Coronavirus: Residents being told to work in DIFFERENT specialty

[chemsmith]

None of us want to do inpatient medicine. I have yet to meet anyone besides IM docs (and sometimes not even them) who want to do inpatient medicine. But in a national emergency, there is no want. Our IM colleagues will be needed in the ED and the ICU and they'll be overworked and flooded with patients. We have to help, the same way we would want help if our specialty suddenly dealt with some emergency. Even if there is no legal way for them to force you to do it, to challenge your program on this will likely result in problems between you and them for the duration of your residency.

That said, if you have some health concern for yourself or your spouse or kids, you may be able to find a way around it if you're so inclined. I know a resident who's a single mom who cares for her elderly mother and her daughter with asthma. She will be among the very last called to help, if at all, unless she can find alternative living arrangements for herself and insure her mother and daughter can get along without her.

I will argue that there is want. Layman hoarders who have no routine contact with the sick wanted N95 masks, and they got them. Hospitals want their indentured employees to work without adequate PPE to keep things running, and they are getting their wish. I never subscribed to the physician-as-martyr trope and I will not start now, national emergency or not.

---

Members don't see this ad.

 

[Mass Effect]

I will argue that there is want. Layman hoarders who have no routine contact with the sick wanted N95 masks, and they got them. Hospitals want their indentured employees to work without adequate PPE to keep things running, and they are getting their wish. I never subscribed to the physician-as-martyr trope and I will not start now, national emergency or not.

If your question is can anyone literally force you to work on medicine, the answer is of course not. But I interpreted your question as whether or not you can refuse to work on medicine by telling your program you don't want to. The answer to that is that while they cannot force you (as no one can force anyone to do anything), don't think for a second that won't affect your relationship with the program. For now, I've only heard of hospitals asking for volunteers. So don't volunteer. I haven't. But it may get to the point that it's mandatory. Just as the layman hoarders got backlash, the expectation of employees working without PPE got backlash, I think refusing to work (assuming you have PPE and it's what they determine is mandatory) because you don't "want" to will also trigger backlash by your PD. If you have a reason besides "want" for not working medicine, that's different as I mentioned above. But telling your hospital you don't want to work medicine if it really does become a dire emergency is not going to go over well.

 

[rokshana]

I will argue that there is want. Layman hoarders who have no routine contact with the sick wanted N95 masks, and they got them. Hospitals want their indentured employees to work without adequate PPE to keep things running, and they are getting their wish. I never subscribed to the physician-as-martyr trope and I will not start now, national emergency or not.

This is what I am questioning; can they really? Do they actually have that power?

Yes they do...and unlike an attending that can decide to quit...they can find another job...as a resident , if you are dismissed from a residency, it can be difficult to find another one...effectively you career could be over.

If there is danger or over duty hours, you may appeal to the ACGME, but in a national emergency and a pandemic , not sure how much they will hold to things.

Most likely you would not be expected to take care of covid pts or even icu pts... but certainly can triage and do simple admissions which then will free up those residents...IM, FM,EM,etc to be able to be assigned to where they can be

You can certainly refuse, but not without consequences...if you are willing to accept the consequences of your actions, then do that.

 

[chemsmith]

If your question is can anyone literally force you to work on medicine, the question is of course not. But I interpreted your question as whether or not you can refuse to work on medicine by telling your program you don't want to. The answer to that is that while they cannot force you (as no one can force anyone to do anything), don't think for a second that won't affect your relationship with the program. For now, I've only heard of hospitals asking for volunteers. So don't volunteer. I haven't. But it may get to the point that it's mandatory. Just as the layman hoarders got backlash, the expectation of employees working without PPE got backlash, I think refusing to work (assuming you have PPE and it's what they determine is mandatory) because you don't "want" to will also trigger backlash by your PD. If you have a reason besides "want" for not working medicine, that's different as I mentioned above. But telling your hospital you don't want to work medicine if it really does become a dire emergency is not going to go over well.

You make it sound like "want" is an arbitrary and superficial desire to its own end. The reasons you listed "besides want" are valid for everybody; special circumstances are not necessary. This is a potentially lethal virus - everyone has a right to be concerned for their own personal safety and the safety of their families - not just single mothers with elderly co-inhabitants. No one should feel guilty or selfish for not wanting to jump in from the sidelines on this one. My question was not whether "want" alone is a justification for not working in this scenario - I was really just wondering if drafting residents into another specialty was a technically enforceable action which I think you have answered that it is most likely not. My reasons are sound, and if there is "backlash" it certainly isn't going to come from my PD who has demonstrated in exemplary fashion that resident safety is a top priority during this time.

