List of Programs That Terminate Residents

This could get interesting.

exPCM said:

After looking at this board I think it would be good to start a list of programs that terminate residents. I have a format in mind.
Please give calendar year of termination, institution, specialty, PGY level of terminated resident, and reason if known

Example:
2009 - University of XXXX - Anesthesiology - PGY-2 - poor performance on inservice exam

I think this could be a valuable resource for future residents.

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I think if you go searching around, you'll find that termination of residents is relatively common, and any list you can create will be abridged and suffering from sample bias.

I'm just not sure how relevant it is that Beth Israel fired an OB resident 5 years ago when there are literally dozens of other OB programs that probably fired residents last year.

There is not a single research study which does not have some sort of bias.

I guess having a list is better than no list which basically rely on word of mouth.

How is UK Wichita compare to UK at Kansas city?

There are 2 types of word of mouth.

1. Like this one, which does actually say event (firing) did happen for whatever reason. There are always 2 sides of story.

2. Other word mouth is like urban legend where event may or may not have happened and it goes around like rumor mill and get multiplied by many factor.

I am assuming people who are sending PM to original poster are actual victims and they don't want to identify themselves for whatever reasons would mean event (firing) did happen. So you can make your own assumptions why did it happen? If this thread ever get decent responses one potentially can see if certain hospital/program is not resident friendly because of work load or can't get competitive residents to begin with. On the negative side I doubt this thread will ever get meaningful responses to show certain pattern at least it remains to be seen.

I was under the impression, that you must perform quite poorly to be relieved from a residency program and it is a very difficult task to be done. It does not make sense for residency programs to actively seek to terminate an individual. Basically, residency programs need that labor, no?
Although there is that whole Virginia case going on with the resident & having read that case, the resident did seem faultless.

I know of 2 residents who were relieved from Ochsner GS Residency program in their 3rd yr of residency d/t failing Step 3 > 2x each and not being able to pass it by the required PGY-3 year.

I guess the question to ask here would be, does anyone know of residents that were relieved from a program b/c they had personality clashes with Attdgs who sought out to get rid of them? That's kinda the doom, doom, scary factor...All I know is I'm going into residency with a smile on my face every-day, no matter what!

exPCM said:

I am not suggesting that your program is bad or that the terminations were improper. What I am suggesting is we have a system where residents are being terminated and the circumstances are often quite varied.

I think we need to shine a light on these terminations as the ACGME likely will not. I don't know what will happen but if each termination receives widespread publicity such as being posted at this site then I wonder if it might lead programs to make greater efforts at remediation if the situation is appropriate.

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It's hard to take you serious anyway, but when you keep talking about residents getting Terminated, and you have an avatar of Ah-nold, I can't help but chuckle.....

SLUser11 said:

It's hard to take you serious anyway, but when you keep talking about residents getting Terminated, and you have an avatar of Ah-nold, I can't help but chuckle.....

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Thanks for pointing that out

try malignantresidency.com....there's supposedly a list in there--the bad residency list

turquoiseblue said:

try malignantresidency.com....there's supposedly a list in there--the bad residency list

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From malignantresidency.com:
"The unlucky ones in extremely malignant programs are harassed (some times even sexually) and tortured beyond imagination and are in most cases are also forced to see psychiatrist. Worst form of slavery!"

Not sure how credible that site is, looks like it's composed of one guy blogging about mistreatment of IMGs.

In reponse to ariee,
I know a resident who got terminated who was a very good resident, and had crazy high board scores and in service exam scores, and was NOT incompetent. And no, it was not me. This was totally due to a personality conflict and NOTHING else.

I also know another person who damn near got fired, and I seriously, seriously doubt he sucked as a resident, based on knowing him in medical school. I think he just got on the wrong side of 1 or 2 faculty who were powerful, and that was just about the end of that.

You can believe what you want, but there are clinically sucky residents who graduate with really no significant black marks on their evaluation, and there are clinically good residents who treat their patients well and are generally OK people, but get canned because they get on the wrong side of a particular person(s) who has power. Thank God it never happened to me, but it does happen...

