Residency contract not extended after 2 years, 1 year out, NEED advice.

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

rockhardplace

New Member
10+ Year Member
Joined
Sep 7, 2011
Messages
3
Reaction score
0
i completed 2 years in a psychiatry residency training program. in the second year, i was told eventually that my contract was not being renewed, and that i should resign. i did so but realized later that my program is not interested in helping me continue my training elsewhere. i did nothing unethical, illegal, etc. but was told that if i did not resign, i would be fired and that this was in my best interest. neither program director nor assistant program director wrote me LORs, and most of the attendings wouldn't either. i got one from a psychologist and the chairman and had an older one which i used for the match last year, trying for IM, FP and psychiatry. NO interviews.

now a year later and am wondering what to do... i'll ask you all for whatever advice you can give. i have specific questions and will appreciate any input.

1.i am thinking about making money and feel that a career shift (into healthcare consulting say at accenture) would be the quickest way to go about doing this. the question is if i did this for a year or so, would getting back into residency be more difficult? i figured i'd start sending out new resumes for non clinical jobs while i am also preparing for the match this year, but am wondering what if i take a position then later if and when i get a residency interview, will they look at me unfavorably because of this?

2. i was thinking in order to get newer letters of recommendation, i would pay americlerkships or some similar company that offers pay for clinical exprience. any experience or recommendation here? is it a good idea?

3. do i have a better chance of starting over as a PGY1 in some other specialty vs starting as a pgy3 in psychiatry?

4. when do i know that i have to quit trying to get back into a residency? 2 years, 3, 4, ??"

5. i am in the process of applying for a permanent license as i have the right amount of post graduate training years. but this is taking a lot longer than i thought it would. could it be because of my old residency program trying to make it difficult for me to get the license?

6. what else can i possibly do to get back into residency?

sorry for the long message, just not sure what i should do next.

Members don't see this ad.
 
Couple of questions: why were you fired? Be honest with yourself...bad evals? Patient death? Multiple errors?

The longer your leave away from residency, the tougher it'll be to get back in.
 
Couple of questions: why were you fired? Be honest with yourself...bad evals? Patient death? Multiple errors?

The longer your leave away from residency, the tougher it'll be to get back in.
 
1.i am thinking about making money and feel that a career shift (into healthcare consulting say at accenture) would be the quickest way to go about doing this. the question is if i did this for a year or so, would getting back into residency be more difficult? i figured i'd start sending out new resumes for non clinical jobs while i am also preparing for the match this year, but am wondering what if i take a position then later if and when i get a residency interview, will they look at me unfavorably because of this?

First, I seriously doubt any consulting firm is going to hire you. You failed out of a residency program. Why would someone want to hire you? What skills do you bring to the table? If you have something else to offer, then perhaps.

Think of it this way: would you hire someone who failed out of medical school to help you find a new residency program? Probably not, unless they already had a track record of success in this area.

2. i was thinking in order to get newer letters of recommendation, i would pay americlerkships or some similar company that offers pay for clinical exprience. any experience or recommendation here? is it a good idea?

It seems unlikely that a 1-3 month clerkship experience will outweigh whatever happened in your 24 months of residency.

3. do i have a better chance of starting over as a PGY1 in some other specialty vs starting as a pgy3 in psychiatry?

The fact that you are asking this question demonstrates that you don't understand the situation at all.

Your program terminated you. Presumably, they did so because your performance was not felt to be acceptable (rather than they ran out of funding, or some other system problem like that). So, you will not be able to convince any other residency program to take you as a PGY-3. If you're interested in staying in psych, then you should be looking for a PGY-2 spot. You need to repeat your PGY-2 to prove that you're ready for your PGY-3.

You should choose to switch specialties if another field actually interests you, or if whatever problems you ran into in psych would be less of an issue in a different field (i.e. perhaps another field plays to your strengths better).

4. when do i know that i have to quit trying to get back into a residency? 2 years, 3, 4, ??"

When you're tired of trying. Also, if you get no interviews this year, you won't get any next year unless you do something to make yourself more attractive to programs.

5. i am in the process of applying for a permanent license as i have the right amount of post graduate training years. but this is taking a lot longer than i thought it would. could it be because of my old residency program trying to make it difficult for me to get the license?

It's possible. It depends on what amount of PGY is needed. If your state requires 12 months, then you're probably fine. If 24, they probably require 24 satisfactory months of training, and your program may consider some (or all) of your PGY-2 as unsatisfactory.

6. what else can i possibly do to get back into residency?

There isn't any easy answer. Missing from your post are any explanation or understanding of the problems that got you into this position. I don't care if you post them here, but you need to understand what those are, and how you can get beyond them, before you'll have any success.
 
First, I seriously doubt any consulting firm is going to hire you. You failed out of a residency program. Why would someone want to hire you? What skills do you bring to the table? If you have something else to offer, then perhaps.

Think of it this way: would you hire someone who failed out of medical school to help you find a new residency program? Probably not, unless they already had a track record of success in this area.




There isn't any easy answer. Missing from your post are any explanation or understanding of the problems that got you into this position. I don't care if you post them here, but you need to understand what those are, and how you can get beyond them, before you'll have any success.

Wow, way to bum the op out without offering much in the way of useful suggestions. People apparently get fired for reasons that are unclear to us on this forum (and that they obviously can't share publicly), why not address what they can do rather than berate them for getting fired in the first place?
 
Wow, way to bum the op out without offering much in the way of useful suggestions. People apparently get fired for reasons that are unclear to us on this forum (and that they obviously can't share publicly), why not address what they can do rather than berate them for getting fired in the first place?
Well, I probably deserved that. It's been a long day, and I was probably a bit too direct with my feedback.

Trying to be helpful:

1. Decide what you want to do. Do you want to continue in psych? Or do you want to do something else? Part of how you decide will be based on your interests. Part will be based upon what happened to get you terminated.

2. If you want to do psych, then concentrate on getting a PGY-2 position. You're willing to repeat 6-12 months of training to prove that you've got the skills (or to help address any deficiencies).

3. If you want to do something else, then you'll probably be looking at a PGY-1 position. Apply into the match which just started. You're definitely not too late, but you'll need to scramble (bad term, I know...) to get your LOR's written and scanned in a timely manner.

4. Getting a license would be very helpful. You might be able to get a job which would 1) bring in income, and 2) give you clinical experience. At a minimum, you'd be able to try to volunteer to get clinical experience.

5. Make certain you understand why you were terminated from your old program. Try to get some honest feedback from someone you trust.
 
