Terminating residents

[NotAProgDirector]

There is no simple answer. It depends on what field, what happened to get you terminated, what your application looks like, whether you're a USMG or IMG, etc. Too many variables to give you any advice. Best option is to apply to programs, and see what happens.

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[dragonfly99]

Agree with aprogramdirector.
The usual way to do this is to apply for new spots...usually outside of the Match...and then see what happens.
I had a friend who either was terminated or resigned (I don't know all the details) from a program at the end of the intern year. He basically didn't get along with the program director and a few of the attendings. They tried to say it was a competence issue but it was hard because he hadn't really done anything wrong that they could find, and also he had the highest grade of any resident (including upper level residents) on the in service exam and had been AOA at his med school, etc. He ended up switching specialties and going to another residency in another state and doing well. I think it may/would be easier to switch to another field, particularly a less competitive one (i.e. go from something else to IM or family practice). I think is someone is not a US grad with some good LOR's and high USMLE scores, getting in to a 2nd residency after being booted from one, or leaving on bad terms, would be damn hard.

Threads like this should be a word of warning to all med students to pick your residency very carefully. If something seems "not right" at your interview, or it seems you won't fit in there, don't go. If you're not fitting in while you're an intern and think it won't get better, start making plans to get the h-ll out of there before you get booted. In my friend's case, he saw the writing on the wall and he had excellent LOR's from off-service rotations, so he was able to get out with not much long term damage. He also got a lawyer to help him negotiate at some point, but I don't know the details of that...I think he made some agreement with the old residency program that they mutually wouldn't say bad stuff about each other.

 

[sanrevelle]

im not premed or med; i was randomly reading this thread. wow...i gotta say, medical residencies sound incredibly intimidating. kudos to all of you who've gone through this shat/or currently going through it right now.

 

[dingleberry007]

I was wondering... as a carribbean student, do I have to be more weary of such ill treatment from my program director?

I mean, if US grads are put through such ordeals, should i just train myself to being a "yes man" and pray each day that i dont step on anyone's toes?

 

[dragonfly99]

dingleberry,
This is not based on anything scientific, but I would say that as a Caribbean grad your chance of being in a residency that will treat you less well is higher than your average US grad, though I'm sure there are many less well known residencies that take Carib grads and treat them fine too.

Keep in mind that most people get through residency without any major problems, so don't be overly freaked out by this thread.

Yes, I do think that being a "yes man" (or "yes woman") is more likely than not going to keep you out of trouble during residency. The PD's want someone who is going to do his/her job, not make any waves and that nobody complains about.

 

[dr0277341283141]

I am so very screwed right now. Things are looking worse and worse for me. I expect to receive a pink slip by Christmas. Yeah.

 

[amanbano]

I was dismissed, I felt under a microscope, I felt incompetent, it is really one of the saddest thing that can happen in your career...

 

[aucdiver]

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!

emeth23 - my sentiments exactly!!!!!!! I can't repay $250,000 back on 8.50/hr.

 

[secretwave101]

In exploring the legacy of terminated residents from our program, I found that most did pretty well. Many of them probably just weren't right for our specific program.

One guy had all kinds of trouble here, but ended up chief resident of another program.

 

[3dtp]

In exploring the legacy of terminated residents from our program, I found that most did pretty well. Many of them probably just weren't right for our specific program.

One guy had all kinds of trouble here, but ended up chief resident of another program.

Many of them????? Most of them????? How many of them were there? Inquiring minds want to know!

 

[secretwave101]

I guess that might have sounded a little freaky!

I think we've had something like 6 or 7 over our 18 year history. One guy was sleeping with nurses in the call room. One faked the paperwork for an entire month rotation and hung out on a beach.

Both of those particular cases (I'm told) would probably have survived, too, if they'd been more apologetic about it once they got caught.

The thinking in my program is that you need to do usually more than one stupid thing, and then not apologize for it or try to change. Our faculty tolerate much more than your average Subway manager would put up with.

 

[dragonfly99]

Wow, secretwave. Wow.
I think that faking a rotation and sleeping with nurses in the call room would both be grounds for termination, though I think the first one is definitely worse (shows lack of commitment to education).

 

[aucdiver]

Aprogdirector and dragonfly,
I read the entire thread and have found your input to be very thoughtful and helpful. Thank you for taking the time to post here. I have to admit, if I weren't in this situation (not offered a PGY3 FP position, despite stellar evals), I would find it very difficult to read the rants. It's easy to see why PDs don't offer residents with dings on their record at least the courtesy of an interview. Why deal with the drama if you don't have to? I commend the two of you for actually seeking it out and attempting to help us.

