Quoted: Forced resignation from residency

[NotAProgDirector]

I was forced to resign my ER residency with only 4 months to go. I found myself in a political struggle between the chief of staff and my program director. I was doing so much moonlighting for the chief of staff that I was often pulled out of the ER to take care of a situation on the medical floor or to go to medical records to do discharge summaries to get a doctor off the suspension list. I had never failed a rotation. I had many tardy and absences that the chief of staff got excused as I was doing work for him. That was all a year and a half ago. Since that time I continued to work for the Chief of staff covering the ICU and evolving into the hospital procedure person (central lines, intubations, chest tubes, LP’s and the one man IV team doing ultrasound guided peripheral lines). I have been moonlighting in ER’s around the state. Now I’ve become concerned that I won’t be able to finish by boarding process without the 4months needed to complete residency. I’m so sick of being in this predicament that I am actually willing to do residency over again, yet I only have funding for 4 months. Any advice would be appreciated.

You are not going to like my answer.

It is completely, absolutely, unequivicably unacceptable for your moonlighting to interfere with your residency training in any circumstance. Getting "pulled" from your ED responsibilities to do other work is unacceptable and probably illegal (in terms of Medicare fraud).

Had I been your program director you would not have resigned. You would have been fired, and you would not have received any credit for any time that was compromised by your moonlighting. End of story.

When you are a resident, that's your job. Anything that gets in the way of your job is unacceptable.

But, this is the situation you're in, and your question is whether there is any way to rescue yourself. There are several options:

1. One solution is to try to beg your position back. You clearly admit that you did a bad thing and that it won't happen again. You offer to work the whole year, make up anything you missed, etc.

2. You could look for a new program to take you. Your best option is to find a program with an open PGY-3 position and complete a whole year. You could also look at new programs -- any program that's opened in the last 1-2 years will have no PGY-3's, and maybe they'd be willing to have you.

---

Members don't see this ad.

 

[Apollyon]

Something doesn't pass the "sniff" test. "Chief of Staff"? Who is that? I mean, when I think back to my time as a resident, I had a "division chief", whose boss was the "department chairman", as my specialty was a division and not a department at the time. If my division chief was pulling me from clinical duty to do procedures, that would happen exactly once before my program director put a stop to that. The chief of the medical staff? I don't even know who that was (I think I know, but not sure), and, again, when I was a resident, the equivalent of the chief of staff was a surgeon, and he had 40 or so of his own from which to choose, versus some EM resident.

Likewise, why would an EM resident be dictating DC summaries for private docs who were on suspension? When I was a resident, the only DC summaries I dictated was when I was off service.

Now, after being out more than a year, the hospital leans on this person to do procedures? Aren't there other residents there? I can't think of even one allopathic EM program that is unopposed. If this person was dropping in the central lines and chest tubes, does that mean there are no surgeons or IM residents or FM residents? No critical care docs?

That's why I wonder if this person was in an osteopathic program; if so, that would complicate matters greatly, as there are 1/10th as many osteo EM programs vs allo. As I said, something doesn't pass the sniff test.

 

[NotAProgDirector]

From the OP:

Thanks PD. I feel so ashamed of putting my PD, a man I considered a great friend, in such a situation. ??Do I really have the audacity to ask for forgiveness?? I compromised his carrer and all my fellow residents. ??When have I done enough time to deserve an audience with any PD again????
When the chief of staff first started calling to have me leave my residency post he would call the attending and the attending would tell me what to do. That was in the 1st and 2nd year. All my fellow residents knew what was happening and at the beginning of pgy3 were getting disgruntled. The ED is staffed by a group and the groups' contract was up and the hospital was getting bids (maybe that is why the requests from the chief of staff were granted without a noticeable hesitation from the attending. My PD and I were really tight, I love the guy, really he taught me great tricks and helped me really master the patient flow dynamics to keep the pod turning admits and discharges. The bubble burst when I was doing an out rotation (in an out of state ER) and my chief of staff called the chief of staff (of the out rotation hospital) to call the ER, to send me back to my main hospital to cover the ICU. Of course the ER I was doing the rotation also had an ER residency and it just so happened that I was working with the program director that day (another great guy). He called my PD and when I arrived in the unit, my PD just shock his head and said and asked if I had any vague comprehension of the bad situation I had put him. He explained it to me the next day, and he asked, what would I do if the rolls were reversed and I said I would fire my *****. We sat back in a long moment of silence and he said resign and trust me. I did. He wrote me and outstanding letter and set me up with a good job in a rural ER. That was one and a half years ago.
Looking back, it's an awful mess. Initially, I can say with full confidence I was innocent to what was going on, by my PGY3 year I was no longer innocent. Because I like my PD so much I am so damn ashamed of putting him in that spot.
Now, as Ive resolved that my training was really tainted, and I desperately want to be trained, how do I answer the question, ?????Why did you resign with only four month to go????

My only advice is to tell the truth.

