Terminating residents

[dr0277341283141]

This thread is great, and timely.

I'm scared to say too much because I don't know if one of my faculty is reading this thread. Exactly who of you is a worm?

I am having problems. I have entered the probation chute. I suppose I will be terminated soon. Yes, I have contacted a lawyer. I had to contact around eleven before one would feel comfortable working with me.

Fortunately, I saw this coming and I was able to submit my ERAS application before I was put on probation. Needless to say, nobody gave me this advice.

Five other residents told me that they would talk to the PD for me. None have. I don't blame them, they are just trying to save their arses. Each one of them here pity me and are convinced they are next.

I have advice to those who are applying for residency. Please see these two papers:
PMID 7859951
PMID 12189638

Many other papers on pubmed describe attrition rates for other specialties.

Anyway, the second reference describes attrition rates in residencies overall. The USMG attrition rate is around 2.5% with a calculated statistical statistical error of around 0.5% For such a low number, the sigma must be less than 2.5%, because no residency has less than a 0% attrition rate. So that means that the upper limit on any normal residency is around 5%! To be an unusual program, they would expel more than one resident in 20.

Since this rate is so low, the poster above's advice is very accurate. SUSPECT ANY PROGRAM WITH GREATER THAN A 0% ATTRITION RATE DUE TO TERMINATION IN THE LAST 10 YEARS. I say 10 years because the data above is for a 10 year rate.

So what can we do as residents to prevent this kind of abuse? Not much, really. But we can change the system over time. The first thing is to educate those in medical school to NOT rank programs with a high attrition rate. Figure it out guys, if you're marginal and you're ranking a given program because it's a "shoe in," you're not doing yourself a favor because you'll fail there: they'll pick up on the fact you're marginal, and you'll be terminated. Eventually these programs will go extinct because nobody will go to them.

Surprisingly, the first paper above describes a termination rate in family medicine programs which is around 7%! What a specialty! It's the garbage dump of residencies, you'd think they'd want to retain primary care physicians, yet they terminate! Amazing! (Yeah, I know I've used up all my exclamation points.) The rate at my residency has been 33% in the last two years yielding a minimum 10-year expulsion rate of 7%, yet it must be higher because I know they've expelled other residents in the last 10 years.

My firm belief is that any program with a 10-year expulsion rate over 7.5%, that is, two sigma above the mean, should be deaccredited by the ACGME. The implementation would be the following: a warning after 3 years, an investigation at the 5 year mark with a plan, a reinvestigation at the 8 year mark and deaccrediting at 10 years. They're getting paid to train residents, right? And after getting through medical school, you're not starting with dubious material. Besides, it's the same in medical school: two sigma below and you're out. It's the standard that we are held to. Residents are humans, too, and shouldn't have their lives ruined because the faculty stink, have no ability to teach and have poor interpersonal skills.

I wish everyone the best, try not to get raped. Please pray that I get into another program.

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[NotAProgDirector]

I'm scared to say too much because I don't know if one of my faculty is reading this thread. Exactly who of you is a worm?

Well....

Anyway, the second reference describes attrition rates in residencies overall. The USMG attrition rate is around 2.5% with a calculated statistical statistical error of around 0.5% For such a low number, the sigma must be less than 2.5%, because no residency has less than a 0% attrition rate. So that means that the upper limit on any normal residency is around 5%! To be an unusual program, they would expel more than one resident in 20.

Not sure that the statistics you have quoted are correct. Because the attrition rate is low and, as you mentioned, can't be less than zero, the distribution is likely non-normal. That's where my statistics knowledge ends. However, I agree with you in principle that if the failure rate is greater than 5%, then something seems not good. Residents leaving to go to another specialty would seem not a major issue (from the resident perspective, although I guess you could argue that this would be bad for program morale).

Since this rate is so low, the poster above's advice is very accurate. SUSPECT ANY PROGRAM WITH GREATER THAN A 0% ATTRITION RATE DUE TO TERMINATION IN THE LAST 10 YEARS. I say 10 years because the data above is for a 10 year rate.

I'm hoping that's a typo. 0%? I should be suspicious of a program that takes 25 interns a year x 10 years = 250 interns, if any one of those 250 fails out?

Figure it out guys, if you're marginal and you're ranking a given program because it's a "shoe in," you're not doing yourself a favor because you'll fail there: they'll pick up on the fact you're marginal, and you'll be terminated.

If you're marginal, and you don't do well, then what should I do? Presumably try to help. And if help doesn't work? Pass you anyway and let someone whose skills I can't vouch for graduate?

Surprisingly, the first paper above describes a termination rate in family medicine programs which is around 7%! What a specialty! It's the garbage dump of residencies, you'd think they'd want to retain primary care physicians, yet they terminate! Amazing!

First, this is needlessly hurtful. FM may be less competitive than other fields, but that's only because reimburements are low. I'd argue that FM could be much more challenging than some other competitive fields. Perhaps you don't like FM. Fine. But calling FM a "garbage dump" is uncalled for and unprofessional.

I doubt they terminate people for fun. FM is less competitive. Less competitive candidates get into it. You'd expect the termination rate to be higher. Just because we may need PCP's as a nation (which is debatable, but that's a topic for another thread), that doesn't mean we should lower our standards and simply graduate anyone who starts a residency.

The rate at my residency has been 33% in the last two years yielding a minimum 10-year expulsion rate of 7%, yet it must be higher because I know they've expelled other residents in the last 10 years.

That doesn't sound good. Either they are particularly vindictive, have poor teaching so people don't learn, make poor choices for their resident selections, or are so non-competitive that only the least qualified candidates apply, and hence the high failure rate.

My firm belief is that any program with a 10-year expulsion rate over 7.5%, that is, two sigma above the mean, should be deaccredited by the ACGME. The implementation would be the following: a warning after 3 years, an investigation at the 5 year mark with a plan, a reinvestigation at the 8 year mark and deaccrediting at 10 years.

Currently in IM, the rule is you must graduate 80% of the residents who start in their PGY-1. Remember that this 20% loss includes those who change their mind and switch into another field and those who fail out. Perhaps 80% is too low.

And after getting through medical school, you're not starting with dubious material. Besides, it's the same in medical school: two sigma below and you're out. It's the standard that we are held to.

Now this is certainly not true. I have had several interns start who, as far as I could tell, never learned anything in medical school yet passed. Or, the school wanted their graduation rate to be high and simply passed them on.

And, no system is perfect. Just because you graduated from medical school doesn't mean that you'll succeed as a resident. And for foreign schools, the situation is more grey -- there may be curricular differences, cultural differences, technilogical differences, etc, which make it much more difficult for international grads to succeed in a residency program.

Residents are humans, too, and shouldn't have their lives ruined because the faculty stink, have no ability to teach and have poor interpersonal skills.

I wish everyone the best. Please pray that I get into another program.

