ACGME’s role & Malignant Programs

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I'd add to that list personalities of the residents. If a program repeatedly ranks individuals with toxic personalities, the program will reflect that.



I don't think anyone is pretending malignancy in residencies doesn't exist. Of course it does. It's just not very common is all.
Yep.

My residency fired one person a year every year I was there. By the above standard my program would be considered malignant.

But it absolutely isn't. 2 of those residents just sucked. The 3rd was fired 2 months into my intern year so I have no clue what happened there.

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Yep.

My residency fired one person a year every year I was there. By the above standard my program would be considered malignant.

But it absolutely isn't. 2 of those residents just sucked. The 3rd was fired 2 months into my intern year so I have no clue what happened there.

Agreed. We had a resident who had such concrete thinking that she couldn't adapt to different situations and risked placing patients in harm's way. We had one that had significant substance abuse issues, and we had one who was just plain struggling and should have gone into a different field.

We also lost a resident in my class because she decided during intern year to pursue another (more competitive specialty), and quit after intern year (after she matched).
 
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I’ll just leave this right here....
Sometimes bad things happen to good people. I chose not to pursue lawsuit which would be most helpful in wages lost. I want to stay in academia should I decide to return. A lawsuit won’t help that. I was a golden child. I just got sick and was a sitting duck. My PD has been on probation before and they still won’t get rid of her after this. She must be running clinical trials like gangbuster. It’s all about money in the end. Program also scored <50% almost across the board on recent ACGME survey. The program will still be able to hide this and continue functioning. I posted what’s below on heme/onc thread as well.

Lots to say on this topic but I’ll try to be brief with my situation. Wondering if it is even worth reapplying elsewhere in the future or exiting medicine completely at this point?

MD PhD from MSTP matched to research/fast track for heme/onc in a pretty good program. Worked my butt off to get here - inner city public school kid, first gen graduate with blue collar parents. Finished first year of fellowship with outstanding reputation on track for faculty position with a basic science project on novel leukemia therapy with pharm dept chair. Then I got pneumonia and formal dx of systemic lupus or as my PD called it - my mystery illness. PD dealt with my situation very very inappropriately and poorly.

End result, I got fired under hospital bylaws for taking too much time. HR/PD refused any accommodations even with my having full support from her clinic boss, cofellows and dept chair. I just wanted call nights off for a month or 2 until I got symptoms controlled. Been dealing with lupus for about 10 yrs now without a formal diagnosis so I know what I am and am not capable of at this point.

So do I punish myself and reapply in the future? Would any programs really try to support my continuing if I prove my worth in intellectual property and recommendations? Or do I default into consulting? ☹ Some guidance from the wise would be greatly appreciated.
 
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I don't understand.

1. You got fired for taking too much time? How much time off did you take? it sounds like you couldn't progress in your fellowship (there's some rule about not taking more than a certain amount of time per year or training is extended), but you should have still been protected by FMLA even if training had to be extended.

2. Your post implies this recently happened, but then you say you've been dealing with lupus for 10 years, so are we talking about something that happened 10 years ago? You also say you have a formal dx of lupus now, so do you mean you were dealing with vague symptoms of the illness for 10 years without the dx?

3. Since you mention fellowship, I assume you got credit for residency? You say you fast-tracked so I'm not sure. Are you considered a residency graduate?

Given that you were fired for taking too much time off based on hospital rules (which I still find suspect), I'm not clear on how this means your program, itself, was malignant.
 
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Imo this is an example of an egregious case of a chairman at a residency program running amok:
The Case Report conclusively found:
 Witnesses' testimony substantiated the allegations that Bahnson has made direct
or implied threats to members of the Department of Urology;
 By making threats about future employment, recommendation letters, and taking
paternity leave, Bahnson has behaved in a way that is in conflict with Ohio States’
values of Integrity, Openness and Trust, and Empathy and Compassion;
 Investigators found that there is a pervasive fear in the Department of Urology
that Bahnson will follow through on his threats. There is a culture of fear and
intimidation in the Department of Urology;
 There is sufficient evidence that Bahnson's behavior is consistent with a hostile
work environment, which exists when an employee experiences workplace
harassment and fears going to work because of the offensive, intimidating. or
oppressive atmosphere generated by the harasser;
 The mechanisms in place through the Residency Program to protect residents did
not function as intended;
 The impact of Box's lack of authority as Residency Program Director is that there
has been no buffer between residents and Bahnson's intimidating behavior;
 Witness testimonies substantiate the allegation that Bahnson made physical
contact in a threatening manner with a former resident. This type of behavior is a
direct violation of university policy and is unacceptable. Based on the witnesses'
testimony of direct and implied threats, physical contact of an aggressive nature
and intimidation that has disrupted the work environment in the Department of
Urology, the conclusion of the investigation is there is a finding of sufficient
evidence of a policy violation as it relates to the university's Workplace and
Family and Relationship Violence Policy 7.05;
 The witness testimonies substantiated the allegations that Bahnson engaged in
harassment by making multiple comments relating to national origin;
 The conclusion of the investigation is there is a finding of sufficient evidence of a
policy violation as it relates the university's Affirmative Action, Equal
Employment Opportunity and Non-discrimination/Harassment policy
 