With that said, I know a fellow resident who was fired because he failed step 3 too many times. He wasn't a star resident, but he wasn't the worst, either. He eventually passed and got a license and is now practicing Urgent Care, after a week-long unpaid probationary period, to get signed off by a BC doc. to get malpractice.
I'm licensed, but haven't been as lucky. I applied for some federal jobs, since they don't require malpractice, and any state license will do, but I'm met with the barrier of the clinic requiring BE/BC for hiring. I have been jobless for 10 months (3 months of appeals, 3 months for FCVS credentialing, and 3 months for licensure credentialing.) I'm almost tempted to spend the $3k to have thedoctorjob send out 1,000 resumes and cover letters for me. I feel as if residencies won't look at me, since I've completed the 2nd year, but to be Board Eligible in FP your final 2 years of residency must be completed at the same program. It's very difficult to get info on resident reimbursement issues, but what I've learned is that programs get reimbursed for 3 years of training for a FP resident, and having completed 2 years, any program that would take me won't get reimbursed for one of those years.

Through my experiences, my recommendation are:
Don't burn bridges. You need these people, whether you like it or not. (luckily, I learned this the easy way, not the hard way)
Get LORs. Preceptors that will write on your behalf are crucial.
Once you pass step 3 send your packet in to FCVS. This helps with licensure in most states.
Get a license! If you are an IMG, the only state you can be licensed in with only intern year complete is Wisconsin, and it's only $126. see the FSMB website for a list of state requirements for initial licensure. Supposedly, with any state license you can apply on usajobs to find a federal job, even if you have to work in timbuctu for IHS, DIHS or BOP (google federal and the initials if you don't know what it is). What I don't know is if a residency would take me after getting a job at one of these places. Will it help or hurt me when I try to pursue residency again? Other questions I have for AprogDirector: Is it even possible to restart a residency as a PGY1? is a PGY2 possible after completing PGY2? What would make me a candidate after this? Certainly a year without a job can't help.

Good luck to everyone, and thanks for everyone's input. It helps to know that you aren't alone in this. No matter what, don't despair. This is a test. If you can pick yourself up after this, you can do anything!

 

[bworkaholic]

Hello All,

After reading this thread it is quite relieving that I am not alone in this situation. I am PGY2 of FP, finishing my first half of the second year. Due to extreme pressure from faculty (they say that I am defensive and not able to please the faculty), I am in the process of deciding to resign as it has started to affect my health.

I asked my PD to give some time off so I could rejuvenate myself and get back in the game but she is rather putting me on remedial month and after that month she will see if I need to be on probation.

I am not able to decide what to do, some of the attendings really give me hard time and don't receive any kind of respect what so ever.

Please help.

 

[NotAProgDirector]

What I don't know is if a residency would take me after getting a job at one of these places. Will it help or hurt me when I try to pursue residency again? Other questions I have for AprogDirector: Is it even possible to restart a residency as a PGY1? is a PGY2 possible after completing PGY2? What would make me a candidate after this? Certainly a year without a job can't help.

Having a job is better than nothing, but not sure if it will be really helpful in the long run. Can't be any worse than where you are now.

Funding issues are not as clear as you suggest. After 3 years of training, your DME will be reimbursed at 50% but IME remains at 100%. So there is still funding for residents beyond the minimum training, but that funding is reduced (which in these upcoming tight economic times, might be a real problem).

You can start as a PGY-1 or PGY-2 again, esp if you change fields (where it would be necessary). Many programs will not repeat your PGY year if it was satisfactory and you obtained credit for it.

 

[NotAProgDirector]

Hello All,

After reading this thread it is quite relieving that I am not alone in this situation. I am PGY2 of FP, finishing my first half of the second year. Due to extreme pressure from faculty (they say that I am defensive and not able to please the faculty), I am in the process of deciding to resign as it has started to affect my health.

I asked my PD to give some time off so I could rejuvenate myself and get back in the game but she is rather putting me on remedial month and after that month she will see if I need to be on probation.

I am not able to decide what to do, some of the attendings really give me hard time and don't receive any kind of respect what so ever.

Please help.

Sounds like your program is getting ready to terminate you.

