Termination

[Iahmdid]

I was recently terminated after two months of PGY 3 surgery position. I previously did two preliminary years at a program and then research for two years after which I matched into a categorical 3d year position at another program. My first program wanted to keep me but did not have a vacancy. My scores were mediocre but I was great clinically and had a lot of support from attendings and very strong letters and publications. When I applied for the pgy 3 spot however I noticed my case log print out only included 20% of the cases I did. When I called my program coordinator he said not sure why they are not showing up and told me to call ACGME. ACGME said since I am in reaserch and not residency I don't have an account and they cant give me more information or more accurate printout and I will have access to my logs again when Im a resident so I changed the printout to the number of cases I had done.

When I started the new program I got access to my logs and realized they were logged incorrectly and that's why they weren't showing up so then I started to log them correctly but the program found out and fired me for professional misconduct.

I simply do not know how to move forward anymore and am shocked this was cause enough for termination.

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[Gastrapathy]

If you have proof that you were correcting an error and your prior program can support this, you should appeal. If you were correcting the logs based on your memory...that was a bad decision.

 

[Iahmdid]

If you have proof that you were correcting an error and your prior program can support this, you should appeal. If you were correcting the logs based on your memory...that was a bad decision.

I provided proof and my prior PD verified I did the cases. And I appealed and the termination was not overturned.

 

[Gastrapathy]

Did they pile on other performance related reasons?

You need an attorney.

 

[Iahmdid]

Did they pile on other performance related reasons?

You need an attorney.

I got an attorney and he was present during the hearing. I had no other professionalism issues, no competency issues and provided evaluations from my two years at the previous program as well as summative competency report that showed no issues and 12 character reference letters from previous attendings, co-residents, and medical school classmates. This treatment was so harsh and I really thought I would at least be given option of probation or resignation.

But now that the hearing is done and termination upheld there is not much I can do. I am hoping I will be able to find another position but with this on my record my chances seem almost impossible and I am just sinking into a slow depression

 

[kemper6036]

it does seem excessively harsh. there have been residents who have literally killed or seriously harmed or mismanaged a patient with multiple complaints regarding professional conduct that were allowed to continue, sometimes with hardly a slap on the wrist. there must be more to the story, because it is hard to believe a resident being terminated for what amounts to a clerical error

 

[Gastrapathy]

Seems like it's time to get the courts involved and get a new attorney.

Have you spoken with your old PD since then? Any way he can help you get a different spot?

 

[Iahmdid]

Seems like it's time to get the courts involved and get a new attorney.

Have you spoken with your old PD since then? Any way he can help you get a different spot?

I did speak with him. He was upset that I didn't have him write a letter explaining I had the cases instead of changing the printout myself and in his eyes its poor professionalism and thinks it will not be overlooked by other PDs but he is willing to write me a letter of explanation/ support

 

[Iahmdid]

it does seem excessively harsh. there have been residents who have literally killed or seriously harmed or mismanaged a patient with multiple complaints regarding professional conduct that were allowed to continue, sometimes with hardly a slap on the wrist. there must be more to the story, because it is hard to believe a resident being terminated for what amounts to a clerical error

Well we had a four hour hearing and no other issues were raised by the PD. We spent 4 hours talking about how cases are logged and that my cases were initially logged incorrectly and therefore should not have been included in the printout. I provided support that I was never informed or told by my previous PD that anything was wrong in my logs and regardless I was able to correct the logs after re-entering residency. I also provided a print out from the perioperative services showing all the cases I was scrubbed in as the only or most senior resident and that it was unfathomable that the original print out was even close to correctly reflecting what I did but in the end they were focused on the point that I should never have changed a document because that demonstrates poor professionalism. I guess it does but is it enough to end someone's entire career? I can't re-apply for residency because I have already done 2.2 years and I can't find a new position to transfer to because now I have a termination on my record.

 

[Gastrapathy]

Certainly seems harsh. I don't really know how this works. Do residents normally log the cases or were you in a system you weren't supposed to touch? Can you appeal directly to the university president with the obvious implication that you'll sue if you lose? You've got very little to lose at this point.

 

[AdmiralChz]

I changed the printout to the number of cases I had done.

