Resident Corrective Action/Probation

[NotAProgDirector]

Yes, you can still have a successful career. But whatever is the problem, you need to solve it. If it's incomplete paperwork, then you need to stop that. Probation = next violation means you're terminated. Your performance / behavior needs to be perfect going forward. If the sole problem is paperwork completion, this seems completely self inflicted. You need to solve this issue, plus figure out why it's happening.

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[FlowRate]

As someone who is about to be placed on probation, just want to know if anyone made it through this to have a successful medical career? I was in danger of probation per my PD previously due to repeated failure to complete paperwork,etc, and was now taken off a rotation after a brief period of time for issues not related to substance use or violent/inappropriate behavior.

You got a great answer from APD. I can say I've known of residents in my former program who were on some sort of monitored status. Our program went the extra mile to try to help residents improve. It's ultimately on the resident to put in the effort and come to terms with whatever deficiency is identified, however.

 

[xffan624]

As someone who is about to be placed on probation, just want to know if anyone made it through this to have a successful medical career? I was in danger of probation per my PD previously due to repeated failure to complete paperwork,etc, and was now taken off a rotation after a brief period of time for issues not related to substance use or violent/inappropriate behavior.

I made it through but ended up leaving my original residency and completing a residency that was more suited to my skillset. Currently licensed and employed with six figure salary.

Definitely follow the advice given above. Control what you can control. No stupid mistakes or carelessness. If worst comes to worst, don't burn bridges. Despite the fact that I left my original residency I left it on good terms and this helped not only in transitioning to another residency but in future licensing as well.

 

[VA Hopeful Dr]

As someone who is about to be placed on probation, just want to know if anyone made it through this to have a successful medical career? I was in danger of probation per my PD previously due to repeated failure to complete paperwork,etc, and was now taken off a rotation after a brief period of time for issues not related to substance use or violent/inappropriate behavior.

Yes. I was put on probation midway through intern year. Graduated with no other issues in 2013 and ben practicing since.

 

[guytakingboards]

As someone who is about to be placed on probation, just want to know if anyone made it through this to have a successful medical career? I was in danger of probation per my PD previously due to repeated failure to complete paperwork,etc, and was now taken off a rotation after a brief period of time for issues not related to substance use or violent/inappropriate behavior.

This may be reading into things a bit, but it sounds like you have a problem understanding how significant your deficiencies are. I'm inferring that incomplete paperwork and whatever the issue that got you put on probation are two different things. 1) incomplete paperwork IS a very big deal. It may not seem like it to you, but good care coordination and patient care depends on timely paperwork completion. People DO get suspended/removed from medical staff as attendings for paperwork issues. 2) whatever the second issue is, I'm inferring that you think it not being in the categories you listed means it's not as bad. That may or may not be true but it is definitely moot. It was bad enough to get you removed from a rotation and placed on probation, so you'd damn well take it seriously.

 

[sirspamalot]

Being let go may have absolutely NOTHING to do with anything other than personality clashes and some pretty unpleasant and even dishonest attendings. It can, in rare circumstances, even happen twice in a row if you're terribly unlucky.. and still result in a good outcome.

You must however have a good reference (or two) from within your existing program, and, in general, be an effective student and speaker otherwise. Without these traits, you're effectively SOL. That, and a very healthy dose of perseverance.

Ideally you just "Transfer" to another program rather than have anything more serious occur. 0.02.

 

[sirspamalot]

Yes. I was put on probation midway through intern year. Graduated with no other issues in 2013 and ben practicing since.

Probation or double secret probation?

 

[dozitgetchahi]

Probation or double secret probation?

Good question. A lot of programs will do the “PIP” thing to start (aka double secret probation), which doesn’t get reported publicly.

 

[Nephro critical care]

Over the course of my residency (3 years) I saw 3 residents not complete. One was essentially terrible and deserved the boot. Though managed to get into another speciality and graduated from that residency. Another had interpersonal conflicts with the PD and was asked to repeat a year. He instead got into another program and completed his residency. Now he did a fellowship and is working at a very prestigious hospital. There was a 3rd one who was just targeted by the faculty in 2nd year. In my opinion he got a raw deal and was harassed and finally his contract was not renewed. To my knowledge he had to leave the medical field. I later came to know from the ICU attendings that they wanted to give him a passing grade in his final crucial rotation but the PD convinced them to fail him.
The odd thing about all these residents is they were all BLACK. There were three black residents in 3 years and none of them managed to get through the residency. The faculty was overwhelmingly white.
After I had graduated I learned there was a 4th resident that entered the residency and she was having problems too. I don’t know if she was able to graduate. Guess what she was black too.

 

[dozitgetchahi]

Over the course of my residency (3 years) I saw 3 residents not complete. One was essentially terrible and deserved the boot. Though managed to get into another speciality and graduated from that residency. Another had interpersonal conflicts with the PD and was asked to repeat a year. He instead got into another program and completed his residency. Now he did a fellowship and is working at a very prestigious hospital. There was a 3rd one who was just targeted by the faculty in 2nd year. In my opinion he got a raw deal and was harassed and finally his contract was not renewed. To my knowledge he had to leave the medical field. I later came to know from the ICU attendings that they wanted to give him a passing grade in his final crucial rotation but the PD convinced them to fail him.
The odd thing about all these residents is they were all BLACK. There were three black residents in 3 years and none of them managed to get through the residency. The faculty was overwhelmingly white.
After I had graduated I learned there was a 4th resident that entered the residency and she was having problems too. I don’t know if she was able to graduate. Guess what she was black too.