I don't have any doubts that there are people who get canned b/c they can't hack it, but I'd personally want to stay away from any program that has fired people more than once in a blue moon. It either means the teaching isn't good, or they can't attract a good crew of residents, or the faculty are hard to get long with.

A lot of programs, particularly surgical programs, might fire a resident for not passing Step 3 by the beginning of 3rd year, b/c as mentioned above it is often required in many states to get a full license by that time in your training. For surgery, they may need the upper level surgical residents to have a full license in case they have to operate semi-alone late at night...I don't really know. Usually this type of stuff is clearly stated when you apply, so these Tulane people likely knew what they needed to do, but just weren't able to do so. Surgery is a tough field and if you aren't physically and mentally ready, it's not a good field to pursue IMHO.

dragonfly99 said:

In reponse to ariee,
I know a resident who got terminated who was a very good resident, and had crazy high board scores and in service exam scores, and was NOT incompetent. And no, it was not me. This was totally due to a personality conflict and NOTHING else.

I also know another person who damn near got fired, and I seriously, seriously doubt he sucked as a resident, based on knowing him in medical school. I think he just got on the wrong side of 1 or 2 faculty who were powerful, and that was just about the end of that.

You can believe what you want, but there are clinically sucky residents who graduate with really no significant black marks on their evaluation, and there are clinically good residents who treat their patients well and are generally OK people, but get canned because they get on the wrong side of a particular person(s) who has power. Thank God it never happened to me, but it does happen...

I don't have any doubts that there are people who get canned b/c they can't hack it, but I'd personally want to stay away from any program that has fired people more than once in a blue moon. It either means the teaching isn't good, or they can't attract a good crew of residents, or the faculty are hard to get long with.

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OOOooooh, one word= SCARY! Seriously, that puts the jitters in me.

DF, can you suggest how residency applicants for this year can ask/figure out if a program has had these such issues???

Nutso, the politics of medicine is tiring, no?

I guess we need to put Johns Hopkins' surgical program on this list (see thread below).

I hope people will send in more stuff...this is interesting.

Ariee,
I don't know if you can honestly plan how to definitely avoid this. One thing is to just not show your frustration to people (like nurses or higher-ups) even if you get frustrated. Other than that, I would just personally avoid places where the house staff seem obviously unhappy when you go for your interviews, and try and talk to some house staff other than those handpicked by the program director, and also avoid any place that you feel like you won't "fit in" to the culture, or would otherwise feel unhappy. If you're a workaholic then you might do just fine at a program with a lot of work hours, but if makes you miserable and cranky then be honest with yourself. Likewise, if you can't live somewhere that's dark and cold 5 months out of the year, then don't apply there. I would personally avoid placed that have fired multiple residents in recent years, b/c personally I think it's a bad sign...that is just my opinion but having been through residency I just don't feel like there are THAT many irredeemably bad apples. Maybe that's b/c I went to a solid residency program, though...I haven't got experience with residents at a ton of different medical centers, only 4 or so where I've been.

exPCM said:

1. University of Chicago - Anesthesiology - I received message that the program has extended training of several residents in the last few years and fired one resident who ended up going to the Cleveland Clinic program where they did well.

2. Beth Israel in Boston - OB/GYN - I received message that a resident was terminated due to issues with an attending about 5 years ago and that the resident went to another program and did well.

3. Ochsner General Surgery - post above reports 2 residents were terminated in their 3rd yr of residency d/t failing Step 3 > 2x each and not being able to pass it by the required PGY-3 year.

4. University of Mississippi General Surgery - message received that PGY4 resident dismissed last year, reportedly due to anger management issues.

5. Johns Hopkins General Surgery - PGY3 resident terminated allegedly due to mental health issues. (see link: http://forums.studentdoctor.net/showthread.php?t=660565 )

6. VCU-Shenandoah Valley Family Practice Residency - reportedly PGY1 resident notified of contract non-renewal, resident appealed and was placed on probation, subequently resigned - (see link: http://forums.studentdoctor.net/showthread.php?t=658953 )


P.S. I am unable to verify the accuracy of all the info above but am only posting what was reported to me or has been posted on the web. To everyone: please feel free to update the list and add to it on your own. I think the list could potentially become a useful resource.