 

[rokshana]

You make it sound like "want" is an arbitrary and superficial desire to its own end. The reasons you listed "besides want" are valid for everybody; special circumstances are not necessary. This is a potentially lethal virus - everyone has a right to be concerned for their own personal safety and the safety of their families - not just single mothers with elderly co-inhabitants. No one should feel guilty or selfish for not wanting to jump in from the sidelines on this one. My question was not whether "want" alone is a justification for not working in this scenario - I was really just wondering if drafting residents into another specialty was a technically enforceable action which I think you have answered that it is most likely not. My reasons are sound, and if there is "backlash" it certainly isn't going to come from my PD who has demonstrated in exemplary fashion that resident safety is a top priority during this time.

Want IS arbitrary...NEED is not.

Frankly, no, “want” is not a valid reason...you really think the pregnant attending or the ED doc with DM “wants” to be at work and then go home and expose their family??

If you are the only or one of the few that says I’m not coming to work, then your PD will act accordingly...you may think he is your friend, but when policy/emergency directives say to him, utilize your residents, he is not going to risk his job for you.

Again, you want to drop out from working, it’s ultimately your choice, but there could be consequences...and for a resident that, worst case scenario, it the end of your medical career.

 

[twospadz]

Yeah, in NYC hospitals they (hospital leadership) have taken away (canceled) all resident and employee (nurse, tech, etc) vacations and leaves, saying we are all essential employees. So, no one has any vacation time coming up, its been rescinded.

And they (NYC programs / hospitals) are working with ACGME now to allow 4th year med students to start residency earlier, especially with all the travel restrictions and foreign grads may not even be able to start July 1.

"But if the number of cases continues to rise, it is possible that graduating students could start seeing patients — though not necessarily ones with the virus — even before their residencies are scheduled to begin in July.​

“It could be not even a week or two before we have to sweep away some of those restrictions,” Dr. Muller said."​

Coronavirus in N.Y.: ‘Deluge’ of Cases Begins Hitting Hospitals​

​

Also, many states now are suspending restrictions (ie months of paperwork) on obtaining a state license, and are speeding up the process so docs and other allied professions can start working quicker and be licensed (florida, west virginia, etc)

Huh. I work in NYC. My vacation time hasnt been rescinded. But then again Im psychiatry so i dont know. I was supposed to have mine in March but pushed it back to May on my own accord.

 

[chemsmith]

Want IS arbitrary...NEED is not.

Frankly, no, “want” is not a valid reason...you really think the pregnant attending or the ED doc with DM “wants” to be at work and then go home and expose their family??

If you are the only or one of the few that says I’m not coming to work, then your PD will act accordingly...you may think he is your friend, but when policy/emergency directives say to him, utilize your residents, he is not going to risk his job for you.

Again, you want to drop out from working, it’s ultimately your choice, but there could be consequences...and for a resident that, worst case scenario, it the end of your medical career.

Haha, SDN never fails with the dramatics and doomsaying. My whole point is that there is no policy/emergency directive to warrant this. I'm looking for rational arguments, not emotional hyperbole. This thread is cancelled.

 

[Mass Effect]

You make it sound like "want" is an arbitrary and superficial desire to its own end. The reasons you listed "besides want" are valid for everybody; special circumstances are not necessary. This is a potentially lethal virus - everyone has a right to be concerned for their own personal safety and the safety of their families - not just single mothers with elderly co-inhabitants

No one has said you don't have a right to be concerned, but you will not be admitting Covid patients. You will be helping out on medicine services so that medicine residents can help where they are actually needed - with Covid patients. You will be admitting CHF exacerbations, cancer patients, non-Covid flu or pneumonia patients, COPD patients, trauma patients, SBO patients, etc. No one is going to understand why a doctor is refusing to admit the above patients in a pandemic.

My question was not whether "want" alone is a justification for not working in this scenario - I was really just wondering if drafting residents into another specialty was a technically enforceable action which I think you have answered that it is most likely not

Where did I say it most likely is not?

 

[Mass Effect]

Haha, SDN never fails with the dramatics and doomsaying. My whole point is that there is no policy/emergency directive to warrant this. I'm looking for rational arguments, not emotional hyperbole. This thread is cancelled.

If you want a rational argument, here's one. Look up what happened in Italy and proceed at your own risk.

 

[RangerBob]

Haha, SDN never fails with the dramatics and doomsaying. My whole point is that there is no policy/emergency directive to warrant this. I'm looking for rational arguments, not emotional hyperbole. This thread is cancelled.

Your program is your boss. It's a national emergency. You do what they say. It's really a simple as that. Rokshana's statement is absolutely not hyperbole.

