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Fired/dismissed from residency program in 51st week
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first, I would suggest that 3 complaints lodged against you in under a year is pretty significant. Second, I would point out that that is what is "on the record", and a PD also will have other "off the record" info about you which shapes his decisions. You have to realize that a big part of residency, perhaps most, is to learn how to work with others, as a functioning member of the team. Nobody cares only that patient care doesn't get affected. Lots of senior residents spend countless hours catching things that fall through the cracks and patient care doesn't get compromised, but that hardly equates to the juniors doing their jobs professionally. I think a lot of folks who never held a professional job before have a difficult time making the adjustment to being a good employee, but this aspect of residency shouldn't be underemphasized and is what can get you fired more often than the patient care aspects.
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Multiple official complaints lodged in your file, plus an unsatisfactory eval? I would say you have your work cut out for you if you're thinking of appealing. Why are you a prelim Medicine intern - did you have an advanced PGY-2 spot lined up, or did you not match?
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I agree that three complaints and an unsatisfactory evaluation need to be taken professionally, but maybe we're being to hard on the OP. Where I trained, almost everyone got at least one "complaint" of some form or another. People got into trouble when they weren't receptive to the feedback and got into trouble for the same thing multiple times. Programs are also different; some fire residents regularly, while others put up with all kinds of "incidents." I also think internal medicine is less tolerant of negative evals than some of the surgical fields (where all kinds of fire-starters keep getting promoted).
The original question is hard to answer. On the surface, it seems that your deficiencies are relatively minor, but people on SDN don't have have all of the details of your case. Were you already on probation when this nursing-paging issues came up? Frankly, paging issues come up all the time. If a nurse can't get a hold of the intern (who might be off, battery dead, etc.), they'll try the senior or an overhead page. If this fails, they might try the general admit pager to try to solve this issue. It would only get reported if the intern in question was extremely rude or it was a recurrent problem. If every missed page resulted in dismissal, there would be no residents left. Were there other negative/marginal evaluations in your file that while still "satisfactory" were still harsh enough to put you under the microscope? I think the questions you to ask yourself is "why me?" Why were you under the microscope in the first place? As a previous poster stated, medicine folk are often unaccustomed to working in a professional environment. We may study and test well, but often fall short in figuring out others expectations and fixing problems before they become too big.
The original question is hard to answer. On the surface, it seems that your deficiencies are relatively minor, but people on SDN don't have have all of the details of your case. Were you already on probation when this nursing-paging issues came up? Frankly, paging issues come up all the time. If a nurse can't get a hold of the intern (who might be off, battery dead, etc.), they'll try the senior or an overhead page. If this fails, they might try the general admit pager to try to solve this issue. It would only get reported if the intern in question was extremely rude or it was a recurrent problem. If every missed page resulted in dismissal, there would be no residents left. Were there other negative/marginal evaluations in your file that while still "satisfactory" were still harsh enough to put you under the microscope? I think the questions you to ask yourself is "why me?" Why were you under the microscope in the first place? As a previous poster stated, medicine folk are often unaccustomed to working in a professional environment. We may study and test well, but often fall short in figuring out others expectations and fixing problems before they become too big.
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An appeal can be on procedural grounds and/or on substance grounds.
Usually an appeal on procedural grounds is easier to succeed on. The first thing to do is have an knowledgeable adviser on your side - union official, residency adviser, etc. Human Resources are not on your side. People in the program hierarchy are unlikely to be on your side (even if they are sympathetic and friendly, they have their own futures to consider). A lawyer who knows the area (familiar with the law, with the particular contract of employment/terms of appointment in question, and with the organisation) might help, but you might want to consider whether or not to keep such a person in the background, to minimise confrontation. (You might also think that things have gone beyond that, but if you want to stay in the program, them minimising confrontation is the way to go for the moment.)
The sorts of procedural grounds which are easiest to win on are a failure of the program to comply with an essential step. Even if all the essential contractual steps have been complied with, you may be able to argue that what has happened to you was procedurally unfair (eg others in your situation have had extra warnings, so it was unfair that you didn't get a similar warning) or that the adverse effects are disproportionate. You are unlikely to succeed if your appeal is based on the fact that you did not read or did not understand your contract of employment, or that you did not realise that two formal disciplinary offences put you at risk of dismissal if this had been stated in your contract.
As to an appeal on grounds of substance, it will be difficult for you to now reopen the two earlier decisions, as you will be considered to have accepted them through inertia if nothing else. As to the third formal allegation against you, that of not returning pages, you need to see all the evidence on which it is based (it would be procedurally unfair if you did not see all that evidence). You then need to provide as much evidence as you can to demonstrate that the allegations are not true - page records, time records, patient records (if access to these is within the HIPAA/hospital rules), witness statements, and so on. Proving that the allegations are not true is more likely to get you a successful outcome than either trying to show that the allegations are not fully made out, or that the your response to the pages met the standards applicable in the hospital. But you should use those arguments if you need to.
When making your appeal, you need to think about what you want from it. Create a list of outcomes which are better than being dismissed without any credit (presumably starting with being dismissed with credit, and moving on to being dismissed with credit and passable references, then on to staying in the program but with additional time and training requirements, and so on. Try to work out who you would need to persuade to give you those outcomes and what you would need to do/offer in order to persuade them. You need them to want to help you, so think about what would make them want to help you.
As to the substance of your problem, I am going only on your post. But from that I get that there have been three or more formal incidents which have been drawn to the attention of the program by three or more different people, and that there are other instances of difficulties as well (eg the "personality conflict" with the second year resident). Whether you stay in your current program or try to find another, this pattern is likely to be held against you unless you can demonstrate that you have dealt with the underlying reasons for it and it will not happen again. Some formal training in communication and interpersonal skills might be one place to start with this. Agreeing to undertake such training might be something you could offer the program as part of an appeal/negotiation. But I think you would be wise to undertake it in any case and whatever the outcome of the appeal.
