5th yr radiology resident fired for missing TB test

[reno911]

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I did read it and I do understand that. I appreciate the original premise that this resident was terminated or suspended or something. However, part of the case/argument/defense of injustice is that his/her name was not on the list of residents warned of potential adverse action for failure to comply with a simple thing like PPD. I find that argument unconvincing and actually goes against the resident. The issue is that a residency program would either

1. be filled with a bunch of non-communicating robots for colleagues to get warnings of such and this resident to not hear about them
2. or he/she would need to have their head burried in a cave to not hear all the gossip that would swirl.
3. AND have a very unusual PD/AsstPD/Prog coord in that a list of residents are targeted for potential adverse action and the program not make some moves....

This is a very complicated way of saying you just don't believe the guy. He says that he never received any sort of communication (possibly an email, but we're not even sure about that) and that it was a surprise to him. As I have said before, if you don't believe his story, then it's easy to find fault with him.

In the version of events in your head, this guy MUST have heard about it somehow even if was through gossip or other means. Reading his story, it is clear that his version is that he didn't hear anything. You are judging him by what you think happened rather than what he said happened.

Hello! That is why companies go to a salaried and non-hourly pay structure. The costs of overtime, etc... are no longer an issue for the company/business. And, this is exactly what hospitals, schools, etc... do to physicians and teachers, and etc... This is what Physicians complain about as well, the un-reimbursed care and tasks they perform.... including administration, etc...

This is all interesting, largely true, and only tangential to the point. It doesn't change the fact that these things are costs. Here's some different ways to look at it if you're confused:

1. The most direct way in which they are costs is that the response of the physician is to just try to do more in less time. Surely, you realize this is a common behavior. As a result work is probably done too quickly and less carefully, mistakes are made, and these mistakes may result in actual monetary costs.

2. Indirectly, if you pile up a bunch of non-reimbursed work on physicians they get frustrated and they leave. This happens all of the time in academia, as I assume you are aware. These people then need to be replaced and that is a substantial cost to the business.

So, while on a very superficial level, you can sweep these types of costs under the rug because there is no immediate cash outlay, they are very real costs. However, many large institutions make the mistake of ignoring them. Apparently, you do too.

 

[JackADeli]

This is a very complicated way of saying you just don't believe the guy...

In the version of events in your head, this guy MUST have heard about it somehow...

Again, maybe he didn't get the email.... that he thinks, as a senior resident accidently automatically deleted via spam filter. And, in his defense, he was not named, on the list of residents transmitted to his program, as one of the residents in danger of adverse action of suspension/termination/etc... And, while not being named, maybe his colleagues failed to comment to anyone of this threat list. And, while his colleagues kept him out of the loop & nobody talked about the annual ritual PPD, maybe everyone in his program administration did not take this threat list seriously and failed to mention to anyone in the program.... More accurately, i don't buy the story as, based on experience as student, resident, attending, and human nature the pieces don't really jive.

...while on a very superficial level, you can sweep these types of costs under the rug because there is no immediate cash outlay...However, many large institutions make the mistake of ignoring them. Apparently, you do too.

Sure, if you say so....
Allowing rule bending and/or instituting multiple layers of additional efforts to get employees to comply for fear of loosing employees in the future because you hold them accountable to easy and simple obligations... I understand the argument of the "softer" costs and potential "future costs" that are often argued as reasons why the immediate can be ignored and rules bent and etc... because the physician or other such body is of great value. That is the nice cuddly way. However, there are real costs and risks associated with healthcare worker exposures and with accreditation and etc....

Yes, we will not agree and you are free to mistakenly believe that since I do not agree I am some how not aware or have not considered these potential and/or softer costs. Your uber sophisticated and I am just to simple to understand a PD may quit/seek another position because his resident failed to get a PPD and created a headache and extra work that somehow is now the hospitals fault......

 

[reno911]

Yes, we will not agree and you are free to mistakenly believe that since I do not agree I am some how not aware or have not considered these potential and/or softer costs. Your uber sophisticated and I am just to simple...

If you want to be understood, you should stop contradicting yourself. Now you say you've been considering these costs all along. But before you said

Yet, you have not really cited any real examples of potential costs. I am just not seeing any real expense in this

I'm sure you'll tell me how I'm taking you out of context, even though there's not a lot of other ways I can interpret the above.

Furthermore, you have completely misunderstood the reason why this can't be resolved. It has nothing to do with you being "too simple", or whether or not I think that. While that may certainly be the case, the actual reason is because we each have plausible positions and there is no evidence other than our assertions. To recap:

The JackADeli Position: Firings such as these will deter others from non-compliance and make administering such things (i.e., TB test compliance) cheaper. This cost savings outweighs any losses associated with the occasional firing of otherwise productive employees.