I find your use of the word "raped" a poor choice, again. Perhaps you have never cared for a rape victim and seen the devastation created. Getting fired sucks, no doubt, but the two are not comparable in my opinion.

The worst prognostic sign in any remediation process is the resident not recognizing that they are part of the problem. The new mantra is that "people are not to blame for errors, systems are" and that is mostly true. However, when I sit down with a struggling resident and the first thing they tell me is that the problem is their resident / attending / call schedule / alignment of the planets / etc, I know that I will likely be terminating the resident. It is sad.

 

[nsap102]

Very interesting post. Especially for me.

To aProgDirector,
Would you please elaborate on your comment saying that a program must graduate at least 80% of its resident's. As it turns out, there is someone else in the same boat as me.

Furthermore, does that 80% percent also include in comming transfers? i.e. Program has 20 residents. Fires 4, yet hires another 4.

dr0277341283141
Thank you for the post. I now know what types of questions to ask about when I interview (hopefully)

 

[secretwave101]

The fair hearing can really only answer a single question -- was the PD's decision fair? It can't answer the question "Was the PD's decision correct?"

I wish this was true. My PD asserted the same thing to reassure me that my role would be largely procedural. He wasn't being deceptive, he was just misinformed. He recently apologized to me about it. The first thing they told me when I sat down in the appeal committee meeting was that we were charged with evaluating both the procedural fairness of the firing, and the legitimacy of the firing itself. I can assure you, the latter of the two has caused no small amount of angst for me.

Faculty evaluate a resident's suitability for a career in medicine. Not me. I'm not paid for that and have no expertise in this type of analysis.

 

[Sarcoidosis]

Wow, good post. This seems very much like my surgical rotation as a med student. There is a lot of politics involved, alliances among residents and attendings. "Marked" residents in the program... wow all this is true and surprising to know that this is not infrequent.

I would really like an opinion from a lawyer with regards to how a resident starting their rotation can protect themselves from being abused by the program. Specifically, what type of documentation to keep? I know I am getting very paranoid but better to know now then to regret later.

 

[dragonfly99]

There isn't really any way that you can protect yourself as a resident, besides trying to be a good resident, and perhaps as importantly, learning how to influence people and/or make them like you. There's no paperwork you can keep or stategy you can employ to protect yourself. Most claims of resident incompetence or "problem resident or doctor" firings come down to a he-said, she-said situation, and the program director and other faculty are going to have more power than you, in fact almost absolute power.

Most residents get through residency without major problems/issues so this is unlikely to be an issue for you. The best thing I can say is try to pick a nonmalignant residency...if you find out any residents (well more than 1 or so) have left or been kicked out within the past 5-6 years I would say that is a bad sign. Also, read books that tell you how to win friends and influence people...i.e. books like salesmen/businesspeople study to learn how to influence others.

 

[marsupial]

that some people got a fair hearing with other docs. I just got "your contract's not renewed, feel free to finish your intern year but sucks to be you after June". THat was it. I wait tables now.

 

[secretwave101]

firings come down to a he-said, she-said situation, and the program director and other faculty are going to have more power than you, in fact almost absolute power.

This is absolutely true. I saw it play out in our process, but I'm also told that the courts give nearly-complete deference to the PD and faculty in these decisions also.

So don't piss 'em off!

 

[mjl1717]

I would've simply said, NO. I'm sorry but you can keep me dangling in the hospital extra hours, have me carry yet another patient on my overloaded census, or spring an extra call on me, but that is simply crossing the line. Getting paid a Taco Bell hourly wage is no where near enough to force me to serve on a kangaroo court like that.

Agree, sometimes it is wise to fight back (parry thoughtfully)..
Not good to be a girl every single time! [eg.-"Im not taking that" And present your case diplomatically if they are mature and professional!]

 

[exPCM]

I think that one thing that would help solve the problem of pervasive resident termination is a change in Medicare rules so that whenever a resident is terminated, the Medicare funding for the resident's spot at the program is terminated until the time the resident would have completed the program had they not been fired. As it is now the program can just pick up another resident and maintain the funding.
An example of this change would be an IM program that has 30 resident spots with Medicare funding of 120K per year per resident as below:
2008-2009 academic year
PGY1 - 10 residents
PGY2 - 10 residents
PGY 3 - 10 residents
Funding = 30 residents x 120 K = 3.6 million

Now if the program fires two PGY-1s the program should lose their funding until the time the two interns would have finished the program.

So in 2009-2010 and 2010-2011 they would get funding of 28 residents x 120K = 3.36 million.

Then their funding would go back up to 3.6 million in 2011-2012 assuming they had not fired any other residents.
If they would lose funding by firing residents, the residency programs would have a stronger incentive to remediate rather than fire residents.

 

[NotAProgDirector]

If they would lose funding by firing residents, the residency programs would have a stronger incentive to remediate rather than fire residents.

... or, programs would simply not hire anyone who didn't appear to be a 100% sure thing.

... or, it would create a system where residents were forced to resign. I would think that any such rule would differentiate between firing and resignation -- else if one of my PGY-1's were to switch to another field, I would be "punished" for this, hence I might try to prevent it.

 

[secretwave101]

... or, programs would simply not hire anyone who didn't appear to be a 100% sure thing.

That's the goal already. But with the exception of derm and some of the sx fields, the pressure to avoid the scramble mitigates this. To get perfect residents, most programs would need to have open slots every few years. Maybe there needs to be less pressure to fill all the spots every year, so programs are willing to only hire the applicants they feel great about.

 

[exPCM]

... or, programs would simply not hire anyone who didn't appear to be a 100% sure thing.

... or, it would create a system where residents were forced to resign. I would think that any such rule would differentiate between firing and resignation -- else if one of my PGY-1's were to switch to another field, I would be "punished" for this, hence I might try to prevent it.

I do agree that such a rule would have to distinguish between a resident being fired and a resident who voluntary resigned to transfer to another program or for personal reasons, etc.

 

[peerie]

Interesting idea about the funding issue, I like the thought that a program would have to account (in some way) for the loss of a resident. I would imagine, that a good program would use this to work with a resident wheras I could see that a bad program would have to - well, maybe make some changes in how they deal with their residents. AProg's comments are also good; it's a complex issue.

In the end, I think that the marketplace rules and that it's buyer beware. If you can do your homework, ask good questions, check the environment for signs of weirdness, then an applicant can possibly avoid a poor program. If a program is really 'bad' then it seems the market would reflect that. The presence of huge numbers of IMG/FMGs does confuse (and obfuscate) the issue, though, because they can currently slot in when someone does leave.

Well at least we're talking about this topic, which is a start.

 

[3dtp]

Interesting idea about the funding issue, I like the thought that a program would have to account (in some way) for the loss of a resident. I would imagine, that a good program would use this to work with a resident wheras I could see that a bad program would have to - well, maybe make some changes in how they deal with their residents. AProg's comments are also good; it's a complex issue.

