Psychiatry resident canned at George Washington University

[JustAGuy]

Supposedly GWU fired this resident for having cancer, and now she's suing them.

http://www.idealmedicalcare.org/blog/hospital-fires-doctor-for-having-cancer/

I'm betting it probably had more to do with her making public posts talking bad about her program and attendings. It will be interesting to see what comes out on this.

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[SomeDoc]

Supposedly GWU fired this resident for having cancer, and now she's suing them.

http://www.idealmedicalcare.org/blog/hospital-fires-doctor-for-having-cancer/

I'm betting it probably had more to do with her making public posts talking bad about her program and attendings. It will be interesting to see what comes out on this.

There are often more than two sides to every story. The article displays just one.

Psychiatrists in particular would be attuned to issues of splitting in reading such an article. Hopefully it works out well for both parties.

 

[FlowRate]

I doubt they fired her for having cancer...

Probably fired for not showing up to work.

 

[lymphocyte]

Supposedly GWU fired this resident for having cancer, and now she's suing them.

http://www.idealmedicalcare.org/blog/hospital-fires-doctor-for-having-cancer/

I'm betting it probably had more to do with her making public posts talking bad about her program and attendings. It will be interesting to see what comes out on this.

There's two sides to every story. That means there's two sides. I withhold judgement on everybody involved, including GWU. It's too easy to blame.

And I'd like to point out that it was the author of the post, Pamela Wibble, America's self-proclaimed "leading voice for ideal medical care" and the author of "Pet Goats and Pap Smears," who made the sensationalistic claim that this resident was fired just because she had cancer. The resident herself acknowledged that what happened probably reflected her missing work and her outspokenness about the situation.

Really all I see here is an unfortunate situation, the actual details of which I know nothing about, that seems to have been co-opted to push a broader agenda. I also see one sick resident who publically lost her entire career, and one residency programme that might have its reputation unfairly tarnished.

Even my dig at Pamela Wibble is a little unfortunate. She raises some important points about physician suicide and mental health stigma. I'm just not sure if the resident's best interests are being served here. Sometimes the onus is on more experienced doctors to say, "This may suck, but it's just not how things are done. And I'm not going to post your name and story on a website that could jeopardize your future chances at anything, because you'll probably get a lot of eye-rolling, rightly or wrongly [like what's happening in this thread]."

 

[Crayola227]

mmm don't know that I agree

do programs push people out for needing too much sick leave or reasonable accommodations? You bet they do.

as far as making this a big case, it sorta depends on what the resident's goal are
she might get a muzzle deal out of the pressure being put on
or money settlement

hard to say what this does for her clinical career otherwise, but if she's done with clinical medicine or foresees that, than that factors into the choice to make public or not

 

[splik]

it doesn't matter what the reason for her termination was, no one is going to want to have to explain why they fired someone with cancer in front of a jury. suing is the best recourse she has to get her job back or to reach another settlement that could be sizeable (for example all future lost earnings that would have been accrued through a lifetime of practicing psychiatry). GWU has a terrible reputation as an institution and was famously successfully sued after expelling a student for being admitted to their inpatient psych unit for depression and not even allowing him to collect his belongings from his dorm with the threat of police. In that case the dean of students hand delivered the notice to the student while he was still on the GWU psych ward.

 

[lymphocyte]

suing is the best recourse she has to get her job back or to reach another settlement that could be sizeable

Interesting. I'd imagine they would have built a paper-trail before pulling the trigger to fire (or at least being able to point to something very specific in the resident contract). I'm not a lawyer though.

 

[splik]

Interesting. I'd imagine they would have built a paper-trail before pulling the trigger to fire (or at least being able to point to something very specific in the resident contract). I'm not a lawyer though.

If they were sensible then they would have established some sort of pattern. However, people with cancer are protected under the ADA, and as cancer is an emotive topic, even if she were a hot ball of personality disordered mess, it doesn't play well. unless they had evidence she was actively endangering patients (which is much harder to do in psychiatry, given the standard of care is so low in the first place and we're not usually dealing with life-or-death situations) it is not going to be something they are going to want to take to court even if there was a very legitimate reason for firing her. you just don't fire people with cancer.

 

[birchswing]

Did she say anything more than what was written on the Care2 page bio? It hardly seemed like damning statements. Also, I thought employers tried to push people onto medical leave rather than firing them in cases like this. Firing just seems stupid (for their own sake, let alone hers).

 

[Crayola227]

Interesting. I'd imagine they would have built a paper-trail before pulling the trigger to fire (or at least being able to point to something very specific in the resident contract). I'm not a lawyer though.

yes but threatening to sue is the only option to do her any good

what's true is she had BEFORE termination invoked the ADA, there was a better chance at keeping her job
and at that point you're holding them hostage from firing you, and you're holding them hostage in that they can be sued, what they are holding you hostage to is all the bad things they can say to justify termination. So often the compromise is resignation.

it's absolutely true from the moment you get sick or any other issues like that there's certain steps they take and documentation they do to faciliate a future termination

 

[Crayola227]

Did she say anything more than what was written on the Care2 page bio? It hardly seemed like damning statements. Also, I thought employers tried to push people onto medical leave rather than firing them in cases like this. Firing just seems stupid (for their own sake, let alone hers).

there's a whole host of reasons they might fire you and it benefits them in some ways

usually they don't want to

 

[splik]

having consulted in some of the sorts of cases, in my experience the resident frequently has a personality disorder or is otherwise seen as a "difficult person" and has little insight into their behavior. That said, usually the department has done something wrong (for example engaging in medicare fraud, or engaging in ethically questionable practices) or overreacting to something or a faculty member has done something bad (like sexually harass the resident) and then they try to cover it up.