Given the late stage in the disciplinary process (two warnings and then dismissal for a repeated pattern of conduct is pretty standard) you need to be past the stage of denying that you have a problem, and onto the stage of accepting that you have a problem and that you need to change - unless you can wholeheartedly do this, and persuade your PD and others that you are doing it, you are unlikely to have much if any success.
Your post should be a warning to others that they need to read and understand all the provisions in their contracts of employment, and that any disciplinary action is a serious matter which puts their continued employment in doubt and should not be ignored.
Usually an appeal on procedural grounds is easier to succeed on. The first thing to do is have an knowledgeable adviser on your side - union official, residency adviser, etc. Human Resources are not on your side. People in the program hierarchy are unlikely to be on your side (even if they are sympathetic and friendly, they have their own futures to consider). A lawyer who knows the area (familiar with the law, with the particular contract of employment/terms of appointment in question, and with the organisation) might help, but you might want to consider whether or not to keep such a person in the background, to minimise confrontation. (You might also think that things have gone beyond that, but if you want to stay in the program, them minimising confrontation is the way to go for the moment.)
The sorts of procedural grounds which are easiest to win on are a failure of the program to comply with an essential step. Even if all the essential contractual steps have been complied with, you may be able to argue that what has happened to you was procedurally unfair (eg others in your situation have had extra warnings, so it was unfair that you didn't get a similar warning) or that the adverse effects are disproportionate. You are unlikely to succeed if your appeal is based on the fact that you did not read or did not understand your contract of employment, or that you did not realise that two formal disciplinary offences put you at risk of dismissal if this had been stated in your contract.
As to an appeal on grounds of substance, it will be difficult for you to now reopen the two earlier decisions, as you will be considered to have accepted them through inertia if nothing else. As to the third formal allegation against you, that of not returning pages, you need to see all the evidence on which it is based (it would be procedurally unfair if you did not see all that evidence). You then need to provide as much evidence as you can to demonstrate that the allegations are not true - page records, time records, patient records (if access to these is within the HIPAA/hospital rules), witness statements, and so on. Proving that the allegations are not true is more likely to get you a successful outcome than either trying to show that the allegations are not fully made out, or that the your response to the pages met the standards applicable in the hospital. But you should use those arguments if you need to.
When making your appeal, you need to think about what you want from it. Create a list of outcomes which are better than being dismissed without any credit (presumably starting with being dismissed with credit, and moving on to being dismissed with credit and passable references, then on to staying in the program but with additional time and training requirements, and so on. Try to work out who you would need to persuade to give you those outcomes and what you would need to do/offer in order to persuade them. You need them to want to help you, so think about what would make them want to help you.
As to the substance of your problem, I am going only on your post. But from that I get that there have been three or more formal incidents which have been drawn to the attention of the program by three or more different people, and that there are other instances of difficulties as well (eg the "personality conflict" with the second year resident). Whether you stay in your current program or try to find another, this pattern is likely to be held against you unless you can demonstrate that you have dealt with the underlying reasons for it and it will not happen again. Some formal training in communication and interpersonal skills might be one place to start with this. Agreeing to undertake such training might be something you could offer the program as part of an appeal/negotiation. But I think you would be wise to undertake it in any case and whatever the outcome of the appeal.
Given the late stage in the disciplinary process (two warnings and then dismissal for a repeated pattern of conduct is pretty standard) you need to be past the stage of denying that you have a problem, and onto the stage of accepting that you have a problem and that you need to change - unless you can wholeheartedly do this, and persuade your PD and others that you are doing it, you are unlikely to have much if any success.
Your post should be a warning to others that they need to read and understand all the provisions in their contracts of employment, and that any disciplinary action is a serious matter which puts their continued employment in doubt and should not be ignored.
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Sorry to hear that this happened to you.
While none of us were there to truly know what happened, it is certainly plausible to me that the incident with the chief resident earlier in the year may have left some bad blood that caused them to look for a reason to get rid of you. I do think there are cases in medicine where you get on the bad side of one wrong person and it does spoil the rest of your residency experience. Additionally, sometimes people talk to each other and a bad interaction with one person can lead to more bad interactions with their buddies within the residency/hospital/etc., so even a "pattern" of problems doesn't necessarily mean you're the one who has the problem.
I think there is a tendency in the culture of medicine to use interns as a scapegoat for anything that goes wrong, so I do think it's important for those of us hearing your story to acknowledge that we can't be sure that what happened was entirely your fault. Some residency programs treat their residents better than others do, and some are quicker to fire people than others are. The reality is that residency programs are run by human beings who are not immune to making decisions on personal feelings and other unfair, subjective criteria.
However,to have any hope of surviving this, I agree with those who say you certainly do need to be willing to accept their grievances, and certainly keep your head down and not make any waves in any future residency training.
I definitely agree that i would at least talk about the contract and your options with an experienced lawyer, though probably not raise the threat of legal action with the residency. What does your contract say about the termination process?
I also am of the opinion that if having a disagreement with a nurse or not getting and returning a page were grounds to fire residents, every residency class would have at least one fired resident.
At every hospital I've been at, there have been incidents where the paging system malfunctions and some pages are never received. Of course, sometimes nurses page the wrong person or mis-dial without realizing it.
Is there a record of the pages that you allegedly did not answer that shows they were directed to the right phone number? I have heard that some hospitals keep records of pages, so I would definitely raise that issue at the appeal.
You definitely have my sympathies. Whatever the reason this happened, it's an awful thing for any resident to go through.