While I don't really have much in the way of useful suggestion, I really can't imagine any PD offering a spot to a "forced to resign" resident without finding out in detail exactly why this came to be and probably speaking in detail on the phone to the prior PD. I think any additional LORs are going to be a waste of time because there is only one person a new program is going to want to talk to. Thus the OPs options are to see if there is any way to remediate (unlikely given what the OP wrote thus far), or find a way to get licensed and work or do research someplace where he might impress attending level types who can ultimately help him find something through back channels.
 
thanks for the advice.

in response to some of the follow up questions. i honestly don't know why exactly my contract was not renewed. i know that i was told by my PD that i should tell future programs that ultimately the review committee did not feel that i had the skills necessary to function independently as a 3rd year resident.

i know a few more facts as well. i scored in the 90th percentile both years, number one in my class on the in-service exam, and number 4 and 6 overall in the residency class of about 50, years 1 and 2. i know that i had the DSM basically memorized. i know that in the first year, i had an arrogant attitude but that i was trying to fix this in the second year. i know that i stepped on a lot of toes, inadvertently. i also know that i managed to turn around those 2 or 3 attendings, nurses, social workers who essentially thought that i was very arrogant. but not to much avail obviously.

again, i didn't do anything illegal or unethical. i did not make many mistakes, at least not more than anybody else. when i left, the PD said that i should look at the positive, namely that i wasn't losing my license. he said that it would be hard to get back into a residneyc, but it would not be impossible.

is it true that a new program would want to speak to my old program director even if i am not going for an advanced level position? meaning if i restart as a pgy1 as well.?
 
when i left, the PD said that i should look at the positive, namely that i wasn't losing my license. he said that it would be hard to get back into a residneyc, but it would not be impossible.

Wow, those are tough criticisms. Your previous PD isn't going to make it easy for you to get another spot.
 
I'm not quite sure what happened to you, legally speaking. If you completed your second year but were not offered a contract for the third year, where did the bit about you "resigning" come in?

What did your contractual agreements with the school say about notification to you of problems with your residency, remediation, and so on? Do you have any grounds for saying that what happened to you did not comply with the obligations your program had towards you? If you do, what does your contract with the program say about your methods for getting that put right? If your "resignation" was in fact just a way for the program to get you to go quietly without exercising any rights you might have, there should have been something you got in return for going quietly. It is probably too late now: you have little or no negotiating leverage from outside an organisation which previously employed you.

If you really don't understand what happened to you, then I don't think you will get anywhere with a new residency because you won't understand what went wrong, and that makes it likely the same problem will happen again. Do you have the right to see all the evaluations you got in residency? If so, is there someone at the program, or an outside expert, who could go through them with you to pinpoint the issues and suggest ways you need to change to deal with them?

On the substance of your problem, it seems to me that you may have concentrated on your technical skills and relationship with your patients, and not balanced that by realising the importance of your relationship with work colleagues of all kinds. Practically any employment these days is about team working, as having an effective team is essential to getting the job done. Sometimes this translates into "being a good team member" being more valued by others in the team than outcomes for individual patients. You can argue that this is screwed up, selfish and short-sighted, and leads to organisations running more for their own benefit than for the persons ostensibly meant to benefit (eg hospitals running for the benefit of staff not patients, banks being run for the benefit of bankers not shareholders or society). But it is how it is, and you aren't going to change the system single-handed. The working world is a lot bigger and more complicated than it used to be only a couple of decades ago, and the scope for people who work best on their own is a lot more limited.

If you want another team (ie, program) to take a chance on you, you need to recognise what has been going on, and to demonstrate that you recognise it and have learnt to deal with it. Perhaps one of the team working courses that management training provides? An explanation of why you were late to the party in recognising the need for teamworking could also be useful (eg your residency was your first experience of employment, or you failed to recognise the need to translate team working skills learnt at MacDonalds to your new employment setting, etc.)

Good luck.
 
"resignation" was in fact just a way for the program to get you to go quietly without exercising any rights you might have, there should have been something you got in return for going quietly

this is what the resignation was. my pd told me that the committee was not going to extend my contract so i might as well resign. he said that i could disagree and go through a specific outlined process, but likely nothing would come of it, and i would then not have the support of the program in going forward into my next position. i felt i would need their support, but unfortunately very little support has come.

now i am thinking about asking the pd, assistant pd, chairman and some attendings if they might feel comfortable supporting me for a different specialty via LORs. any thoughts on this about how to go about doing it short of just asking/pleading?
 
Don't mention that you went to a residency at all. Just say you've been a private MCAT tutor for those two years and that you'd like to try consulting.
 
now i am thinking about asking the pd, assistant pd, chairman and some attendings if they might feel comfortable supporting me for a different specialty via LORs. any thoughts on this about how to go about doing it short of just asking/pleading?

The first thing to do is to work out what your case is. You've got three possible areas of persuasion.

The first is "I was promised support in return for not exercising my rights". As soon as you can, write done as detailed an account as you can remember of what was said when: details of meetings, who was present, what was said. You are not going to send out this detailed account: it is just an aide memoire for yourself, as long narrative justifications are easier to dismiss than short sharp bullet points. When you have set out the full story on what was said to you when boil it down to the essentials (eg "At a meeting with [X] on [date], X said [promise of support in return for not exercising your contractual rights"].

The second area of persuasion is the case you would have made if you had exercised your rights to follow a process, ie the substance of why you should have been allowed to progress in your program. The main points here will be on the substance of the issue (your good clinical performance) and the procedural failures of the program in dealing with any failures on your part (eg they didn't follow all the contractual steps necessary, or inform you of issues so that you could remedy them, etc). Again, boil it down to the main points.

The third area of persuasion is your acknowledgement of the issues the program had with your performance, and your plan for dealing with those issues so that they will not be a problem in your future as a resident and a practising doctor. Again, keep it to the main points rather than a long narrative.

Once you have worked out what your case is, you need to decide who to put it to and how. The first two areas I've outlined are relevant only
to the PD/Chairman/admin/hierarchy of the program. Their purpose is to persuade them that it is easier/better for them to help you now rather than face the (implied only at this stage) possibility of having to answer your points in a more formal setting, or even in the courts. The purpose of the third area is to make them want to help you, or at least persuade them that by helping you they will not be just passing the problems they have had with you on to some other program and then to the medical profession as a whole. This third area might also be the one which you can use to try to persuade individuals in the program who are outside the
direct program hierarchy to help you on an individual basis.

As to the best method by which to put your case, this will depend on the situation. You might try letters which briefly set out the main points you have in your favour and ask for a meeting to discuss a way forward which will meet the needs of both you and the program.

