Terminating residents

[Doowai]

This resident had done a year of prelim surgery before coming to the family medicine program. He was doing central lines and such and staff at the hospital felt uncomfortable with what he was doing being a first year intern. He was told to "cool it" by the PD. I know he continued to do some things even after the the PD told him to stop.
I was on OB with him when the second thing happened. I was not in the room with the resident but the nurses indicated he was crass and had ask for a vaccum for a delivery. The resident told me he was not serious about the vaccum but the nurse became hypervigilent and the story took on a life of it's own. The nurses stirred up the husband and patient and went to administration. He was called in shortly and was terminated on the spot. The resident denies having any written warnings. I don't know exactly what happened other than he is GONE. The nurses are very happy with themselves and have put a large X on his picture at the nursing station. The PD will not say much other than he was terminated because he was putting patients as risk.

This was in Mobile Al, right? I doubt this story happened twice last year.

---

Members don't see this ad.

 

[memberkane]

-------------------

 

[LADoc00]

Resident Termination is a one of the saddest topics ever. Most of the residents who train to become doctors know nothing else. Many a residency program terminating residents dont bother about what happens to the residents. I've known a good resident who was terminated because of some misunderstanding with his advisor and then placed under a microscope before termination. No one looks good when looked at so closely. Why are residencies ruining lives of these residents. When the residents try to get other jobs or get into other residencies, they are viewed as people who have done something very wrong and are denied their career.
Many times termination can leave a resident jobless, hopeless and despondent.
I am looking for people who feel they have been wrongly terminated from their residencies or who have been terminated for a good reason, but want to make a change.
Is there anyone out there who knows how to help residents who have been terminated from their residency.
Is there anyone who knows of anyone who has been terminated and would like to start a support group.

I know some residents who have been terminated, for one reason or another.

I think everyone in and outside the system has no clue as to the real risk involved in spending half a decade preparing for med school, med school itself and residency only to fail in the final chapter. Its the equivalent of preparing 15 years for the Olympics and cramping up before the race begins and being unable to compete.

The risk vs. reward curve for medicine, specifically for MDs is horribly broken unless you are aiming towards high 6 to 7-figure career options. I wonder when everyone will figure this out.

 

[dragonfly99]

I think there are undoubtedly some residents who are not suited for any type of clinical medicine, and who do need to "wash out" I suppose, but I think the true number is probably really small. We already have other vetting processes (USMLE, med school admissions and med school itself) to weed out those who simply don't have the ability. The skill sets needed for something like pathology or radiology or physical med/rehab are way different than for anesthesia, surgery, etc. and someone who sucked at one might be great at another.

Right now we have a system where programs and house staff are in a relationship that should be symbiotic, but can easily become a codependent or abusive type situation. It should be easier for residents to switch specialties and/or residencies...not in a way that would make the whole process totally chaotic, but it seems that right now it's an "all or nothing" type situation. A graduating med student picks a residency, and for the most part has to stay there, in that specialty at that training program, and if the resident doesn't make it for any reason, the resident is totally hosed in terms of ever having a clinical career. Similarly, programs are stuck with whatever residents they get, even if it turns out the resident wasn't suited for that particular specialty or something, or just somehow didn't fit inwell there. The programs are afraid of potential future lawsuits, so they start documenting like hell every little deficiency they see or perceive in interns and other lower level residents. The whole system can become adversarial very quickly. A lot of the folks who are supposed to be doing the teaching either don't have time, don't have the inclination or are simply not well trained to be teachers, and/or to identify real deficiencies in residents and make a plan to remediate those.

In the old days, people did rotating internships where they could "try out" different specialties to some extent, and programs could recruit residents from among that group of rotating interns if they wanted. People also could switch specialties to some degree (GP becomes a surgeon after adding on 3 years of surgical training, etc.). I don't have the answers for all this but it seems we could do better than we are doing right now...

 

[dr0277341283141]

This was in Mobile Al, right? I doubt this story happened twice last year.

Doowai, it's terribly uncool to blow someone's cover. You could get people in trouble.

 

[Old_Mil]

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.

Which is why, on interview day, if I got even the slightest whiff of funkiness from the PD the program fell from wherever it was on my pre interview wish list to "do not rank."

 

[dr2323]

Which is why, on interview day, if I got even the slightest whiff of funkiness from the PD the program fell from wherever it was on my pre interview wish list to "do not rank."

Wish I had had the savvy to pick up on it sooner, fix what I needed to with me, and stay off his radar.

 

[tibor75]

3dtp is 100% correct. What you want as a resident is to be VERY friendly to attendings and the chief residents, and become popular. If you cannot do that, then just stay under the radar and you'll be O.K.

well said. I"m convinced that the majority of people kicked out of residencies were too stupid to know how to behave properly. being nice goes a long way. Not arguing with an attending even when you are right goes a long way.

 

[tibor75]

I know some residents who have been terminated, for one reason or another.

I think everyone in and outside the system has no clue as to the real risk involved in spending half a decade preparing for med school, med school itself and residency only to fail in the final chapter. Its the equivalent of preparing 15 years for the Olympics and cramping up before the race begins and being unable to compete.

The risk vs. reward curve for medicine, specifically for MDs is horribly broken unless you are aiming towards high 6 to 7-figure career options. I wonder when everyone will figure this out.