I have seen something like this…

When I was a fellow, it seemed like each year they picked one fellow out of the two classes to **** on. They were way more critical of that person than other fellows, criticized that person harshly for making the exact same mistakes the other fellows were making, etc. In one case, some of it was deserved - otherwise, it frankly wasn’t.

One of the years, the person who was singled out was the only hispanic fellow they had ever had. The other year, that fellow was the only male fellow they had that cycle (every other fellow out of the two classes at that point was female, and the dept faculty was also at least 2/3 female if not more).

 

[sirspamalot]

Probation at one program?

You can survive. Maybe even twice. But..

The real question is: why. Is it bad luck? Horrible PD/vicious staff? Lack of intellectual power or persistence?

Fix what you can, move on (with a nice LOR) to another program. Wonderful things can still happen, if one addresses the YOU problem.

 

[anonperson]

Over the course of my residency (3 years) I saw 3 residents not complete. One was essentially terrible and deserved the boot. Though managed to get into another speciality and graduated from that residency. Another had interpersonal conflicts with the PD and was asked to repeat a year. He instead got into another program and completed his residency. Now he did a fellowship and is working at a very prestigious hospital. There was a 3rd one who was just targeted by the faculty in 2nd year. In my opinion he got a raw deal and was harassed and finally his contract was not renewed. To my knowledge he had to leave the medical field. I later came to know from the ICU attendings that they wanted to give him a passing grade in his final crucial rotation but the PD convinced them to fail him.
The odd thing about all these residents is they were all BLACK. There were three black residents in 3 years and none of them managed to get through the residency. The faculty was overwhelmingly white.
After I had graduated I learned there was a 4th resident that entered the residency and she was having problems too. I don’t know if she was able to graduate. Guess what she was black too.

There was a resident in my program who got fired/contract non renewal for their last year (4 year residency).

They were WHITE and FEMALE.

They apparently sucked so it was fine.

 

[sirspamalot]

Programs have no business terminating a resident in year 4 of 5 or 3 of 4 or whatever. This should be as rare as hens teeth.

Someone who is a problem early on needs to be heavily counseled, treated with dignity and if necessary, moved on in a constructive way.

 

[anonperson]

Programs have no business terminating a resident in year 4 of 5 or 3 of 4 or whatever. This should be as rare as hens teeth.

Someone who is a problem early on needs to be heavily counseled, treated with dignity and if necessary, moved on in a constructive way.

Sometimes a resident just can't make it to becoming a competent safe physician. Who cares if that realization is in year 2 or year 3? It's unfortunate but it's reality.

This was an OB GYN residency that was pretty supportive.

Might as well cut their losses rather than unleash them on the community. You know how much damage a bad OB can do? I've seen a couple out in the community that suck. It's not pretty.

 

[Iamnew2]

Sometimes a resident just can't make it to becoming a competent safe physician. Who cares if that realization is in year 2 or year 3? It's unfortunate but it's reality.

This was an OB GYN residency that was pretty supportive.

Might as well cut their losses rather than unleash them on the community. You know how much damage a bad OB can do? I've seen a couple out in the community that suck. It's not pretty.

Depends what the "deficit" is - if the person in question can't do surgeries, poor long term/chronic knowledge base, etc perhaps. But if the deficits are "communication" BS, "personality" and other non-sense that's code word for "We don't like you" then not so much.

 

[Nephro critical care]

There was a resident in my program who got fired/contract non renewal for their last year (4 year residency).

They were WHITE and FEMALE.

They apparently sucked so it was fine.

There was a WHITE female resident at my hospitalist program who had constant problems with drugs. She was finally let go but given a supportive LOR and later she got into another program and is now director of a hospitalist program.
The BLACK male resident who my program director schemed to get out never got back into a residency program.
BLACKS are 14% of US population but only 4.7% MD are blacks. Lots of janitors in hospitals are black though.

 

[anonperson]

There was a WHITE female resident at my hospitalist program who had constant problems with drugs. She was finally let go but given a supportive LOR and later she got into another program and is now director of a hospitalist program.
The BLACK male resident who my program director schemed to get out never got back into a residency program.
BLACKS are 14% of US population but only 4.7% MD are blacks. Lots of janitors in hospitals are black though.

Why post empty stats?

70% of NBA players are Black. No one's complaining about over representation there.

Is there supposed to be some quota? Does it have to model the racial makeup of the United States?

 

[Iamnew2]

There was a WHITE female resident at my hospitalist program who had constant problems with drugs. She was finally let go but given a supportive LOR and later she got into another program and is now director of a hospitalist program.
The BLACK male resident who my program director schemed to get out never got back into a residency program.
BLACKS are 14% of US population but only 4.7% MD are blacks. Lots of janitors in hospitals are black though.

It's hard being a minority and in Medicine particularly when in a leadership position - I can tell you that from experience as a Hispanic, female medical director.