While none of us were there to truly know what happened, it is certainly plausible to me that the incident with the chief resident earlier in the year may have left some bad blood that caused them to look for a reason to get rid of you. I do think there are cases in medicine where you get on the bad side of one wrong person and it does spoil the rest of your residency experience. Additionally, sometimes people talk to each other and a bad interaction with one person can lead to more bad interactions with their buddies within the residency/hospital/etc., so even a "pattern" of problems doesn't necessarily mean you're the one who has the problem.
I think there is a tendency in the culture of medicine to use interns as a scapegoat for anything that goes wrong, so I do think it's important for those of us hearing your story to acknowledge that we can't be sure that what happened was entirely your fault. Some residency programs treat their residents better than others do, and some are quicker to fire people than others are. The reality is that residency programs are run by human beings who are not immune to making decisions on personal feelings and other unfair, subjective criteria.
However,to have any hope of surviving this, I agree with those who say you certainly do need to be willing to accept their grievances, and certainly keep your head down and not make any waves in any future residency training.
I definitely agree that i would at least talk about the contract and your options with an experienced lawyer, though probably not raise the threat of legal action with the residency. What does your contract say about the termination process?
I also am of the opinion that if having a disagreement with a nurse or not getting and returning a page were grounds to fire residents, every residency class would have at least one fired resident.
At every hospital I've been at, there have been incidents where the paging system malfunctions and some pages are never received. Of course, sometimes nurses page the wrong person or mis-dial without realizing it.
Is there a record of the pages that you allegedly did not answer that shows they were directed to the right phone number? I have heard that some hospitals keep records of pages, so I would definitely raise that issue at the appeal.
You definitely have my sympathies. Whatever the reason this happened, it's an awful thing for any resident to go through.
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I'm really not trying to be mean but I'm just impressed you have such a superiority complex that it got you fired.
Did you skip brown nosing 101 to study at home during medical school or something?
I mean unless your program is malignant as all get out, they know they are screwing you over, and you are such a *use your imagination* that they are willing to do it. Amazing.
I think its time to self reflect and find out why you are so incorrigible because you have several more years of always being wrong ahead of you and that's a long road to hoe if you cant accept that.
Did you skip brown nosing 101 to study at home during medical school or something?
I mean unless your program is malignant as all get out, they know they are screwing you over, and you are such a *use your imagination* that they are willing to do it. Amazing.
I think its time to self reflect and find out why you are so incorrigible because you have several more years of always being wrong ahead of you and that's a long road to hoe if you cant accept that.
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Attey,
I am withdrawing my post.
I do truly wish you luck.
I am withdrawing my post.
I do truly wish you luck.
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" I hope when it's over you can advertise here what the site is so others applying there will have a heads up. Obviously, you need to get your own situation taken care of first, but a warning for others may come in very helpful."
If he's smart he won't be doing this. Medicine is a pretty small community, and you don't get far badmouthing programs. Second, the way licensing works, he is going to need this program to provide documentation and letters throughout his career. So he wants to at least cordially part ways.
If he's smart he won't be doing this. Medicine is a pretty small community, and you don't get far badmouthing programs. Second, the way licensing works, he is going to need this program to provide documentation and letters throughout his career. So he wants to at least cordially part ways.
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I think there is no question that a bad fight with the chief set the tone for his downfall. But that doesn't mean he still wasn't the one with the problem. He may have just continued to do the kind of things the chief needed as ammunition to get him fired. As harsh as it sounded, I have to agree with one of the prior posters that the OP must have been beyond tolerable for a program to not even let him finish out the year after 51 weeks. That's beyond not caring about what happens to you, that's going out of their way to make sure this loose cannon doesn't get a license and the ability to be a doctor. Which makes me think we are missing a lot of the story. I've known folks who were awful interns, but they usually were allowed to finish out their contact unless they represented a real danger to patients to the extent a program wouldn't in good faith be willing to have such person advance to the next year without remediation. Second, regarding pages, sure all of us have dropped a page or two. We know that if you are in the middle of something critical, the nurse calling to see if Mr X can have some gas-ex can wait. But I have seen at least one case where a person frequently didn't return any pages for a long block of time each night and was unfindable or unreachable (presumably asleep) during a night float shift where they were supposed to be handling floor work. There are folks like that who try to abuse the system, and know that the nurse will call the senior eventually if it's really important. Most programs have had someone like this at some point, and they inevitably don't get their contracts renewed, and its never their fault that nobody could reach them -- the excuses are endless. Usually starts in med school, where you can disappear for stretches at night and nobody seems to notice so you try it in residency. And for a While your peers cover for you. But not forever.
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If he's smart he won't be doing this. Medicine is a Pretty small community, and you don't get far badmouthing programs. Second, the way licensing works, he is going to need thi program to provide documentation and letters throughout his career. So we wants to at least cordially part ways.[/QUOTE]
true, you have good insight. If he decides to take action against this site by any legal means he will likely not be able to disclose the information any way.
The site must think they have enough credible evidence to back their decision. I hope all turns out okay for the poster whether they decide they need help with people skills or whether it was truly a site issue and not a resident issue.
true, you have good insight. If he decides to take action against this site by any legal means he will likely not be able to disclose the information any way.
The site must think they have enough credible evidence to back their decision. I hope all turns out okay for the poster whether they decide they need help with people skills or whether it was truly a site issue and not a resident issue.
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Acknowledging that none of us really know the details of what happened, I see a couple of possible reasons for the 51st week termination.
1) They're quite spiteful and angry about the OP's attitude and wanted to teach a lesson. Professionally or otherwise.
2) They hoped that time would teach the OP the lessons necessary, but now have decided that it isn't remediable for this individual and they don't want the problem just being passed onto another program. They don't want the OP to be practicing in the medical field anymore.
