I have decided I have to leave, now what specialty?

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I can't continue to go through harassment and abuse (now intensified by my meetings with the hospital and staff). I simply don't have the support to deal with this situation and it is destroying me. I don't want a law suit. All I ever wanted was to learn. I know that this is letting the "powers that be win" but for my own sake, my mental health and education, I want to leave. I was told that this sort of malignant behavior occurs frequently in medicine, and if possible, I would like to know which specialties are the least malignant (I understand that a big part of it is the people).

Originally Posted by Jackwhite

I can't continue to go through harassment and abuse (now intensified by my meetings with the hospital and staff). I simply don't have the support to deal with this situation and it is destroying me. I don't want a law suit. All I ever wanted was to learn. I know that this is letting the "powers that be win" but for my own sake, my mental health and education, I want to leave. I was told that this sort of malignant behavior occurs frequently in medicine, and if possible, I would like to know which specialties are the least malignant (I understand that a big part of it is the people).

From your prior posts I think we discerned that you are in a small program, likely OB, and that you won't really have your PDs support to leave, although they haven't actually tried to fire you or ask you to quit. You have given us very little info in terms of your competitiveness. However coming from a not ultra competitive field without really having a ringing endorsement of your PD, you probably aren't going to jump to a competitively "better" specialty, so that pretty much leaves the world of FM, Peds, psych and IM as your best shots.

malignancy is found in every field, it is not specialty specific but program specific. You could easily jump from the frying pan into the fire. In fact the places most likely to take a chance on you without PD backing might be programs which churn and burn residents for sport themselves. I think the advice you got in the other thread to stick it out probably is still the safest course. Could you find a more compassionate program in FM or Peds which might incorporate some of the things you presumably liked about OB? Sure. Might you leave an unpleasant program and end up in an outright malignant program, having lost a year in the process? Absolutely.

As a psych resident, I would say malignancy is pretty rare in psych (it DOES happen, but generally the personality type that is attracted to psych is not as prone to malignant behavior as the personality type that tends to be drawn to surgery).

Originally Posted by peppy

As a psych resident, I would say malignancy is pretty rare in psych (it DOES happen, but generally the personality type that is attracted to psych is not as prone to malignant behavior as the personality type that tends to be drawn to surgery).

Probably true, but that field has some of the least overlap with OB, so I have to wonder if the OP will even like it. Most of us realize from med school rotations that benign fields you have little interest in can be painful even for just a few weeks, let alone a career. You might be better off suffering through a bad residency in a field you mostly find interesting, and hope you can find a different set up post residency.

Originally Posted by Jackwhite

I can't continue to go through harassment and abuse (now intensified by my meetings with the hospital and staff). I simply don't have the support to deal with this situation and it is destroying me. I don't want a law suit. All I ever wanted was to learn. I know that this is letting the "powers that be win" but for my own sake, my mental health and education, I want to leave. I was told that this sort of malignant behavior occurs frequently in medicine, and if possible, I would like to know which specialties are the least malignant (I understand that a big part of it is the people).

wow, with the work hours and now this, residency sound absolutely terrifying.

Originally Posted by zoner

wow, with the work hours and now this, residency sound absolutely terrifying.

Residency per se isn't terrifying. The hours are survivable, and less than they were a few years ago. But you are going to work very hard and not every program treats their trainees with the same level of respect and collegiality. I'd say the vast vast majority of places are not malignant -- if you work hard and keep your head down you'll make it through. You may work crazy hours and hate your life, but they treat you as a future professional most of the time. But in every large group there will be outliers, either programs that are outright malignant, or residents that simply don't figure out how to play the game and take abuse because of it. I'd say the posts on SDN present a disproportionate view because most of the folks who get through intact never post here. But as a future resident you must must must talk to current residents at programs you are interested in, and do away rotation if possible, so you go into things with your eyes open.

Originally Posted by Law2Doc

Probably true, but that field has some of the least overlap with OB, so I have to wonder if the OP will even like it. Most of us realize from med school rotations that benign fields you have little interest in can be painful even for just a few weeks, let alone a career. You might be better off suffering through a bad residency in a field you mostly find interesting, and hope you can find a different set up post residency.