In the end, I think that the marketplace rules and that it's buyer beware. If you can do your homework, ask good questions, check the environment for signs of weirdness, then an applicant can possibly avoid a poor program. If a program is really 'bad' then it seems the market would reflect that. The presence of huge numbers of IMG/FMGs does confuse (and obfuscate) the issue, though, because they can currently slot in when someone does leave.

Well at least we're talking about this topic, which is a start.

Another thought would be to create a centralized resident "records/training transcript" independent from their institution that the program must provide copies of all training documents/evaluations/badness/goodness etc, every quarter. This would insure a record independent of an institution which would be fully safe an credible as a central training repository. The ABIM already does this on an annual basis. If this were developed, it would allow residents a measure of confidentiality should they decide a program doesn't mesh for them. Honest PDs (the majority, I think), will not like the prospect of having an unvarnished third party repository, and not so honest programs will like it even less, since it pins them to a story which cannot be altered. If the document wasn't in the repository, it simply doesn't exist/can't be used against a resident. This might allow some measure of independence in which residents can pass on their bona fides to a prospective new program.

 

[drsav]

That sounds interesting.
Well, I think Dr. Chen from the UW 2000 incident should have considered the nuclear option if he knew he had a case. But Some residents firmly believe that they dont have a case.

I know several people who will testify that their attendings told them that they were a scapegoat and several of them who were treated unfairly because of a misunderstanding. At times the program director has favorites and tends to believe everything that she/he hears from them.

To the attending who has written before me. I would say; sometimes one needs to get nuclear. I agree that the PD has a lawyer and thats why they feel invincible. I heard from the GME director that the PD has documented things very well and there usually would be no way around this termination.

I've known someone who had 5 months remaining to go in his residency and they terminated him. They werent able to find dirt on him until the last day of termination when they terminated him with false accusations. And at the time of the dismissal proceedings with the GME director; they didnt even allow him to see his file. This violated Due Process. What if something was written in there that was untrue or was someone else's perception about the truth.

The bottom line is that: If you really believe that you were wronged then GO NUCLEAR before you go balistic.
I believe there should be a class action Lawsuit against all the PDs who think they are invincible or who can target residents and ruin their career.

And whenever there is going to be a bad evalutation for a resident; there should be a lawyer to help the resident. The resident advocate/advisor is usually the one making all the accusations and cannot take on the function of helping the resident. The 'option to have a lawyer' is nonsense as the residents are usually naive and trust their backstabbing advisors or PD. So they must have a (ACGME paid for) lawyer with no ties to the residency.

If anyone wants to help set up a fund and/or a group that would help those residents who have been discriminated for any reason or who have been wronged then contact me at [email protected]
Let us set up a resident grieving forum and spread the news to prevent what happed with Dr. Chen and the itseems nice PD at UW in 2000.
We are doctors, We care First. Let us Care for Our Fellow Doctors also.

fernsa: Can you please explain the Dr. Chen from the UW 2000 incident?

 

[drsav]

I think that one thing that would help solve the problem of pervasive resident termination is a change in Medicare rules so that whenever a resident is terminated, the Medicare funding for the resident's spot at the program is terminated until the time the resident would have completed the program had they not been fired. As it is now the program can just pick up another resident and maintain the funding.
An example of this change would be an IM program that has 30 resident spots with Medicare funding of 120K per year per resident as below:
2008-2009 academic year
PGY1 - 10 residents
PGY2 - 10 residents
PGY 3 - 10 residents
Funding = 30 residents x 120 K = 3.6 million

Now if the program fires two PGY-1s the program should lose their funding until the time the two interns would have finished the program.

So in 2009-2010 and 2010-2011 they would get funding of 28 residents x 120K = 3.36 million.

Then their funding would go back up to 3.6 million in 2011-2012 assuming they had not fired any other residents.
If they would lose funding by firing residents, the residency programs would have a stronger incentive to remediate rather than fire residents.

What happened if a program always terminates residents 6 months after they start training and do not fill the vacancy until six months later, or the beginning of the next academic year. Do they keep the funding without paying any resident 's income?

 

[drsav]

This thread is great, and timely.

I'm scared to say too much because I don't know if one of my faculty is reading this thread. Exactly who of you is a worm?

I am having problems. I have entered the probation chute. I suppose I will be terminated soon. Yes, I have contacted a lawyer. I had to contact around eleven before one would feel comfortable working with me.

Fortunately, I saw this coming and I was able to submit my ERAS application before I was put on probation. Needless to say, nobody gave me this advice.

Five other residents told me that they would talk to the PD for me. None have. I don't blame them, they are just trying to save their arses. Each one of them here pity me and are convinced they are next.

I have advice to those who are applying for residency. Please see these two papers:
PMID 7859951
PMID 12189638

Many other papers on pubmed describe attrition rates for other specialties.

Anyway, the second reference describes attrition rates in residencies overall. The USMG attrition rate is around 2.5% with a calculated statistical statistical error of around 0.5% For such a low number, the sigma must be less than 2.5%, because no residency has less than a 0% attrition rate. So that means that the upper limit on any normal residency is around 5%! To be an unusual program, they would expel more than one resident in 20.

Since this rate is so low, the poster above's advice is very accurate. SUSPECT ANY PROGRAM WITH GREATER THAN A 0% ATTRITION RATE DUE TO TERMINATION IN THE LAST 10 YEARS. I say 10 years because the data above is for a 10 year rate.

So what can we do as residents to prevent this kind of abuse? Not much, really. But we can change the system over time. The first thing is to educate those in medical school to NOT rank programs with a high attrition rate. Figure it out guys, if you're marginal and you're ranking a given program because it's a "shoe in," you're not doing yourself a favor because you'll fail there: they'll pick up on the fact you're marginal, and you'll be terminated. Eventually these programs will go extinct because nobody will go to them.

Surprisingly, the first paper above describes a termination rate in family medicine programs which is around 7%! What a specialty! It's the garbage dump of residencies, you'd think they'd want to retain primary care physicians, yet they terminate! Amazing! (Yeah, I know I've used up all my exclamation points.) The rate at my residency has been 33% in the last two years yielding a minimum 10-year expulsion rate of 7%, yet it must be higher because I know they've expelled other residents in the last 10 years.

My firm belief is that any program with a 10-year expulsion rate over 7.5%, that is, two sigma above the mean, should be deaccredited by the ACGME. The implementation would be the following: a warning after 3 years, an investigation at the 5 year mark with a plan, a reinvestigation at the 8 year mark and deaccrediting at 10 years. They're getting paid to train residents, right? And after getting through medical school, you're not starting with dubious material. Besides, it's the same in medical school: two sigma below and you're out. It's the standard that we are held to. Residents are humans, too, and shouldn't have their lives ruined because the faculty stink, have no ability to teach and have poor interpersonal skills.

I wish everyone the best, try not to get raped. Please pray that I get into another program.

Is this program in the same location as Dr Chen incident: WI

 

[drsav]

I was selected by my PD to serve on the Board that is hearing the appeal of one of our residents that was recently fired. It's horrible. The Board is made up of faculty members and hospital administrators. I'm the token resident.