1) They're quite spiteful and angry about the OP's attitude and wanted to teach a lesson. Professionally or otherwise.
2) They hoped that time would teach the OP the lessons necessary, but now have decided that it isn't remediable for this individual and they don't want the problem just being passed onto another program. They don't want the OP to be practicing in the medical field anymore.
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so what. He doesn't need to be a martyr to the cause. He still "needs" this program to fill out paperwork for him countless times for licensing purposes, so it would be foolish to create more animosity than there already is by sullying the program by name on a public board.
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You're speculating with zero information about the program. The only info the OP has posted is a trend in problems with the OP, not in the program.
If multiple other people had been fired, all after having tiffs with a chief or the PD, that would be different.
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Agreed. But with the added suggestion that if #1 is true, the OP must have done something a lot more significant than simply not returning a few pages, because it takes a lot to get multiple folks that worked up about you that they want to do something out of spite.
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I would agree. And they would probably cite major problems in attaining basic competencies in professionalism. Despite all this, I did go to the ACGME site right now (I have a few minutes before my next pt), and found this in the institutional requirements:
"II.D.4.d).(1) Non-renewal of appointment or non-promotion: In
instances where a residents agreement will not be
renewed, or when a resident will not be promoted to the
next level of training, the Sponsoring Institution must
ensure that its programs provide the resident(s) with a
written notice of intent no later than four months prior to the
end of the residents current agreement. If the primary
reason(s) for the non-renewal or non-promotion occurs
within the four months prior to the end of the agreement,
the Sponsoring Institution must ensure that its programs
provide the resident(s) with as much written notice of the
intent not to renew or not to promote as circumstances will
reasonably allow, prior to the end of the agreement.
II.D.4.d).(2) Residents must be allowed to implement the institutions
grievance procedures if they receive a written notice either
of intent not to renew their agreement(s) or of intent to
renew their agreement(s) but not to promote them to the
next level of training."
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so either the OP was given notice some time ago, or the "primary reason" for his dismissal just happened. If neither he has some procedural grounds for a grievance. But I don't really see that getting him back in the game at this particular program.
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You've already received a bunch of very reasonble suggestions and advice here. I'll add/clarify a few points:
1. Terminating a prelim intern in June is a rare event. Your appeal process will take much more work to deal with than simply letting you finish. It's extremely unlikely that this is "spite" -- first they would have had to "hope" for some new event to occur this late in your training to be a trigger, and honestly terminating you this late doesn't really teach you any more of a lesson than terminating you earlier. Terminating you this late does avoid the coverage problem that terminating you earlier might have caused, but again as mentioned above most programs would simply let you graduate and move on rather than bother with the headache of firing you. So....
2. The reason they fired you is probably that your performance is completely unacceptable. 3 official complaints about your interpersonal skills in a single year, when you have been warned before, is way above the usual. As mentioned by others, there were probably many other less official complaints. The last complaint was about not returning pages, and that can be spun as "patient abandonment" which is very serious. Which leads to....
3. You seem to have no insight / understanding into your performance / behavior. The six core competencies are just that -- six domains in which physicians must be competent. You can be fine in patient care, but if your professionalism or communication skills are felt to be unsatisfactory, you fail. Arguing that you communicate fine 95+% of the time is not acceptable, as your performance appears to be very far from the norm. You were not fired for your repeated reports of concern. You were fired because of your lack of insight / lack of doing anything about it / not taking it seriously.
What to do about it? Well, you should probably appeal it -- simply because it's hard to make your situation any worse. In fact, my program would have an automatic appeal of a decision like this. To be honest, your best chance is to hope that you can get this reversed on a "technicality". Programs have to follow their policies. You ask if it's OK if you were never on probation, or never told that you'd be fired if it happened again. The answer is: "It completely depends on what your program/institutional policies state". If they say that you need to be on probation first, and that it needs to be in writing, then you can appeal that. Some programs will allow immediate termination for professionalism issues without probation. As mentioned above, if the program spins this as patient abandonment -- i.e. the nurses needed help and couldn't find a physician to help them despite multiple pages -- you could be in really big trouble. So, your best chance to get this reversed is to show that your program didn't follow their own internal rules. Trying to prove that the punishment is worse than the crime, or that the crime didn't happen, are much more difficult. In the appeal process, expect your program to pull out many more complaints / events that didn't create official complaints in your file.
You didn't mention what comes after your prelim year. If you have an advanced program to go to, they will be told about this and it may completely invalidate your match.
It's completely up to your program to give you "no credit" for the year. What actually happens is they give you an unsatisfactory overall professional rating, and the ABIM will not grant any credit. This is completely within their rights, and if your professionalism issues were as serious as I expect they may have been might be fully warranted. It's common for people with communication problems like this to minimize them, blame others, and make excuses. Your last statements about being professional 365.24.7 are classic. Let me answer them for you:
Yes. Being a professional physician means being professional 365.24.7. That actually includes both when you are at work, and when you are not (which is a strange concept, but true non-the-less). It applies at all times, to all interactions. Although we all have events / experiences where we are less professional than we set our goals to be, those events are not "unprofessional" but rather are "minor lapses" which we often work out ourselves (i.e. by recognizing that we have caused problem and apologizing / addressing it directly and immediately after the event). Meeting this standard 95% of the time is not acceptable. More telling is your apparent lack of progress in improving, nor any commitment on your part to improve.
1. Terminating a prelim intern in June is a rare event. Your appeal process will take much more work to deal with than simply letting you finish. It's extremely unlikely that this is "spite" -- first they would have had to "hope" for some new event to occur this late in your training to be a trigger, and honestly terminating you this late doesn't really teach you any more of a lesson than terminating you earlier. Terminating you this late does avoid the coverage problem that terminating you earlier might have caused, but again as mentioned above most programs would simply let you graduate and move on rather than bother with the headache of firing you. So....