True. If someone has no interest in psych, I would not recommend going into it just because it's usually less malignant. However, if someone wants to switch out of surgery because they've realized surgery isn't their kind of thing after all, psych is a viable option.

Originally Posted by Law2Doc

Residency per se isn't terrifying. The hours are survivable, and less than they were a few years ago. But you are going to work very hard and not every program treats their trainees with the same level of respect and collegiality. I'd say the vast vast majority of places are not malignant -- if you work hard and keep your head down you'll make it through. You may work crazy hours and hate your life, but they treat you as a future professional most of the time. But in every large group there will be outliers, either programs that are outright malignant, or residents that simply don't figure out how to play the game and take abuse because of it. I'd say the posts on SDN present a disproportionate view because most of the folks who get through intact never post here. But as a future resident you must must must talk to current residents at programs you are interested in, and do away rotation if possible, so you go into things with your eyes open.

what do you mean by "do away rotation" and also how do you play the game so as to not take the abuse?

Originally Posted by zoner

what do you mean by "do away rotation" and also how do you play the game so as to not take the abuse?

Away or audition rotations are ones where a med student does a rotation at a program they are considering applying for residency. Helps the student sell themselves but also gives the student inside info as he talks with folks beyond what you get in an interview.

Playing the game is something you hopefully start to learn as a med student. But a handful of interns each year never learn what is expected of them as a resident, and are as a result simply bad at the job. They never make that leap from being the student waiting to be told what to do to the self starter who takes care of things and always has checked what the attending is going to want to know. And they get abused because of it. It's not a hard job, but some folks refuse to take that next step of being THE doctor -- they often lack self awareness that they aren't doing the same thing their other residents are doing, and multiple meetings with the PD about it sometimes don't get the message across. For them, residency can be very painful.

I think the more accurate definition of "playing the game" is not voicing your concerns about the issues that are going on in your program that everyone seems to "accept" (lack of equipment, unsafe practices, abusive behavior, etc.). It has nothing to do with skill level. People in every field, specialty and discipline suffer abuse and it is not necessarily a result of poor performance or " folks refuse to take that next step of being THE doctor ". Residents quickly learn to keep their mouth shut, even if it isn't in the interest of the patient or even the betterment of their education. So when someone steps up , or whistleblows in a way, that person will suffer. It can be anything from questioning an outdated technique to asking for more didactics. The unfortunate practice of playing the game also unfortunately leads to residents to treat the abused as if they deserve bad treatment for speaking up, even if they agree completely with the accusations or criticisms made by the abused. It is horrible and isolating and acceptable because everyone is afraid of becoming the next victim.

That's exactly how I see it as well. I'd also add that it's important to know who you are dealing with at any given time. If you're working with the chair or PD, push for peak performances to establish your reputation. The opinions of the few outweigh the many.

Originally Posted by Jackwhite

I think the more accurate definition of "playing the game" is not voicing your concerns about the issues that are going on in your program that everyone seems to "accept" (lack of equipment, unsafe practices, abusive behavior, etc.). It has nothing to do with skill level. People in every field, specialty and discipline suffer abuse and it is not necessarily a result of poor performance or " folks refuse to take that next step of being THE doctor ". Residents quickly learn to keep their mouth shut, even if it isn't in the interest of the patient or even the betterment of their education. So when someone steps up , or whistleblows in a way, that person will suffer. It can be anything from questioning an outdated technique to asking for more didactics. The unfortunate practice of playing the game also unfortunately leads to residents to treat the abused as if they deserve bad treatment for speaking up, even if they agree completely with the accusations or criticisms made by the abused. It is horrible and isolating and acceptable because everyone is afraid of becoming the next victim.

Um no. Most programs are not malignant. And some percentage (not all) of folks who feel their program is malignant actually aren't very good residents, which is why they aren't treated so great. Thats what I'm referring to as playing the game. I've seen situations at relatively benign program where one or two residents every few years contracts were not renewed because the residents for whatever reason couldn't figure out the job, even after multiple discussions with the PD and chiefs. In one case a guy didn't listen to instructions and actually hurt a patient. In another, the guy would routinely lie about checking labs and other things, because he somehow felt it better to make up something than concede to an attending that he didn't remember to check. Nobody else had these issues, and generally the semi-annual reviews were love-fests.

