Abusive Residency Programs

[mongoosert]

It is troubling and hard to believe that residents still work in difficult and abusive environments. For those of us looking at applying to programs this fall, how do we deal with this?

I've heard bad things about resident abuse at UCLA (even discussed on interview spreadsheet), do programs just let this happen?

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[Gfunk6]

Your options are extremely limited unfortunately. The best way is to avoid the situation entirely by doing your due diligence and speaking with the residents during interviews.

If you find yourself in this situation, the path of least resistance is to try to transfer. ACGME does have mechanisms in place to report abuse "anonymously" but whistleblower protection is weak. Thus you may find yourself ostracized/marginalized by the program (best case) or subject to outright expulsion and subsequent black listing from all Rad Onc programs.

Given the above, you can understand why most residents keep their heads down and mouths shut. It is not worth risking your career and livelihood over principle.


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[Gfunk6]

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[berag]

If you feel that your program is abusive, fill out the ACGME surveys honestly.

 

[bluebubbles]

With rad onc becoming less competitive for reasons outlined elsewhere, the MATCH favors applicants. In other words, if you have a lot of interviews, be proactive in asking residents and faculty about proxies for abuse or lack thereof:

- # of work hours
- 1:1 or double coverage
- nurse practitioner support
- documentation burden
- protected research time

The program least likely to abuse residents is one with a good reputation that places grads in good jobs, 1:1 coverage, lots of NPs, low documentation burden, 12+ months of protected research time, generous vacation/conference time, and averages <50 hours/week of work time.

Of course, the best way to gauge a program is to rotate there. Or, if you have a friend or alum of your school who is a current resident, that's also a reliable info source.

And, I disagree with Gfunk6. If your program is truly abusing you and you can't change that, you can always quit. It's not like you're on an H1B visa. If you're pressured into staying in an environment that makes you unhappy, it's just another sign that you're in an abusive program.

 

[thecarbonionangle]

SO they are still eating their young despite expanding the program for cheap grunts? NOT surprised. That seems to be the trend in rad onc as a whole. AND YES, they "do let it happen" because residents are replaceable. There are many grunts who would take that spot. Chairs are not thinking about you at all---quicker you realise this mate, the better.


As an aside, in general, residency is residency so let's not call a program where you may work 60 hours a week "Abusive" and they majority of programs will not give you "+12 months" of research. There are certainly abusive programs out there. I've heard some horror stories, but let's have a fair definition of what that means. you are still going to have your weekends, generally be home for dinner and have time to go to the gym and not ROT in call room missing your family, and your children if you have them. Do your research and ask questions. Its tough to know exactly unless you rotate somewhere.

 

[Ray D. Ayshun]

I think a reasonable way of getting an impression of how programs will treat residents is whether the chair and PD have residents on their service combined with what you think of the chair and PD based on your interactions w them during interview, away, etc. if they're decent people and interact with residents on a weekly+ basis, I'm very doubtful they'd allow much mistreatment. If one or both has no real regular interaction w residents, good person or no, they may have less interest in how things work.

 

[RSAOaky]

Lol 12 months+ protected research time. I agree with the sentiment above. I would draw a distinction between programs where residents work hard and programs that are malignant. Radiation oncology is, in general, a specialty with very good hours. That doesn't mean that programs where residents are staying till 7pm some days or, gasp, coming in on the weekends, are malignant. Nor are programs where residents have a higher case volume. > 1:1 coverage is not ideal, but even that is not something I would jump to calling malignant.

It's pretty clear on interviews when people are unhappy so don't dismiss that, but take it with a grain of salt as well. All programs have issues. Sometimes those issues are misanthropic residents.

 

[Reaganite]

Am I the only one who read this as a not-so-subtle attempt to put UCLA on blast? (Not that I'd complain ).

 

[Neuronix]

There's no such thing as over 12 months of research. You're required to have 3 years of clinical experience in a rad onc residency. The only exception is Holman pathway.

I don't blame research-oriented applicants for looking for significant protected research time in their residency program. The more time and resources you have to do research, the more potential you'll have to publish and earn grants that will get you the academic positions.

I certainly interviewed at places and formed my own impression. There are happy programs and unhappy programs. Things can change though, even from year to year. My experience was generally that negative things about programs are pretty hushed even by current residents, and if there's a negative rumor about a program it's often true (though not always).

In response to shogun, I will play devil's advocate here. If the residents aren't working that hard clinically, it's very unlikely they're being abused. I will grant you that their training may be plus or minus. If they have less clinical volume but a lot of good teaching, they might be very well trained if they read a lot. However, if they are working hard clinically, it could be a high scut, low teaching, high unhappiness type program, or it could be a low scut, high teaching, high happiness type program. It's hard to know until you've talked to people or rotated at that program.

I personally avoided 100% attending coverage programs after rotating at two where the residents were miserable trying to do this. These programs tended to put residents in a very awkward positions with regards to taking vacation or being in two places at once. It may not always be the case. As faculty, I'd love to have a resident 100% of the time because they are a big help and it frees me up to do more academic things, but I recognize that their job isn't to serve me.