2. The reason they fired you is probably that your performance is completely unacceptable. 3 official complaints about your interpersonal skills in a single year, when you have been warned before, is way above the usual. As mentioned by others, there were probably many other less official complaints. The last complaint was about not returning pages, and that can be spun as "patient abandonment" which is very serious. Which leads to....
3. You seem to have no insight / understanding into your performance / behavior. The six core competencies are just that -- six domains in which physicians must be competent. You can be fine in patient care, but if your professionalism or communication skills are felt to be unsatisfactory, you fail. Arguing that you communicate fine 95+% of the time is not acceptable, as your performance appears to be very far from the norm. You were not fired for your repeated reports of concern. You were fired because of your lack of insight / lack of doing anything about it / not taking it seriously.
What to do about it? Well, you should probably appeal it -- simply because it's hard to make your situation any worse. In fact, my program would have an automatic appeal of a decision like this. To be honest, your best chance is to hope that you can get this reversed on a "technicality". Programs have to follow their policies. You ask if it's OK if you were never on probation, or never told that you'd be fired if it happened again. The answer is: "It completely depends on what your program/institutional policies state". If they say that you need to be on probation first, and that it needs to be in writing, then you can appeal that. Some programs will allow immediate termination for professionalism issues without probation. As mentioned above, if the program spins this as patient abandonment -- i.e. the nurses needed help and couldn't find a physician to help them despite multiple pages -- you could be in really big trouble. So, your best chance to get this reversed is to show that your program didn't follow their own internal rules. Trying to prove that the punishment is worse than the crime, or that the crime didn't happen, are much more difficult. In the appeal process, expect your program to pull out many more complaints / events that didn't create official complaints in your file.
You didn't mention what comes after your prelim year. If you have an advanced program to go to, they will be told about this and it may completely invalidate your match.
It's completely up to your program to give you "no credit" for the year. What actually happens is they give you an unsatisfactory overall professional rating, and the ABIM will not grant any credit. This is completely within their rights, and if your professionalism issues were as serious as I expect they may have been might be fully warranted. It's common for people with communication problems like this to minimize them, blame others, and make excuses. Your last statements about being professional 365.24.7 are classic. Let me answer them for you:
Yes. Being a professional physician means being professional 365.24.7. That actually includes both when you are at work, and when you are not (which is a strange concept, but true non-the-less). It applies at all times, to all interactions. Although we all have events / experiences where we are less professional than we set our goals to be, those events are not "unprofessional" but rather are "minor lapses" which we often work out ourselves (i.e. by recognizing that we have caused problem and apologizing / addressing it directly and immediately after the event). Meeting this standard 95% of the time is not acceptable. More telling is your apparent lack of progress in improving, nor any commitment on your part to improve.
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I'm still really puzzled by this. As mentioned above, firing you with one week left of the program is a pretty strong action, and you'd hope they would have pretty good reasons for doing it. We know that you had these bad interactions with people, but how bad were they? I can understand your reluctance to share any specifics, but jeez, it's just hard to picture how it could have reached this point. And how bad was this not returning pages thing? I think we all have issues with promptness sometimes (especially as an intern) because we're juggling so many things at one time. Did you just straight up not respond after being paged several times? I'm still trying to think through what your programs motivation could be -- they were going to get rid of you in a week anyway with graduation.
As for the professionalism thing, unfortunately, its meaning can be pretty nebulous. 3 complaints in a year could probably count as not mastering professionalism. My understanding is that you need to pass on each of the ACGME core competencies, so your above average clinical knowledge doesn't make up for the professionalism stuff.
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A couple more thoughts. Please don't take this as trying to be mean / piling on, but I hope the following will help:
Your PGY-2 is in serious jeopardy. Many contracts state that you must complete your PGY-1 satisfactorily. At this point, probably best to focus on your PGY-1 issues, but undertand that you may be completely unemployed. This may trigger your loan payments / deferrals.
Being called into your PD's office to review problems with your behavior, even once, would make most people recognize that this is a HUGE problem. Small problems do not make it up the chain of command that far. Most people would not need to be told that your career was on the line for this. I have, unfortunately, been through this before. And I have learned that the best way to fix the situation is to say, directly: "If this behavior continues, I may have to terminate your training and your career would be at risk". Saying something as direct as this is difficult, most people will couch it in more benign language. Your PD probably did so, and you missed it.
There is no requirement for your PD to warn you specifically, nor for them to remediate you. They must tell you what your deficiencies are, and give you a chance to resolve them. The onus for improvement is on you.
Your suggestion that this is vindictive (or, more accurately, your acceptance of this suggestion posted by others) is further evidence of your lack of insight. It's your program's fault. They are being unreasonable and unfair. This is no big deal. That's the way you sound here, and likely the way you sound at work.
I have bolded this, because I want you to read it carefully. This paragraph completely encapsulates your problem. You are totally making excuses. You did not take this seriously despite multiple warnings.
I was hoping to edit my post before it got quoted. I want to add "It breaks my heart to suggest this, but your best option might be to appeal this on procedural grounds". Understand that although this might be the best option for you, it will make you look less professional. If you break the law and get off on a technicality, you are innocent as far as the law is concerned, but you are not innocent.
You misunderstand my post. Your lapses were not 'minor lapses'. I was trying to say that we all have minor lapses, which we address on an ongoing basis. Your problems were all major lapses. That's why you ended up in your PD's office discussing them. The fact that you think they are minor lapses is the problem here.
Absolutely. Three official professionalism complaints would put you well beyond the norm. Honestly, ONE official complaint is well beyond the norm.
