Canceling interviews at the last minute

[Bluejay87]

So, what is the absolute latest that you can cancel an upcoming interview without looking like a total schmuck? Um, asking for a friend...

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[3882370]

Long enough for someone on a waitlist to get invited and make arrangements for the interview.

 

[OldPsychDoc]

Less than 2-3 business days--you'll look like a schmuck and bad things will be thought about you.

 

[notdeadyet]

Anything less than a week and you'd better have a damn good reason. Be classy.

 

[Gavanshir]

No better time than right now. And please PM me where you are canceling so that I can call them. Thanks.

 

[psychattending]

The official guidelines from the residency directors group is a minimum of 2 weeks.

http://www.aadprt.org/application/f...DPRT_Resident_Applicant_Guidelines_part_1.pdf

Doing it with less time is considered unprofessional and is disrespectful of others.

 

[Bearrie]

That being said, if you are truly uninterested I think most would prefer to know now so you both don't waste time/resources. I cancelled one interview last moment. Probably not a good idea to make a habit of it but things will be okay I think.

 

[psychattending]

I suspect most people who cancel within 2 weeks have known far earlier that they are not interested in a specific program and have just postponed finalizing the decision. Hence why it is a professionalism issue. Within the two week period I have already expended my critical resources and time making a schedule, preparing material, etc. The amount saved on my end is minimal at that point when an applicant cancels.

 

[OldPsychDoc]

I suspect most people who cancel within 2 weeks have known far earlier that they are not interested in a specific program and have just postponed finalizing the decision. Hence why it is a professionalism issue. Within the two week period I have already expended my critical resources and time making a schedule, preparing material, etc. The amount saved on my end is minimal at that point when an applicant cancels.

To say nothing of the collegial discourtesy of holding onto a scarce resource that others would value, and which they may need to incur additional costs and inconveniences to access at short notice--if possible at all.

 

[MacDonaldTriad]

Just ask yourselves how much time would work for you if you were on a wait list and you were told you could be interviewed if you could get yourself to our program by X amount of time. That would be the amount of time you should give us. After that, just think of the ire you will create in our coordinators after they find faculty, residents, lunch, and people to help guide you through your interview day just to say "never mind". Once these things are put in people's schedules, you have been granted a lot of physician time to and you should think twice about cavalierly rejecting this. On the other hand, if you have no chance of wanting to match us, please don't waste our time.

 

[SourceOfDenial]

Recently had two cancellations, one 9pm the night before left a message, another just didn't show.

Don't do that guys. Psychiatry is a relatively small field, and people talk.

 

[technopoly]

Cancelled at one program about 3 days less than a month in advance, and with the holidays approaching I still felt pretty guilty about it (feeling guilty is my super power.). Most of the angst came from having to choose between interviewing at different great programs during my Sub-I month when time off is limited... but I hope someone else can grab the spot and love the program.

 

[Gavanshir]

How do you PDs go about contacting other candidates once an interview cancels? Do you have a separate "waitlist" of sorts that has already been prepared or do you just go back to the pile of applications and randomly send out some invites? Is there any benefit to sending emails to programs now expressing that you would appear for an interview in the event of a cancellation?

 

[OldPsychDoc]

We already have a stratified wait-list for that--a LONG one--so your email would probably just get you added to that.

 

[MacDonaldTriad]

I haven't figured out a process yet. Only about five or six cancelations so far and none of them were far enough in advance to let anyone else in. I also have a very large pile of wait list applicants. My need for our wait list isn't up to me really. It is still wait and see.

 

[thoffen]

Cancel your interview as soon as you decide you don't want to do it. The only risk is that some PD is connected to some other PD at an outside program and compares applicants. Otherwise, PDs do not want to waste time interviewing people who are not interested in their program, and do sometimes have the ability to fill slots with someone who might even at the very last minute. If you don't want to be a schmuck, simply state that you wanted to cancel earlier and was embarrassed to do so out of respect, but felt it better that they instead have the opportunity to find someone who could succeed there.

 

[notdeadyet]

If you don't want to be a schmuck, simply state that you wanted to cancel earlier and was embarrassed to do so out of respect, but felt it better that they instead have the opportunity to find someone who could succeed there.

