Quoted: Threat of termination by attending

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I am a first year resident, and previously received an after hours call from an attending about a hospital consult. I passed the message on to my co-resident who was on call, and informed the attending that i did this. Then the attending gave me more details to pass along to my co resident. I texted the attending my co resident's phone number so that he could communicate directly with my co-resident (we were both just getting started), and the attending called me and went off on me, called my chief resident and I was asked to apologize to the attending, which I did.

Since then, for the past several months, this attending has been unusually demanding and expects very fast responses when inquiring about their patients. I always respond back within a few hours if not immediately, and do what I am asked. Then one weekend morning the attending texted me for an update. I got ready, went into the hospital, started rounding and texted back that i was rounding. The attending asked what time I would see the patient, and I didn't immediately respond. A few minutes later, I was in a room with a patient, and the attending started calling and texting non stop until I finished with the patient and left the room. The workload was unusually high and I had the normal several other attendings that I was rounding on. I then answered the phone, and was told that this is strike two, and that the attending isn't afraid of me and will tell everyone in the hospital from physicians to residency administrators to administration, etc. what a bad resident I am, that I will be fired, and basically to the effect that my future will be ruined. When the attending said this, I said "I feel like such a meeting with a mediator or administration would be helpful to clarify expectations." I was feeling very uneasy as the attending was yelling and cursing at this point. The attending then responded "you are not important enough for a meeting. You will never see any of my patients again." That was the end of the conversation.

I then called my residency director who apologized for the attending's behavior, said this attending is "no angel" and said for me to document the threats, and that its no big deal if I don't work with this attending.

What should I do? Contact an employment lawyer? Am I at risk of being terminated? If so, I figure it would be difficult to get another resident job if terminated already. I have received good evaluations thus far and feel like my performance has been at least satisfactory, but it is scary for me. Thank you in advance for any advice.

Unfortunately, this is currently a topic of discussion on the resident board also, with several posters (including myself) discussing how the process can be changed to make residents more protected.

So, here's the deal: If your PD really has your back, then you'll be fine. Chances are, this attending is a jerk to everyone -- including the PD. That means that your PD will need to stand up to him if he starts to make a stink. I can't tell you whether he/she'll do this, or cave in and then create problems for you in the future.

That being said, I don't see how you can "not work with this attending". What happens if you're on call and one of his/her patients has a problem? How's that going to work? Routine overlap might be prevented, but I doubt you can work in this program without ever working with this jerk again.

Next, we're only hearing your half of the story. You need to ensure, as much as possible, that the problem is really with the faculty member and not with you. If you really are slow to return pages, pass off work to others, slow, incomplete, lazy, etc then you need some honest feedback. I do see this -- a resident who starts to struggle is often picked out by my most "discriminating" faculty. Others are willing to make excuses -- a new intern, a busy schedule, etc.

Don't forget about making sure that you're doing OK. Being mistreated like this at work can cause depression, insomnia, etc.

OK, so what do you do?

1. Hiring / contacting an employment lawyer is a waste of money. If they terminate you, it will be because they have documented that your performance is sub par. I highly doubt a lawyer will be able to help -- this is not a contract dispute.

2. You need to document, as best as possible, every conversation (good or bad) that you have with this person. I'd try to recreate the timeline above. As acurrately as you can, as much detail as you can. How long did it take you to respond? How many patients were you managing? Had you triaged them based upon their illness severity? You continue this forever. Every conversation.

3. You will have regular reviews with your PD regarding your progress in the program. You should request a copy of a written summary of each meeting, and keep these in your own files.

4. Some have advocated for a pocket recorder to record these conversations. Many smart phones can do this also. Be very careful with this -- wiretap laws are state specific, and you can get in tons of trouble for recording people without their permission or knowledge. This is a question that you could pose to a lawyer.

5. You'll need to decide whether you want to "play the game". If he pages you again, do you drop everything and call him back right away? Essentially give him what he wants. It isn't right, but sometimes (sadly) it's the best way to address the issue.

6. You need a plan, in writing from your PD, about how you are supposed to "avoid" this person without getting into trouble about shirking your work. As mentioned above, I'm certain that you and this guy will cross paths again -- best to be prepared (both from what you will do, and what your program expects of you).

Confidential reply from Original Poster:

