Fired/dismissed from residency program in 51st week

[Law2Doc]

Do you think that bias might be at least partially because the majority of residents that we all know are catagoricals?

I know about as many folks in advanced residencies as in categorical residencies.

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[45408]

No. I wonder where I said that? Reading comprehension and not making jump-the-shark presumptions will be helpful to you while in residency.

Jump the shark?

 

[Substance]

Jump the shark?

Ah yes. This could be defined as to do something that makes one lose all credibility from that point on.

It's based on an episode of Happy Days where The Fonz goes waterskiing(complete with leather jacket) and jumps over a shark as everyone watches mouths agape. That's when Happy Days lost all credibility.

Other examples include:

The Cosby Show's addition of Pam.
The entire "Who Shot JR" season of Dallas was a dream
The ending of LOST
The ending of Roseanne

etc.

 

[Gastrapathy]

and yet you are comfortable labeling a PD "devoid of compassion and class". Sounds like a similar leap in the other direction.

This debate remains totally irrelevant to the OP or his request for advice. The reason we are taking his side is HE ASKED FOR ADVICE. Its his career at stake and, as I wrote before, the blame game is completely irrelevant to him. You get to play rhetorical games on the webz and wonder about his character. He gets to play russian roulette with his livelihood. How fun.

 

[Osteoimperfecta]

This debate remains totally irrelevant to the OP or his request for advice. The reason we are taking his side is HE ASKED FOR ADVICE. Its his career at stake and, as I wrote before, the blame game is completely irrelevant to him. You get to play rhetorical games on the webz and wonder about his character. He gets to play russian roulette with his livelihood. How fun.

The ease with which folks on the thread are brushing off the magnitude of this on OP's life and career makes me very uncomfortable. I for one don't believe there is such a thing as selective compassion, you either have it or you don't.

 

[HondoCrouch]

Well hopefully he got a lawyer and has a professional handling this situation, probably did seeing as how he deleted his posts and isnt posting anymore.

Society probably has about a million bucks tied up in this guys education/training and it really shouldnt be that easy to end someones medical career.

If this guy really made it through 51 weeks with good evals and there is not adequate documentation supporting the firing any decent lawyer will get this guy credit for the year at the least.

 

[Apollyon]

The entire "Who Shot JR" season of Dallas was a dream

Those were two different storylines, with 7 years between them.

 

[Substance]

Those were two different storylines, with 7 years between them.

Good call. I had misreferenced it there. Season 8 was not the Who Shot JR season. I apologize for the error.

 

[EagerToBeMD]

Ah yes. This could be defined as to do something that makes one lose all credibility from that point on.

It's based on an episode of Happy Days where The Fonz goes waterskiing(complete with leather jacket) and jumps over a shark as everyone watches mouths agape. That's when Happy Days lost all credibility.

Other examples include:

The Cosby Show's addition of Pam.
The entire "Who Shot JR" season of Dallas was a dream
The ending of LOST
The ending of Roseanne

etc.

Not that it matters, but it wasn't the Who Shot JR season of Dallas that was a dream. That was a hit. It was the Bobby being dead season.

As a rising 4th year, I have no advice for the OP, but it really scares me that this could happen. I'm wishing you the best, OP. I agree with others who've said that unless you were a danger to patient safety or others around you, there's no reason for a program to cut you one week before the end of the year. That's just vindictive.

 

[chocomorsel]

Where in this thread did you guys figure out this danger OP poses to patients? I guess you can make some type of 3 step argument how arguing with the chief will eventually kill a patient, but jeez guys! From what I gather this is simply a case where OP clashed with the wrong people and got canned. I dare say OP will still be on staff if he was nice to the chief resident and PD while arguing constantly with patients(which is very common btw). We all know the prelim intern about to go start derm/rads/optho or whatever else is not popular among internal med folks is not on anyone's favourites list. But firing on the last week of the year? You have to have a better reason than what OP described IMO. We exploit the argument of patient safety way too much. There was a time when physicians physically abused trainees and hid behind this same argument. It is time we call it what it is.

Amen, hallelujah, praise the Lord. Couldn't say it better myself. So many people in these threads always take the holier than though attitude as if they've never had disagreements with others. I've been in a similar situation and was placed on remediation for 6 good/long months. At least I knew to learn to shut up and smile even though I don't agree that it's ok to be treated like crap/talked to any kind of way just because I am a resident. Last I checked I was a grown woman not some idiot child but in residency you gotta deal with some **** that you wouldn't have to in the real world all in the name of what? I have yet to figure out. And they love to throw out the whole "professionalism" into it when it doesn't agree with them.

At least I got the talking to which I may/may not have agreed with and the lovely remediation to teach me to keep my mouth shut. There's my insight. Right or wrong, keep your disagreements to yourself is what I learned. This guy/gal got the shaft without any form of remediation/probation/repetition, nada. That right there is cause enough for appeal, even though most times these things do not go in our favor.

Good luck OP.

 

[chocomorsel]

I agree there's some circular reasoning, but I disagree that the other possibility you cite is "equally likely". Doing nothing is what a PD normally does in week 51 to get rid of a prelim. And he goes away in 1 weeks time. The inertia to do something is simply not there. You have to do something significant to create the kind of inertia to start what clearly is going to involve the PD in an appeals process and maybe subsequent legal or ACGME inquiry for months to come. So yeah, the punishment here suggests the crime. There simply has to be more to this story. The OPs lack of insight in having been warned, and his 3pm the record complaints support this notion as well.

As far as the process being frightening in terms of complaints and being judged by your seniors, I absolutely agree. Some nasty nurse who doesn't like how you snapped at her at 3am can put something in your permanent record. Which is why you learn quick to play nice. Most residents will get one such complaint over the course of a 3+ year residency. In most cases it's not significant. The PD won't call you in for a sit down. If he does, it may be to hear your side of the story after which he says don't worry about it. In most cases it won't even warrant a separate sit down, and will simply be something he mentions in your semiannual review. In this case it wasn't one instance in the course of a residency, it was three in less than a year. And the PD had a special sit down with the resident and certainly didn't say don't worry about it. So that already should send up a red flag that we aren't talking about the normal minor snafu.