 

[PTPoeny]

Depends what the "deficit" is - if the person in question can't do surgeries, poor long term/chronic knowledge base, etc perhaps. But if the deficits are "communication" BS, "personality" and other non-sense that's code word for "We don't like you" then not so much.

I disagree or at least want to add nuance for any resident reading this and thinking this means their residency is out to get them rather than the resident having a real problem that needs to be addressed. While some deficit categories can be used as vague "we don't like you" BS that doesn't mean there aren't real, quantifiable deficits that can very legitimately get a resident fired in those categories as well

One intern I worked with just could not write a daily progress note despite having fewer patients on inpatient months so the chief resident could sit down with them every day for multiple inpatient months to go over their notes and correct them to have both an exam and a plan... This went on record as a communication deficit.

In addition, there have been posters on here who have posted about being put on probation for communication and admit to routinely getting their daily progress notes finished days late on inpatient services.

 

[sirspamalot]

Why post empty stats?

70% of NBA players are Black. No one's complaining about over representation there.

Is there supposed to be some quota? Does it have to model the racial makeup of the United States?

Tell us more oh white privileged one. Lol.

 

[Iamnew2]

I disagree or at least want to add nuance for any resident reading this and thinking this means their residency is out to get them rather than the resident having a real problem that needs to be addressed. While some deficit categories can be used as vague "we don't like you" BS that doesn't mean there aren't real, quantifiable deficits that can very legitimately get a resident fired in those categories as well

One intern I worked with just could not write a daily progress note despite having fewer patients on inpatient months so the chief resident could sit down with them every day for multiple inpatient months to go over their notes and correct them to have both an exam and a plan... This went on record as a communication deficit.

In addition, there have been posters on here who have posted about being put on probation for communication and admit to routinely getting their daily progress notes finished days late on inpatient services.

Umm residency is a very academic and unrealistic practice type environment. For example in my former practice the Medicine team would put in patient notes days later, would write H&P's days later after admission as opposed to within 24 hours, etc. They would rarely ever renew the plan, would copy and paste the subjective portion of the notes, etc. Despite my complaints nothing happened. Getting notes late is certain not something that's ok in residency but happens frequently outside of academia/residency.

 

[dozitgetchahi]

It's hard being a minority and in Medicine particularly when in a leadership position - I can tell you that from experience as a Hispanic, female medical director.

In my aforementioned fellowship, the biases were pretty obvious if you looked at the yearly departmental photos:

- You could tell that someone had been choosing for attractiveness…all fellows (particularly the women) were unusually attractive relative to the “norm” of graduating IM residents they had chosen from. They’d never had an “unattractive” fellow in the 50+ year history of the department.

- Racially speaking, there was a very pronounced preference for caucasians. There had been a handful of fellows who were Jewish and/or from the Middle East, but they were very light skinned with mild features and could have passed as Caucasian. They’d never had a black fellow. The only Hispanic fellow they had ever had was again very light skinned and could have passed for being Caucasian. There were a small handful of Asians, but again no Indians or anyone with darker skin tones.

- Departmental leadership was again all white. They’d never had a black attending. They had only had a small handful of Indian or Asian attendings in their history, and many of those had left by the time I started fellowship.

- The gender composition of the department had changed markedly over time, from being almost entirely male in the early days of the department to being at least 2/3 female while I was a fellow (and now closer to 75% female if I look at the current department roster). Unsurprisingly, their most recent fellow classes have started to be overwhelmingly female as well.

 

[IonClaws]

If someone has a deficiency that they can improve, they generally do and come off of the remediation plan. The remediation plan is the due process. It says here is problem X, you have time Y to fix it. If so, we're cool. If not, this won't work out. What alternative strategy would you suggest?

But no plan by the program of what to do to fix problem X because...they're a training program? Doesn't sound like a remediation plan to me...

 

[BoardingDoc]

But no plan by the program of what to do to fix problem X because...they're a training program? Doesn't sound like a remediation plan to me...

This thread is crazy. I saw the alert that someone had responded to a post I made and saw this. I had to look up what I wrote. You're responding to a post I made almost 3 years ago. This thread ran a course, died out, got necrobumped, died out, then was necrobumped again and has been limping along ever since.

Also, I suspect that remediation plans do in fact give suggestions. E.g. read more. Come up with more concise presentations. Be on time. Don't argue with your colleagues etc etc. If there were specific examples of how there was no plan whatsoever in this thread, I don't recall as again, I wrote this in early 2020.

 

[sirspamalot]

In the old days though, there was no remediation plan. Stuff was done behind closed doors and if they wanted you out, you were gonna go out just on made up subjective stuff (even if you were on time, passed all exams nicely, and gave good presentations). Or if they couldn't get you out (5th year?) then they'd simply ignore you, disgusted with you. That all pales in comparison to a Dr. Duntsch type guy.. how that guy got thru remains a mystery.

I hope academic training has improved, I think it has. But it seems that many departments still tend to be attractive to sociopaths who like exercising their power.

As faculty.. I can tell you that the only time I went off on someone was when they outright lied to me about something. I wonder what became of that schmuck (who didn't get kicked out). Zero tolerance for dishonesty in medicine. Zero.