Just cancel. No need for the big explanation. The schmuck part is implied.

 

[thxleave]

How do you PDs go about contacting other candidates once an interview cancels? Do you have a separate "waitlist" of sorts that has already been prepared or do you just go back to the pile of applications and randomly send out some invites? Is there any benefit to sending emails to programs now expressing that you would appear for an interview in the event of a cancellation?

I was in interview last week, where person called places within 8 hour drive. He said he received 2 more interviews by calling places saying he can be there within a moment notice. I don't know how true it is, but he did say he was at that current interview due to late cancellation.

 

[nancysinatra]

I suspect most people who cancel within 2 weeks have known far earlier that they are not interested in a specific program and have just postponed finalizing the decision. Hence why it is a professionalism issue. Within the two week period I have already expended my critical resources and time making a schedule, preparing material, etc. The amount saved on my end is minimal at that point when an applicant cancels.

I disagree. Late canceling an interview is not a professionalism issue. It's a manners issue, and it may burn bridges, but that's about it. The only people who would label this a "professionalism" issue would be program directors, because they're the ones whose time has been wasted. But I don't see PDs fretting about all the wasted time forced upon students and residents as part of the overly cumbersome NRMP process or other aspects of medical training.

And if you really think this is a "professionalism issue" then do you also believe that it's "unprofessional" for medical school applicants to to wait until May to turn down the med school admissions offers they don't plan to accept? Applicants have to strategize, after all, and the fact that you may be inconvenienced in the process makes it rude, but not unprofessional.

 

[nancysinatra]

Just cancel. No need for the big explanation. The schmuck part is implied.

Exactly.

 

[clausewitz2]

I disagree. Late canceling an interview is not a professionalism issue. It's a manners issue, and it may burn bridges, but that's about it. The only people who would label this a "professionalism" issue would be program directors, because they're the ones whose time has been wasted. But I don't see PDs fretting about all the wasted time forced upon students and residents as part of the overly cumbersome NRMP process or other aspects of medical training.

And if you really think this is a "professionalism issue" then do you also believe that it's "unprofessional" for medical school applicants to to wait until May to turn down the med school admissions offers they don't plan to accept? Applicants have to strategize, after all, and the fact that you may be inconvenienced in the process makes it rude, but not unprofessional.

You'll have to walk me through the logic of how attending a number of interviews that is literally an integer multiple of the number at which chance to match asymptotes forms a coherent strategy. I'm a tad confused.

 

[splik]

professionalism is the most toxic concept in medicine today. The uncritical expansionism of this project seeks to govern and control physicians in every sphere of our lives - from what we wear, buy, eat, drink, post on social media to whom we have sex with. Professionalism enshrines the elitism, misogyny, and racism that has for too long characterized medicine by privileging a white bourgeois notion of what values and behaviors are acceptable. As physicians become increasingly at the mercy of market forces, the notion of professionalism oppresses and disenfranchises by reaffirming a collective mythology over individual rights - thus it becomes "unprofessional" for physicians to strike, or to want better work hours or greater pay. Professionalism is the stick we beat each other with. To deem someone "unprofessional" or to note "lack of professionalism" is often little more than thinly veiled name-calling that cuts deep - it is not only an assault on one's values and behaviors, but on one's identity and competency by calling into question your very suitability for your job.

(of course it's poor form to cancel an interview late. and actually i think it might be unprofessional to cancel an interview late. but i do think the term is vastly overused, is pernicious, nebulous and ultimately destructive to the field.)

 

[OldPsychDoc]

professionalism is the most toxic concept in medicine today. The uncritical expansionism of this project seeks to govern and control physicians in every sphere of our lives - from what we wear, buy, eat, drink, post on social media to whom we have sex with. Professionalism enshrines the elitism, misogyny, and racism that has for too long characterized medicine by privileging a white bourgeois notion of what values and behaviors are acceptable. As physicians become increasingly at the mercy of market forces, the notion of professionalism oppresses and disenfranchises by reaffirming a collective mythology over individual rights - thus it becomes "unprofessional" for physicians to strike, or to want better work hours or greater pay. Professionalism is the stick we beat each other with. To deem someone "unprofessional" or to note "lack of professionalism" is often little more than thinly veiled name-calling that cuts deep - it is not only an assault on one's values and behaviors, but on one's identity and competency by calling into question your very suitability for your job.