I, even as a rehab physician, can legally do surgery. So can a pathologist. Typically there are plenty of far more qualified people to do it though, and people that insurers will cover. But in national emergencies, people do things outside their scope of practice because they're the best one for the job.

I do not want to treat inpatient medicine patients. However, it is my moral and ethical duty to do so if required. It's not about policy. We are physicians, and if this thing continues to get worse, as we expect, we're going to need all hands on deck. Our surgeons are learning vent management. Hospitalists who only work the floor are learning to manage vents and treat ICU patients. Psychiatrists--well they'll likely have plenty of work within their scope with all the panic... My outpatient PM&R colleagues are being asked to help manage the inpatient units, and they're also refreshing up their inpatient medicine skills.

We are all going to be working outside our comfort zone. If I were a resident, I'd be nervous to be co-opted to treat COVID patients. And I'm nervous if the hospital asks me to do it now. But I will do it if I'm needed. Because if we're being asked, then it means things are really hitting the fan, and your brothers and sisters in humanity need your help.

 

[rokshana]

Haha, SDN never fails with the dramatics and doomsaying. My whole point is that there is no policy/emergency directive to warrant this. I'm looking for rational arguments, not emotional hyperbole. This thread is cancelled.

You think so? Go read the many many threads on residents dismissed from their programs for a lot less than refusing to work during a pandemic.

That goes in your letter or statement from your PD...you will be nothing short of a pariah.

Can’t wait til your post in a few months...I was dismissed from my residency after the pandemic because I refused to work...what can I apply for?

 

[hallowmann]

Haha, SDN never fails with the dramatics and doomsaying. My whole point is that there is no policy/emergency directive to warrant this. I'm looking for rational arguments, not emotional hyperbole. This thread is cancelled.

I think you are missing the point here. Does your contract list every single one of your clinical duties or even your required rotations? Mine doesn't. You are a trainee. If your program wants to add a new requirement of 2 rotations of internal medicine, they can do it whenever they want as long as it doesn't (1) extend your training, and (2) affect your ability for board certification. They can take away elective time or count it as other types of credit.

My program requires X amount of a certain procedure. If I don't meet them, I don't graduate and have to extend training, and in order to avoid that, they can force me to stay on doing a rotation outside of my specialty that gives me those procedures or use elective time for it. Neither the ACGME nor my specialty boards require an X number of that procedure, but because my program does, I have to fulfill it in order to satisfactorily complete residency training.

You are acting like the rules are not made by your program. The RRCs and ACGME gives programs a broad range of ways in which to manage your training. If that means drafting you to cover IM patients, that's what that means. Obviously no one can "force" you to do anything you don't want, but they could certainly force you to take an LOA or extend training or even dismiss you if you refuse to work.

 

[chemsmith]

You think so? Go read the many many threads on residents dismissed from their programs for a lot less than refusing to work during a pandemic.

That goes in your letter or statement from your PD...you will be nothing short of a pariah.

Can’t wait til your post in a few months...I was dismissed from my residency after the pandemic because I refused to work...what can I apply for?

I'm quaking in my boots.

 

[chemsmith]

I think you are missing the point here. Does your contract list every single one of your clinical duties or even your required rotations? Mine doesn't. You are a trainee. If your program wants to add a new requirement of 2 rotations of internal medicine, they can do it whenever they want as long as it doesn't (1) extend your training, and (2) affect your ability for board certification. They can take away elective time or count it as other types of credit.

My program requires X amount of a certain procedure. If I don't meet them, I don't graduate and have to extend training, and in order to avoid that, they can force me to stay on doing a rotation outside of my specialty that gives me those procedures or use elective time for it. Neither the ACGME nor my specialty boards require an X number of that procedure, but because my program does, I have to fulfill it in order to satisfactorily complete residency training.

You are acting like the rules are not made by your program. The RRCs and ACGME gives programs a broad range of ways in which to manage your training. If that means drafting you to cover IM patients, that's what that means. Obviously no one can "force" you to do anything you don't want, but they could certainly force you to take an LOA or extend training or even dismiss you if you refuse to work.

My contract does list my clinical duties, I'm sorry if yours does not. I'm also sorry that your program requires you to perform procedures not required by your speciality board. And do you have a source for your claim that the ACGME gives programs the right to radically alter resident training? That is what I am after - real citations of policy or precedent for such an action, not impotent, submissive fearmongering with no factual basis.

 

[GoSpursGo]

My contract does list my clinical duties, I'm sorry if yours does not. I'm also sorry that your program requires you to perform procedures not required by your speciality board. And do you have a source for your claim that the ACGME gives programs the right to radically alter resident training? That is what I am after - real citations of policy or precedent for such an action, not impotent, submissive fearmongering with no factual basis.