 

[FlowRate]

If there were specific examples of how there was no plan whatsoever in this thread, I don't recall as again, I wrote this in early 2020.

I just re-read the thread since you mentioned it was wonky... turns out I replied basically the exact same thing three times, each time the thread was necro'd.

 

[Redpancreas]

As soon as a program gets you evaluated by a psychiatrist and places you on probation, they are 100% going to non-renew you. They are just going through the motions so they won’t be sued. If anyone is in this situation, start looking for programs ASAP. That’s my advice.

This advice may or may not be coming from personal experience and I have no reason to suspect it's not coming from a good place. That said, usually when programs have you see the program's mental health services, it's not meant to be malignant. I know it's not what the quoted comment says but sometimes, people often naturally have a level of distrust acquired through the process.

In other words, while I won't say it doesn't exist, I don't think it's common for programs to have a psychiatrist evaluate you with intent to identify reasons to dismiss you. Offering mental health services may be a box they have to check. That's the distinction and the point I want to make is that if you're offered mental health services, approach them with an open mind. They're not there to get you to admit you have a mental health disorder or personality disorder so the program can report that to the medical board and get you dismissed (provided you are not trying to harm patients). Their goal is to provide mental health support where possible.

 

[sirspamalot]

They're not there to get you to admit you have a mental health disorder or personality disorder so the program can report that to the program and get you dismissed. Their goal is to provide mental health support where possible

The cynic in me says: best be sure the mental health folks are not connected in any way with your organization now or in the past.

 

[Redpancreas]

The cynic in me says: best be sure the mental health folks are not connected in any way with your organization now or in the past.

That's the cynicism I'm trying to dispel but my opinion's solely based on my experience and I don't blame you for holding your reservations. I've seen much more corrupt practices at medical and financial institutions. That said, I feel that in most cases, the referral to mental health should be viewed (at worst) as the program going through the motions so they can say they offered maximal support so there's no violation of rights, etc. It's similar to physicians doing ordering the full work-up even though they're pretty sure it won't yield a diagnosis.

The main point is that many of these mental health resources do help and I don't feel they're being influenced by the program probe and find evidence to dismiss you. Contrast that to sports where highly paid athletes are often pressured by team physicians to do XYZ and thus seek a second opinion to ensure they make the decisions in their best interest and not the team's. In those cases, there's way more money involved and the reason to make a false recommendation can be the difference in millions. In the case of mental health with residents, I think PDs are just trying to ensure they provide residents who they feel are struggling maximal support before escalating any remediation process.

Again, the reason I make this distinction is so that those offered mental health services to approach them with an open mind. They may lead to utilizing alternative services, but I don't feel like the mental health providers at university's are trying to get residents fired.

 

[FlowRate]

Again, the reason I make this distinction is so that those offered mental health services to approach them with an open mind. They may lead to utilizing alternative services, but I don't feel like the mental health providers at university's are trying to get residents fired.

While there have most likely been egregious abuses of power in residency programs at times, I agree with you that in most cases offering MH services is benign. At our institution we had like an adjunct faculty member who offered sorta like an EAP setup where she'd see someone up to 3-5 times, kept personal written records (never entered in institution EMR) and then, if needed, would facilitate referral outside of the system. It would be a huge liability for MH professionals to be sharing confidential information with program leadership...

 

[Redpancreas]

While there have most likely been egregious abuses of power in residency programs at times, I agree with you that in most cases offering MH services is benign. At our institution we had like an adjunct faculty member who offered sorta like an EAP setup where she'd see someone up to 3-5 times, kept personal written records (never entered in institution EMR) and then, if needed, would facilitate referral outside of the system. It would be a huge liability for MH professionals to be sharing confidential information with program leadership...

Exactly.

 

[Warped Apostle]

question: if your residency contract not get renewed, or you choose to change a specialty, what is the best way to find another position? Re-register with ERAS or looking on Internet? Please provide your advice

I reregistered through ERAS and went through the interview and match. I had a colleague that switched specialties and just sent emails to PD saying he was looking for a PGY-2 position next year. Turns out a lot of programs were expanding and he had some great interviews. There are some specialty specific forums where programs will post openings, but it seems that mass emailing may be the better option.

 

[Warped Apostle]

As someone who is about to be placed on probation, just want to know if anyone made it through this to have a successful medical career? I was in danger of probation per my PD previously due to repeated failure to complete paperwork,etc, and was now taken off a rotation after a brief period of time for issues not related to substance use or violent/inappropriate behavior.

Generally programs start with their own version of probation which I have heard people successfully making it through. However when it is descaled to GME, it gets to be almost impossible. I'd jump ship before it got to that point.

 

[finalpsychyear]

My residency actually fired 2 residents. One who threatened to punch a resident and one who lacked competency. I have seen how much some can get away with. One colleague literally skipped a few months off service in rotations and was immediately put on probation when they found out. They had also scored very low on the service exam intern year. Yet, they were actually very intelligent. Ended up scoring highest on the remaining years and would do extra calls and show up and round on our inpt unit on wknds adding billable to the bottom line. They got away with so much but it didn't matter because they always admitted to whatever they did and i guess made up for it in other ways. Interesting Person.

 

[SilverCat]

Generally programs start with their own version of probation which I have heard people successfully making it through. However when it is descaled to GME, it gets to be almost impossible. I'd jump ship before it got to that point.

