Avoid Maimonides Surgery program unless you want to be abused. It is a Malignant program.

[Perrotfish]

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Wonder if some academic attendings would benefit from bodycams to document their toxicity and hold them publicly accountable. Would their behavior change if a larger audience were able to observe their outbursts?

They would definitely improve if that was the rule. The problem is they'd all quit any job that tried to implement the rule, unless there was some enormous offsetting benifit. You get to make as many demands of your employees as you're willing to pay for. If it costs 300K to hire an OB to take call it's going to cost way more than that to hire an OB who agrees to be publically shamed for bad behavior AND take call.

Heading into 1984 territory there...

This isn't actually unexplored territory. Everyone who works at a call center is monitors for quality assurance. A lot of nurses are recorded when they make phone calls to patients. Its just a privilege of being a highly paid professional to not be watched all the time.

 

[Lawpy]

Just want to get some clarification on the following.

1. Why do malignant programs exist?

2. How can these malignant programs be stopped and be converted into programs with better working environments?

 

[username456789]

Just want to get some clarification on the following.

1. Why do malignant programs exist?

2. How can these malignant programs be stopped and be converted into programs with better working environments?

This can mostly be boiled down to the simple fact that some people are garbage.

 

[Oh_Gee]

Wonder if some academic attendings would benefit from bodycams to document their toxicity and hold them publicly accountable. Would their behavior change if a larger audience were able to observe their outbursts?

the bodycams would just magically stop working during periods of $#!t going down

 

[libertyyne]

Getting chewed out isn't the same as some of the horror stories you'll hear. I got asked if I needed some Midol on my first day because I had to hold traction in a really awkward position for 3+ hours and my shoulder started cramping. Sure it's not really appropriate, but I it wasn't a that big of a deal to me and it actually ended up being a great rotation. That's not the same as regularly getting berated in front of the entire team for things you didn't even mess up or getting taken into a closet by a group of senior residents and getting screamed at for an hour straight. The stuff I dealt with seems to be pretty common, the other issues I described aren't the norm and are signs of a malignant program.



Really? The worst residents I've ever met were the female OB/Gyns. It legitimately felt like it was a real life version of the movie Mean Girls but in a hospital.

What you are describing in my opinion is a joke, that may be considered in poor taste, but is nothing even close to what I would consider getting chewed out. I just assumed , and maybe wrongfully so, that a large number of surgical programs are places where you will get berated in private or in the OR if you are not performing up to expectations or make a mistake that may endanger a patient.


When I think of toxic or malignant programs I think of physical abuse and constant threats of ending one's career, favoritism, rascism, sexism, etc.

 

[raiderette]

Wonder if some academic attendings would benefit from bodycams to document their toxicity and hold them publicly accountable. Would their behavior change if a larger audience were able to observe their outbursts?

Can you imagine the subpoena for bodycam footage for malpractice suits? No thank you.

 

[libertyyne]

Can you imagine the subpoena for bodycam footage for malpractice suits? No thank you.

we had our attendings flip **** when they tried to install camera's in the OR for this reason.

 

[Oso]

Anyone with google knows to avoid Maimonides surgery like the plague.

And yeah, NYC has a ton of hospitals stuffed full of IMGs who they abuse the **** out of. I’ve met a few IMGs at these no name hospitals. One girl told me she hadn’t had day off in 5 months.

Wtf. How does this even happen?

 

[KnuxNole]

Their "resident life in photos" seems quite happy....

Regardless, a classmate is at that hospital in a different residency, and hated it. Malignant all around. Some of the NYC residencies have it's problems already, but this just screams malignant. ACGME should send stealth reps to watch what happens...it'd be interesting.

 

[Stagg737]

What you are describing in my opinion is a joke, that may be considered in poor taste, but is nothing even close to what I would consider getting chewed out. I just assumed , and maybe wrongfully so, that a large number of surgical programs are places where you will get berated in private or in the OR if you are not performing up to expectations or make a mistake that may endanger a patient.