(of course it's poor form to cancel an interview late. and actually i think it might be unprofessional to cancel an interview late. but i do think the term is vastly overused, is pernicious, nebulous and ultimately destructive to the field.)

But how do you really feel about this, splik?

 

[splik]

But how do you really feel about this, splik?

heh...well leading black psychiatrist Walter Shervington went even further and said "Racism, professionalism, and elitism, have been, are, and will be, major demons embodied in the disciplines and society, majorly interfering with the task of quality mental health care to all people. Each demon may require two or more exorcists' lives as we attempt to expel them, but like the character of the Old Priest in "The Exorcist", Father Merrin, we must prepare our trainees to have the strengths to battle the demons when the time comes."

 

[thoffen]

I agree that professionalism as a concept has turned into political leverage, and in many instances in a dangerous way. There is, however, nothing wrong with emphasizing the need to be timely, follow-through, interact with others with respect, etc. Call it responsibility or basic human decency if you like. The objective piece of professionalism is valuable. When you encounter it being used against people, find a better environment. Or, if it suits you, work toward establishing a new culture.

 

[OldPsychDoc]

.... There is, however, nothing wrong with emphasizing the need to be timely, follow-through, interact with others with respect, etc. Call it responsibility or basic human decency if you like. ....

This.
90% of our complaints about residents fall explicitly into those three specific areas.
It's not rocket surgery.

 

[MacDonaldTriad]

Culturally competent, Atkins’s friendly, free range, gluten free, professionalism is being overblown, but it also is essential, calamitous if missing, and almost impossible to remediate. If I could find a valid and reliable way to screen for a lack of something in the application process, this would be an order of magnitude more relevant than intelligence. Let’s face it, brains are a dime a dozen in this field. I’ll take people who can successfully manage people any day.

 

[notdeadyet]

It's a generational and/or experience thing. Professionalism only became a bigger and bigger issue in medical training when folks started noticing less and less of it in young doctors in the pipeline.

And I'm not talking about those who came up and challenged inherent prejudice and exploitation to make medicine better. These folks were professionals. I'm talking more about the "I don't want to do it so I won't" or "I will half-a$$ it until I get a better call room" or "this doesn't apply to me because I'm so unique" types. These folks are not professional.

The professionalism concept can and has been exploited by attendings to encompass more than it is meant to (or has any right to) until there is danger of it losing any meaning. When a medical student asks a question that runs counter to something an instructor said, the attending is out of line for calling that "unprofessional." Bad attending.

But there is also a baby-out-with-the-bathwater scenario at play when medical students and residents dismiss the professionalism concept as a whole as something meaningless since many have not worked as professionals before. When a resident skips mandatory activities because they don't like them, don't want to do them, or disagrees with them, this is "unprofessional" and pretending it's a bad word doesn't make it any less accurate. The rest of us still have to pick up your slack.

What has been happening on many college campuses lately with this weird fixation on making class discussions "safe" and focusing on coddling instead of striving to challenge ideas and values makes me think this is going to be more and more of an issue. Particularly when you consider that this sort of thing seems much more prevalent at the Ivier place. Combine that with a lot of the "special snowflake" approach to childrearing lately (particularly amongst those kids who end up at said Ivies) and I think there are going to be some real interesting times ahead in creating new doctors or lawyers or other professional types in which your needs don't always come first.

There is a way to have a voice, be an individual, challenge authority, and make substantial and innovative change in big, ugly, antiquated systems while still being a professional. If you think you are so important that this doesn't apply to you, it betrays a sense of entitlement that will ultimately likely work against you.

 

[Merovinge]

But there is also a baby-out-with-the-bathwater scenario at play when medical students and residents dismiss the professionalism concept as a whole as something meaningless since many have not worked as professionals before. When a resident skips mandatory activities because they don't like them, don't want to do them, or disagrees with them, this is "unprofessional" and pretending it's a bad word doesn't make it any less accurate. The rest of us still have to pick up your slack.