But no, by playing the game I didn't mean not whistle blowing or sucking it up and taking abuse (although there is some tongue biting, coming in sick, etc In residency for sure) I meant not doing all those unprofessional things that could create abuse for yourself. Some people just don't get the very hierarchical almost military nature of residency, the expectations, or what the term professionalism means in that particular setting. And some never make that jump from med student to resident in a timely fashion, despite not so subtle hinting that it's time to stop calling the attending every time you want to give an antiemetic or pain med in the middle of the night.

We obviously have very clear differences in our definition of the phrase, but in my case my definition applies.

Originally Posted by Jackwhite

I think the more accurate definition of "playing the game" is not voicing your concerns about the issues that are going on in your program that everyone seems to "accept" (lack of equipment, unsafe practices, abusive behavior, etc.). It has nothing to do with skill level. People in every field, specialty and discipline suffer abuse and it is not necessarily a result of poor performance or " folks refuse to take that next step of being THE doctor ". Residents quickly learn to keep their mouth shut, even if it isn't in the interest of the patient or even the betterment of their education. So when someone steps up , or whistleblows in a way, that person will suffer. It can be anything from questioning an outdated technique to asking for more didactics. The unfortunate practice of playing the game also unfortunately leads to residents to treat the abused as if they deserve bad treatment for speaking up, even if they agree completely with the accusations or criticisms made by the abused. It is horrible and isolating and acceptable because everyone is afraid of becoming the next victim.

I am in a very benign program but even here I've learned to keep relatively quiet unless a patient will actually be harmed. It's rare the person who will admit they don't know the latest therapy or changes to the standard of care. Even more rare is the person who appreciates having a resident point it out. There are ways to point out issues without instigating hatred and disgust against you and I've been pretty lucky in this regard. If something is really bothering you, it's better to save it for those anonymous ACGME surveys.

Anyway, you should try to stick out. You'll have a hell of a time switching now and the known could very well be better than the unknown.

Originally Posted by Roguelyn

.... If something is really bothering you, it's better to save it for those anonymous ACGME surveys....

do not do this. This actually can hurt the program and always gets back to the PD, who ends up having to respond to these things, and then he will be upset that there are residents who don't have the courtesy to complain to him first before badmouthing the program nationally. It tends to be pretty easy to narrow down who was the complainant. You don't create a happy workplace doing this.

I think the more accurate definition of "playing the game" is not voicing your concerns about the issues that are going on in your program that everyone seems to "accept" (lack of equipment, unsafe practices, abusive behavior, etc.). It has nothing to do with skill level. People in every field, specialty and discipline suffer abuse and it is not necessarily a result of poor performance or " folks refuse to take that next step of being THE doctor ". Residents quickly learn to keep their mouth shut, even if it isn't in the interest of the patient or even the betterment of their education. So when someone steps up , or whistleblows in a way, that person will suffer. It can be anything from questioning an outdated technique to asking for more didactics. The unfortunate practice of playing the game also unfortunately leads to residents to treat the abused as if they deserve bad treatment for speaking up, even if they agree completely with the accusations or criticisms made by the abused. It is horrible and isolating and acceptable because everyone is afraid of becoming the next victim.
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agree w/this, for the most part. I think that in general OB/gyn and some surgical programs (such as general surgery and some others) tend to be the most "malignant" because they attract more absolutist personalities and they tend to work harder than most other specialties, which makes people tired and cranky. Also I feel that the risk of harming patients and the risks of lawsuits probably weighs heavily upon peoples' minds, particular the attendings.
Family practice tends to attract more friendly personalities, so if you just want to do OB you might troll around or do some quiet phone call making and see if there might be an FP place perhaps with OB fellowship that you could transfer to.

Also, there are more specialties that you could move into that are not that competitive. Physical med/rehab tends to probably have a lot of "nice" people as well and probably not malignant. Most pathologists I know are relatively soft spoken and probably not going to try to ream you out all the time, although might not be the most gregarious people ever. But not sure about the pathology job outlook. Ditto for nuclear med.

