Acgme

[Getgo123]

Can someone refer me to a thread or respond to a question regarding how the ACGME approaches program complaints/violations? What if a program does not meet 75% of the criteria in the specialty specific requirements document the ACGME publishes? It makes me wonder if there is a blind eye turned towards some programs considering the glaring issues here.

What is the best approach to handling this with the ACGME? Does one call first? I am confident that I have sufficient information to warrant a "check up" but I wanted to know how far that will go.

FYI, I personally feel this issue needs to be addressed on an ethical level and I am not concerned about backlash (although I am sure it will come).

Thanks for your help.

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[Law2Doc]

Can someone refer me to a thread or respond to a question regarding how the ACGME approaches program complaints/violations? What if a program does not meet 75% of the criteria in the specialty specific requirements document the ACGME publishes? It makes me wonder if there is a blind eye turned towards some programs considering the glaring issues here.

What is the best approach to handling this with the ACGME? Does one call first? I am confident that I have sufficient information to warrant a "check up" but I wanted to know how far that will go.

FYI, I personally feel this issue needs to be addressed on an ethical level and I am not concerned about backlash (although I am sure it will come).

Thanks for your help.

First, bear in mind that you can screw up your own and your coresidents careers if you take steps to tank/unaccredit your program so make sure it's really a problem that you can't plod through. Second, the ACGME doesn't really have much ability to search out problems, it waits until it hears about problems. Not a blind eye so much as simply not facing the right direction unless someone points them. Your program im sure submits paperwork indicating how they are meeting the requirements. Third, most programs and hospitals have internal avenues for whistle blowing -- you really are supposed to exhaust those first before you go to the ACGME. If you really want to be "ethical" that's probably your move unless there's evidence that it would be futile. Fourth, you potentially may want to talk to a lawyer, mentor or other advisor first, before you do this because there will be backlash, and there are always better ways to address these things with a minimum of backlash. Sometimes suggesting an attainable fix is a better tactic then whistle blowing. It's impossible to give great advice on the facts given, but always bear in mind that residency is a finite path, a lot of stuff can be learned on your own and honed in fellowship, and if it's tolerable sometimes you need to stick your principles into your back pocket and just muscle through. Good luck.

 

[Getgo123]

I have already secured a spot in a different specialty. I am very concerned about the incompetence of graduating physicians here. Additionally, the GME turns a blind eye to these things when they realize ACGME funding is at risk.

 

[Law2Doc]

I have already secured a spot in a different specialty...

then it's not your problem any longer. No point swatting at a hornets nest that isn't even in your way. If the people still in the program feel strongly they can deal with it, but you left; it's one thing if you were stuck there, but its never cool to set fire to a building on the way out the door, leaving other folks to pay the price.

Plus since you left everyone from attending to intern is going to call it sour grapes and paint you as the sole malcontent and a good riddance.

 

[IlDestriero]

then it's not your problem any longer. No point swatting at a hornets nest that isn't even in your way. If the people still in the program feel strongly they can deal with it, but you left; it's one thing if you were stuck there, but its never cool to set fire to a building on the way out the door, leaving other folks to pay the price.

Plus since you left everyone from attending to intern is going to call it sour grapes and paint you as the sole malcontent and a good riddance.

I disagree. If the program is not meeting the criteria required to maintain a training program you should send a letter. It must be addressed, not swept under the rug.

Cheers!

 

[NotAProgDirector]

The ACGME website has a reasonably detailed process for reporting program non-complicance. There are three levels:


You can submit a concern: http://www.acgme.org/acWebsite/resInfo/ri_formalcomplaint.asp

A concern requires that the PD review the issue and submit a written response to the RRC. Concerns do not change a program's accreditation status.

You can submit a Formal Complaint: http://www.acgme.org/acWebsite/resInfo/ri_complaint.asp

This seems pretty similar to a concern, but now can result in a change in cycle length or accreditation status.

You can submit an Egregious Violation. This seems limited to catastrophic events -- like your hospital collapses, or "all faculty quit". Although you might catrgorize your program as having egregious violations, I doubt they will meet these examples.

 

[zihuatanejo]

Can someone refer me to a thread or respond to a question regarding how the ACGME approaches program complaints/violations? What if a program does not meet 75% of the criteria in the specialty specific requirements document the ACGME publishes? It makes me wonder if there is a blind eye turned towards some programs considering the glaring issues here.

What is the best approach to handling this with the ACGME? Does one call first? I am confident that I have sufficient information to warrant a "check up" but I wanted to know how far that will go.

FYI, I personally feel this issue needs to be addressed on an ethical level and I am not concerned about backlash (although I am sure it will come).

Thanks for your help.

Since you don't have a fear of backlash, you can certainly approach the ACGME about this issue to see what they can do. However, I would not place much faith in ACGME doing the right or sensible thing. The ACGME is essentially a bureaucratic entity that creates sometimes stupid and burdensome rules leading to unnecessary paperwork and bureaucratic hurdles. Their main raison d'etre is to serve a public relations role for GME programs to make it look like the public safety and interest is being protected. Their goal is not to advocate for residents or protect residents in any way.