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When male resident urologists attempted to take paternity leave, Bahnson would send the
requesting male an email stating “please see me.” During these “please see me” meetings,
Bahnson would threaten and verbally abuse the requesting male urologists. His statements
included “good surgeons don’t take paternity leave,” that he “eliminated paternity leave” and he
will reduce everyone’s vacation from three weeks to two weeks if too many residents take
paternity leave. Moreover, Bahnson stated he would, if possible, “extend” the requesting males
urological training in retaliation for taking paternity. Bahnson made thinly veiled threats stating
he will not believe males are “competent surgeons” if they take paternity leave, and that they
should remember he signs their certificates of graduation at the end of training, which are
necessary for taking the boards.
A third male resident requested paternity leave one week before Wilson and Smock did.
This third resident's wife had a high risk pregnancy. Bahnson sent the resident a "please see me
email." He threatened the resident that he will not sign off on his graduation certificate if
paternity leave was taken, as by Bahnson’s definition a resident who takes paternity leave is not
a competent surgeon. On information and belief, due to Bahnson's known history of threats and
intimidation regarding paternity leave, the resident recorded the meeting with Bahnson using an
audio device.
On information and belief, Bahnson told two female urology residents to take birth
control so they do not become pregnant. One of these female residents was told by Bahnson to
"come to my office and take birth control, or be fired."

In early 2011, ACGME survey results were reported in which Ohio State’s urology program performed poorly in the responses by the residents, particularly in the categories of fear and intimidation, ability to bring up concerns of program deficiencies without retaliation, the program's interest in teaching residents, and if the residents would choose the program again if given the option to.
In response, Bahnson stated he will extirpate the “bad residents” and that the residents are “despicable people.” Bahnson retaliated against the residents, including Wilson, by directing negative performance reviews.
In Spring 2011, the ACGME visited Ohio State’s urology department to investigate the
poor survey results and evaluate accreditation. After the ACGME visit, Bahnson was removed as
Program Director. On information and belief, Bahnson was removed as Program Director
because of the actions taken by the ACGME. Ohio State enabled Bahnson to appoint Box as his
successor as Program Director.
Ultimately, the ACGME renewed Ohio State’s accreditation for three years, instead of
the maximum renewal of five years. The shortened renewal greatly angered Bahnson, and
Bahnson stated his anger publically on several occasions. During an educational meeting with
the faculty and residents, Bahnson told the residents "shame on you" for "ruining the program."
In 2013, a graduated resident was prevented from moonlighting after Box refused to sign
his hospital credentialing papers and made comments to the hospital causing the resident to have
credentialing denied. Box later claimed these actions were done by “accident.” On information
and belief, Box prevented this resident from moonlighting at the direction of Bahnson in
retaliation for ACGME survey results.
In 2013, another graduated resident was prevented from starting his job for a significant
period of time because Bahnson and/or Box negatively reported his professionalism and hygiene.
On information and belief, this action was taken in retaliation for ACGME survey results.
While Wilson was employed at Ohio State, at least six residents left the program or had mental breakdowns due to Bahnson’s malicious behavior: A resident switched from urology to anesthesia because the program was “a big problem" A resident switched from urology to business; Another resident switched from urology to anesthesia; A resident transferred to Louisville, Kentucky;  A resident was fired and Bahnson has taken actions to prevent the resident from being able to practice medicine in any capacity; Due to the harassing nature of Bahnson and the Ohio State urology program, a resident was committed to a mental institution for a period of time; Due to the harassing nature of Bahnson and the Ohio State urology program, another resident now requires continuous psychotherapy, which the resident did not require before residency

A resident stated that when he approached Bahnson to change the order of presentations
in conference, Bahnson said to him "I'm assuming you are here to turn in your resignation; you
know more about education than I do."
Another resident stated to Ohio State that Bahnson threatened to “cut off his balls.”
Another resident stated that after a patient complained about his care, Bahnson said to
him "If that ever happens again, I will call up your future jobs and tell them not to take you."
Another resident stated that he has heard Bahnson say in a group setting "Remember, I'm
the one who signs your recommendation letter at the end of residency."
98. Ohio State found the testimony of the residents credible on these issues
 
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I don't understand.

1. You got fired for taking too much time? How much time off did you take? it sounds like you couldn't progress in your fellowship (there's some rule about not taking more than a certain amount of time per year or training is extended), but you should have still been protected by FMLA even if training had to be extended.

2. Your post implies this recently happened, but then you say you've been dealing with lupus for 10 years, so are we talking about something that happened 10 years ago? You also say you have a formal dx of lupus now, so do you mean you were dealing with vague symptoms of the illness for 10 years without the dx?

3. Since you mention fellowship, I assume you got credit for residency? You say you fast-tracked so I'm not sure. Are you considered a residency graduate?

Given that you were fired for taking too much time off based on hospital rules (which I still find suspect), I'm not clear on how this means your program, itself, was malignant.