 

[Doodledog]

More from the OP

Apollyon, I see your point, I envy that you must have trained in a big established professional shop. Let me explain, I’m in the Osteopathic world, small residency program, the hospital system is private, 6 community hospitals and one medical center (and the medical center is not that big compared to even a small university center.) I worked 80% of the time in the smallest community hospital in the system.
As for the “Chief of Staff”, I’m not talking about department chiefs, not the chief of medicine, not the chief of surgery, the-the chief of all medical staff. It’s a bit hard to say no to that guy. Furthermore; I’m fairly certain it’s his hospital. So imagine my PGY-1 year … one other ER guy, one IM pgy1, a Radiology PGY1 and a few transitional year students. Above us, about 10 or so residents scattered through the specialties in different PGY years.
As for how I became the “procedure *****”, prior to med school I did a career as an RN/Paramedic on a chopper. Codes and procedures were second nature. My first rotation was night call, I had no senior resident to turn to, I would just wonder on down to the ER and ask the attending how I should mitigate the issue at hand; and, yes, I was scared to death much of the time. I’m embarrassed to admit that I still feel that fear of, how I will handle presentation X complicated by Y and alone in rural Z. All the reading and conferences haven’t taken that fear away. Maybe we all have it and never talk of it? I digress.
Apollyon, I how that helps with the sniff test. I wish it didn’t sniff so badly.

 

[michaelrack]

Normally I am not a big advocate for lawsuits in cases of resident termination/dismissal- judges can't grant academic credit, usually the most that can happen is the judge can award the resident some few months or years of their measley salary.
However, in this case I see the potential for a multimillion dollar suit against the hospital/chief of staff, and I would encourage the OP to consult a lawyer. Hospital personnel may have inappropriately pressured the resident (OP) to perform non-residency duties during a time when medicare was paying for his residency. I am not 100% sure about this, but I think it is worth talking over with a lawyer.

good luck

 

[Apollyon]

I was thinking something similar, and that makes it part of a bigger problem - it wasn't an ACGME approved residency, but AOA. As such, there are 44 active programs (more than I thought), and the majority are in MI, OH, and PA. This means almost everybody knows everybody. That makes it much more difficult, as I don't believe AOA is accepted for ACGME residencies (fellowships are different), and you would be looking for ABOEM boarding, not ABEM.

I don't have a good answer (and this is coming from a guy that scrambled - twice - to get into my residency, and am working my last shift tonight, because my hospital system is closing down).

 

[NotAProgDirector]

Normally I am not a big advocate for lawsuits in cases of resident termination/dismissal- judges can't grant academic credit, usually the most that can happen is the judge can award the resident some few months or years of their measley salary.
However, in this case I see the potential for a multimillion dollar suit against the hospital/chief of staff, and I would encourage the OP to consult a lawyer. Hospital personnel may have inappropriately pressured the resident (OP) to perform non-residency duties during a time when medicare was paying for his residency. I am not 100% sure about this, but I think it is worth talking over with a lawyer.

good luck

I think this totally depends upon the circumstances. If the OP was working as a resident and someone at the program says "Hey, go do this moonlighting" and somehow coerces them / forces them to do it, then yes that might be a case.

But I read all of this differently. That the OP worked as a resident during the day, then did moonlighting at night / day off, but then needed to catch up on charting etc and so was "pulled" from their residency to catch up.

In any case, the OP couldeasily end up being the one blamed for any illegality. They would need to have clear proof that they were forced to do this, and not that they did it for the money.

I was thinking something similar, and that makes it part of a bigger problem - it wasn't an ACGME approved residency, but AOA. As such, there are 44 active programs (more than I thought), and the majority are in MI, OH, and PA. This means almost everybody knows everybody. That makes it much more difficult, as I don't believe AOA is accepted for ACGME residencies (fellowships are different), and you would be looking for ABOEM boarding, not ABEM.

I don't have a good answer (and this is coming from a guy that scrambled - twice - to get into my residency, and am working my last shift tonight, because my hospital system is closing down).

Agreed, the OP will get ZERO ABIM credit for any AOA program.

Hope you have a plan B?

 

[NotAProgDirector]

From the OP:

Thanks for the input from all. This much I have resolved. No lawsuits, my PD would get pinched very badly and I would as well. As for the Chief of Staff, much more cop-ability. This is a powerful man in my area, I fear him a great deal. Ive seen what has happened to disagreeable physicians that attempted to stand toe to toe with him.

Once, I said no to leaving the ED to finish charts to get the high volume admitting docs off suspension (so they could admit to our hospital and not the competition). I was sure that he could have me canned and state license pulled to never practice medicine again. Now, I doubt that could really happen, but as a pgy1 is wet myself as I marched for the charting room.

There are other circumstances like this, yet we are straying from the point. I love my wife, 3 daughters and 2 dogs (both girl dogs ....Im so out numbered) and I love the study, the science and the practice of medicine. I want away from this mess and to get back to my goals. Aprogramdirector gave me the hard advice of swallowing my pride and humbly returning to my old PD and ask for forgiveness. Its just so damn hard to face him after now having a better awareness of just what a dangerous mess I made for someone I called a friend and mentor. Im not a crying man but I cant even imagine the words coming out of my mouth without chocking up. Maybe a beta-blocker and atropine together would give me a clear voice and dry mucous membranes.... or the toxidrome would make me crazy....or crazier.

I welcome any advice from different angles. As I said before I would happy to do another residency, even in IM, if it meant freeing myself from my situation.