Options:

You likely have the right to take time off. Under the FMLA (Family Medical Leave Act) you can take time without pay for a medical problem. You would need a physician to certify that you have a medical problem. This could be a psychiatrist if needed. Time off is time without pay, and they must take you back at the end.

However, if you do so against the wishes of your PD, they'll be likely to proceed with termination upon your return anyway.

You can always resign, but then getting a new program can be difficult. You could talk to your PD about resigning, and ask for a letter summarizing your performance in the program. You might be able to convince him/her to write the letter before you resign, so that you can know what it will look like.

 

[bworkaholic]

Thank you for your response aProgDirector.

Wow!! do you think they can terminate me...I did not give enough thought to that? Do you mean that if a resident is on a remedial month the chances of getting terminated go up? I was under the impression they could only terminate me after putting me on probation not otherwise. Please clarify.

Thanks again for your help.

Regards

 

[dragonfly99]

bworkaholic,
The writing is on the wall. Your program is laying the ground work to get rid of you.
If I were you, the first thing I would do is go to your PD, beg and grovel and tell him/her how much you want to be there (even if not totally true) and that you are ready to do whatever is necessary to stay there. Do NOT argue. Do NOT act defensive with anyone no matter how much criticism you get on the wards. Your answer should be "Yes sir, whatever you say sir" whenever told to do anything. You also need to think about what your role is in all this. Why are you in trouble and other residents aren't? Sometimes people get unfairly targeted, but you probably have done some things also to contribute to the situation you have ended up in. Maybe the program will change their mind about firing you if you work hard for a couple of months - most important is to act very agreeable and get people to like you. Making good medical decisions is of course important, but especially if you are a medical student or intern, knowing a lot is not what gets you the good evaluations. It's how well you are perceived to "play" with others.

If you don't like your program you could look at transferring out, and could try collecting LOR's from faculty who are friendly toward you, but you run the risk that the PD will find out and might not like it. It would be easier to transfer residencies while you are still in one, though, as opposed to after being fired or quitting. I'd sign up for FindAResident and see if you can find programs on there that you might want to transfer to.

 

[bworkaholic]

Thank you draganfly99, your response give me a direction and re-think about my priorities.

I really appreciate your help

Regards

 

[nsap102]

Hey,

If you don't mind, I'd like to shift gears. Are there any success stories about interns/residents who got canned but then went on to find another residency?

I'm specifically interested in how and where they did that. Also, are there any alternate career choices?

Thank you

 

[dragonfly99]

Yes there are.
I have a friend (no, it's NOT me, I promise) who basically left a program at end of his intern year (surgery or OB, can't remember which) and switched to IM in a different city and did well. He even got a highly competitive medicine fellowship. I am not sure on the details of the leaving of the first program, but I know that they either did fire or were trying to fire him...I actually think that he resigned but only after getting certain concessions from them, probably that they would not say anything overtly bad about him. I don't know the details. I do know he had advice from an attorney, but don't know if the attorney was used as an intermediary between him and the program or only for advice/personal use. He still has to mention/explain the termination/leaving the program when he applies for medical licenses, but so far it looks like he's getting approved for a state license without problems. This person was a US grad who was probably AOA (definitely high class rank) and has very high step scores, which I'm sure helped. Also he is known to be a good clinician. The firing at the first program was due to general personality conflicts and he felt being targeted by the PD and a few of the faculty in the first program. I think there is probably some truth in that given the fact that the PD later got fired, and also there had been several other residents who left or got canned from that same program, despite the fact that it's at a solid academic hospital which really shouldn't be getting a lot of residents who can't hack it.

In any case, I think if you get canned from residency and you manage to get a 2nd residency, it's definitely two strikes and you're out. If you get into trouble at the 2nd residency, I think you're hosed. For an IMG who gets canned from one residency, I would think things would be bleak in terms of being able to get another residency here. Everyone's case is different, but at the least you better have some faculty who will help you out with LOR's and phone calls, and you better have passes your USMLE exams.

 

[thedoctorjob]

I'm almost tempted to spend the $3k to have thedoctorjob send out 1,000 resumes and cover letters for me. I feel as if residencies won't look at me, since I've completed the 2nd year, but to be Board Eligible in FP your final 2 years of residency must be completed at the same program.

The only time that we recommend a resident use our service in this situation is if they have already decided to work for a year or two and then re-apply to residency programs.

You will definitely be able to get into a program as long as your persevere and try all possible avenues.

Good luck!