Give me a break. How many doctors are unemployed? How many doctors struggle to make ends meet? You'd think in today's economy more doctors would appreciate the benefits they have, instead of whining about the rare possibility that they may, shudder, be fired. Oh noes!

 

[aucdiver]

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.

I never did figure out what DME and IME are. I thought maybe I could figure it out with time. Please explain. Also, if I started in another field, what happens to reimbursement (DME,IME)?

I have a couple of job offers on the table now, and would like to know which one will give me the best chance of getting my FP board certification. OccMed/Urgent Care in the civilian sector doing mostly DOT physicals, General Practitioner doing mostly return to duty physicals for the military, or Bureau of Prisons job treating the inmates. It's obvious I lost one year of my life and won't get accepted to a residency this year, but perhaps next year, I could find a PGY2 slot somewhere. What will it take to be a resident candidate again??????

 

[NotAProgDirector]

I never did figure out what DME and IME are. I thought maybe I could figure it out with time. Please explain. Also, if I started in another field, what happens to reimbursement (DME,IME)?

I have a couple of job offers on the table now, and would like to know which one will give me the best chance of getting my FP board certification. OccMed/Urgent Care in the civilian sector doing mostly DOT physicals, General Practitioner doing mostly return to duty physicals for the military, or Bureau of Prisons job treating the inmates. It's obvious I lost one year of my life and won't get accepted to a residency this year, but perhaps next year, I could find a PGY2 slot somewhere. What will it take to be a resident candidate again??????

For your residency funding questions, start here.

I'm not sure which of those jobs would be best for trying to get a PGY-2. I would think that the prison job would give you the broadest experience. The others sound really boring.

 

[dragonfly99]

but program director, don't you think that working in a prison still has somewhat of a stereotype attached to it? They might assume it was the only job he could get. I would pick either of the other 2 jobs above it.
I think if one of the jobs allows any contact with other docs, especially fp's, that you could network with, that might be the best one. I would think that doing urgent care or interacting with military personnel would be better and less stressful than working in a prison. However, I agree you might see more cool pathology as a prison doc. Personally, I'd pick the job that seems least stressful, since you will be trying to look for a new residency at the same time.

 

[NotAProgDirector]

Good points. I guess I was looking at it as "which of the above jobs would prove I have what it takes to be a resident".

 

[dr2323]

In my experience, the attorney involvement was useless and cost a lot of money. My stack of good eveluations also seems to carry no wieght. I am, however, considering filing a "concern" and/or formal complaint with the ACGME, as it appears that my hospital's policy of allowing no appeal process for "academic" training extensions (as opposed to disciplinary extensions) is against the ACGME published requirements, as was the lack of timely notification and documentation. Has anyone out there done this or heard about this process? Am I just going to bring more vengeance down upon myself? and does anyone have experience with the appeal process?

 

[NotAProgDirector]

The ACGME will not usually get into a disagreement between an individual resident and a program.

From their website:

BEFORE FILING A COMPLAINT READ THIS:
The ACGME will investigate, if substantiated, noncompliance with accreditation standards that relate to program quality. The ACGME will not intervene on behalf of an individual complainant regarding matters of admission, appointment, credit, promotion, or dismissal of faculty, residents or fellows.

Hence, perhaps, the ACGME will look at whether your program needs to give you some sort of appeal process. Personally, I'd ask your GME office as the best way to do this. Getting the ACGME involved is only going to make a PD's dysfunctional personality worse, IMHO. It's like calling the IRS to help sort out a tax problem. Sounds like a good idea, usually opens a world of hurt.

 

[DarthNeurology]

Right now we have a system where programs and house staff are in a relationship that should be symbiotic, but can easily become a codependent or abusive type situation. It should be easier for residents to switch specialties and/or residencies...not in a way that would make the whole process totally chaotic, but it seems that right now it's an "all or nothing" type situation. A graduating med student picks a residency, and for the most part has to stay there, in that specialty at that training program, and if the resident doesn't make it for any reason, the resident is totally hosed in terms of ever having a clinical career. Similarly, programs are stuck with whatever residents they get, even if it turns out the resident wasn't suited for that particular specialty or something, or just somehow didn't fit inwell there. The programs are afraid of potential future lawsuits, so they start documenting like hell every little deficiency they see or perceive in interns and other lower level residents. The whole system can become adversarial very quickly. A lot of the folks who are supposed to be doing the teaching either don't have time, don't have the inclination or are simply not well trained to be teachers, and/or to identify real deficiencies in residents and make a plan to remediate those.

In the old days, people did rotating internships where they could "try out" different specialties to some extent, and programs could recruit residents from among that group of rotating interns if they wanted. People also could switch specialties to some degree (GP becomes a surgeon after adding on 3 years of surgical training, etc.). I don't have the answers for all this but it seems we could do better than we are doing right now...

This is a great post and articulates very well why abusive relationships happen so frequently in medicine, and why it is much more adversarial than working together. It is all or nothing, once you sign on to a program you had better be sure that you made the right choice and that the program director is on your side, if nobody is on your side you are screwed. This is why interviewing is so crucial for medicine, you have to believe that the faculty with stick with it and help educate you.

It is easy and lazy to label an intern as incompetent, after being in your program for half a year, as I have seen happen, but really, there should be some responsibility on the part of attendings to be good (not necessarily great) teachers and make an effort to have cordial relationships with residents.

