Residency contract non-renewal. How should I move forward?

[gutonc]

Any thoughts on Step 3? I can't find any specific dates (such as the MCAT back in my day, which was given 2x per year) so I'm guessing that you can sign up for Step 3 at any time? Also, if you had tons of free time, how much would you spend studying for Step 3? I spent 4-5 weeks on step 1 and 2, made >220 on both.

Step 3 has specific dates, but there are a lot of them and they are spread throughout the year so you can pretty much take it whenever.

If I had tons of free time I would spend about 6 ounces of it studying for Step 3 and the rest doing something to improve my CV...or pay the rent. Step 3 won't really do much to improve (or worsen) your application at this point. And frankly, it's the easiest of the steps by far. I probably spent a total of 25 hours over the course of a month studying for it, usually an hour or two at a time, and scored 15 points higher than my Step 2 (which was about 15 points higher than my Step 1...which I studied an insane amount for).

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[sella turcica]

Step 3 has specific dates, but there are a lot of them and they are spread throughout the year so you can pretty much take it whenever.

If I had tons of free time I would spend about 6 ounces of it studying for Step 3 and the rest doing something to improve my CV...or pay the rent. Step 3 won't really do much to improve (or worsen) your application at this point. And frankly, it's the easiest of the steps by far. I probably spent a total of 25 hours over the course of a month studying for it, usually an hour or two at a time, and scored 15 points higher than my Step 2 (which was about 15 points higher than my Step 1...which I studied an insane amount for).

Let me clarify what I was thinking - if I take Step 3 and pass with a decent score, I assumed that this would help convince a place (even somewhat) that I'm not a complete crap resident. It surprises me to hear that this wouldn't matter, but perhaps that is true.

As for beefing up the cv, I'm not sure how to realistically do that in the interim. Jobs are hard to come by and I might end up doing some kind of random crap-job in the time being. It would be nice to do something in clinical research/etc but obtaining something related will be sheer luck. People see MD on a cv and probably assume that I won't walk in the door for <75k.

 

[gutonc]

Let me clarify what I was thinking - if I take Step 3 and pass with a decent score, I assumed that this would help convince a place (even somewhat) that I'm not a complete crap resident. It surprises me to hear that this wouldn't matter, but perhaps that is true.

If you had gotten 185 on Step 1 and 2 and then rocked a 260 on Step 3, then yes, it would probably help you out a little bit. But you did fine (not stellar, but just fine) on Step 1 and 2. Nobody is going to take an extra look at your app because you bump another 20 or 30 points on Step 3 simply because that's not really a useful comparator since very few other applicants have taken it. A good score on Step 3 is roughly equivalent to being involved in your med school's IM interest group. Potentially something to talk about during an interview but not particularly important.

As for beefing up the cv, I'm not sure how to realistically do that in the interim. Jobs are hard to come by and I might end up doing some kind of random crap-job in the time being. It would be nice to do something in clinical research/etc but obtaining something related will be sheer luck. People see MD on a cv and probably assume that I won't walk in the door for <75k.

I understand this and it definitely makes life difficult for you. I guess what I don't understand is what you've done with your med school to help you out in this situation. You've stated previously that your dean was aware of your situation and helping you out. That's honestly your best chance at this point. Put your tail between your legs and go hobbling back home. Sucks, but that's the reality at this point.

 

[NotAProgDirector]

Step 3 is offered on a rolling basis, so once you register for it you get a "window" of 2-3 months to take it. You can simply sign up any day in your window and take it (although don't forget it's two days long).

You should be certain that there is no more than 7 years between whenever you passed your first step exam, and step 3. Anything longer than that can cause licensing problems in the future. Assuming you are on a "normal" timeline, this shouldn't be a problem (you likely took Step 1 about 3-4 years prior, so you have plenty of time).

What to do about getting your career back on track depends heavily on what you want to do. You absolutely should apply / participate in next year's match. However, you might be able to finagle an off cycle opening -- if I have someone drop out of my program, I'll look at my applications from prior grads, and try to get someone to start early.

 

[Leukocyte]

Very sorry to hear your about situation, Sella Turcica. Keep your chin up, and only look forward. Do not give up on residency. Medicine is not the same, and every field is different. You must apply again in the next match season this September. Try to apply to a different specialty from the one you were in.

I had a medical school friend who also had his contract non-renewed when he was an intern (that was about 6 years ago). He was an IMG. What he did was, he took Step 3 and did well on it. He also started working as a "medical floor secretary" at a hospital. He then applied to programs in a different specialty in the Match. His new specialty was acctually more competetive than his old one. He got a pre-match very early on in the application season! He then went to complete his new specialty with no problems.