 

[aucdiver]

The only time that we recommend a resident use our service in this situation is if they have already decided to work for a year or two and then re-apply to residency programs.

You will definitely be able to get into a program as long as your persevere and try all possible avenues.

Good luck!

Thank you for the suggestion. The advice is very much appreciated. To re-cap what you have written, you suggest that I find employment for a year or two and then re-apply to residency programs, in order to be the most successful.

 

[thedoctorjob]

Thank you for the suggestion. The advice is very much appreciated. To re-cap what you have written, you suggest that I find employment for a year or two and then re-apply to residency programs, in order to be the most successful.

No, I don't want to suggest that is what you should do. What I'm saying is that the only time we promote our services to residents who have not finished is if they decide that they want to work for a year or two first.

I think your best chance is to try now to get back into programs. But if that doesn't work, then we could help.

 

[BlondeDocteur]

I have a question for you, doctorjob: where on earth did you get the models for your website's front page? Who's the kid with the oblongated soul patch, or Igor standing behind him in the mad scientist costume?

 

[thedoctorjob]

I have a question for you, doctorjob: where on earth did you get the models for your website's front page? Who's the kid with the oblongated soul patch, or Igor standing behind him in the mad scientist costume?

We didn't do our own photo shoots for those. They're purchased from private photographers. Dr. Soul Patch has always creeped me out a bit. Is it really that hard just to shave that one little strip?

 

[cali-ob]

I had never heard of thedoctorjob.com until today. this seems very interesting. I wonder, has anyone with an NHSC obligation used their services?

 

[emeth23]

yes this sounds crazy...but does anyone know any medical residents who have had a bad break and opted to be a physician assistant? sometimes it seems like a nice option.

 

[dragonfly99]

I actually think this is a good idea (MD to PA) and should be created as an option for people who either get into med school and/or residency and find that it's not what they wanted (i.e. don't want the terrible hours, end up with family obligations, etc.) but still want to do something medical. Also, there are folks who went to med school in other countries who probably would make great PA's if there were some sort of accelerated track they could take into PA school. Right now there isn't a mechanism for doing this that I know of...I mean one would have to start all over and do all of PA school.

 

[core0]

I actually think this is a good idea (MD to PA) and should be created as an option for people who either get into med school and/or residency and find that it's not what they wanted (i.e. don't want the terrible hours, end up with family obligations, etc.) but still want to do something medical. Also, there are folks who went to med school in other countries who probably would make great PA's if there were some sort of accelerated track they could take into PA school. Right now there isn't a mechanism for doing this that I know of...I mean one would have to start all over and do all of PA school.

This will probably happen about the time there is a shortcut for PAs to finish medical school - ie never. Technically there is a way to do this. ARC-PA has a mechanism to allow schools to give credit for previous medical training. However, just as there are structural problems to giving PAs credit for medical school there are problems giving credit for medical school for PA school.

The other issue from the PA profession is that this has been tried before and the results have been disastrous. The three attempts to certify FMGs as PAs have resulted in malpractice claims and board actions all out of proportion to their numbers. This alone would make any PA program very reluctant to do any kind of program like this. FMGs are represented in PA programs (around 5%) as regular students. There is also one PA program that I am aware of that gives medical students from its medical school advanced standing if they want to transfer to its PA school.

David Carpenter, PA-C

 

[Samoa]

yes this sounds crazy...but does anyone know any medical residents who have had a bad break and opted to be a physician assistant? sometimes it seems like a nice option.

I know of one person who opted out of a DO program and went to PA school instead. Not sure what the reason was, or whether she's still happy with that decision.

 

[Taurus]

The other issue from the PA profession is that this has been tried before and the results have been disastrous. The three attempts to certify FMGs as PAs have resulted in malpractice claims and board actions all out of proportion to their numbers.

They were FMG's. How would US MD/DO grads fare in the midlevel role? I'm sure they were do just fine.

 

[core0]

They were FMG's. How would US MD/DO grads fare in the midlevel role? I'm sure they were do just fine.

Would they? There are reasons that states require at least an internship to practice and most hospitals require completion of a residency. This is for independent practice, but there are risk models from the insurance companies that show again good reason for this. The other issue is the exact same problem that Law2doc stated. There would be two groups both called "doctor" with different levels of training and different levels of independence.

David Carpenter, PA-C

 

[Taurus]

Would they? There are reasons that states require at least an internship to practice and most hospitals require completion of a residency. This is for independent practice, but there are risk models from the insurance companies that show again good reason for this.