I made it off without probation, but was later removed from a rotation due to the program's concerns about my 'stress levels.' Removed after one week on the rotation, not even given a chance to make any changes.Not really given more feedback than 'I seem stressed.' Essentially, they probably thought that I was too terrible for improvement, but didn't want to hurt my feelings, and since they were an outside rotation for my program, could just remove me without issue. My PD isn't talking about probation, but I'm done with clinical rotations (completed first year). PD doesn't think I'll do anything clinical at this point, just telling me to focus on research. I asked to be put on a repeat rotation, but the request was denied. I'm also Bombing at research as well now, so that's not an option either.

Feeling that my clinical career is over at this point, and I just have to accept it, which is hard given that I've put so much time into it. No one has confidence in my clinical abilities, including myself. Honestly, if it didn't look so bad on my resume, would rather leave the program than be given graduation only for pity.

Sorry for this update; I know no one is interested but just need to vent.

 

[Iamnew2]

I made it off without probation, but was later removed from a rotation due to the program's concerns about my 'stress levels.' Removed after one week on the rotation, not even given a chance to make any changes.Not really given more feedback than 'I seem stressed.' Essentially, they probably thought that I was too terrible for improvement, but didn't want to hurt my feelings, and since they were an outside rotation for my program, could just remove me without issue. My PD isn't talking about probation, but I'm done with clinical rotations (completed first year). PD doesn't think I'll do anything clinical at this point, just telling me to focus on research. I asked to be put on a repeat rotation, but the request was denied. I'm also Bombing at research as well now, so that's not an option either.

Feeling that my clinical career is over at this point, and I just have to accept it, which is hard given that I've put so much time into it. No one has confidence in my clinical abilities, including myself. Honestly, if it didn't look so bad on my resume, would rather leave the program than be given graduation only for pity.

Sorry for this update; I know no one is interested but just need to vent.

Sorry that you are going through this Feel free to vent if it helps.

 

[j4pac]

Over the course of my residency (3 years) I saw 3 residents not complete. One was essentially terrible and deserved the boot. Though managed to get into another speciality and graduated from that residency. Another had interpersonal conflicts with the PD and was asked to repeat a year. He instead got into another program and completed his residency. Now he did a fellowship and is working at a very prestigious hospital. There was a 3rd one who was just targeted by the faculty in 2nd year. In my opinion he got a raw deal and was harassed and finally his contract was not renewed. To my knowledge he had to leave the medical field. I later came to know from the ICU attendings that they wanted to give him a passing grade in his final crucial rotation but the PD convinced them to fail him.
The odd thing about all these residents is they were all BLACK. There were three black residents in 3 years and none of them managed to get through the residency. The faculty was overwhelmingly white.
After I had graduated I learned there was a 4th resident that entered the residency and she was having problems too. I don’t know if she was able to graduate. Guess what she was black too.

Honestly, I’d report that to the ACGME. It may be a coincidence…I think that we’ve all met bad residents of all colors, but it probably deserves to be looked at.

 

[Nephro critical care]

Honestly, I’d report that to the ACGME. It may be a coincidence…I think that we’ve all met bad residents of all colors, but it probably deserves to be looked at.

Our IM program had this subtle undercurrent of racism that nobody openly spoke about but was implied and every sensible person understood it. About 60% of our residents were from the Indian subcontinent. About 35% were white mostly all DOs with just one US MD over the 3 years I was there. About 5% were black these were a mixture of US MDs and a DO. Interestingly 90% of the faculty/attending physicians were white ; mixture of Caucasians and some Jewish physicians. Some Indians. There was just one black attending physician and he was from Nigeria. This was in a community that was about 70% black/inner city.

I was top of my class with exceptional USMLE scores from an Asian country. And yet when I got in I had some immigration issues as a result of which in my 2nd rotation I had to go almost every day to the USCIS office. My performance therefore was subpar on that rotation. My resident (white) wasted no time in giving me a failing grade and I was immediately placed on probation. My PD made me repeat 2 rotations and told me if I didn't pass I would be dismissed. It was a big shock to me. At that time I did not even know what probation meant.

I wasn't a bad resident I just had a rotation where my performance was affected by immigration issues. I did realize that white residents were annoyed of my knowledge base. I then worked extremely hard, kept quiet and became an excellent " Uncle Tom ". I knew my place and did not try to compete with the whites. Within a couple of rotations people noticed that and then I had excellent grades.

Actually all the Asian brown residents knew their place and became excellent Uncle Toms as well. We brown people know that with the color of our skin we were never going to be able to compete with whites. We saw that no matter how hard we worked they would always get to be the
'best residents' and get attendings calling to stump for them for fellowship spots.

The attendings then focused on the BLACK residents. Blacks have been in the US for much longer than us Asians and they are no longer willing to be Uncle Toms anymore. If they were treated like crap by the white faculty they called BS and refused to be subservient. But they were still small in number compared to the faculty. The white faculty ganged up on them and failed them in rotations for trivial things and one by one they were forced to resign/got terminated.