LMGTFY - Let Me Google That For You

For all those people who find it more convenient to bother you with their question rather than to Google it for themselves.

lmgtfy.com

ACGME Response to the Coronavirus (COVID-19)

ACGME President and CEO tells the graduate medical education community which ACGME activities are being suspended to allow the GME community to focus on patient care during the COVID-19 pandemic. Visit this section for updated guidance and information.

acgme.org

I think they're being intentionally vague, but the part under impact on clinical volume seems relevant: "The ACGME recognizes that institutions have reduced the volume of their elective visits and procedures and have redeployed residents to support the critical services of the hospital as a result of the COVID-19 pandemic." At a minimum seems to recognize that measures to "radically alter resident training" may be required.

This is a classic argument of whether residents are "learners" or "employees." I think in practice, the answer is usually "whichever is worse for the residents," so in this case you're probably stuck doing whatever your hospital tells you to do. That statement certainly doesn't sound like the ACGME is going to do anything about it--heck, they're not even going to take your feedback survey!

 

[Smurfette]

My contract does list my clinical duties, I'm sorry if yours does not. I'm also sorry that your program requires you to perform procedures not required by your speciality board. And do you have a source for your claim that the ACGME gives programs the right to radically alter resident training? That is what I am after - real citations of policy or precedent for such an action, not impotent, submissive fearmongering with no factual basis.

Per ACGME's 3/11 statement:
"Rotations
Over the next several months there may be significant pressures on the health care system. The ACGME recognizes that patients must be cared for and that exigent circumstances may require residents/fellows to be redeployed to meet the needs of patients. Significant changes in resident/fellow education of more than four weeks in duration should be reported to the Executive Director of the applicable Review Committee. "

 

[hallowmann]

My contract does list my clinical duties, I'm sorry if yours does not. I'm also sorry that your program requires you to perform procedures not required by your speciality board. And do you have a source for your claim that the ACGME gives programs the right to radically alter resident training? That is what I am after - real citations of policy or precedent for such an action, not impotent, submissive fearmongering with no factual basis.

Obviously others have posted pretty clear statements by the ACGME for this pandemic, but also:

Per the RadOnc ACGME Requirements:

"While programs must demonstrate substantial
compliance with the Common and specialty-specific Program Requirements, it is
recognized that within this framework, programs may place different emphasis on
research, leadership, public health, etc."

Read it for yourself. While it has some very specific minimum requirements, it does not preclude the program from separately requiring you to do other rotations. As long as it doesn't exceed 12 mos during the 48 month PGY2-5 period, they can do whatever they want. The language is purposefully vague to allow programs autonomy in how they structure the curriculum. Like I said, they could easily take away an elective and replace it with medicine if they wanted.

Also can you be a bit more specific about how your contract lists clinical duties? Unless it describes it as an exhaustive list, chances are there's a lot more leeway there than you're implying. I also wouldn't be surprised if a lot of it is equally as vague as a lot of the RRC document.

 

[LucidSplash]

Here’s a rational argument: good luck getting a job without recommendations from your residency when you’re done. Even your first job will ask for references. If you refuse to help out when national public health crisis demands it, and they don’t fire you, I’m not sure you can expect their help getting a job when you’re done.

I’m a hospital-employed surgery attending. I have no compunctions about helping where needed as my skills allow. But if I did, it is the same deal. Would be pretty tough to explain leaving a job because I was asked to work in the ICU or with medicine patients during a national emergency and I refused. Doubt I’d be able to find a job again.

You may want to argue the semantics of whether a resident is a student or an employee. Whatever. Last I checked you were a doctor. As far as I know, most medical schools still have graduates recite the Hippocratic oath. It may not be legally binding but you’ll be hard-pressed to find professional colleagues to support you for walking off a job in the middle of this pandemic. You may want to refamiliarize yourself with the Hippocratic oath.

 

[FlowRate]

My contract does list my clinical duties, I'm sorry if yours does not. I'm also sorry that your program requires you to perform procedures not required by your speciality board. And do you have a source for your claim that the ACGME gives programs the right to radically alter resident training? That is what I am after - real citations of policy or precedent for such an action, not impotent, submissive fearmongering with no factual basis.

Funny enough, something people should look for in IM residencies is being required to do procedures not required by the specialty board. Turns out ABIM doesn't require much.

But I'm just being facetious.