So there is definately hope. If an IMG did it, you as an AMG can definately do it. So take Step 3 and find a job (any medically related job), and apply in the Match in September. Keep your chin up, and move forword to your goal.

Best of Luck.

 

[RadOncDoc21]

Step 3 can be an important factor IF the rest of your application is strong. One thing it does is that it is one less thing for a PD to worry about and it shows you can prepare and pass a board exam. I know most people on here claim step 3 is the easiest but trust me, you do not want to fail and have to retake it as an off cycle resident. I didn't match into rad onc and all I had left was step 3... So make it count!

As the above post stated, anything is possible and it's up to you to make it happen. You just need to keep trying and an opportunity will reveal itself.


Good luck!

 

[Law2Doc]

Let me clarify what I was thinking - if I take Step 3 and pass with a decent score, I assumed that this would help convince a place (even somewhat) that I'm not a complete crap resident. It surprises me to hear that this wouldn't matter, but perhaps that is true....

the problem is you'd be doing comparably well on a test that nobody else is putting much time or effort in on. If you studied really hard, you "should" do better than the majority who are just doing enough world problems to pass. so whether places put any stock in an above passing score is questionable. Passing tells them you will actually be able to get licensed, which s important.

But doing well above passing is kind of the equivalent of hitting an inside the park home run against a team that's not even playing anyone in the outfield. Some people might appreciate your swing and your hustle, but most will say that against that kind of lazy competition, it's hard to give you kudos.

Just my two cents.

 

[sella turcica]

the problem is you'd be doing comparably well on a test that nobody else is putting much time or effort in on. If you studied really hard, you "should" do better than the majority who are just doing enough world problems to pass. so whether places put any stock in an above passing score is questionable. Passing tells them you will actually be able to get licensed, which s important.

But doing well above passing is kind of the equivalent of hitting an inside the park home run against a team that's not even playing anyone in the outfield. Some people might appreciate your swing and your hustle, but most will say that against that kind of lazy competition, it's hard to give you kudos.

Just my two cents.

I do agree with you that it probably won't make me stand out in a crowd - after all, there are also MS4's applying for residency who have not been non-renewed and they will also look better than me because of that. Same with residents switching specialties with intern year already completed. I don't kid myself that Step 3 will suddenly make me look as good as those guys. However, I am trying to make myself look as good as I can in the interim, since this is a narrow window for me. I imagine that once I get 2-3 years out from now, it will be a lot harder to get back in than it is right now. I have some connections in the clinical trials field (and I currently live in an area overflowing with that stuff) so I'll probably swing into that for now. Anybody else have suggestions on what to do, in the interim?

 

[SnowyRox]

What sort of work are you doing in the meantime?

Did you find a clinical or non-clinical job?

 

[sella turcica]

What sort of work are you doing in the meantime?

Did you find a clinical or non-clinical job?

Trying not to divulge too much information right now, but I'd like something in the EHR or clinical research realm. They would fit me well. I signed up for Step 3, it can't hurt to get that thing out of the way.

 

[dragonfly99]

I would spend several hours/day for a few weeks studying for the Step 3. Maybe even a month or two.
I agree that you should try to get a medically-related job.
I would then after a few months look for an off-cycle stop, while at the same time reapplying to the Match. You need to decide which specialty though (your same old one or a new one).

 

[sella turcica]

Now that I am preparing to enter the residency application cycle again, I was wondering what I ought to do about my personal statement. Clearly the situation will come up during interviews but should I talk about this in a personal statement now? Of course with all the "I learned xyz from this and blah blah". Good idea or not?

 

[NotAProgDirector]

My personal n=1 opinion is to address it head on in ome facet of your application. Otherwise, it seems you're "hiding" something, and I'm unlikely to explore your application further for fear of what I would find (and hence wasting my time). If you are submitting an LOR from the PD of your prior program, it might all be discussed there and then addressing it in your PS is less critical. You could also address it in the "reason you left" box when you enter it as prior training -- but I don't know how much room they give you there, and whether you can adequately address it there.

 

[Attending1]

Hi guys,

Just happened to see this unfortunate thread on SDN. Residency contract non renewal/ getting fired from residency is a life changing event for a resident, and this topic needs to be discussed and debated much more - ethically and legally

I am an IMG who did an Internal medicine residency in India, worked as an Assistant Prof of IM in India, before moving to the US, and completing my IM residency in the US in flying colors. I have been practicing as an Attending Physician at a medical centre in Virginia for more than 10 yrs.

Now all of us, especially Attendings (those who have crossed the bridge) need to understand that residents are a very vulnerable group, and most of these residents being fired, even those deemed academically weak are very much salvageable. (I'm not talking about the resident fired for criminal behaviour)

These "resident incompetence" firings, in my opinion, are mostly because:

Many of Attendings and PDs, (especially at places where firing residents is commonplace) are shirking their job !