 

[Iamnew2]

Our IM program had this subtle undercurrent of racism that nobody openly spoke about but was implied and every sensible person understood it. About 60% of our residents were from the Indian subcontinent. About 35% were white mostly all DOs with just one US MD over the 3 years I was there. About 5% were black these were a mixture of US MDs and a DO. Interestingly 90% of the faculty/attending physicians were white ; mixture of Caucasians and some Jewish physicians. Some Indians. There was just one black attending physician and he was from Nigeria. This was in a community that was about 70% black/inner city.

I was top of my class with exceptional USMLE scores from an Asian country. And yet when I got in I had some immigration issues as a result of which in my 2nd rotation I had to go almost every day to the USCIS office. My performance therefore was subpar on that rotation. My resident (white) wasted no time in giving me a failing grade and I was immediately placed on probation. My PD made me repeat 2 rotations and told me if I didn't pass I would be dismissed. It was a big shock to me. At that time I did not even know what probation meant.

I wasn't a bad resident I just had a rotation where my performance was affected by immigration issues. I did realize that white residents were annoyed of my knowledge base. I then worked extremely hard, kept quiet and became an excellent " Uncle Tom ". I knew my place and did not try to compete with the whites. Within a couple of rotations people noticed that and then I had excellent grades.

Actually all the Asian brown residents knew their place and became excellent Uncle Toms as well. We brown people know that with the color of our skin we were never going to be able to compete with whites.

The attendings then focused on the BLACK residents. Blacks have been in the US for much longer than us Asians and they are no longer willing to be Uncle Toms anymore. If they were treated like crap by the white faculty they called BS and refused to be subservient. But they were still small in number compared to the faculty. The white faculty ganged up on them and failed them in rotations for trivial things and one by one they were forced to resign/got terminated.

Unfortunately it’s not uncommon what you describe.
My “crimes” in residency were: having frizzy hair (sadly I still do even as a medical director nothing I can do about it despite years of trying to find solutions), which apparently was unprofessional?, apparently my pants were wrinkled on one occasion and that was also unprofessional, not appearing to be “happy” on all rotations. Medicine is rough

 

[Crayola227]

This advice may or may not be coming from personal experience and I have no reason to suspect it's not coming from a good place. That said, usually when programs have you see the program's mental health services, it's not meant to be malignant. I know it's not what the quoted comment says but sometimes, people often naturally have a level of distrust acquired through the process.

In other words, while I won't say it doesn't exist, I don't think it's common for programs to have a psychiatrist evaluate you with intent to identify reasons to dismiss you. Offering mental health services may be a box they have to check. That's the distinction and the point I want to make is that if you're offered mental health services, approach them with an open mind. They're not there to get you to admit you have a mental health disorder or personality disorder so the program can report that to the medical board and get you dismissed (provided you are not trying to harm patients). Their goal is to provide mental health support where possible.

The issue isn't with the simple fact of you seeing a psychiatrist or that the psychiatrist in question does not approach the individual patient with every intention of helping them as much as they can - I will grant you that whatever MH professional involved has pure motives, the issue is that it doesn't change the motives of the *program* in all this.

On the surface it would appear they want to "help" you, but if things are at the point the program thinks you need professional MH assistance, then I would say they probably think your performance is pretty poor, and it's anyone's guess if they feel they can accommodate the time it will take to right a MH ship.

I think we all understand that treating MH issues so severe they are impairing you at work (there is evidence somewhere that many high functioning professionals, it really takes a lot for a clinical diagnosis of say depression to get to a point of say, patient endangerment, typically the issue is that *efficiency* tanks first, and programs, all of medicine, is particularly concerned about that to a point that well I digress), that we would expect that to take some time at least on the order of weeks, for medications or other interventions to have effect.

So again, I wonder the extent this is about help *from the program.* If it's shown you need actual help, then program can say they're not going to accommodate, that they can't. This is not too hard for them to push this line in court, actually. I know this because I've seen it.

If it's shown that you are fine from a MH standpoint, again, that just makes it easier to fire you.

My point is this ABSOLUTELY can be used by a program in a no-win fashion against the resident, no matter how earnest or pure the treating provider.

Now, add in the fact that yes, psychiatrists do have biases when it comes to these things. I know some that are very much on the side of the resident, and others with less sympathetic views. When the PROGRAM chooses the psychiatrist for you, well, can't we all agree it's some form of the worst kind of conflict of interest for someone to have their MH provider chosen for them by their employer or anyone else in a position of regulatory authority over someone, like say a medical board?

Why do you think medical boards and programs do not want you to just be evaluated by the MH provider of your choice and just take THEIR word for how you are doing?? Because obviously you have found someone you feel is in your corner. Because that is generally how people pick their provider.

So while arguably from their perspective the one YOU pick is a less than ideal candidate for evaluating things in an "objective" way in their view, or to take into consideration the objectives of whoever sent you, but if the idea is that YOUR selected physician is not sufficient because they are going to be "biased" by virtue of the fact you chose them... how does this same argument not apply to one chosen by the employer/medical board?

Your point is taken that regardless of who chooses a professional, the odds are that they are a professional and mean a patient well, whatever well means in their view (there is some variation among providers even when all else is equal, just one reason for patients to select their providers), the poster's point that this is rarely coming from a place of the program trying to salvage you vs just check a box to fire you, doesn't make that any less true.

