Advice appreciated for a graduating resident

[JackRussell]

---

Members do not see this ad.

In the threads, I have seen a similar situation for medical students and interns, but not for a graduating resident...

This is my last year as a resident, and I matched into a fellowship. All of my evaluations have been at or above average, including those from the PD when I was on his service earlier in the year. All except two summarize that I am at or above the level I should be, including his. (yes, the two who summarize me as below average gave average answers to the detailed questions, which makes no sense). The PD has said many times, including with witnesses, that he disregards those two recommendations because of personality issues.

However, at my six month meeting, he stated that he is not planning on signing my papers to register for the Board exam. To summarize, he said that the attendings unanimously feel that I am not ready for advancement, and not to expect it. I reread my evaluations after this meeting to be sure I was not suffering from selective memory. When I ask the attendings with whom I am working now about this, they are clueless; no one has told them there is a plan not to graduate me, and they do not understand it. Given the experience I have had at this program (terrible treatment of residents by certain individuals), and the recent actions of the department (delaying paperwork for several people until deadlines are passed; last year's graduates had to pay a late fee to sit for their Boards because the PD's papers were late), I have no reason to think that this is not serious. I also have to have final papers to enter fellowship, although technically as long as this happens by June 30, I will be ok, but won't sit for Boards this year.

My question is this:
If he flatly refuses to sign my papers or says (as he also suggested) that I have to stay an extra 6 months, is there any recourse? Also, I am told there are jobs out there for non-BE/BC physicians... after all, I will have completed the entirety of my residency, but will not be considered board eligible. Clearly, this is not ideal. 😡 However, I have a home to sell, a home to buy, and a cross country move to plan. I think it is absurd to expect someone to wait until the end of the academic year to be notified of final status.

Any advice/insight/resources will be GREATLY appreciated. I am at my wit's end. And finishing residency is supposed to be fun. 🙁

 

[PainDr]

Can you think of anything you may have done to piss him off so much? Regardless, this is very serious and requires serious action. He must produce objective evidence that you shouldn't be allowed to finish on time and can't just leave you hanging like that. You need to act now! I hope you kept copies of your evals because you'll need them. Contact your GME office (in writing and by certified mail), explain the situation and include copies of your evaluations. End the letter by asking for formal arbitration. If a satisfactory resolution isn't forthcoming, you're next step would be to contact your RRC and retain legal counsel. You could even call the RRC first and ask for guidance. Good luck.

 

[JackRussell]

Yes, I have printed my evaluations. Our program uses a web-based system, and I have them all in hard copy. I do not believe I have personally pissed him off... as I said, all of last year's graduates had a dog-fight to get their papers signed, too. Also, his evaluation (which is printed) was at or above average for my level.

The RRC is a great idea, although in the meeting, he actually made it a point to say that they "always side with a PD" who does not graduate a resident. Our GME is NOT supportive of residents. When issues are brought to them, the response is "this is something you need to discuss with your PD" and once he finds out about the meeting, there is retaliation. 🙁

I am in the process of retaining legal counsel, especially in light of the risk of losing my fellowship.

 

[MOHS_01]

Good luck. I have known many residents who were allowed to graduate and sit for boards when they should not have been turned out on the unwitting public.

If you really do not have glaring deficiencies, go to the GME. Some program directors are just pricks, and you would be surprised to find out how many have enemies.

The reason for the formal evaluation system is to prevent scenarios such as this -- if a deficiency has not been made known to you, remediation steps discussed and taken, the PD is then considered negligent. This is a matter for the GME office.

 

[angel80]

How did you do on your inservice exams each year? I've heard of programs who don't let people sit for boards if they don't think that person will pass. They don't want their program board passing rates to be low, so they make the residents study for a few extra months before they can take the boards. They don't make residents repeat rotations. I think it's a really stupid practice

 

[NotAProgDirector]

This sounds like a horrible situation. My 2 cents:

1. Contacting the RRC will probably not be helpful. The RRC is in the business of determining whether programs are following the "rules" or not -- how much call, education vs service, etc. They do not get involved in this type of problem, and leave it up to individual PD discretion.