Let me explain: "Residency Training" - that's what it's called - is not a job, it is training;
Attendings are supposed to coach residents reg. focused history taking, clinical examination, eliciting signs, work up and management plans for patients - are they really doing these things sincerely? I found many of the Attendings known to be "tough", to actually be lazy bullies - who would want residents to be submissive labourers rather than treat them as "doctors in training". Most of the tough Attendings want to play "judge", but don't have the competence to play "teacher"! And, they are getting away with it.

If a resident, especially an intern, is terminated for academic incompetence, then it means that the Attendings/ PD/ program who recruited him just a year ago is incompetent in screening, interviewing and admitting residents. What penalty is the program going to pay for it's failure?

Secondly, there needs to be stringent and objective legal apparatus for evaluating the steps taken by the program to remediate the resident, before nonrenewal/ termination. Only after exhaustive and objective remedial exercise should a program be given authority to terminate a resident.

Failure in the ability to remediate should lead to enquiry reg. this failure by the board/ acgme, and a stringent punishment ex: loss of accreditation should be imposed if determined that the program made no concrete/ objective remedial exercise

Thirdly, the PD's letter should not be a "sword of Damocles" around a terminated resident's neck. The requirement for a previous PD's letter, when applying for a fresh PGY-1 position should be abolished; Even for a PGY 2 or 3 position, only the given credit should be mentioned

Of course, if a criminal act/ proven sexual misconduct is the cause of termination, then it must be mentioned in the PD letter/ communicated to the licensing board.

I must say, that I too felt very vulnerable to the whims and fancies of my Attendings/ senior residents during residency, - as have so many of you - and this is due to the gross imbalance of power between faculty and residents. I was thankful to my prior training on many an occasion, and felt that this helped me do some out-of-the-way extra work to please their whims. My IM residency training in India was very strong on the teaching front, despite lacking in facilities compared to the US. Residents there had guaranteed 3 yr terms - you can't be kicked out unless you indulge in criminal activities/ blaring medical negligence etc. - if you are an academically poor resident, you will fail to clear the exit examinations or will have to repeat the course over again - but you will at least not be kicked out based on hearsay. What i say, is that despite the US medical facilities being the best in the world, the US residency system is embroiled in hearsay medieval politics even compared to developing Asian countries.

That's the point - residents should not have to be virtual slaves trying to please their seniors and Attendings- they should be secure trainees with their minds focused on gaining medical experience.

I hope that the senior Attendings in the SDN, especially people like APROGRAMDIRECTOR take note of my points, and strive to improve the pitiable working conditions of medical residents.
Thanks

 

[gutonc]

Just so we're clear here. The program that aPD runs is one of the most resident friendly and supportive programs in the country. Calling him out is quite poor form on your part. Particularly as a new user coming out of nowhere.

 

[rokshana]

on a thread 2 years old no less…

PLEASE come here and "tell us" exactly how it should work…

 

[IlDestriero]

If anything, with the push for defined clinical competencies and trajectories, probation, remediation, repeating years and termination will become a lot more common.
And it's probably for the best. The weak wont squeek through and be borderline incompetent and the troubled may get the appropriate counseling needed to turn things around before they get the axe.

 

[NotAProgDirector]

I actually agree mostly with Attending1's post. There have been several threads on termination recently, and all of them raise concerns that programs are not giving residents adequate time/support to improve, but simply dump them at the first sign of trouble.

Some points:

1. Programs should make a good faith effort to remediate residents who are struggling. This usually involves a period of 3-6 months where the resident gets extra help/supports/schedule adjustments etc, where "unsatisfactory" performance doesn't lead to termination (but satisfactory performance is required by the end). Otherwise, the resident is simply likely to end up in trouble again quickly.

2. Our evaluation systems are flawed, as they are subjective by nature. Other than for procedures and knowledge tested on an MCQ exam, everything else involves another human being assessing skills, and that is fraught with difficulty. Programs need to keep this in mind, recognize that a single poor evaluation (or a group of poor evaluations that are all "related") may not adequately reflect the performance of the resident.

3. Communication is key. Resident need to know when their performance falls below standards, what the timeline for improvement is, and what the possible outcomes (for both successful and unsuccessful) remediation are.

4. I do agree that accepting a resident into your program involves a commitment to help that resident develop their clinical skills. If a resident fails out of my program, it is partially my responsibility to help that resident find the next stage in their training -- obviously some of the responsibility falls on them also. Others may not agree. If we view residency as a job, most employers don't help their fired employees get a new job.

Now, what to do about it. That's complicated.