No matter how I vote regarding the final decision regarding this resident's termination, I'm on the bad side of someone. Irrespective of the case itself, how am I expected to go against the faculty member on the Board? They've already decided this resident needs to go...what if the Board forces the faculty to take him back? What if they have to take back a resident they fired...because the resident voted against us?

As mentioned, residents have no power. This wouldn't be so bad if we didn't need to keep our jobs so desperately (at least, with 4 kids and a quarter mil in loans, I sure do). Me, with no power whatsoever, now have to serve on a Board where I'm caught in a power-differential meat grinder. There's no way to make everyone happy, and there's no way to "fly under the radar". The question isn't whether or not I can escape without pissing someone off...it's who's the least dangerous to cross?

I've got 8 months to go. Just 8 little months. Less time than it takes to gestate a human being. All I want is to make it.

You are playing with and destroying other Doctor's life.
There is no excuse to do what is convenient for you, and not what you should do. What goes around comes around, and it will come to get you, sooner or later. If you cannot be impartial, do not serve on this Board

 

[drsav]

Perhaps, but at some programs it is done frequently, (or at least less than rarely). This is a topic I know something about. A program terminated two residents quietly the year before I went there, affluent community hospital, prestigious town, etc. The year I arrived, it terminated 5 more. Of these, two were justified.

At least two of the residents were ordered to see a hospital appointed psychiatrist who found "issues." One of the residents was concerned about program mis-information meant to induce residents to rank the program, another about rules violations and a third just complained at the wrong time following a prolonged on-call time (over 40 hours on duty).

One of the residents called me after a final year contract was signed and a week later he was terminated on Christmas Eve. The phone call I got frightened me enough that I insisted this resident come over for dinner. Suffice it to say, that had I not interceded, another UW story would have been repeated.

I worked with these residents, know their stories, know the hospital's side, and know the truth.

In each of these cases, the program's actions were precisely the same. It was though they were reading from the same comic book, only the names of the residents were changed. Four of these residents went on to get into other programs, although it took between 2-4 years to move on. They have all completed their next residencies and are in practice and doing well. I am privy to things that would curl your hair, and lead you to wonder why anyone would ever consider medicine as a career.

A resident at another program in the same system reported to me that "program directors have a meeting where they learn how to 'punish' residents who displease them." [Language tidied.]

Fortunately, I have met with many residency directors at professional meetings, regional medical society meetings and in other forums, who are honest, dedicated and diligent. In discussing these concerns with them, they universally decry such behavior, but when asked if they would work to help remediate such residents, nearly all are at least somewhat reluctant to help residents on the outs with a program. In the words of one PD, "...these guys need to be stopped. They make us all look bad." But, people are afraid that residents with "problems" may actually have problems.

The "nuclear option" is not viable. In many states, the legal protections for residents are non-existent. The courts, the medical boards, feel that "protecting the public" from "bad doctors" trumps the individual. They defer to the program directors and the hospitals who employ them, in all but the most egregious cases. This, coupled with the NRMP match and expectations that once in a program, no matter how bad, no matter how misled one was in selecting a program, you will finish in that program and nowhere else.

This leads to a situation ripe for abuse, human nature being what it is. I agree with above posters who think we need some form of independent, unbiased review with teeth, particularly in light of the ACGME's repeated unwillingness to call abusive programs to task. The ACGME states it will not intercede on behalf of individual residents, the NRMP says it is only a "matching" operation and once the contract is signed, its role is consumated.

This situation was, in part, the basis for the NRMP lawsuit by Paul Jung and company. Not only is the NRMP anti-competitive, it also deprives every single person in residency of a freedom to move from one position to another.

This is not likely to change, as it benefits the hospitals and the government, in that residents are economically and physically restricted from seeking better positions, thus allowing bad programs to continue unabated with little to no incentive to improve. And the powerful will not voluntarily relinquish their power.

How can you work in a program like this, and know what you know? Have you ever thought about doing something effective, other than listening to the residents' complaining?
I agree with yeasterbunny, you must be midcoast of Lake Michigan ...

 

[Old_Mil]

Interesting thread. I've been asking "How many residents have left the program in the last 6 years (two classes for a 3 year program)? How many were fired?" If the answer to the first question is more than 1 - or the answer to the second is more than 0, I move on down the road to the next program...and it doesn't matter if its Harvard or Hoboken Community Hospital providing the answer. I also rule out any program that has irregular numbers of residents in its classes.

While I'm sure that there are situations that don't work out for perfectly valid academic/personal reasons from either the program's or the resident's perspective, there are certain gambles I'm not prepared to take with my career - and getting involved in a bad case of office politics is one of them.

Remember, medical education is the same everywhere. Harrison's is no different in California than it is in Cleveland. It's the people that make a program and a shiny new facility or a big "name" on a piece of paper certainly aren't adequate compensation for working with bad actors.

 

[dragonfly99]

Old mil,
I actually think that's kind of smart.
Of course, a program could definitely have a legitimate reason for firing a resident, but it sure is hard to tell things like this when you are an applicant. Sometimes people leave specialties like medicine, though (i.e. leave to do derm or radiology) so it's not necessarily a bad program just because some residents left. It might actually be a good program (i.e. several interns/2 years left my med school's medicine program due to matching in to derm, which they probably couldn't have done if @ a lesser program).

 

[WorkaholicsAnon]

You are playing with and destroying other Doctor's life.
There is no excuse to do what is convenient for you, and not what you should do. What goes around comes around, and it will come to get you, sooner or later. If you cannot be impartial, do not serve on this Board

I agree with this. Secretwave, your ethical duty is to make the decision that you feel deep down is the fair one to the resident being judged, not worrying about your own butt and how your vote might affect it. You know, the ethics and morals that supposedly your med school looked for in your character when selecting you as a med student? Apparently, it really does matter in your profession.

 

[dragonfly99]

Medicine fellow here...
I think you guys are being pretty harsh on mr secretwave. Nowhere in his post did I see where he was planning to throw this other resident to the wolves just ot make himself look better. He's just saying that he's being put in an untenable position, and it sucks no matter which way he decides, which I pretty much agree with. One of you suggested he should refuse to serve on the committee...oh yeah, I'm SURE that would work. What if the answer is, "Do it or you're fired!". Should he then resign out of moral outrage? That's not a realistic suggestion. I think he's stuck doing it, and all he can do is try to be as fair as he can. The idea that he can be "unbiased" is silly. He is under pressure from multiple sides...of course the dept./PD and perhaps from the resident being threatened with termination, and/or his or her friends.

For what it's worth, the AMA is just about to issue guidelines for how residencies should be treating their residents. I've seen the document, and one of the things in there is a statement that in cases of probation/termination, there should be a member of the house staff on the committee to evaluate such residents, but it should be A RESIDENT FROM A DIFFERENT DEPARTMENT. That is totally true. It's just inappropriate to have a resident from the same department. He/she is likely already going to have an opinion about the person, thus cannot be unbiased. Also there are the obvious issues of the person on the committee feeling pressure from his/her dept. and program director. It's just wrong on so many levels.