 

[Piebaldi]

Yeah, in NYC hospitals they (hospital leadership) have taken away (canceled) all resident and employee (nurse, tech, etc) vacations and leaves, saying we are all essential employees. So, no one has any vacation time coming up, its been rescinded.

And they (NYC programs / hospitals) are working with ACGME now to allow 4th year med students to start residency earlier, especially with all the travel restrictions and foreign grads may not even be able to start July 1.

"But if the number of cases continues to rise, it is possible that graduating students could start seeing patients — though not necessarily ones with the virus — even before their residencies are scheduled to begin in July.​

“It could be not even a week or two before we have to sweep away some of those restrictions,” Dr. Muller said."​

Coronavirus in N.Y.: ‘Deluge’ of Cases Begins Hitting Hospitals​

​

Also, many states now are suspending restrictions (ie months of paperwork) on obtaining a state license, and are speeding up the process so docs and other allied professions can start working quicker and be licensed (florida, west virginia, etc)

That's interesting re: the allowing of 4th year med students allowing to start earlier and getting rid of the onerous paperwork - I wonder if that will make things change in the future regarding paperwork, licensing, etc?

 

[siliso]

I’m detailed to 7 12s in the ED starting tomorrow, so. We’re in this together.

I didn’t ask anyone if I could be legally forced to do this. Have some team spirit...it’s game time okay? Solidarity to all.

 

[evilbooyaa]

I will argue that there is want. Layman hoarders who have no routine contact with the sick wanted N95 masks, and they got them. Hospitals want their indentured employees to work without adequate PPE to keep things running, and they are getting their wish. I never subscribed to the physician-as-martyr trope and I will not start now, national emergency or not.

I'm with you when you said "I don't want to work inpatient medicine without appropriate PPE for the clinical situation". Doesn't mean N95 on every outpatient, but I think a surgical mask throughout the day is reasonable.

I'm not with you when you say "Even if I am provided appropriate PPE I refuse to do inpatient medicine, as a resident".


The vast, vast likelihood is that you are not going to be pulled to do inpatient medicine work. Slightly higher chance if you live in a hotbed - Seattle, NYC, SF.

It will look bad if you are adamant and say no, and may influence your ability to get a job. I don't foresee them firing you for it but could put you under the microscope.

I would worry about this only when push comes to shove and you are expected to go do inpatient admissions.

 

[anonperson]

I'm quaking in my boots.

The general consensus is that programs have leeway, especially in the current situation.

If your PD tells you that you're needed in an capacity not related to your specialty , are you really going to print out that specific part of the contract and waive it in their face?

Give me a break.

Hypothetically, let's say that works. You don't help out and are kept on service because of a contract stipulation, do you think your program won't find a way to fire you in the future?

Any resident can be nit picked to death and have enough of a paper trail to be fired if you anger the wrong people. Doesn't matter how good you think you are.

Also, in the real world when out in practice, physicians do happen to remember when other physicians leave them hanging and screw them over. You think they're referring patients to you?

If a d bag needs a call covered etc, you think I'm going out of my way to help them out?

 

[calvinhobbes]

Hey just an update: as of today in my hospital in NYC, the Peds Service is seeing ALL patients 30 and under (for floor and ICU) because of surge and need of beds. The Peds ER is seeing all age groups.

 

[calvinhobbes]

We are also very short on masks and are being told to re-use masks (N95s are almost non-existent, so surgical masks are being re-used from patient to patient) —but I’m sure you all already heard that. Wishing everyone luck during these uncertain times, and hope the fed government gets their **** together!

 

[calvinhobbes]

NYU med students may graduate early (article from CNN today)...maybe other school will follow, too:

 

[Matthew9Thirtyfive]

NYU med students may graduate early (article from CNN today)...maybe other school will follow, too:

USUHS is doing the same thing.

 

[sunsta]

Are Fellows that are deployed to be Staff in Medicine, will they be compensated more as they are working more hrs as a hospitalist.. And how often would they get off.

 

[calvinhobbes]

Are Fellows that are deployed to be Staff in Medicine, will they be compensated more as they are working more hrs as a hospitalist.. And how often would they get off.

Not sure as it varies, in my hospital GI fellows are taking calls on medicine floor bc IM needs the help (many quarantined residents, burn-out, etc). I know that if you work through your vacation that has been cancelled, you will be compensated extra. Not sure about specifics for fellows though.

 

[chemsmith]

The general consensus is that programs have leeway, especially in the current situation.

If your PD tells you that you're needed in an capacity not related to your specialty , are you really going to print out that specific part of the contract and waive it in their face?

Give me a break.

Hypothetically, let's say that works. You don't help out and are kept on service because of a contract stipulation, do you think your program won't find a way to fire you in the future?