As far as seniors being your bosses, you get used to it. In a lot of ways it's a better system, because they remember being in your shoes, and know that if they have your back, they pretty directly earn your loyalty. When residents work as a team, they all cover for each other, a united front against the attending. The attending can be annoyed at an intern, but when the chief steps in and says, yeah he told me about that and I told him to go ahead (whether true or not) the wind often goes out of that sail pretty quickly. And that culture can make a residency a pretty nice place to work even if it means you stay an extra hour here and there to make sure your senior doesn't have to, or can tell the attending with a straight face that it's getting done. The catch is that when a resident doesn't "get it" or tries to abuse the system at the expense of his teammates, he can easily find himself outside of the tight family.

Please tell me how you happen to know this information out of the thousands of residents out there. You are making presumptions as you don't have the personnel files to support your claim. For all we know some PD's overlook a whole lot of **** over and over and some put people on probation/suspension/whatever for the least of indiscretions.

Three complaints may be nothing for one institution/PD while 1 is too much for another. I mean it is all variable, and no one knows all the variables to solve the equation. Each case is different.

The one sure thing here is the OP was not given a chance to remediate/probate/repeat. I bet you in his/her resident handbook somewhere there's a process that is clearly written out that should be followed when there's a "troubled resident". I have been in a similar situation and have been the "troubled resident". He was given a verbal warning and then fired less than a month before graduation.

Now any way you look at it, that is foul and lacks due process. Isn't that what all you lawyers are gung-ho about? Due process?

 

[chocomorsel]

I disagree, most PDs I talked to will tell you their ultimate goal is to convert all their advanced programs to categorical. Makes recruiting easier, but there is also word out there that internal med has been hostile to prelims heading to some other specialties. This program in question could have done something prior to week 51, but they protected their schedule and waited to fire the intern when it was logistically feasible while screwing up OP's advanced program's schedule. OP's advanced program will not be thanking them for preventing an "incompetent" physician from moving ahead, they probably know it was a hit move. Simple as that. The lesson the advanced programs are learning from nonsense like this is to wrestle that first year away from the hands of internal med, or they might screw you over. I don't mean to make this a war between specialties, but for as long as we are being honest, we all know this is a real problem in our community. I can't tell you how many times I have seen a derm intern victimised for no obvious reason except for what I think is jealousy or dislike. Derm intern coughs and it is a display of the chip on his/her shoulder. Same thing happens when internal med or fam med is rotating on some specialty or surgical service, and they are perceived to be sub-par by default for no good reason. In fac,t I have seen the best family med resident in a program rack up multiple bad evals and warnings on a surgery rotation mostly because she pissed the wrong(singular) person off. Again, I am not sure what specifically OP did, but I am not ready to accept the argument that a week 51 firing = OP must have sucked real bad.

I am a strong advocate for physicians sticking together from all specialties for the purpose of keeping our profession viable, and preventing the impending onslaught from government, midlevels and whatever other tsunami is brewing. This cannot happen if we don't learn to respect ourselves. That is why I asked the question: if we can't take care of our own and respect each other, why should anyone respect us?

\

Agreed again. The nurses seem to have it down on sticking together and for each other while the docs are all about themselves. It's sad but I think alot of us have this attitude that we as doctors are smarter/better and therefore we should be beyond all the bull**** so called"unprofessional" crap.

Truth is, we are first human and we make mistakes and have disagreements. We should try to learn from them and help each other out, bring each other up instead of treating each other like crap as we climb up the professional ladder and throwing each other under the bus when someone screws up.

 

[Law2Doc]

Please tell me how you happen to know this information out of the thousands of residents out there. You are making presumptions as you don't have the personnel files to support your claim. For all we know some PD's overlook a whole lot of **** over and over and some put people on probation/suspension/whatever for the least of indiscretions.

Now any way you look at it that is foul and lacks due process. Isn't that what all you lawyers are gung-ho about is due process?

First I don't think it's going out on a limb to say that three formal complaints in a single year is a lot. We know it was a lot for this program because the PD called a sit down meeting with OP. OP concedes that he didn't appreciate the gravity of the situation, but does not deny that the PD gave some form of the "You'd better shape up" speech. Second, I think we decided earlier in this thread that either OP got requisite notice or did something else at the end of his residency that merited immediate firing, or else he's going to prevail on procedural technicality grounds. In my experience folks always tone their foibles down in these kinds of threads, so there may have been a fourth incident OP didn't feel was as big a deal as his program did, or the PD gave him formal notice during the sit down and OP didn't appreciate the significance.

 

[Law2Doc]

Agreed again. The nurses seem to have it down on sticking together and for each other while the docs are all about themselves. It's sad but I think alot of us have this attitude that we as doctors are smarter/better and therefore we should be beyond all the bull**** so called"unprofessional" crap.

Truth is, we are first human and we make mistakes and have disagreements....

you can't go far as a profession if you don't hold people's feet to the fire to uphold the basic standards of professionalism. There's a difference between making mistakes and acting unprofessional. Everyone makes mistakes. You are allowed to be wrong, particularly during your training. But you still have to conduct yourself along a certain code of conduct. But it is damaging to the profession as a whole to allow people to advance in their training if they don't live up to the basics. The profession is stronger, and maintains it's integrity precisely because it conducts the screening process, and screens out the folks who can't manage the basic appropriate conduct. Otherwise, there would be a lot of people who associate the notion of doctor with any number of bad examples who might skate by.

 

[Substance]

The profession is stronger, and maintains it's integrity precisely because it conducts the screening process, and screens out the folks who can't manage the basic appropriate conduct. Otherwise, there would be a lot of people who associate the notion of doctor with any number of bad examples who might skate by.

I guess this would make sense in the OPs case if the OP had failed to express the basic appropriate conduct. But first one must define what that is.

