s unusual for the ACGME to place an established teaching hospital -- as opposed to a single program -- on probation, and it suggests a broader concern about the overall operation of the residency program.

“It does happen,” Dr. Janice Orlowski, chief health-care officer for the American Association of Medical Colleges, said. “But it’s not common.”

Foreign medical students who are training in the U.S. typically are required to attend an ACGME-accredited residency program as a condition of their VISAs. If Roger Williams was to lose its accreditation, that could jeopardize the medical residents’ VISAs 

But Armenio says he is confident that the ACGME will find Roger Williams’ remaining residency programs -- including internal medicine -- are the strongest that they have been in years. One measure of the quality of a hospital’s residency program is its “pass rate,” or percentage of residents who pass their medical board exams. Roger Williams’ most recent class of internal medicine residents, Armenio said, had 100% board pass rate. The board pass rate for internal medicine nationally in 2019 was  91%, according to the American Board of Internal Medicine. 

While on probationary accreditation, the ACGME is expected to interview Roger Williams’ residents and review the programs’ operations, including its adherence to rules such as a maximum 80-hour work week. An on-site visit is scheduled for September.

Aremnio said he is confident that the hospital will regain full accreditation. He likens the probationary status to getting a notice from the Internal Revenue Service (IRS). “Even though you know you paid your've done everything on the up-and-up, you're nervous to get a letter,’’ he said. “But in the long run, you're confident that there's nothing to hide.”

--Lynn Arditi, health reporter, can be reached at larditi@thepublicsradio.