Any resident can be nit picked to death and have enough of a paper trail to be fired if you anger the wrong people. Doesn't matter how good you think you are.

Also, in the real world when out in practice, physicians do happen to remember when other physicians leave them hanging and screw them over. You think they're referring patients to you?

If a d bag needs a call covered etc, you think I'm going out of my way to help them out?

No, I don't think my program will fire me, they are just as dependent on resident labor as the rest of the hospital. It sounds like what you and posters above you are alluding to is retaliation - just because this has been an acceptable practice in medicine in the past (and it may still be the case in your practice) it does not mean that everyone will bend over so willingly to do things they are not comfortable with. I feel bad for everyone on here posting fearmongering about this level of retaliation towards residents who stand up - you must have have experienced significant malignancy during training to resign to this line of thinking.

And 2011 called, they want their meme back.

 

[Piebaldi]

No, I don't think my program will fire me, they are just as dependent on resident labor as the rest of the hospital. It sounds like what you and posters above you are alluding to is retaliation - just because this has been an acceptable practice in medicine in the past (and it may still be the case in your practice) it does not mean that everyone will bend over so willingly to do things they are not comfortable with. I feel bad for everyone on here posting fearmongering about this level of retaliation towards residents who stand up - you must have have experienced significant malignancy during training to resign to this line of thinking.

And 2011 called, they want their meme back.

I doubt they would fire residents at this time - with the massive drop income across the globe and industry in general, healthcare is one of the few industries holding on - even if barely. and given that residents/fellows get paid a pittance, it's one of those situations where losing a physician that can provide services for a minimal cost - even if a resident/fellow - would be more detrimental than helpful.

 

[GoSpursGo]

It sounds like what you and posters above you are alluding to is retaliation

As has been pointed out several times, there is broad consensus that programs can reassign residents (and attendings) into whatever capacity is needed during a crisis. If they close down the service you're supposed to be on and tell you to go staff COVID patients, and you say, "Nah I'm gonna stay home," then if they fire you it's not "retaliation," it is an entirely foreseeable outcome from choosing not to do your assigned duties. They're not going to pay you to sit on your butt if you could be doing something to help and you're choosing not to.

Good for you that it seems that you're in a part of the country where COVID isn't blowing up to the point where they're desperate enough to ask for help from specialties that are non-clinical. I hope it stays that way. But if it does get to that point, I don't think it would be wise to test your theory on whether or not they can make you come to work.

 

[NITRAS]

Look, chemsmith, I hope things go well for you. I really do, but don't think that your program is so dependent on "resident labor" that they wouldn't fire you. Lots of people will see refusing to do something that a reasonable physician thinks you could do in an emergency situation is paramount to violating basic principles of being a physician.

Different places have different situations, of course. I'm not judging your situation, but realize that your PD will be.

 

[anonperson]

No, I don't think my program will fire me, they are just as dependent on resident labor as the rest of the hospital. It sounds like what you and posters above you are alluding to is retaliation - just because this has been an acceptable practice in medicine in the past (and it may still be the case in your practice) it does not mean that everyone will bend over so willingly to do things they are not comfortable with. I feel bad for everyone on here posting fearmongering about this level of retaliation towards residents who stand up - you must have have experienced significant malignancy during training to resign to this line of thinking.

And 2011 called, they want their meme back.

The meme is on point

Also, Lol for thinking residents are not replaceable.

They may not fire you, but don't think if they asked you to help out and you refused because of contractual language there wouldn't be some type of repercussion.

 

[LucidSplash]

No, I don't think my program will fire me, they are just as dependent on resident labor as the rest of the hospital. It sounds like what you and posters above you are alluding to is retaliation - just because this has been an acceptable practice in medicine in the past (and it may still be the case in your practice) it does not mean that everyone will bend over so willingly to do things they are not comfortable with. I feel bad for everyone on here posting fearmongering about this level of retaliation towards residents who stand up - you must have have experienced significant malignancy during training to resign to this line of thinking.

And 2011 called, they want their meme back.

Re: retaliation. I don’t know that everyone here is saying that “retaliation” is acceptable. I see more people describing to you what is reality. Obviously no one thinks you should be put into an unsafe situation without appropriate PPE. I have told my resident that if we are consulted on a patient + or presumptive + for COVID19, he is not to go into the room unless there’s some kind of life-threatening hemorrhage going on that needs pressure held. I only have one rotating through at a time, and it doesn’t make sense to me to put him at risk when I have to see the patient anyway. Downtown at the mothership the situation is a little different at the moment. But we still have enough PPE on hand if we are judicious. So I’ll back you if you don’t have appropriate PPE.