If there is someone who has a good grasp of the situation and can advise you in person, that would probably be better for you than anonymous advice over the internet. Now is the time to network by calling on friends and contacts. If there is professional help you can call on, it might be worth doing that too, given the stakes involved.
 
This is a common practice in residency programs today. Read the link below about a resident - its a shame that programs that should teach the residents abuse them. I'm extremely shocked.




http://www.residentscafe.com/node/3086



The first thing to do is to work out what your case is. You've got three possible areas of persuasion.

The first is "I was promised support in return for not exercising my rights". As soon as you can, write done as detailed an account as you can remember of what was said when: details of meetings, who was present, what was said. You are not going to send out this detailed account: it is just an aide memoire for yourself, as long narrative justifications are easier to dismiss than short sharp bullet points. When you have set out the full story on what was said to you when boil it down to the essentials (eg "At a meeting with [X] on [date], X said [promise of support in return for not exercising your contractual rights"].

The second area of persuasion is the case you would have made if you had exercised your rights to follow a process, ie the substance of why you should have been allowed to progress in your program. The main points here will be on the substance of the issue (your good clinical performance) and the procedural failures of the program in dealing with any failures on your part (eg they didn't follow all the contractual steps necessary, or inform you of issues so that you could remedy them, etc). Again, boil it down to the main points.

The third area of persuasion is your acknowledgement of the issues the program had with your performance, and your plan for dealing with those issues so that they will not be a problem in your future as a resident and a practising doctor. Again, keep it to the main points rather than a long narrative.

Once you have worked out what your case is, you need to decide who to put it to and how. The first two areas I've outlined are relevant only
to the PD/Chairman/admin/hierarchy of the program. Their purpose is to persuade them that it is easier/better for them to help you now rather than face the (implied only at this stage) possibility of having to answer your points in a more formal setting, or even in the courts. The purpose of the third area is to make them want to help you, or at least persuade them that by helping you they will not be just passing the problems they have had with you on to some other program and then to the medical profession as a whole. This third area might also be the one which you can use to try to persuade individuals in the program who are outside the
direct program hierarchy to help you on an individual basis.

As to the best method by which to put your case, this will depend on the situation. You might try letters which briefly set out the main points you have in your favour and ask for a meeting to discuss a way forward which will meet the needs of both you and the program.

If there is someone who has a good grasp of the situation and can advise you in person, that would probably be better for you than anonymous advice over the internet. Now is the time to network by calling on friends and contacts. If there is professional help you can call on, it might be worth doing that too, given the stakes involved.
 
Lying on a job application/interview is a pretty good way to not get a job.

many hospitals have policies that will only state, dates of employment, pay grade, position. they cannot say you were terminated. check with HR. them giving any other information can open them up to lawsuits.


by the way, just to let you know with these program directors who think they are above the law. get an attorney. it is ILLEGAL to give negative comments about former workers. so your former program director can be sued as well as the hospital in the case of retaliation. i would consider it an avenue. especially if you spoke up or against any particular policy or that program director.
 
many hospitals have policies that will only state, dates of employment, pay grade, position. they cannot say you were terminated. check with HR. them giving any other information can open them up to lawsuits.


by the way, just to let you know with these program directors who think they are above the law. get an attorney. it is ILLEGAL to give negative comments about former workers. so your former program director can be sued as well as the hospital in the case of retaliation. i would consider it an avenue. especially if you spoke up or against any particular policy or that program director.

No, it's not illegal. It's illegal to give FALSE information about a former employee. Hospital (or company) policy and the law are two very different things, and it's unlikely that a PD in otherwise good standing would have significant negative consequences from giving an accurate accounting of the circumstances regarding the ending of a resident's employment. Especially if the reference stuck only to things that were already on record.

Lawyering up is not a magic bullet, and much like the insanity defense is an often discussed but not very useful strategy.
 
No, it's not illegal. It's illegal to give FALSE information about a former employee. Hospital (or company) policy and the law are two very different things, and it's unlikely that a PD in otherwise good standing would have significant negative consequences from giving an accurate accounting of the circumstances regarding the ending of a resident's employment. Especially if the reference stuck only to things that were already on record.

Lawyering up is not a magic bullet, and much like the insanity defense is an often discussed but not very useful strategy.

actually it is ILLEGAL to give FALSE advice yes. However, the reason hospitals HR establish policies about not giving any other information is it puts them at MAJOR risk to being sued because bad information given out is hard to identify if it is correct or not correct.

because one cannot determine the level of information given out that ventures outside of the standard policy and procedure of the HR department, an attorney can show that

1.) the PD went out of his/her way to break company HR policy and say bad things about the resident
2.) This can be seen as Retaliation if the resident brought up anything bad about the PD or program itself

If this were to go to court, people see an employee who lost their job and a high paid PD who is breaking company policy that is negatively affecting the former person from paying loans and having a career. If there is any basis for retaliation, which it looks like it would especially if a person is KNOWINGLY violating the HR policy and on more than one occasion for this particular employee, they are going to get SLAMMED with a lawsuit.

this isnt just "lawyering up". the person does have rights and if he can build that case, a jury would be convinced. the hospital would not let it go to trial they would settle it though and probably let him off with a resignation without any negative remarks.

gotta be careful with anything negative you say about people because of the negative impacts on their life puts you at risk.

source: worked for attorneys that sued on this exact basis
 
1.) the PD went out of his/her way to break company HR policy and say bad things about the resident
2.) This can be seen as Retaliation if the resident brought up anything bad about the PD or program itself

.

source: worked for attorneys that sued on this exact basis

For all of the amateur lawyers out there, employment law does not translate very well to residency, which is a hybrid situation of employment/academics.

In many cases, the PD is not acting as the agent of the hospital, but of the department/residency program.

A lawsuit may get a terminated resident a year or so of resident salary, but it is not going to get him advanced in academic standing or get him credit for rotations.
 
As Michaelrack said, forget about normal employment law. It doesn't apply to residents.

OP, how burned are the bridges with your former PD/chairman/attendings? As I see it, you did these people a huge favour by resigning. Having to fire a PGY-3 who doesn't want to be fired is a big headache and you avoided that for them by going quietly. Some letters/calls on your behalf are not unreasonable in return.

It's understandable that you don't want to post the exact reason for your resignation. However, if you were told by your PD that you were lucky not to lose your license, it must have been something worse then a mere personality clash with an attending. Presumably something interfering with patient care/safety. You'll have to find a way to convince your future program that this issue has been addressed.
 
many hospitals have policies that will only state, dates of employment, pay grade, position. they cannot say you were terminated. check with HR. them giving any other information can open them up to lawsuits...