I think this is the crux of the problem, in that you fabricated an official document. That was why you were terminated in a hurry, I honesty missed this in the first read through.

This is tough because lying to the ACGME is a significant violation, that could have lingering effects for the program at large - residencies have had their certification revoked (and thus closed) for widespread misconduct like this. Clearly this is an isolated event, but I can't blame the GME office.

You are in a very tough spot. You'll probably have to lawyer up heavily you might be able to squeeze something out. This should be a huge warning for other posters out here - NEVER lie to an accrediting body. Honestly it will be tough to get into another residency with an ACGME violation, sorry to say. Good luck.

 

[Iahmdid]

I think this is the crux of the problem, in that you fabricated an official document. That was why you were terminated in a hurry, I honesty missed this in the first read through.

This is tough because lying to the ACGME is a significant violation, that could have lingering effects for the program at large - residencies have had their certification revoked (and thus closed) for widespread misconduct like this. Clearly this is an isolated event, but I can't blame the GME office.

You are in a very tough spot. You'll probably have to lawyer up heavily you might be able to squeeze something out. This should be a huge warning for other posters out here - NEVER lie to an accrediting body. Honestly it will be tough to get into another residency with an ACGME violation, sorry to say. Good luck.

Yeah I understand your point except I didn't lie to the acgme. I changed a document that was wrong to show the new program that I had done more cases but the acgme has a record of all my cases which were not changed by me.

 

[Gastrapathy]

Yeah I understand your point except I didn't lie to the acgme. I changed a document that was wrong to show the new program that I had done more cases but the acgme has a record of all my cases which were not changed by me.

Still confused. Did you change an original document in a way that was supposed to leave someone the impression that it was still the original (ie not altered) or in a way that made it obvious these were your changes?

 

[Iahmdid]

Still confused. Did you change an original document in a way that was supposed to leave someone the impression that it was still the original (ie not altered) or in a way that made it obvious these were your changes?

The former.

 

[Gastrapathy]

Ok. So...that's obviously worse and while I still think their decision was harsh, it's defensible. I'm not sure what to do from here but I think your only hope is your old PD helping you find any residency at his own institution.

 

[ThoracicGuy]

Well we had a four hour hearing and no other issues were raised by the PD. We spent 4 hours talking about how cases are logged and that my cases were initially logged incorrectly and therefore should not have been included in the printout. I provided support that I was never informed or told by my previous PD that anything was wrong in my logs and regardless I was able to correct the logs after re-entering residency. I also provided a print out from the perioperative services showing all the cases I was scrubbed in as the only or most senior resident and that it was unfathomable that the original print out was even close to correctly reflecting what I did but in the end they were focused on the point that I should never have changed a document because that demonstrates poor professionalism. I guess it does but is it enough to end someone's entire career? I can't re-apply for residency because I have already done 2.2 years and I can't find a new position to transfer to because now I have a termination on my record.

You can always reapply for residency. You can also look for a program to transfer to. But the odds are stacked against you based on what has been posted here.

 

[Smurfette]

So you doctored or forged the case log (to the correct numbers) you submitted when you applied to the program, and then later tried to alter the real case log to correspond to the faked report? Lying on an application is something that no program/hospital/state licensing board will get over. If you had submitted the official log but included a letter stating it was inaccurate and your actual numbers were ___, they probably wouldn't care about the changes you made once you had access.

How did you get into this position in the first place? Did you not enter your own cases at your first program or verify the accuracy? As an aside, how is it that the new program even noticed this? They have multiple residents to track, so what stood out about your logging that made them investigate? Some of my co-residents were behind logging hundreds of cases, and no one was ever accused of anything other than procrastination, even if they were backlogging a ton of old stuff.

As far as applying to new programs, if you have a professionalism red flag, you'll have to be very clear about explaining what happened, as well as be willing to repeat some of your training (i.e. look for PGY1 or 2 spots or prelim spots). But you also need to make sure both of your prior PDs will give you a favorable reference in order to have a chance.

 

[Iahmdid]

So you doctored or forged the case log (to the correct numbers) you submitted when you applied to the program, and then later tried to alter the real case log to correspond to the faked report? Lying on an application is something that no program/hospital/state licensing board will get over. If you had submitted the official log but included a letter stating it was inaccurate and your actual numbers were ___, they probably wouldn't care about the changes you made once you had access.