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This is a great idea, maybe it could be made into something more than a thread.

While some programs might 'feel' unfairly singled out (probably like how some residents feel), it would help people who interview at these programs, or who are eventually employed at them, to understand what went wrong with former residents and how they could avoid the same situation.

dragonfly99 said:

A lot of programs, particularly surgical programs, might fire a resident for not passing Step 3 by the beginning of 3rd year, b/c as mentioned above it is often required in many states to get a full license by that time in your training. For surgery, they may need the upper level surgical residents to have a full license in case they have to operate semi-alone late at night...I don't really know. Usually this type of stuff is clearly stated when you apply, so these Tulane people likely knew what they needed to do, but just weren't able to do so. Surgery is a tough field and if you aren't physically and mentally ready, it's not a good field to pursue IMHO.

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Just a quick correction: Ochsner's General Surgery program is not affiliated with either LSU or Tulane, although it does recruit some residents from these two schools every year.

ExPCM and DarthNeurology-
Malignantresidency dot com site was started with the same good intent. The list in the site contains both IMG friendly and non-IMG friendly malignant programs. It is not a blog. We collect all useful information and posts relevant to malignant programs. The review submissions we receive are very, very sad. We remove identifiable information and slander and make it brief and publish.
We are aware that not all programs are malignant and only a few are malignant. Yes, there are cases when the intern or resident may be at fault but termination is unwarranted and reflects bad on the ability of the program and management to peacefully remedy problems. Victims of such programs' MD career is most times doomed.
ExPCM- Are the programs you listed really extremely malignant? Extremely malignant in the sense they kick interns and residents out of the program. You mentioned that you received messages on few in your list, would you please have the reviewers submit to malignantresidency dot com following the submission instructions in the site? How reliable is the information regarding other programs in your list?

Please contact the email id listed in review submission topic in malignantresidency dot com.

To the moderator - Please don't delete this post. malignantresidency dot com is no competition to your site. It is a very, very low volume site meant for helping budding doctors.

I'll add one.

Neurosurgery at Cleveland Clinic. Every year, someone gets canned. I overheard some neurology attendings talking about it.

Interesting thread

The 'what to do' topic in malignantresidency dot com was updated. Many thanks to the contributor (and SDN and exPCM for getting us the contributor). This topic is more important than the 'malignant residency list'.

DarthNeurology said:

While some programs might 'feel' unfairly singled out (probably like how some residents feel), it would help people who interview at these programs, or who are eventually employed at them, to understand what went wrong with former residents and how they could avoid the same situation.

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I, for one, would love for prospective residents to be able to look the interviewers in the face, during Match season, and ask, plain and simple, "How many people have left the program, or been terminated in the last year, and why?"

I remember one program where the program director said they had two openings for senior-level spots, and then the residents privately informing that it was five. That alone was an interesting discrepancy.

This thread is long overdue. As one of the above posters noted, the autonomy in which programs function, with so little oversight, is just an appalling situation. As others privately have noted, how does a program justify termination of residents beyond the first year? In principle at least, if a first year resident passes that year he has established "competency" for that year's work, and if the second year is done, the same applies. How does a resident get to the last year and suddenly lose a position months prior to graduation? I've heard this story echo repeatedly and not just from IMGs. Frankly, it appears that something is rotten, and it's not in Denmark.

Please continue the thread. It's very interesting, even if just anecdotal.

Thanks,

Nu

NuMD97 said:

I, for one, would love for prospective residents to be able to look the interviewers in the face, during Match season, and ask, plain and simple, "How many people have left the program, or been terminated in the last year, and why?"

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hmmm...not sure that this would set a great tone at the interview ha ha ha I do agree that transparency is important, however!

I think it would be valuable to find out during the interview day from residents (and maybe even a program administrator??? though questionable) whether or not they are aware of any institutional processes/policies to address "problems".