Not the way the world works, I'm afraid. PDs talk all the time. They absolutely can say you were terminated -- it is fraud to do otherwise. If they recommend you and you screw up and it turns out they knew you were a screw up and had previously fired you for similar issues, THEN they can be subject to liability.
So expect PDs to give candid evaluations to other PDs freely. Don't kid yourself that they won't even mention that they fired you, or otherwise gloss over why you are leaving their program.

To some extent employment law concepts do apply to residents, but what PharmaTope is quoting is simply not even normal employment law. References are expected to be honest and candid. There is at least as much liability in leaving out pertinent details of someone's employment history as there is in honestly bashing them. I'm sure you can find HR folks at a few places that have silly internal rules like you are describing, but I promise you that this isn't how 90% of the corporate or hospital world works, nor is it how courts handle these issues.
 
Not the way the world works, I'm afraid. PDs talk all the time. They absolutely can say you were terminated -- it is fraud to do otherwise. If they recommend you and you screw up and it turns out they knew you were a screw up and had previously fired you for similar issues, THEN they can be subject to liability.
So expect PDs to give candid evaluations to other PDs freely. Don't kid yourself that they won't even mention that they fired you, or otherwise gloss over why you are leaving their program.

To some extent employment law concepts do apply to residents, but what PharmaTope is quoting is simply not even normal employment law. References are expected to be honest and candid. There is at least as much liability in leaving out pertinent details of someone's employment history as there is in honestly bashing them. I'm sure you can find HR folks at a few places that have silly internal rules like you are describing, but I promise you that this isn't how 90% of the corporate or hospital world works, nor is it how courts handle these issues.

i had no idea of that. i know some of the hospitals i was at had strict rules about what information they give out. they only confirmed dates of employment, salary, and job title. i asked why they couldnt give any thing else they said "policy of the hospital for liability reasons we only confirm that information, we cannot give information if an employee was terminated or not". i was surprised to be honest.
 
thanks for the advice.

in response to some of the follow up questions. i honestly don't know why exactly my contract was not renewed. i know that i was told by my PD that i should tell future programs that ultimately the review committee did not feel that i had the skills necessary to function independently as a 3rd year resident.

i know a few more facts as well. i scored in the 90th percentile both years, number one in my class on the in-service exam, and number 4 and 6 overall in the residency class of about 50, years 1 and 2. i know that i had the DSM basically memorized. i know that in the first year, i had an arrogant attitude but that i was trying to fix this in the second year. i know that i stepped on a lot of toes, inadvertently. i also know that i managed to turn around those 2 or 3 attendings, nurses, social workers who essentially thought that i was very arrogant. but not to much avail obviously.

again, i didn't do anything illegal or unethical. i did not make many mistakes, at least not more than anybody else. when i left, the PD said that i should look at the positive, namely that i wasn't losing my license. he said that it would be hard to get back into a residneyc, but it would not be impossible.

is it true that a new program would want to speak to my old program director even if i am not going for an advanced level position? meaning if i restart as a pgy1 as well.?


I don't think your situation is intrinsically insurmountable . . . obviously it looks bleak now. Psychiatry is different from other areas of medicine in that you need to be a good listener, an arrogant surgeon is OK and surgery residents need to be "pushy" to be effective. How do you get kicked out of a psychiatry residency? Probably from not being empathetic enough with patients?

I would look at other fields of medicine, realize that psychiatry PDs all listen to each other, while other PDs, such as in medicine or fp or something might understand how psychiatry wouldn't be a good fit for some.

I find it interesting that you admit that you were arrogant, and that you tried to fix this. Truly arrogant people I have met will not admit this (it takes decades of therapy for a person with such a personality disorder to admit it IMHO). Usually it is the nice person who blames themselves for such a situation . . .

Some attendings don't want overly confident residents around them, they want them to be in awe of their skills/reputation and thus to be insecure. Medicine is as much about navigating a field of difficult personalities with big egos as it is about doing well on a test. You got top scores, obviously, and showing off might have lead you to "step on others toes".

Personally, I think that smart people are giving seconds thoughts about medicine as a career due to the politics and infighting. Yeah, yeah, I know this stuff exists elsewhere, but the stakes aren't so high (in terms of personality conflicts spinning out of control into career ending debacles) as in other fields.

APD's response is typical of PDs, (or at least of attendings), if you are fired from a residency program then why would anybody in the world ever want you to do anything again? There is a lot of insecurity in medicine in that attendings don't want any criticism, ever, and the sight of a fired resident excelling at another program would chip away at their ego too much. (APD may not be like this as he apparently helped some other residents get positions outside of his program when they were let go).

Anyway, realize that when something like this happens it can indicate failures on both side of the aisle. If you have the book knowledge, and other good marks, then they should have notified you of what was wrong. Often times attendings don't do this as it is uncomfortable and it is easier just to collate all the negatives into the final review and fire the resident. If an attending doesn't like you, do you think they will take the time to let you correct some deficiency? Most likely not , I know some who are not tht ethical.

I still think that the positives of medicine outweigh the negatives, but it is a close call. As an attending you can see patients on your own and help people, especially if you are motivated to stay current and provide the best care you can.

Medical school and residency can be, basically, a 7+ year trail of hazing, and it doesn't end there as more folks are working in hospitals. There are plenty of attending level physicians who do not feel they get the respect they deserve and hate working with abusive bosses. I can name a dozen attendings that I wish I never met.
 
Last edited:
<<I find it interesting that you admit that you were arrogant, and that you tried to fix this. Truly arrogant people I have met will not admit this (it takes decades of therapy for a person with such a personality disorder to admit it IMHO). Usually it is the nice person who blames themselves for such a situation . . .

Some attendings don't want overly confident residents around them, they want them to be in awe of their skills/reputation and thus to be insecure. Medicine is as much about navigating a field of difficult personalities with big egos as it is about doing well on a test. You got top scores, obviously, and showing off might have lead you to "step on others toes".

Personally, I think that smart people are giving seconds thoughts about medicine as a career due to the politics and infighting. Yeah, yeah, I know this stuff exists elsewhere, but the stakes aren't so high (in terms of personality conflicts spinning out of control into career ending debacles) as in other fields.

APD's response is typical of PDs, (or at least of attendings), if you are fired from a residency program then why would anybody in the world ever want you to do anything again? There is a lot of insecurity in medicine in that attendings don't want any criticism, ever, and the sight of a fired resident excelling at another program would chip away at their ego too much. (APD may not be like this as he apparently helped some other residents get positions outside of his program when they were let go).