How did you get into this position in the first place? Did you not enter your own cases at your first program or verify the accuracy? As an aside, how is it that the new program even noticed this? They have multiple residents to track, so what stood out about your logging that made them investigate? Some of my co-residents were behind logging hundreds of cases, and no one was ever accused of anything other than procrastination, even if they were backlogging a ton of old stuff.

As far as applying to new programs, if you have a professionalism red flag, you'll have to be very clear about explaining what happened, as well as be willing to repeat some of your training (i.e. look for PGY1 or 2 spots or prelim spots). But you also need to make sure both of your prior PDs will give you a favorable reference in order to have a chance.

Correct. My logs were inaccurate because my previous PD did not catch that they were logged incorrectly and when I tried to correct it I was in research and did not have access to my logs and instant of writing a letter I changed the report to the correct number which I later corrected when I was back in residency.

I should have done what you suggested here but I did not lie about the actual cases. I guess I became nervous that the report was not an accurate reflection of my logs and Thought I would be able to correct it once I had access since I knew other residents had to do the same once our former PD told us we were logging cases incorrectly.

It was indeed stupid and unprofessional but not a lie about my actual number of cases.

 

[Iahmdid]

Ye

Oh. I think I missed this in the original post.

OP doctored their case log at the time of their application to a categorical position.

Yeah. That was really, really stupid.

yes it was stupid but I was locked out of my acgme account since I was in research and could not correct it unless I was back in residency but I realized that I would not be able to get residency with a log that said I only did 15 cases in two years! Had my former PD noticed I was logging cases incorrectly or had I known before leaving for research I would have simply corrected them.

It was an error in judgment but enough for termination when I provided documentation of those cases as well as my former Pd confirmed that the cases I put down were accurate and he had not informed me of the logging error? I pleaded for probation and even resignation.

 

[kemper6036]

No. the ACGME case logs can be updated anytime until graduation when the system locks you out.

IMHO this whole story makes no sense. I simply cannot imagine that a PD would view correcting an inaccurate case log to an accurate one as anything other than a good thing.

which is why i said there has to be something missing from the story

 

[Winged Scapula]

Correct. My logs were inaccurate because my previous PD did not catch that they were logged incorrectly and when I tried to correct it I was in research and did not have access to my logs and instant of writing a letter I changed the report to the correct number which I later corrected when I was back in residency.

I should have done what you suggested here but I did not lie about the actual cases. I guess I became nervous that the report was not an accurate reflection of my logs and Thought I would be able to correct it once I had access since I knew other residents had to do the same once our former PD told us we were logging cases incorrectly.

It was indeed stupid and unprofessional but not a lie about my actual number of cases.

I believe you still aren't getting it.

They aren't concerned about whether you lied about the cases, or about the number of cases you did.

You were punished because you forged an official document. In the eyes of the program, its the slippery slope. What's next? Altering medical records?

 

[AdmiralChz]

There are many ways to handle a case log which is incorrect (which honestly is likely a user input issue), from writing the ACGME, having your old or new PD/PC inquire about it, or calling the office yourself.

But you didn't do those things. Instead you altered the case report document and put what you believed to be true on it. you should never, EVER do this. What would have stopped you from lying and inflating your statistics? Or someone else from lying and saying they have all their numbers when in fact they are quite short? Do you see the issue here? Its a severe lack of professionalism, and honestly I don't see why you did it in the first place - to shore up your numbers to help with your surgery application?

 

[Iahmdid]

Ye

There are many ways to handle a case log which is incorrect (which honestly is likely a user input issue), from writing the ACGME, having your old or new PD/PC inquire about it, or calling the office yourself.

But you didn't do those things. Instead you altered the case report document and put what you believed to be true on it. you should never, EVER do this. What would have stopped you from lying and inflating your statistics? Or someone else from lying and saying they have all their numbers when in fact they are quite short? Do you see the issue here? Its a severe lack of professionalism, and honestly I don't see why you did it in the first place - to shore up your numbers to help with your surgery application?