I'm not proposing that we compare a fresh MD/DO grad and a PA with 20 years of experience. Let's compare a fresh MD/DO with a fresh PA grad. I think that the MD/DO would perform as well or probably better than the PA, not only because the MD/DO would be better trained but because the academic standards to be accepted into a MD/DO school is higher therefore you have more talented people.

There would be two groups both called "doctor" with different levels of training and different levels of independence.

If NP's are going to the DNP and PA's may go to the DPA, wouldn't you already have that situation? You'll have DNP's and DPA's both calling themselves "doctors" but have less training and autonomy than physicians. If all of these groups are moving toward 4 year "doctorate" degrees, then we should just change the system so that a 4 year MD/DO without residency training is equivalent (to put it mildly) to DNP's or DPA's. If that happens, I think that physicians should support their own and preferentially hire non-residency trained MD/DO's to function in the midlevel role.

 

[emeth23]

i like taurus! and agree 100%

 

[core0]

I'm not proposing that we compare a fresh MD/DO grad and a PA with 20 years of experience. Let's compare a fresh MD/DO with a fresh PA grad. I think that the MD/DO would perform as well or probably better than the PA, not only because the MD/DO would be better trained but because the academic standards to be accepted into a MD/DO school is higher therefore you have more talented people.

This used to be the norm.They were called GPs. The profession of medicine made the decision that they were going to specialize. I hardly think they are going to go back. If you want GPs again its simply a matter of allowing anyone that has graduated medical school to practice medicine. You could even develop a graduated system leading to independent practice as they have in other countries.

If NP's are going to the DNP and PA's may go to the DPA, wouldn't you already have that situation? You'll have DNP's and DPA's both calling themselves "doctors" but have less training and autonomy than physicians. If all of these groups are moving toward 4 year "doctorate" degrees, then we should just change the system so that a 4 year MD/DO without residency training is equivalent (to put it mildly) to DNP's or DPA's. If that happens, I think that physicians should support their own and preferentially hire non-residency trained MD/DO's to function in the midlevel role.

The problem is that you want it both ways. You want the word physician to be synonymous with doctor. But your profession uses it to designate a number of levels of the profession.
What is someone who graduated medical school but is not licensed to practice medicine called?
What is someone who graduated medical school but is working as a physician in training under a limited license called?
What is someone who graduated medical school and has an unrestricted to practice medicine called?

Its all the same title.

In my opinion physicians want no part in having non-residency trained MD/DOs in practice. What leads in part to the value that physicians have in the medical system is rarity imposed by internship and residency. If you take away that restriction on practice what is to stop someone from replacing US physicians with cheaper foreign workers (ie what has happened somewhat with nursing).

The PA profession has developed over the last 40 years through evolution. We remain the last generalists. The trade off we make is the ability to move among different areas of medicine vs. independent practice. If you want to allow non-residency trained MD/DOs to practice, fine, just don't call them PAs because they aren't.

David Carpenter

 

[Taurus]

This used to be the norm.They were called GPs. The profession of medicine made the decision that they were going to specialize. I hardly think they are going to go back. If you want GPs again its simply a matter of allowing anyone that has graduated medical school to practice medicine. You could even develop a graduated system leading to independent practice as they have in other countries.

As you repeatedly point out, GP's are dinosaurs. While some states may allow physicians to practice with just an internship, it is nearly impossible today for those physicians to be able to get reimbursed from Medicare or private insurance or to be able to get hospital privileges. Therefore, these physicians would have to try to run cash-only practices, which is nearly impossible to run today. Therefore, the system has evolved to the point where a physician can't effectively practice without completing a residency. So you can clearly draw a distinction between attending physicians and physicians who have not completed residencies.

If both the NP's and PA's will move to a 4 year "doctorate" degree in the near future, I can assure you that both groups will want to be called "doctors" and both will want to have full reimbursement and hospital privileges and scope as attending physicians. The DNP's have already begun to spread this message among their own and in the PR pieces they put out (read my signature). You can expect them to be even more forceful about it in the future as they lobby for equal privileges. If their efforts fall short, the DNP's next move will be to create so-called "residencies" for themselves which will be nothing compared to a medical residency. When that happens, the DNP's will finally claim that there is no distinction in education between physicians and DNP's. The DPA's will take a similar path.