The reno911 Position: Firings productive employees in this way has significant associated costs. These costs are far greater than the expense required to make an occasional phone call in cases of non-compliance.

As much as you would like to assert your position as being superior, barring some sort of rigorous analysis involving actual costs and some actual data, it would be impossible to prove which approach is actually more cost effective. That's where the problem is.

 

[JackADeli]

If you want to be understood, you should stop contradicting yourself. Now you say you've been considering these costs all along...

I'm sure you'll tell me how I'm taking you out of context, even though there's not a lot of other ways I can interpret the above...

Sure, if you say so.

...we each have plausible positions and there is no evidence other than our assertions..

Ok.

....JackADeli Position: Firings such as these will deter others from non-compliance and make administering such things (i.e., TB test compliance) cheaper. This cost savings outweighs any losses associated with the occasional firing of otherwise productive employees...

Close, but somewhat oversimplified. I would say, in this specific circumstance of a simple and easily completed employment obligation required of hundreds if not thousand of employees within the institution:

....TEMPORARY/SHORT TERM REVOCATION OF PRIVILEGES such as these will deter others from non-compliance and make administering such things (i.e., TB test compliance) cheaper. This cost savings outweighs any TEMPORARY INCONVENIENCE associated with the occasional TEMPORARY/SHORT TERM REVOCATION OF PRIVILEGES of otherwise TEMPORARY EMPLOYEE ANTICIPATED TO DEPART IN ANY EVENT albeit productive employees...

We have no evidence these actions resulted in any loss of company productivity. However, we do know that residents are by nature non-permanent employees. It may not be nice but is a reality. So, using them as an "example" does not necessarily loose an organization a "productive employee". Residents are from the business standpoint a good taget for sending a message. They are motivated to correct any adverse action resulting from their infraction, without invoking an attorney early if ever, in order to graduate and...LEAVE. A resident's ultimate agenda is in general to LEAVE.

 

[reno911]

We have no evidence these actions resulted in any loss of company productivity.

Well yes, because they unfired him, so the loss is pretty small in this one case (just like a single phone call would have been a small loss). I was under the impression that if you had things your way he would have stayed fired.

They are motivated to correct any adverse action resulting from their infraction, without invoking an attorney early if ever

Perhaps a resident wouldn't get an attorney "early", but he would have a bigger reason to get one than anyone else. If a resident loses his job, esp in a competitive field like radiology, he is essentially unemployable in his chosen profession, so he should be expected to fight the most vigorously (i.e., causing the most expense), and get an attorney involved at some point. Attending physicians, nurses, medical assistants, would have a much easier time getting similar jobs after such a firing.

 

[JackADeli]

Well yes, because they unfired him, so the loss is pretty small in this one case... I was under the impression that if you had things your way he would have stayed fired...

We are obviously on two different planes of reality.
Early in this discussion, others & I expressed our belief the resident wasn't "really" fired in the first place... Not going to rehash or go in circles on that...

...Perhaps a resident wouldn't get an attorney "early", but he would have a bigger reason to get one than anyone else. If a resident loses his job, esp in a competitive field like radiology, he is essentially unemployable in his chosen profession, so he should be expected to fight the most vigorously (i.e., causing the most expense), and get an attorney involved at some point. Attending physicians, nurses, medical assistants, would have a much easier time getting similar jobs after such a firing.

Again, on two different planes of reality.
I can't speak for anyone else. My interpretation early on was he wasn't "really" fired. This was cost effective, temporary, albeit dramatic inconvenience. The issue of him being a ~temporary employee is not to say he is easily fired. Rather, making him swet doesn't really have any adverse effect on the employers hopes for retention... since that have none. They are "physicians" and yet more readily held accountable then most primadonna attending physicians. The resident is expected to suffer through all the indignities of residency, comply with the contract/code of conduct/obligatory hoop jumping, complete their training, and leave!

They are very easily used as dramatic examples. This event would clearly generate buzz in the gossip mill. It would stimulate the allied health folks. It would shake up an apparently non-compliant residency administration. The situation would resolve fairly quickly. The admin could even dock the resident vacation time. Chances are, the fight wouldn't be worth it and more risky to the resident. Thus, he/she would feel screwed/robbed of some vacation, complete residency, leave bitter but leave...with no attornies involved. Very effective.

