Not allowed to attend orientation?

[agranulocytosis]

Posting this for a friend...

Signed a contract, contract stated something to the effect of this being a tobacco-free program, and evidence of the contrary would result in termination.

So, urine gets dipped and is positive for nicotine and metabolites.

The program director is notified and informs the orientee to not attend orientation until further notice.

What's your guys' take? I think the orientee should wait until further notice (reportedly at noon the next day) since it's a hassle for the program to rank, fire, then hire an un-ranked individual this close to July 1, and willingly offer to submit to a substance abuse/dependence/assistance program of their choosing in order to comply.

As a side note: I think this should be a wake-up call for ALL prospective residents and applicants: your interview is never complete, and you should consider yourself to be in interview mode at all times, even during orientation.

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[Chillbo Baggins]

Maybe I'm missing something, but wouldn't nicotine from gum or a patch also create a positive result? Seems like the burden of proof is on the program to prove it was actually tobacco.

 

[agranulocytosis]

Orientee fully disclosed of smoking habits to the PD during the post-urine screen meeting. I found all of this out after all was said and done!

 

[surgonc2017]

He should stay away and probably email PD saying it was an honest mistake and he's already quit yesterday


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[colbgw02]

I've had superficial involvement with this, but my understanding is that they're not testing directly for nicotine. It's something else in tobacco, primarily from smoking, but - apparently - chewing it can also cause a positive result.

I would make sure that he has a secure copy of his PD's instructions, and then comply. Obviously, hospital policies vary, but there's a chance that he will simply get retested again after 60 or so days of employment. Assuming he quits/abstains strategically, then all should be fine.

Regarding the interview-never-being-over aspect of this, was this person not notified of the hospital's policy? That would be a huge oversight, which is why I think it's more likely that he was made aware but just didn't pay attention or give it its due attention.

 

[Dral]

At my institution, if someone is positive for nicotine use, they will not be hired. They may then try again no less than 6 months out from the first test.

I believe where I am, if for some reason it is found out one who is already working here uses nicotine, they will be required to go through a tobacco use cessation program.

My guess (could totally be wrong) is that the PD is seeing if they need to go through protocol and not hire your friend for residency, or if something can be worked out with a tobacco cessation program.

Unfortunately for your friend, there are numerous people who would be willing to start residency yesterday, so your friend is easily replaced. While the person would have to go through the credentialing process and all that, they would undoubtedly be able to be on board sooner than your friend if the institution doesn't budge on their non-hire policy (as aforementioned, at my institution, the resident would have to wait at least 6 months to start versus finding a new hire and getting them in gear and ready could probably happen in less than a month).

And in terms of proving that it was tobacco and not some other form of nicotine, well, the institution doesn't have to really prove that. If their hiring guidelines state that a positive nicotine test results in non-hire and someone has a positive nicotine test (for whatever reason), then that equals non-hire. Individual institutions get to make their own rules.

Good luck to your friend.

 

[Raryn]

This is institution (and state) dependent. Certain programs like the cleveland clinic draw a hard line here. In other places, it's flat-out illegal to discriminate against smokers.

Your "friend" was unlucky. On the other hand, he should have known about this well before the match and should have either taken it into account when ranking... or quit for a couple months before orientation. Nothing to do at this point but sit tight and hope the program comes up with something.

 

[deleted480308]

I don't know that your friend was unlucky. They knew the rules and broke them. If I was them, I'd get proof of being in a cessation program send it to them with my borderline begging apology and offer to undergo any other additional cessation programs they offer/require along with the requisite "how much I love this program"

 

[AdmiralChz]

I don't know that your friend was unlucky. They knew the rules and broke them. If I was them, I'd get proof of being in a cessation program send it to them with my borderline begging apology and offer to undergo any other additional cessation programs they offer/require along with the requisite "how much I love this program"

I agree. I interviewed at couple of places that had hard lines like this for residency and fellowship - they were VERY upfront about the tobacco testing and repeated the policy multiple times during the day and afterwards in post-interview communication. I seem to recall most having a two-step failure policy, but I believe one institution was very hard and immediately put a new hire on probation with a failed test with immediate dismissal a month later with a subsequent fair test. They were VERY clear that if you didn't agree with the policy then you should train elsewhere.

I know you feel badly for your friend, but he or she knew the risks. She might have a chance to salvage if they have a two strike system like I've seen, but pretty horrendous decision-making.

 

[BADMD]

I think the orientee should wait until further notice (reportedly at noon the next day) since it's a hassle for the program to rank, fire, then hire an un-ranked individual this close to July 1, and willingly offer to submit to a substance abuse/dependence/assistance program of their choosing in order to comply.

It may not be up to the PD. The PD is the person's supervisor, but not the boss. The PD runs the residency, but cannot directly hire or fire anyone; that is a function of GME. As far as GME is concerned, the person can't fulfill their contract. That person is no longer their problem. However finding someone to fill the spot is the PD's problem. The individual affected needs to find a way to stop cold turkey and beg GME for a chance to retest.

 

[LucidSplash]

It likely isn't even the GME. These policies affect all hospital employees and the hospital (via Medicare funding) writes the checks. The person would have to receive an exemption from the hospital administration/C-suite. The PD and GME together would need to request it for them. Which is likely what the PD is trying to do and told the OP's friend to sit tight while he works on that.