 

[PharmaTope]

you can't go far as a profession if you don't hold people's feet to the fire to uphold the basic standards of professionalism. There's a difference between making mistakes and acting unprofessional. Everyone makes mistakes. You are allowed to be wrong, particularly during your training. But you still have to conduct yourself along a certain code of conduct. But it is damaging to the profession as a whole to allow people to advance in their training if they don't live up to the basics. The profession is stronger, and maintains it's integrity precisely because it conducts the screening process, and screens out the folks who can't manage the basic appropriate conduct. Otherwise, there would be a lot of people who associate the notion of doctor with any number of bad examples who might skate by.

maybe the "profession" should start fighting to stop the "midlevels" who are no competent from standing in and taking care of patients with no guidance than ****ting all over a resident based on many times bull**** reasons.

 

[Law2Doc]

maybe the "profession" should start fighting to stop the "midlevels" who are no competent from standing in and taking care of patients with no guidance than ****ting all over a resident based on many times bull**** reasons.

Those are two very separate and unrelated issues. I agree that the profession should address the encroachment by certain forms of midlevel who want to call themselves "doctor" but avoid the same degree of training. But that has absolutely nothing to do with whether or not it feels a particular resident passes muster. I think doctors should hold to a certain level of professionalism everyone within it's ranks, and that doesn't affect the notion of whether they ought to be addressing the midlevel issues. if you are somehow suggesting because midlevels are out there outside of the profession providing crummy service that it should be okay to allow folks within the profession to be doing the same, I strongly disagree.

 

[chocomorsel]

you can't go far as a profession if you don't hold people's feet to the fire to uphold the basic standards of professionalism. There's a difference between making mistakes and acting unprofessional. Everyone makes mistakes. You are allowed to be wrong, particularly during your training. But you still have to conduct yourself along a certain code of conduct. But it is damaging to the profession as a whole to allow people to advance in their training if they don't live up to the basics. The profession is stronger, and maintains it's integrity precisely because it conducts the screening process, and screens out the folks who can't manage the basic appropriate conduct. Otherwise, there would be a lot of people who associate the notion of doctor with any tnumber of bad examples who might skate by.

Ha ha. That's laughable. I don't know how many times I have seen surgeons on the other side of the curtain chewing out the residents/nurses/techs to an "inapropriate level". They make their point then proceed to completely and utterly humiliate the person in front of everyone in the OR. That is highly "inappriate conduct". Do you have any idea what happens to these lovely surgeons? Not a damn thing for a very long time. Write up, after write up, they are tolerated because they are "the best". And finally after years, then maybe something happens.

Professionalism comes from the top, and many times as people rise up the ranks they forget about how ****ty they were treated when they were junior and treat their inferiors just as foul.



And it's not just in surgery, but in every field in medicine. Most notoriously surgery/obgyn. If these senior residents/attendings themselves are giving prime examples of unprofessionalism, how do they expect the juniors to learn how to treat each other.

The culture is slowly changing and more attendings are starting to be "disciplined", whatever that means but we as residents are treated like **** by everyone and are just expected to grin and bear it like we have no feelings. And we can't just say screw you and go get another job as you can in the real world and nurses/staff/techs know that.

I did in my past life when I was bullied. Didn't take that **** lying down, I gave my notice and left after having some words with the bully. It's a two way street.

Amazing the things we put up with in medicine.

 

[Law2Doc]

Ha ha. That's laughable. I don't know how many times I have seen surgeons on the other side of the curtain chewing out the residents/nurses/techs to an "inapropriate level". ...

Amazing the things we put up with in medicine.

pointing out other people who should also be disciplined doesn't make the resident who acted unprofessional any less culpable. Two wrongs don't make a right. I agree that folks higher up should set an example. I also agree that a hospital or practice is going to shrug off a complaint against a rainmaker. That's true in every facet of life, and it's not right but it also never absolves those folks lower down on the food chain from following the rules.

 

[Osteoimperfecta]

maybe the "profession" should start fighting to stop the "midlevels" who are no competent from standing in and taking care of patients with no guidance than ****ting all over a resident based on many times bull**** reasons.

True, except the motivation is not to protect professionalism most times, but to bully. Patients could write 5 star reviews about OP and he/she will still be fired if he/she clashed with the wrong upper levels.

Remember bullies by definition typically "have personalities that are authoritharian, combined with a strong need to control or dominate. It has also been suggested that a prejudicial view of subordinates can be particular a risk factor."

"Bullies are attracted to the caring professions, such as medicine, by the opportunities to exercise power over vulnerable clients and over vulnerable employees."

"The stereotype of a "victim" as a weak inadequate person who somehow deserves to be bullied"

http://www.bmj.com/content/324/7340/786.2

To answer your question, we cannot fight midlevels, managed care, insurance companies, politicians etc, because we are products of a bullying machinery which teaches us to lay low, take whatever you get, and walk on thin ice. This is what we learn in residency and our early attending years, so how in the world does anyone think we can just flip from such a timid posture to one where we are fighting for or against anything. Workplace bullying also kills team spirit, so there goes our ability to come together for anything. The only fights we know are the ones targeted at vulnerable subordinates, and when we do, we fight to kill.

 

[Shikima]

Been reading this thread for a while, and while there are many good points, it overlooks the elephant in the room; No one has adequately defined what "professionalism" is and how to address the issues from power abuse from said loose definitions.

Everyone can claim everyone is unprofessional, but what it comes down, the bottom line, is that we're all enabling the same behavior patterns that we'd all like to see extinguished. It's a self-perpetuating prophecy. Under the guise of said "unprofessional" conduct, nothing is clear cut and ultimately is used by egomaniacs and bullies to assert social control, even when the social situation is fundamentally flawed due to said personality traits.

 

[wine is good]

I try not to write too often, but, I'm getting pretty pissed off here. From reading these posts, I see more and more why physicians gets screwed so much by everybody else. You people like to give your own colleagues ****. Instead of fighting for each other, you tear each other down and berate the new scapegoat (usually someone in trouble with the superiors).