 

[secretwave101]

You are playing with and destroying other Doctor's life.
There is no excuse to do what is convenient for you, and not what you should do. What goes around comes around, and it will come to get you, sooner or later. If you cannot be impartial, do not serve on this Board

Although I can agree with the couple of sentiments in this vein, they also smack of self-righteous arm-chair ethics and it sorta pisses me off.

The point of my post was to describe the realities of my situation. OF COURSE I shouldn't care about my own future, my children's lives, or my daily-ballooning personal debt or the extra call burden in this situation and I should simply evaluate the facts as I see them. But if you think these issues didn't cross my mind, then perhaps you're a Jeffery Dahmer-like mental sepratist.

The decision-making process regarding wheather or not to recuse myself was exactly what I was wrestling with in my original post. My point was that none of the residents in our class would be able to TRULY offer an unbiased opinion in the appeals process. It's like saying "I tried really hard to not notice the results of the other study group...so I guess it's double-blinded".

The best advice I got on this board was to recommend that a resident from a different program sit on the board next time. I made this recommendation to our PD and the advisory board; noting that using a resident from our program was slightly flawed and prone to bias irrespective of the intentions of the serving resident.

That said, I elected to remain on the board. I think the process as a whole is a good one; shortcomings are far outweighed by the benefits. I believe the process produced an admirable level of justice for the appealing party.

I truly believe I was impartial in my assessment of the case, within the constraints of being human and having a vested interest in the outcome of the situation. I feel comfortable with my ultimate vote regarding the terminated resident (how I voted, and the final vote tally of the board, is confidential). I have felt better about the choice as time has passed. I think that, under the circumstances, the process was extremely fair.

 

[secretwave101]

Dragonfly - I got all huffy and wrote my post before your's showed up.

Thanks for the support.

 

[DarthNeurology]

The worst prognostic sign in any remediation process is the resident not recognizing that they are part of the problem. The new mantra is that "people are not to blame for errors, systems are" and that is mostly true. However, when I sit down with a struggling resident and the first thing they tell me is that the problem is their resident / attending / call schedule / alignment of the planets / etc, I know that I will likely be terminating the resident. It is sad.

Well, I think that for anybody who knows how to play the game they would recite the, "I recognize that I am not performing at level and want to fix the problem."

PDs in general don't want to hear how bad their program is, or how bad their attendings are, in fact I think the ones who run substandard problems know it in their hearts and are more prone to attack residents who start talking about the obstacles that poor attendings can create. I feel it is projection, i.e. the psychological defense which if a resident complains about the malignancy of a program the PD reasons that it must be false criticism and turns it back on the resident saying that they can't handle criticism. (PDs can't handle criticism very well themselves, or otherwise residents in this country would be more free to speak their minds. . . )

In the end it takes two to tango, i.e. if a resident is doing poorly and has legitimate complaints about the program then there is also a systemic component as well. Honestly, for APD I don't think it is a "prognostic sign" but more of a "if you don't stop mentioning how you are harrassed here we are going to fire you" sign. (For APD this is something that ticks off him/her subconsciously maybe such that the resident doesn't have a chance to stay in the program.)

From the student/resident side it makes the school/program look bad if you are being questioned about a problem on a rotation where the attendings are pretty bad and the residents are lazy and they school/program can't acknowledge this, that is also "sad."

 

[Fighter08]

I have been recently terminated from a Family Practice residency program. I passed all my rotations and my performance was always outstanding, until I lodged a complaint of sexual and emotional harrasment, under the urge of my advisor, against the major teaching pediatrician attending.

The offending physician, who was already on probation, has been fired from the teaching service but continues to practice medicine in the same hospital. Subsequently, his partners, my program director and my advisor retaliated against me.

First, they failed me, for the first time, my pediatrics rotations.
Secondly, placed me under strict surveillance, videa-taping, direct obs and increased scrutiny.
Thirdly, demoted my promotion to a second year and forced me to remediate peds and failed me again.

Finally, my PD gave me two options whether I resign or she will terminate me. I was going to be fooled and resign but I did not. She refused to give me any credits or a letter, so why do I make it easy for her? She recently fired me. She still refusing to give me a proof of the eleven months I passed or a verified letter so I can transfer/apply to another program.

I have NEVER been on probation, or suspension and never received any written or verbal warnings. I am shocked. I contacted the ACGME but they told me that they can not help. However, they wanted me to file a complaint so they can initiate a site visitation. I also contacted the ABFM to get my credits but they have no jurisdiction over PDs. I am stuck. My attorney wants to take the case to the EEOC and HRC for retaliation, demotion and sexual harrasment. I am waiting for the appeal.

Is there any one can help? advice? or support? I am number 5 resident fired in less than three years from this program. I am so disgusted from them and will do anything to defend my rights whatever it takes. My only regret that I said "No" to the harrasser but in fact I don't regret. I may lost my residency position for a while, but gained my selfrespect.
Ms. N

 

[BlondeDocteur]

My God, Ms N, that is truly awful. I have no advice-- hope your lawyer's a good one-- but my condolences. What an awful thing to go through. I seriously cannot believe in this day and age that sexual harassment is tolerated and brushed under the rug like that.

 

[DarthNeurology]

I have been recently terminated from a Family Practice residency program. I passed all my rotations and my performance was always outstanding, until I lodged a complaint of sexual and emotional harrasment, under the urge of my advisor, against the major teaching pediatrician attending.

The offending physician, who was already on probation, has been fired from the teaching service but continues to practice medicine in the same hospital. Subsequently, his partners, my program director and my advisor retaliated against me.

First, they failed me, for the first time, my pediatrics rotations.
Secondly, placed me under strict surveillance, videa-taping, direct obs and increased scrutiny.

Thirdly, demoted my promotion to a second year and forced me to remediate peds and failed me again.

Finally, my PD gave me two options whether I resign or she will terminate me. I was going to be fooled and resign but I did not. She refused to give me any credits or a letter, so why do I make it easy for her? She recently fired me. She still refusing to give me a proof of the eleven months I passed or a verified letter so I can transfer/apply to another program.

I have NEVER been on probation, or suspension and never received any written or verbal warnings. I am shocked. I contacted the ACGME but they told me that they can not help. However, they wanted me to file a complaint so they can initiate a site visitation. I also contacted the ABFM to get my credits but they have no jurisdiction over PDs. I am stuck. My attorney wants to take the case to the EEOC and HRC for retaliation, demotion and sexual harrasment. I am waiting for the appeal. But my attorney is not hoping on it as the appeal committe panel will be other program directors and usually they favor each others. He was helping the other fired resident few months ago, so he has experience with their outcomes.