Unfortunately, I was actually fired 6 mos ago. Fought for 6 mos trying to get reinstated with my Dept chair at the helm. Even had CFO and President of hospital call on my behalf. Since I fast tracked, I was not board eligible. I fought for this and just took boards a couple weeks ago. Woo! However, by taking boards I forfeit my fellowship spot. I chose job security over further punishment.

Problem is my PD lied to HR. I had to get HR involved once I had lupus on my dx list. So her lies are permanently on my record and ultimately I was fired based on these. Other females also had similar issues just not as pronounced as mine. Said I bashed the program and her name on a blog (posted below). Both untrue. HR came up with many excuses for firing me but all were debunked by the chair and so they just said I took too much time. Even lawyers didn’t understand how it could happen. ACGME survey also showed <50% across the board placing the program on probation.
www.kevinmd.com

A loss of physician support at a time of need
I fear burnout and lack of ingenuity will transform physicians into pariahs ripe for the firing.
www.kevinmd.com
www.kevinmd.com

Even worse, the chair of dept wanted PD demoted but medicine chair won’t sign off. I am told he has been blinded by her lies. It’s just a very malignant program and I’d be better served elsewhere. I’m just wondering if programs would in any way facilitate my success even though I’m a high risk high reward candidate. I did finish first year of fellowship without issue and only had something like 4 mos of clinical to finish. Both my chair and malignant heme director offered to write me LoR stating they’d make sure I’d have my pick.

I’m just so tired of all this BS that I just want to quit before I even got a chance to start. I feel like I have so much to offer cancer research and patients. My mindset is heme/onc or bust. I wasn’t lazy or a bad fellow. I just got sick for a little. I also got pericarditis randomly in Med school. Took some Aleve and kept chugging. So I’ve probably had lupus for a long time gone undiagnosed. My program was 100% malignant and GME did absolutely nothing to help me or prevent this. The field is losing a good physician for nothing. It’s not even like they can fill my spot.
 
Imo this is an example of an egregious case of a chairman at a residency program running amok:
The Case Report conclusively found:
 Witnesses' testimony substantiated the allegations that Bahnson has made direct
or implied threats to members of the Department of Urology;
 By making threats about future employment, recommendation letters, and taking
paternity leave, Bahnson has behaved in a way that is in conflict with Ohio States’
values of Integrity, Openness and Trust, and Empathy and Compassion;
 Investigators found that there is a pervasive fear in the Department of Urology
that Bahnson will follow through on his threats. There is a culture of fear and
intimidation in the Department of Urology;
 There is sufficient evidence that Bahnson's behavior is consistent with a hostile
work environment, which exists when an employee experiences workplace
harassment and fears going to work because of the offensive, intimidating. or
oppressive atmosphere generated by the harasser;
 The mechanisms in place through the Residency Program to protect residents did
not function as intended;
 The impact of Box's lack of authority as Residency Program Director is that there
has been no buffer between residents and Bahnson's intimidating behavior;
 Witness testimonies substantiate the allegation that Bahnson made physical
contact in a threatening manner with a former resident. This type of behavior is a
direct violation of university policy and is unacceptable. Based on the witnesses'
testimony of direct and implied threats, physical contact of an aggressive nature
and intimidation that has disrupted the work environment in the Department of
Urology, the conclusion of the investigation is there is a finding of sufficient
evidence of a policy violation as it relates to the university's Workplace and
Family and Relationship Violence Policy 7.05;
 The witness testimonies substantiated the allegations that Bahnson engaged in
harassment by making multiple comments relating to national origin;
 The conclusion of the investigation is there is a finding of sufficient evidence of a
policy violation as it relates the university's Affirmative Action, Equal
Employment Opportunity and Non-discrimination/Harassment policy
Basically what happened to me. I submitted a complaint about intimidation and discrimination after having a witnessed discussion with my PD. See blog above. Medicine chair did not like that. So instead of investigating, he went along with having me fired at my PDs discretion. And btw, my PD has already been on probation once. I am not the only one to report her for discrimination. She has been known to tell pregnant females they can’t take full FMLA without prolonging training. Come to find out...my PD cared for medicine chairs family member. I got screwed 10x over by the internal workings of big medicine. I don’t want to pursue legal action. Not worth my time or money if I want to practice.

Let me also tell you that being fired over the phone by a stranger without warning and not even allowed to get my belongings is quite humbling. I kept my cool. Never even received a call or apology from PD until a month later the dept chair reaches out and is mortified by what happened. Integrity and dignity out the window.
 
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Basically what happened to me. I submitted a complaint about intimidation and discrimination after having a witnessed discussion with my PD. See blog above. Medicine chair did not like that. So instead of investigating, he went along with having me fired at my PDs discretion. And btw, my PD has already been on probation once. I am not the only one to report her for discrimination. She has been known to tell pregnant females they can’t take full FMLA without prolonging training. Come to find out...my PD cared for medicine chairs family member. I got screwed 10x over by the internal workings of big medicine. I don’t want to pursue legal action. Not worth my time or money if I want to practice.