For example, where I trained, we had a monthly meeting of a resident quality assurance committee. The committee was multidisciplinary in nature and though the discussion was private, the residents were informed of its existence. Additionally, there was a whole process for action: ie: committee discussion -> recommendations -> warning letter (if needed, and would not appear on "permanent record") -> discussion with resident ->action plan. The plan would be tailored to the problem (ie: establishing reading assignments for knowledge deficits, connecting with a mentor for organizational/process problems, etc etc). If there was still a problem, probation would be considered (this does appear on permanent record). Termination could not be considered unless someone was placed on probation for a fair amount of time - during which s/he could try to demonstrate improvement.

Is the system perfect? - no...but I think having a system is a good sign that the program is not out to dismiss residents on a whim.

adam6 said:

hmmm...not sure that this would set a great tone at the interview ha ha ha I do agree that transparency is important, however!

NuMD97 originally wrote: I think it would be valuable to find out during the interview day from residents (and maybe even a program administrator??? though questionable) whether or not they are aware of any institutional processes/policies to address "problems".

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Of course this would never happen. Prospective residents just want to enter the system, "cooperate and graduate" as it were, and let the rest fall as it may.

But one can dream, can't one?

Nu

I have another. ENT at Cleveland Clinic.

I know of a senior ENT resident there who is being pressured to leave by the program.

It's also interesting that they happen to have an open ENT PGY2 spot.

ENT PGY-2 Vacancy in Cleveland Clinic, OH

put Forbes Family Practise, Monroeville PA right up there
fired 4 people in last 3 years.... none had step 3 issues!!
residents r scared to blow up the ACGME survey

aProgDirector said:

I have terminated (or had resign) 3 residents in the last 5 years. Two went on into other fields. One ended up with no spot, mostly because they didn't follow up leads we had found together. So, am I running a bad program or what?

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Well, looking at your stats, I would definitely think twice before I chose to become a resident in your den. It could just be a coincidence, but at the same time, the chance that something in your program is not beneficial to residents, seems higher than the mean.

RegularNihilist said:

...the chance that something in your program is not beneficial to residents, seems higher than the mean.

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With all due respect to aPD, his/her biggest problem may be the inabilty to choose a potential resident, not anything wrong with the program itself. Residents have to take some ownership for their inability to finish a program, as most residencies want to graduate all of their residents, but it is more important to graduate competent physicians. The problem with this thread is that it is tough to sort out whether it is a program problem or a resident problem. I'd guess that at many of these places it is just as much the latter as the former, as I can say that was the case for the two residents that have been "encouraged to look elsewhere for residency" since I've been here.

SocialistMD said:

With all due respect to aPD, his/her biggest problem may be the inabilty to choose a potential resident, not anything wrong with the program itself.

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Or there is something about you which makes ppl with personality disorders believe they would stand a better chance in your working environment, or something else. I'd love to see a comparison, how the terminated residents fare elsewhere.

Residents have to take some ownership for their inability to finish a program, as most residencies want to graduate all of their residents, but it is more important to graduate competent physicians.

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That seems like total BS. That must be the rationalization used to excuse axing residents, whereas the actual reason is to get rid of trouble, or to accommodate personnel whose feelings have gotten hurt, be it middle aged female nurses with an excessive authority complex, or doctors who can't stand being talked back to, no matter how friendly the tone may be. 2nd, if competent physicians was the key, and the residents have done well on the USMLEs, you'd need feedback from the patients, or observe the residents in front of the patients to see how competent they actually are. I'd love to see what the competence criteria is actually based on. Slander?

There are so many program. I think it is driven general environment.

aProgDirector said:

I have terminated (or had resign) 3 residents in the last 5 years. Two went on into other fields. One ended up with no spot, mostly because they didn't follow up leads we had found together. So, am I running a bad program or what?

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Yep. I had to fire 3 employees last year and did alot of soul searching about my hiring and retention philosophy. Also had to spend long hours in heart-to-heart conversations with my technical supervisors.
At the end of the day, lots of terminations especially of "executive-type" staff like residents reflects badly on you and your management ability.