Look, there is no excuse in my mind why the program allowed this poor bastard to continue to work and then fire him at 51 weeks, unless he absolutely did a horrible thing (intentionally kill a patient or complete gross neglegence, raped somebody, etc). That is wrong and is a clear example of a program exploiting a person to get work out of that individual, then, denying the credit they deserve for that work.

What we get here is one post after another making some sort of assumption about what the OP did, and selling him out to the higher ups to be hung out to dry. You people do work in a hospital, don't you? You do see the unfair treatments that residents get on a daily basis, do you not? Why do you stick you head in the sand and pretend that somehow you are superior to somebody without knowing all the facts. If I were you, I would withhold judgement, because, in my own personal experience, residents usually get UNFAIRLY treated, rather than the other way around, and it is a recurring problem.

The OP needs to fight this. That's a year's time of hard work, and firing at 51 wks, in my opinion, doesn't make a whole lot of sense. If he was good enough to stay around for 51 weeks, then, he deserves credit for the year.

 

[Law2Doc]

...
Look, there is no excuse in my mind why the program allowed this poor bastard to continue to work and then fire him at 51 weeks, unless he absolutely did a horrible thing (intentionally kill a patient or complete gross neglegence, raped somebody, etc).
...

The OP needs to fight this. That's a year's time of hard work, and firing at 51 wks, in my opinion, doesn't make a whole lot of sense. If he was good enough to stay around for 51 weeks, then, he deserves credit for the year.

We all agree that there may be procedural/notice issues in firing someone last minute. But let's assume for the sake of argument that he had a fourth formal complaint in week 50, after already being sat down and read the riot act by the PD. Let's also assume for the sake of argument that in light of this latest complaint the PD and others have serious concerns about OPs professionalism and whether he has done enough that they are comfortable graduating him from their internship, thereby foisting his issues on another PD. Are you suggesting that there are no situations short of rape or murder where throwing up roadblocks is reasonable? This guy is going to have their name on his CV from here on out. By graduating him, they are certifying that he has done everything necessary they require for them to comfortably advance him. It hurts their reputation if he emerges from their program and is a problem. It will impact future residents emerging from their program. Reputation is huge. I think the notion that you are entitled to graduate from internship merely because you didn't rape or murder someone is a bit unreasonable.

 

[wine is good]

We all agree that there may be procedural/notice issues in firing someone last minute. But let's assume for the sake of argument that he had a fourth formal complaint in week 50, after already being sat down and read the riot act by the PD. Let's also assume for the sake of argument that in light of this latest complaint the PD and others have serious concerns about OPs professionalism and whether he has done enough that they are comfortable graduating him from their internship, thereby foisting his issues on another PD. Are you suggesting that there are no situations short of rape or murder where throwing up roadblocks is reasonable? This guy is going to have their name on his CV from here on out. By graduating him, they are certifying that he has done everything necessary they require for them to comfortably advance him. It hurts their reputation if he emerges from their program and is a problem. It will impact future residents emerging from their program. Reputation is huge. I think the notion that you are entitled to graduate from internship merely because you didn't rape or murder someone is a bit unreasonable.

What the hell you talking about? The rape thing was a half-ass attempt at joke. You use that as an argument?

You are assuming he did something wrong so profoundly that he would get fired. You DON"T know. That was my point and you are a prime example of what I'm talking about. You guys love to throw **** around and see if it sticks. I'm done. I made my statement, and that's all I wanted to do. I'm going back under the rock I crawled from. But, mark my word, some day you may find yourself in a similar situation and you will look back at what I said. We need to start sticking together. There are numerous examples all the time how physicians are being slapped around by the higher ups, because they got no power, and you people are putting flame to the fire. Good luck.

 

[Osteoimperfecta]

..... let's assume for the sake of argument.... Let's also assume...

Like someone else pointed out, you get to assume and wager on what really happened, while OP gets to ponder what is left of a career built over many years. For as long as you are assuming, why stop at assuming OP was bad enough to get fired? Why can't you assume this could be another case of vindictive termination? Wait, you think that is a rare event in medicine? There is a reason why we assume people are innocent until proven guilty, and we don't get the luxury to assume people are guilty.What if this is that "rare" vindictive firing? Would it be fair to pile insult on injury? This is not some statistics question, it is possibly a human beings career/life. Again, if you know something we don't know then I might understand, but assumptions are exactly what they are.

 

[ilovepath]

I share oi's sentiments and think this is built upon the culture during pre-med..that there's this competitive personality type selected for that is competitive and automatically has the default position that all their peers are less than them. This shared default position is what instantly has people instantly crucify, stigmatize the op and anyone else in their position. It's likely the same impulse that encourages programs to take adverse positions without fear of repercussions, because they know everyone within a forum, another program, licensing board, hospital has the default position that the program must have legit motives.

Like someone else pointed out, you get to assume and wager on what really happened, while OP gets to ponder what is left of a career built over many years. For as long as you are assuming, why stop at assuming OP was bad enough to get fired? Why can't you assume this could be another case of vindictive termination? Wait, you think that is a rare event in medicine? There is a reason why we assume people are innocent until proven guilty, and we don't get the luxury to assume people are guilty.What if this is that "rare" vindictive firing? Would it be fair to pile insult on injury? This is not some statistics question, it is possibly a human beings career/life. Again, if you know something we don't know then I might understand, but assumptions are exactly what they are.