I agree somewhat with the idea that if you aren't sure you can get something better, and you actually like your specialty field, and you don't think they are likely to throw you out, you might want to suck it up, especially if you've only got a couple years left. You might get into a crappier program, particularly if the PD is going to obstruct you. Do you think they want to keep you but torture you? Why won't they just let you resign if you're driving them crazy? I wouldn't resign without reasonable possibility of getting into another residency like fp or IM, but you seem articulate and probably not foreign (based on the way you write) so I would think if the PD didn't poison your application you could probably get something in another specialty.

Just because you hate your program doesn't mean you hate your specialty, but it could be that you don't like your specialty either...

Originally Posted by Law2Doc

do not do this. This actually can hurt the program and always gets back to the PD, who ends up having to respond to these things, and then he will be upset that there are residents who don't have the courtesy to complain to him first before badmouthing the program nationally. It tends to be pretty easy to narrow down who was the complainant. You don't create a happy workplace doing this.

If patients lives are at risk, it's worth reporting it and upsetting the PD. Those are the types of issues that should be corrected. Just making stuff up and reporting minor issues isn't fair to anyone, of course.

Originally Posted by Roguelyn

If patients lives are at risk, it's worth reporting it and upsetting the PD. Those are the types of issues that should be corrected. Just making stuff up and reporting minor issues isn't fair to anyone, of course.

Theoretically yes. The right thing is the right thing. But when you are at a program where there is a target on your back, doing the right thing can get you killed.

Originally Posted by Roguelyn

If patients lives are at risk, it's worth reporting it and upsetting the PD. Those are the types of issues that should be corrected. Just making stuff up and reporting minor issues isn't fair to anyone, of course.

Complaining to the ACGME on an annual survey that your attendings dont know the current treatments or standard of care isn't really appropriate. It won't help the patients but could certainly hurt the program. The ACGME survey doesn't even deal with these topics, it focuses on residency issues like duty hours, didactics, ability to confidentially raise issues etc. In general there is very little in the survey that wouldn't more appropriately be raised internally first unless they your program has proven to be hostile to such discussions. Blindsiding your PD is always going to make things worse for you. It's not like he doesn't see everything negative that people send in about the program -- he is going to be asked to respond to this stuff.

Originally Posted by Roguelyn

If patients lives are at risk, it's worth reporting it and upsetting the PD. Those are the types of issues that should be corrected. Just making stuff up and reporting minor issues isn't fair to anyone, of course.

Originally Posted by Law2Doc

Complaining to the ACGME on an annual survey that your attendings dont know the current treatments or standard of care isn't really appropriate. It won't help the patients but could certainly hurt the program. The ACGME survey doesn't even deal with these topics, it focuses on residency issues like duty hours, didactics, ability to confidentially raise issues etc....

If there are truly incidents that can negatively impact patient care then an anonymous ACGME survey is not the way to go. If you're too scared to face the person who is going outside the standard of care or who is making mistakes, and/or unwilling to go to someone else with your concerns, then there usually are anonymous ways of reporting such things, usually through the hospital's QA/QC committee/board, or ultimately the State licensing board. But, again, it may not be worth the hassle, and in smaller programs probably not difficult to deduce as to who narc'ed.

Update: I was able to secure a transfer in my current specialty. I went through the appropriate channels and can assure you, if you play your cards right, you can get out of a malignant situation. I pray for the person who fills my spot.

how can we report the attendings who go outside the standard of care or who make mistakes(without geting killed?). or to whom?

Originally Posted by in2win

how can we report the attendings who go outside the standard of care or who make mistakes(without geting killed?). or to whom?

Typically, your PD would be the best person; followed by a mentor (if you have one) or trusted attending with whom you have a good relationship...

If you don't, or if your PD is either the attending in question or just a raging d-bag, then hospital risk management may be the way to go.

What you don't want to do is put yourself into a war of attrition; as much as it pains me to say, you will probably lose (even if you're right).

-d

Sent from my DROID BIONIC using Tapatalk

Originally Posted by Jackwhite

Update: I was able to secure a transfer in my current specialty. I went through the appropriate channels and can assure you, if you play your cards right, you can get out of a malignant situation. I pray for the person who fills my spot.

Glad to hear things worked out for you. Hope the new program is a much better environment for you, and that you will do well.