I don't disagree with this at all, but it's still a situation that requires context. When the resident who just finished 24 hours of call skips his mandatory didactics to get some sleep, I hardly find them guilty of putting themselves above their education or any other nonsense. Sure maybe they knew that was what neurosurgery residency was going to be like, but it doesn't make the situation any less absurd (and the above happens in psychiatry, although far less often). I've had colleagues jet after a lecturer cancels, even if someone is coming an hour later, because it's a chance to spend a few hours with their children. I'm sure people would call them unprofessional, but medicine is tough and taking a few moments to yourself or your family is needed at times.

 

[notdeadyet]

When the resident who just finished 24 hours of call skips his mandatory didactics to get some sleep, I hardly find them guilty of putting themselves above their education or any other nonsense.

Yeah, it's tough, but we all know the slippery slope.

First folks skip didactics post-24-hour call to get some sleep. Then folks skip it the next morning because they were post-long-call or pre-long call or some such. Then folks just skip it because of a litany of reasons. Then because of poor showing at didactics, attendings dial it in and the quality of the training suffers.

This sequence, or one like it, pretty much always happens when folks decide the policies don't apply to them because of a "unique" circumstance. The problem is that truly unique circumstances are rare. And if the circumstances are not unique (like the one you describe above), you work to change the policy.

That's how it is a "professionalism" thing. If something doesn't work, residents try to problem solve it out and get it changed so that it works. That's professional. Faculty hear residents out and trying to make accommodations so that the program can work while also respecting the residents well-being. That's professional.

The problem in your example: if a program has mandatory didactics, in all likelihood it's because they weren't mandatory at one point and folks just flaked (no one has sign-in sheets for meetings that are consistently well-attended outside of union/liability silliness). So instead of skirting around the problem (the unprofessional thing), you fix the problem.

The fix in your example: Have a required 85% show rate. If a program has 85% of residents showing for didactics, the PD would likely be delighted. The PD treats you like a professional and you can decide which ones you'll skip because you're burned out, tired, frazzled, or have an urgent deadline or family obligation. In turn, you act like a professional and do not miss more than 15%.

It only falls apart when folks are unprofessional. The PD can say, "screw it" and not make any accommodations like the one above. Or the residents can take advantage of such a plan and then 85% becomes the new mandatory, and lo-and-behold there are a bunch of "unique" situations that bring them below that number.

 

[thoffen]

Sure. But chocolate chip cookies on an intermittent reinforcement schedule is easier and probably more effective.

 

[notdeadyet]

Well, sure, if you're going to go straight for the big guns...

 

[OldPsychDoc]

The "sniff test" for professionalism though, is often simply "Would they get away with this on a 'real job'?"

Could you consistently come in late, inappropriately attired, and not get cited for it on your next review?
Could you decide that half of the meetings the Boss invites you to are "just a waste of my time, not worth the bother" and still expect to have a job next year?
Could you take a day off with short notice even though you have customers/clients scheduled to meet with you on that day, expecting that someone else will call and notify them?

I know that there is always some tension between the trainee role and the employee role as far as residency is concerned, and frankly, a lot of pre-meds become med students become residents without actually having to engage with the rules and expectations of the non-academic, competitive job market--but this is what it frequently comes down to.

 

[hamstergang]

If I could find a valid and reliable way to screen for a lack of something in the application process, this would be an order of magnitude more relevant than intelligence. Let’s face it, brains are a dime a dozen in this field. I’ll take people who can successfully manage people any day.

I didn't realize this before becoming chief and actually getting involved in the performance of other residents. There's one that doesn't seem too bright imo, but stays organized and works hard, and is trainable and good to have around. Another one may be more intelligent but the lack of professionalism just makes this person a nightmare. There's always problems at every site and I just don't know how to fix this. After this experience, I'd rather professionalism get overblown than underblown.