 

[lymphocyte]

However, people with cancer are protected under the ADA

I'm not a lawyer, and I don't think anybody else here is either, but that's just not true. "Cancer" is not covered by the ADA. The ADA defines the term disability, but it doesn't include include a list of conditions that are always considered a disability. Each case has to be judged on its own merits according to certain legal criteria. And it's not just the ADA that applies, but the relevant circuit court decisions, administrative decisions by the EEOC, and the specifics of her employment clause.

My point is this: nobody knows anything. It's all speculation. I reserve judgement of all parties here, though I question the wisdom of publicly disclosing facts of the case as they might pertain to litigation.

 

[Crayola227]

well its not up to her to invoke the ADA - they are the ones that should know this. presumably she told them she had cancer (sounds like it). If you dont disclose youre diagnosis than you are not protected by the ADA but if you do then one would reasonably expect a large institution to know these things. termination is not something that happens at the departmental level so someone must have consulted legal counsel.

I meant invoked as you said it - letting HR and PD know you have an ADA protected condition, to use in a later lawsuit if they don't follow it. Because you're right, there's no protection and they can't be held to it if you don't.

 

[splik]

I'm not a lawyer, and I don't think anybody else here is either, but that's just not true. "Cancer" is not covered by the ADA. The ADA defines the term disability, but it doesn't include include a list of conditions that are always considered a disability. Each case has to be judged on its own merits according to certain legal criteria. And it's not just the ADA that applies, but the relevant circuit court decisions too, as well as the specifics of her employment clause.

yes this is correct, but splitting hairs. Perhaps I shouldn't have phrased it like that. obviously if someone had a BCC or CLL it's unlikely they would be covered, but my point is she is covered. Though having read the complaint, it looks like she is going after them for violation not only of the ADA, but also FMLA, the DC FMLA and the DC Human Rights Act. She is suing for her job back (or back and front pay), compensatory damages, punitive damages.

 

[SeniorWrangler]

Going outside the system to involve the government always results in the institution joining ranks against you. It's the medical equivalent of the police department's "blue wall of silence."

 

[HarryMTieboutMD]

Also keep in mind it is pretty difficult to fire a resident. Most departments give ample chances and bend over backwards to keep someone because being down someone creates scheduling nightmares, etc. I know nothing about GW's psych department or the institution's policies on resident termination, but I would be VERY surprised if she were not given multiple chances to improve upon whatever her deviant behavior actually was. That said, the Miami neuro resident who got drunk and assaulted the Uber driver on a video that went viral was ultimately fired, which is surprising given 1) the strength of Florida's PHP (called PRN) especially for med student and resident involvement and 2) the lack of professional standards at the U in general (Thug U, Nemeroff, booster issues, etc)

 

[splik]

Also keep in mind it is pretty difficult to fire a resident. Most departments give ample chances and bend over backwards to keep someone because being down someone creates scheduling nightmares, etc. I know nothing about GW's psych department or the institution's policies on resident termination, but I would be VERY surprised if she were not given multiple chances to improve upon whatever her deviant behavior actually was. That said, the Miami neuro resident who got drunk and assaulted the Uber driver on a video that went viral was ultimately fired, which is surprising given 1) the strength of Florida's PHP (called PRN) especially for med student and resident involvement and 2) the lack of professional standards at the U in general (Thug U, Nemeroff, booster issues, etc)

nonsense it is very easy to fire a resident and invent reasons and a paper trail. the issue is more that it is typically not in the interests of a department to do so (need a warm body, affects morale, affects recruitment, threat of legal action) so usually the resident is someone who pisses off the wrong people as most of the time it is more hassle to fire a resident than keep them. however I am familiar with surgical programs that happily axe residents they don't like and invent reasons to do so

 

[lymphocyte]

nonsense it is very easy to fire a resident and invent reasons and a paper trail.

Do you really know what you're talking about here? For example, what's a programme supposed to do with an "invented paper trail"? Enter it into discovery? Congratulations. You've falsified evidence, perjured yourself, and your attorney has a duty to remediate. And do you really think opposing counsel isn't going to subpoena records and testimony to cross-verify? What's the risk/benefit for a programme here? I don't know what surgery residency you're talking about, but if it went around "happily axing" residents, then I would think its name would be hollered from every SDN mountaintop.

Here's the deal:

1. You keep saying "covered by the ADA." But having a disability under the ADA doesn't automatically entitle you to protection under the ADA. There are a lot of other requirements, including the obligation to perform "essential job functions" despite reasonable accommodations (meeting a very specific legal criteria). Hence, the particulars and a paper trail are key.

2. I am not a lawyer, but I know enough lawyers to confidently say this: if anybody found themselves in this situation, they should meticulously document everything and speak to a lawyer sooner rather than later. I also wouldn't tell anybody I was speaking with a lawyer, until it was clear they were getting ready to dump you. You can preempt to a certain extent.