Let me also tell you that being fired over the phone by a stranger without warning and not even allowed to get my belongings is quite humbling. I kept my cool. Never even received a call or apology from PD until a month later the dept chair reaches out and is mortified by what happened. Integrity and dignity out the window.
Not to defend actions, but this isn't the PDs fault. Full FMLA is 6 weeks. You can't sit for your boards if you take more than 30 days off in a year unless you extend training. So yes, you can't take full maternity leave in IM or an IM subspecialty without extending your training program. Anywhere.
 
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Not to defend actions, but this isn't the PDs fault. Full FMLA is 6 weeks. You can't sit for your boards if you take more than 30 days off in a year unless you extend training. So yes, you can't take full maternity leave in IM or an IM subspecialty without extending your training program. Anywhere.

Also true for surgery.

Will also comment that for FMLA leave, legally, your employer CAN terminate you if you are off longer than 12 weeks. It does not mean you can be off indefinitely or take more than that amount of time off cumulatively in a given year and still be guaranteed your job.
 
Also true for surgery.

Will also comment that for FMLA leave, legally, your employer CAN terminate you if you are off longer than 12 weeks. It does not mean you can be off indefinitely or take more than that amount of time off cumulatively in a given year and still be guaranteed your job.
Replying to both. Both are moot points. Just the tip of the iceberg for what my PDs done in the past eg using job opportunities/placements as leverage to barter away training extensions or threaten remediation. I know I can be fired at will after FMLA is up. But FMLA was used inappropriately in my case. There was no interactive process. Just think if you dispose of learners like this then where do you draw a line. No one wants to attend a program where there’s no learning and full indentured servitude. And I sure hope you never fall on hard times. Life isn’t predictable. You’re nitpicking. Look at the bigger picture.
 
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Not to defend actions, but this isn't the PDs fault. Full FMLA is 6 weeks. You can't sit for your boards if you take more than 30 days off in a year unless you extend training. So yes, you can't take full maternity leave in IM or an IM subspecialty without extending your training program. Anywhere.

FMLA is 12 weeks.

As for time off and board eligibility, this must be specialty dependent. Good to know the rule for IM. For psych, I believe it's 60 days in an academic year.
 
FMLA is 12 weeks.

As for time off and board eligibility, this must be specialty dependent. Good to know the rule for IM. For psych, I believe it's 60 days in an academic year.
Is that 60 days full time off?

In my FM program we'd get new moms 2 months by doing 30 days vacation and a 30 day elective that could be done at home - medical spanish or something like that.
 
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FMLA is 12 weeks.

As for time off and board eligibility, this must be specialty dependent. Good to know the rule for IM. For psych, I believe it's 60 days in an academic year.
You're right, 12 weeks. Regardless, it's a number above the maximum # of days you can take off and remain board eligible without extending training.
 
FMLA is 12 weeks.

As for time off and board eligibility, this must be specialty dependent. Good to know the rule for IM. For psych, I believe it's 60 days in an academic year.
If you need more time off you can take leave of absence without pay. I’ve seen residents do this for up to a year at the institution where I worked. Your spot is protected in this case. I am well versed in leave, FMLA and all that Jazz. I’m not disputing that hospitals can fire at Will. They can even do it without cause. Just remember, we are all in this together. It could happen to you too so don’t get sick.

I’m just wondering if reapplying is worth it. I probably could have finished from where I was situated. I’d only have a few clinical months to finish then 2 yrs of research. I love medicine and taking care of people. I’m also being realistic. I know lupus doesn’t get any better with time. Repeating a whole two years of indentured servitude just doesn’t sound appealing. I know it doesn’t get easier. I’m trying to understand if the lack of support I received is common or if some programs would actually put in the effort to help me succeed. I’m highly intelligent and know what I’m capable of. It’s hard for me to accept that residents/fellows can be disposed of like this. We aren’t labor. We are learners.

I’ve come to terms with maybe life is pushing me down another path but many many faculty have urged me to keep going and reapply. I’m so torn most of the time. The logical choice would be to get out while I can but I know I’ll miss it.
 
Your terminology about leave is somewhat confusing. FMLA doesn't require an interactive process -- that's ADA accommodations. Programs can offer leave for as long as they want, but there's no requirement and there's no guarantee of your job after the 12 weeks of FMLA. If you go out on disability leave, there may be laws about that. Some of this is state specific, so it's possible that the laws in your state are different than those elsewhere.

Regardless, that's not what you're really asking. First, if you can sit for the IM boards then you're considered fully trained. Your career is not over -- you can work in primary care or as a hospitalist. You could be a hospitalist on a heme inpatient service. You could get a job working in a place with a heme fellowship, have them get to know you, and get a spot. You could apply for Heme fellowships again -- the worst that happens is you get turned down. It's too late now -- the season is well underway -- so you need to focus on getting a job and getting more clinical experience.

You have an illness. It's being treated, and you're better now. Get your career back on track.
 
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Is that 60 days full time off?

In my FM program we'd get new moms 2 months by doing 30 days vacation and a 30 day elective that could be done at home - medical spanish or something like that.

To tell you the truth, I'm not 100% positive how it worked. I just know that's what pregnant residents did during residency. I believe they used vacation/sick time, then FMLA after that. But they didn't have to extend unless they were out more than a total of 8 weeks per academic year. Psych may be a tad different too because mose of PGY 4 year is elective time.