Anyway, realize that when something like this happens it can indicate failures on both side of the aisle. If you have the book knowledge, and other good marks, then they should have notified you of what was wrong. Often times attendings don't do this as it is uncomfortable and it is easier just to collate all the negatives into the final review and fire the resident. If an attending doesn't like you, do you think they will take the time to let you correct some deficiency? Most likely not , I know some who are not tht ethical.>>

This is the best post I've seen on this topic. Very astute. So much so, that I had to chime in. Too often, the role of the program director is completely overlooked in resident termination/non renewal - when something like this happens, it is absolutely a failure on the part of the program as well, and hence, the PD. There are 2 sides to every case like this, and PD's need to step up and take responsibility for at least for part of the problem. I've seen clinically competent, conscientious residents get canned without any reason other than getting on the wrong side of a powerful attending. I've seen this happen to residents just a few months from graduation who were in *good* academic standing (yes, that's right, no prior academic warning or probation!) the entire time before the termination. In those cases, it is easier to fire the resident in order to pacify the attending, rather than a true attempt at mediation and at least exploring the dynamics of what's going on between the 2 individuals. It's part of the PD's job description. Far too often, it doesn't happen, which is both ridiculous and sad.

I also agree that the OP had insight into his problems and tried to correct them, so he wasn't truly arrogant. He certainly doesn't come across as arrogant here. To the OP: I wish you the best of luck and truly hope you'll get the references you need to find the right residency program for you. It does exist. Peace.
 
How do you get kicked out of a psychiatry residency? Probably from not being empathetic enough with patients?

Not really. Of the psych residents I've known who've been kicked out (and I know a few), this isn't it. More likely causes are big boundaries violations (sleeping with patients -- it happens), competency issues or just straight up poor effort. I don't know of a single psych resident who got kicked out for not having empathy. So, we get fired for the same things everyone else gets fired for.
 
I disagree that the OP would be unattractive to a consulting company. His key asset is his MD degree (as well as license to practice... hopefully that will eventually arrive). I don't think the fact he failed in his clinical training program has much bearing... he's not going to be doing clinical medicine while working for Accenture or BCG.

As far as asking for a positive LOR from the previous program... I doubt you'll get much help without getting on your knees and pleading. They obviously have a negative impression of you, and aren't out to do you any favors. I doubt they'll feel much guilt for failing to come through with "support", considering they don't seem to like you very much.
 
I disagree that the OP would be unattractive to a consulting company. His key asset is his MD degree (as well as license to practice... hopefully that will eventually arrive). I don't think the fact he failed in his clinical training program has much bearing... he's not going to be doing clinical medicine while working for Accenture or BCG...

"failing in a clinical training program" doesn't win you a job in a competitive industry like consulting. There really isn't the shortage of folks with advanced degrees seeking consulting jobs that some people on here think. Consulting firms aren't hiring a degree. They are hiring dynamic individuals who have honed their skills in another industry such that they bring value to the table. Thus they want the guy who comes highly recommended, not the guy with the barebones degree. I promise you very few of the folks who have MDs but for whom residency didn't pan out easily transition into consulting. Can it be done? Sure. Is an MD and a license all you need to get through that door? Not even close. In this economy it's much more likely you find a job you can use your medical license than nab a consulting gig without prior employer references.
 
They are hiring dynamic individuals who have honed their skills in another industry such that they bring value to the table.

L2D, you are just plain wrong. You are hostile to residents who have had this problem and as others have pointed out on other threads you talk a party line where the resident is 'wrong' and the program and pds are 'right.' Let's hope if you ever encounter a similar situation you are able to finally understand that as Darth and others have pointed out - these vague political fights do occur and they do end otherwise excellent residents' careers.

You are blind to the truth and you blame the victim. Stop and consider that they might be telling the truth. It's very scary isn't it? Don't think that your blind allegiance to bland corporate thought will save you when it comes to your turn up at bat.

I know an otherwise excellent resident who was forced to resign because of a fight with some obs. This person did not want to deliver babies alone in the hospital - no senior, no attending - as a new intern, and yet that was the expectation of the service. It sounds incredible but there it is. I know many stories of many residents who endured similar situations. Most went on and did well - but Darth is right. The weird political fights are not worth it when the stakes get too high. There are bullies in medicine and the system needs to change.
 
L2D, you are just plain wrong. You are hostile to residents who have had this problem and as others have pointed out on other threads you talk a party line where the resident is 'wrong' and the program and pds are 'right.' Let's hope if you ever encounter a similar situation you are able to finally understand that as Darth and others have pointed out - these vague political fights do occur and they do end otherwise excellent residents' careers.

You are blind to the truth and you blame the victim. Stop and consider that they might be telling the truth. It's very scary isn't it? Don't think that your blind allegiance to bland corporate thought will save you when it comes to your turn up at bat.

I know an otherwise excellent resident who was forced to resign because of a fight with some obs. This person did not want to deliver babies alone in the hospital - no senior, no attending - as a new intern, and yet that was the expectation of the service. It sounds incredible but there it is. I know many stories of many residents who endured similar situations. Most went on and did well - but Darth is right. The weird political fights are not worth it when the stakes get too high. There are bullies in medicine and the system needs to change.

It's true -- we have a lot of people who probably know very little about the consulting industry (I'm there with them) who act like they're experts on the consulting hiring practice. And I still don't see where it's helpful to tell the op he essentially has no options to work again in any decent paying capacity, which is essentially what l2d and apd are saying.
 
L2D, you are just plain wrong...

You are blind to the truth and you blame the victim. Stop and consider that they might be telling the truth. It's very scary isn't it? Don't think that your blind allegiance to bland corporate thought will save you ....

um I think you are attacking me for something I never said in this thread. I'm not aware that I blamed the OP here. I simply posted that to get another Residency any future PD is going to want to talk to the prior PD. I also said that management consulting firms are not simply hiring any MD with a heartbeat -- leaving residency is going to get questioned in this avenue as well. These are true statements. Please actually read posts before claiming someone is "plain wrong".
 
...And I still don't see where it's helpful to tell the op he essentially has no options to work again in any decent paying capacity, which is essentially what l2d and apd are saying.

telling someone that they will have a cakewalk getting back into residency or consulting is better? I think some of us are realists and are telling the OP what he probably already knows, that without some form of at least lukewarm recommendation from his prior PD, he's in a very tough spot. Put yourself in a future employers position. What kind of due diligence would you do if OP applied for your residency spot/consulting spot?
 
telling someone that they will have a cakewalk getting back into residency or consulting is better? I think some of us are realists and are telling the OP what he probably already knows, that without some form of at least lukewarm recommendation from his prior PD, he's in a very tough spot. Put yourself in a future employers position. What kind of due diligence would you do if OP applied for your residency spot/consulting spot?