If you try to make the ACGME oversee this, it's going to get messy quickly. Rather than this being a cooperative, joint process it is likely to turn into an adversarial mess. And, if you put the ACGME in charge of remediation, you're likely to get a one-size-fits-all approach, which isn't going to work well. So I wouldn't do that. You could consider ACGME rules to define what remediation is -- how long, etc. But even that will get very messy quickly.

I do think it would be reasonable to have programs be required to list all candidates that did not complete training. Even this will be very controversial -- for example, I have had residents leave my program to go elsewhere for personal reasons, even though their performance was fine. So a 0% non-completion rate is not necessarily the "right" target. But a simple measure of non-completion and (perhaps) a breakdown of who has a training position for the next academic year and who does not might be interesting and helpful. Ultimately, the ACGME could use such a metric to measure program quality.

I think the idea of making the PD letter bland is a bad idea overall. It certainly is possible that a resident will fail out of a program and end up with a poor review that "isn't deserved" -- i.e. the evaluation system overstated problems, they had a temporary life stressor that caused problems, etc, and then this letter could haunt them. However, it's also possible that a poorly performing resident could jump from program to program. Since each program would be unable to discuss problems with the next, the resident could run into the same problems over and over. I have seen this happen. Plus, even if the law was such that an official letter from the PD could only say what credit they had received, I would not accept someone into my program without a release to speak with the other PD first -- and I expect many PD's would do the same. So, overall, I don't think this is terribly workable.

 

[cognitus]

Do we know for a fact that OP did not receive enough feedback? Do we know whether OP simply lacks insight? The possibly of this happening scares the bejeezus out of me.

 

[Attending1]

I agree that it is very difficult to formulate solutions to deal with residents facing termination for unsatisfactory performance.

And it is possible, that many of these residents facing termination are weak academically or socially.

However, termination from residency surely means sudden and permanent banishment from medical practice for almost 99% of these terminated residents, which is too cruel for graduates hardly 1 yr out of medschool.

And so, we need reform in the way we deal with residents whom we don't want.

Just like programs were forced to reform working hours via the 80 hr rule.

Some possibly helpful ideas:

1. Residency programs should have longer interviews ( even 2 separate days/ second look interviews) where the core clinical skills of potential residency applicants are evaluated independently by several faculty members by standardised methods/ OSCE.

Here, the program would have to filter applicants carefully, and lesser number of people would be called for interviews - but the program faculty will have a much better understanding of the clinical skills of their potential residents. Besides, getting to know if those residents will socially fit in with them. Programs should not fill spots unless they are very satisfied and sure that they want the resident.

2. Once residents match with the program, it should be a secure 3 yr position.

What if the resident turns out to have unsatisfactory performance ? Then it's time for the program to honor it's commitment and make a big effort in chalking out a remedial plan for the resident over a 3 - 6 month period, including 1 or 2 months for focused study in skill deficit areas

A program that does not have the resources/ capacity for remediation should not be allowed accreditation. And remediation should be a legally binding requirement for the program, not charity from the program towards the resident.

3. What if the resident still lags behind ? Then, help the resident move to residencies in other specialties where he could still be good. Ex: a resident less efficient in fast paced inpatient IM could still be good in Psych/ palliative care.



4. I am in favour of a bland PD letter which states credit received. There should be a column which states whether the nonrenewal was for criminal behaviour or not. Conversation between PDs for contract non renewed/ terminated residents should be prohibited, except when termination is for criminal reasons.


Let me tell you why -
The PD who deems a resident unfit for his program will almost certainly talk poorly about the terminated resident ( irrespective of whether the termination was truly just or not) to the prospective PD.

When the prospective PD knows (from previous PD's letter) the terminated resident's received (satisfactory)academic credit, and knows that the resident was not terminated for criminal reasons, then WHY should he talk to the naysayer PD ? For gossip, and getting bad opinionated ? When the prospective PD/ program can always evaluate the transferring resident on their own, and ascertain his fitness !


5. Importantly, the reasons for termination should be communicated confidentially only to ACGME/ certifying board.

This will check an incompetent resident hopping residencies.

Because, if the resident performs poorly even in a second residency, then ( after non renewals in at least 2 consecutive residencies, with overlapping documented defiencies in both residencies), only then should the resident be deemed unfit for medical practice - this should be communicated by Cerifying board/ ACGME to the resident

Here, the Certifying board should have a "resident reentry course" somewhat like the " physician reentry course" here

http://www.ama-assn.org/ama/pub/education-careers/finding-position/physician-reentry.page

Residents who satisfactorily pass this course should be given a due " certificate of reentry completion" and should be allowed to apply for PGY- 1 of any discipline unfettered.