Medicine in a way advertises for the wrong people, i.e. medical school admissions want applicants who are caring and want to serve their community. Problem is, such idealistic people would have problems swallowing their pride and being forced to pretend to be "wrong" to an attending. People who succeed in medicine are those who are basically gluttons for punishment, in terms of abuse and harrassment, and who feel comfortable in such poor working conditions. Before medical school I had heard friends and family is medicine describe how "hard" it was and how "hard" residency is, . . . I used to think it was the amount of knowledge you needed to know or working with patients who were dying, but in reality it is dealing with malignant personalities, such as attendings and program directors that often degrade some interns/residents daily, . . . if you are in that situation and *don't* think, "This isn't what I signed up for." then you are no longer sane and believe that being mean to people is normal, which is how a lot idealistic residents really change.

Who would think that a hem/onc doctor would stop a chemotherapy treatment short of 80% completeness because a patient couldn't afford the copayments anymore, but it happens all the time and is rationalized away. If you ask any premed student they would be shocked and would also want to be the hem/onc physician who doesn't do this, but shortcuts and not really caring for patients happens all the time on the wards and it is sad.

Everyday in medicine you are tested by people who will do very mean things to you, and it does change your personality in fundamental ways.

 

[DarthNeurology]

For your residency funding questions, start here.

I'm not sure which of those jobs would be best for trying to get a PGY-2. I would think that the prison job would give you the broadest experience. The others sound really boring.

I have seen prison patients before, as a medical student, and it was a great learning experience as you learn some of the more extreme levels of pathology as well as the extreme ends of the social spectrum. Doing a physical examination on a murderer can be scary though, I was always watching exactly where their arms were and never turned my back on them, how long does it take to gouge out someone's eyes?? The prison guard waiting usually near the door might not be able to make it in time. Usually they only cuff one limb to the bed, sometimes the arms if they have a history, but usually just a leg.

 

[DarthNeurology]

Doowai, it's terribly uncool to blow someone's cover. You could get people in trouble.

I am sure that there are hundreds, if not thousands, of medical professionals that know what happened at this institution, and medical students might decide to go elsewhere for residency. This is the *only* way to have checks and balances in the medical system such that bad program directors are outed by a history of being malignant.

 

[dr2323]

The ACGME will not usually get into a disagreement between an individual resident and a program.

From their website:



Hence, perhaps, the ACGME will look at whether your program needs to give you some sort of appeal process. Personally, I'd ask your GME office as the best way to do this. Getting the ACGME involved is only going to make a PD's dysfunctional personality worse, IMHO. It's like calling the IRS to help sort out a tax problem. Sounds like a good idea, usually opens a world of hurt.

yes, I've reviewed their potential role, and I've met with our DIO who is very sympathetic, but still seems to advise that I accept the extension of my time as it appears that laissez faire approach to PDs is the rule. what if I could get him to allow an appeal? what then?

 

[dragonfly99]

dr2323,
You have to look at the potential risk/benefit of trying to fight an extension of training. The overwhelming likelihood is that if you do, you will lose. Program directors have broad latitude in being able to train residents the way they want...if the PD says you are not ready to go on, likely nobody is going to overturn that. And the more you fight it, the more the PD will hate you. The PD may even decide to fire you. I know someone who got training extended x 6 months in a specialty with 4 years of GME training. It probably would keep him from getting a fellowship, but it didn't keep him from getting a decent job after finishing residency. If you get canned from residency, you're going to have an uphill both ways battle to even get some kind of decent job. Your situation sucks, but being fired would suck more. If I were you I wouldn't fight any more than what is reasonable...i.e. no lawsuits and no threatening the PD. The PD has more power and I don't think you will win. The only thing that I think might help is if a bunch of attendings disagreed with the PD (I mean, attendings from your program). That likely won't happen, because they either agree with the PD and/or are likely to just go along.

 

[NotAProgDirector]

yes, I've reviewed their potential role, and I've met with our DIO who is very sympathetic, but still seems to advise that I accept the extension of my time as it appears that laissez faire approach to PDs is the rule. what if I could get him to allow an appeal? what then?

You always have a right to appeal. Whether or not you should do so is not clear. If you win, your PD must promote you on schedule, but you can bet that you will be under the microscope and any further problems will be dealt with. If you lose, then it's evidence of your lack of insight.

 

[DarthNeurology]

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.

The worst part is that your PD doesn't like you . . . if superiors don't like you in medicine, i.e. really think you are a "bad person" then sure, they will magnify and distort any interaction with you irregardless of what you do, as he/she thinks you are arrogant and should be kicked out of medicine, that is just the way some attendings deal with their own shortcomings. It can be frustrating to deal with such attendings as your frustration will waste your energy and even when you do things right they can be made to look bad. If this is true, and you seem to know that your PD hates you then you need to assume the worst that he/she will do anything to get you kicked out of residency, the 6 months of observation is just time to gather more ammunition against you, i.e. the PD isn't sitting on any fence waiting to see whether you will become "unarrogant".

I would say your best option is to file an appeal and organize your case well and talk to the other attendings ALOT on the service about their perceptions of you. Face it, at this point you can NEVER salvage any normal working relationship with such a PD who doesn't like you. Don't listen to what the DIO or whoever says, they know you will probably be gone in 6 months without having finished residency and just want to protect their job and the institution from a lawsuit or something.