 

[choosingwisely]

Mongoose and other potential applicants, if there are any signs or stories of abuse they are most likely real. When there is smoke in this setting, there is usually a fire, if not something worse. Most residents don’t want to rock the boat. If there is abuse, the feared consequences of reporting prevent residents from coming forward. It’s a sad fact that most abuse goes unreported.


In response to Reganite, the post reminds of the adage, “you reap what you sow”

 

[thecarbonionangle]

Applicants need to do their research and look into things. The program in question has concerns dating back over years in this community. Last year, a program with concerns went unfilled for one spot. Programs reap what they sow but so do applicants. If you rank a program, you have to very much be willing to go there and get through it. If there are many rumours that something may stink, don't be fooled by the interview date theatrics. Many times these rumours are true. Residents don't want to ruffle any feathers and they certainly aren't going to tell you much in one day. if you are truly interested in a program, I would do a rotation and observe for a month. Other things to look for which may lead to unhappiness have already been mentioned by others.

 

[RSAOaky]

It's cool that you think working more hours translates to better training. And I don't know, maybe it does for some people. Everyone learns differently. But FWIW, of the residencies I'm familiar with, the one with the highest and arguably most diverse case volume also has the best hours. This is because of NP support, low documentation burden, etc.

And dude, working 45 hours a week + reading + research sounds like a full-time job to me.

Sounds like residency to me. Pretty sure you'd still come in well below the 80 hour work week.

 

[choosingwisely]

I think the concerns about some programs are beyond just hours and scut. The hierarchical nature of medicine can so easily lead to abuse. Some programs still think it is okay for residents to be yelled at, belittled, and bullied. Hard to believe this can be the case in a field where we treat cancer patients…

 

[fiji128]

I know something about this, abuse is not working long hours and things like that (which don't get me wrong can suck) but rather a program where residents are harassed, bullied and generally terrorized by attendings. These types of places still exist, guaranteed. It's really hard to pick up on this on the interview day but if you hear the people working there bad mouthing the place that could be a give a away. Once you are in a program not much you can do about it besides hold your head down as the whole system is geared to protecting programs and hospitals and not the residents (despite whatever the ACGME may claim), except maybe in the most egregious of cases.

 

[Reaganite]

I would just caution you to be very careful Who you talk and complain to. When I was training many years ago our GME made it sound like any complaints were anonymous and I had definite concerns about my program. Of course everything I said was not kept confidential. I was however in very good standing and my concerns were legitimate so the pay back so to speak was subtle. There is a lot to consider when reporting a program. I will tell you the whole process made me very aware how little we actually mean to our directors. They really don't give a **** about us. We are free labor bottom-line

 

[nkmiami]

Just to play devils advocate- was an attending at a very non-malignant program and certainly had some residents with no interest in the field who complained just about everything. When all is said and done, I dont think they save time/free labor either, when you factor in teaching and having to go to daily/weekly resident lectures etc.

 

[evilbooyaa]

Just to play devils advocate- was an attending at a very non-malignant program and certainly had some residents with no interest in the field who complained just about everything. When all is said and done, I dont think they save time/free labor either, when you factor in teaching and having to go to daily/weekly resident lectures etc.

You mean Rad Onc residents who had 0 interest in the field? What does that mean?

 

[nkmiami]

Regarding malignant faculty- Programs can be staffed by faculty whose behavior would not be tolerated in the outside world, either because they are rude to referring docs, are "teflon"- get out of doing consults/treatments/only see new consults one day a week, or exhibit bizzare time consuming idiosyncrasies- I remember one "DCIS expert" from medical school who would insist that his resident track down the past 5 years of mammograms, and another who took days to review scans and come up with a treatment plan for a simple bone met.

 

[seper]

Good stories. I'll add that I know firsthand of a program, where a faculty member punched a medical student in the face.

 

[RSAOaky]

I think it all goes both ways. Being a resident in a competitive field is a privilege. Similarly, being an attending with resident coverage is also a privilege. As soon as either side of the equation starts to take that for granted things go awry. Unfortunately that can be a balance that is often difficult to find, and in such a small field where we work so closely with one another small perturbances can have big effects. One unhappy resident or attending can be disastrous for a small program and can make everyone's life miserable.

I think it's variable how much time residents save and how much attendings rely on them. I know attendings that could not survive a week without a resident, and when they don't have coverage all hell breaks loose. I also know residents that are of...limited used.

 

[maimodo]

If you feel that your program is abusive, fill out the ACGME surveys honestly.

In Maimonides Medical Center Surgery program, they abuse the residents both physically and mentally. No one complains about the hours even when they work 120hrs/week. The program attendings on multiple occasions have threatened the residents that they will be fired or be retaliated against if they talk to ACGME. They are told they will lose their spot. So how can anyone do anything in such environment?

 

[Chartreuse Wombat]

If true- a credible complaint with evidence to the ACGME Surgery RRC can close the place down within a few weeks. It has happened before.