If you need more time off you can take leave of absence without pay. I’ve seen residents do this for up to a year at the institution where I worked. Your spot is protected in this case

Hm, not sure about that. That may be institution specific, much like deferring or taking a leave of absence in med school.

Regardless, that's not what you're really asking. First, if you can sit for the IM boards then you're considered fully trained. Your career is not over -- you can work in primary care or as a hospitalist. You could be a hospitalist on a heme inpatient service. You could get a job working in a place with a heme fellowship, have them get to know you, and get a spot. You could apply for Heme fellowships again -- the worst that happens is you get turned down. It's too late now -- the season is well underway -- so you need to focus on getting a job and getting more clinical experience.

You have an illness. It's being treated, and you're better now. Get your career back on track.

I believe the poster said he/she is not board eligible due to fast-tracking.
 
To tell you the truth, I'm not 100% positive how it worked. I just know that's what pregnant residents did during residency. I believe they used vacation/sick time, then FMLA after that. But they didn't have to extend unless they were out more than a total of 8 weeks per academic year. Psych may be a tad different too because mose of PGY 4 year is elective time.

Hm, not sure about that. That may be institution specific, much like deferring or taking a leave of absence in med school.

I believe the poster said he/she is not board eligible due to fast-tracking.
I wasn’t eligible per ABIM but had completed 3 years of training. All clinical. My chair had my PD and IM PD write a letter saying I fulfilled requirements for IM residency. I took IM boards this past August. Had to fight for it but very very grateful to at least be employable. I am hoping it won’t be an issue when I apply for licensure in another state.

I didn’t want to discuss in too much detail about leave. You don’t have to use FMLA all at once. For accommodations/interactive process, you could use FMLA for certain days like when I asked for call days off. Instead my PD forced me to take it all at once which didn’t make much sense because I was on research/T32 and functional still. I needed leniency. Instead I got railroaded. Don’t like to blame others for things that happen to me in life. Just deal with it. However, my PD has a reputation that precedes her. I worked in the same arena/specialty as her. I even tried to collaborate with her and that’s when my problems started. Fellows have even stopped showing interest in malignant heme because they don’t want to be targeted. It’s not just me and I wasn’t the first. I was just a sitting duck and she has a guardian devil in the system. Whatcha gonna do?
 
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You don’t have to use FMLA all at once. For accommodations/interactive process, you could use FMLA for certain days like when I asked for call days off. Instead my PD forced me to take it all at once which didn’t make much sense because I was on research/T32 and functional still.

Just did some reading on this for anyone else who is curious. Info here: Fact Sheet 28I - Wage and Hour Division (WHD) - U.S. Department of Labor

It would appear that your PD should not have been allowed to demand that you take your FMLA in bulk as the employer is required to allow FMLA leave to be taken in the smallest increment that other episodes of leave allowed to be taken in. Typically one would assume that this would be a single sick day in non-FMLA cases so you certainly should have been able to do that. That said, if taking leave for a half day is not routinely granted in the program it would seem that the program has no obligation to allow you to take only evenings off.

I could see the program making the argument that even if you took the day that you were on call off, they could say that your subsequent day at work would then be required to be a call day which would then of course require you to take that day off as well. Repeat the process every day for 12 weeks and the end result is that you take all your FMLA leave at once.
 
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This is what I've been saying on page 1. People need to like this.

No, you didn't. You went on about problem residents not being at fault.

There are malignant programs, malignant PDs, etc. The ACGME needs to help malignant programs improve. I know of two residency programs that have such characteristics....well three.

No one ever denied that malignant programs exist and that the ACGME should help those programs improve. What people argued is that 9 times out of 10, it's not the program that's malignant.
 
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Nope. I've seen several programs where malignant attendings exist, residents who spread rumors about other residents, etc.

That’s like every job dude. I’m pretty sure every job I’ve worked there’s been people who “spread rumors” and gossip about other people.

Also for the guy above who was taking about how you can’t tell if a resident gets kicked out every year or not...again what other job do you know of where they would tell you if they fired someone in your position in the company regularly? Youd probably get a sense of it by talking to people in the industry (other residents) and gossip but no employer is going to come out and tell you the manager for your division is a dick and people leave the company every couple years, wanna join?

It’s not that there’s anything particularly unique about the workplace dynamics in residency. Ask the nurses about their managers and be ready to hang out for a while ;) It’s the total lack of leverage residents have and huge difficulty finding another job if removed from the program.
 
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That’s like every job dude. I’m pretty sure every job I’ve worked there’s been people who “spread rumors” and gossip about other people.

Also for the guy above who was taking about how you can’t tell if a resident gets kicked out every year or not...again what other job do you know of where they would tell you if they fired someone in your position in the company regularly? Youd probably get a sense of it by talking to people in the industry (other residents) and gossip but no employer is going to come out and tell you the manager for your division is a dick and people leave the company every couple years, wanna join?

It’s not that there’s anything particularly unique about the workplace dynamics in residency. Ask the nurses about their managers and be ready to hang out for a while ;) It’s the total lack of leverage residents have and huge difficulty finding another job if removed from the program.