I've resolved to spend more time in investing in new hires, developing talent and being more selective in who I employ in the first place.

Obviously continuing on your hire-n-fire path is weak sauce.

RegularNihilist said:

Well, looking at your stats, I would definitely think twice before I chose to become a resident in your den. It could just be a coincidence, but at the same time, the chance that something in your program is not beneficial to residents, seems higher than the mean.

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LADoc00 said:

Yep. I had to fire 3 employees last year and did alot of soul searching about my hiring and retention philosophy. Also had to spend long hours in heart-to-heart conversations with my technical supervisors.
At the end of the day, lots of terminations especially of "executive-type" staff like residents reflects badly on you and your management ability.

I've resolved to spend more time in investing in new hires, developing talent and being more selective in who I employ in the first place.

Obviously continuing on your hire-n-fire path is weak sauce.

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These blanket criticisms toward aProgDirector do not do justice to the complexities of the Human-Resources-aspects of residencies. I would like to pose some counterpoints:

1. Sometimes true mentoring/managing involves telling an individual that s/he is not right for a position. Haven't we all seen people (peers, students, attendings, etc) who are clearly ill-suited for medicine yet are promoted through med school, residency, etc? For some of these individuals, it is not necessarily a problem that is easily remediated (ie: personality, anxiety, bedside manner)- and so it is easier to move them along (and make them someone else's problem) than invest the time and effort it would take to try to improve the situation (and may, ultimately, be unsuccessful). If no one tries to redirect them to a more suitable career -- that is neglect of duty.

2. In the corporate world - which is, granted, different than medicine - I have learned from family members who work in HR that it is very difficult to screen workers effectively. The interview, references, resume - these may all seem great and they can still be a great big loser who causes tons of problems for the company. Similarly, we have this problem in medicine. No one wants to terminate people casually - and there is the issue that we have all invested so much to be in medicine and no one wants to detract/derail that. But I go back to point number one. Just because you graduated from med school, doesn't mean you should be a doctor - or, rather, that you should be in your chosen sub/specialty. Program directors have a duty to their residents but also to the public - and some people should not be inflicted upon the populice.

All these presupposes that you still do the utmost to screen appropriately and remediate diligently. But you cannot just blame administration without consideration of the difficulties of the job. I realize that I came from an unusually "nice" residency program and recognize that there are a number of programs/directors on the other end of the spectrum out there. But I think it goes back to my previous post/statement - try to find out about the program's processes for dealing with trouble.

Very few physicians have solid people skills, let alone business acumen AND mentoring/leadership ability. Much of the crap that does go on in medicine doesnt suprise me as a result of this.

My criticisms arent blanket. They are pointed and direct. Copping out by indicating that human interaction is "too complex" and therefore employers should accept failure is actually weaker sauce then being a crappy mentor to begin with...

I have seen many residents/fellows and even junior attendings terminated. Some of those by their poor choices but all those were in the background of poor leadership and mentorship by their superiors.

RegularNihilist said:

... if competent physicians was the key, and the residents have done well on the USMLEs, you'd need feedback from the patients, or observe the residents in front of the patients to see how competent they actually are. I'd love to see what the competence criteria is actually based on. Slander?

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I second LADoc00's observations.

If these were criteria used for assessing competency, a whole lot of trainees would be flying out the door. A great USMLE score does not a great physician make. Also, competency does not equal bedside manner, which is what you appear to be solely eluding to. Besides, patients are the worst people to assess anyone's "competency". Sure they could comment on bedside manner, but they don't have the first clue about correct medical decision making. Either way, if attendings had a fly-on-the-wall ability to follow most trainees around, first, there would be wholesale dismissal of trainees, later, and we're talking at least a few years of change in mentality, would trainees become both competent and professional enough to be considered "competent", in my book.