Tldr
Provider motives =/= program motives, and regardless you're probably hosed. Use caution in seeing any provider YOU did not select, and was instead selected by an agent that may not have your individual wellbeing 100% their #1 focus

 

[Crayola227]

That's the cynicism I'm trying to dispel but my opinion's solely based on my experience and I don't blame you for holding your reservations. I've seen much more corrupt practices at medical and financial institutions. That said, I feel that in most cases, the referral to mental health should be viewed (at worst) as the program going through the motions so they can say they offered maximal support so there's no violation of rights, etc. It's similar to physicians doing ordering the full work-up even though they're pretty sure it won't yield a diagnosis.

The main point is that many of these mental health resources do help and I don't feel they're being influenced by the program probe and find evidence to dismiss you. Contrast that to sports where highly paid athletes are often pressured by team physicians to do XYZ and thus seek a second opinion to ensure they make the decisions in their best interest and not the team's. In those cases, there's way more money involved and the reason to make a false recommendation can be the difference in millions. In the case of mental health with residents, I think PDs are just trying to ensure they provide residents who they feel are struggling maximal support before escalating any remediation process.

Again, the reason I make this distinction is so that those offered mental health services to approach them with an open mind. They may lead to utilizing alternative services, but I don't feel like the mental health providers at university's are trying to get residents fired.

The better advice I think, is for a resident to reach out and try to find a MH provider on their own, preferably one where notes are not in the institution EMR, at the first sign of trouble.

If a resident has any inkling of issues, like a past history of depression, anxiety, anything really, even a dx of ADHD from childhood, the minimum is to at the start of residency contact your insurance, find out who is accepting patients, and have their number written down where you can find it. Use it sooner rather than later. Even if no formal diagnosis or something reaching clinical significance, then seek some counseling. Many residents find they end up needing it at some point, and a lot of people can use it regardless.

Sounds a bit crazy because you're swamped and time and self care and etc, but I'm saying waste no time reaching out and do it at the first sign of you internally measuring some problem, and DEFINITELY if it seems like others at work are starting to comment something seems off about you.

The pre-existing relationship with a MH provider of your own choosing will always be superior to whatver option someone else is trying to choose for you who may not have your interests first. Likely you will have more trust and rapport with this person anyway.

Also, if you have had any history of mental illness, or you have one of those diagnoses that don't generally just "go away" and can rear their head at stressful life moments with an exacerbation (like OCD, BPAD, recurrent MDD, ADHD, etc), again, you will have better damage control if you already have someone to help you maintain if you are maintaining, or help if you decompensate. Also, the fact that you have been "proactive" in seeking care before it had to be suggested, only looks on you favorably if things end up with you in front of your PD.

I'm bringing up the board, because if your performance really is very poor and there is suspected mental health issues, people forget that many types of probation or adverse actions against residents, especially with a mental health or even a suspected mental health component, end being reportable to the board.

My point being that many things that end up with you in front of the PD, be aware it can end up with you in front of the board too, depending on severity and what's involved. A PD may be mollified by knowing you are seeing a psychiatrist, but know that the medical board is its own entity, and they may not stop there, they may want to conduct their own investigation and they may want your medical records and can subpoena them even in many jurisdictions.

So the point again, is do yourself a favor and seek mental health treatment. We can deliver this message. It's better you do it early, before anyone is asking you to.

This is different from concerns people in medicine have about licensing and the medical board and questions on those forms. Yes, it's often easier for your career if you are not psychiatrically hospitalized. But also, your life is worth more than a career in medicine anyway. And also, the issue is always less what particular diagnosis you have or what meds you take, and more, can you be trusted to seek help when you need it? That will generally be better than trying to hide your issues and then decompensating to where action is taken against you.

 

[IonClaws]

In the old days though, there was no remediation plan. Stuff was done behind closed doors and if they wanted you out, you were gonna go out just on made up subjective stuff (even if you were on time, passed all exams nicely, and gave good presentations). Or if they couldn't get you out (5th year?) then they'd simply ignore you, disgusted with you. That all pales in comparison to a Dr. Duntsch type guy.. how that guy got thru remains a mystery.

I hope academic training has improved, I think it has. But it seems that many departments still tend to be attractive to sociopaths who like exercising their power.

As faculty.. I can tell you that the only time I went off on someone was when they outright lied to me about something. I wonder what became of that schmuck (who didn't get kicked out). Zero tolerance for dishonesty in medicine. Zero.

Understood, though back in the day weren't there also way more residency spots, and getting another was nowhere near as hard as it is now?

 

[sirspamalot]

I don't know if the overall # of residency spots across the spectrum has changed all that much.

Certainly in my field, there is a glut* which is causing big problems.

 

[Iamnew2]

Understood, though back in the day weren't there also way more residency spots, and getting another was nowhere near as hard as it is now?

No there are simply more people in the match, in residency etc as there are more med schools etc which makes it harder. Overall there’s always an increase even if small in residencies in general

 

[IonClaws]

No there are simply more people in the match, in residency etc as there are more med schools etc which makes it harder. Overall there’s always an increase even if small in residencies in general

Ah, yes, you're right. Basically it ends up as the same situation though (lower applicant:residency spot ratio).