You have made a few assumptions here. I did call my PC first who said he could not access my logs because I was no longer in residency. I called the ACGME who said I could no longer access my logs because I was no longer in residency. I specially I asked them if my former institution could be given access and they said not unless they take me on as a resident again. Since I left after two years and did research I technically did not have an ACGME account and therefore there was no way for me to get an official report from them so at this point I had a two year old report that was inaccurate and could not be changed unless I was back in residency which I likely would not be able to with a report that said I did 15 cases in two years.

And yea you are right the principle issue is of professionalism and I could have easily lied or inflated except I provided significant documentation to show that in fact I underestimated but changed it the closer amount of what I actually did.

My former PD can verify I changed it to the correct amount and that he dis not realize I had been logging anything incorrectly and missed it. His words not mine.

So there were several mitigating issues here to consider and the fact that it was a solitary incident with someone with an otherwise impressive professionalism track record.

 

[RadOncDoc21]

OP... I'm sorry you have to go through this and from what you stated, there appears to be a rationale reason for your actions. Unfortunately, the program felt was something inexcusable.

I still can't help but think there was something else we're missing for them to be so harsh, unless there was something that directly involved patient care.

 

[SouthernSurgeon]

So there were several mitigating issues here to consider and the fact that it was a solitary incident with someone with an otherwise impressive professionalism track record.

Yeah, those aren't "mitigating circumstances". Those are excuses.

There are a number of things you could have done. For one, you could have logged your cases correctly or identified a problem with logging prior to being locked out of the system. We all log our own cases, and the ultimate person responsible for your case logs is you. Any problem with the logs is your fault; the first step here should be acknowledging that.

Now, when you did identify the problem, before you applied, you could have:
(a) Pushed harder on the PD and/or ACGME for an opportunity to correct it
(b) Had your PD discuss this in their LOR or in separate communication and provide accurate case data and acknowledge the issue
(c) Acknowledge the problem yourself in your PS
(d) Provide external data supporting the correct case logging.

But you didn't do any of those things. You did the one thing you absolutely could not do - you forged your official case log in your application.

I don't see a way out of this one.

 

[rokshana]

You have made a few assumptions here. I did call my PC first who said he could not access my logs because I was no longer in residency. I called the ACGME who said I could no longer access my logs because I was no longer in residency. I specially I asked them if my former institution could be given access and they said not unless they take me on as a resident again. Since I left after two years and did research I technically did not have an ACGME account and therefore there was no way for me to get an official report from them so at this point I had a two year old report that was inaccurate and could not be changed unless I was back in residency which I likely would not be able to with a report that said I did 15 cases in two years.

And yea you are right the principle issue is of professionalism and I could have easily lied or inflated except I provided significant documentation to show that in fact I underestimated but changed it the closer amount of what I actually did.

My former PD can verify I changed it to the correct amount and that he dis not realize I had been logging anything incorrectly and missed it. His words not mine.

So there were several mitigating issues here to consider and the fact that it was a solitary incident with someone with an otherwise impressive professionalism track record.

again, you are not getting the issue....you forged an official document...it doesn't matter if the information was accurate, its the ACT...as SS said, you had other avenues to bring that information to the attention of your PD or in your applications and you chose to do the one that was illegal.

 

[Iahmdid]

OP... I'm sorry you have to go through this and from what you stated, there appears to be a rationale reason for your actions. Unfortunately, the program felt was something inexcusable.

I still can't help but think there was something else we're missing for them to be so harsh, unless there was something that directly involved patient care.

I can only tell you what happened which I have in great detail. I have never been involved in any situation compromise patient care or any other issue of professionalism.

 

[Winged Scapula]

I think we can move on from the cause of the termination because I think it's quite clear that those of us here who are surgeons understand the gross unprofessionalism here.

Whether or not there are mitigating circumstances or excuses is unimportant.

OP, did you want some advice on what to do now or are you simply venting? At this point you need to MoveOn. I'm not sure if another surgical program will take their chances on you but if you want we can discuss options.


Sent from my iPhone using SDN mobile

 

[Iahmdid]

I think we can move on from the cause of the termination because I think it's quite clear that those of us here who are surgeons understand the gross unprofessionalism here.

Whether or not there are mitigating circumstances or excuses is unimportant.