When I think of toxic or malignant programs I think of physical abuse and constant threats of ending one's career, favoritism, rascism, sexism, etc.

It was definitely a joke, but there are medical students who if they heard jokes like that on a regular basis would be reporting to their schools that they were working in an unacceptable environment or that they weren't comfortable around their attendings. I was just pointing out that there's a difference between getting ripped on a bit and a malignant environment.

Honestly, I don't even think being berated by attendings makes a program malignant if the criticism is warranted. If ended up endangering someone's life because I made a stupid mistake or wasn't paying attention, I'd expect to get some extremely harsh criticism. However, there is a difference between being berated, which is pretty common at a lot of places, and regularly being berated for small things or things which you didn't do or weren't your responsibility. The former is pretty common in many difference residencies, the latter is not and is a sign of malignancy.

Wtf. How does this even happen?

By applying to programs that don't care about your education and only see you as a meat pusher whose job is to help their bottom line along with residents who are fearful of losing their position and thus their career if they don't bend over and take whatever is thrown at them.

 

[Stroganoff]

the bodycams would just magically stop working during periods of $#!t going down

Yeah, I hear ya. Still developing the idea. Perhaps any cameras would have to be outside the control of those most likely to abuse them. So in other words, place them free-standing in the facilities. Any portable cams would be on residents/other staff instead.

The whole gist of the idea was that by holding garbage people publicly accountable, it would modify their behavior.

 

[Stroganoff]

By applying to programs that don't care about your education and only see you as a meat pusher whose job is to help their bottom line along with residents who are fearful of losing their position and thus their career if they don't bend over and take whatever is thrown at them.

If this is the case (malignant programs treating their residents as meat pushers for their bottom line and prime pickings for abuse), then perhaps a paradigm shift is in order.

Residents sign contracts, yes? So they're essentially indentured servants to a program for x years, making lateral mobility difficult/impossible.

In the "real world" without contracts, the way to leave an abusive employer is to go work somewhere else. Perhaps if residents simply need to meet certain # hours; # procedures of type X, Y, Z; or meet certain milestones of competence then it would give residents more mobility through their post-graduate training.

To that end, totally change the way residency is done so that residents can leave and transfer to other programs as they please to check off all the competency "boxes" that they need to graduate. This mitigates the situation of the abused resident feeling "stuck" or indentured to one program, emboldening garbage people to abuse their slaves.

 

[Goro]

Just want to get some clarification on the following.

1. Why do malignant programs exist?

2. How can these malignant programs be stopped and be converted into programs with better working environments?

I can't answer the second, but I surmise that a toxic residency exists for the same reason toxic academic departments exist. I've seen Chairs who either didn't do anything, who played favorites, or were toxic personalities in own right, and seemed to hire like-minded people AND a mix of natural victims.

Into this volatile mix is the mindset of "this is how I was trained; so if I could take it, so can you!"

Those of you who have to deal with this, you have my sympathies.

BTW, I wonder where all the Carib apologists are???

 

[KU Brendan]

BTW, I wonder where all the Carib apologists are???

Lying on a sunny beach.

 

[xClashx]

Example of LCME's incompetence.

 

[libertyyne]

Example of LCME's incompetence.

This would fall under ACGME.

 

[Stagg737]

If this is the case (malignant programs treating their residents as meat pushers for their bottom line and prime pickings for abuse), then perhaps a paradigm shift is in order.

Residents sign contracts, yes? So they're essentially indentured servants to a program for x years, making lateral mobility difficult/impossible.

In the "real world" without contracts, the way to leave an abusive employer is to go work somewhere else. Perhaps if residents simply need to meet certain # hours; # procedures of type X, Y, Z; or meet certain milestones of competence then it would give residents more mobility through their post-graduate training.