That being said, many of the places I interviewed at for fellowship had similar stipulations and the programs made it clear they literally could not hire anyway who used tobacco based on the hospital rules. OP may be SOL, though I certainly hope there's a way his PD and GME can work out an exemption.

 

[rokshana]

I've had superficial involvement with this, but my understanding is that they're not testing directly for nicotine. It's something else in tobacco, primarily from smoking, but - apparently - chewing it can also cause a positive result.

I would make sure that he has a secure copy of his PD's instructions, and then comply. Obviously, hospital policies vary, but there's a chance that he will simply get retested again after 60 or so days of employment. Assuming he quits/abstains strategically, then all should be fine.

Regarding the interview-never-being-over aspect of this, was this person not notified of the hospital's policy? That would be a huge oversight, which is why I think it's more likely that he was made aware but just didn't pay attention or give it its due attention.

programs that have this requirement do usually disclose this info at the interview (prior to ranking). I would find it highly unlikely that the program did not give the applicant that info...i can also find it highly likely that the applicant didn't pay attention to said info.

 

[NotAProgDirector]

This will be completely outside of GME or your PD's control. There will be an HR policy about this. Whatever that policy says, that's what's going to happen. Usually, if you fail a drug intake screen, you are "not hired" rather than "fired". Firing someone is complicated, so hiring someone who fails a drug test and then re-testing them later is usually considered a bad idea. Usually, the policy states a "no-rehire" period of 6-12 months.

Almost certainly, your friend is out of a job. HR is not going to make an exception for an intern, most likely. You should review the policy and see if there is even any chance of an exception / waiver, and who would get to make that call.

Once you fail a test like this, and if you can't be hired because of it for at least 6 months, your friend should assume that your program will fill the spot with someone else in the meantime, and they are much less likely to consider you the next year. Your friend will be free to look for another open position -- although not until the match waiver is processed (which the program will request, if they decline to hire your friend).

Whatever your friend does, they should NOT attend orientation if they were told not to.

 

[agranulocytosis]

Update:

Looks like he dodged a bullet and will be allowed to proceed with his training, albeit under an electron microscope. I made every attempt to keep it gender-neutral, but I guess this is something only a guy would do! The question I had for everyone was more general in how to proceed and to get others' perspectives on the situation, as opposed to specifically the "not attending" orientation bit, so apologies for the confusion.

 

[deleted480308]

Update:

Looks like he dodged a bullet and will be allowed to proceed with his training, albeit under an electron microscope. I made every attempt to keep it gender-neutral, but I guess this is something only a guy would do! The question I had for everyone was more general in how to proceed and to get others' perspectives on the situation, as opposed to specifically the "not attending" orientation bit, so apologies for the confusion.

Is your friend dumb enough to touch another cigarette?

 

[BoardingDoc]

Update:

Looks like he dodged a bullet and will be allowed to proceed with his training, albeit under an electron microscope. I made every attempt to keep it gender-neutral, but I guess this is something only a guy would do! The question I had for everyone was more general in how to proceed and to get others' perspectives on the situation, as opposed to specifically the "not attending" orientation bit, so apologies for the confusion.

Find out exactly what the policy says. Don't do anything that will result in termination. This seems pretty straightforward. If he doesn't have the willpower to quit cold turkey (I would think that the current scenario would provide sufficient motivation), talk to a doctor and consider buproprion or something.

 

[Crayola227]

Update:

Looks like he dodged a bullet and will be allowed to proceed with his training, albeit under an electron microscope. I made every attempt to keep it gender-neutral, but I guess this is something only a guy would do! The question I had for everyone was more general in how to proceed and to get others' perspectives on the situation, as opposed to specifically the "not attending" orientation bit, so apologies for the confusion.

I don't think this is a gender thing.

No one has really touched on just how addicting nicotine/smoking is, and how difficult it is to quit. In fact, based on a lot of data, I would say it's almost unreasonable to *expect* people to be able to do so. That doesn't mean that people can't or that we shouldn't do all we can for that outcome.

My first cigarette was at age 11, and I was completely addicted from my first real puff then. I had seen all the DARE stuff but was skeptical that one time was enough to lead to a lifelong clusterf*ck, and made a stupid childish mistake I have forever paid for since then. Typical story.

In any case, I've had a lot more success compared to most in quitting, although it's a typical story of multiple attempts, and rounds on and off the wagon.

On one hand, I am less sympathetic to smokers because I think, "if I can, you should be able to." On the other hand, I recognize how difficult it is, and that all the things going for/against my own tenuous success don't apply universally.

We'd like to think for all that makes us different from addicted rats that any human could, but I don't think that's true. I've come to the conclusion that the default scenario is that this is a lifelong addiction that people don't come back from, and that anyone that does is just an exception to the rule.

I think it's ridiculous that something legal like smoking (whether or not it should be legal aside) is used in hiring decisions. What's next, how much red meat you eat?

TLDR
Quitting is so hard that I don't think it's possible for everyone, and that's not just a gender thing
Whether or not it should be legal, it is, so workplace discrimination is ridic IMO
As always, friend should do whatever it takes to dot/cross all i's/t's, and bend over as much as the program wants, at all times, or risk losing career
Cautionary tale