If your medical condition did interfer with your work then contact the americans with disabilities association and protect your right. Plain and simple some PDs/attendings won't want you to practice medicine if you ever had a medical condition that affected your work, irregardless of recovering or how well you are doing now.

Sadly to say, your goose is cooked unless something changes. I would first talk confidentially to other attendings if you can to find out why the PD is doing this and what is the real motivation. Realize that you are on your way out and do what you would do if you knew 100% that you would be kicked out after the 6 months of "observation." i.e. get an ADA lawyer and file a complaint and talk to every attending you can to bolster your case.

 

[DarthNeurology]

You always have a right to appeal. Whether or not you should do so is not clear. If you win, your PD must promote you on schedule, but you can bet that you will be under the microscope and any further problems will be dealt with. If you lose, then it's evidence of your lack of insight.

I think a resident should file a complaint if they believe that they have been judged unfairly, and that should be the sole criteria.

I wouldn't second guess and worry about making anybody more upset as if the resident believes he or she has been unfairly judged/treated then the attendings already don't respect the resident if this is the case.

Losing can all mean all sorts of things in reality, from a lack of insight to the PD exerting pressure on attendings to side with them, to a loss of perspective among attendings and how bad training/environment/malignancy is at a program. At least you know you that you did the right thing.

There are a lot of very malignant personalities in medicine at the attending and PD level, I think people who want power are drawn into academia and faculty positions and lack perspective when getting into personal conflicts with subordinates.

I have seen some *amazing* conflicts among people at the dean's level with department heads and they fight quite literally like school children! And sure, I have seen it lead to a department chair being fired! This is the "politics" of medicine at some, but not all places, at the nice places everybody really respects each other and such conflicts are unhead of. Mostly I would say the Northeast has this problem, but I have seen it everywhere, and it is sad. I once was on a service where the attending we were working with was harrassed daily by a department chair who came down and yelled at him in front of everybody, everyone knew he was very good clinically and patients loved him and the department chair was from Mars. Knowing this, and how destructive such fights are at that level, they are very lopsided and worse at the PD vs. resident level.

This is what really S&@#$ about medicine in general in that in other fields, yes, you will have a more collegial relationship with your colleagues.

Abraham Lincoln sad that basically the best test of person isn't putting them into adverse circumstances as many of us can survive adversity, but to give a person power . . . and see how they survive that. Power corrupts and when you a person who has been PD for a long amount of time, sure, they probably lose a good deal of their perspective and letting someone pass is more a personal seal of their approval based on gut feelings and subjective evaluations of the person's character not based on their work performance.

 

[dragonfly99]

Darth,
you're assuming that it's a done deal that the OP is going to get canned. I think it's probably at least 50/50 that he will. I think if he ticks off the PD more, the likelihood of eventually getting canned goes up.

I have known people who had training extended by 6 months, still graduated and got pretty good jobs. However, if the OP gets fired he probably won't get into another residency and will have to go around forever as a non board certified doc who didn't finish a residency. That's a pretty big risk to take. At least if he swallows his pride for now, and accepts the "remediation" months, he has a chance at finishing.

I think the OP should talk more (but carefully) with other attendings who had him on service. Get their honest assessment of the OP's strengths and weaknesses. If they all feel like the PD, then appealing is going to backfire and it's probably not worth it.

 

[NPR]

that's horrifying

i wonder how common these scenarios are?

ive never heard of anyone being terminated although admittedly, i have 2 years worth of clinical experience, 1 of them being MS4

 

[DarthNeurology]

Darth,
you're assuming that it's a done deal that the OP is going to get canned. I think it's probably at least 50/50 that he will. I think if he ticks off the PD more, the likelihood of eventually getting canned goes up.

I would estimate his chances of surviving residency as being very low, . . . I think that honestly the PD really hates this resident, we all know times when superiors had a problem and wanted to "knock down" subordinates, i.e. make them admit that they aren't as good doctors as they believe they are OR are just plain mean and when their emotions get involved you can't redeem yourself.

This seems like one of those situations where the PD *has* gone off the reservation and is attacking a resident openly as being "arrogant" or something along those lines. When it reaches that juncture, it really is the point of no return.

While I am sure there are some cases where a remediation worked, i.e. for a resident who had a more decent relationship with the PD, this relationship is not a "teacher to student" relationship but an angry boss type relationship, he/she doesn't want the resident to get better at being a doctor, he or she doesn't want the resident to survive residency, such an occurrence would be at odds with their view of themselves as being a good PD and making the right decision.

With this level of animosity no good can come from this, and basically pretending that nothing is wrong here just feeds the PD's quite possibly unfair delusional judgment makes it worse. Time for some reality, time for an appeal.

If someone hates you, then they hate you, it is hard to make them hate you more and I think standing your ground and filling an appeal may actually get some respect from such a bully. The only way to "win" or survive would be to appeal and basically say no, I am not that lousy of a resident here is what other more sane people say about me, and show the evaluations from other attendings at the appeal. The PD if he/she can will use the 6-month period only for more evidence to get ride of the resident so you don't want to be trapped in that box.

Personally I would consider resigning citing irreconcilable personality conflicts on the service, and would look for another residency position which would be hard, but which could be found. Being made to remediate something without a clear reason why is a big red flag that you are being manipulated for hidden reasons.