OP, did you want some advice on what to do now or are you simply venting? At this point you need to MoveOn. I'm not sure if another surgical program will take their chances on you but if you want we can discuss options.


Sent from my iPhone using SDN mobile

I originally posted for advice and not admonition. I realized what I did was wrong and I have to be forthcoming to move forward. Any advice would be appreciated.

 

[RadOncDoc21]

I can only tell you what happened which I have in great detail. I have never been involved in any situation compromise patient care or any other issue of professionalism.

Logging cases must be different for surgery or has changed significantly since I was a resident because up until my final day I had full access to my case logs (pre-lim and residency) and could edit the cases. The logs were pretty broad and I did not have to include specific details except for type of procedure, disease site and of course the patient.

As stated above, the situation is neither here nor there and I am truly sorry you had to go through this. I hope you do find another position soon and no matter what, use your experiences in a positive way to guide you moving forward. Good luck!

 

[Lostin_space]

I can only tell you what happened which I have in great detail. I have never been involved in any situation compromise patient care or any other issue of professionalism.

I'm so sorry for what's happened to you. I'm certainly not a surgeon so I guess I don't "understand" the gravity of the issue. I see it maybe as a mistake, but don't see how that does not deserve at least a second chance. To fire someone for correcting logs? Its not like you made them up, especially since you have proof. As the Radonc poster mentioned, our logs are much much simpler - it's just the case/procedure, time frame, and sometimes diagnosis, but there is no specific patient identification or anything like that.

I really think you deserve another chance, especially after all those years you put in. Can't you appeal, or talk to the PD or something like that?

 

[gutonc]

I'm so sorry for what's happened to you. I'm certainly not a surgeon so I guess I don't "understand" the gravity of the issue. I see it maybe as a mistake, but don't see how that does not deserve at least a second chance. To fire someone for correcting logs? Its not like you made them up, especially since you have proof. As the Radonc poster mentioned, our logs are much much simpler - it's just the case/procedure, time frame, and sometimes diagnosis, but there is no specific patient identification or anything like that.

I really think you deserve another chance, especially after all those years you put in. Can't you appeal, or talk to the PD or something like that?

Still not sure if the OP gets it, but you appear to not understand the issue at hand.

He did not get in trouble for not logging his cases. He got in trouble for forging an official ACGME document and submitting it as proof of his cases. The fact that the forged document was a more accurate representation of his actual case history is irrelevant. The fact that he forged...FORGED AND SUBMITTED AS ORIGINAL...an official document is the only issue here.

And it's a huge one.

The OPs best option is to get the support of prior PD in a future application season. Maybe for something other than Gen Surg.

 

[RadOncDoc21]

As has been stated a number of times here, the issue isn't the correcting of the logs - it's the forgery in the first place. OP altered an official document and submitted that false document in their application packet. It doesn't matter what the "correct" number of cases is (and OP more or less admitted above that they were guestimating the correct numbers as their final updated case log wasn't identical to the forged numbers).

Put it another way - college student applying to medical school notices their transcript listed a C in organic chemistry when they actually received an A. So college student erases the C and writes an A on top, submits that as their official transcript. How would a med school react to that?

I'm not going to justify what he did and I personally would not have altered the document. Obviously, the current PD feels the same way but the OP is arguing he did have an "A" which he can prove.

Again, I'm not justifying his action but can "understand" where he is coming from and feel he could have got a more of a benefit of the doubt (Disclosure: This is coming from a non-surgeon-thank God)...

 

[rokshana]

I'm not going to justify what he did and I personally would not have altered the document. Obviously, the current PD feels the same way but the OP is arguing he did have an "A" which he can prove.

Again, I'm not justifying his action but can "understand" where he is coming from and feel he could have got a more of a benefit of the doubt (Disclosure: This is coming from a non-surgeon-thank God)...

smh....doesn't matter if he actually had the "A" as a legitimate grade...you call the registrar and get THEM to correct the grade...not hack into the registrars account to change the grade yourself...

its not the content that is of issue, its the manner that it was handled that is of the issue...and i'm not a surgeon either but i get that its the ACT of the forgery that is the big mistake.

this is no different than say, lying to a medical board about something, getting caught and having problems...its not WHAT you lied about, its the LIE itself...