Medicine as a whole is a cesspool of personality disorders. You either learn to thrive in it, or you go on to fail and then come here to b1tch and whine as to how badly you were mistreated. Although, there are attendings, nurses, senior residents, admins, techs, etc. out there who are on power trips, or PDs who tell their residents to fudge their duty hours surveys, or a myriad of other issues. It's part of this cesspool. From my observations, the folks who were seemingly wronged blame everyone except themselves, for the most part. They simply lack a certain degree of inner insight. I see it every day. They believe they're being singled out, etc. Yeah, they are being singled out, probably because they're a-holes. Funny, how the same attendings, nurses, senior residents, admins, techs, etc. treat other trainees differently.

Sorry if no one has sat you down and told you this, so here goes...
You are not god's gift to mankind. Get over yourself.

"Nobody ever says it's them, not me. If it's anybody, it's me." -George Costanza, "Seinfeld"

aProgDirector said:

1. I've had to terminate 3 residents in 5+ years. My graduation rate is well above 95%.

2. Of the people I have had to terminate, I helped all of them get back on their feet in a new training program. As mentioned, one person failed to do their part and hence ended up with nothing (although has now started training in another program). The other two were successful in their new programs. No one's career came to an end.

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That really shows that APD wasn't out "to get" any resident as they all got a residency program elsewhere, believe you me, a lot of attendings/program directors feel that if you aren't up to their snuff then you shouldn't be in medicine, and if you are *outside* of medicine then they will lie and exaggerate stuff to get you in trouble and kicked out, to them it doesn't matter . . . to have a program director work with residents who had to go elswhere says a lot.

So folks should give APD credit for that.

Are the other programs on the list also good or even great programs that weren't a good fit? Hard to say, but you really need to research places before you apply.

I do think that residents can get into a negative feedback cycle. Let's face it, if you mess up on the first day with some attendings then they see you as a problem and will harass you for the rest of the block, and if you get a lot of abuse it messes with your self esteem so it becomes a self full filling prophecy. In this way it is a crap shoot if you run across an attending that doesn't like you as it can have devastating consequences on what you are doing.

I still think this thread is great as it gives people a heads up, I have done clinical rotations at not so good places, places that have bad reputations where residents quit, get fired, are harassed non-stop, and sometimes come back. These are the high drama places where you can get suck into a malignant atmosphere and start fighting with people.

Sadly, when you watch the evening news and here there was a killing on the corner of such and such, it usually doesn't come as a surprise if that area of town has a bad reputation.

Same thing with residency programs, if a lot of residents are getting canned it could mean it is a high drama place where "stuff" happens. . . the low key places for residency that you don't here anything about negatively are on average probably better places.

At the malignant places people walk around like they are the guardians of the medical education system and have a block on their shoulder and basically love yelling at residents and students because they figure that they are saving lives by doing this, as well as by holding back some residents for minor reasons, maybe they are right in some cases, but a lot of times they do a lot of damage to people around them and just make the residency a worse place to work.

At nice places people have lives they are satisfied with and do a lot mentoring of residents, whereas at other places the only thing that matters is the evaluation, not the teaching process that resulted in the evaluation.

If a program has a lot of fired residents it could well mean that they have deficiencies, but that they didn't care to change what needed changing in the program so they have to fire residents every year. Happens at some places that are super malignant where they don't care about the residents.

Super malignant programs, where attendings complain about the patients, residents, students, and where there is a lot of harassment is like joining a street gang, believe me, I have seen residents speak about patients in horrible terms just minutes after checking up on them, and if you are around such behavior long enough this sociopathy oozes all over you and you might absorb some of it. It is not surprisng that residents get thrown under the bus at these programs . . .

95% retention is pretty good, I was thinking of residency programs with 3-4 people/yr so 3 dumped residents in 5 years sounded like alot.

Still, I wonder how many attendings in residency programs can do what Jaime Escalante did for impoverished Hispanic high school students in Los Angeles.

Maybe residencies need a "motivational" training track to get people back in shape? Dunno.

Medicine isnt hard (perhaps aside from some procedural stuff that requires skill), every medical school graduate should be trainable.

they just terminated a resident on tonight's Gross Anatomy