 

[dragonfly99]

I agree with looking for another residency position, but the OP probably isn't going to find one in time (i.e. before he has to agree to the remediation vs. not).

The person I knew who had to repeat 6 months didn't have a good relationship with the PD either and the PD didn't like him. He still made it through residency, though. I actually know >1 person like that. I don't know anybody who has fought the PD/appealed a suspension or remediation and won....I guess it's probably happened some time, but not commonly. Usually the presumption is that the PD is right and knows what he is doing in evaluating residents. It's obvious the PD doesn't like this person, but I disagree that you can't make someone hate you more. You can. Oh yes, you can.

Not many good options in this situation...only bad options and worse options, and unclear what is best for him to do.

I still say he needs to talk w/other attendings and see if he'll have ANY support at all before he decides to appeal (which I wouldn't do anyway...I'd just try to leave ASAP). Just because the OP thinks his evals were OK...they might not be. I mean, if they are marked "average/passable" and most other residents get a 7 or 8/10 for whatever they are being rated on, the PD can just say that the OP was just barely adequate/passable, or that the attendings were trying to be nice and they never give anybody below a 4/5 of 10, and so that the OP's evals really aren't that great.

 

[aucdiver]

Good points. I guess I was looking at it as "which of the above jobs would prove I have what it takes to be a resident".

This is the way I have to look at it as well. I actually WANT something challenging and prisoners don't scare me, but the stigma of "prison medicine" does worry me a bit. WILL it be seen as "the only job I could get"?

I will be in the scramble, but what program is going to take someone with 2 years of residency for a PGY1 position? I can only try, right? Am I wasting my money, energy and time?

13 months and I'm still unemployed. On the bright side, I'm eligible for unemployment benefits again in 2 weeks.

 

[NotAProgDirector]

This is the way I have to look at it as well. I actually WANT something challenging and prisoners don't scare me, but the stigma of "prison medicine" does worry me a bit. WILL it be seen as "the only job I could get"?

I hate to point it out, but it actually is the only job you could get. Of the choices of jobs you could possibly get, it seemed the best.

I will be in the scramble, but what program is going to take someone with 2 years of residency for a PGY1 position? I can only try, right? Am I wasting my money, energy and time?

13 months and I'm still unemployed. On the bright side, I'm eligible for unemployment benefits again in 2 weeks.

I don't know if someone will take you for a PGY-1 spot. There are funding issues, and it depends exactly what happened in your prior training. Seems worth a try though, since your other options aren't great. If you interview for PGY-1 spots, there's always a chance someone will offer you a PGY-2 instead.

 

[DarthNeurology]

The person I knew who had to repeat 6 months didn't have a good relationship with the PD either and the PD didn't like him. He still made it through residency, though. I actually know >1 person like that.

I don't know anybody who has fought the PD/appealed a suspension or remediation and won....I guess it's probably happened some time, but not commonly. Usually the presumption is that the PD is right and knows what he is doing in evaluating residents.

I still say he needs to talk w/other attendings and see if he'll have ANY support at all before he decides to appeal (which I wouldn't do anyway...I'd just try to leave ASAP). Just because the OP thinks his evals were OK...they might not be. I mean, if they are marked "average/passable" and most other residents get a 7 or 8/10 for whatever they are being rated on, the PD can just say that the OP was just barely adequate/passable, or that the attendings were trying to be nice and they never give anybody below a 4/5 of 10, and so that the OP's evals really aren't that great.

That is interesting that you know residents who have been on remediation and have survived with the PD not liking them to boot! It does make sense to slavage the situation, if you can, it is hard to change a "first impression", even one made just on the first day. Obviously, finishing residency is better than not.

But if nobody ever appeals anything than it sort of becomes a forgone conclusion that the PD can re-evaluate passing evaluations and hand-out remediations for no reason. All the more reason to know what type of program director you will get when interviewing.

It would be *great* if somebody on SDN could figure out a way via some national organization to mail out post-residency questionaires to all residents, and have it only be numerical replies, i.e. on a scale of 1 to 10 how good is the PD when it comes to timely/fair evaluations. And even, how many times during the past year have you seen the PD unfairly treat/evaluate a fellow resident, if a program got a statistically significant evidence of this then you would know to apply elsewhere if you could. Even if just 25% of residents logged on and completed the questionnaire it would be a great source of information for residency applicants.

 

[dragonfly99]

That is interesting that you know residents who have been on remediation and have survived with the PD not liking them to boot!

That (the PD not liking them) is usually how people GET required to do remediation, isn't it? I mean, +/- having some so/so evaluations from attendings. But we all know residents who kind of suck in terms of medical knowledge and decision making, but never seem to get called on it or have to do any kind of remediation...it's because the PD, and maybe other attendings too, like their personalities, so they manage to slide.

Your idea of a nationwide residency survey is interesting, but I don't think any organization is going to spend time on doing that. The AMA would be the logical choice, but they've got bigger fish to fry. However, scutwork.com and similar sites, if people actually filled out the evaluations, would suffice. The problem is, few people do. But I know that systematically malignant-type residencies end up eventually getting found out, usually. I know of at least one where the house staff were telling the 4th year med students/applicants to stay away because the place is malignant...if it's bad enough, the house staff won't be willing to lie to the applicants about how great things are. That was the case @one of the places I know of where the person had to do the extra 6 months.