 

[mohammedelamien]

I would like to start by saying, I am deeply sorry this is happening to you at this moment of your career, overall its not good. I did not read all the posts so apologize for my little contribution. I am not into what happened whom to blame and all that sort of painful helpless efforts. I will give you my advice based on personal experience similar to yours.
#1. "accept it or not" Residency programs are above errors!, DO NOT waste time trying to win this appeal and so forth, NO body will help you including ACGME, Lawyers, etc. If your program fired you they will handle any debate to prove their points, DOCTORS persona. I have no doubt the educators in your program wanted you to succeed but for some reason that did not work. I dislike to point fingers on whom to blame, You on the other hand, have the ability and control try to reflect on your part and work on it for the future.
#2. File for unemployment right now; and do not waste your time trying to reach settlements, like "you resign and may be that will help you to get into other residency program in future". DO not go that route, You are in vulnerable stage right now do not add financial stresses to your situation. You may have family and kids depending on you they have needs. DO not jeopardize that by reaching silly agreements with your program "with the illusion you will find another program to accept you". At this time be nice to your family and try to hold on! they are your real support.
#3. Take time and retool try to do your best and hope some other residency programs take you as resident and continue your training, chances are harder now but never loss hope GOD will provide; Some day you will be working for one of these Health Business Owners and making living for yourself and family. All this will be part of the your past. When that happen provide good care to your patients. Please do not hold any negative energy towards your program, Just shake it off and let it go and believe me they are not evil or tried to hurt you but this was meant to be.
I hope something Good will happen to you, please share that too when it happen, I will keep you in my prayers.

 

[EagerToBeMD]

We all agree that there may be procedural/notice issues in firing someone last minute. But let's assume for the sake of argument that he had a fourth formal complaint in week 50, after already being sat down and read the riot act by the PD. Let's also assume for the sake of argument that in light of this latest complaint the PD and others have serious concerns about OPs professionalism and whether he has done enough that they are comfortable graduating him from their internship, thereby foisting his issues on another PD. Are you suggesting that there are no situations short of rape or murder where throwing up roadblocks is reasonable? This guy is going to have their name on his CV from here on out. By graduating him, they are certifying that he has done everything necessary they require for them to comfortably advance him. It hurts their reputation if he emerges from their program and is a problem. It will impact future residents emerging from their program. Reputation is huge. I think the notion that you are entitled to graduate from internship merely because you didn't rape or murder someone is a bit unreasonable.

Yeah, I think you need to read that post again. It's clear the poster never suggested that only rape or murder should get someone fired from internship. He's saying that at the 51st week, that's all that he could have done to justify stringing him along all year then getting rid of him one week shy of graduation. I tend to agree. He was good enough at week 40, at week 45, at week 46, at week 47, at week 48, at week 49, and at week 50. What could have possibly happened that would convince the program that he's not suitable physician material in that last week?

 

[Law2Doc]

Yeah, I think you need to read that post again. It's clear the poster never suggested that only rape or murder should get someone fired from internship. He's saying that at the 51st week, that's all that he could have done to justify stringing him along all year then getting rid of him one week shy of graduation. I tend to agree. He was good enough at week 40, at week 45, at week 46, at week 47, at week 48, at week 49, and at week 50. What could have possibly happened that would convince the program that he's not suitable physician material in that last ?

the prior poster was pretty clear that he thought there was no excuse for firing someone in week 51 unless they did something "horrible". I still would suggest that if the OP was warned multiple times about issues he was having that it is totally conceivable that the last straw might occur toward the end of the program. Is the program supposed to say 51 weeks is close enough to the end that it's too late to do something about it? How about week 40? You see where this goes. If you are going to give people second, third, fourth chances, the natural consequence is that the folks who come up short after all their chances will come up short later in the year. The program shouldn't be punished if they were nice earlier on and told the OP you get one more chance. You don't get to decide that you've done enough to graduate from internship, the program does. And again, most programs are obligated to not pass problems on to the next program. If someone doesn't do what is required to get their intern certificate, they are not supposed to give it. This presumes a year of adequate work, not 51 weeks and you are close enough.

I don't mean to bash the OP - the dude already got the advice he needed and got to pm with aPD back on the first page of this thread. But his situation created useful fodder for discussion about what a program is supposed to do when an intern has multiple lapses of professionalism, and they feel their hand is forced to either fire someone, try remediation, or look the other way at the end of a contract year. I would point out that remediation doesn't work here- if you make the guy repeat the year, you still end up screwing the prelim up with his advanced program, so you end up with a pissed off intern working for you who blames you for his career demise. And again, if a program doesn't feel he lived up to the requirements of his intern year, they have the duty not to advance him. Their reputation is forever tied with his.

 

[NotAProgDirector]

Having been in situations like this before, I can tell you that it is very difficult. The major difficulty comes from this question: How bad does something have to be before you decide that they can't go forward? For non-clinical issues (communication skills, professionalism, etc) it's even harder.

Also complicating matters is that when the problem is non-clinical, it's usually something different every time. Not answering pages, difficulty with support staff, trouble with supervising residents, failure to complete required documentation, etc. I may warn a resident "not to do something again", only to have them do something else. I make it clear to residents that any further professionalism violation, even if something completely different, puts their training at risk.

Some examples to think about (note that none of this has anything to do with the OP):

1. What if a resident lies about being sick? Calls in sick, and is then seen out and about? Or calls in sick and is discovered that because their child has the day off from school, they needed to stay home with them? Lets say in all cases that they were not on call, not in clinic, and no one needed to be pulled to work for them (i.e. they were on an outpatient / elective block).

2. What if a resident inappropriately accesses a chart? Let's say they want to know when someone's birthday is, so they look it up. Or they are just interested so they snoop around. Or they claim that they mistakenly clicked on the wrong name.

3. What if a resident fails to show up for a shift, or repeatedly shows up late for shifts such that others must stay late?

What if these things happened repeatedly, the resident was warned, and then happens again in week 49-51?

If a PD terminates a resident, then we have a few choices:

Let them finish, vs terminate -- this is really, really hard. By this time, usually said resident is uniformly disliked by all of their peers as they've managed to irritate them all. If I;ve warned them that further problems will get them terminated, then that happens whether it's week 10 or week 51.

"Credit" -- how much credit should the resident get? It might be different if their performance was fine until the end when they did something that gets them terminated, vs a repeated history of problems that culminated in termination. Also, it depends on what we mean by "credit". The ABIM measures training in months, so it would be possible to give someone fired at the end 11 months of credit. However, the ABIM requires us to evaluate "Moral and Ethical Behavior" on a pass/fail basis -- and if we choose fail, you get no credit for the year. If a resident is a prelim, then only what their future board requires matters (not the ABIM).