To that end, totally change the way residency is done so that residents can leave and transfer to other programs as they please to check off all the competency "boxes" that they need to graduate. This mitigates the situation of the abused resident feeling "stuck" or indentured to one program, emboldening garbage people to abuse their slaves.

You can quit and leave residency whenever you want, it's a job just like in any other industry. The problem is that no one is going to hire you if you just decide to quit. The only stipulations with lateral mobility in terms of ACGME standards is that you have to stay at whatever program you match into for at least a few months (I believe 3), then you can transfer to whatever program you want so long as that program will accept you. It's part of how people are able to leave surgery residencies and transfer into less competitive fields pretty easily.

The reason you see people staying at malignant programs is that you often need letters of rec to transfer to other programs, and if the program is truly malignant then they won't write those letters for you and just bad mouth you so you can't transfer. It's not an issue of whether or not it can be done, it's that there are often significant barriers to accomplishing that which and those who end up at weak, malignant programs are likely the candidates that the solid programs didn't want in the first place. So even if a spot opened up at a better program, why would they take them?

 

[Goro]

Example of LCME's incompetence.

LSME = medical schools
ACGME = Residencies

 

[Stroganoff]

You can quit and leave residency whenever you want, it's a job just like in any other industry. The problem is that no one is going to hire you if you just decide to quit. The only stipulations with lateral mobility in terms of ACGME standards is that you have to stay at whatever program you match into for at least a few months (I believe 3), then you can transfer to whatever program you want so long as that program will accept you. It's part of how people are able to leave surgery residencies and transfer into less competitive fields pretty easily.

The reason you see people staying at malignant programs is that you often need letters of rec to transfer to other programs, and if the program is truly malignant then they won't write those letters for you and just bad mouth you so you can't transfer. It's not an issue of whether or not it can be done, it's that there are often significant barriers to accomplishing that which and those who end up at weak, malignant programs are likely the candidates that the solid programs didn't want in the first place. So even if a spot opened up at a better program, why would they take them?

I get that, dude.

What I'm saying is that -- as you mentioned -- there is too much friction in changing programs. The whole LOR requirements and application process. It's designed so that you pretty much stick with one program until graduation.

What I'm advocating is a more mobile business model that removes the friction of lateral mobility so that all post-graduates have to do is earn a defined, objective set of metrics, or competence units. However that's measured. # hours, # procedures, # patients, # of cases of X,Y,Z, etc.

Removing friction and changing the paradigm should lessen the prevalence of malignant programs, since employees are more empowered, more mobile, and are able to more easily transfer to other programs without the obstacles of requiring LOR from the very abusive people who would seek to ruin somebody.

 

[IlDestriero]

Really? The worst residents I've ever met were the female OB/Gyns. It legitimately felt like it was a real life version of the movie Mean Girls but in a hospital.

They don’t get any better as attendings either. Trust me!


--
Il Destriero

 

[Raryn]

I get that, dude.

What I'm saying is that -- as you mentioned -- there is too much friction in changing programs. The whole LOR requirements and application process. It's designed so that you pretty much stick with one program until graduation.

What I'm advocating is a more mobile business model that removes the friction of lateral mobility so that all post-graduates have to do is earn a defined, objective set of metrics, or competence units. However that's measured. # hours, # procedures, # patients, # of cases of X,Y,Z, etc.

Removing friction and changing the paradigm should lessen the prevalence of malignant programs, since employees are more empowered, more mobile, and are able to more easily transfer to other programs without the obstacles of requiring LOR from the very abusive people who would seek to ruin somebody.

Tell you what. Lets do a thought experiment.

Pretend you're a program director. You have a limited number of seats - the ACGME has decided based on patient/case volume that you can support X residents. The hospital/government/whatever has also only given you enough money to pay Y residents (a number that may be less than or equal to X). You always have more applicants than you have seats and when your program is at its complement of Y residents, they work hard, but they get all their work done and everything is going well.