Look forward to your comments and suggestions

 

[Attending1]

Just so we're clear here. The program that aPD runs is one of the most resident friendly and supportive programs in the country. Calling him out is quite poor form on your part. Particularly as a new user coming out of nowhere.

Gutonc, you completely misunderstood me.

I read enough on SDN to know that APROGDIRECTOR gives out genuinely constructive advice

thats why, I made a mention for him to comment

And, what do you think we should do to make resident evaluations more objective ?

 

[Arcan57]

Attending1,
Entry into residency is a highly competitive endeavor and is fundamentally different from the job market that exists post-residency. You could easily have a "certificate of residency re-entry" for failed residents and it would have exactly 0 impact on their ability to actually obtain a residency position. Many specialties these days are essentially closed to anyone other than 1st time applicant AMGs or require significant political connections. Someone that fails out of residency has failed out of residency and I don't see that stigma disappearing because of any non-residency remedial courses. I'm not saying that no terminated residents continue medical training, but that a certificate would be unlikely to be useful.

 

[NotAProgDirector]

1. Residency programs should have longer interviews ( even 2 separate days/ second look interviews) where the core clinical skills of potential residency applicants are evaluated independently by several faculty members by standardised methods/ OSCE.

Here, the program would have to filter applicants carefully, and lesser number of people would be called for interviews - but the program faculty will have a much better understanding of the clinical skills of their potential residents. Besides, getting to know if those residents will socially fit in with them. Programs should not fill spots unless they are very satisfied and sure that they want the resident.

This is not practical. It often takes months to know if a resident is underperforming. We have residents who stumble in the first few months who then go on to do fine. 2 days of interviews isn't going to help.

2. Once residents match with the program, it should be a secure 3 yr position.

What if the resident turns out to have unsatisfactory performance ? Then it's time for the program to honor it's commitment and make a big effort in chalking out a remedial plan for the resident over a 3 - 6 month period, including 1 or 2 months for focused study in skill deficit areas

A program that does not have the resources/ capacity for remediation should not be allowed accreditation. And remediation should be a legally binding requirement for the program, not charity from the program towards the resident.

I do think that some guidelines regarding remediation would be helpful. But putting any time course on it is complicated. Plus, a program that "doesn't care / isn't invested" isn't going to do much better if told to remediate a resident for 3 or 6 months. That's why I like the option of having programs report how many residents have left publicly, and whether they have a new 1+ year training spot.

3. What if the resident still lags behind ? Then, help the resident move to residencies in other specialties where he could still be good. Ex: a resident less efficient in fast paced inpatient IM could still be good in Psych/ palliative care.

Totally agree

4. I am in favour of a bland PD letter which states credit received. There should be a column which states whether the nonrenewal was for criminal behaviour or not. Conversation between PDs for contract non renewed/ terminated residents should be prohibited, except when termination is for criminal reasons.


Let me tell you why -
The PD who deems a resident unfit for his program will almost certainly talk poorly about the terminated resident ( irrespective of whether the termination was truly just or not) to the prospective PD.

When the prospective PD knows (from previous PD's letter) the terminated resident's received (satisfactory)academic credit, and knows that the resident was not terminated for criminal reasons, then WHY should he talk to the naysayer PD ? For gossip, and getting bad opinionated ? When the prospective PD/ program can always evaluate the transferring resident on their own, and ascertain his fitness !

I think this is unrealistic. As mentioned by someone else, I'd simply stop taking anyone from another program rather than risk trouble. If a resident got into trouble in a prior program, I'd have no way to assess whether my program was likely to be successful. And PD's don't always talk poorly about residents who are terminated -- I try to help, and try to be honest.

5. Importantly, the reasons for termination should be communicated confidentially only to ACGME/ certifying board.

This will check an incompetent resident hopping residencies.

Because, if the resident performs poorly even in a second residency, then ( after non renewals in at least 2 consecutive residencies, with overlapping documented defiencies in both residencies), only then should the resident be deemed unfit for medical practice - this should be communicated by Cerifying board/ ACGME to the resident

Here, the Certifying board should have a "resident reentry course" somewhat like the " physician reentry course" here

http://www.ama-assn.org/ama/pub/education-careers/finding-position/physician-reentry.page

Residents who satisfactorily pass this course should be given a due " certificate of reentry completion" and should be allowed to apply for PGY- 1 of any discipline unfettered.

I do like this idea, that the ACGME consolidates resident performance data. This would avoid residents "omitting" prior training instead of disclosing prior problems. Not sure how a "reentry course" would work -- seems like each person that fails out might need unique help.