 

[Coupd'Cat]

The cynic in me says: best be sure the mental health folks are not connected in any way with your organization now or in the past.

Agreed, I would also be cautious. It will vary from institution to institution. However, I have a close friend who was let go after probation (he was unable to keep up with workflow, made efforts to respond to feedback). He was convinced to sign a release of information for his therapist (mistake, do not do this please) and also to undergo a forensic psychiatry evaluation, I kid you not. He was also a person of color, to what those have pointed out before--Asian in particular. He had no family wealth to fall back on and ended up couch surfing. The discrimination exists. I'm not saying white residents are immune. However, the I've seen too many Black students and residents get over-scrutinized. My own institution went through lengths to graduate a student who was sexually harassing multiple students (white, male) while going out of their way to drug test another student (black) for weed. What helped was sharing stories like the OPs in order to better know how to navigate the administration, what your legal protections were or weren't, and to have the social support to make it through the fallout. Individual administrators and program leaders are not malicious, I hope, but the structure of the administration and resident/student probation process is one of isolation and covertness that can sow fear and helplessness. It's a little known hazard of pursuing medical training.

 

[jon stewart]

Agreed, I would also be cautious. It will vary from institution to institution. However, I have a close friend who was let go after probation (he was unable to keep up with workflow, made efforts to respond to feedback). He was convinced to sign a release of information for his therapist (mistake, do not do this please) and also to undergo a forensic psychiatry evaluation, I kid you not. He was also a person of color, to what those have pointed out before--Asian in particular. He had no family wealth to fall back on and ended up couch surfing. The discrimination exists. I'm not saying white residents are immune. However, the I've seen too many Black students and residents get over-scrutinized. My own institution went through lengths to graduate a student who was sexually harassing multiple students (white, male) while going out of their way to drug test another student (black) for weed. What helped was sharing stories like the OPs in order to better know how to navigate the administration, what your legal protections were or weren't, and to have the social support to make it through the fallout. Individual administrators and program leaders are not malicious, I hope, but the structure of the administration and resident/student probation process is one of isolation and covertness that can sow fear and helplessness. It's a little known hazard of pursuing medical training.

They made him sign a release of his pysch/psychology visits?
Isn't this a huge red flag?
That information is supposed to be protected and under multiple Firewalls for goood reason. Giving it
Up undermines all of that

Makes
Me wonder if medicine really cares or everyone is just cya
Also makes me wonder at point does one get an attorney involved.
Someone who. Actually has your interests at hand

 

[finalpsychyear]

They made him sign a release of his pysch/psychology visits?
Isn't this a huge red flag?
That information is supposed to be protected and under multiple Firewalls for goood reason. Giving it
Up undermines all of that

Makes
Me wonder if medicine really cares or everyone is just cya
Also makes me wonder at point does one get an attorney involved.
Someone who. Actually has your interests at hand

No part of medicine at least anymore cares about physicians. Everyone once your an attending is simply out to take advantage and use you to the max while trying to pay you the least. You can add replace you with a mid level to that list now as well.

 

[Coupd'Cat]

They made him sign a release of his pysch/psychology visits?
Isn't this a huge red flag?
That information is supposed to be protected and under multiple Firewalls for goood reason. Giving it
Up undermines all of that

Makes
Me wonder if medicine really cares or everyone is just cya
Also makes me wonder at point does one get an attorney involved.
Someone who. Actually has your interests at hand

My friend was dissuaded by the institution for hiring an attorney. Attorneys he consulted unfortunately shared that it would be difficult to prove a case of wrongful dismissal. Generally, a medical school only has to prove is that a student did not meet their academic standards--which, incidentally, can be changed by the medical school administration year to year. Something as inconsequential as not completing an online attestation or submitting some small form can be cited as failing to meet the academic standards.

You can also see how social disadvantage (poverty, lack of privileged social connections) is at play here. My friend was from a family of immigrants without connection to lawyers, didn't know where to start with reaching out to lawyers. He wanted to do what the institution told him would be in his best interest, hence he followed along when they asked him to sign a release of his psych visits. Institutions benefit when we don't know our own rights, and the medical system is effective at eroding our sense of entitlement to rights and distorting our value system. You have already jumped through so many hoops, often times are knee-deep in loans, you're grateful for being accepted in the first place, and if the institution says roll over because otherwise your application to residency will be screwed (a smear on your MSPE or dean's letter) and your career will be over and you have to return to wherever you came from with no MD and several wasted years, it takes a lot to say "no."

The individual in the same school who was caught watching female students change clothes and harassing them with sexually explicit voicemails and video calls came from a family of physicians and had connections with other highly educated professional types such as lawyers. He lawyered up. Last I heard, he was an internal medicine resident. Knowledge of how to move in the system can be considered its own form of wealth, accumulated and shared among families.

A medical student's main recourse is to prove that they were discriminated against based on identification as a protected group (e.g. race, gender). An institution which has a track record of discriminating against students in this way would hopefully be more vulnerable to such a claim, if the information were available to lawyers and students alike. This requires a level of transparency which an institution is not incentivized to provide.

 

[jon stewart]

Wow that's terrible. I'm sickened even reading this. I cannot imagine being thrown to the wolves and not having anyone who is on your side. Then only to be further manipulated.