Is there any one can help? advice? or support? I am number 5 resident fired in less than three years from this program. I am so disgusted from them and will do anything to defend my rights whatever it takes. My only regret that I said "No" to the harrasser but in fact I don't regret. I may lost my residency position for a while, but gained my selfrespect.
Ms. N

It seems like your advisor set you up?? Like he/she urged you to file a complaint and then turned on you? The usual outcome when a subordinate files a complaint against an abusive attending in a position of power is that the subordinate gets creamed, i.e. pushed out of medicine and that the abusive attending plays a game of musical chairs where he/she has less teaching responsibilities.

Realize that it will be hard to get another residency position, but I believe that you can do so if you apply broadly. Filling a lawsuit would help out future residents, but wouldn't help you as much as you would have spend years doing it, . . . years you could spend getting another residency.

PM me the name if you could as I would love to figure out which program did this and put them on my personal "have no contact with" list.

 

[DarthNeurology]

My God, Ms N, that is truly awful. I have no advice-- hope your lawyer's a good one-- but my condolences. What an awful thing to go through. I seriously cannot believe in this day and age that sexual harassment is tolerated and brushed under the rug like that.

On the wards all sort of harrassment occurs, be it sexual in nature or otherwise, . . . actually sexual harrassment probably is more dangerous for the harrasser as is making racial slurs and comments, but this happens as well.

Often, it is not out and out and out sexual harassment per se, but say a chief resident pokes fun at a student for not being married to not spending time with her boyfriend or makes other personal comments, . . . it is wrong, but hard to protest it as being sexual harassment on the spot, i.e. it is more subtle. I have seen this happen, and it is hard to tell if it is a joke or not, sure some female med students make jokes with male residents of a sexual nature and if you read a transcript and didn't know the student was laughing you might think it was sexual harassment.

I don't think it is appropriate to make personal comments about others, but it happens all the time as attendings/residents make personal comments about what students/residents are wearring ect. I have seen a group of male and female students/residents make sexual jokes, (I just turn red and try not to look offended) and later a female student will say that she was offended, so yes, I would guess that female students and residents do get offended, which is why I think it is best not to make these comments in the first place, i.e. it is easy to offend someone without knowing it.

My point is that male attendings who offend aren't slapping women and calling them "honey" like they did years ago which has now been clearly set as harrassment, but there is subtle interaction that female residents/students don't enjoy, which may be why it is so prevalent yet nobody says anything that the time.

In the end power corrupts, and if someone has all of this power over you in med school/residency then you are hard pressed to say anything about marginal comments.

It is sort of like being in the Navy I guess, or a military unit, sure there is harrassment, but you can't really complain and the harrassers do it partly in their mind to mold everybody into a team (I think attendings do it just because they can and are mean).

 

[dragonfly99]

fighter08
You are already fired, so the advice I am giving you is different that it would be to someone trying to AVOID being fired.
I think you need to get the advice of a good attorney, who is experienced with contract/employment law. I actually would favor some sort of mediation...I know you want to "get" your program, but realistically it probably won't happen. They most probably have the "dirt" on you, in the form of adverse evaluations, etc. (even though you passed everything, there is undoubtedly some bad stuff/comments written about you that they can use against you). Also, there is no organization that is going to stand up to you. The AAMC, NBME, etc. don't stand up for residents in individual disputes with residencies. I think your best bet is to try and extract a commitment from the residency program to get a letter certifying your 11 months of training that you did and passed, and for you to get a copy of your files that they have. I have a friend who was let go from a program after 1 year...since she saw it coming she already was working on transferring to another program in a different specialty, and she got a lawyer. Her family is wealthy, etc. and she is American, which made this all easier. Somehow the lawyer got a copy of her files. Since she had done very well on all her exams, etc. and done well in her offservice rotations, she was able to transfer out to another specialty at a different hospital, at which she did well. What you need to do is get OUT of this situation with minimal damage to you. Taking down this pediatrics attending may not be an option for you. Filing an EEOC complaint may be an option but it will take years to resolve. You need to move on with your career. Try to get your lawyer to set up a meeting with him, you and your PD, and work out a list of conditions you can all agree to....for example they agree to let you have a letter certifying your training and not to say anything overtly bad about you, and you agree not to badmouth them. It sucks but I think it's the best you will be able to do for yourself, and it just might work. Getting another residency might be hard, but if other attendings liked you they might be able to pull strings for you at other residencies that would interview you.

 

[Fighter08]

Dragonfly99:
Thank you for your reply. Over an entire month, my attorney met with their attorney and tried hard to get a letter and the credits but the PD wanted to cut them into 8 months and morovere, she wanted my written resignation before giving us any paper. We did not trust her. I was urged to go through the difficult way. Upto date, I gathered 22 letters of recommendation from diffrent attendings/services I rotated. They all testified my competency and interpersonal skills, which totally contradict what she claimed. I know if the case entered the court, the PD could lose her position for unlawfully firing me. I really don't care about the monetary compensation, but what else can I do in the interim. Ironically, I have one year waiver from the ABP, because I had successfully completed peds abroad, so I applied for PL-2 and peds fellowship, but still every director request a letter from her.
My PD is so arrogant, dictatoric and has ego, but I believe that it will fall on her.

 

[Fighter08]

It seems like your advisor set you up??

Yes, I was used as a "Pawn". But there is no need to cry over the spilled milk. I have to move on and maintain my strengnth and poise through my journey with the law. I appealed the decision and waiting for the greivance. She has no proof of any deficiency, thanks God. She claims that they were verbal complaints

Thanks for the comment. I am applying but no one wants to offer me an interview without her letter. I will just keep praying.

 

[dragonfly99]

I don't know fighter...it's great that you got 22 letters of recommendation, but to me it sounds like you are still going to lose the year, or at least 6 months, of training. The PD doesn't want to give you credit (for 12 months) and I doubt you'll be able to make her. If you don't want to go back to that particular program, then what is the point in refusing to resign? You've already been fired anyway and you know you won't get a positive recommendation from your PD, so what does it matter? Maybe you should think about taking the 8 months of credit, which is better than 0 months, and your 22 letters of recommendation, and restarting somewhere else as a PGY1. I don't think anyone will take you as a PGY2, given the cloud hanging over your head. I'm not making a personal judgment about you...I just think that you'll lose in court. If the program wanted to get rid of this person (the PD) they would have already done it. If she truly treated you terribly then usually people like that eventually shoot themselves in the foot anyway...I don't see the point in you letter her drag you down with her even further. Just move on. Get some of those attendings who liked you to call up people they know at other program(s), and get yourself into another program.