I had a prelim intern who had a poor interaction with a nurse. It was a complicated situation -- a different environment, some cultural differences, and some poor communication skills. She was on night float, so was working semi-independently (i.e. resident was not right there to buffer her). Official complaint ended up on my desk.
Before I had a chance to even read it, she was in my office that morning. She felt terrible that things had gone badly. She wanted to do better, but was worried that the next night the same problems would happen. Wanted to do whatever she could to fix the situation. I set up a meeting with myself, her, the nurse, and the nurse supervisor for that evening. We talked it out. Everyone apologized to everyone else. Problem solved, no further complaints.
That's the norm.
As above
Your PGY-2 is in serious jeopardy. Many contracts state that you must complete your PGY-1 satisfactorily. At this point, probably best to focus on your PGY-1 issues, but undertand that you may be completely unemployed. This may trigger your loan payments / deferrals.
Being called into your PD's office to review problems with your behavior, even once, would make most people recognize that this is a HUGE problem. Small problems do not make it up the chain of command that far. Most people would not need to be told that your career was on the line for this. I have, unfortunately, been through this before. And I have learned that the best way to fix the situation is to say, directly: "If this behavior continues, I may have to terminate your training and your career would be at risk". Saying something as direct as this is difficult, most people will couch it in more benign language. Your PD probably did so, and you missed it.
There is no requirement for your PD to warn you specifically, nor for them to remediate you. They must tell you what your deficiencies are, and give you a chance to resolve them. The onus for improvement is on you.
Your suggestion that this is vindictive (or, more accurately, your acceptance of this suggestion posted by others) is further evidence of your lack of insight. It's your program's fault. They are being unreasonable and unfair. This is no big deal. That's the way you sound here, and likely the way you sound at work.
I have bolded this, because I want you to read it carefully. This paragraph completely encapsulates your problem. You are totally making excuses. You did not take this seriously despite multiple warnings.
I was hoping to edit my post before it got quoted. I want to add "It breaks my heart to suggest this, but your best option might be to appeal this on procedural grounds". Understand that although this might be the best option for you, it will make you look less professional. If you break the law and get off on a technicality, you are innocent as far as the law is concerned, but you are not innocent.
You misunderstand my post. Your lapses were not 'minor lapses'. I was trying to say that we all have minor lapses, which we address on an ongoing basis. Your problems were all major lapses. That's why you ended up in your PD's office discussing them. The fact that you think they are minor lapses is the problem here.
Absolutely. Three official professionalism complaints would put you well beyond the norm. Honestly, ONE official complaint is well beyond the norm.
I had a prelim intern who had a poor interaction with a nurse. It was a complicated situation -- a different environment, some cultural differences, and some poor communication skills. She was on night float, so was working semi-independently (i.e. resident was not right there to buffer her). Official complaint ended up on my desk.
Before I had a chance to even read it, she was in my office that morning. She felt terrible that things had gone badly. She wanted to do better, but was worried that the next night the same problems would happen. Wanted to do whatever she could to fix the situation. I set up a meeting with myself, her, the nurse, and the nurse supervisor for that evening. We talked it out. Everyone apologized to everyone else. Problem solved, no further complaints.
That's the norm.
As above
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I want to change / clarify my advice:
If you want to fight this, your best option is to try to challenge it on procedural grounds.
If you want to fix this, your best option is to go back to your PD, be extremely apologetic, explain that you apparently completely underestimated your problem and did not address it, and want to make amends. You understand that you are unlikely to get your position back, nor get credit for your training. You want to learn from this, address your problem, and then hopefully get another training position. You want to make amends to those you have hurt, and are looking for help to do so.
The choice is yours. Note that the second option is unlikely to get you your position back, no credit for the year.
In addition, if you'd feel more comfortable discussing this in PM, please feel free to do so.
If you want to fight this, your best option is to try to challenge it on procedural grounds.
If you want to fix this, your best option is to go back to your PD, be extremely apologetic, explain that you apparently completely underestimated your problem and did not address it, and want to make amends. You understand that you are unlikely to get your position back, nor get credit for your training. You want to learn from this, address your problem, and then hopefully get another training position. You want to make amends to those you have hurt, and are looking for help to do so.
The choice is yours. Note that the second option is unlikely to get you your position back, no credit for the year.
In addition, if you'd feel more comfortable discussing this in PM, please feel free to do so.
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Did I not tell you "TRUE. You have good insight"?
Therefore, your "so what" is really not called for. As stated before, it will likely not be able to be disclose anyway, nor, reading from his/her posts above, he/she is NOT interested in disclosing. Therefore, whatever you or I either one have to speculate about is a mute point.
I am not arguing points over this matter, it sounds like the poster is getting some great advice and help from a PD.
again, thanks for you insight.
I truly wish you luck attey.
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You are funny~!
I quote you, "
Acknowledging that none of us really know the details of what happened, I see a couple of possible reasons for the 51st week termination.
1) They're quite spiteful and angry about the OP's attitude and wanted to teach a lesson. Professionally or otherwise.
2) They hoped that time would teach the OP the lessons necessary, but now have decided that it isn't remediable for this individual and they don't want the problem just being passed onto another program. They don't want the OP to be practicing in the medical field anymore. "
I would say what you have posted here is a little speculation on your part as well.
Thanks for giving me a good giggle.
You might want to consider the definition of 'speculation'.
BTW, I am not saying anything about 'multiple firings'. I meant who knows. In any case I am glad the OP posted. This is the type of situation many may never consider...........(yes this is speculating some may have never considered this may happen). It's great lesson material for future students.
Again, Attey,
I truly wish you luck. You have many major decisions in front of you.
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You are funny~!
I quote you, "
Acknowledging that none of us really know the details of what happened, I see a couple of possible reasons for the 51st week termination.
1) They're quite spiteful and angry about the OP's attitude and wanted to teach a lesson. Professionally or otherwise.