 

[birchswing]

What has been happening on many college campuses lately with this weird fixation on making class discussions "safe" and focusing on coddling instead of striving to challenge ideas and values makes me think this is going to be more and more of an issue. Particularly when you consider that this sort of thing seems much more prevalent at the Ivier place. Combine that with a lot of the "special snowflake" approach to childrearing lately (particularly amongst those kids who end up at said Ivies) and I think there are going to be some real interesting times ahead in creating new doctors or lawyers or other professional types in which your needs don't always come first.

The inability to challenge ideas at universities began before this recent trend in academic departments and with individual professors. I was shocked when I went to college at how obsequious students are. I came from a sheltered high school with do-gooder students and was expecting college to be like something from the 1960s, but I found it was more of the same. I know it sounds trite, but I found that you can be academically punished for having opposing views from your professor.

I can't speak to the idea of making things safe as much because I've only read the articles and haven't been on these campuses to experience what people are talking about. But if it is a problem it seems like it's sort of an execution of some of the inflexible ideas that have been percolating in academia for some time.

I have conflicting thoughts on it. When I take a step back and think about it from a meta level, I realize that sometimes to make people think in a new way you almost have to unflinchingly present a world filtered through the new paradigm you want to become the norm. And so in some ways I look at this inflexibility as a type of successful rhetoric.

On the other hand, once those ideas gain ground and acceptance, I feel there has to be a place to discuss them. It's almost like it takes brute force to get certain new ideas onto the table, but once they're there, I feel the brute force necessary to maintain those ideas as norms can prevent discussion.

As a less abstract example, almost all countries in the world have banned land mines. And it's not something most people on college campuses are really passionate about. So if someone wanted to discuss the possible merits of landmines, it could be a topic of discussion. There's not enough fear around land mines that people would freak out about such a conversation. Maybe that's because it's a largely settled question, or maybe it's because it's not a trending topic of our time.

The thing is that with social questions I'm not sure if there will ever be settlement. Maybe it's always a battle.

I wasn't around during the first feminist movements or earlier movements on college campuses. I wonder what it was like back then. For some reason, I have this sense that social discussions didn't used to be so clinical and concrete. Maybe because they took place during the free love period. In my mind's eye I can imagine a hippie talking about a businessman holding the people down but at the same time saying the businessman himself is held down and how they're all connected, blah, blah, blah.

But today some of the language and rhetoric is really acerbic and confrontational, and I can't see how it would leave people anything other than defensive. Some of it is just so mindless and reptilian to the point that I see some activists alienating people who agree with them. They are too concrete in their thinking to accept that openness to considering many ideas is not the same as abandoning the goal of human rights.

 

[splik]

The "sniff test" for professionalism though, is often simply "Would they get away with this on a 'real job'?"

Could you consistently come in late, inappropriately attired, and not get cited for it on your next review?
Could you decide that half of the meetings the Boss invites you to are "just a waste of my time, not worth the bother" and still expect to have a job next year?
Could you take a day off with short notice even though you have customers/clients scheduled to meet with you on that day, expecting that someone else will call and notify them?

I know that there is always some tension between the trainee role and the employee role as far as residency is concerned, and frankly, a lot of pre-meds become med students become residents without actually having to engage with the rules and expectations of the non-academic, competitive job market--but this is what it frequently comes down to.

Sorry but residency is a "real job" and the problems you describe arise when we overemphasize the trainee role of physicians in order to oppress them. Of course people are going to act less than professional if they are not treated as such. It irritates the hell out of me when medical students and residents that use language to suggest resident physicians are students rather than employees, though this is reinforced by institutions (including my own who claimed that residents weren't employees in order to exploit us and we took them to court over it), and has these consequences where people then don't turn up to didactics (seeing it as an educational activity rather than part of their job which they are paid to do), or shirking on duties they see as non-educational (forgetting that patient care trumps all else).

btw I would agree that all the examples you give above are unacceptable but what I am railing against is the charges against what people do in their own time as unprofessional or people wanting work-life balance, maternity leave etc being called "unprofessional". Sadly the vast expanse of what now comes under the nebulous term of "professionalism" only seeks to undercut and eclipse the behaviors that I think we can all agree are unacceptable in the workplace.

 

[notdeadyet]

Sorry but residency is a "real job" and the problems you describe arise when we overemphasize the trainee role of physicians in order to oppress them.

