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breaking match agreement

Discussion in 'General Residency Issues' started by gentamicin, Mar 25, 2007.

  1. gentamicin

    gentamicin Member
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    Hi all,

    I am currently doing a transitional year and this coming July I am supposed to start my PGY 2 anesthesia spot which I matched into last year. However, I have decided that I do not want to do anesthesia anymore and have been offered a position in another specialty at my program. I plan on accepting that position. However, what are the consequences of breaking my match with the anesthesia program? If I let them know now, is it enough time for them to find someone else? When is the latest that I should let them know by? Also, I don't recall getting a contract from the anesthesia program after the match. Am I supposed to be getting one soon? What should I tell the anesthesia program that I matched into? Should I tell them the truth that I have changed my specialty plans? Please advise.

    thanks
     
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  3. Stimulate

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    I believe matching via NRMP IS the contract, you can probably read the terms and conditions on their website. I would also make sure your new potential program director is on-board with this issue because him/her may be your best resource in this situation. It may help you that you are staying within the same hospital/GME department.

    I have heard of residents breaking match agreement with little or no opposition from their program director, but I have also heard of PD's suing the resident. From what I recall though the most they can recover from you is a year's salary.

    Maybe your new PD can smooth things over with the old PD, however, I wouldn't wait too long because there is still plenty of time for them to fill that spot.
     
  4. 8744

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    I have never heard of such a thing. It sounds almost too ludicrous to believe and would be the equivalent of taking a job, getting another offer at the eleventh hour which you take, and then being asked by your jilted employer to pay a years salary. If this were the case, it would be just another example of an abusive and resident-unfriendly system which I am appalled that so many of you, otherwise reasonable people, would defend.

    Why not sue you for the $110,000 that the hospital loses if they lose a resident?
     
  5. Winged Scapula

    Winged Scapula Cougariffic!
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    While its been awhile since I've been up to date on match news, I agree with Panda - I've never heard of a resident being sued, especially successfully, for violating his match contract. Seems a tad personality disordered but then again we are talking about medical "professionals" here aren't we?

    At any rate, your "contract" is that with the NRMP, which when you matched you agreed to do your PGY2 year in Anesthesia at the program you matched to. That doesn't mean you can't break your contract - talk with your current PD and see if they can smooth things over with the Anesthesia PD. While it is late, I'll bet they can find someone in a heartbeat who didn't match into Anesthesia last year and is hunting around for something to do. I wouldn't worry about it - and despite my frequent comments about egocentric residents, it doesn't apply here - you've found something else you want to do and have the opportunity to pursue it. Just let the Anesthesia program know asap (assuming you have a contract from the other specialty you are going in to).
     
  6. 8744

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    If your new program will accept you, there is nothing the NRMP can do. Since the program also has to abide by NRMP rules, they might not want to risk their standing with the NRMP on your account. On the other hand, the NRMP is a money-making enterprise and would probably not want to lose the fees from the program over something like this.
     
  7. Stimulate

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    The difference is that a resident agrees to the terms of a contract when entering the NRMP match. Why is it so unfair that a program would hold you to the terms of your mutually agreed upon contract? I also doubt that a program would actually sue a resident who breaks their contract but IT CAN HAPPEN.

    When you are interviewing for a job and talking to several prospective employers there is no written contract so choosing another job at the 11th hour is legal and the employer has no damages.
     
  8. 8744

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    Right. It is always better to handle everything on a civil and friendly level. You should be prepared to fight like a cornered pole-cat but it is not necessary most of the time
     
  9. 8744

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    Funny you should mention it but we once hired a guy who actually signed our firm's employment contract and then called the next day to say that his old firm, at the 11.9999 hour, had wooed him back. Oh well. After the usual cursing and harumphing we went looking for a new engineer.

    Odds of getting any damages from him, even if contractually stipulated: Zero point zero zero.

    I want to point out something else that I find ironic. On one hand, many representatives of The Man will tell you that residents lose the hospital money, are a huge liability, are good for nothing, and could be replaced easily by PAs...but at the same time programs that lose their residents sure are pissed to have such a burden removed from their noble shoulders. If I'm to believe what I have read on several recent threads, you'd think that every resident who didn't show up would be celebrated with high fives and smiles all around.

    Could it be that residents, the modern equivalent of the Piece de Indies, are valuable commodities and much sought after by the medical plantation owners?
     
  10. Adam_K

    Adam_K Indentured
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    :laugh:

    I think that you've hit the nail on the head.
     