2. You should ask to review your residency file. You should have full access to most of the contents of the file (the only exception should be for any letters of reference for which you waived your right to review), although they may require you to review it in the program's office and may limit your ability to copy items.

3. You should get a faculty mentor -- someone who can help represent you (see below)

4. A lawyer can be helpful, but remember that most GME decisions like this are subject to "academic due process", which is different from the usual "due process" of being fired from a job. I'm not a lawyer (thank god!), but academic due process basically means that the program has to follow it's own internal rules about how non-promotion (or dismissal) of residents is addressed, and that residents must be given a chance to improve their performance prior to any adverse action. The courts repeatedly have stated that they want academic programs to assess who is competent and who is not, as long as institutions follow their own internal policies. Hence, the legal system does not have all that much to offer in situations like this.

5. You need to review your GME/department/residency policies. These must be publicly available somewhere, usually in a "Housestaff manual" or something similar. Usually they are developed by the GME office, but individual programs also can have their own policies. The most important question to ask first is "Did your program follow it's own internal policies?". For example, many programs have a spectrum of "remediation", followed by "probation" and then "termination" -- the language may vary, but there is usually some sort of "warning" stage, followed by "you're in real trouble" followed by "you're fired". Unless there was an egregious event, they must follow these policies.

From your story, I get the sense that 1) they didn't warn you that you were in trouble before telling you that you were not going to be promoted, and 2) they did not give you a chance to improve your skills. If so, the proposed action is illegal and you are on very good footing to contest this.

6. Once you've seen your file (just to be sure there are no surprises in there) and reviewed the policies (both GME and your own program), then you contact the GME office. The head of GME is called the DIO. They MUST have a "grievance" procedure -- exactly what that procedure is varies between institutions, but it should give you some independent arbiter to help solve this disagreement. In addition, many DIO's first meet privately with the PD / resident in question to try to solve the problem without a formal hearing. Should you go to a grievance hearing, you should argue 1) they did not follow their own policies in this decision; and 2) your evaluations are all satisfactory or above. This is also where your faculty mentor comes in handy -- they can argue your side of the situation, be a support, etc. Many grievance policies strictly forbid bringing a lawyer.

7. If that doesn't solve the problem, then it's time for a lawyer.

The prior poster mentioned that perhaps this is due to low ITE scores. Just for the record, it is "unacceptable" for your PD to use your ITE scores to determine who can and cannot take the boards. I would like to say it's "illegal", but that's probably not true -- the ITE "rules" state that you are not allowed to use the scores to determine who can and cannot take the boards, but the ABIM rules don't say anything about it -- hence using the ITE scores to determine who takes the boards is wrong but it's probably not actually illegal, and the worst that could happen is that program not being eligible to take the ITE any longer.

Good luck! PM me if you'd like any more specific advice.

 

[JackRussell]

I appreciate all of the information!

Yes, I did poorly on my inservice last year, but when they administered a remediation exam, I got 17% more questions correct than the minimum set a priori by the PD (and got more questions correct than the minumum for the graduating seniors). Also, I have a faculty advisor... who was NOT invited to this meeting and who was equally angry about it all. If I were not living this, I would think I woke up in a sitcom, honestly. I need to think carefully about going to GME, because they have a terrible track record of bouncing issues back to the PD, who probably created the word retaliation. 😡

My other thought is requesting a formal meeting again in March with the PD and my advisor and requesting a letter documenting his assessment at this time. Any thoughts? It still gives me time to go to GME/RRC/rally my attorney in time for registration for the Board exam.

 

[NotAProgDirector]

Yes, I did poorly on my inservice last year, but when they administered a remediation exam, I got 17% more questions correct than the minimum set a priori by the PD (and got more questions correct than the minumum for the graduating seniors). Also, I have a faculty advisor... who was NOT invited to this meeting and who was equally angry about it all.

The ITE is not supposed to be used for high stakes decisions. Hence, how you scored on it should not be used to decide whether or not you can take the boards. You can read more about it here.

I agree that bringing your faculty advisor to your meeting makes sense. Perhaps you should both review your file together rather than "taking your PD's word for it".