I'm going to get behind L2D on this one. The OP is in a crappy situation (which s/he is hopefully aware of) and there are no magical solutions to be had in spite of what any delusional cheerleaders here say. The likelihood of getting any kind of "medically related" job without at least a neutral recommendation from his/her PD is not zero, but it's asymptotically close.

The best option at this point is to...actually, I don't have any idea what the best option is for the OP.

S/He could certainly throw in with the match in the same or a different specialty this year but chances are slim. S/He could go the "non-clinical" route but, again, these jobs aren't exactly a cakewalk to get. S/He could get a license (assuming eligibility) and try to work the public health/uninsured angle for some kind of a gig.

Honestly, the OP is kind of boned.
 
APD's response is typical of PDs, (or at least of attendings), if you are fired from a residency program then why would anybody in the world ever want you to do anything again? There is a lot of insecurity in medicine in that attendings don't want any criticism, ever, and the sight of a fired resident excelling at another program would chip away at their ego too much. (APD may not be like this as he apparently helped some other residents get positions outside of his program when they were let go)

I think that many PD's would be nervous about taking someone who failed out of another program. The concern is that, whatever caused the problem in the first place would cause a similar problem. These situations often turn into "He said/She said" -- the resident tells one story, and the PD another. It's impossible to know where the truth lies, and as a PD the safe thing for me to do is not take a risk on a resident who might be a problem. I'm not defending this type of behavior, but it's not surprising and I can't denounce it -- it seems unfair to the resident, but it's also a big problem for a program if they take a resident who then does poorly.

Your comments about "egos" are likely directed at the OP's original program being unwilling to write a fair letter about his/her performance. I fully agree with you there -- programs should be required to generate a letter summarizing the resident's performance. This too will be an area of contention, as the resident often disagrees with the program's evaluation but at least it would be in writing.

And I still don't see where it's helpful to tell the op he essentially has no options to work again in any decent paying capacity, which is essentially what l2d and apd are saying.

I disagree with your summary of my comments. Nowhere did I say that the OP has no options. He or she has several options.

First, the OP needs to decide whether they want to pursue more training in psych, training in another field, or something non-clinical.

If psych, then they need to look at PGY-2 openings. Again, due to the disagreement between themselves and their former program, I doubt any psych program will give the OP a PGY-3 spot since they can't be certain that they are sufficiently competent for it. But, if the OP is willing to repeat a year, a PGY-2 spot is not impossible. The OP could look for PGY-2 spots that become open in the middle of the year -- someone drops out, becomes ill, loses their visa, etc. In that case, the program will really need/want to fill the slot, and the OP might be able to get in.

If something else, then they need to get into the match. Their psych training will not give them any credit towards any other field.

Most importantly, the OP needs to assess what went wrong in the prior residency. I can't tell if the OP was truly clinically incompetent, or stepped on the wrong toes, or even perhaps was completely screwed by their program. I can't tell the difference from here. But the OP has to know the answer, and chances are they will need help in assessing it. Regardless, the OP needs to know what went wrong. Let's say, for argument's sake, that the OP pissed off someone important and got fired. Their clinical skills were completely fine. In that case, what did they do? Because, whatever it was, they need to learn to never do that sort of thing again. [And, to be honest, I'm not convinced that people really get terminated for one event like this. Usually there is a string of events, some horrible, and some just bad.] The point is that the OP needs to know the honest truth about what happened, or the past is likely to repeat itself.
 
The burden of proof in medical training will always be on the resident. The resident will always be blamed or held responsible. It is not a free market system and the power differential is too great. Abuse occurs because it can, and residents remain silent out of fear.

This is the system of medicine that creates mistakes and problems. Patients have bad outcomes or die because of this fear, not only among medical trainees but also among staff - nurses, unit clerks, cnas. Maybe, one day we could change this system. Is there any other profession where you walk such a narrow ledge, fearful of angering the 'wrong' person and thereby losing your position?

Insisting that the trainee is responsible for these negative outcomes removes the responsibility from poor or even dangerous programs. Training assumes a responsibility from the program to teach and not simply use the resident for free labor. Absolutely people should learn from experiences and mistakes, and take responsibility for their part in what happens. We all should. But to send a resident out after two years knowing it will likely end their professional career must have some aspect of intent because of the way training works.

This system is faulty and needs to be revised.
 
The burden of proof in medical training will always be on the resident. The resident will always be blamed or held responsible. It is not a free market system and the power differential is too great. Abuse occurs because it can, and residents remain silent out of fear.

This is the system of medicine that creates mistakes and problems. Patients have bad outcomes or die because of this fear, not only among medical trainees but also among staff - nurses, unit clerks, cnas. Maybe, one day we could change this system. Is there any other profession where you walk such a narrow ledge, fearful of angering the 'wrong' person and thereby losing your position?

Insisting that the trainee is responsible for these negative outcomes removes the responsibility from poor or even dangerous programs. Training assumes a responsibility from the program to teach and not simply use the resident for free labor. Absolutely people should learn from experiences and mistakes, and take responsibility for their part in what happens. We all should. But to send a resident out after two years knowing it will likely end their professional career must have some aspect of intent because of the way training works.

This system is faulty and needs to be revised.

gotta agree with you, i hate seeing people abused. i hate seeing residents at the hospitals i work with abused and treated like garbage.
 
I think that many PD's would be nervous about taking someone who failed out of another program. The concern is that, whatever caused the problem in the first place would cause a similar problem. These situations often turn into "He said/She said" -- the resident tells one story, and the PD another. It's impossible to know where the truth lies, and as a PD the safe thing for me to do is not take a risk on a resident who might be a problem. I'm not defending this type of behavior, but it's not surprising and I can't denounce it -- it seems unfair to the resident, but it's also a big problem for a program if they take a resident who then does poorly.

I think APD misunderstood what I said, (because I didn't clearly delineate my ideas well in the post). Yes, the reality is that a new program director would question why a resident was canned from a prior program, and whether taking on the resident would be worth the risk.

What I meant when I said that, "if you are fired from a residency program then why would anybody in the world ever want you to do anything again?", was in reference to the fired resident finding, and succeeding, in something outside of medicine. I just meant that the fired resident shouldn't sell himself short. The better than average, or maybe even average, medical school applicant has great grades and a bright future, even if they don't ultimately go into medicine, and there are non-clinical pathways.

In terms of what is fair for fired residents, decades ago there was a shortage of qualified residents, and presumably it was easier to obtain a second residency. Obviously, this has its drawbacks in terms of patient safety, but doubtlessly some unfairly canned residents were able to move on to greener pastures.