Physicians need to anticipate these changes. The best way to counteract the aggression by the NP's and PA's is simply to undercut them. By allowing MD/DO's without residencies to work as midlevels and if physicians show a preference for their own, there will be less demand for NP's and PA's. Today, the bottleneck for becoming an independently functioning physician is to simply be accepted to medical school. Every US MD/DO grad who wants a residencies today can get one, although it may not be to the one they want. The bottleneck needs to shift to being accepted to residency. Only the best and brightest will get into residencies, while everyone else can work as midlevels until they get one. That's why I support the expansion of classes and opening of more schools. I find the for-profit DO school, Rocky Vista, to be intriguing. If that school is successful and many other schools like it open, they can significantly increase the number of med grads. Over time, there may be a paradigm shift where the majority of midlevels are physicians without residency training. This is how it should have always been in my opinion. Why did we create and enable non-physicians groups to practice medicine without a medical license? Surgery can only be performed by surgeons. Medicine should only be practiced by physicians. We opened a Pandora's Box when we opened the doors to non-physicians.

 

[dragonfly99]

Taurus
<As you repeatedly point out, GP's are dinosaurs. While some states may allow physicians to practice with just an internship, it is nearly impossible today for those physicians to be able to get reimbursed from Medicare or private insurance or to be able to get hospital privileges. Therefore, these physicians would have to try to run cash-only practices, which is nearly impossible to run today. Therefore, the system has evolved to the point where a physician can't effectively practice without completing a residency. So you can clearly draw a distinction between attending physicians and physicians who have not completed residencies.>

That was the point I was trying to make earlier in this thread. I find it crazy that an NP or PA who is right out of school can work and bill for his/her services and easily be hired at places like urgent cares, etc. because of being "board certified". However, a physician who has completed medical school, or even med school plus an internship and has a license but no finished residency and no specialty board certification yet may find it impossible to find ANY job. This is because a lot of the insurance companies just won't pay anything for his/her services, and most hospitals won't allow him/her inside the door. However, a PA or NP recently graduated from school won't have that problem at all. It doesn't make sense because a physician who graduated medical school and has done a year or two of residency IS competent to treat at least some types of patients, particularly if help/supervision is available.

I just don't think it's right that we've created this situation where somebody with 4-6 years of medical education has basically NO job prospects at all, whereas with the completion of a 4 yr med school+3 year residency and board certification someone magically morphs from totally unemployable to having the ability to get many, many jobs as a physician. It doesn't affect me personally because I'll never be in that situation...I'm board certified and done with residency. However, there are people out there who are just floating, SOL because they did something like 1 or 2 years of residency, but didn't finish for various reasons (IMG who could only find a prelim year but no categorical residency, women who had a baby and took time off, folks who didn't get along with program director and fired from a residency or left, etc.). What I was saying is that we should consider having some pathway to certify these folks to function in some role like PA or NP's...it's a shame to waste their training and I don't think it's fair to them or the general public, who could use their services.

 

[Taurus]

Suppose such a system were put in place, how would you propose the licensing work? As of now, despite the practical barriers in place, a physician with a license is a physician with a license.

Say a BC physician hires a "mid-level" physician. Both are licensed. There is really nothing that forces the "mid-level" to adhere to the practice guidance set forth by the senior physician. I think this, in and of itself, might make many physician shy away from your proposal. Remember: we love mid-levels, as long as we can control them.

Our medical leaders need to recognize that times are changing. Medicine today is vastly different than it was 50 years ago. You can't practice medicine today where you can get reimbursed and get hospital privileges without finishing a residency. You didn't have this aggression by the NP's and PA's decades ago either.

You can update the state laws to draw a distinction between attending physicians and ones who haven't completed a residency, but there is already something de facto. As I've already pointed out, you can't practice medicine today where you can get reimbursed and get hospital privileges without finishing a residency. That effectively draws a clear distinction between the two groups of physicians.

If we as physicians don't do anything and if we don't recognize the ambitions of these midlevel groups, the NP's and PA's will carve up a piece of medicine for themselves without our input. We can be proactive and help shape the future.

I think that the AMA is taking steps. Increasing class sizes, opening more schools, and responding to the DNP are good first steps. I'm not sure if the AMA will go far enough though. We, the members of profession, need to push the AMA to go as far as possible. We need to donate, get involved in AMA, get involved at the state level, get elected into Congress, etc.