2) They hoped that time would teach the OP the lessons necessary, but now have decided that it isn't remediable for this individual and they don't want the problem just being passed onto another program. They don't want the OP to be practicing in the medical field anymore. "
I would say what you have posted here is a little speculation on your part as well.
Thanks for giving me a good giggle.
You might want to consider the definition of 'speculation'.
BTW, I am not saying anything about 'multiple firings'. I meant who knows. It's a HR issue and the OP would not have this info.
In any case I am glad the OP posted. This is the type of situation many may never consider...........(yes this is speculating some may have never considered this may happen). It's great lesson material for future students.
Again, Attey,
I truly wish you luck. You have many major decisions in front of you.
Interesting. It actually wasn't meant to be funny. I would define speculation in this context as akin to conjecture. From dictionary.com(one of multiple definitions on the site):
conjectural consideration of a matter; conjecture or surmise: a report based on speculation rather than facts.
I would contrast this with a hypothesis:
a proposition, or set of propositions, set forth as an explanation for the occurrence of some specified group of phenomena, either asserted merely as a provisional conjecture to guide investigation (working hypothesis) or accepted as highly probable in the light of established facts.
The OP gives evidence that he/she has had multiple complaints filed from different individuals. That's clear data to support a problem with the individual. Without evidence that this has happened before with anyone else, there is no data to support a problem with the system. Therefore, from the evidence we have there's no reason to think "he may not be the first and may not be the last for this to happen to." Unless you're referring to all residencies everywhere and then it's possible this could happen again. I presumed you're talking about this program.
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Dont waste time. Seek immediate advice from an attorney who has experience in this area.
Whether this is your fault/justified/vindictive/unfair/whatever is irrelevant.
Your career and all you've worked for all your life is on the line here. A situation of this gravity deserves a professional perspective. You are too scared/emotional to handle this yourself.
It's all going to come down to what is documented, a good lawyer on your side could make them cave just to avoid the headache.
Whether this is your fault/justified/vindictive/unfair/whatever is irrelevant.
Your career and all you've worked for all your life is on the line here. A situation of this gravity deserves a professional perspective. You are too scared/emotional to handle this yourself.
It's all going to come down to what is documented, a good lawyer on your side could make them cave just to avoid the headache.
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It's never a bad idea to get legal advice in termination situations. But I wouldn't say fault is "irrelevant". If a program feels OP is so unprofessional that he shouldn't progress to the next year, they won't cave. At least not in the next week, and that's all they need to hold out for for him to lose his advanced spot.
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The case is obviously an 'issue of situation'. Therefore, thats where the term 'debate' comes in. You feel you are 'hypothesizing' from the 'choice' of definition you choose. It's only one of many definitions that exists for the term 'speculation'.
{QUOTE}I presumed you're talking about this program.[/QUOTE]
Make presumptions (let me clarify, 'when making a complete assumption') can cause your speculation to be comepletely incorrect.
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Let me understand this:
1) OP argued with a resident
2) OP argued with a nurse
3) OP was reported for not returning a page
4) OP got an unsatisfactory from a second year resident (who by definition is not a good evaluator yet)
Don't know about you guys but these scenarios are just as common as normal saline in every hospital. A program that fires a resident on week 51 for these is truly a rouge program IMO.
Remember according to OP "no official or written remediation, no probation, no notification that dismissal would occur on the next incident"
At the end of the day the very personality defects we are crucifying OP exist with more than half of our attendings who btw went through the same process. So who are we kidding?
1) OP argued with a resident
2) OP argued with a nurse
3) OP was reported for not returning a page
4) OP got an unsatisfactory from a second year resident (who by definition is not a good evaluator yet)
Don't know about you guys but these scenarios are just as common as normal saline in every hospital. A program that fires a resident on week 51 for these is truly a rouge program IMO.
Remember according to OP "no official or written remediation, no probation, no notification that dismissal would occur on the next incident"
At the end of the day the very personality defects we are crucifying OP exist with more than half of our attendings who btw went through the same process. So who are we kidding?
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Osteo,
You had better prepare for serious attack. The storm is likely to hit soon.
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If we could lay off the personal attacks, that would be great.
Please do not derail the thread any further. If any of you want to exchange personal insults with another user, take it to prviate messages. Otherwise, the thread is getting closed.
Thanks.
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Osteo,
You had better prepare for serious attack. The storm is likely to hit soon.
Maybe it is my years in combat with the marines, but the one thing that really pisses me off is people throwing their team members under the bus. Not saying you did the right things with your job, but physicians need to learn the concept of taking care of their own the right way.
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I think there's degrees to these things. Having a disagreement is one thing. Being rude or unprofessional is another, even if a person knows a lot of medicine. A regional medical director I interviewed with recently called them "competent jerks." Sure they're in medicine, but he didn't want to hire them. The PD may be trying to prevent someone like that from being able to move on in medicine. What I do not know is how egregious the problem is for the OP. We have to deal with a balance of authority - there's a chain of command in medicine, and for many reasons the intern is at the near bottom. Did the OP not do what the attending or senior told him/her to do? That's a big deal since it's the upper levels that really have responsibility for the patient outcome. While following the hierarchy, there's also a need to play nice with others at all levels. More flies with honey than with vinegar.
While there's been a long history of tolerating personality pathology in medicine (moreso in certain specialties), "because that's the way we've always done it" is falling by the wayside as new generations enter the field. Narcissistic personalities in medicine are more likely to ignore warnings or feedback from others, and ultimately lead to serious medical errors. That's not good for patients.
And as aProgDirector has stated, there's obviously big problems here for the original poster, including but not limited to the OP's lack of insight into the problem, and thus likely not posting other significant events or evidence simply due to lack of awareness of how outside the norm it really is.