A difficult choice for a resident perhaps (losing a spot is worrisome) but evidence of retaliation would compound the problem for the institution.

I suspect that many programs would view a whistleblower in this context as someone with integrity and perhaps even courageous. There are several examples of medical students and residents standing up for what is right. Assuming the statements above are true and can be substantiated- the residents have no one to blame but themselves.

 

[Haybrant]

Makes you wonder when we'll start seeing these harassment accusations against physicians. We know baby boomers have a lot of dirtbags that have run wild and there is no doubt that thousands of Med students and residents have been harassed by them abusing their power. PRobably more in surgery than elsewhere but no doubt it will be everywhere. That generation that continues to try and screw our generation over is not clean and where there is smoke there is fire.

 

[seper]

Don't worry - the new generation is graduating from college and will kick us out from our well paid jobs pretty soon.

 

[Mandelin Rain]

I would think the the instances of outright abuse/malignancy i.e. public humiliation/shaming, screaming, hitting, punching, kicking, throwing objects, sexual harassment, etc... is likely low in this field, relative to others.

However, there is the more insidious "malignancy" (for lack of a better term) by which a program allows it's staff to shirk their duty to, or employs staff simply unable to, educate. That's the real crime about some of these programs. You get 4 years to become proficient in the practice of radiation oncology. During this time you usually work longer hours, live some place you really don't want to live, stay broke, etc.... for the carrot of clinical training and career mentorship. I'd much rather be kicked in the shin monthly by some maniac who otherwise provides an excellent clinical education than treated with gross indifference as long as my dictations are timely.

 

[OTN]

I would think the the instances of outright abuse/malignancy i.e. public humiliation/shaming, screaming, hitting, punching, kicking, throwing objects, sexual harassment, etc... is likely low in this field, relative to others.

However, there is the more insidious "malignancy" (for lack of a better term) by which a program allows it's staff to shirk their duty to, or employs staff simply unable to, educate. That's the real crime about some of these programs. You get 4 years to become proficient in the practice of radiation oncology. During this time you usually work longer hours, live some place you really don't want to live, stay broke, etc.... for the carrot of clinical training and career mentorship. I'd much rather be kicked in the shin monthly by some maniac who otherwise provides an excellent clinical education than treated with gross indifference as long as my dictations are timely.

STRONGLY agree with this. It drove me crazy in residency when I would do all the work for an attending but get no teaching in return. That's the deal: I do the crap work, you teach. Some attendings just refused to care.

 

[thecarbonionangle]

Problem lies in the way academic departments are run. Attendings are kept around for "publications", many are written by residents and medical students. Its all cheap labour. Some are good teachers and care about education but a significant portion of them could care less, most pay lip service to the commitment. Many people went into academics so they could enjoy the benefits of residency coverage. There is a significant number of "academic" programs where residents are quietly unhappy about didactics and teaching (see the survey in Red Journal) and wish for significant improvements. These are all just private practices camouflaged as residency programs. What are residents to do in these situations? very little, unfortunately. You can write a bad eval, complain to Chair/PD who likely cares little about what you think, the ACGME survey and get your program in trouble and shoot yourself in the foot further? If there is something this expansion issue continues to show us is how little people care about the plight of residents and how Chairs just care about the bottomline and filling the pockets. Every year seems like more revised talks and projections and zero action, continued expansion by our "leaders"

 

[deleted18755]

Problem lies in the way academic departments are run. Attendings are kept around for "publications", many are written by residents and medical students. Its all cheap labour. Some are good teachers and care about education but a significant portion of them could care less, most pay lip service to the commitment. Many people went into academics so they could enjoy the benefits of residency coverage. There is a significant number of "academic" programs where residents are quietly unhappy about didactics and teaching (see the survey in Red Journal) and wish for significant improvements. These are all just private practices camouflaged as residency programs. What are residents to do in these situations? very little, unfortunately. You can write a bad eval, complain to Chair/PD who likely cares little about what you think, the ACGME survey and get your program in trouble and shoot yourself in the foot further? If there is something this expansion issue continues to show us is how little people care about the plight of residents and how Chairs just care about the bottomline and filling the pockets. Every year seems like more revised talks and projections and zero action, continued expansion by our "leaders"

I've been in private practice for awhile now but this has been true for a long time (seems like much worse now). What I've seen recently and is even more sad is a private practice being acquired by an academic center and the physician who is there is kept on and his salary is decreased but he is told "sure you're salary is lower but you now have stability being under the umbrella of the university/academic center plus we will 'give' (as if they are property of the Chairperson or Program Director) you a brilliant young resident who will greatly increase your quality of life and lifestyle."

You think you've seen some indifferent or ineffective "teachers" at academic centers? God help the poor resident who thinks he is going to get a good education from a dude who has made it very clear since graduation that he has no interest in teaching and has in fact been in private practice for 25+ years but suddenly is forced to join an academic center, given the title of "clinical instructor" and "given" full resident coverage. So, so sad, but I see this only getting more common and the "leaders" in our field couldn't care less.