This is exactly the big difference. Its not just a job in residency. Its a requirement to use a degree that cost those students multiple year to get, cost them hundreds of thousands of dollars to get and cost tax payers even more to support both the school and the residency. That's exactly why there should be more safeguards and resident rights, but in all honesty, sometimes it seems like there's less, because programs can always employ the "employee" angle or the "student" angle whenever it suits them. In general courts tend to defer to their judgement.

Listen, I'm not some random guy that went straight from school to residency as my first job. I'm a non-trad with plenty of other work experience in industry. I know what its like to have a job, and its probably one of the reasons why I've never gotten close to having issues in residency. The problem is, I also see how flawed things are and how vulnerable residents are especially compared to other jobs. For most people its fine. They do their work, they are normal with people and things work out. That said, I've seen people abuse the system too, and its catastrophic when it happens to residents. Its not common, but it happens, and when you see it, it sucks.
 
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This is exactly the big difference. Its not just a job in residency. Its a requirement to use a degree that cost those students multiple year to get, cost them hundreds of thousands of dollars to get and cost tax payers even more to support both the school and the residency. That's exactly why there should be more safeguards and resident rights, but in all honesty, sometimes it seems like there's less, because programs can always employ the "employee" angle or the "student" angle whenever it suits them. In general courts tend to defer to their judgement.

Listen, I'm not some random guy that went straight from school to residency as my first job. I'm a non-trad with plenty of other work experience in industry. I know what its like to have a job, and its probably one of the reasons why I've never gotten close to having issues in residency. The problem is, I also see how flawed things are and how vulnerable residents are especially compared to other jobs. For most people its fine. They do their work, they are normal with people and things work out. That said, I've seen people abuse the system too, and its catastrophic when it happens to residents. Its not common, but it happens, and when you see it, it sucks.

Yes, you're right. The lack of resident rights is a problem. No one disputed that. But I think what gets people on-edge with these threads is what some believe constitutes a malignant program and the belief that malignant programs are the norm. Malignant residents are way more common than malignant programs.
 
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....malignant residents exist because the system failed them to become prepared for residency. The residency has the responsibility to ensure that any resident becomes a good physician. When a "problem resident" is identified, all hell breaks loose for the resident in an effort to get him or her fired. This is why malignant programs exist.
I said that before >.>

This is where you lose credibility. The above suggests you don't understand the meaning of the word malignant. If you do understand and still think that your educational institutions are responsible for YOUR personality, then you truly don't get what it means to be an adult. It is not anyone else's responsibility to get a resident to stop spreading rumors about their colleagues or stop treating Uber drivers like crap or stop sending slanderous anonymous letters to the fellowships of their colleagues or stop missing shifts at work. It is the responsibility of the resident and the resident alone and any argument to the contrary can't possibly be taken seriously by anyone who's ever worked a day in his/her life. Your boss is not responsible for your personality. Ever.
 
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....malignant residents exist because the system failed them to become prepared for residency. The residency has the responsibility to ensure that any resident becomes a good physician. When a "problem resident" is identified, all hell breaks loose for the resident in an effort to get him or her fired. This is why malignant programs exist.
I said that before >.>
Wow. Just going to go ahead and try to absolve yourself of the need for any personal responsibility whatsoever? Seriously, your comment oozes of so much self entitlement that it is borderline indistinguishable from trolling.
 
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Just did some reading on this for anyone else who is curious. Info here: Fact Sheet 28I - Wage and Hour Division (WHD) - U.S. Department of Labor

It would appear that your PD should not have been allowed to demand that you take your FMLA in bulk as the employer is required to allow FMLA leave to be taken in the smallest increment that other episodes of leave allowed to be taken in. Typically one would assume that this would be a single sick day in non-FMLA cases so you certainly should have been able to do that. That said, if taking leave for a half day is not routinely granted in the program it would seem that the program has no obligation to allow you to take only evenings off.

I could see the program making the argument that even if you took the day that you were on call off, they could say that your subsequent day at work would then be required to be a call day which would then of course require you to take that day off as well. Repeat the process every day for 12 weeks and the end result is that you take all your FMLA leave at once.
I would have had 2 and maybe 3 call nights max each month. No day off on the following day. I was asking for 3 full days off per month using FMLA via interactive process. I noticed that call nights really messed with my ability to have a regular sleep schedule which would affect my work each week and just build up on one another. I needed to optimize my health and go to appts at the same time. Fellows offered to cover. We can’t take half sick days/FMLA. Not allowed. I was denied the 3 days/month, told I had to take all FMLA at once. I was then told by a counselor to ask HR. Obviously a bad idea but what choice did I have. I was already up a creek.
 
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Not trolling. Trying to make a point about how both parties can be at fault but more fault can be placed on the program in certain circumstances.
Douche bags are douche bags...just because they managed to make it out of medical school doesn’t mean that they aren’t douches...thing is in residency it can become glaringly obvious...no program is going to make them less douchey.
 
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Douche bags are douche bags...just because they managed to make it out of medical school doesn’t mean that they aren’t douches...thing is in residency it can become glaringly obvious...no program is going to make them less douchey.