 

[Attending1]

Attending1,
Entry into residency is a highly competitive endeavor and is fundamentally different from the job market that exists post-residency. You could easily have a "certificate of residency re-entry" for failed residents and it would have exactly 0 impact on their ability to actually obtain a residency position. Many specialties these days are essentially closed to anyone other than 1st time applicant AMGs or require significant political connections. Someone that fails out of residency has failed out of residency and I don't see that stigma disappearing because of any non-residency remedial courses. I'm not saying that no terminated residents continue medical training, but that a certificate would be unlikely to be useful.

I think that there should exist a "Resident reentry course program " (RRP) comprehensively designed by ACGME / NBME (personalized for the resident based on his previous perceived reasons to fail)

It should be atleast of 3 months duration, address various areas of resident competencies, and should include regular feedback, besides genuinely assessing improvement and response to that feedback.

Such a reentry program should be designed such that specially trained staff physicians would be able to scrutinize resident deficiencies, and response to feedback in a faster, more objective, more efficient manner - when compared to a the assessment in a regular residency program setup. One-to-one interaction in the reentry course setting will enable much more efficient and discerning evaluations.

Importantly, RRP would be a lifeline, and ray of hope for terminated residents. The genuinely academically poor terminated resident will sink in the reentry course evaluation, while the good,wrongly terminated resident will float.

The RRP can be of great practical use

Ex: Say, a FP intern with 9 months of credit gets canned for "lack of communication skills/ lack of knowledge". If the RRP comprehensively checks and certifies him as competent overall and improved/ competent even in these perceived deficient areas, then this resident stands a much better chance for an offcycle FP position compared to a nonRRP certified terminated resident


Besides, the prospective programs will breathe easier about picking the RRP reentry course certified resident, than a non-RRP terminated resident who only has his previous PD's reference

An RRP certified terminated resident will also come across as someone more seriously committed to improvement

 

[candbgirl]

Most of these responses seem to be laying the blame for resident issues at the PD, hospital, attending etc feet. What about the resident? Does the resident share any responsibility for his failings? It seems everyone is bending over backwards to protect the resident, to find him another spot , to protect his career. Aren't some residents just bad docs? Aren't some residents just ill equipped to be docs? What responsibility does the resident have in this mess? Is it only to deny he was told, deny he was evaluated, only see positives in Evals when negatives are there too etc? What about the patient receiving care? Now that's what scares me! Of course I may be jaded since I had a near death experience compliments of a PGY2 last summer. And the funny thing is the attendings, residents and hospitalists spent days running around covering for her.

 

[Attending1]

Most of these responses seem to be laying the blame for resident issues at the PD, hospital, attending etc feet. What about the resident? Does the resident share any responsibility for his failings? It seems everyone is bending over backwards to protect the resident, to find him another spot , to protect his career. Aren't some residents just bad docs? Aren't some residents just ill equipped to be docs? What responsibility does the resident have in this mess? Is it only to deny he was told, deny he was evaluated, only see positives in Evals when negatives are there too etc? What about the patient receiving care? Now that's what scares me! Of course I may be jaded since I had a near death experience compliments of a PGY2 last summer. And the funny thing is the attendings, residents and hospitalists spent days running around covering for her.

Nobody recommends sheilding dangerous/ negligent doctors - be they residents or attendings

There are a lot of good residents getting canned unfairly - and the debate is about how to prevent them being unfairly canned.

Now, it is very possible that you might have genuinely faced a bad resident- even though we don't know the details of your situation

 

[gutonc]

There are a lot of good residents getting canned unfairly - and the debate is about how to prevent them being unfairly canned.

Cite your source.

 

[Arcan57]

Who's going to administer this re-entry program? How do you ensure that it fairly measures the resident's abilities if the resident is paying to take the course, or how do you fund it if it's not directly paid for by the resident? The amount of supervision required would be essentially a full time gig (since the resident is accused of being unable to safely practice independently) so you're looking at paying easily low to mid 5 figures for 3-6 mo of the preceptors time. I'm also no sure how to ensure that someone that performs adequately while being continuously supervised is able to maintain that once they transition back to a residency.

 

[Attending1]

Who's going to administer this re-entry program? How do you ensure that it fairly measures the resident's abilities if the resident is paying to take the course, or how do you fund it if it's not directly paid for by the resident? The amount of supervision required would be essentially a full time gig (since the resident is accused of being unable to safely practice independently) so you're looking at paying easily low to mid 5 figures for 3-6 mo of the preceptors time. I'm also no sure how to ensure that someone that performs adequately while being continuously supervised is able to maintain that once they transition back to a residency.

The reentry program would have to be administered by an official body, say NBME/ ACGME.