 

[hello1234!]

Another non-surgeon here ... but I imagine this is out of the PDs hands at this point. I don't really know who decides if residents have the proper credentials to work in hospitals, but I just don't see how they could keep you at the PGY-3 level if you only had 15 official cases logged at the time of hiring ... ... seems like it would be risky on their part and open them up to liability.

I don't think your career in medicine is over. Give yourself a break, go to an all-inclusive resort in Mexico and then come up with a new plan.

 

[RadOncDoc21]

smh....doesn't matter if he actually had the "A" as a legitimate grade...you call the registrar and get THEM to correct the grade...not hack into the registrars account to change the grade yourself...

its not the content that is of issue, its the manner that it was handled that is of the issue...and i'm not a surgeon either but i get that its the ACT of the forgery that is the big mistake.

this is no different than say, lying to a medical board about something, getting caught and having problems...its not WHAT you lied about, its the LIE itself...

Philosophically it was always the "truth" and not a "lie."

Yes all I do get the point, the action of what he did is the issue and it was wrong. However, I've seen people kill patients due to negligence and get away with just a slap on the wrist. So to all who read this, don't forge but killing is ok (sarcasm).

 

[tfdngiatall]

smh....doesn't matter if he actually had the "A" as a legitimate grade...you call the registrar and get THEM to correct the grade...not hack into the registrars account to change the grade yourself...

its not the content that is of issue, its the manner that it was handled that is of the issue...and i'm not a surgeon either but i get that its the ACT of the forgery that is the big mistake.

this is no different than say, lying to a medical board about something, getting caught and having problems...its not WHAT you lied about, its the LIE itself...

Surgeon here and while I agree that the document should not be altered a few things don't match up with your analogy because sounds like OP said tge called their PC and acgme and therefore the "registrar" and were told their account doesn't exist anymore.

When I went into research I was logged out and needed to go back and log cases and correct issues but sounds like OP didn't have this option.

Also I am confused about why the OP former PD didn't point out the OP was not progressing? 15 cases after two years would be a serious red flag...

 

[Iahmdid]

Another non-surgeon here ... but I imagine this is out of the PDs hands at this point. I don't really know who decides if residents have the proper credentials to work in hospitals, but I just don't see how they could keep you at the PGY-3 level if you only had 15 official cases logged at the time of hiring ... ... seems like it would be risky on their part and open them up to liability.

I don't think your career in medicine is over. Give yourself a break, go to an all-inclusive resort in Mexico and then come up with a new plan.

No I had all my cases logged but only 15 showed up on the report I had because that report only shows cases logged in a specific category. I was logged out of my account and couldn't correct that printout or provide any other printout. From the acgme representative I was told Neither I or my former PD could access my logs or account unless I was back in residency.

But others here have raised valid point that I could have thought of other means such as getting a letter from PD etc and thats on me...

 

[Iahmdid]

smh....doesn't matter if he actually had the "A" as a legitimate grade...you call the registrar and get THEM to correct the grade...not hack into the registrars account to change the grade yourself...

its not the content that is of issue, its the manner that it was handled that is of the issue...and i'm not a surgeon either but i get that its the ACT of the forgery that is the big mistake.

this is no different than say, lying to a medical board about something, getting caught and having problems...its not WHAT you lied about, its the LIE itself...

You are right that forging a document is wrong but your comparison is overly simplistic and the assumption that one mistake naturally leads to another is also flawed. How do you while in training make sure someone doesn't make the same mistake again? If they make the same mistake again.

The assumption that I would not learn from this mistake when I have an otherwise clean record is in itself extremely punitive IMHO. Because I not only lost my job but am struggling to move forward in the career I have dedicated many many years to, have no way to pay residency and will likely be unemployed for the remainder of this year.

 

[Iahmdid]

You are right that forging a document is wrong but your comparison is overly simplistic and the assumption that one mistake naturally leads to another is also flawed. How do you while in training make sure someone doesn't make the same mistake again? If they make the same mistake again.

The assumption that I would not learn from this mistake when I have an otherwise clean record is in itself extremely punitive IMHO. Because I not only lost my job but am struggling to move forward in the career I have dedicated many many years to, have no way to pay residency and will likely be unemployed for the remainder of this year.