3. I have zero clue about the merits of this case, but I don't see the wisdom in speaking publicly if litigation were a realistic possibility (as opposed to a Hail Mary). Why? Because you better have your facts 100% correct, nobody really cares, I'd imagine an embarrassed programme is a vengeful programme, and your public reputation is at stake--on Google, forever. Some in this thread even seemed comfortable speculating about the presence of a personality disorder on the basis of a few snippets. The lay public might not be as sophisticated as ya'll, but they'll be just as rigorous in forming their opinions.

 

[splik]

Do you really know what you're talking about here? For example, what's a programme supposed to do with an "invented paper trail"? Enter it into discovery? Congratulations. You've falsified evidence, perjured yourself, and your attorney has a duty to remediate. And do you really think opposing counsel isn't going to subpoena records and testimony to cross-verify? What's the risk/benefit for a programme here? I don't know what surgery residency you're talking about, but if it went around "happily axing" residents, then I would think its name would be hollered from every SDN mountaintop.
.

I can tell you I have have personally been the victim of false allegations that could have resulted in my termination from residency. To this day, I still do not know who made this allegation. Luckily my program director was supportive of me and an independent investigation exonerated me of any wrongdoing. Had I been in a more toxic program, been more widely disliked, had a program director who pandered to whatever the faculty wanted, or who was less supportive, I could have easily been fired. So yes I know what I am talking about, and since that time have been active in championing and defending residents' rights, and become more widely familiar with issues across the country. Like you I am not a lawyer, and have been using concepts loosely but I think most people know what I mean when discussing the ADA. This does not represent a misunderstanding of the law, and I regret any confusion I may have caused, but it I think it has been clear to most people what I mean when I use non-legal terms. Of course it is for the court/jury etc to decide whether the person should be protected by the ADA - the defendants will likely be arguing that she should not, I didn't think it was necessary to spell out the obvious.

Also do not underestimate the power of groupthink and cognitive dissonance. When people become complicit in creating a paper trail, they do not believe they are lying, falsifying records, or would be perjuring themselves. Also the point of a paper trail is to avoid it coming to court, but to file motion for summary judgment. One technique is for faculty to all write bad evaluations (having not completed evaluations at the time of the rotations) for a targeted resident at once. This creates a paper of trail of multiple individuals raising serious concerns about clinical competence/professionalism or whatever about the individual. You also have to bear in mind that residents are in the unique situation of being "student"-employees in medical training. The courts are going to rely heavily on the training program to establish the incompetence of the individual giving them a degree of power they would otherwise not have. None of the faculty are going to testify in favor of the plaintiff.

 

[Doctor Bagel]

She's already terminated, so I think going public is probably her best bet at this point. It doesn't sound like GW was going to help her find another residency, and being a physician without having completed residency is pretty much like not being a physician. Might as well go nuclear at this point. Who knows what really happened, but I suspect most residency programs (the non-malignant ones) would do whatever they could to accommodate someone who had cancer even if they weren't obligated to do so (and I don't think they always are -- FMLA covers what 90 days and isn't even required for people in their first year of employment. I'm less sure about ADA as well). Likely even if said resident had a personality disorder, which btw, we have no reason to believe she has (would we be asking this question if she were male, less attractive, etc?).

 

[HarryMTieboutMD]

Also do not underestimate the power of groupthink and cognitive dissonance. When people become complicit in creating a paper trail, they do not believe they are lying, falsifying records, or would be perjuring themselves. Also the point of a paper trail is to avoid it coming to court, but to file motion for summary judgment. One technique is for faculty to all write bad evaluations (having not completed evaluations at the time of the rotations) for a targeted resident at once. This creates a paper of trail of multiple individuals raising serious concerns about clinical competence/professionalism or whatever about the individual.

This, I will agree, is shockingly common. As soon as a problem (read- clashes with attending) med student or resident is identified, the rest of the faculty almost blindly follows suit...

 

[SpaceDoc]

This goes right along with their known trend of terminating / attempting to terminate a resident after finishing PGYII every year since 2011 (perhaps longer but that is as far back as I can track). They were especially successful this year as they could simply say this resident missed time at work and cite that as unsatisfactory or unprofessional. They saw cancer and thought easy target. I was interested enough in the past to spend time on this and I was able to get the names of 5 residents they have done this to. Some did not want to talk about it and some shared some info which I found to be fascinating. I mean, this happens every year in this program. There are only 6 people in this program every year. There is a reason for it. Will it become public? Who knows.

 

[lymphocyte]

This goes right along with their known trend of terminating / attempting to terminate a resident after finishing PGYII every year since 2011 (perhaps longer but that is as far back as I can track). They were especially successful this year as they could simply say this resident missed time at work and cite that as unsatisfactory or unprofessional. They saw cancer and thought easy target. I was interested enough in the past to spend time on this and I was able to get the names of 5 residents they have done this to. Some did not want to talk about it and some shared some info which I found to be fascinating. I mean, this happens every year in this program. There are only 6 people in this program every year. There is a reason for it. Will it become public? Who knows.

The plot thickens.

 

[nancysinatra]

There's two sides to every story. That means there's two sides. I withhold judgement on everybody involved, including GWU. It's too easy to blame.

