Member 56634

f_w,

I (like Panda) have the advantage of having worked in the private non-healthcare sector prior to med school. Apart from the arguments we have about the system (such the match, the effect of the government GME subsidy, and the use of professional licensing to limit residents options), I have a different perspective having hired and fired employees in the private sector.

While I agree that not giving notice reflects poorly on the employee, I think that what is really unprofessional is the following. First and foremost is overworking the prelim surgery resident. Had I tried to have my employees work anything even resembling that kind of schedule, they would have walked off the job and across the street into the waiting arms of the competition. One of the greatest problems with the current system is that there is effectively no competition for residents once they are employed. This is partly why I believe it is a form of indentured servitude. One of the many ways any employee is able to improve his lot is to try and make it on the open marketplace.

I had an employee who accepted a job from a competitor almost literally across the street (down it actually in the neighboring business park) and quit on the spot after I could not match the offer he received (increased pay, responsibility, signing bonus and a promotion). The competitor knew that my employee was quiting on the spot and didn't care (why should they? after all, they are not getting paid to make my job easier). I pled with the employee to give two weeks notice, as corporate policy was that someone leaving without minimum notice would never be considered for rehire. He decided to burn his bridges. Did I like it? No. Did it cause my department problems? Yes. Were we able to overcome these? Sure.

Now, as far as references go. My corporation had a very strict policy. Unless there was documented gross misconduct or criminal wrongdoing on the former employee's part, the only information we released were dates of employment upon a signed/written waiver from the former employee. In the case of gross misconduct or criminal wrongdoing, our legal department would handle it with one of the lawyers calling their counterpart at the other firm. If I had done what Kimberli Cox's PD had, I would have been disciplined. Why? Because the company would needlessly have been exposed to threat of a lawsuit from the departed employee. (Thanks to our current system of licensing and specialization, PDs are effectively shielded from these. Power corrupts and absolute power corrupts absolutely.)

The system that exists for residents today, puts them at the mercy of their PDs. While many are decent folks who put in extra hours for the sake of their residents, we all know that not all do. As there is no real competition between programs once the resident has matched, there is no way for the resident to improve their lot without falling out as "unprofessional behavior" can be very, very broadly interpreted (you even admit this below).

Again, the fact that there is little or no competition for the residents once signed is the problem. The market is not fully able to function to act as a restraint on malignant PDs.

Forgive me for pointing this out, but you are obscuring the argument. Comparing indentured servants to those who enjoy the advantages of a free market for their services is I think, very misleading.

Your tech probably has the following advantages over a resident.

Better pay per hour and probably per annum.
Far better working conditions (certainly when it comes to hours worked).
The ability to walk across the street to the competition after giving adequate notice. In other words, the market works for him.