 

[dalovers]

I have an extraordinarily messed up situation that I am trying to navigate. I am at the moment looking into possible options. Of note, I have been told because of my sloppy documentation (which basically is my preround plan but not the work rounds final plan that we were advised was for the attending to include in the note and never as bad as a falsified document stating perm cath C/D/I and then on check out being told that the attending wants me to go look at the site to make sure there is no pus becasue no one looked at it) and perfunctory physical exams (funny no one ever watched me do one) that I will need to do remediation and within the same breath..."I don't think you are a good match for our program". My issues...I am in a heated custody/child support battle that no matter how much i let go of my kids my two (yes two!!) fathers continuously keep taking me back to court for contempt and child support ($650/mnth) and modification and child support of now $1100/mnth (I am already 20K in the hole to lawyers and recently lost another 3500 bucks and am now two months behind in rent) and constant threats and the two tag team me with my two kids by interrogating them and then calling each other to see. My exhusband wife follows me on the weekends to see if I am spending time with my kids. Needless to say I am not always "happy" and as outgoing and extroverted as is my normal self. So the stress of this left me with an error of omission in forgetting to check out the plan on a patient, which was followed up on but later in the afternoon.

So I am thinking of possible strategies to move on with my career.

1. Remediate and get credit and for "social reasons" see if I can relocate to a better "match".
2. Cut my losses and start over and scramble for PGY-1 again.
3. Try to just collect my credits and find a program sensitive to my needs

I have been told that letting me go is not on the table as far as the clinical competency committee is concerned. Remediation may be three months. But reading this forum has been dismal and my persoal outlook is bleak. Ultimately I just need to get out of the area away from any more litigation and get a fresh start. Any advice?

 

[cali-ob]

that (above post) sounds like a very unique and personal situation, not really similar to what others have been going through. Your work performance is likely a reflection of the chaos going on in your personal life.
The obvious answer seems that you need to deal with your personal/family life before you can hope to have a fresh start anywhere.
I don't know what your relationship to your PD is, if you feel that they would be supportive of you if you were to divulge the details of what you are going though....that is a big decision. Because it would admittedly make any employer nervous. However, it seems you need to step away from things so you can wrap up what's going on at home so to speak. I'm sorry you are in such a mess, and obviously, with bills to pay you probably cant afford to take a leave of absence or anything like that. But maybe you can get some paid leave for FMLA or something? I don't know if this situation would qualify, but maybe your own personal sanity (psychiatric health) d/t what you are experiences might earn you a couple of weeks break. I would contact your hospital's EAP program if they have one. They have to be confidential. Good luck...that all really sucks.

 

[dragonfly99]

Agree with cali-ob.
It doesn't seem that switching residencies and possibly moving elsewhere, with all the financial and other stresses involved with moving, would really help much.

Agree with getting help from workplace EAP people.

Also, if the child support is really too much for you to be able to pay, consider writing to or approaching the judge(s). That's just an idea, and I'm not an attorney, but it seems like it would be worth a shot. Perhaps they didn't have a clear understanding of your finances when the child support payments were set. You could also consider getting a cheaper apartment and/or renting out a room in someone's house (like another resident/intern) if that would be cheaper.

 

[Doowai]

A resident is really at a disadvantaged position here - attendings know which side their bread is buttered on, so they will always choose siding with the program if they know what is good for them. Your fellow residents also know they too will be left out in the cold if they side with a fellow resident so they will leave you to the wolves in their own best interest. And really it could all hinge on some personal petty feelings on the part of a PD or attending who can easily influence the PD.

It seems any resident should play defensively from the beginning - get copies of all formal evaluations as they occur, ask for LOR's from attendings as the go as evidence to use against any future allegations that might indicate otherwise, send a couple of emails fishing for feedback to fellow residents and keep copies of any that indicate you are well liked and get along well with others and are doing a good job - as well as any emails indicating there is a problem with the PD or other attendings.

I know I have kept copies of a number of emails from my former fellow residents indicating problems with a specific attending, and in favor of me. Luckily I never needed it and got a favorable letter from my previous PD, but I now think this is just simply de rigeur

 

[dragonfly99]

http://www.grifols.com

I received an email with various hospitalist and other job openings, including listings of plasma donor centers which are looking for MD's or DO's with a license to supervise the donor centers on a part or full time basis. It just says you must be currently licensed in the state of the donor center, but doesn't mention anything about needing to be board certified/board eligible. Not sure if they'd hire a resident who has been terminated and/or is between residencies, but it might be an option for some of you.

 

[dr2323]

Darth,
you're assuming that it's a done deal that the OP is going to get canned. I think it's probably at least 50/50 that he will. I think if he ticks off the PD more, the likelihood of eventually getting canned goes up.

I have known people who had training extended by 6 months, still graduated and got pretty good jobs. However, if the OP gets fired he probably won't get into another residency and will have to go around forever as a non board certified doc who didn't finish a residency. That's a pretty big risk to take. At least if he swallows his pride for now, and accepts the "remediation" months, he has a chance at finishing.

I think the OP should talk more (but carefully) with other attendings who had him on service. Get their honest assessment of the OP's strengths and weaknesses. If they all feel like the PD, then appealing is going to backfire and it's probably not worth it.