But if I was evaluating a new partner to join the group and it came to light that they had refused to help out across specialty lines during this crisis just because they were asked to act in an area not strictly within their specialty, I wouldn’t want them as a partner because their ethics and values would not match my own in a way necessary for a good partnership. I think many physicians would feel the same way. Maybe you see that as “retaliation” but I do not.

I really do wish you the best. I think most people here are trying to tell you how the world IS, not suborning retaliation or abuse. You’ll make your own choices as we all will.

 

[chemsmith]

Re: retaliation. I don’t know that everyone here is saying that “retaliation” is acceptable. I see more people describing to you what is reality. Obviously no one thinks you should be put into an unsafe situation without appropriate PPE. I have told my resident that if we are consulted on a patient + or presumptive + for COVID19, he is not to go into the room unless there’s some kind of life-threatening hemorrhage going on that needs pressure held. I only have one rotating through at a time, and it doesn’t make sense to me to put him at risk when I have to see the patient anyway. Downtown at the mothership the situation is a little different at the moment. But we still have enough PPE on hand if we are judicious. So I’ll back you if you don’t have appropriate PPE.

But if I was evaluating a new partner to join the group and it came to light that they had refused to help out across specialty lines during this crisis just because they were asked to act in an area not strictly within their specialty, I wouldn’t want them as a partner because their ethics and values would not match my own in a way necessary for a good partnership. I think many physicians would feel the same way. Maybe you see that as “retaliation” but I do not.

I really do wish you the best. I think most people here are trying to tell you how the world IS, not suborning retaliation or abuse. You’ll make your own choices as we all will.

I think it is a stretch to say that the objections I am raising constitute "refusal". I know when to draw the line, trust me - I have not made it this far by not knowing when to shut up and do as I'm told. But I will question directives I see as unwise or unjust. I have a good relationship with my PD - if I am requested to work on the floors I will raise my objections but when push comes to shove I will not "refuse". I also find it quite presumptuous that GME at my hospital would assume that the cancer care needs of the patients I help to treat everyday are somehow less medically urgent. We'll see - I think the likelihood that I will be drafted to the inpatient world is quite low, so I'm not sweating. I seem to have ruffled the feathers of some people in this thread who think residents should be subservient to every administrative whim - I view this as a success as well.

 

[LucidSplash]

I think it is a stretch to say that the objections I am raising constitute "refusal". I know when to draw the line, trust me - I have not made it this far by not knowing when to shut up and do as I'm told. But I will question directives I see as unwise or unjust. I have a good relationship with my PD - if I am requested to work on the floors I will raise my objections but when push comes to shove I will not "refuse". I also find it quite presumptuous that GME at my hospital would assume that the cancer care needs of the patients I help to treat everyday are somehow less medically urgent. We'll see - I think the likelihood that I will be drafted to the inpatient world is quite low, so I'm not sweating. I seem to have ruffled the feathers of some people in this thread who think residents should be subservient to every administrative whim - I view this as a success as well.

Your GME/institution is likely following national society recs on cancer care at the moment. You will likely have fewer in-house and outpt cancer patients to care for if/when the virus infections begins to peak wherever you are. Consider that before criticizing their plan. Everyone has a boss, even your boss’ boss.

Your original post in this thread cited that you didn’t want to work on inpatient floors which is why you chose your specialty and asking if they can enforce a policy to make you. That’s what I’m using as a basis for my answers to your posts. I think you’re backpedaling a little now with a more moderate response in this most recent post. But don’t pretend that’s been your clearly stated position all along and we are all being dramatic because you really meant this more moderate response all along. We aren’t mind readers.

Also kinda ridiculous to characterize the possibility of being asked to work on an inpatient floor during a national public health crisis, if there is a manpower shortage, as an institutional “whim.”

 

[smq123]

No, I don't think my program will fire me, they are just as dependent on resident labor as the rest of the hospital.

You realize that while the program is dependent on resident labor, they're not dependent on YOUR particular labor? And that there are a lot of FMGs and IMGs that would happily take your place with even less whining?

None of us are that precious that we can't be expected to lend a hand in the ER or the floors if necessary.

 

[LucidSplash]

You realize that while the program is dependent on resident labor, they're not dependent on YOUR particular labor? And that there are a lot of FMGs and IMGs that would happily take your place with even less whining?

None of us are that precious that we can't be expected to lend a hand in the ER or the floors if necessary.