 

[Samoa]

I find it crazy that an NP or PA who is right out of school can work and bill for his/her services and easily be hired at places like urgent cares, etc. because of being "board certified". However, a physician who has completed medical school, or even med school plus an internship and has a license but no finished residency and no specialty board certification yet may find it impossible to find ANY job. This is because a lot of the insurance companies just won't pay anything for his/her services, and most hospitals won't allow him/her inside the door. However, a PA or NP recently graduated from school won't have that problem at all. It doesn't make sense because a physician who graduated medical school and has done a year or two of residency IS competent to treat at least some types of patients, particularly if help/supervision is available.

I just don't think it's right that we've created this situation where somebody with 4-6 years of medical education has basically NO job prospects at all, whereas with the completion of a 4 yr med school+3 year residency and board certification someone magically morphs from totally unemployable to having the ability to get many, many jobs as a physician. It doesn't affect me personally because I'll never be in that situation...I'm board certified and done with residency. However, there are people out there who are just floating, SOL because they did something like 1 or 2 years of residency, but didn't finish for various reasons (IMG who could only find a prelim year but no categorical residency, women who had a baby and took time off, folks who didn't get along with program director and fired from a residency or left, etc.). What I was saying is that we should consider having some pathway to certify these folks to function in some role like PA or NP's...it's a shame to waste their training and I don't think it's fair to them or the general public, who could use their services.

I'm glad I'm not the only one who finds this particular double standard ridiculous.

 

[aucdiver]

T

That was the point I was trying to make earlier in this thread. I find it crazy that an NP or PA who is right out of school can work and bill for his/her services and easily be hired at places like urgent cares, etc. because of being "board certified". However, a physician who has completed medical school, or even med school plus an internship and has a license but no finished residency and no specialty board certification yet may find it impossible to find ANY job. This is because a lot of the insurance companies just won't pay anything for his/her services, and most hospitals won't allow him/her inside the door. However, a PA or NP recently graduated from school won't have that problem at all. It doesn't make sense because a physician who graduated medical school and has done a year or two of residency IS competent to treat at least some types of patients, particularly if help/supervision is available.

I just don't think it's right that we've created this situation where somebody with 4-6 years of medical education has basically NO job prospects at all, whereas with the completion of a 4 yr med school+3 year residency and board certification someone magically morphs from totally unemployable to having the ability to get many, many jobs as a physician. It doesn't affect me personally because I'll never be in that situation...I'm board certified and done with residency. However, there are people out there who are just floating, SOL because they did something like 1 or 2 years of residency, but didn't finish for various reasons (IMG who could only find a prelim year but no categorical residency, women who had a baby and took time off, folks who didn't get along with program director and fired from a residency or left, etc.). What I was saying is that we should consider having some pathway to certify these folks to function in some role like PA or NP's...it's a shame to waste their training and I don't think it's fair to them or the general public, who could use their services.

I completed 2 years of residency, and have an unrestricted license, but I've been jobless for almost a year. I have more training and experience than newly graduated PAs and NPs, but I am the bastard stepchild with cerebral palsy. I was interviewing for jobs after graduation when I lost my job. Now, I can't be licensed in my state currently, and must move. I even secured $110,00 in loan repayment grants to practice after graduation in my home town. I don't understand why there is such a physician shortage but I still can't get a job in a normal FP clinic. It just makes little (notice that I didn't say NO) sense to me. Why is a certification for PA or NP worth more than a certification for MD????? I'm not a board certified specialist, but I AM a board certified Generalist. Isn't the USMLE, put out by the National BOARD of Medical Examiners a BOARD examination? Passing USMLE 3 should be worth more than those others.
Sorry for the rant, but Dragonfly has a good point. I can be an asset to a clinic, but instead, I'm home following this thread. (FYI, I have my first Urgent Care interviews next week, so everyone wish me luck!)
I appreciate your input. It is refreshing to have input from the outside.
Thanks.

 

[dragonfly99]

It IS stupid, aucdiver. I hope you get one of those jobs.

 

[dr0277341283141]

aucdiver: let me know how it goes. all the best.

 

[CambieMD]

Residency termination is a very difficult issue. I have only known one who was terminated. He had been 'remidiated' multiple times. The line was finally drawn when he was caught stealing narcotics from the hospital.

I have known others that SHOULD have been fired. It is VERY difficult to fire a resident. There are those exceptions where it wasn't deserved, but I don't think they are that common. Success can still be had though.