I read the link, and I honestly don't care what the other side is. Even if the resident in question is blatantly lying, I still don't care what GWU's side is. It's David vs. Goliath, and so even IF the resident is a totally incompetent, unreliable piece of work, and even IF he/she faked a cancer diagnoses (which I have no reason to believe any of that's the case, but I'm just saying) - even then I'd still side with the resident and against GWU. Because what needs to happen in medical training in this country is that more and more residency programs need to be exposed for what they are - malignant mills of cheap labor that skirt employment laws - and if GWU can be made an example of, I'm all for it. Seriously, trainees all over America need to get together and declare war on residency programs. They need to insist on being paid a wage that is commensurate with their student loans, demand a power structure that honors something other than the ice-cream-cone hierarchy immortalized in the House of God, and demand fair leave and termination policies. End of story.

 

[lymphocyte]

Because what needs to happen in medical training in this country is that more and more residency programs need to be exposed for what they are - malignant mills of cheap labor that skirt employment laws - and if GWU can be made an example of, I'm all for it. Seriously, trainees all over America need to get together and declare war on residency programs. They need to insist on being paid a wage that is commensurate with their student loans, demand a power structure that honors something other than the ice-cream-cone hierarchy immortalized in the House of God, and demand fair leave and termination policies. End of story.

Edit: See below.

 

[lymphocyte]

I read the link, and I honestly don't care what the other side is. Even if the resident in question is blatantly lying, I still don't care what GWU's side is. It's David vs. Goliath, and so even IF the resident is a totally incompetent, unreliable piece of work, and even IF he/she faked a cancer diagnoses (which I have no reason to believe any of that's the case, but I'm just saying) - even then I'd still side with the resident and against GWU. Because what needs to happen in medical training in this country is that more and more residency programs need to be exposed for what they are - malignant mills of cheap labor that skirt employment laws - and if GWU can be made an example of, I'm all for it. Seriously, trainees all over America need to get together and declare war on residency programs. They need to insist on being paid a wage that is commensurate with their student loans, demand a power structure that honors something other than the ice-cream-cone hierarchy immortalized in the House of God, and demand fair leave and termination policies. End of story.

I had three reactions to what you wrote. Complicated.

1. Outright applause. An eloquent call to arms. H L Mencken-esque and I can get on board (I mean the Mencken reference as a compliment.)

2. However, it's not just residents who suffer from those who think "work to live" and "live to work" are interchangeable. And the vast majority of people don't end up with > 4 x the median household income at the end of four miserable years of toil. Even factoring in debt, residents win big in the long run getting trained with mostly FICA-funded GME positions. And anec-data aside, it seems pretty darn hard to fire a resident, though I acknowledge it happens and the fear is certainly real--just like it is for most workers. The system for most people is incredibly dehumanising, though, at some point, the vast majority of residents move on to much greener pastures, while everybody else chews cud. But. That doesn't change the fact that residents are suffering.

3. But who is really responsible to change things? The onus shouldn't be on trainees to "declare war" on residency programmes. They seem like the the most vulnerable in this process. High debt, getting "black-listed," no comparable career alternatives. The burden weighs heavy. Meanwhile, where are the medical schools in all of this? The attendings? The academics? The professional organisations? What disappoints me the most isn't that the system seems so lopsided (nothing is perfect, everything is in progress), but that there are so many bystanders who don't feel compelled to defend vulnerable workers (in this case, residents). It's pretty hard to fathom that a law was required to limit the resident work week to 80hrs on average. And who pushed that law through Congress? It certainly wasn't the residents. It was a well-connected and rich layperson. So it goes.

No easy answers for me. I'm still pessimistic that things will change. Why? All the incentives line up the wrong way--even for the residents, who want to get done with training as quickly as possible to pay off their massive debt. At the end of the day, a dollar is a dollar, and when the culture in general values the dollar over people's well-being, well, people suffer. That's just as much true for residents as for patient's. Yeah, yeah. Roll your eyes. I'm for worker's rights and universal healthcare too. Puppies and rainbows for everybody. But it's not always obvious--especially to vulnerable workers--that economic security shouldn't be placed at odds with personal well-being. Try telling that to medical students or residents 200K+ in debt... Everybody is for the system until the system turns against them.

 

[Ceke2002]

I read the link, and I honestly don't care what the other side is. Even if the resident in question is blatantly lying, I still don't care what GWU's side is. It's David vs. Goliath, and so even IF the resident is a totally incompetent, unreliable piece of work, and even IF he/she faked a cancer diagnoses (which I have no reason to believe any of that's the case, but I'm just saying) - even then I'd still side with the resident and against GWU. Because what needs to happen in medical training in this country is that more and more residency programs need to be exposed for what they are - malignant mills of cheap labor that skirt employment laws - and if GWU can be made an example of, I'm all for it. Seriously, trainees all over America need to get together and declare war on residency programs. They need to insist on being paid a wage that is commensurate with their student loans, demand a power structure that honors something other than the ice-cream-cone hierarchy immortalized in the House of God, and demand fair leave and termination policies. End of story.

*thunderous round of applause!