I mean pay rent or my loans (not residency)

 

[Lostin_space]

I'm not going to justify what he did and I personally would not have altered the document. Obviously, the current PD feels the same way but the OP is arguing he did have an "A" which he can prove.

Again, I'm not justifying his action but can "understand" where he is coming from and feel he could have got a more of a benefit of the doubt (Disclosure: This is coming from a non-surgeon-thank God)...

This. I'm totally with the RadOnc guy on this. I guess as a non-surgeon myself as well I don't see the gravity and as he (I assume you are a he but sorry if I'm mistaken) points out, if you can prove you got an A, I'm not sure it's such an issue. Maybe there would have been a better way of going about it, sure but ultimately OP was right in that the cases were logged incorrectly and an inaccurate representation of his actual scores. Maybe because our logs are much more fluid and don't require as much detail I guess I don't understand the gravity so much. It's not like OP said something that he did not do. It's not like he's like oh I did "100 lap choles" (i'm just making up a number as I have no idea how many you all do inresidency) but he only did 10 or something. If he can prove he did 100, isn't he just correcting an incorrect document? I mean if anything the ACGME document was wrong if the cases were logged incorrectly and OP did not get credit for what he actually had done so that if anything was false.
Like the RadOnc guy said, I would also give him the benefit of the doubt.

 

[Lostin_space]

You are right that forging a document is wrong but your comparison is overly simplistic and the assumption that one mistake naturally leads to another is also flawed. How do you while in training make sure someone doesn't make the same mistake again? If they make the same mistake again.

The assumption that I would not learn from this mistake when I have an otherwise clean record is in itself extremely punitive IMHO. Because I not only lost my job but am struggling to move forward in the career I have dedicated many many years to, have no way to pay residency and will likely be unemployed for the remainder of this year.

I agree with this. I think it's way too punitive, and I don't think that you did it with a nefarious intent. Can you appeal?

 

[Lostin_space]

Philosophically it was always the "truth" and not a "lie."

Yes all I do get the point, the action of what he did is the issue and it was wrong. However, I've seen people kill patients due to negligence and get away with just a slap on the wrist. So to all who read this, don't forge but killing is ok (sarcasm).

Again I'm totally with the RadOnc guy on this. I have seem gross and I mean gross negligence, on a number of times by surgeons, with a slap on the wrist and a letter of apology, etc without much more. I get that what OP did in theory but was but as Radonc points out, he is 100% right on that it was philosophically always the truth. Again OP should have gone about this a better way but to destroy his career like this way too punitive. We are always taught to be soooo understanding and empathetic and what not but we are cruel, destructive and punitive to our own.

 

[gutonc]

This. I'm totally with the RadOnc guy on this. I guess as a non-surgeon myself as well I don't see the gravity and as he (I assume you are a he but sorry if I'm mistaken) points out, if you can prove you got an A, I'm not sure it's such an issue. Maybe there would have been a better way of going about it, sure but ultimately OP was right in that the cases were logged incorrectly and an inaccurate representation of his actual scores. Maybe because our logs are much more fluid and don't require as much detail I guess I don't understand the gravity so much. It's not like OP said something that he did not do. It's not like he's like oh I did "100 lap choles" (i'm just making up a number as I have no idea how many you all do inresidency) but he only did 10 or something. If he can prove he did 100, isn't he just correcting an incorrect document? I mean if anything the ACGME document was wrong if the cases were logged incorrectly and OP did not get credit for what he actually had done so that if anything was false.
Like the RadOnc guy said, I would also give him the benefit of the doubt.

You clearly don't get it. It had nothing to do with the log or what was (or wasn't) in it. The OP forged an official document and passed it off as original. Although @rokshana's analogy may have been a bit flawed, this is the same as changing your transcript or altering your MSPE or a LOR. The content, before and after the change, is irrelevant. What matters is the forgery/fraud.

The OP seems to understand the issue, the error and (better late than never), alternative approaches that s/he could have taken.

 

[Iahmdid]

You should read the book "forgive and remember"

It discusses surgeons and error types. In summary this was a "normative" error. These are considered to be much less amenable to teaching and correction than other types of errors.