Thanks for the feedback. That's been my take at this point, I'm asking all the attendings I work with for feedback and discussing my situation honestly with them. Like I said, I've been in practice for a while, I've been very open-minded about where I may not be performing up to snuff, but I think I have decent insight into how I compare to the average senior resident. I am leaning toward pushing for an appeal at this point for a few reasons, 1. a miracle may occur and it helps my circumstance, 2. it will further the cause of due process in academic and peer review, which is sorely lacking, and 3. if he does try to can me after I ask for an appeal and/or file a complaint with the ACGME, it will have the appearance (and the reality) of retaliation, from which we do have some legal protections.

I'm already board certified, I'll have a job to go to if this goes up in flames, but I'll be pretty pissed if the past few years turn out to be a waste of time.

 

[DarthNeurology]

Thanks for the feedback. That's been my take at this point, I'm asking all the attendings I work with for feedback and discussing my situation honestly with them. Like I said, I've been in practice for a while, I've been very open-minded about where I may not be performing up to snuff, but I think I have decent insight into how I compare to the average senior resident. I am leaning toward pushing for an appeal at this point for a few reasons, 1. a miracle may occur and it helps my circumstance, 2. it will further the cause of due process in academic and peer review, which is sorely lacking, and 3. if he does try to can me after I ask for an appeal and/or file a complaint with the ACGME, it will have the appearance (and the reality) of retaliation, from which we do have some legal protections.

I'm already board certified, I'll have a job to go to if this goes up in flames, but I'll be pretty pissed if the past few years turn out to be a waste of time.

That is good you are board certified already, i.e. have a job after all of this, does that mean that you did a different residency prior to this? Amazing story I am sure.

I think it is good to appeal/report this as it appears the PD is sort of toying with you, and isn't making clear what needs to be changed. That is good you got feedback from other attendings who like your work. Good Luck!

 

[dragonfly99]

Agree it changes things if you are already board certified in something else, dr123.

As you point out, if you do have to extend training it might leave you somewhat "marked" in the future. However, like I said, that happened to someone I know and he still got a pretty good private practice job...not sure if he totally came clean about the extended training but I'm sure they could figure out that he finished 6 months late. If you try to appeal and you lose, the PD might just fire you with <6 months left, which would totally suck.

This does sound like more of a personality conflict between the PD and dr1213...very unfortunate. I still think it will be hard to win an appeal, but best of luck. If you want to try it is certainly your right to do it...and if the PD decides he just doesn't want to deal with it any more, perhaps you'll win. However, I'd just worry about getting jobs in the future because in some way he will have to "sign off" on things like saying that you finished residency with a satisfactory performance.

 

[terminated]

I just found out that I am not being renewed for my R-2 on March 25th and find the details in this thread interesting. I will spare you the details surrounding why but essentially it boils down to a personality issue where my PD strongly believes that I would be happier somewhere else. Not much of an option given that I own a home here, my husband works near and we can't just up and go anywhere else!

I am doing the following things right now
1) Filing a grievance with the residency program
2) Filing a grievance with the affiliated hospitals human resources

If in the end I am not able to get a renewal through these processes I would take it to the next level and possibly consider a wrongful termination lawsuit. I will spare the details but I have reason to believe that this is a viable option if eventually necessary...

I have several questions
1) What resources are people aware of for searching out other R-2 positions?
2) What other types of jobs are people aware of for doctors who never finish a residency and thus can't practice... (an awful possibility but one I must consider)
3) Are there any other resources that anyone is aware of which may assist in this process?

I have 90 days to work this out and to say the least I am extremely worried. Even if I get another R-2 position lined up it would still mean relocating to another area and leaving my family behind, a sacrifice I would be willing to make if need be, but certainly not my first choice.

All residents know the challenges associated with not completing a residency but when you combine these factors with a mortgage, the current economy and a family the outlook becomes downright depressing if I am not able to get renewed here.

 

[Winged Scapula]

I just found out that I am not being renewed for my R-2 on March 25th and find the details in this thread interesting.

Unless I am missing something, your program is in violation of their agreement with the ACGME which requires 4 months notice of termination/non-renewal of contract (ie, March 1st):

Non-renewal of appointment or non-promotion: In
instances where a resident’s agreement will not be
renewed, or when a resident will not be promoted to
the next level of training, the Sponsoring Institution
must ensure that its programs provide the resident(s)
with a written notice of intent no later than four
months prior to the end of the resident’s current
agreement. If the primary reason(s) for the nonrenewal
or non-promotion occurs within the four
months prior to the end of the agreement, the
Sponsoring Institution must ensure that its programs
provide the resident(s) with as much written notice of
the intent not to renew or not to promote as
circumstances will reasonably allow, prior to the end
of the agreement.

According to the above, you must have had to do "something" to require termination between March 1st and March 25th.

I have several questions
1) What resources are people aware of for searching out other R-2 positions?
2) What other types of jobs are people aware of for doctors who never finish a residency and thus can't practice... (an awful possibility but one I must consider)
3) Are there any other resources that anyone is aware of which may assist in this process?

If we knew what field you are in and whether or not you have an unrestricted license, it would assist in offering more advise.

 

[terminated]

Apologies, I haven't used message boards ever and didn't want to burden with too much information. I have a temporary license am also an IMG and have already completed USMLE Step 3.