My usual plan in these cases is to give the resident credit for "time served" rounded down to the complete month. They will certainly get an unsatisfactory rating on at least one of the competencies, and likely a marginal overall rating -- the ABIM doesn't require additional training for that, as long as they improve going forward. In their final documentation for their training, I'll explain the issue that led to their temination. I'll usually "recommend with reservation", rarely "not recommend" if something is truly egregious. I will also usually comment that I would not recommend a full license without further training. Giving someone absolutely no credit seems like overkill, but we are only hearing one side of the story here.

 

[Law2Doc]

...

My usual plan in these cases is to give the resident credit for "time served" rounded down to the complete month. They will certainly get an unsatisfactory rating on at least one of the competencies, and likely a marginal overall rating -- the ABIM doesn't require additional training for that, as long as they improve going forward. In their final documentation for their training, I'll explain the issue that led to their temination. I'll usually "recommend with reservation", rarely "not recommend" if something is truly egregious. I will also usually comment that I would not recommend a full license without further training. Giving someone absolutely no credit seems like overkill, but we are only hearing one side of the story here.

credit for 11 months and an unsatisfactory rating is enough to tank his advanced residency goals, and the ability to find another month of intern year with this on your CV is probably pretty tough, so I would say in the OP type case the end result isn't all that different.

 

[Gasworks]

In all honestly, it looks like the OP is getting shafted pretty hard. Given the harsh nature of the dismissal I'm going to bet that the PD has all of the paperwork in order to make his decision stick.

The only piece of advice I have is for the OP to get on his knees and beg the PD at his pgy2 program to intervene on his behalf. Maybe a heartfelt PD to PD conversation and an offer to complete the "extra week" at his new program could convince him to reverse his decision and let him at the very least finish out the year on paper.

Also to answer some of aPD's comments:

1. What if a resident lies about being sick? Calls in sick, and is then seen out and about? Or calls in sick and is discovered that because their child has the day off from school, they needed to stay home with them? Lets say in all cases that they were not on call, not in clinic, and no one needed to be pulled to work for them (i.e. they were on an outpatient / elective block).

The answer to this is an extra saturday call or extra lost vacation days. Most places I've worked required no documentation of illness (doctors note) for a single sick day. Too sick to work doesn't mean too sick to pick up the wife from the train station. I was also under the impression that lack of child care was a perfectly good reason to miss work. Do you expect someone to bring a toddler to morning rounds? Maybe leave them at home unsupervised with a box of matches?

2. What if a resident inappropriately accesses a chart? Let's say they want to know when someone's birthday is, so they look it up. Or they are just interested so they snoop around. Or they claim that they mistakenly clicked on the wrong name.

This has NOTHING to do with the residency program. It is strictly an HR issues and will be handled by your friendly hospital rule enforcer. Last time they gave us the inservice I believe they were firing on the first offense.

3. What if a resident fails to show up for a shift, or repeatedly shows up late for shifts such that others must stay late?

I would again respond to this with extra call and lost vacation time. Eventually the same people who have to stay late will benefit from an extra saturday off.

What if these things happened repeatedly, the resident was warned, and then happens again in week 49-51?

The only resident to be fired during my residency was in the last 6 months of her training. She decided to transport an ICU patient without a monitor from the OR and did not realize the patient had died in the hallway some time along the trip. Her attending that day, who was not even required to be present for transport, eventually wound up taking a $2.5 million malpractice hit as a result. Please tell me where "playing sick" and "showing up late" add up to anything even close to that?

 

[michaelrack]

I was also under the impression that lack of child care was a perfectly good reason to miss work. Do you expect someone to bring a toddler to morning rounds?

Isn't that what wives are for?

Seriously, a doctor needs to be able to devote himself to learning medicine during his residency. Childcare issues need to be sorted out before starting residency.

 

[Doctor4Life1769]

Isn't that what wives are for?

Seriously, a doctor needs to be able to devote himself to learning medicine during his residency. Childcare issues need to be sorted out before starting residency.

Emergencies do happen. Like a child being sick..

What if both work? What if the babysitter/nanny was sick or had an emergency? What if he/she's a single parent? It's just easier to claim a sick day than try to find someone on VERY short time's notice.

My question is, how intrusive are PDs nowadays that they can tell if someone took a sick day to stay at home and take care of their child/kids? I'm totally not acceptable to residents who take a sick day and go to the bar or go shop or whatever, but to stay home for ONE DAY to take care of their kid is a bad thing?

 

[michaelrack]

Emergencies do happen. Like a child being sick..

What if both work? What if the babysitter/nanny was sick or had an emergency? What if he/she's a single parent? It's just easier to claim a sick day than try to find someone on VERY short time's notice.

My question is, how intrusive are PDs nowadays that they can tell if someone took a sick day to stay at home and take care of their child/kids? I'm totally not acceptable to residents who take a sick day and go to the bar or go shop or whatever, but to stay home for ONE DAY to take care of their kid is a bad thing?

The only excuse, in my opinion, to take a sick day is if the resident is sick enough to be in the hospital, or is very contagious.

Single parents shouldn't go into medicine (unless the spouse died while the other parent was already started in their medical training)

 

[Law2Doc]

The only excuse, in my opinion, to take a sick day is if the resident is sick enough to be in the hospital, or is very contagious.
...)

there are certainly residencies where being sick is not an excuse for not showing up to your shift. Nor is not having a backup plan for daycare. It's a cultural thing. I've seen folks so sick at work that they got IV infusions before rounds. Other residencies may give out personal days like candy. You just have to understand what you signed on for and play accordingly.

 

[MrBurns10]

there are certainly residencies where being sick is not an excuse for not showing up to your shift. Nor is not having a backup plan for daycare. It's a cultural thing. I've seen folks so sick at work that they got IV infusions before rounds.

Yeah I've heard of this, and it's so dumb. You can bet I would never apply to a program whose culture promoted this, no matter the prestige.