The third reaction was this. The onus shouldn't be on trainees to "declare war" on residency programmes. They seem like the the most vulnerable in this process. High debt, getting "black-listed," no comparable career alternatives. The burden weighs heavy. Meanwhile, where are the medical schools in all of this? The attendings? The academics? The professional organisations? What disappoints me the most isn't that the system seems so lopsided (nothing is perfect, everything is in progress), but that there are so many bystanders who don't feel compelled to defend vulnerable workers (in this case, residents). It's pretty hard to fathom that a law was required to limit the resident work week to 80hrs on average. And who pushed that law through Congress? It certainly wasn't the residents. It was a well-connected and rich layperson. So it goes.

No easy answers for me. I'm still pessimistic that things will change. Why? All the incentives line up the wrong way. Even for the residents, who want to get done with training as quickly as possible to pay off their massive debt. At the end of the day, a dollar is a dollar, and when the culture in general values the dollar over people's well-being, well, people suffer. That's just as much true for residents as for patient's. Yeah, yeah. Roll your eyes. I'm for worker's rights and universal healthcare too. Puppies and rainbows for everybody. So unionise away, but the history of the Labour Movement in the US hasn't exactly been a total win. It's not always obvious--even to workers--that economic security shouldn't be placed at odds with personal well-being. But try telling that to a medical student or resident 200K+ in debt. Everybody is for the system until the system turns on them.

It shouldn't be up to trainees or residents, the highers ups should give more than two ****s about those who work for them. But if they don't, or they're not prepared to, then why take it lying down? Organise, unionise, stop work for all non emergent cases until your demands are met, or they're at least prepared to come to the table and negotiate. Proper deference for titles aside, if you're a Doctor who's (for example) working for a large hospital/healthcare organisation then you're a worker, and chances are that organisation relies on people like you to bring in the money for them - okay then, fine, see how long that money wheel keeps spinning when the workers down tools.

 

[deleted736562]

I read the link, and I honestly don't care what the other side is. Even if the resident in question is blatantly lying, I still don't care what GWU's side is. It's David vs. Goliath, and so even IF the resident is a totally incompetent, unreliable piece of work, and even IF he/she faked a cancer diagnoses (which I have no reason to believe any of that's the case, but I'm just saying) - even then I'd still side with the resident and against GWU. Because what needs to happen in medical training in this country is that more and more residency programs need to be exposed for what they are - malignant mills of cheap labor that skirt employment laws - and if GWU can be made an example of, I'm all for it. Seriously, trainees all over America need to get together and declare war on residency programs. They need to insist on being paid a wage that is commensurate with their student loans, demand a power structure that honors something other than the ice-cream-cone hierarchy immortalized in the House of God, and demand fair leave and termination policies. End of story.

I'm sure someone here will come in and say residents are getting 4/5 hours of didactics every week and are a burden on everyone else....

 

[lymphocyte]

*thunderous round of applause!

It shouldn't be up to trainees or residents, the highers ups should give more than two ****s about those who work for them. But if they don't, or they're not prepared to, then why take it lying down? Organise, unionise, stop work for all non emergent cases until your demands are met, or they're at least prepared to come to the table and negotiate. Proper deference for titles aside, if you're a Doctor who's (for example) working for a large hospital/healthcare organisation then you're a worker, and chances are that organisation relies on people like you to bring in the money for them - okay then, fine, see how long that money wheel keeps spinning when the workers down tools.

Something similar happened in the UK this year (where they have stronger labour laws). I'm curious if anybody knows how the junior doctor strike turned out? I can't find any definitive updates.

 

[Ceke2002]

Something similar happened in the UK this year (where they stronger labour laws). I'm curious if anybody knows how the junior doctor strike turned out? I can't find any definitive updates.

Last I heard a preliminary agreement had been reached between the BMA and the Government, new contracts were being drafted and were going to be presented to the Junior Doctors for a vote on whether to accept - something like that anyway.

 

[Ceke2002]

they rejected it

Ah, thanks, I wasn't up to date on that.

 

[randomdoc1]

nonsense it is very easy to fire a resident and invent reasons and a paper trail. the issue is more that it is typically not in the interests of a department to do so (need a warm body, affects morale, affects recruitment, threat of legal action) so usually the resident is someone who pisses off the wrong people as most of the time it is more hassle to fire a resident than keep them. however I am familiar with surgical programs that happily axe residents they don't like and invent reasons to do so

I have to agree with splik on this one. I have seen residents happily axed and the dean of my medical school attests to this too. It is not hard to create a paper trail, distort truths, exaggerate, and gather a few more people who do not like the person. It is sickening. Yes, unfortunately there are unpleasant people but that doesn't necessarily mean that just because someone is not liked by X, Y, and Z, they would make for a crappy physician. There's a shortage of physicians, it takes tons of resources to train one, and I find it really greedy for people in power to do these things just to satisfy their personal selfish needs. Besides, what are we? Toddlers? Just because you don't like someone, let's wreak hell on them and maybe ruin their career. How mature...Of course, I'm talking about cases where a resident is wrongfully terminated. There are cases where termination is indicated but wrongful termination happens quite a lot. And, I give kudos to people who are loud about the cases where that is indicated.