 

[exPCM]

Dragonfly99:
Thank you for your reply. Over an entire month, my attorney met with their attorney and tried hard to get a letter and the credits but the PD wanted to cut them into 8 months and morovere, she wanted my written resignation before giving us any paper. We did not trust her. I was urged to go through the difficult way. Upto date, I gathered 22 letters of recommendation from diffrent attendings/services I rotated. They all testified my competency and interpersonal skills, which totally contradict what she claimed. I know if the case entered the court, the PD could lose her position for unlawfully firing me. I really don't care about the monetary compensation, but what else can I do in the interim. Ironically, I have one year waiver from the ABP, because I had successfully completed peds abroad, so I applied for PL-2 and peds fellowship, but still every director request a letter from her.
My PD is so arrogant, dictatoric and has ego, but I believe that it will fall on her.

Due to the harrassment issue you described I really think you need to contact your EEOC office for help: http://www.eeoc.gov/offices.html
You can file an EEOC complaint and get the government to work for your cause. It is unacceptable for you to have been subjected to such adverse working conditions.

 

[dr0277341283141]

A search of the net regarding the Dr. Chen incident reveals:

http://www.washington.edu/alumni/columns/sept00/choices.html

drsav: no, I don't go to the Dr. Chen school.

I'd love to talk about everything but I once had a friend at another institution. He wrote something on scutwork.com, was readily terminated, and it took him years and a lawsuit to recover.

We are not protected. We are slaves.

 

[3dtp]

How can you work in a program like this, and know what you know?

If you are trapped in a program like this, knowing how things are, you learn to survive. Or you don't. I have survived.

Have you ever thought about doing something effective, other than listening to the residents' complaining?

Indeed. I have counseled quite a few residents who have found themselves in adverse situations and worked with them to recover their careers. Sometimes successfully, sometimes not. I am intimately involved in other aspects of this problem to bring about long term solutions, but it took us half a century to dig the hole we are in, it will take longer to un-dig it. And, as I have said before, the powerful will not readily give up their power.

I agree with yeasterbunny, you must be midcoast of Lake Michigan ...

If there were only one of these programs in the country, you could be right. But, on the other hand, since there are more than one, you could be mistaken.

 

[3dtp]

Dragonfly99:
Thank you for your reply. Over an entire month, my attorney met with their attorney and tried hard to get a letter and the credits but the PD wanted to cut them into 8 months and morovere, she wanted my written resignation before giving us any paper. We did not trust her. I was urged to go through the difficult way. Upto date, I gathered 22 letters of recommendation from diffrent attendings/services I rotated. They all testified my competency and interpersonal skills, which totally contradict what she claimed. I know if the case entered the court, the PD could lose her position for unlawfully firing me. I really don't care about the monetary compensation, but what else can I do in the interim. Ironically, I have one year waiver from the ABP, because I had successfully completed peds abroad, so I applied for PL-2 and peds fellowship, but still every director request a letter from her.
My PD is so arrogant, dictatoric and has ego, but I believe that it will fall on her.

You and your attorney are wise not to trust her. Besides having the piece of paper, even it you got exactly what you want on paper, potential new programs will pick up the phone and they will talk.

If your program director is as you describe and is dishonest, likely truth will not be exchanged. Your letters of reference will help in that regard, as well as your willingness to talk in unvarnished candor about what happened and why you took the actions you took. This is your best defense. You will have to say to your prospective program director that you are not on the best of terms with your present past PD and why and why things will be different in your new position.

Unfortunately, residents have nearly no power in here. There is presently a case pending before the US Supreme Court we are watching closely. In this matter, an attending cardiologist in Texas was fired on economic grounds, but the mechanism used was to say he was a bad doctor. He won a widely publicized $364M verdict in the Texas trial court. I believe that the trial court decided that the hospital did libel the Dr., and did maliciously revoke his credentials for economic gain. The case was appealed to the United States Circuit Court of Appeals which overturned the verdict, saying that malice, libel and disingenuous peer review did not matter. It remains to be seen how this will ultimately play out.

Some states, California, NY and Michigan are leveling the playing field somewhat. Make sure your attorney is not only well versed in employment litigation, but also medical staff privileging and licensure matters, as these will all come into play here. In these states, hospitals have lost significant power, but the balance is still strongly on the institutions side for several reasons, some legal, some political. The political side is that hospitals are in the community, will be in the community long after you are gone, and are very skillful at playing politics which lead to judges being elected, newspapers reporting favorable news etc.

 

[michaelrack]

PDs in general don't want to hear how bad their program is, or how bad their attendings are, in fact I think the ones who run substandard problems know it in their hearts and are more prone to attack residents who start talking about the obstacles that poor attendings can create. I feel it is projection, i.e. the psychological defense which if a resident complains about the malignancy of a program the PD reasons that it must be false criticism and turns it back on the resident saying that they can't handle criticism. (PDs can't handle criticism very well themselves, or otherwise residents in this country would be more free to speak their minds. . . )
."

I know I am going off on a tangent here, but what you are describing isn't really projection. An example of Projection would be an attending feeling (unconsciously) incompetent and accusing a resident of being incompetent.

 

[Fighter08]

Due to the harrassment issue you described I really think you need to contact your EEOC office for help: http://www.eeoc.gov/offices.html
You can file an EEOC complaint and get the government to work for your cause. It is unacceptable for you to have been subjected to such adverse working conditions.

Dear exCPM, Thank you for the advice. My attorney wanted to start the EEOC and the HRC (Human Relation Commission) both at the same time. He believes strongly in winning the case. But do you advice me to start now, or wait until I attend the appeal and receive their final decision?

 

[Fighter08]

You and your attorney are wise not to trust her. Besides having the piece of paper, even it you got exactly what you want on paper, potential new programs will pick up the phone and they will talk.

If your program director is as you describe and is dishonest, likely truth will not be exchanged. Your letters of reference will help in that regard, as well as your willingness to talk in unvarnished candor about what happened and why you took the actions you took. This is your best defense. You will have to say to your prospective program director that you are not on the best of terms with your present past PD and why and why things will be different in your new position.

Unfortunately, residents have nearly no power in here. There is presently a case pending before the US Supreme Court we are watching closely. In this matter, an attending cardiologist in Texas was fired on economic grounds, but the mechanism used was to say he was a bad doctor. He won a widely publicized $364M verdict in the Texas trial court. I believe that the trial court decided that the hospital did libel the Dr., and did maliciously revoke his credentials for economic gain. The case was appealed to the United States Circuit Court of Appeals which overturned the verdict, saying that malice, libel and disingenuous peer review did not matter. It remains to be seen how this will ultimately play out.

Some states, California, NY and Michigan are leveling the playing field somewhat. Make sure your attorney is not only well versed in employment litigation, but also medical staff privileging and licensure matters, as these will all come into play here. In these states, hospitals have lost significant power, but the balance is still strongly on the institutions side for several reasons, some legal, some political. The political side is that hospitals are in the community, will be in the community long after you are gone, and are very skillful at playing politics which lead to judges being elected, newspapers reporting favorable news etc.

