The Tulane University School of Medicine residency program, where doctors fresh from medical school embark on the last leg of their training, promotes itself as a diverse institution that aims to reflect the population of New Orleans.
The school’s website refers to the importance of serving New Orleans’ large Black population. And Tulane has had some success in attracting doctors of color. In 2014, a combined residency program in pediatrics and internal medicine recruited the school’s first ever all-minority, all-female cohort.
“We strive to get our practitioners to look like the people we take care of,” said an administrator in an online video aimed at attracting residents to the internal medicine program, one of 19 residencies at the 186-year-old institution.
But last month, the dismissal of Dr. Princess Dennar, a Black program director who ran the school’s internal medicine-pediatrics residency before a committee voted to remove her, sparked an outcry that has challenged those claims of inclusivity.
Dennar filed a lawsuit against Tulane alleging racial discrimination four months before a committee comprised of 15 Tulane program directors and other doctors voted to remove her from her post.
Afterward, dozens of current residents signed a letter calling for the removal of the medical school’s current dean and alleging that there is “deeply entrenched structural racism and bias” throughout Tulane. A letter signed by 28 alumni of the medical school said that allegations of racial discrimination were “not surprising in the least” based on their experience.
And in recent weeks, a social media movement has urged new doctors applying for residencies to boycott Tulane.
Dennar’s dismissal has turned a spotlight on one of New Orleans’ most prominent medical institutions and comes as establishments across the U.S. are facing criticism over their handling of issues surrounding race and discrimination.
According to interviews with residents and other members of the Tulane medical community, along with lawsuit filings and a report from the school’s accrediting agency, much of the controversy centers on a long-running conflict between two charismatic doctors: Dennar, a beloved director of the medicine-pediatrics program, and Dr. Jeffrey Wiese, former head of the school’s internal medicine residency and current associate dean.
Wiese is known for rebuilding the Tulane residency program following Hurricane Katrina and was an important cheerleader and recruiter for the medical school on the speaking circuit. Residents said his letters of recommendation opened doors to competitive fellowships and prestigious positions.
“Being able to say I went to residency with Wiese, people would know what that meant,” said a resident who graduated in 2014. “Tulane meant Wiese. Wiese meant Tulane.”
Dennar, a Philadelphia native, got her medical degree from Drexel University and joined Tulane in 2008 as a medical director of the internal medicine residency ambulatory service. By 2009, she had been promoted to running the medicine-pediatrics program.
Several residents in her program said she was a caring mentor who also demanded excellence. Dennar was the reason many residents, especially people of color, came to Tulane.
“It’s rare to come across someone who looks like me in academics,” said Dr. Chioma Udemgba, who graduated from residency in 2020. “A Black female physician? It checked all the boxes. I had to go here; I had to be mentored by her.”
Many residents who knew them said Wiese and Dennar were brilliant doctors. But their relationship was strained.
“They’re both really big personalities,” said a current resident, a person of color, who noted that it was an enjoyable experience working with both of them. “The acrimonious relationship between them is longstanding.”
In 2017, Dennar testified internally against Wiese’s program manager, who resigned after an internal report found instances of racial discrimination, according to a lawsuit later filed by Dennar’s program coordinator. Wiese’s program manager quietly resigned.
After that, there was a “culture of retaliation,” according to the racial discrimination lawsuit Dennar filed against Tulane in October.
Wiese was in charge of scheduling resident rotations, and Dennar alleged that Black women in her program were consistently placed on the most exhausting schedules, some of which frequently required 28-plus hour shifts. The scheduling also led to unsafe conditions for patients where residents performed procedures without the oversight of a supervisor, the lawsuit alleged.
Wiese did not respond to interview requests.
Udemgba said she was warned that a residency in the med-peds program would be hard for her when she started in 2016.
“You have to fight tooth and nail to get the things that you need,” she remembers another Black resident saying.
Soon, Udemgba knew what they meant. At group meetings with residents from other programs, everyone talked about what rotations they were on.
“Every time I come in, I’m like, ‘I’m on ward, I’m on ICU,’ ” said Udemgba, referring to the inpatient ward and intensive care unit, where the sickest patients are treated. “And everyone else is on this elective or that elective. Somehow, I’m always on the harder rotation.”