However, today, the power is heavily in the court of the PDs, despite the fact that residents spent years planning for a medical career, and that the decision of the PD could remove a qualified and talented doctor from the work force. Yes, incompetent doctors need to be removed, but I'm sure a lot of good doctors are fired more due to systemic problems with the residency program. And, of course, the system can, and sometimes is, abused by power hungry PDs who use their power to punish residents whom they don't like (really, don't respect is the issue).
 
Last edited:
Not really. Of the psych residents I've known who've been kicked out (and I know a few), this isn't it. More likely causes are big boundaries violations (sleeping with patients -- it happens), competency issues or just straight up poor effort. I don't know of a single psych resident who got kicked out for not having empathy. So, we get fired for the same things everyone else gets fired for.

Oh, yes, I agree, these are the specific violations which lead a psych resident to be fired, but I would argue that lack of empathy for patients is at the heart of the issue:

1. If you have empathy for a beautiful bipolar patient who wants to sleep with you, would you take advantage of her/him? No, of course not.

2. If you worry about your patients, would you let your work slide (outside of severe clinical depression)? No.

3. If you have empathy for psych patients and are concerned about their welfare and interested in their issues, would you allow yourself to be incompetent (outside of a learning disability)? No.

A very poor psych resident I knew didn't care a lick about the patients, was getting people to do his work for him, and really just wanted to get a high paying job. He was very lazy. What is his problem?? If you have an empathetic connection to your patients, then that will carry you through.

Some residents who leave medicine often have enough empathy, but can't deal with the political/paperwork aspects of medicine, i.e. "I love my patients, but I can't deal with the department chairman or the paperwork . . .
 
Last edited:
  • Like
Reactions: 1 user
The burden of proof in medical training will always be on the resident. The resident will always be blamed or held responsible. It is not a free market system and the power differential is too great. Abuse occurs because it can, and residents remain silent out of fear.

This is the system of medicine that creates mistakes and problems. Patients have bad outcomes or die because of this fear, not only among medical trainees but also among staff - nurses, unit clerks, cnas. Maybe, one day we could change this system. Is there any other profession where you walk such a narrow ledge, fearful of angering the 'wrong' person and thereby losing your position?

Insisting that the trainee is responsible for these negative outcomes removes the responsibility from poor or even dangerous programs. Training assumes a responsibility from the program to teach and not simply use the resident for free labor. Absolutely people should learn from experiences and mistakes, and take responsibility for their part in what happens. We all should. But to send a resident out after two years knowing it will likely end their professional career must have some aspect of intent because of the way training works.

This system is faulty and needs to be revised.

I would assume that in the mafia, if you piss off the wrong person . . . you lose more than just 'your position', you'll be Danny F***ing Kayed before you know it.

But seriously, the power to fire residents and inspire fear is a 'career perk' that a lot of attendings and PDs couldn't live without. Though I think that while the situation looks static, over the past decades there has been more focus on resident's rights and the fairer treatment of students and residents, and likely the situation will improve. If more residents and students file lawsuits, and if more word about malignant programs/attendings gets out, then the side that holds the power will have to tread more carefully.
 
Last edited:
Oh, yes, I agree, these are the specific violations which lead a psych resident to be fired, but I would argue that lack of empathy for patients is at the heart of the issue:

1. If you have empathy for a beautiful bipolar patient who wants to sleep with you, would you take advantage of her/him? No, of course not.

2. If you worry about your patients, would you let your work slide (outside of severe clinical depression)? No.

3. If you have empathy for psych patients and are concerned about their welfare and interested in their issues, would you allow yourself to be incompetent (outside of a learning disability)? No.

A very poor psych resident I knew didn't care a lick about the patients, was getting people to do his work for him, and really just wanted to get a high paying job. He was very lazy. What is his problem?? If you have an empathetic connection to your patients, then that will carry you through.

Some residents who leave medicine often have enough empathy, but can't deal with the political/paperwork aspects of medicine, i.e. "I love my patients, but I can't deal with the department chairman or the paperwork . . .

Following that logic, you could say almost all residents in all fields who are fired are fired because they lack empathy. To be a good psychiatrist, you do need empathy. To survive a psychiatry residency, you need the same skills that you would need to survive any other residency. We don't get fired because of not being good at psychotherapy or at relating to patients. Our value to our program is the work we do in the inpatient units (placing orders, writing notes, not killing people) and on call (writing notes, placing orders, performing brief evaluations). None of this stuff requires any special sensitivity (in fact, sensitivity is a negative) that other residents don't have to have.
 
Following that logic, you could say almost all residents in all fields who are fired are fired because they lack empathy. To be a good psychiatrist, you do need empathy. To survive a psychiatry residency, you need the same skills that you would need to survive any other residency. We don't get fired because of not being good at psychotherapy or at relating to patients. Our value to our program is the work we do in the inpatient units (placing orders, writing notes, not killing people) and on call (writing notes, placing orders, performing brief evaluations). None of this stuff requires any special sensitivity (in fact, sensitivity is a negative) that other residents don't have to have.

From personal experience, I would say that "empathy", or ultimate concern for a patient's well being is paramount to being effective in a clinical setting. I think that if you are super-concerned about your patients you are able to handle a higher patient load and you will be extra diligent in your work. I think that if you are empathetic with a patient, and their family, you would treat them as well as if they were a member of your family.

Empathy goes beyond "not killing patients" (which would be bad for you as a resident, so maybe is just motivated by self-interest for some), and pulls you to think what you need to do to get the patient well fast, to anticipate problems, and to come up with a good gestalt for the overall patient's condition. Yes, you can, for example, chug through dozens of patients in a diabetes clinic by just using a patient checklist, but it will make it harder.

Sympathy (merely feigning caring for a patient) is what is taught in medical school, i.e. how to "establish rapport" or, in other words, how to make the patient you believe you care, while of course you have the cold clinical detachment which allows you to get your work done. So yes, I guess that educated sympathy can get in the way of your work.

I am saying that empathy forces you to be more diligent and to live with your patient's problems and know them inside out rather than just managing them in a detached manner. Maybe what I am talking about it more than empathy, or super-empathy, empathy to the point of, "Uh-Oh, I know the attending and chief resident say Mr. Williams is recovering, but I better order another blood culture and labs because I am really worried." Empathy allows you to manage your patients on a higher level because you are motivated to predict several steps down the line what they might need.
 
"Empathy is the capacity to recognize and, to some extent, share feelings (such as sadness or happiness) that are being experienced by another sapient or semi-sapient being. Someone may need to have a certain amount of empathy before they are able to feel compassion"

from wikipedia.
 