 

[Merovinge]

having consulted in some of the sorts of cases, in my experience the resident frequently has a personality disorder or is otherwise seen as a "difficult person" and has little insight into their behavior. That said, usually the department has done something wrong (for example engaging in medicare fraud, or engaging in ethically questionable practices) or overreacting to something or a faculty member has done something bad (like sexually harass the resident) and then they try to cover it up.

Can you explain this a bit more? I'm wondering if you mean that many departments are committing fraud/ethically questionable practices and thus do NOT fire someone to avoid an investigation or somehow scapegoat this onto a resident?

 

[randomdoc1]

Can you explain this a bit more? I'm wondering if you mean that many departments are committing fraud/ethically questionable practices and thus do NOT fire someone to avoid an investigation or somehow scapegoat this onto a resident?

I'm guessing a resident can be not terminated OR terminated to serve some of these purposes. For example, someone can label a resident as psychiatrically unstable...possibly psychotic if they fear a resident can expose the program in someway. I know it's a violation of HIPAA or possibly even plain defamation (which can also be ground for suing but is notoriously hard to prove and get claims for) but I can picture this happening. Or maybe another example is there is an adverse outcome and it might be tempting for a department to scapegoat a resident, label them as incompetent for whatever reason and terminate the resident so they look good even though studies show that when adverse events happen, it is usually a multitude of factors (e.g. swiss cheese model). On the other hand, I can also see how some programs may decide to keep a resident if they fear a termination will expose them of something bigger?

 

[IndigoBoy0]

One resident who was originally in the class of 2015, joined the class of 2016. one resident who was in the class of 2015 left and transferred into EM. one resident in the class of 2016 transferred into a more competitive program on the other coast. the class of 2017 has had no attrition in residents. the class of 2018 has apparently had the termination of the resident who was the discussion of this thread, and she has been replaced. Other residents who have left were replaced. I am not aware of any other residents having left though it could have happened. Residents who are terminated do not find themselves landing in more competitive programs or competitive specialties so um... they certainly have a higher turnover than average but i wouldn't read too much into it. i have some friends who went there for residency and they liked it and have done well for themselves. the institution as a whole does not have a good track record on things and has many flaws but I am not clear on whether this extends to the psychiatry department but it is not a toxic program by any stretch of the imagination though i am sure it is far from perfect and like most programs there will be residents who are the darlings of the program and can do no wrong, and residents who are victimized or otherwise bitter.

I don't think she was replaced. There was a new person added to the class of 2019, but they always take in a new PGY2. No one has been added to this years class to take her spot which makes the whole thing even more odd. If they were getting funded for x number of spots and y quits why wouldn't they directly replace him/her unless they had too many people to begin with because lots of people in this program constantly take maternity leave... sick leave... graduate late. Also interestingly, there have been other people in the program who have been sick and been able to take much more time then this resident with no concern so I think it points to more of an issue that they just didn't like her/she was a "problem resident"/was doing something wrong/wanted to get rid of her.

 

[Ceke2002]

I don't purport to understand the system in America, and I know it's obviously a very different cultural environment to Australia, but I still think its total BS that any of you guys should be treated badly or be put out of a job for no good reason, or some made up nonsense reason. To me a healthy community forms part of the back bone of society, so why shaft those people who are working towards, or work in the healthcare field, especially when they're the ones who can actually do something to improve people's condition in life. I just find it incredibly sad and frustrating to hear about seemingly good people being given the short end of the stick for petty, bulldirt reasons, and then seemingly having little to no recourse.

 

[Shikima]

I don't purport to understand the system in America, and I know it's obviously a very different cultural environment to Australia, but I still think its total BS that any of you guys should be treated badly or be put out of a job for no good reason, or some made up nonsense reason. To me a healthy community forms part of the back bone of society, so why shaft those people who are working towards, or work in the healthcare field, especially when they're the ones who can actually do something to improve people's condition in life. I just find it incredibly sad and frustrating to hear about seemingly good people being given the short end of the stick for petty, bulldirt reasons, and then seemingly having little to no recourse.

The difficulty lies wherein of the training of physicians in contrary to the at-will employment laws of each state since there is no national law.

 

[Ceke2002]

The difficulty lies wherein of the training of physicians in contrary to the at-will employment laws of each state since there is no national law.

And I can imagine trying to implement a national law wouldn't exactly go down to well, not to mention with the size of the US be extremely difficult to do.

 

[kva]

It looks like Stephanie had filed suit against GWU for employment discrimination, at least a month prior to sending the letter to Wibble.

http://www.plainsite.org/dockets/30...rt/waggel-v-the-george-washington-university/

 

[sesquiculus]

This goes right along with their known trend of terminating / attempting to terminate a resident after finishing PGYII every year since 2011 (perhaps longer but that is as far back as I can track). They were especially successful this year as they could simply say this resident missed time at work and cite that as unsatisfactory or unprofessional. They saw cancer and thought easy target. I was interested enough in the past to spend time on this and I was able to get the names of 5 residents they have done this to. Some did not want to talk about it and some shared some info which I found to be fascinating. I mean, this happens every year in this program. There are only 6 people in this program every year. There is a reason for it. Will it become public? Who knows.

Been following this situation for some time. This alone tells you it is nothing new, but an established pattern.

Any resident termination is very rare, particularly in psychiatry. One a year says there is something either seriously wrong with their choice of residents or with the department itself. Which seems more likely? Assuming the case goes this far, it will be very interesting to see what emerges on discovery.