Thank you 3dtp for sharing with me this story. You are probably the only one who understands why I did not resign. In fact, I figured out that termination won't be so diffrent from resignation, in term of the letter she planned to provide. She was very mad from me when I left her office telling her that I should receive my 12 months credits and a letter before handing her my reignation. Would you mind telling me how long it took for the cardiologist to appear in the supreme court? Did they pay him back the salary he lost?
Isn't it disgracful and shamful for a big health organization to have their reputation jeopardized. My PD is new, has been only for one year but used to be associate director. She is also he DIO.

 

[DarthNeurology]

I know I am going off on a tangent here, but what you are describing isn't really projection. An example of Projection would be an attending feeling (unconsciously) incompetent and accusing a resident of being incompetent.

While what I am describing is not the classical description of projection as a defense mechanism, . . . I believe that the same psychological principle is at work.

For example, most PDs are pretty heavily invested in their program, at least from a past applicant's perspective PDs love to talk about how their program is especially strong and all programs seem to be "above average." Such that a program's identity and the PD's identity are fused to one extent or another in that the PD takes a large amount of the responsibility and praise as well for a program's shortcomings and good reputation respectively.

I don't find it hard to believe that a resident complaining about a bad attending on the service might be seen by the PD as a complaint about the program in general and their leadership as well. It is as if I met the Mayor of my town and told him what an awful job his secretary of transportation is doing and how in general the Mayor's office is poorly run and rude. Of course the Mayor would take this personally. Same way as if a resident has a complaint, legitimate even, that the program director's ego is bruished.

One way to react to this is to displace the accusations of incompetence on the resident. While we all enjoy APDs advice here, it is generally true that if there is a problem on the wards between a resident and an attending that there is pressure for the resident to say that it is all his/her fault, . . . if you blame the attending then somehow you aren't taking responsibility and can't understand your own weaknesses (which is basically throwing back the resident's argument in his/her face). APD mentioned that a resident who can't see the they are part of the problem is doomed to be kicked out of the program, . . . seems like something that happened more than once in APD's case, however, APD acknowledged a bias against residents who attribute perhaps a lousy grade on one rotation to a very nasty attending, who wouldn't?? Just something to be aware of as a resident that bringing up a poor attending's teaching/clinical "style" could subconsciously impact your impression on the program director.

While my analogy is not the snap-shot of projection you learn in psychiatry, the principle is the same. The state of medical education today is such that program directors and attendings are very hesitant to respond to resident's complaints/concerns, partly I believe as program directors and attendings don't respond to criticism well and tend to project their feelings on residents occassionally.

While you nitpicked at my comment I considered mentioning (and have I guess!) that unconsciousness refers to lack of awareness of the physical surroundings, which is different from subconsciousness, i.e. the mental processing done that we are unaware of but yet impacts our lives in profound ways.

However, I agree that an attending could be made to feel "incompetent" by a resident and then project this on the resident, . . . I think the resident does this by questioning the quality of training at a residency program which would make any PD feel incompetent.

 

[michaelrack]

While what I am describing is not the classical description of projection as a defense mechanism, . . . I believe that the same psychological principle is at work.

.

sorry, I looked at your example again, and I guess it could be considered projection. Not a textbook example, though real life is seldom as clear as what's in textbook.

 

[michaelrack]

While you nitpicked at my comment I considered mentioning (and have I guess!) that unconsciousness refers to lack of awareness of the physical surroundings, which is different from subconsciousness, i.e. the mental processing done that we are unaware of but yet impacts our lives in profound ways.

.

I think the traditional division is conscious, preconscious, and unconscious (probably spelling these wrong).

Unconscious, in psychoanalytic terms means that the info/feeling is not available to a person's awareness except under special conditions such as psychoanalysis.

Preconscious means that the info/feeling is not in your awareness, but can be brought into awareness without too much effort.

This is probably more than anyone but a psychiatrist needs to know

 

[dragonfly99]

wow, michaelrack! You are either a psychiatrist, or your med school taught more psychoanalysis than mine...mine only believed in the "medical theories of psychiatry" and pretty much pooh poohed all that interesting psychoanalytic stuff. Damn! It would have been nice to learn some of that instead of just memorizing drugs and DSM definitions...LOL!

 

[exPCM]

Dear exCPM, Thank you for the advice. My attorney wanted to start the EEOC and the HRC (Human Relation Commission) both at the same time. He believes strongly in winning the case. But do you advice me to start now, or wait until I attend the appeal and receive their final decision?

If the appeal is only a formality and they do not intend to reinstate you then I see no reason to wait.

 

[3dtp]

Thank you 3dtp for sharing with me this story. You are probably the only one who understands why I did not resign. In fact, I figured out that termination won't be so diffrent from resignation, in term of the letter she planned to provide. She was very mad from me when I left her office telling her that I should receive my 12 months credits and a letter before handing her my reignation. Would you mind telling me how long it took for the cardiologist to appear in the supreme court? Did they pay him back the salary he lost?
Isn't it disgracful and shamful for a big health organization to have their reputation jeopardized. My PD is new, has been only for one year but used to be associate director. She is also he DIO.

I do agree with your decision not to resign, inappropriately. Every one who resigns for pre-textual reasons does the program director a favor. If a resident resigns I believe you are correct in your assessment that it is roughly the same as being fired. The difference comes down the road. A resigned resident has absolutely no power to negotiate anything. A fired resident has recourse and has not tacitly admitted the termination is proper. Most medical license applications I've seen have some form or variation on the question: Have you ever been disciplined, terminated from or resigned from a program while being investigated or resigned in lieu of termination?

Personally I think you have nothing to lose by forcing the institution to actually fire you which will strengthen your case, since you are doing everything possible to oppose it.

As for the EEOC/labor board complaints, this will infuriate the program. I agree that this is a reasonable thing to do, but let's look at it from another perspective: Could a bona fide complaint be used as leverage with the institution to help convince them to do the right thing? The devil you fear the most is the unknown, not the the one you see in front of you and can deal with. Also, in many states (your mileage may vary), the EEOC/labor board will require you to complete all possible avenues of internal appeals process, pro forma or not, before they will act.

On the other side of this is some people are not a good fit for medicine, and for those who are unfortunate enough not to realize it until they are in residency (or perhaps beyond, even), an event like this may be a wakeup call to consider other alternatives. It is important to be fully self-aware and self-critical when in these situations.

 

[michaelrack]

wow, michaelrack! You are either a psychiatrist, or your med school taught more psychoanalysis than mine...mine only believed in the "medical theories of psychiatry" and pretty much pooh poohed all that interesting psychoanalytic stuff. Damn! It would have been nice to learn some of that instead of just memorizing drugs and DSM definitions...LOL!

I'm a former psychiatrist and general internist, now a sleep specialist. My med school training was similar to yours- went to med school at u of iowa, where dsm and meds were stressed.

 

[emeth23]

of course no one wants to face the daunting task of seeking another program or job after termination, but for those residents who have been terminated or know someone that has been, what are the realistic options of finding another residency program to continue their training? unfortunately, medical school training doesn't allow us the option to work at star bucks and pay of a quarter of million in student loans!