  11. sunlioness

    sunlioness Fierce. Proud. Strong
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    It's ok to accept another position, but let the anesthesia program know ASAP. It's just common courtesy.

    Someone in my internal medicine program decided he hated medicine midway through his internship and wanted to do anesthesia. He found a spot from someone in your situation. So they'll find someone for the spot fairly easily given enough notice. This kind of stuff happens all the time and most people understand that feelings change and want someone who actually wants to be there.
     
  12. dysfunk

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    I matched into a prelim program on the west coast while my significant other matched to a program on the east coast. We met after the interviewing process and tried to rank programs so that we would be together, but it didn't work out that way. Furthermore, I didn't read the fine print, and no one ever told us that we could declare couples status all the way until the ranklist.

    I found someone I want to be with and am doing whatever I can to be in close proximity to her. I now am trying to be friendly and explain my situation to my PD, but he is not happy about it. He basically said that he can't find anyone now... it's too late. I'm worried about breaking the contract, but I may go ahead and do it. I found a position near my s.o. Should I contact the NRMP pre-emptively to avoid major punishment? And what should I do about the PD?
     
  13. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner
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    Even if they sued, you could have your lawyer look into it, because if the program breached your contract first (ie, not giving enough vacation, working too many hours, etc), then they can't successfully sue you.

    That being said, I seriously doubt they would even try.
     
  14. Victor3816

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    I'm in a similar (although not as severe) situation as dysfunc and wanted to ask for direction...my girlfriend and I ranked the same hospital first at the assurances of the anesthesia pd that we would match together (we did not couples match)...I matched in anesthesia there, and now she's starting a surgery residency in July that will be 200+ miles away (her third choice). I have ample elective time during my prelim year (at a different hospital), and am thinking of contacting the anesthesia pd at her program to see if I can do an elective there (and see where that goes).

    Has anyone been in this situation before? Could the anesthesia pd at my girlfriend's hospital offer me a PGY-2 position? Would they violate NRMP rules by doing so?

    Thank you for any response!
     
  15. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner
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    You can certainly do an elective there. He can offer you a position if he has one to fill, but he won't invent one for you. And yes, it would be a violation of NRMP rules, but it wouldn't be the first time it has happened.
     
  16. docB

    docB Chronically painful
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    I imagine that the programs are upset because they will be replacing someone who matched with someone who is still not placed even after the scramble. Their choice, which has been forced on them by the candidate breaking the NRMP agreement, is to take what they can get with likely dubious quality or leave the spot open. Neither is particularly attractive.

    Leaving the spot open does cost the program and it screws the other residents. It sucks to be in a program designed for X when it suddenly drops to X-1. I know that when my classmates or those in the class behind me got pregnant it meant more work.
     
  17. 8744

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    The program screws the other residents. It's not ambiguous or a passive voice kind of thing as in "the Residents were screwed."

    It's "The program screwed the residents."
     
  18. docB

    docB Chronically painful
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    I understand your bitterness and resentment. I felt the same way and I still see it in the residents here. It's a cruel, impersonal and dehumanizing system. I certainly think you should take your rage and try to channel it into some sort of positive like working to change the system.

    It is important to note that the comments about healthcare not depending on residents is true. If there were suddenly no residents some academic centers would collapse but the non-academic institutions would continue as they are. American healthcare is not dependent on resident labor. We would notice the absence in a few years when there's no one to hire but that's a training issue, not an exploitation of labor issue which is what's at the center of your hatred of the system.

    Here's my suggestion for fixing medical education:
    Doing 2 years of didactic in med school is a waste.

    Create a real premedical education system where college students take all the basics (bio, chem, ochem, physics, whatever) and then, if they have done well enough to merit advancement, they would take biochem, physiology, embryology, histo, basic anatomy in college instead of doing some major coursework they really don't want to do. If they really want to complete a major in biochem and go to med school then they'll have to extend college.

    Med school 1st year is advanced anatomy (read as human cadavers), path, pathophys, physical diagnosis, etc. Students would start rotating with teams as soon as possible to learn the nuts and bolts of the hospital.

    Second and third year med school would look like the current third and fourth. Fourth year would be like a rotating internship/ elective rotations in the students specialty of choice.

    PGY1 could then dispense with a lot of the generalist stuff and concentrate on the resident's specialty. By eliminating the filler rotations the residency could be restructured to concentrate more on the specialty of choice and could demand less day to day overtime. That decompression of the residency could get people through with less angst.