I'm not sure that's true. Part of the tension is that neither residents nor programs really treat residency as a real job and residents as real employees.

If this were the case, residents would be free to walk down the street to the next employer if they didn't like how they were treated. But residents don't have that ability which is part of the problem and why residents occasionally tolerate treatment the shouldn't have to. If this were the case, residents would be fired by programs when they pull shady, weak, or undergrad $hit at the residency. But this isn't the case and "problem residents" that pop up from time to time would be let go in a heartbeat in almost any other field, let alone one that involves safety issues.

This is why there is the tension. Programs don't really want residents to act like employees (e.g.: walk if mistreated) and residents don't really want to be treated like employees (e.g.: fired if not cutting it or if a bad fit).

Of course people are going to act less than professional if they are not treated as such.

True. But things like mandatory meetings and many things we gripe about as residents are not inherently unprofessional. In fact, residents often gripe loudest when they are treated like professionals. Mandatory training, picking up slack to make up for co-workers shortcomings, and being asked to lean in during times of crisis/challenge are exactly what employers expect of professionals but tend to ruffle resident features. Walk into a resident meeting and tell them they all have to take a couple extra nights of call because someone's out sick and watch the reaction. But this is part and parcel in any other professional work environment.

btw I would agree that all the examples you give above are unacceptable but what I am railing against is the charges against what people do in their own time as unprofessional or people wanting work-life balance, maternity leave etc being called "unprofessional". Sadly the vast expanse of what now comes under the nebulous term of "professionalism" only seeks to undercut and eclipse the behaviors that I think we can all agree are unacceptable in the workplace.

Totally agree. The very idea that someone can be "unprofessional" when not at work shows definition creep.

As for work-life balance issues, advocating for yourself and your colleagues is not unprofessional. Asking for a raise, improved working conditions, more vacation, humane conditions, etc. is actually very professional and programs pretending otherwise are being self-serving. With one VERY BIG caveat, and that's that residents advocate professionally, which isn't always the case. I love medicine and love psychiatry and loved residency, but if I left academics, the one thing I would cherish is not hearing "it's not fair" so frequently.

 

[deleted736562]

I'm not sure that's true. Part of the tension is that neither residents nor programs really treat residency as a real job and residents as real employees.

If this were the case, residents would be free to walk down the street to the next employer if they didn't like how they were treated. But residents don't have that ability which is part of the problem and why residents occasionally tolerate treatment the shouldn't have to. If this were the case, residents would be fired by programs when they pull shady, weak, or undergrad $hit at the residency. But this isn't the case and "problem residents" that pop up from time to time would be let go in a heartbeat in almost any other field, let alone one that involves safety issues.

This is why there is the tension. Programs don't really want residents to act like employees (e.g.: walk if mistreated) and residents don't really want to be treated like employees (e.g.: fired if not cutting it or if a bad fit).

True. But things like mandatory meetings and many things we gripe about as residents are not inherently unprofessional. In fact, residents often gripe loudest when they are treated like professionals. Mandatory training, picking up slack to make up for co-workers shortcomings, and being asked to lean in during times of crisis/challenge are exactly what employers expect of professionals but tend to ruffle resident features. Walk into a resident meeting and tell them they all have to take a couple extra nights of call because someone's out sick and watch the reaction. But this is part and parcel in any other professional work environment.

Totally agree. The very idea that someone can be "unprofessional" when not at work shows definition creep.

As for work-life balance issues, advocating for yourself and your colleagues is not unprofessional. Asking for a raise, improved working conditions, more vacation, humane conditions, etc. is actually very professional and programs pretending otherwise are being self-serving. With one VERY BIG caveat, and that's that residents advocate professionally, which isn't always the case. I love medicine and love psychiatry and loved residency, but if I left academics, the one thing I would cherish is not hearing "it's not fair" so frequently.

I'm sure residents would love to be treated as employees. That will mean better access to a competitive market, better pay, better hours, better benefits and the ability to negotiate your contract. Now who stands losing from all of that? It's the AMA and the programs that have been adamant to classify residents as students, for obvious reasons. The whole match process is one big monopoly that is in violation of anti-trust laws and the NRMP managed to lobby so that they get a bill with an exemption when residents sued, because it's "education".