I know of residents who have been terminated and others who have been made to repeat parts of their training. I think that programs graduate physicians who should not have been allowed to complete their training. Programs often do a poor job mentoring problem residents. The feed back is poor of absent.

Cambie

 

[error404]

What, exactly, is indicated by "going nuclear?"

Thanks for the thread-- enlightening and traumatic.

 

[Lonestar]

I have to agree with CambieMd.

In addition, it is really sad that residency programs nowdays care less about what actually is deficient with their residents rather than label then "unprofessional", etc. I have personally seen many of my residency classmates either get canned for "academic" reasons or be given 6 extra months just because certain attendings (ones that carry a lot of weight - whatever this means) did not like these specific residents. Can you belive the arrogance of some these academic guys? Rather than helping these residents these guys just want to make it harder for these poor souls to graduate. They don't care about these residents.

 

[dragonfly99]

Agree with Lonestar. I have also seen this (residents forced to repeat 6 months of residency, etc., really due to attendings not liking their personalities , rather than some serious performance issues). Luckily it never happened to anyone really close to me, but I sure felt sorry for folks in that situation, as it seemed just at the whim of certain academic attendings, who overlooked the screwups of other residents who were good at playing the necessary political games.

 

[emeth23]

what options are available for a resident who is force to resign or face termination in the middle of their pgy-3 year in psychiatry. unfortunately to be board eligible for psychiatry you have to have "2 consecutive years of training in the same program." I only have a year and a half, and my program director is not willing to allow me to finish the remaining six months. as a consequence, I effectively could never practice psychiatry as a profession.

 

[dr2323]

deleted

 

[dr2323]

I have to agree with CambieMd.

In addition, it is really sad that residency programs nowdays care less about what actually is deficient with their residents rather than label then "unprofessional", etc. I have personally seen many of my residency classmates either get canned for "academic" reasons or be given 6 extra months just because certain attendings (ones that carry a lot of weight - whatever this means) did not like these specific residents. Can you belive the arrogance of some these academic guys? Rather than helping these residents these guys just want to make it harder for these poor souls to graduate. They don't care about these residents.

Being embroiled in this process for a few months now, I can give you my take on a resident's options, at least at my institution.

2 and 1/2 months before my end date, I was informed that I had an unsatisfactory performance and will be required to extend my training by 6 months. No concerns re: safety of my practice or knowledge deficit, and no bad evaluations for the 6 month period in question, just that I wasn't moving fast enough, which was ascribed to a medical issue that was promptly corrected.

Because of the timing and the significant adverse impact this will have on my livelihood and my permanent record, I consulted a lawyer, which was, I can say, utterly useless and I think "hardened pharaoh's heart", so to speak. My PD, who I do honestly believe doesn't like me, thinks I'm arrogant, and has been looking for a way to knock me down a few pegs, had agressively sought to label me as "impaired". When that failed, he included "unprofessional behavior" in his documentation of my deficiencies to the board. When I expressed my disagreement with that characterization, he threatened to fire me. So I signed off on it, having no choice anyway.

As a resident, I have no legal rights in this process - the choices are these: if the issue is kept as an "academic remediation", then there is no appeal available, but one is told that the issue is then kept confidential and not reportable to the medical board. Of course, any training extension is reportable in any credentialling/licensing process one undergoes for the rest of your career, so the scarlet letter is there regardless. If the issue is pursued as "disciplinary", it becomes public record, but an appeals process is available. Once I got to that level of understanding, however, I was so paranoid that I had no faith that an appeal would get me anywhere even though I thought I had a good case. And being in "remediation" now, my PD can fire me at any time. At which point, I could appeal...and so it goes.

Just as background, I've been licensed and board certified in another specialty for over 15 yrs, with no problems and a high level of achievement, so it's not like I'm an untested physician. I support a family of 5. I'm glad the medical issue was fixed, but I'm paying a high price for it, because of my status as a resident. If/when I do get through this, I intend never to put myself in such a vulnerable position again when it comes to my livelihood, if at all possible. I never expected to be dealing with something like this when I decided to respecialize.

So right now I'm just swallowing the verdict and trying to ramp up my performance so as to avoid providing any further ammunition, but working under microscope makes me aware that one can be made to look bad very easily. I am trying to identify who my real allies are on the faculty, as I've made some wrong calls on that during this process.

I think getting a lawyer alienated other program faculty and higher-ups who might have otherwise been more supportive. They have generally let my PD lead the charge and steamroll over me.