 

[Doctor4Life1769]

Yeah I've heard of this, and it's so dumb. You can bet I would never apply to a program whose culture promoted this, no matter the prestige.

Agreed.

 

[Doctor4Life1769]

The only excuse, in my opinion, to take a sick day is if the resident is sick enough to be in the hospital, or is very contagious.

Single parents shouldn't go into medicine (unless the spouse died while the other parent was already started in their medical training)

Doesn't apply to me, but was throwing out a hypothetical that is very much real in today's society, including those in residency.

 

[NotAProgDirector]

The only resident to be fired during my residency was in the last 6 months of her training. She decided to transport an ICU patient without a monitor from the OR and did not realize the patient had died in the hallway some time along the trip. Her attending that day, who was not even required to be present for transport, eventually wound up taking a $2.5 million malpractice hit as a result. Please tell me where "playing sick" and "showing up late" add up to anything even close to that?

This is a really interesting example. The error, transporting a patient without adequate monitoring, is a multilevel issue. Nursing should have arranged the monitor. Patients going from the OR to the ICU usually have a whole gaggle of people -- respiratory, nursing, physician, etc -- all playing a role. I'm sure there is more to the story (and you don't need to post it here), but if this was a case of an undersupervised resident making a clinical error with a catastrophic outcome, that's not necessarily a fireable offence in my book. Repeatedly showing up late, however, is something completely under your control and unacceptable.

Seriously, a doctor needs to be able to devote himself to learning medicine during his residency. Childcare issues need to be sorted out before starting residency.

Emergencies do happen. Like a child being sick..

What if both work? What if the babysitter/nanny was sick or had an emergency? What if he/she's a single parent? It's just easier to claim a sick day than try to find someone on VERY short time's notice.

My question is, how intrusive are PDs nowadays that they can tell if someone took a sick day to stay at home and take care of their child/kids? I'm totally not acceptable to residents who take a sick day and go to the bar or go shop or whatever, but to stay home for ONE DAY to take care of their kid is a bad thing?

The only excuse, in my opinion, to take a sick day is if the resident is sick enough to be in the hospital, or is very contagious.

Single parents shouldn't go into medicine (unless the spouse died while the other parent was already started in their medical training)

Just to be clear, the point of the examples was to generate controversy.

My feeling is that all parents, single or not, can certainly be physicians. Both medical training and raising children are serious long term commitments. Hence, if anyone pursues both, it is their responsibility to ensure that they do not conflict. Kids will be ill, and there might be snow days or other school cancellations. Parents in the medical field should anticipate this and have backup plans, and backup-to-the-backup plans. I know (from personal experience) that this can be a pain, but it's the right thing to do. So, no, I don't consider a routine sick day for a child an acceptable use of a sick day IMHO - especally if calling in sick means that someone else needs to be pulled to cover your shift. Obviously, if your child is seriously ill, that's another matter.

 

[captaincrunch]

This thread may have gotten a little off topic, but it's pretty interesting. Even though medicine is a large time commitment, I don't think residency programs should start thinking they are above the law. Certainly punishing residents for taking legitimate sick days would be very problematic. For one, it is an obvious discriminatory practice. Second, there is good evidence that sick doctors are dangerous to patients. When I was a resident, I remember an attending sending me home for coughing too much in rounds. Her logic: she didn't want the patients sick and the rest of the team sick. She let me attend table rounds in the morning (so I would be in the loop), but no patient contact. I was shocked at the time, but in hindsight it was probably the right decision. There is a certain ego in medicine that we all have that causes us to push ourselves too hard (e.g., IV fluids for ourselves before rounds) that is best avoided.

Similarly, any resident program wound be wise to avoid even appearing like they discriminate against single parents. I agree: back up arrangements should be made, but things do happen. It should be rare event, but I doubt a jury would be sympathetic to a residency program that fired a resident for asking to leave early to tend to a sick child. Of course, there is little evidence that any of these scenarios are relevant to the OP.

But I think this discussion hits on an important point. Often people in these forums believe their programs are out to get them (e.g., malignant PD). In reality, I think things go really bad for residents when their co-residents (i.e., peers) turn on them. Frequent sick days, cutting out early, letting family interfere with residency, etc, are sure-fire ways to accomplish this. Any resident who finds themselves under the microscope would do well to make sure their peers think well of them.

 

[dragonfly99]

Your kid being sick (unless it's some sort of life threatening thing requiring hospitalization, etc.) would not have been an acceptable reason to miss work at my medicine residency. Honestly, it would put too much of a burden on other people who would then have to do the resident's or intern's work for him/her. People with kids need to have a spouse, family, or baby sitter w/backup babysitter for situations like this. Many residencies have little elective and/or non-call time and if people are getting pulled they are essentially getting pulled from what little clinic and/or ER shift time they have (and forced into doing medicine wards or ICU call). However, if someone was seriously ill (say, febrile, vomiting, or pregnant and put on bed rest) people would be understanding and make it work some way. Residents are not really like other hospital employees...at least not in all ways.

That said, there are a lot of different residency cultures. I also think that as work hours are limited more and more, this sort of thing (using sick days for routine stuff like having a bit of a cold, a sick kid, etc.) will become more common and it's less of a big deal to be missing somone for a 12-14 hour shift versus a 30 hour one.

 

[Law2Doc]

... I also think that as work hours are limited more and more, this sort of thing (using sick days for routine stuff like having a bit of a cold, a sick kid, etc.) will become more common and it's less of a big deal to be missing somone for a 12-14 hour shift versus a 30 hour one.

it's actually more of a big deal thanks to the duty hour limitations because chiefs aren't as free to pull people to fill an absent persons duties/shift when everyone is closer to their hour caps. This is part of the reason the (surgery) culture of no absences developed in the first place -- when everyone was already working crazy hours they couldn't be expected to take on your duties as well. Now that the caps are lower, other specialties start seeing the same issues. Most programs don't have ample residents that there is someone available to float -- if someone is out one or more people have to up their hours to fill the void.

As far as the suggestion that this is discriminatory toward single parents, I'm not sure that a policy of no absences whatsoever discriminates. It sucks for everyone equally.