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Osteo,
if a PFC ignored or argued with his lieutenant, argued and fought with locals in a town he was stationed in, didn't follow orders when given directly that showed clear dereliction of duties, that wouldn't be grounds for reprimand if not discharge from the military?
Is there a scenario in your mind that would warrant dismissal of an intern?
Again, in reality I'm agnostic on this situation. I don't know the OP or what really happened. I do know I've met many a person in medicine who no one (other attendings, residents, students, nurses, patients) think should be practicing. All too often people are allowed to skate by because it's a lot harder to put up the roadblock. Akin to high school graduates that're illiterate. People pass the buck, and patients ultimately suffer.
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There is no reason you can't take both roads aPD suggests. I would ask to sit down with the PD to discuss options (maybe with an attending that likes me) and apologize without admitting anything.
If that does nothing, I would appeal on every angle possible (both procedural and others). If you are female, a minority, disabled in the slightest way, then claim bias. Claim retaliation for the prior argument. Formally request access to phone records to prove that you didn't miss pages (most pagers are like mobile phones and this info is available). They will probably say no but that just make it seem less justified when this ends up in court.
Pay an employment attorney to do the talking for you. Explain the harm to you if you lose your PGY2 slot. Your entire career and millions of dollars in lifetime income are at stake and it only matters to you. What is a $10,000 lawyer bill compared to that?
I know others have argued that you deserve this based on your track record. The bickering above is irrelevant to your situation. Who cares? You can't. If you make it through this, then you can spend some time working on gaining insight into why this happened.
FIGHT!
If that does nothing, I would appeal on every angle possible (both procedural and others). If you are female, a minority, disabled in the slightest way, then claim bias. Claim retaliation for the prior argument. Formally request access to phone records to prove that you didn't miss pages (most pagers are like mobile phones and this info is available). They will probably say no but that just make it seem less justified when this ends up in court.
Pay an employment attorney to do the talking for you. Explain the harm to you if you lose your PGY2 slot. Your entire career and millions of dollars in lifetime income are at stake and it only matters to you. What is a $10,000 lawyer bill compared to that?
I know others have argued that you deserve this based on your track record. The bickering above is irrelevant to your situation. Who cares? You can't. If you make it through this, then you can spend some time working on gaining insight into why this happened.
FIGHT!
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I have the biggest issue with jerks in medicine, but before you draw your conclusion about OP, remember some of the jerks the ones deciding who the jerks are. I love aProgDirector and Law2Doc's contribution on this forum but I am in total disagreement on this issue. This looks like a hit move by the program, an abandonment of a team member, and disregard for due process. I am basing my opinion on the OP's post, I have no rights to assume OP is lying or withholding other information which seems to be the general assumption on the thread. "trying to prevent someone like that from being able to move on in medicine" ??? Remember this is a life that is getting destroyed, at least they need to do it with some class and dignity.
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Thanks for jumping in.
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I think you are undervaluing the facts here. Per the OP, he had a significant fight with his chief resident -- ie his supervisor, not "a resident". He has 3 official reports filed against him. Who knows how many informal things are out there. He was called in for a sit down by the PD about these. He got in trouble for not returning pageS. Not "a page". We are left to our own experiences how insidious you have to be to get reported for this. And the program felt so strongly about this that they would rather terminate him at 51 weeks rather than have the problem resolve naturally by his leaving a week later. all of this points to more severe lapses of professionalism than OP has related. This isn't really another equally plausible theory. I think that's why aPD, I and others have piled on OP here. To a large extent the fact that OP seems to blow off 3 complaints within a year and getting called in to talk to his PD as no big deal probably frames our opinion. The fact that we know folks who didn't manage to navigate intern year and make similar excuses like -- nobody is professional 24/7, probably taints our view of OP too. Could this be a spiteful rogue PD? Sure. But is this the most likely explanation? Not so much.
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Attey, it seems you bring up another important issue indirectly - when someone is miserable in what they're doing (you were disinterested in internal medicine), it comes out and affects everyone. All the more reason to think carefully before choosing medicine in general and a specialty. Physicians in general get years of practice at suppressing our own needs (physical and emotional) for the sake of a job. Sometimes and some people are not as good at suppressing their frustration. Sometimes and some people don't see the benefit and need to suppressing their frustration. Glad to hear Attey that you have a game plan, and wish you good luck.
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Not in disagreement with you on the possibility that OP was not doing his/her job right. I am just tired of everyone always erring on the side of the resident being at fault in any firing situations on SDN. Like I said, the 3 official complaints listed above are not left field type issues. We see these things from a lot of medical personnel all the time in the hospitals. You guys are minimizing the implications of firing an intern; that is a life ruined or at least about to be. Certainly not something that should be done without due process or compassion. Again, if we cannot take care of our own decently why should anyone have any respect for us. Nurses or any of the other allied health workforce will never respond to a thread like this the way we do.
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Firing a resident on his last week with your program is the similar to flying the said PFC to afghanistan and abandoning him/her in the hands of the taliban. The plan was not to punish or correct, but to ruin and destroy this indvidual. Nothing about that screams class, team, or dignity. Yes folks should be fired, but there must be due process. The message sent constantly by these erratic firings is that residents are walking on thin ice. Most of us have received that message and are willing to play the game, but some now assume thin ice is normal ground. We are a strange workforce, no one else does the kind of nonsense we do.
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Osteo,
I am glad to see you sticking to your guns. I agree, only the OP knows what the complete set of circumstances were, but the action taken was so extreme.
I have no clue who's in the wrong here. Both sides probably could have handled it a little differently. However, the result ending in termination on 51st week seems so harsh that it makes one wonder what the actual goal was in this particular situation.
This situation is unreal and truly unfortunate.
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