Oh yes. These days it is so easy to coast through medical school doing the bare minimum and disappearing early from clinical days. When I tried to work the students a little bit getting them experience with DC summaries I was called into the Dean’s office for giving them “scut.”

This coddling allows some negative and self-centered folks to glide right into residency where they hit a brick wall of responsibility. It can be a jarring transition.

While we are being honest, this thread is pretty much a dumpster fire.
 
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Oh yes. These days it is so easy to coast through medical school doing the bare minimum and disappearing early from clinical days. When I tried to work the students a little bit getting them experience with DC summaries I was called into the Dean’s office for giving them “scut.”

This coddling allows some negative and self-centered folks to glide right into residency where they hit a brick wall of responsibility. It can be a jarring transition.

While we are being honest, this thread is pretty much a dumpster fire.

How dare you try to help those students with big boy work.
 
I would have had 2 and maybe 3 call nights max each month. No day off on the following day. I was asking for 3 full days off per month using FMLA via interactive process. I noticed that call nights really messed with my ability to have a regular sleep schedule which would affect my work each week and just build up on one another. I needed to optimize my health and go to appts at the same time. Fellows offered to cover. We can’t take half sick days/FMLA. Not allowed. I was denied the 3 days/month, told I had to take all FMLA at once. I was then told by a counselor to ask HR. Obviously a bad idea but what choice did I have. I was already up a creek.

You're getting your terminology confuzzled. FMLA is leave due to illness. You can use FMLA to go to appointments, or because you're too sick to work. You can use it continuously or intermittently. What you can't do is say "I can't take call because of my illness, so I'll just call in sick those days and claim FMLA". Or, as mentioned above, if you were to take those days in advance as FMLA, the program could just swap the call day with someone else.

What you could try to do is claim a disability under the ADA. You could say "being up all night and working the next day, even if I just get inerrupted a few times, is impossible for me because of my illness". You would need a physician to attest to this. If you make that request to your employer and you qualify for protection under the ADA, then your employer is required to have an "interactive process" with you to determine whether there is a reasonable solution.

If this was a temporary request -- no call for a month or two, then OK to take call again, I'd just swap your calls out to the future -- you'd do less call now, and more call later. If this was a permanent request - you can never do 24 hour call - then that's much more complicated. Options:

1. I could state that 24 hour shifts are an essential function of the position, and that there are no accommodations for them (I would need to have this in writing as part of my program's requirements).
2. I could say "Well, you need to do night work and you need to do day work as part of your training. If you can't do 24 hour shifts, then we can split them into 12 hour shifts." This would require that other people split their shifts also, which could be a huge imposition on them (although the ADA doesn't care about impositions on other people).
3. What I might do is say that you have to do just as much work as everyone else, some mix of night and day work, but I'm willing to be flexible. You say you can't work after a night shift, so we'll have you take call only on Friday nights -- that way you have the whole weekend off to recover. Because you'll be working less nights, you'll work more days. The way to make that fair for everyone else is to have you work weekend days -- you work the day shifts, rounding on the inpatients, etc. They cover night shifts. Ultimately you'll end up working more weekends than everyone else, but this arrangement lets you work a reasonable number of nights (required by the curriculum) and makes up for those lost nights with more weekend days.
 
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You're getting your terminology confuzzled. FMLA is leave due to illness. You can use FMLA to go to appointments, or because you're too sick to work. You can use it continuously or intermittently. What you can't do is say "I can't take call because of my illness, so I'll just call in sick those days and claim FMLA". Or, as mentioned above, if you were to take those days in advance as FMLA, the program could just swap the call day with someone else.

What you could try to do is claim a disability under the ADA. You could say "being up all night and working the next day, even if I just get inerrupted a few times, is impossible for me because of my illness". You would need a physician to attest to this. If you make that request to your employer and you qualify for protection under the ADA, then your employer is required to have an "interactive process" with you to determine whether there is a reasonable solution.

If this was a temporary request -- no call for a month or two, then OK to take call again, I'd just swap your calls out to the future -- you'd do less call now, and more call later. If this was a permanent request - you can never do 24 hour call - then that's much more complicated. Options:

1. I could state that 24 hour shifts are an essential function of the position, and that there are no accommodations for them (I would need to have this in writing as part of my program's requirements).
2. I could say "Well, you need to do night work and you need to do day work as part of your training. If you can't do 24 hour shifts, then we can split them into 12 hour shifts." This would require that other people split their shifts also, which could be a huge imposition on them (although the ADA doesn't care about impositions on other people).
3. What I might do is say that you have to do just as much work as everyone else, some mix of night and day work, but I'm willing to be flexible. You say you can't work after a night shift, so we'll have you take call only on Friday nights -- that way you have the whole weekend off to recover. Because you'll be working less nights, you'll work more days. The way to make that fair for everyone else is to have you work weekend days -- you work the day shifts, rounding on the inpatients, etc. They cover night shifts. Ultimately you'll end up working more weekends than everyone else, but this arrangement lets you work a reasonable number of nights (required by the curriculum) and makes up for those lost nights with more weekend days.
Doesn’t matter. What’s done is done. The details of leave and ADA are lost at this point. I had ADA accommodations requested by my rheumatologist a month into leave with request for call days off. It was flat out denied. I was forced to take all my FMLA when I wasn’t sick. A lawyer suggested to use FMLA for call days. I was told by PD I could only return when back to 100% and nothing less. I really am not trying to go back and forth on this.