The program would need to be expertly structured, such that it measures abilities of the resident to function in supervised/ and unsupervised settings. And measure these competencies in a more efficient/ comprehensive way than in a regular residency - because the whole design and purpose of this program is to check competencies. It can be done, the official bodies have got the resources and capabilities for such a program

Note that even in residency, a resident is never totally unsupervised

It would cost 5 figures, but that cannot be helped.

 

[holylife]

I also did not get a contract renewal and only got 6 out of 12 months of internship credit. The question i have is should i send out the PD letter or not? I don't know what he wrote.

Thank you

 

[Attending1]

I also did not get a contract renewal and only got 6 out of 12 months of internship credit. The question i have is should i send out the PD letter or not? I don't know what he wrote.

Thank you

You have to mention that you did a residency and got 6 months credit.
Ask the PD what he intends to write, even better ask him for a copy of the PD letter.
You need to know the contents of that letter to apply meaningfully, as you need to prepare for explaining your version of whatever he is going to mention.
Best of luck

 

[PTPoeny]

Resident terminations also protect the other residents in the program.

It sucks to have to work with a resident who has given up and will only put in the "minimum effort". They may magically develop "car trouble" and not be able to get to the hospital at least 2-3 days a month on inpatient rotations but only ever on Mondays and Fridays. The "car trouble" may also make them late at least once a week. They may constantly complain that they have the worst schedule and they are overworked when they actually have the least call and least night float because the chief residents are sick of calling in jeopardy most weeks. They may have absolutely no insight and complain that they are treated horribly because other residents won't switch shifts with him after called in for jeopardy to cover for this resident. They may claim that they experience religious discrimination when they did not ask for certain days off ahead of time that are religious holidays and just assumed they wouldn't have to come in those days despite the fact they are on the floors.

Being down a resident would have sucked too, but at least we could have planned for it with each rotation rather than each day not knowing if this resident was just 2 hours late again or if they weren't going to show up and just hadn't called in yet. This method just resulted in a lot of work getting dumped on the residents on the same rotations as him with no notice. Sometimes life situations change and people no longer want to be at a program they applied to but they won't leave. The resident I worked with did not do anything criminal which is what most of you are setting the bar at for dismissal in your proposals. Attendance is an easily verifiable and I feel should be another criteria for which residents can be dismissed at any time under any reforms.

If I had to apply again I would make sure the program I went to was willing to fire residents for not showing up to work.

 

[IlDestriero]

If you don't show up for an anesthesia residency, you'll be gone quick. The OR is the $$ cow for the hospital. Nothing stops the money train.

 

[Attending1]

Resident terminations also protect the other residents in the program.

It sucks to have to work with a resident who has given up and will only put in the "minimum effort". They may magically develop "car trouble" and not be able to get to the hospital at least 2-3 days a month on inpatient rotations but only ever on Mondays and Fridays. The "car trouble" may also make them late at least once a week. They may constantly complain that they have the worst schedule and they are overworked when they actually have the least call and least night float because the chief residents are sick of calling in jeopardy most weeks. They may have absolutely no insight and complain that they are treated horribly because other residents won't switch shifts with him after called in for jeopardy to cover for this resident. They may claim that they experience religious discrimination when they did not ask for certain days off ahead of time that are religious holidays and just assumed they wouldn't have to come in those days despite the fact they are on the floors.

Being down a resident would have sucked too, but at least we could have planned for it with each rotation rather than each day not knowing if this resident was just 2 hours late again or if they weren't going to show up and just hadn't called in yet. This method just resulted in a lot of work getting dumped on the residents on the same rotations as him with no notice. Sometimes life situations change and people no longer want to be at a program they applied to but they won't leave. The resident I worked with did not do anything criminal which is what most of you are setting the bar at for dismissal in your proposals. Attendance is an easily verifiable and I feel should be another criteria for which residents can be dismissed at any time under any reforms.

If I had to apply again I would make sure the program I went to was willing to fire residents for not showing up to work.

First, residents lacking punctuality need to be sternly dealt with.

But it sounds arrogant if one assumes only himself/ herself doing a good job, and bay for firing those "other" residents whom you assume to be dishonest

Turning up late, having car problems/religious issues/ whatever other generalisations that you make need to be investigated, and THEN action needs to be initiated against those wilfully dishonest.

It's easy to talk tough, and blame/ talk about dumping people, but some questions that a resident needs to ask himself/ herself include:
Am I perfect?
Been absolutely sincere/ honest/ timely in my work ?
Really how good are my clinical skills ?
How many times has a senior resident or attending helped me, and overlooked my own shortcomings?

You would be surprised how many interns/residents are "horrible" ( including the promoted ones who talk tough later), and don't realize that they'd be fired too if Attendings were not benevolent.