In fact, given the absence of whistleblower protections, the ACGME's so called resident concern or complaint process can harm the complaining resident in one of two ways. In the resident concern process, the particular GME program's accreditation is not affected. However, the resident still faces the possibility for retaliation from the program. ACGME has no rules or enforcement mechanisms to prohibit such retaliation. Moreover, the residency program can even choose to ignore the ACGME or stipulate that its communications with the ACGME regarding the resident's concern are confidential and can't be shared with the resident. Thus, the resident could end up filing a non-anonymous concern and end up with nothing to show for it except for the possibility of retaliation from the program.

The resident complaint process is not necessarily anymore advantageous than the resident concern process. The main difference is that the resident complaint process could potentially affect the GME program's accreditation, which is not exactly in the complaining resident's best interest. Moreover, for a complaint to get anywhere, the resident has the burden of proving that there have been systemic and recurrent violations of ACGME rules. Thus, ACGME would never deal with problems affecting individual residents and their education or training in the absence of such systemic and recurrent violations of ACGME rules

Moreover, ACGME encourages the reporting of so-called "egregious" problems regarding GME programs not because they care about protecting residents and their education or training but because they don't want to face public embarrassment by having these problems somehow escape ACGME scrutiny and potentially appear as blaring newspaper headlines.

 

[dragonfly99]

It seems like you are safely away from the program but if you are still in the same institution or city or immediate geographic area, you may still need to worry about retaliation. Also, sometimes you have to get certifications from the program where you did internship...such as certificate of completion, or them to confirm you worked there and what years, etc. If the same PD, etc. still work there in a few years when you are applying for jobs, they could drag their feet on providing required documents. That would not necessarily be likely to happen, but it could.
Morally/ethically you will be doing the right thing if you report to ACGME if you seriously have concerns about the program turning out people who are competent vs. not. I'm not sure I think they'll do anything based on one person's complaint. It seems like the best thing would be if multiple people filed similar complaints. Is there anyone else who bailed out and/or graduated in recent years who has similar concerns and would be willing to act along with you?

 

[Law2Doc]

...Also, sometimes you have to get certifications from the program where you did internship...such as certificate of completion, or them to confirm you worked there and what years, etc. If the same PD, etc. still work there in a few years when you are applying for jobs, they could drag their feet on providing required documents. ...

very true.

 

[Getgo123]

I looked into this and this is what I have learned:

Residents do not have much recourse when it comes to bullying, harassment or unfair treatment from a program. The GME and HR department work for the hospital. The hospital mainly wants to protect the department and would be more likely to remove a single resident than rectify a major systems-based problem.

The ACGME is very limited with regards to the support that they can provide to individuals - they mainly address work hour violations and issues with residents (as a group). They can try to remind the program of the ACGME rules and regulations but can not force a program to act. The resident's only option is to file a complaint or concern, and depending on the time line, it may be a useless exercise.

 

[3dtp]

It seems like you are safely away from the program but if you are still in the same institution or city or immediate geographic area, you may still need to worry about retaliation. Also, sometimes you have to get certifications from the program where you did internship...such as certificate of completion, or them to confirm you worked there and what years, etc. If the same PD, etc. still work there in a few years when you are applying for jobs, they could drag their feet on providing required documents. That would not necessarily be likely to happen, but it could.

And it does/did happen and has been documented. I have seen it, first hand. The GME director was relieved and the PD moved on to another institution (doing who knows that damage there), but it did happen. I have not data on the probability it will or will not happen.

Morally/ethically you will be doing the right thing if you report to ACGME if you seriously have concerns about the program turning out people who are competent vs. not. I'm not sure I think they'll do anything based on one person's complaint. It seems like the best thing would be if multiple people filed similar complaints. Is there anyone else who bailed out and/or graduated in recent years who has similar concerns and would be willing to act along with you?

Agreed. I do not think under most circumstances the ACGME will do much, if anything to correct a problem institution except work hour violations and then only because Congress is watching them closely.

I looked into this and this is what I have learned:

Residents do not have much recourse when it comes to bullying, harassment or unfair treatment from a program. The GME and HR department work for the hospital. The hospital mainly wants to protect the department and would be more likely to remove a single resident than rectify a major systems-based problem.

The ACGME is very limited with regards to the support that they can provide to individuals - they mainly address work hour violations and issues with residents (as a group). They can try to remind the program of the ACGME rules and regulations but can not force a program to act. The resident's only option is to file a complaint or concern, and depending on the time line, it may be a useless exercise.

Absolutely on target in the center of the bulls eye. In days past, the ACGME didn't have graduated levels of complaints, but even then, even in the face of an egregious violation rarely, if ever, acted. Only after much pressure did they even publish a list of programs "on probation." Prior to that, you found out when you asked the PD at the interview, and there is nowhere published the reasons programs were dinged.