    It could work.
     
  19. nitemagi

    nitemagi Senior Member
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    That already exists at some schools in a way, actually, though piecemeal. At UofR (my school), you learn the H&P first semester, then start working in physician's offices 2nd semester seeing patients and working under an attending 1-2 days/wk. You do this through 2nd year. There's still didactics/basic science, but it's all integrated. I also know that Duke does a lot of their clinical rotations during 2nd year, do research/scholarly activity 3rd year, then finish up other rotations 4th year.
     
  20. sunlioness

    sunlioness Fierce. Proud. Strong
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    If that were the system, I wouldn't be a doctor. I was an undergraduate history major and decided to go to med school my senior year in college. After graduation, I did a post-bac to complete my remaining requirements and then applied to med school.

    I know the rest of the world requires people to know they want to be doctors right out of high school, but it never seemed quite "fair" to me that way. Both for the ones who don't realize it until later and for the ones who realize too late that they absolutely hate it. Many of us are too young to pick our careers at age 18-20.
     
  21. docB

    docB Chronically painful
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    But those systems are not driven with the goal of decompressing residencies. I'm suggesting we push everything earlier and trim the fat to make more time so residency is less onerous.
     
  22. docB

    docB Chronically painful
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    That's true. This would make it harder on non trads. I have a similar story. I majored in Poly Sci and wound up being a firefighter then did post bac at UPenn and linked into Temple for med school. But I don't think that keeping the status quo, which is hated by so many, can be justified by looking at the alternatives effects on non trads. If we went to a system like the one I suggest (which is unlikely to happen anytime soon) non trads may have a longer road in post bacc.
     
  23. 8744

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    I assure you that if LSU Shreveport, the only straight-up charity hospital in Northeast Louisiana, were to lose all of its residents, it would collapse to a pale shadow of its current self. This would have a profound effect on every hospital in the area as the now doctorless patients would push the envelope of EMTALA at every joint in town. Either that or they would go to the devil and die from their muliple morbid conditions. There is no money in the budget to pay for expensive help that would be otherwise required.

    The point is that while the majority of hospitals function fine without residents, the big charity and public hospitals are also usually teaching hospitals and absolutely depend on cheap resident labor to function at the levels the public expects.

    And I don't recall I ever said that the entire health care system was dependent on resident labor. But the plantations that have grown used to bartering for their Pieces de Indies certainly do.

    But let's say you're right. Why in the hell do I have to do call so often? If I'm not necessary, the hospital can get along fine without me so I can at least grab me a nap between midnight and five AM.

    And I'm not bitter. Like I said, the pay sucks and the hours are terrible. There's nothing more to it than that.

    Not to mention this: Even if I serve no purpose at all at the hospital, am as useless as a child car seat to Britney Spears, and my job consists of make-work, to keep me doing it for 80+ hours a week for 10 bucks an hour is worse than exploitation. It's cruel and unusual punishment.
     
  24. LADoc00

    LADoc00 There is no substitute for victory.
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    I would spend a few hundred bucks, get the actual contract and have an attorney read over it. Then I would notify your program ASAP you arent coming.

    Contracts law varies alot by state. Since NRMP is not the injured party, the program is, Im not sure what basis they can get you on if you breach it. Which is probably why nothing has happened to anyone who ever does this.

    Conversely, there is NO way a program is going to spend the effort to sue a doc for breach who doesnt want to come there. Just wont happen.

    Either way the whole match thing is a joke and Im estatic I never played right into their hands and opted out.
     
  25. LADoc00

    LADoc00 There is no substitute for victory.
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    Sounds like Urban Myth to me, I have heard of alot and NEVER heard of this. Unless you have plain ******ed legal counsel and acted like like a total jackazz to the PD, why would they do that?

    The salary is nothing tho, the PAIN would be reimbursing the program's legal bills, which could be 100K easy.

    One easy way would be for all MS4 doing to the match to amend it the contract to state "The residency program will advance my first year salary the sum of $10,000 upon matching, an amount to be repaid if I do not perform up to the specified conditions"

    I dont know tho I have taken a contracts law class...it would be VERY hard for a program to PROVE damages and of course if they were given enough time it would be their responsibility to mitigate by hiring another applicant.
     
  26. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner
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    Seriously, if they sue you for your wages, then they should give back the money they got from Medicare for you. The hospital profits from every resident that doesn't order frivolous MRI's on every patient. They might be pissed, but they don't have a lot to sue over.
     

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