 

[Smurfette]

Perhaps a resident wouldn't get an attorney "early", but he would have a bigger reason to get one than anyone else. If a resident loses his job, esp in a competitive field like radiology, he is essentially unemployable in his chosen profession, so he should be expected to fight the most vigorously (i.e., causing the most expense), and get an attorney involved at some point. Attending physicians, nurses, medical assistants, would have a much easier time getting similar jobs after such a firing.[/QUOTE]

Actually, an attending physician who is fired (even for a PPD) will have a harder time finding a job. It has to be disclosed and explained on malpractice apps, licensing apps, insurance apps, etc. If you lose hospital privileges involuntarily, it's a big deal that will cause grief for the rest of your career. Some places will not interview or hire someone who has a 'negative' history like this.

However, I am dubious to believe that a lawyer would change things significantly as most physician (and resident) contracts include a clause stating you must comply with 'health requirements' (whatever phrase they choose) including such things as Tb testing. If the hospital can prove you breached your contract by failing to comply with this, they CAN fire you and your legal recourse may be severely limited regardless of how ridiculous it may seem for a PPD.

Can you two just agree to disagree? I doubt anybody's opinion is going to change at this point...mine hasn't. Moral of the story: get your annual PPD.

 

[reno911]

We are obviously on two different planes of reality.

Yes, that's quite clear. I'm going by the story that was written, and you going by some imagined version in your head that you are convinced is what actually happened based on your experience.

He was fired and then reinstated and that was a good outcome. I can't even imagine what your position is at this point. If all you're arguing for is a temporary suspension until he complies, who would have a problem with that? Based on his description (which once again, I realize you don't believe), he wasn't temporarily suspended. It was not a case of "You are forbidden to work here until the TB test has been done". He was, based on his description, fired, and then ultimately reinstated. There is a massive difference between that an a suspension until he complies.

They are very easily used as dramatic examples. This event would clearly generate buzz in the gossip mill. It would stimulate the allied health folks. It would shake up an apparently non-compliant residency administration. The situation would resolve fairly quickly. The admin could even dock the resident vacation time. Chances are, the fight wouldn't be worth it and more risky to the resident. Thus, he/she would feel screwed/robbed of some vacation, complete residency, leave bitter but leave...with no attornies involved. Very effective.

This is all true only if he is not actually fired. And I think that all of the above measures of dealing with this that you've detailed above are far superior to firing.

What I'm saying is that if he actually gets fired, then the attorney is almost certainly going getting involved. That's why I said agreed with the "early" part of your statement (i.e., the attorney wouldn't come into play "early", but he definitely would if the resident actually got fired).

In the story linked in the OP, the resident seems to make it clear that if he got fired and couldn't get reinstated through his own efforts, he probably would have gotten an attorney to fight it.

 

[reno911]

Actually, an attending physician who is fired (even for a PPD) will have a harder time finding a job

Harder than what? Harder than a resident who is fired in the middle of his residency (that's the comparision I was making) -- Not even close.

I agree that being fired for this reason would make things difficult for anybody, even an fully-trained, licensed, board-certified physician. I didn't mean to imply that it wouldn't be hard.

But as hard as it would be for the attending physician, it would be MUCH harder for the fired resident to find work as a radiologist.

 

[JackADeli]

...We're never going to resolve this on an internet message board.

...This is probably the only thing in your characterization I wholey agree with, that and the point that we will likely not agree...

...Can you two just agree to disagree? I doubt anybody's opinion is going to change at this point...mine hasn't. Moral of the story: get your annual PPD.

I thought we had "agreed to disagree" quite some replies ago....😕

Yes, that's quite clear. I'm going by the story that was written, and you going by some imagined version in your head that you are convinced is what actually happened based on your experience...

Are we back to this line of thought again.... I think we went in circles and I replied and explained etc, etc..... It's called actually thinking about what is said and if it is reasonable... I will leave it to whatever reading comprehension you can muster.

...He was fired and then reinstated and that was a good outcome. I can't even imagine what your position is at this point. If all you're arguing for is a temporary suspension...

Speaks alot. Fired, suspended, restricted, etc.... Point way, way, way back when was it was exceedingly short term and had no real impact beyond the stress and inconvenience of the resident, PD, etc.... In the end, message received, PPD compliance achieved. No room for any attornies.

....What I'm saying is that if he actually gets fired, then the attorney is almost certainly going getting involved. That's why I said agreed with the "early" part of your statement...

Sure...

...In the story linked in the OP, the resident seems to make it clear that if he got fired and couldn't get reinstated through his own efforts, he probably would have gotten an attorney to fight it.

And someone doubts this???

 

[reno911]

\.... It's called actually thinking about what is said and if it is reasonable

I suppose you could call it that. You could also call it creating your own reality. Either way, it's probably responsible for the majority of the disagreement.