The point I am making is that this is a prime example of a malignant program. They are on probation. I don’t need to say anymore than that. I did not know my rights even after seeking counsel and talking to HR. All the information you provide may be 100% true but doesn’t help me now.

So hopefully I recover with enough will and heart to reapply and repeat this all over again. First I must find a new home then a new job. My pockets don’t like this.
 
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Told you they exist. I don't see why all the hostility exists for personal responsibility when there are malignant programs out there.
No one said they don't exist.

No one ever denied that malignant programs exist and that the ACGME should help those programs improve. What people argued is that 9 times out of 10, it's not the program that's malignant.
 
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Come again, in English this time?
Suppose to be funny. Confessional = airing grievances. Posts on thread have lots of feelings without sustenance.

No need to be rude. I was trying to crack a smile. Can’t help that you don’t understand abstract/complex syntax.
 
Suppose to be funny. Confessional = airing grievances. Posts on thread have lots of feelings without sustenance.

No need to be rude. I was trying to crack a smile. Can’t help that you don’t understand abstract/complex syntax.
If you have to explain the joke...
 
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If you have to explain the joke...
I knew I’d get that response. Warranted but christ lighten up people. You pounce and gang up. It’s a forum.

What’s up mean docs of SDN? I thought we were suppose to support not tear down our fellow colleagues.
 
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I knew I’d get that response. Warranted but christ lighten up people. You pounce and gang up. It’s a forum.

What’s up mean docs of SDN? I thought we were suppose to support not tear down our fellow colleagues.
And generally we do. But we also will often suggest areas of improvement or different ways to approach problems so it doesn't happen again.

That said, threads like this are a little bit different. We get one every other month or so. At first it sounds like the program really screwed the resident over. But, as more details emerge it becomes clear 99 times out of 100 that the resident was in fact the problem.
 
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Doesn’t matter. What’s done is done. The details of leave and ADA are lost at this point. I had ADA accommodations requested by my rheumatologist a month into leave with request for call days off. It was flat out denied. I was forced to take all my FMLA when I wasn’t sick. A lawyer suggested to use FMLA for call days. I was told by PD I could only return when back to 100% and nothing less. I really am not trying to go back and forth on this.

The point I am making is that this is a prime example of a malignant program. They are on probation. I don’t need to say anymore than that. I did not know my rights even after seeking counsel and talking to HR. All the information you provide may be 100% true but doesn’t help me now.

So hopefully I recover with enough will and heart to reapply and repeat this all over again. First I must find a new home then a new job. My pockets don’t like this.

It's unfortunate that your program was unwilling to find some accommodation for you. It's possible that your program was only going to let you work if you were 100% -- and that's likely illegal but the law is murky as it depends on what is defined as an "essential function". I think your lawyer gave you terrible advice about FMLA for call days. In any case, I didn't mean to be hurtful, many of these threads are reviewed by others looking for help/advice, so even if these comments don't help you, they might help someone else.
 
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It's unfortunate that your program was unwilling to find some accommodation for you. It's possible that your program was only going to let you work if you were 100% -- and that's likely illegal but the law is murky as it depends on what is defined as an "essential function". I think your lawyer gave you terrible advice about FMLA for call days. In any case, I didn't mean to be hurtful, many of these threads are reviewed by others looking for help/advice, so even if these comments don't help you, they might help someone else.
No worries. The truth hurts. I wish I had a Program Director like yourself who was well acquainted with the ins and outs of disability in the workplace. I believe that my situation is an unfortunate circumstance culminated by lack of experience, support and a series of missteps. It’s what happens when you give a 30 year old with an MBA from a no name school the power to fire anyone.....including learners.

Thanks for the “chin up” in reference to others who may find it helpful. I’m hoping no one ever finds themselves in this position. My PD even had the audacity to call a mandatory meeting with my cofellows to say that I was fired because I got sick and that this would never ever happen to them. I’m hoping so but thinking not.
 
To tell you the truth, I'm not 100% positive how it worked. I just know that's what pregnant residents did during residency. I believe they used vacation/sick time, then FMLA after that. But they didn't have to extend unless they were out more than a total of 8 weeks per academic year. Psych may be a tad different too because mose of PGY 4 year is elective time.

Psych as far as RRC and leave goes is MUCH more lax than other programs. With FM its 30 days in a year, then you must extend training. Overall every specialty is different, but most have the 30 day rule.

Oh yes. These days it is so easy to coast through medical school doing the bare minimum and disappearing early from clinical days. When I tried to work the students a little bit getting them experience with DC summaries I was called into the Dean’s office for giving them “scut.”

This coddling allows some negative and self-centered folks to glide right into residency where they hit a brick wall of responsibility. It can be a jarring transition.

While we are being honest, this thread is pretty much a dumpster fire.

This is highly dependent on the school.
 
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