I tell my resident this all the time: “I’m checked off.” Everytime they apologize because I do an H&P or consult myself because they are seeing other consults or are in the OR with my partner. Everytime I do a procedure or operation by myself because they are otherwise occupied with my partner. I am academically-affiliated because I like to teach. Not because it’s strictly necessary to have a resident to do my job. The mothership is more dependent but also there are more residents? Losing one would be a bit of a PITA, but more for the other residents than for the attendings.

 

[Neuronix]

Hospitals want their indentured employees to work without adequate PPE to keep things running, and they are getting their wish. I never subscribed to the physician-as-martyr trope and I will not start now, national emergency or not.

This is a strawman argument IMO. Has anyone heard of this actually happening?

Nobody can force you to do anything. You're not a slave. There will be no gun pointed at you.

But, why would you refuse to help care for patients to the best of your abilities with appropriate facilities and equipment to do so? What is the motivation to have this discussion about compelling you to act under penalty of losing your residency position? Let's assume you have all the PPE you need. What then? Would you still serve in the inpatient or ICU care of patients with coronavirus? If not, why not?

I'm a rad onc attending, but I would not have felt differently as a resident. We're having this same discussion in the rad onc forum, and I don't understand it at all.

 

[rokshana]

This is a strawman argument IMO. Has anyone heard of this actually happening?

Nobody can force you to do anything. You're not a slave. There will be no gun pointed at you.

But, why would you refuse to help care for patients to the best of your abilities with appropriate facilities and equipment to do so? What is the motivation to have this discussion about compelling you to act under penalty of losing your residency position? Let's assume you have all the PPE you need. What then? Would you still serve in the inpatient or ICU care of patients with coronavirus? If not, why not?

I'm a rad onc attending, but I would not have felt differently as a resident. We're having this same discussion in the rad onc forum, and I don't understand it at all.

The as usual... “ it’s not my job...”

 

[Mass Effect]

I seem to have ruffled the feathers of some people in this thread who think residents should be subservient to every administrative whim - I view this as a success as well.

Geez Louise that's a mighty big chip on your shoulder.

 

[chemsmith]

This thread is getting to be like boomer facebook but replace millennial with resident .

I'll make it easier for you guys; yes, I will be ordering an almond-milk latte as I refuse to care for your patients.

 

[VA Hopeful Dr]

This thread is getting to be like boomer facebook but replace millennial with resident .

I'll make it easier for you guys; yes, I will be ordering an almond-milk latte as I refuse to care for your patients.

You do realize that the vast majority of the people responding to you have been out of residency for less than 10 years (many less than 5 years)? We're not old and we're definitely not part of the old guard of medicine where you sacrifice everything upon the alter of being a doctor. Heck, the lifestyle is one of the reasons I went into FM to begin with.

The point that everyone is making is that being a doctor does come with some expectations. One of those is that if things get really bad, you help out where you can. I have no desire to ever set foot, professionally, into the hospital ever again. But if our hospitalists/EPs get sick and the hospital needs people to handle the easy admissions/fast track in the ED, I'd do it.

Another is that even if its not written into your residency contract, if you refuse to help out things can get very unpleasant for you. There is nothing in my contract about helping out in an emergency, but if the hospital asked and I refused they could easy make me pay for it.

 

[ThoracicGuy]

This thread is getting to be like boomer facebook but replace millennial with resident .

I'll make it easier for you guys; yes, I will be ordering an almond-milk latte as I refuse to care for your patients.

 

[Dr.LeoSpaceman]

Slight tangent: As is probably no surprise, I agree with the "Boomer" faction in this thread. However, I do think the $100b for hospitals in the stimulus should have included a CMS allocation to provide hazard pay for trainees in affected facilities.

 

[Neuronix]

Slight tangent: As is probably no surprise, I agree with the "Boomer" faction in this thread. However, I do think the $100b for hospitals in the stimulus should have included a CMS allocation to provide hazard pay for trainees in affected facilities.

I'm a millennial k thx. That's the funny part about this whole discussion. Most of the physicians advocating for physicians stepping up in this thread are barely out of training themselves.

 

[Dr.LeoSpaceman]

I'm a millennial k thx. That's the funny part about this whole discussion. Most of the physicians advocating for physicians stepping up in this thread are barely out of training themselves.

Antecdotally, the "Boomer/Millenial" dynamic exists. It's just that the breakpoint seems to be people who started training about 10 years ago or so.

 

[VA Hopeful Dr]

Antecdotally, the "Boomer/Millenial" dynamic exists. It's just that the breakpoint seems to be people who started training about 10 years ago or so.

Its almost like once you're out and practicing for a few years your perspective changes...

 

[LucidSplash]

I’m a Xennial. And I’ve been out of training less than a year. And I’m starting to think this guy is just being an ass for the fun of it now.