From the beginning, I have struggled with co-residents and the program in general. The program is unusual in that the residents have traditionally been able to avoid outside rotations and get away with it. I have outperformed all of them on the board competency test, and not hung out with them during daily down times. Instead I actively participate in outside rotations. I am further isolated because I am the only resident in the program that will obtain unique training from another facility in town, as this is a surgical program and I negotiated the extra training as it will be needed for my future job. The chief resident in particular has been very hard on me from the beginning, and I never stood up to this person for the first 6 months of residency. This person would physically block me from opening a chart needed to do my job, call me "jackass" in front of others, scold me publicly on hospital floors, page me late at night asking why something hasn't been done that wasn't my job in the first place, call me out of rotations to do things that I wasn't supposed to be doing, etc. This person criticized me daily it seemed for the first 6 months, it took a toll on me. Any question I asked was met with a nasty reply. I finally went to the PD with specifics after 6 months (I wanted to gain some credibility before complaining), and the PD pointed out that the chief resident was in the wrong for this and to call the PD anytime the chief asked me to do such things. The PD further said there is no chief and all residents are equal. Things improved somewhat, but tension remains. It happens that the chief is very close with the attending that threatened me and I believe they gossip about me, for example I witnessed the chief saying to an attending that I don't respond to important duties (the ones that the chief is supposed to be doing and dumping on me, that my PD said shouldn't happen.) This attending is an "outside" attending and doesn't work with the PD's group. There has been tension between this group and the outside attending in the past, but I don't know details. As for workload, I typically carry more than my share, arrive earlier than my coresidents for rounds, and get more patients seen than my coresidents. I have taken less vacation, off days, sick days, and conference days than my co residents. Attendings from other services have told me that I am different than most residents from our program, because I am more eager and involved, etc. Now I know I'm sounding like I am beyond reproach, but I realize that I am isolating myself with the unique training and not hanging out with my coresidents during rotations, and there are two sides to the story, and I definitely have my own faults. The only thing for me to gain here is how to do the right thing at work in the face of this, not trying to toot my own horn. Again, thank you for the reply and any additional advice.

You are being bullied, first by the "chief" resident and now by his pal the attending. Bullies tend to work in packs. It is possible that once the resident leaves (at the end of this year?) the attending will settle down a bit: I hope so for your sake.

As to how to deal with the situation, apd is right about keeping records. A contemporaneous record of each interaction you have with the attending will be evidence you, and your PD, can use if necessary, and is likely to be better evidence of what is going on than anything the attending would come up with.

The next thing to remember is that one of the most effective ways bullies work is to induce their victims to change their behaviour in ways which harm themselves. The bully then uses this changed behaviour to further undermine the victim. For instance, the bully makes it unpleasant to talk to them. You then, understandably, avoid or delay talking to them. They then present that avoidance or delay as a legitimate criticism of your behaviour, and as a justification for continuing the bullying behaviour. So be aware that one of the aims of the bully is to try to manoeuvre you behave in self-defeating ways, and that you need to monitor your reactions to the bully so that you avoid this.

Finally, it is good that your PD seems on your side. You are likely to come out of this OK if that continues. But it would be a great help to you if other staff on the program think well of you too, just in case, for instance, the PD moves on for some reason. And integrating yourself in your cohort of fellow residents would be a good idea too: can you start joining in some of the group activities? After all, these people will be your colleagues for the next few years and your peers throughout your future career. People who forge relationships of mutual respect and support with their colleagues tend to be more successful in the long run than those who are more isolated.

Finally, make use of any support systems, such as friends and family, that you have away from work. Your current situation may only last a few more months, or may last for the rest of your residency. However long it lasts, leaning on your personal support systems in a difficult time is better than trying to tough it out alone.

From the OP:

I got a call from my program director today saying that the attending who would no longer work with me is willing to work with me again, and it would be good If I could work with this attending because we need the surgical cases and it would look bad and be bad if I don't work with this attending. I expressed that I am willing to work with the attending and it was the attending, not me, who wanted to end the relationship. I did express concern about the way the attending spoke to me, yelling and cursing, etc. My program director said if it happens again, to phone immediately and it will be handled.

Now I am concerned about the past problems continuing and escalating and what effect it may have on my next two years in the program. Thanks for all the past advice and any words of wisdom would be appreciated with the new development.

I don't expect this to end well. But, you need to take the high road.

Bite your tongue even if the attending yells at you. It sounds like you are a surgical resident so I'm kind of surprised that you aren't used to people yelling and swearing at you (only 50% kidding...).

You had better be professional no matter what this guy does...and hope he doesn't make your life too difficult.

And you had better keep your PD on your side...it sounds like he is. If the PD becomes "against" you, you are screwed.
Better try to make friends with some of the residents in your program too, even if you aren't crazy about them. You might like them better once you get to know them...at least some of them.

From the OP

Thanks for all of the replies. I think I will speak to my PD and ask if I am in jeopardy of losing my job. This is my main concern. I can handle being yelled at, was a scrub tech before podiatry school, and work a lot in the OR now, but its the being threatened that I will lose my job and threatened that the attending will ruin my future at the hospital that worries me. I've done all that the attending has asked, but haven't dropped what I am doing while on rotation to act immediately for his consults that is the problem (my PD in the past has said to do consults after rotation, so I thought I was in accordance with guidelines. All the other attendings work well with this system.) As for not hanging out with my co residents on rotation, this means that I actually go to rotation while they hang out in the library or the residents office (at my program the residents actually often do not even go to non podiatry rotation and haven't been required to turn in rotation evaluations, so my rotation preceptors have mentioned that I am doing a much better job than anyone has done before). I do hang out with most of them after hours at happy hours, etc. So I'm feeling kind of like I can't win here. I could go to administration and spill all this information, but that would only alienate me from the PD and their partners and potentially make them (and me?) look bad. They are already on thin ice from past resident problems, so that last thing they need is me stirring the pot with the hospital admin.