Erlanger-UT continue ironing out disputes

In this Jan. 5, 2016, staff file photo, the medical towers at Erlanger Medical Center are shown on the east side of the facility on Third Street near the intersection with Central Avenue in Chattanooga, Tenn.

In the monthslong dispute between Erlanger Health System and the University of Tennessee College of Medicine Chattanooga, a local hospital urged Erlanger's board of trustees to continue allowing doctors to do some of their training at other area hospitals.

The practice has surfaced as one of the issues between Erlanger and the university following a board meeting in November in which the hospital publicly expressed discontent over its relationship with UT. Erlanger CEO Kevin Spiegel said on Saturday his grievance with the external rotations boils down to Erlanger - the medical school's core teaching hospital - losing money sending its residents to other hospitals on the external rotations.

Last Tuesday, CHI Memorial Hospital's board approved a resolution urging Erlanger's board to "vote against any proposal that would limit the approved Chattanooga region training sites for surgical residents, and to engage CHI Memorial in further dialogue to protect access to quality surgical specialties," according to a letter from Memorial to Erlanger.

The letter was sent from Memorial CEO Larry Schumacher to Erlanger Board Chairman Jack Studer and copied to Spiegel, UT College of Medicine Chattanooga Dean Dr. Bruce Shack and Dr. Steve Schwab, chancellor of the University of Tennessee Health Science Center.

"We just don't think that graduate medical education or health care education should be a competitive issue," Schumacher said Saturday. "All of us should be collaborating together to make certain that we do produce the people that we need for caring for our community in the future."

On Thursday, several Erlanger trustees, two University of Tennessee board members, and several key Erlanger executives and College of Medicine officials met to discuss Erlanger's issues over the teaching affiliation agreement with UT, among them external resident rotations.

The issue of doctors in training at Erlanger rotating to other hospitals, including Memorial and Parkridge Medical Center, has festered since at least July.

The bulk of resident training takes place at Erlanger, but in some cases a single hospital might not see the number or diversity of cases required for specialized programs.

Schumacher said the practice of external rotations is common in graduate medical education across the country, and to his knowledge the residents have completed rotations at Memorial for somewhere between 20 and 30 years.

If these rotations were discontinued, some teaching faculty at Erlanger worried residents in training would have been forced to go far away - Saint Thomas Health in Nashville, for example - for certain rotations. That would create unnecessary burdens, they argued.

"It really does prevent the residents from having to go outside of Chattanooga for learning experiences," Schumacher said. "Which I believe, all of us, including some of the faculty and others that I've talked with, believe will continue to help us to recruit surgeons or potential surgical residents to the program and to our community."

Phil Smartt, one of the Erlanger board members in attendance, said he was thrilled with the outcome of the meeting and was "very excited" when he read the letter from Memorial, which offered to compensate Erlanger for the residents who come through the hospital.

"UT and Erlanger have locked arms and said we're moving forward together in unity to make Erlanger the best regional hospital around. We've made great strides," he said.

Shack, who also was in the meeting, said the university is interested in working with all hospitals to provide the best education possible. He expects the issue to be fully resolved in the coming weeks.

"We were concerned primarily that if we eliminated all the rotations to the outside hospitals quickly it would damage the training program," Shack said, adding that any rapid change to programs would be postponed. "That's going to allow us to move in a more studied way to make these changes and continue the education."

Spiegel said that although the current affiliation agreement between the two institutions was signed in 2014, certain long-standing practices are outdated, and as the hospital changes, "growing pains" are to be expected.

"Sometimes if you've been there the way it used to be run, you're not going to be happy. But I can tell you I'm happy. I see the organization moving forward," he said.

Schumacher said he offered to pay Erlanger for the residents several months ago upon learning about the issue, but Erlanger didn't bite.

"I don't understand their position. They're really not saying why other than they don't want the residents to go outside of the Erlanger system," he said.

Spiegel said Memorial may have offered to compensate Erlanger's losses, but it hasn't followed through. Assuming Spiegel starts seeing money from other hospitals that use the residents, he said he would drop the issue.

"I think that's a reasonable request. Nobody in today's day and age provides residents to another hospital without reimbursement," he said, adding that teaching can't support personal business ventures and has to be for teaching purposes.

"We're investing more and more money into our teaching program than ever before in the history of Erlanger, so our commitment to academic medicine is not in question. What's in question is that we're doing it correctly," he said.

Spiegel has led a financial turnaround at Erlanger since taking the helm in 2013. Hospital revenues have grown from about $600 million to about $1.2 billion.

Contact staff writer Elizabeth Fite at or 423-757-6673.