 

[slappy]

I don't think she was replaced. There was a new person added to the class of 2019, but they always take in a new PGY2. No one has been added to this years class to take her spot which makes the whole thing even more odd. If they were getting funded for x number of spots and y quits why wouldn't they directly replace him/her unless they had too many people to begin with because lots of people in this program constantly take maternity leave... sick leave... graduate late. Also interestingly, there have been other people in the program who have been sick and been able to take much more time then this resident with no concern so I think it points to more of an issue that they just didn't like her/she was a "problem resident"/was doing something wrong/wanted to get rid of her.

Because they'll have to find someone.

 

[notdeadyet]

Seriously, trainees all over America need to get together and declare war on residency programs. They need to insist on being paid a wage that is commensurate with their student loans, demand a power structure that honors something other than the ice-cream-cone hierarchy immortalized in the House of God, and demand fair leave and termination policies. End of story.

I hear folks say this as a rallying cry, but here's why I'm dubious:

No other country has medical students rack up the loan debt that we do in the United States. In many countries, medical school is (or is nearly) free.

And...

No other country has doctors who make the kind of money U.S. doctors do.

But how many U.S. docs would vote to eliminate medical school debt in exchange for taking a 20% paycut on their earnings for the rest of their lives? I wouldn't. I don't know many doctors who would. And that 20% payout would still make me a much higher paid doctor than my counterparts in almost any other country, even taking into account cost of living. And today, if I take that proposed 20% of my income and put it towards my massive student loans, I'll still pay the debt off in 12-15 years. And come out millions ahead on the deal than if I took the cut in exchange for zero medical school debt. There are many ways that residents can offset medical school debt and choose not to (emphasis on choose).

I agree that ACGME needs to do a better job policing bad residency programs. But most residency programs, at least the ones I'm familiar with, aren't bad ones. Yes, you will work longer hours than you like. Yes, you will do things you do not want to do. Yes, you will make sacrifices. And yes, you will be treated as another apprentice, like many around the hospital in many fields. Given my experience in other fields, I was pleasantly surprised by how much voice residents get at the table given the fact that we have very, very little practical experience. At many hospitals, residents do a bulk of the workload, but that doesn't mean we can call the shots any more than it does in any other industry.

Residency is definitely a best-of-times/worst-of-times thing, and I don't know anyone who hasn't questioned if it was all worth it at some point. I certainly did. But for the majority of psychiatry residencies out there, I don't think it rates the level of injustice people paint it to be here. It's pretty low on the injustice-scale in the healthcare world and pretty low on the injustice-scale for most things I've encountered in life. In the almost-worst case scenario, you have 4 years of potential suck for a job-for-life that pays in the top 2-4% for a 40 hour workweek.

 

[notdeadyet]

If up-and-coming folks want to avoid some of the bad residency experiences that many residents walk away with, here's a few tips based on potential gripe:

• Debt: Choose the cheapest schooling you can if you are want the highest standard of living. Your school debt will be the biggest one you have in your life (unless you live in the Bay Area or Manhattan, then it will likely be your starter home).
• Wages: They are low in residency. If its important to you, look into programs with moonlighting opportunities. Even at a hard working residency, you will have ample time to moonlight PGY-2-PGY-3. You can double your income by working like a dog. You can increase it by 50% working one weekend per month in many locales.
• Leave and termination policies: Ask. Simply... ask. During the interview process, there should be ample documentation if you request it. If a residency doesn't have it or won't give it to you, this is a problem. Keep in mind that you will not be getting the bennies you would from a good union gig, you will be getting bennies typical of an apprentice-ship. In other words, expect to make up any time you take off in excess (if you need 3 months off for bereavement or baby in excess of vacation/sick, expect to tack that on to the end of your residency).
• Power structure: Ask. What voice and seat at the table do residents have? Little to none? Push that residency down lower on your list. Do they have a role? Good. When you get there, work hard and become a resident leader or a Chief. Then exercise that role to improve conditions and options for your residents.

Your best bet for a happy residency is having a choice of residency. Do what you can to work hard in medical school to improve your chances to get more choice. This doesn't mean a top 10 residency. I'd be comfortable saying that most residencies are good ones. I'd be confident saying the top 1/3rd are very good. This won't make it fun and you will be irritated, tired, outraged, sorrowful, and at times have your turn in the barrel with burnout. But you will also have wonderful times when you realize how much you've learned and what you're capable of because of what you've learned in residency and the time invested in your training by you, your fellow residents, your faculty and your patients. And this will happen at any program.

 

[Mass Effect]

I read the link, and I honestly don't care what the other side is. Even if the resident in question is blatantly lying, I still don't care what GWU's side is. It's David vs. Goliath, and so even IF the resident is a totally incompetent, unreliable piece of work, and even IF he/she faked a cancer diagnoses (which I have no reason to believe any of that's the case, but I'm just saying) - even then I'd still side with the resident and against GWU. Because what needs to happen in medical training in this country is that more and more residency programs need to be exposed for what they are - malignant mills of cheap labor that skirt employment laws - and if GWU can be made an example of, I'm all for it. Seriously, trainees all over America need to get together and declare war on residency programs. They need to insist on being paid a wage that is commensurate with their student loans, demand a power structure that honors something other than the ice-cream-cone hierarchy immortalized in the House of God, and demand fair leave and termination policies. End of story.