A resident's job is to learn and do their work with sincerity.
If a resident feels that he/she is having to pick up another resident's slack, then it should be promptly conveyed to the attending.
It is above designation and pay grade, to start elevating one's own work/ stature and excessively indulge in judging and micromanaging the work of other residents or indulge in backbiting.

A tough talking resident needs to remember that Faculty are always watching "that problem resident" and are also always watching "you"

 

[DermViser]

It's easy to talk tough, and blame/ talk about dumping people, but some questions that a resident needs to ask himself/ herself include:
Am I perfect?
Been absolutely sincere/ honest/ timely in my work ?
Really how good are my clinical skills ?
How many times has a senior resident or attending helped me, and overlooked my own shortcomings?

You would be surprised how many interns/residents are "horrible" ( including the promoted ones who talk tough later), and don't realize that they'd be fired too if Attendings were not benevolent.

It is above designation and pay grade, to start elevating one's own work/ stature and excessively indulge in judging and micromanaging the work of other residents or indulge in backbiting.

A tough talking resident needs to remember that Faculty are always watching "that problem resident" and are also always watching "you"

THIS.

 

[DermViser]

What sort of work are you doing in the meantime?

Did you find a clinical or non-clinical job?

Not to get off topic, but I thought your avatar was a deformed penis at first.

 

[Top Gun]

First, residents lacking punctuality need to be sternly dealt with.

But it sounds arrogant if one assumes only himself/ herself doing a good job, and bay for firing those "other" residents whom you assume to be dishonest

Turning up late, having car problems/religious issues/ whatever other generalisations that you make need to be investigated, and THEN action needs to be initiated against those wilfully dishonest.

It's easy to talk tough, and blame/ talk about dumping people, but some questions that a resident needs to ask himself/ herself include:
Am I perfect?
Been absolutely sincere/ honest/ timely in my work ?
Really how good are my clinical skills ?
How many times has a senior resident or attending helped me, and overlooked my own shortcomings?

You would be surprised how many interns/residents are "horrible" ( including the promoted ones who talk tough later), and don't realize that they'd be fired too if Attendings were not benevolent.

A resident's job is to learn and do their work with sincerity.
If a resident feels that he/she is having to pick up another resident's slack, then it should be promptly conveyed to the attending.
It is above designation and pay grade, to start elevating one's own work/ stature and excessively indulge in judging and micromanaging the work of other residents or indulge in backbiting.

A tough talking resident needs to remember that Faculty are always watching "that problem resident" and are also always watching "you"

Completely agree. Residents who live in glass houses should not throw stones. And not every resident who is favored by faculty is better than anyone else. When I was a PGY2, I did ICU call one night with an intern who did nothing but sit in the ER all night with the nocturnist attending. I was the one who was responding to the ICU nurses' pages and handling problems with the ICU patients. And I did ICU admissions too, since at the program I trained, the intern only does H&Ps until about May or June. Second years do admission orders. The intern did not even show up in the ICU till about 2 AM. What's more, he somehow managed to pi$$ off one of the ICU nurses the following morning. He basically sat in the ER and chatted with the nocturnist all night. Didn't do a lick of work up in the ICU. Yet, he was still the nocturnist's golden child.

 

[chocomorsel]

If you don't show up for an anesthesia residency, you'll be gone quick. The OR is the $$ cow for the hospital. Nothing stops the money train.

This was proven untrue in my residency. And this resident was a known troublemaker. The program just wanted him to graduate. And yes there was an unfair termination of another resident who always showed up, supposedly for unproven drug use.
Unfair treatment does exist in residency. White males can get away with a heck of a lot compared to other sexes and races.

 

[mercaptovizadeh]

This was proven untrue in my residency. And this resident was a known troublemaker. The program just wanted him to graduate. And yes there was an unfair termination of another resident who always showed up, supposedly for unproven drug use.
Unfair treatment does exist in residency. White males can get away with a heck of a lot compared to other sexes and races.

I can't believe you actually went there...

 

[chocomorsel]

I can't believe you actually went there...

I actually did. Yes, in this day of political correctness, it is a reality is lots of places. Not just in medicine. Everywhere. Of course, the lucky white males don't see this to no fault of their own. This is totally normal treatment to them. Life tends to be a lot more fair to a Caucasian male than say a brown or black one. And certainly fairer than to a woman. Such is life. If you are a white male, it is no fault of your own that you don't see this discrepancy, but it exists.

 

[IlDestriero]

The guy deemed untrainable and kicked out of medicine in my Navy intern class was as white as wonder bread. As was the resident that got the axe in my residency class.
One was a southern gentleman as well. Southern temperament and the drawl are usually worth extra credit.
"Y'all just do what you neeed to doo, and I'm happy to help any waay that I caaan."

 

[littlejuan]

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