Which is why, to move on from the blame game, it will be extremely important for you moving forward to understand and demonstrate WHY this was such a severe issue.

I understand your point. It is harder to teach ethics. My immediate reaction to this when it happened was to acknowledge full responsibility for it to the PD and ask for probation. At the time I did not make excuses, was humble and took accountability. Moreover I informed all attendings who supported me and told them I was terminated for my wrong doing.

I don't believe someone with an inherent consciousness issue would do that. And I don't understand why probation or resignation were not options available to me at that point. I have never been involved in any professionalism issues and have never compromised patient care. Are you saying now I should never practice in surgery because of this? That I should struggle to even match into a non surgical position ? Because that seems excessively punitive.

 

[Lostin_space]

smh....doesn't matter if he actually had the "A" as a legitimate grade...you call the registrar and get THEM to correct the grade...not hack into the registrars account to change the grade yourself...

its not the content that is of issue, its the manner that it was handled that is of the issue...and i'm not a surgeon either but i get that its the ACT of the forgery that is the big mistake.

this is no different than say, lying to a medical board about something, getting caught and having problems...its not WHAT you lied about, its the LIE itself...

Not really the same though. Sometimes mistakes are made, not on purpose of course, and it's not meant in a way to lie or somehow get something passed a board - it's just a simple mistake. IT's not intended to be a lie yet you should lose your career over it? Way too punitive. (and i've alluded before to this concern of making a mistake on a licensing app and getting crushed because of it).

 

[Lostin_space]

I understand your point. It is harder to teach ethics. My immediate reaction to this when it happened was to acknowledge full responsibility for it to the PD and ask for probation. At the time I did not make excuses, was humble and took accountability. Moreover I informed all attendings who supported me and told them I was terminated for my wrong doing.

I don't believe someone with an inherent consciousness issue would do that. And I don't understand why probation or resignation were not options available to me at that point. I have never been involved in any professionalism issues and have never compromised patient care. Are you saying now I should never practice in surgery because of this? That I should struggle to even match into a non surgical position ? Because that seems excessively punitive.

Agreed. Part of learning from mistakes is 1- acknowledging that you did something wrong 2- not doing it again 3- being allowed to be in an environment where you can continue "practicing" what you learned

I also dont think that everyone would see things the way the PDs/ACGME did. I personally would maybe have given you probation and a chance.

 

[Lostin_space]

You clearly don't get it. It had nothing to do with the log or what was (or wasn't) in it. The OP forged an official document and passed it off as original. Although @rokshana's analogy may have been a bit flawed, this is the same as changing your transcript or altering your MSPE or a LOR. The content, before and after the change, is irrelevant. What matters is the forgery/fraud.

The OP seems to understand the issue, the error and (better late than never), alternative approaches that s/he could have taken.

I understand what you are saying in regards to the "forgery" as you call it, but I think some of us see it differently. It's not really a "forgery" if it's in fact true. I think firing someone without giving them a chance to remediate their mistake especially after they acknowledged they made a mistake and have not had an issue before is way harsh. People who commit serious crimes are given more of a chance!

Are you saying OP should not at least have gotten probation?

 

[Iahmdid]

You clearly don't get it. It had nothing to do with the log or what was (or wasn't) in it. The OP forged an official document and passed it off as original. Although @rokshana's analogy may have been a bit flawed, this is the same as changing your transcript or altering your MSPE or a LOR. The content, before and after the change, is irrelevant. What matters is the forgery/fraud.

The OP seems to understand the issue, the error and (better late than never), alternative approaches that s/he could have taken.

No they get it. What I did was wrong and they state that. What you are uncomfortable with is that they are not similarly punitive as you. They think it's not enough to end a career and you think it is and you can argue that till the cows come home (i don't know if anyone even uses that phrase anymore).

 

[Iahmdid]

I agree with this. I think it's way too punitive, and I don't think that you did it with a nefarious intent. Can you appeal?

I appealed and during my appeal provided strong evidence that I was the only surgeon in well over 300 cases as well as character reference letters from former attendings, former chief and co-residents and former medical school classmates but termination was upheld.
I never defended my actions during the hearing, apologized, acknowledged responsibility and accountability and agreed to be placed on probation. But no cigar.