Oh, yes, I agree, these are the specific violations which lead a psych resident to be fired, but I would argue that lack of empathy for patients is at the heart of the issue:

1. If you have empathy for a beautiful bipolar patient who wants to sleep with you, would you take advantage of her/him? No, of course not.

.

An empathetic but immoral psychiatrist might. In fact, being an empathetic doctor might increase the risk of performing this boundary violation.
 
An empathetic but immoral psychiatrist might. In fact, being an empathetic doctor might increase the risk of performing this boundary violation.

That might be rarer than you would think. One of the hallmark defining characteristics of antisocial personality disorder is a lack of empathy. Immoral people generally don't have a lot of empathy. I think you are describing poor impulse control in an empathetic person.

Is this the Bill Clinton example? Some supporters said that Bill Clinton simply loved people too much (I feel your pain!), and this is why he had an affair with Monica Lewinksky. I don't think that a psychiatrist who has an affair with patients would be described as "empathetic", as there is a very selfish component to this.

So in describing the effective type of physician I could add more modifiers, calling him or her the "selflessly empathetic doctor" who's prime motivation is well-being of the patient.

Would this wash for a doctor? "I love my patients so much that sometimes I cross boundaries I shouldn't!" Probably wouldn't make a rational defense.

Here is an interesting question, does medical training discourage empathetic tendencies? For example, you are a student on the L&D floor, there are women crying in pain who are in labor. The first time you experience this you might feel somewhat disconcerted, concerned, and yet everybody around you has been habituated to it. Time goes by and you learn to tune out the pain of others. Good or bad? Maybe good because you can work more effectively. Are you really a less empathetic person? Or have you simply learned how to channel your energies without letting your empathy control you?
 
Last edited:
That might be rarer than you would think. One of the hallmark defining characteristics of antisocial personality disorder is a lack of empathy. Immoral people generally don't have a lot of empathy. I think you are describing poor impulse control in an empathetic person.

Is this the Bill Clinton example? Some supporters said that Bill Clinton simply loved people too much (I feel your pain!), and this is why he had an affair with Monica Lewinksky. I don't think that a psychiatrist who has an affair with patients would be described as "empathetic", as there is a very selfish component to this.



I have to disagree. While there are some predatory psychiatrists, moreso the sexual boundary crossing comes from counter-transference, rescue fantasies, or the illusion that the feelings felt for a patient (erotic, etc.) are legitimate and deserve to be acted on. Poor boundaries and the slippery slope can start with small steps like doing something for a patient one usually doesn't do - setting up an outside appt time, hugging, etc. All things that in some context might be appropriate. But then the rule stretching becomes routine or expected, and the line gets blurrier. I've seen a few too many colleagues who overextend themselves for their pt's - at surface an admirable quality, but add in our inherent gift at rationalizing whatever behavior we do, and things could go way too far. This is exactly as you say - the selflessly empathetic doctor - it doesn't seem rational from the outside, but for the individual they create a world where it makes sense. "My patient really needed it, and I'm here to help them, so of course I did it."

Too much empathy + poor boundaries + rationalization = boundary violation in my book.
 
I don't know what empathy has to do with it really.

If you're a bad resident for whatever reason (sloppy, annoying, unreliable, dimwitted, etc.) and they want to get rid of you, they'll look for reasons to justify it. They'll put down stuff that you "didn't have empathy", which hard to prove/disprove either way. They'll also nail you for stuff like not doing your evaluations on time, not having your research project done on time, not having your process improvement project done on time, not having your d/c summaries done on time. The latter is all stuff that we're all behind on, but those of us residents who get good evaluations and are on good terms with the attendings otherwise won't suffer dire consequences from these mishaps. But for the problem residents, they'll nail them for all these things when they go to document stuff for why they're being dismissed.

So don't read too much into it.
 
I have to disagree. While there are some predatory psychiatrists, moreso the sexual boundary crossing comes from counter-transference, rescue fantasies, or the illusion that the feelings felt for a patient (erotic, etc.) are legitimate and deserve to be acted on. Poor boundaries and the slippery slope can start with small steps like doing something for a patient one usually doesn't do - setting up an outside appt time, hugging, etc. All things that in some context might be appropriate. But then the rule stretching becomes routine or expected, and the line gets blurrier. I've seen a few too many colleagues who overextend themselves for their pt's - at surface an admirable quality, but add in our inherent gift at rationalizing whatever behavior we do, and things could go way too far. This is exactly as you say - the selflessly empathetic doctor - it doesn't seem rational from the outside, but for the individual they create a world where it makes sense. "My patient really needed it, and I'm here to help them, so of course I did it."

Too much empathy + poor boundaries + rationalization = boundary violation in my book.

So true. The person I worked with in medical school who slept with a patient seemed like the nicest, most concerned and most caring physician ever. Apparently things went astray around some very needy borderline patient, and it all went downhill. It's not who you think would do it.
 
I don't know what empathy has to do with it really.

If you're a bad resident for whatever reason (sloppy, annoying, unreliable, dimwitted, etc.) and they want to get rid of you, they'll look for reasons to justify it. They'll put down stuff that you "didn't have empathy", which hard to prove/disprove either way. They'll also nail you for stuff like not doing your evaluations on time, not having your research project done on time, not having your process improvement project done on time, not having your d/c summaries done on time. The latter is all stuff that we're all behind on, but those of us residents who get good evaluations and are on good terms with the attendings otherwise won't suffer dire consequences from these mishaps. But for the problem residents, they'll nail them for all these things when they go to document stuff for why they're being dismissed.

So don't read too much into it.

I agree. There's no special empathy test for psychiatry residents. We're residents like everyone else, and we get fired for the exact same things as everybody else. I know Darth is taking empathy is this big philosophical bent, but the residents I've known who've been fired were not more lacking in empathy than the residents who've succeeded.
 
Hey Psych forum regulars: Is this Obie? This all just sounds so familiar...
 
Agree that you are usually nailed on the minor stuff if they just want to get rid of you. That's what they do at any job really. It really comes down to politics and getting along with the people you work with - whatever that means in that position.

As for it getting better for residents I disagree. One PD recently told me about two openings he had in his program and that he had at that moment 1400 applications to chose from. This was a small, out of the way program with a good but modest reputation.

The massive influx of overseas graduates creates this enormous differential. This last match had almost 40,000 applicants for the the total 25,000 positions available. Those are terrible numbers to look at. Medicine is a great field, but it has some definite challenges. I also agree that being empathetic is a good quality but that maybe makes medicine overall harder (= too thoughtful and compassionate).
 
Last edited:
Top