RESIDENT was drastically fired from her family medicine residency at PROGRAM this July 2014. She immediately appealed to the PROGRAM’s board of directors, which after two months of mostly silence, simply denied her appeal without offering any other communication. Her questions, requests for information, objections, and concerns about violations of ACGME requirements were flat out ignored.
The rest of this letter, describes events and circumstances surrounding RESIDENT’s termination. There is ample evidence that her termination was unjustified and in stark violation of multiple PROGRAM and ACGME policies. Worse than the very real and existential threat to RESIDENT’s livelihood, is the way RESIDENT has been treated, the way she was being pressured to resign before being terminated, and the extent to which her concerns, objections, and questions with regard to her termination were ignored even when she appealed to the PROGRAM’s board of directors.
Leading up to her termination, RESIDENT --feeling desperately overworked and behind on her medical documentation-- requested any options that would lower her workload; even offered to extend her residency over an additional year. In response, she was told to take a week to catch her breath and complete outstanding documentation. It was not until halfway through this week that she was informed (in writing by PD) that failure to complete ANY outstanding responsibilities would result in immediate termination for academic reasons.
The email dialogs between RESIDENT and her Program Director(PD) over the past year, make it more than evident that PD was growing increasingly frustrated with RESIDENT voicing her concerns about duty hours violations and patient safety issues arising from hasty documentation practices being forced on residents.
Several emails specifically, further suggest, that RESIDENT has been assigned higher workload (e.g. being assigned higher significantly patient load) directly in response to raising concerns, and has faced disciplinary action (eg. having certain batching privileges revoked) without being given any justifiable reason whatsoever (despite requesting to know the reason).
I believe the following items to be facts, but will immediately inform anyone in receipt of this email if presented with any evidence to suggest otherwise:
- The ACGME requires that when reviewing evaluation and reasons for nonrenewal of appointments, the resident must be allowed a fair hearing and due process.
- The ACGME requires the sponsoring institution to give a resident at least a four-month written notice when his or her performance is unfavorable for promotion or the program is considering termination.
- RESIDENT has never denied that she was behind and unable to catch up on documentation, but PROGRAMS’s EMR software also shows that --during the past year-- RESIDENT, as an R2 was responsible for more documents and patients than any of the other residents in the entire program, including senior 3rd year residents.
- During her entire time at PROGRAM, RESIDENT was never placed on review or probation. She was promoted from R2 to R3 less than month before being terminated without any notice of unsatisfactory performance.
- Although the week to work on outstanding documentation was originally presented to her as the result of her advisor speaking to PD, (RESIDENT had appealed to her advisor about options to reduce her workload in an email and subsequent meeting), RESIDENTS’s advisor did not even know that she had been terminated until RESIDENT emailed her a week after the fact!
- RESIDENT was not informed about where or when the board meeting to address her appeal was held. She was not allowed to attend the meeting. She also was not informed who was present / making this decision.
- RESIDENT has talked to at least one other resident who resigned from PROGRAM in the past for personal reasons and learned that this resident was also pressured to resign.
I personally, find it incredibly hard to imagine genuinely malevolent intentions by PD or other PROGRAM administrators, but at this point am at a complete loss as to what other conclusion to be arriving at. Indeed, PD tried strongly to pressure RESIDENT into resigning, offering letters of recommendation and help finding another residency. If she would not resign voluntarily, she would be fired for academic reasons, was certainly not to expect any letters of recommendation, and should expect never to be able to practice family medicine again! I simply cannot fathom any set circumstances under which this dichotomy can be considered, or appears even remotely ethical or just.
What would you do? The ACGME doesn’t handle individual disputes, legal action would take years, meanwhile finding another residency is proving very challenging. Even if RESIDENT finds a new program, either her or her spouse ends up a single parent with 2 toddlers unless spouse was to throw career (and currently only means of support) out the window.
[edited: I removed one of the items in the list in favor of anonymity.]
If there are other problems you are welcome to approach any resident union that is available. If not writing to the program director and DIO and requesting her records so that she can apply to new jobs seem like a good idea.