While I agree with the spirit of your post, I find it disheartening that all programs are painted with the same brush. Frankly, I'm at a program that treats us well. Our hours are more than reasonable, the workload is more than manageable, our call is ridiculously less than many other programs, our PD has had not only my back, but the back of some of my colleagues when issues came up on other services. I mean, in terms of residency, I think we're spoiled. Let's not forget there are some programs and some PDs out there who actually do give a damn about their residents.

 

[cookymonster]

All psychiatry residencies are uniquely exploitative among medical specialties in their excessive length, even with the duty hour changes. It makes zero sense that a field with our knowledge base has a four year "apprenticeship," while all the primary care specialties are three years. I spent most of fourth year providing the bare minimum of at times unsupervised cheap labor my program forced me to donate, attending one hour of didactics a week, moonlighting for 150 hours a month to get paid a semblance of what I was worth, and taking off at 2pm to catch some z's. Why anyone would tack on a fellowship, with the possible exception of forensics, after sacrificing a prime year of earning potential, defies credulity to me. But obviously the chances that the ACGME recommends reducing the length of training is probably on par with that of ABMS passing a unanimous resolution to abolish MOC. The system is completely stacked in their favor.

The best residency programs are the large ones where you can fly under the radar, moonlight liberally, break duty hour rules, and where hands-off attendings allow you to develop your decision-making autonomously. Quality didactics are nice too. Your time in residency goes by so fast that unless for some crazy reason you want to work your way into the Death Star after training it isn't worth it to get involved with administrative BS or try to fix anything. There are a thousand better uses of your time. When you get done with it all, you're going to feel like a puppy that got adopted out of an animal shelter, and you're going to feel sorry for all the mutts you had to leave behind, but just like all the BS in high school, you'll soon remember that there's nothing you can do about it and quickly consign it to oblivion.

 

[splik]

4 years is not very long. You cannot learn it all in 4 years. you cannot get training in long-term therapy if residency is shorter. The 4th year is the opportunity to hone skills in the basics, as well as acquire leadership and administrative skills, learn different modalities of psychotherapy (for example MBT, ACT, ISTDP), or get exposure to specialist areas in psychiatry (for example adult autism, early onset-dementia, sexual medicine, forensics, paraphilias, eating disorders, pain, sleep, palliative medicine, neuropsychiatry, TBI) or do research/teaching/global mental health etc.

Personally I would have loved to have learned family therapy, couples therapy, psychoanalytic group therapy, mentalization based treatment and functional analytic psychotherapy during residency but I didn't get the chance. I would have loved to have done a sleep medicine rotation, and got more exposure to eating disorders and sexual dysfunction but there is only so much time. I wish I had been able to get more comfortable with the assessment and management of autistic spectrum disorders in adults. I didn't get to do amytal interviewing which would have been cool (but I suppose hypnosis will suffice).

I think a lot of residents are not getting training in using TCAs, MAOIs, clozapine, ECT, some of the newer psychotherapies, administrative leadership/management skills. We would do well to learn how to manage the conditions we cause in our patients (like diabetes).

The problem is not that residency is too long, it is that many programs are unable to effectively train psychiatrists in that time, and many residents are too lazy to effectively use their time appropriately. I learned a huge amount in my 4th year right until the very end (though of course was very ready to be done).

As I've discussed before, I think there is way too much pseudoscience at the heart of residency training and would like to see psychiatrists learn to make real diagnoses rather than pseudomedical diagnoses, use empirical psychological theories rather than just voodoo, and learn neuropsychiatry and medical genetics rather than pseudoscience about the biological basis of mental disorders.

 

[jettavr6]

It looks like Stephanie had filed suit against GWU for employment discrimination, at least a month prior to sending the letter to Wibble.

http://www.plainsite.org/dockets/30...rt/waggel-v-the-george-washington-university/

Don't know if I'm reading this right, but the lawsuit demand is for $300 million dollars.

 

[Doctor Bagel]

I think a lot of residents are not getting training in using TCAs, MAOIs, clozapine, ECT, some of the newer psychotherapies, administrative leadership/management skills. We would do well to learn how to manage the conditions we cause in our patients (like diabetes).

It's not like our ability to learn stops when we end residency, though. I had pretty limited exposure to clozapine as a resident and now use it pretty regularly in my current job. No one becomes a great therapist by the end of residency which is why a lot of people continue to pay for supervision (which is still financially a win versus hanging around making $60k as a resident). Specialties with a much broader scope of knowledge have shorter residencies than we do, and we routinely allow residents to skip their 4th year by fast-tracking into child psychiatry.

 

[cookymonster]

Saying that psychiatry residencies need the fourth year to learn Amytal interviewing, ECT, how to do specialized psychotherapies, treatment of paraphilias, administrative, public, and social psychiatry, treatment and specialized diagnosis of dementias, etc is like saying internal medicine residencies need to be ten years so internists know how to do PCIs, bronchoscopies, colonoscopies, and manage dialysis patients by the time they finish training.

If you want to learn all that stuff, have at it. But not all of it is an essential part of our armamentarium.