The whole balance of power is skewed in one direction. The moralizing that comes is just part of the power structure. Pretending otherwise is out of touch with reality.

 

[notdeadyet]

Free market conditions for residency would only hurt us. A medical school graduate has no employable skills (e.g. no medical license, no DEA), so the free market model would just be a race to the bottom for residents and programs. I suppose it would be a boon for IMGs though. But not DOs and USMDs.

I've heard this idea thrown out before, but we have an example of this in practice: the law. The big differences are that they come out of law school much more employable than we do out of medical school. And there are a lot of unemployed and underemployed lawyers. Nay.

I don't think we have to toss out baby with bathwater. Programs and residents can work together to iron out many of these problems, and do a pretty good job of it at many places. It's a matter of expectations and communication.

 

[Jorje286]

sorry wrong thread

 

[thoffen]

I'm not certain about your ideas notdeadyet. If there were no IMGs, then the supply-demand curve would be vastly different than for lawyers. Factoring them in, I'm still not so sure. Companies will still need qualified employees, and that includes things like speaking the language well and being reasonably acceptable to represent your organization to it's customers. We already have enough challenges on that end.

 

[OldPsychDoc]

...
True. But things like mandatory meetings and many things we gripe about as residents are not inherently unprofessional. In fact, residents often gripe loudest when they are treated like professionals. Mandatory training, picking up slack to make up for co-workers shortcomings, and being asked to lean in during times of crisis/challenge are exactly what employers expect of professionals but tend to ruffle resident features. Walk into a resident meeting and tell them they all have to take a couple extra nights of call because someone's out sick and watch the reaction. But this is part and parcel in any other professional work environment.

[Need to add that, by and large, I've been blessed with residents who "get it": who dot their Is, cross their Ts, back up their colleagues, and step up to challenging circumstances. And the great thing is that they then become attendings who do the same, and who make it worth it to come to work!]

 

[Doctor Bagel]

I

True. But things like mandatory meetings and many things we gripe about as residents are not inherently unprofessional. In fact, residents often gripe loudest when they are treated like professionals. Mandatory training, picking up slack to make up for co-workers shortcomings, and being asked to lean in during times of crisis/challenge are exactly what employers expect of professionals but tend to ruffle resident features. Walk into a resident meeting and tell them they all have to take a couple extra nights of call because someone's out sick and watch the reaction. But this is part and parcel in any other professional work environment.

I think these reactions in residents come in part from the powerlessness inherent in residency. In my non-residency job, I'm pretty OK picking up extra work because I know I have some say in what I pick up and if it becomes too much, I can eventually walk. As a resident, you're essentially told that the program can do whatever they want, and you have to deal with it. In the real adult world, if you've got to cover for other people, you generally come together with your colleagues and figure out how to deal with the situation. If you have to cover for people entirely too much, you get a new job. Residencies are this very top heavy environment where you get essentially told what you're going to do and also that your input isn't that welcome. And you can't walk because that might end your career. When you're treated like children, sometimes you start to act like children.

 

[notdeadyet]

Residencies are this very top heavy environment where you get essentially told what you're going to do and also that you're input isn't that welcome.

And I would tag that as "unprofessional" on the part of the program.

Professionalism is a two-way street. Professionalism on the part of the program requires a willingness to engage with its residents. When problems come up, professional programs problem solve with its residents or (as that tends doesn't tend to work) via the Chiefs, resident's union, and/or resident leadership. A program that deals with problems by telling you what to do and actively discouraging resident input is not keeping up their end of the "professionalism" bargain.

Where residency programs get in to trouble is when folks start polarizing the issue, which only exacerbates the problem (follow much national politics lately?). Programs that throw up their hands and turn their backs on their residents as being entitled, whiners aren't helpful. Residents that throw up their hands and say, "if they treat me like an entitled, whiner, I'm going to act like an entitled whiner" aren't helpful.

 

[nancysinatra]

You'll have to walk me through the logic of how attending a number of interviews that is literally an integer multiple of the number at which chance to match asymptotes forms a coherent strategy. I'm a tad confused.