The ACGME requirement is interesting... I had thought it was 90 days so thought that the program just made the notice of non-renewal in time. The R-1 year ends on June 30 so technically the notice would have had to be filed at the end of Feb. That is powerful information...

 

[Winged Scapula]

Apologies, I haven't used message boards ever and didn't want to burden with too much information. I have a temporary license in Family Practice. I am also an IMG and have already completed USMLE Step 3.

Your license is a training (not temporary) license which is not specific to FM. I suspect you are training in a state where you need more than 2 years of GME to be eligible, as an IMG, for a full and unrestricted medical license.

The ACGME requirement is interesting... I had thought it was 90 days so thought that the program just made the notice of non-renewal in time. The R-1 year ends on June 30 so technically the notice would have had to be filed at the end of Feb. That is powerful information...

It USED to be 90 days. I'm not sure when it changed to 120 days but it is fairly recent. You can see the entire document at acgme.org. 120 days is a common requirement - ie, for ALL programs, ALL specialties.

Again, perhaps I am missing something but I remember thinking about the change and that it would occur before the match so that people who were going through the match again would have to let their program know they were staying/leaving before they knew if they had another position (although most advanced positions are outside the match). We'll see if aPD chimes in here...

 

[Taurus]

Apologies, I haven't used message boards ever and didn't want to burden with too much information. I have a temporary license in Family Practice. I am also an IMG and have already completed USMLE Step 3.

The ACGME requirement is interesting... I had thought it was 90 days so thought that the program just made the notice of non-renewal in time. The R-1 year ends on June 30 so technically the notice would have had to be filed at the end of Feb. That is powerful information...

Even if you stay because of a technicality, do you want to stay in a program whose PD wanted to get rid of you? It will be a long second year there where your every move will be watched in detail.

 

[terminated]

Your license is a training (not temporary) license which is not specific to FM. I suspect you are training in a state where you need more than 2 years of GME to be eligible, as an IMG, for a full and unrestricted medical license.

Your correct about the state licensure requirements

It's unfortunate the ACGME Institutional requirements don't stipulate in what circumstance notice to not renew can occur after the four month time period.

 

[terminated]

Even if you stay because of a technicality, do you want to stay in a program whose PD wanted to get rid of you? It will be a long second year there where your every move will be watched in detail.

In this case given the surrounding circumstances I would absolutely want to stay. I believe that a majority of the faculty would be supportive of my staying and that the program really believes they are doing this for my benefit as they think I am unhappy.

This isn't a function of performance, skill or capability but a personality issue. I think that a reasonable person will see it as such during the appeals process and recognize that it isn't to my benefit or the program's benefit to not renew a resident who is functioning at an above average level overall.

 

[Winged Scapula]

Taurus has a good point about not staying where you aren't wanted. Generally a PD has to have some faculty support to terminate you; could it be that you don't have as much faculty support as you think?

My point in posting the ACGME requirements is that if you chose to fight this (which isn't necessarily the right thing to do in all cases), you have to arm yourself with all the information you need.

An additional consideration is that don't you have to spend the last two years in the same FM program? That means, you cannot pick up a PGY-3 somewhere else, so by terminating you, your current program is dooming you to repeat PGY-2 somewhere else.

 

[terminated]

Taurus has a good point about not staying where you aren't wanted. Generally a PD has to have some faculty support to terminate you; could it be that you don't have as much faculty support as you think?

Yes it is possible that I don't have as much support as I hope to have. I do know that 40% of the faculty are supportive or at least amenable. Several have given me there home numbers and one has agreed to be an advisor to me during this appeals process.

I have reason to believe that not all faculty members were involved in this decision which is a typical for this program. Which does give me some hope during the appeals process.

your current program is dooming you to repeat PGY-2 somewhere else.

I certainly am considering pgy-2 somewhere else (only as an absolutely last resort) but locating and securing this is a whole different beast. It would mean certain separation from my family and my life... Any thoughts on how to locate a pgy-2 outside of the match?

 

[dragonfly99]

terminated
This is kind of unsolicited advice, but I think you should just get the hell out and not fight this. I mean, suppose that by some miracle you win your appeal and the PD is forced to keep you on. He/she is going to make your life hell, and you'll probably end up fired in a year from now anyway...all they have to do is find a few things you did wrong...and all residents do stuff wrong because they are still learning (and even all attendings do stuff wrong because they are human beings).

Especially if you are an intern/PGY1 now, just getting the hell out I think would be the best strategy. Your house can be sold. You can move. It sucks, but you are in a crappy situation now.

It is good if some faculty are willing to stand behind you, but I think you should realize that if you appeal and lose (which is overwhelmingly likely) your PD is going to end up ticked off and will likely try to keep you from getting any other position(s) anywhere else. If you leave now (i.e. could potentially resign instead of being terminated) and bail out for another fp program, or even another specialty, the PD might potentially at least try to be neutral and not bad mouth you to any potential future programs/program directors. Also, those faculty who you think are so supportive might not be so openly supportive if they have to go toe to toe with the PD and potentially your fp department chair.

 

[terminated]

Your house can be sold. You can move.

I appreciate the advice, I take all opinions seriously. Unfortunately unsold home statistics don't support this at all and for now we need to fight for the position. It is a journey that is just beginning and we don't know where it will lead but for now we are confident that appealing it is the correct thing to do.