Many residents were reluctant to say that the tough scheduling was motivated by overt racism or gender bias. But the med-peds program had far more people of color than other programs and several current and former residents, including Dr. Monica Lau, a former chief resident who graduated in 2017, said many female and Black doctors didn’t get the rotations they needed.
“It spanned multiple years of residents,” Lau said. “I think a pattern should say something.”
In April of 2018, seven Black female residents filed a formal discrimination complaint through the schools’ accrediting body, the Accreditation Council for Graduate Medical Education, about the rotations. Dennar filed one at the same time against her own program. A few months before, another resident had also lodged a similar complaint.
Following a site visit, the ACGME issued a report that noted several violations, including that Dennar was not given authority over her program and residents were working more than 80 hours per week. In addition, it found that Wiese had a conflict of interest in overseeing both his and Dennar’s programs.
The ACGME did not find evidence of race or gender discrimination in its site visit. But it also said it “could not be excluded.” The main issue, the report said, was that the relationship between Dennar and Wiese was “not collaborative and healthy.”
As a result of the investigation, the ACGME placed the programs on warning status.
In July 2019, Wiese stepped down as head of the internal medicine program but remained as associate dean of graduate medical education, which oversees all of the medical school’s accredited residency programs.
In February, a graduate medical school committee received the results of a 47-page internal Tulane review of Dennar’s program that was sparked by the accreditor’s report.
Two faculty members in other departments and a resident were tasked with putting it together. The 15-member panel, which Dr. Lee Hamm, dean of the medical school, said in an email was comprised of “a diverse group of Tulane faculty and medical residents” along with “individuals from other institutions” voted unanimously to remove Dennar from her position as program director.
Many current and former residents were livid and saw Dennar’s removal as another example of institutional bias at Tulane.
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A group of students at the medical school formed a coalition with a list of demands for the administration, including an independent investigation and suspension of current leadership.
Alumni wrote an open letter criticizing the decision to remove Dennar. Current residents and medical students have also demanded Hamm’s dismissal. Before Friday’s “Match Day” ceremony at Tulane where newly-minted doctors learn where they’ll be continuing their training, 63 students delivered a petition asking that Hamm not attend.
Supporters of Dennar have flooded social media with the hashtag #DNRTulane, which stood for Do Not Rank Tulane, a call to newly graduated medical students to keep Tulane off their lists of prospective locations for their medical training.
In prepared statements on the controversy, Tulane officials said they have reaffirmed their commitment “to fostering an equitable and inclusive community,” and denounced discrimination. They also defended the institution as “inherently not racist.”
It’s not clear what the conclusions of the panel were. Tulane didn’t answer questions as to who was on the committee or what the report contained.
Dennar also declined to provide the report, citing pending litigation, but in an open letter she publicly criticized it as “filled with errors from the beginning to the end.”
In an interview, Dennar remembered weighing the risk of calling in the watchdogs on her own program, but said she felt it was her only option.
“We run the risk of it looking like something was wrong with our residency program,” she said, “when we are the ones that are whistleblowing.”
Her lawsuit alleged that discrimination went back over a decade.
When Dennar first interviewed for her position in 2008, she said she was told by Hamm, then the chair of the internal medicine department, that they “didn’t want to change the face of Tulane,” according to the lawsuit. By Dennar’s recollection, Hamm also expressed that White medical students would not want to train under a Black program director.
Hamm “emphatically denies these accusations,” according to a statement released by the school.
Whatever the reasons for her dismissal, the allegations were not serious enough to keep Tulane from attempting to reinstate Dennar after the ensuing uproar. After the “do not rank” campaign took off and several media reports appeared, Tulane offered Dennar her position back, with certain conditions.
Dennar made a counteroffer, which Tulane did not entertain. She remains as the medical director of a clinic at University Medical Center and an assistant professor of internal medicine and pediatrics.
The ACGME is now planning another site visit in April, according to its website.
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Residents who have been on the front lines of the coronavirus pandemic said the entire incident has been hard to work through. One noted that with the program in turmoil, the people of New Orleans who seek care at the hospitals the residents serve, many of whom are poor or do not have insurance, could end up suffering the most if young doctors decide to start looking elsewhere for their training.
“Tulane Medicine has attracted people who want to work on social justice for the last decade,” the resident said. “To me, the greatest tragedy would be if people did not come here to do that.”