Now you have a seat open up for a PGY2 spot. One of your residents just won the lottery, or decided they didn't want to do your specialty anymore, or whatever else so they quit. You want to fill that spot. In fact, this spot is outside the match, so you aren't required to use ERAS, the NRMP, or anything else, you can treat it as a job search and hire however you want.

The only people eligible to fill that spot are those who have completed PGY1. Can you imagine (as a PD) any circumstance in which case you wouldn't want to know how their PGY1 went? Just remember, you'll still probably have more applicants than you have spots (that is, you only have the one spot).

 

[Stroganoff]

The only people eligible to fill that spot are those who have completed PGY1. Can you imagine (as a PD) any circumstance in which case you wouldn't want to know how their PGY1 went? Just remember, you'll still probably have more applicants than you have spots (that is, you only have the one spot).

I get what you're saying, but I don't think I advocated that no documentation of PGY(x) progress or performance be kept. Just a total revamp of the ACGME system that removes some of the friction and supports more lateral mobility. Anything that empowers post-graduates and removes the servitude/abuse model that leads to malignant programs.

 

[MSTPlease]

The problem is that no one is going to hire you if you just decide to quit.

So basically unlike a job in any other industry?

 

[Crayola227]

Very common. They need something to do to pass time in the L&D station at night.

Never occurred to me that was a thing, but it makes sense and might explain what happened to me there as well.

 

[Crayola227]

I wish I had the courage you have. I was called an "idiot" and "*sshole" in front of nurses, techs, and patients numerous times by my attending during my 3rd year vascular surgery rotation but I just sucked it up and smiled like a coward. I survived and got an "A" for the rotation, but the entire experience makes me feel really icky inside all these years later --- mostly because I had zero respect for myself as a person.

I sobbed like a baby, hyperventilated to the point the resident had to just send me home because I was too useless to do the morning rounds. A totally different student witnessing this was so uncomfortable witnessing it, they reported it. So don't feel bad.

 

[Psai]

Apparently the married director of surgery was having an affair with a female doctor who was fired after the relationship went sour. This place scares me so much.

Married head of surgery's tryst leads to suit over firing

 

[NontradCA]

When I did OB it was interesting and sad to see the cheerful, optimistic intern slowly get the life sucked out of her over the course of a few weeks.

 

[glypha1104]

Does anyone think this sort of behavior is less common with older matriculants? IMHO, it seems it might be a bit harder to be publicly obnoxious to an older person who has had a prior job/career, responsibilities, family, military time, etc than a younger person with more limited experiences.

 

[nlax30]

Does anyone think this sort of behavior is less common with older matriculants? IMHO, it seems it might be a bit harder to be publicly obnoxious to an older person who has had a prior job/career, responsibilities, family, military time, etc than a younger person with more limited experiences.

I’m not sure if it was less likely to happen to an older trainee but at least during my experience thus far in a couple programs the older residents/fellows who usually had more extensive prior “life experience” (prior careers, etc...) were less likely to tolerate being treated like that and more likely to push back to some degree.

 

[Zebra Hunter]

I’m not sure if it was less likely to happen to an older trainee but at least during my experience thus far in a couple programs the older residents/fellows who usually had more extensive prior “life experience” (prior careers, etc...) were less likely to tolerate being treated like that and more likely to push back to some degree.

Yup, however, there was a negative to this. From my experience, the older residents tend to push back even at very innocuous comments towards them which frequently gets them put on the sh*tlist with the program. I guess it is sometimes hard for a 40 year old to take feedback from an early 30's attending or a 20 something upper level.

 

[nlax30]

Yup, however, there was a negative to this. From my experience, the older residents tend to push back even at very innocuous comments towards them which frequently gets them put on the sh*tlist with the program. I guess it is sometimes hard for a 40 year old to take feedback from an early 30's attending or a 20 something upper level.

Yea, I definitely saw this as well. It was a double edged sword and I saw a couple of my older senior residents have at times a rocky relationship with a few attendings because they were quicker to push back.