I wasn't saying that students should interview at an endless number of places. I just meant that they are unlikely to cancel interviews well in advance during an admissions cycle that is full of uncertainty for applicants.

Say it wasn't psych, but derm. And say you were trying to couples match in derm and neurosurgery, in San Francisco, and one or both of you had failed Step 1. Then we wouldn't be having this discussion.

 

[nancysinatra]

professionalism is the most toxic concept in medicine today. The uncritical expansionism of this project seeks to govern and control physicians in every sphere of our lives - from what we wear, buy, eat, drink, post on social media to whom we have sex with. Professionalism enshrines the elitism, misogyny, and racism that has for too long characterized medicine by privileging a white bourgeois notion of what values and behaviors are acceptable. As physicians become increasingly at the mercy of market forces, the notion of professionalism oppresses and disenfranchises by reaffirming a collective mythology over individual rights - thus it becomes "unprofessional" for physicians to strike, or to want better work hours or greater pay. Professionalism is the stick we beat each other with. To deem someone "unprofessional" or to note "lack of professionalism" is often little more than thinly veiled name-calling that cuts deep - it is not only an assault on one's values and behaviors, but on one's identity and competency by calling into question your very suitability for your job.

(of course it's poor form to cancel an interview late. and actually i think it might be unprofessional to cancel an interview late. but i do think the term is vastly overused, is pernicious, nebulous and ultimately destructive to the field.)

I sure would like to send this post to my former PD.

 

[nancysinatra]

I don't disagree with this at all, but it's still a situation that requires context. When the resident who just finished 24 hours of call skips his mandatory didactics to get some sleep, I hardly find them guilty of putting themselves above their education or any other nonsense. Sure maybe they knew that was what neurosurgery residency was going to be like, but it doesn't make the situation any less absurd (and the above happens in psychiatry, although far less often). I've had colleagues jet after a lecturer cancels, even if someone is coming an hour later, because it's a chance to spend a few hours with their children. I'm sure people would call them unprofessional, but medicine is tough and taking a few moments to yourself or your family is needed at times.

This post to me, is illustrative not of professionalism or unprofessionalism, but of the fact that what is considered professionalism has changed with time. In the 1970s, an intern year in internal medicine involving 36 hour Q2 call was the norm for almost everyone. It's not now. I don't know if that is good or bad, but it was a cultural shift that brought that change.

 

[Dharma]

I saw the word 'meetings' in someone post and immediately smashed by face on the keyboard ...

 

[Mr. Taco]

I haven't figured out a process yet. Only about five or six cancelations so far and none of them were far enough in advance to let anyone else in. I also have a very large pile of wait list applicants. My need for our wait list isn't up to me really. It is still wait and see.

How far in advance is long enough to invite another applicant at your program? Such a shame to think of coveted interview slots going unused. If we cancel an interview within 2 weeks or less of the scheduled date, should we be posting the program and date to give interested, available, waitlisted applicants a chance to contact the program to take our place (as thxleave suggested was the strategy of another applicant and as I've seen discussed in other residency forums) Or would that just cause chaos/more work for the busy program coordinator who already has a waitlist to go off of?

 

[downwithDTB]

My guess is that this is a pretty minor problem. Programs probably generally over interview (why not, the cost/benefit is pretty good). Since most programs aim to interview about 10:1 and the average program ranks 4.5 to fill, the average program interviews twice what it needs to fill. So ~10% no shows doesn't really kill a program, and, being real, there probably aren't a ton (although it happened to a friend) of matches that come out of really late game additions. If any program is still, at this stage, suffering from too many cancellations, they should still be able to scramble together an extra date.

Moral of story: play nice and cancel as soon as you've decided to, it's best for everyone; however, if you're not going to rank a program or will be ranking it really low and don't have a specific reason for going... I'd bet the interviewers would rather surf SDN or write notes for 45 minutes instead of talking to you. That interview "slot" is "lost" either way, and as long as you're not doing it to multiple programs and everyone isn't doing it a lot... It's factored in and nbd. Trying to set up drop swaps on the internet probably won't result in altering match outcomes too much.