 

[eyeMD6299]

I would def hire a lawyer and let him/her take over and handle it.....
from a "hassle" standpoint, if I were a dept/institution, the easiest thing by far IMO would have been to just let him finish the last week, not renew the contract, and all move on....did I miss something amongst these dozens of posts???

 

[a winner is you]

Damn, firing an intern in a prelim year in the 51st week is one of the sickest things I've heard in a while. I hope whatever OP did was egregious enough to basically destroy his career, otherwise that is one vindictive program.

 

[Law2Doc]

...
from a "hassle" standpoint, if I were a dept/institution, the easiest thing by far IMO would have been to just let him finish the last week, not renew the contract, and all move on....did I miss something amongst these dozens of posts???

of course. Which is why a lot of us think there is more the OP must have done/ shrugged off than he posted.

 

[DarthNeurology]

1. What if a resident lies about being sick? Calls in sick, and is then seen out and about? Or calls in sick and is discovered that because their child has the day off from school, they needed to stay home with them? Lets say in all cases that they were not on call, not in clinic, and no one needed to be pulled to work for them (i.e. they were on an outpatient / elective block).

2. What if a resident inappropriately accesses a chart? Let's say they want to know when someone's birthday is, so they look it up. Or they are just interested so they snoop around. Or they claim that they mistakenly clicked on the wrong name.

3. What if a resident fails to show up for a shift, or repeatedly shows up late for shifts such that others must stay late?

What if these things happened repeatedly, the resident was warned, and then happens again in week 49-51?

I can see somebody being fired for #1, and I can also see just eyerolling for #1 too. Personally, I think it would be a bad thing to do, and if I had to do it then I would tell PD in advance, explain child care troubles.

For #2, I think this could potentially be very bad, like getting medical info you shouldn't have, and it could get somebody fired.

#3 People get fired for that, though you have to wonder what is going on

 

[DarthNeurology]

There is another aspect of the "he said she said" PD firing resident scenario, and really of any attending writing a really bad eval of a resident and the resident "blowing it off": really bad communication by the PD/attending, and misunderstanding by the resident.

Though physicians are supposed to be effective communicators, often times there isn't enough listening and effective patient education being done. For example, a patient is newly diagnosed with diabetes, the internist doesn't need to justify how he or she reached the diagnosis to the patient, just that the diagnosis is made and then treatment is discussed. In the past patients rarely challenged what their doctor had to say, this has changed of course, with the internet and public awareness of medical lawsuits and high profile cases.

At any rate, a lot of attendings progressed throughout their training without having to explain the mechanics of their opinions, even life and death decisions. Same thing with giving a resident a bad eval, the attending expects the resident to take it at face value, and change if possible, or at least accept it even if it was given without warning and without time to remediate. I have seen docs give cancer patients the bad news and simply walk out of the room. Same thing with resident evals: Sorry, we find your work unacceptable.

The thing is that if residents get a handful of negative appraisals of their work, a lot of this "noise", by necessity, needs to be filtered out to continue working. The crabby nurses, the rude senior resident, the meaningless jibs from surgery attendings, a lot of this stuff is other folks simply blowing off steam. Then the PD says that you need to be more professional even though you've been up for 18 hours and have been spending hours explaining a medical issue to a geriatric patient. Is it legitimate? Maybe the gruff attending is just blowing off steam? The PD/attending didn't explain a lot, and they didn't seem to really care to see you . . .

I have seen residents blow off bad evals/verbal comments simply because attendings in general complain so much about everything! Many attendings don't feel that they need to justify with facts the poor eval, like on med student evals, they would simply fill out a section as "unsatisfactory" and fill it in with vague comments, or sometimes none.

Other times I have seen a lot of insecure attendings give really bad evals. If the resident challenges the eval, or perhaps hints that it is unfairly subjective, it sort of challenges the attendings medical competence, after all, if the attending didn't evaluate a resident properly and is vindictive, then how do his and her patients feel? Are they able to function well as a doctor? I think this is why PDs/attendings don't like to admit that resident evals can be heavily biased, and are shocked when the eval is challenged by the resident, who the becomes the entitled narcissis.

Because of the internet, and politicians dragging medicine into the 21st Century, I think that more lawsuits and challenges of firings and bad evals will be made by residents. I think that the OP should hire a lawyer, if just to flush out what happened at the program so that it is not repeated.

The sad thing is that this sort of thing happens at the attending level too. There was this one attending who was the department chair, everybody *hated* her guts (as in the attendings under her), and they couldn't do anything about it for years. Attending wouldn't want to go to meetings (which became mandatory), and she would spy on people, in effect seeing if they were leaving the hospital before a certain time even though their work was done and this was standard practice before she came on board. She rarely saw patients, and used her position to bully people, and eventually left after several attending quit. So, while med students and resident don't get the respect and attention they need to do a good job and progress in their training, there are a lot of attendings who are "problem attendings" in their own right.

A lot of people become disillusioned with medicine because of the political infighting and lack of respect, it is sort of endemic in a lot of places.

 

[DarthNeurology]

. . .

 

[michaelrack]

My feeling is that all parents, single or not, can certainly be physicians. Both medical training and raising children are serious long term commitments. Hence, if anyone pursues both, it is their responsibility to ensure that they do not conflict. Kids will be ill, and there might be snow days or other school cancellations. Parents in the medical field should anticipate this and have backup plans, and backup-to-the-backup plans. I know (from personal experience) that this can be a pain, but it's the right thing to do. So, no, I don't consider a routine sick day for a child an acceptable use of a sick day IMHO - especally if calling in sick means that someone else needs to be pulled to cover your shift. Obviously, if your child is seriously ill, that's another matter.

I am many years removed from academia and being a program director (I was briefly director of a sleep fellowship program in 2005). aProgDirector's comments are probably much more relevant for today's medical students and residents than mine. I had to put up with a lot during the medicine part of my med/psych residency (although having great program directors helped); maybe that is why I am so cynical today.