Dealing with a malignant program director

[OnTheRopesMD]

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[SXMMD]

I'm not even an intern yet so take the following with a grain of salt...

Are you doing a 3 year residency? If so, you're a 3rd year with ~7 months left out of 3 grueling years, correct?

Unless you hate medicine, ride it out, you've already proven to be tough enough. No need to let others dictate the course of the rest of your life, you're at the finish line of this particularly significant hurdle. Board cert or bust!

Just my .02

 

[Perrotfish]

Created a throwaway account just because my other one could easily identify me. Also going to be vague on details for the same reason. Anyway, I need some advice on what to do. My PD and I have not had the world's best relationship for quite some time--probably since toward the end of my PGY-1 year and I'm now a PGY-3. I just found out that sometime around a year ago, another faculty told some other residents (who are now done and out in the real world) about what she had been telling them about me. I guess she said she wanted to fire me, but was afraid of getting sued. Instead, she told them that I was close to quitting (true, mostly because I was/am sick of being targeted by her), so they needed to keep riding me so that I would quit. Not much has changed in that time, I get told all the time that I'm a terrible person and terrible doctor even though my testing scores are higher than all of my classmates and I've done way more in the way of academic endeavors. This program has a history of choosing one person to pick on, and two of the last three of those people have quit. How do I deal with this news? I feel completely blindsided and don't even know what to say. For someone who is supposed to be my adviser and my advocate, this behavior is unacceptable.

Thanks for your thoughts.

Important Questions:

1) How long is the residency? 7 more months of an IM residency is a lot easier to get through than 4.5 more years of a neurosurgery residency.

2) How do other faculty members feel about you? Do they ALL want you to quit? Does anyone really like you? How have your evals been?

3) Has the PD ever worked with you as an attending, or is all of her information about you second hand?

4) Was there an inciting event for your poor relationship? Or does she just not like you?

Things you can do

1) Find an advocate. Is there a physician who is willing to be your mentor? Someone you have a good relationship with who is central enough to the program to be your voice at the meetings, and conversely to try work with you to figure out how to keep you from ruffling feathers?

2) Be placating. Remember that residency is indentured servitude, you have fewer practical rights than any other US employee. When you say 'this behavior is unacceptable' it shows a poor appreciation of your position. Your PD's behavior can be unreasonable. It can be unethical. However, unless she's stupid enough to get recorded saying something extraordinarily incriminating/racist there's not really any option about accepting whatever behavior she chooses to exhibit. If she hates you, you're definitely not going to win by fighting back. Adapt to her, whatever she wants you to do. Asking, point blank, what you can to improve (ideally with a mentor in the meeting) can sometimes soften a tough PD. Being a workhorse for her pet research projects might also work. Failing all else if you glue on a fake smile and talk sweetly about improving every time you meet her she may find someone else to take offense to rather than continuing to pursue you.

3) Document. If you're getting criticism that sounds subjective, find a way to make it objective. 'communication problems?' start handing the nurses and patients 360 surveys. 'Attendings have concerns?' Start asking for mid block feedback, and then send them an email summing up the conversation to document. Do it politely, always say that you're looking for ways to improve, rather than documenting that you don't need to improve. Don't ever allow your PD to force you to see a counselor or psychiatrist (you can see one on your own if you'd like, but don't ever disclose it to her). Don't ever admit to any angry thoughts, mind altering substance use, or ethical misconduct. Don't give her a single solid reason to fire you.

4) Ride it out. It sounds like your not in the process getting fired or even on probation. She's trying to harass you into quitting by making you feel bad. So... don't let her. It should be easier now that you know what she's doing. Your job is to get through the next 7 (or 19, or 31) months without giving her an excuse to fire you. She can't make you quit if you don't quit.

 

[HooliganSnail]

I agree with Parrotfish. All of that advice is solid gold

You need to document a lot of things.

360 degree evals are money. You need a trail of paper to document that you are a good resident with good reviews. You already stated your test scores are good, so by having documented evaluations you are taking away any ammuntion.

Put your head down and graduate. That is the key. They own us while we are residents. Once you have graduated, then you can go back later and file complaints with the ACGME and crap. Currently they have you by the balls, so you just need to suck it up.

Don't quit. Don't give in.

 

[RadOncDoc21]

You could start a complaint with the ACGME before they make up something on you to get you kicked out.

It really does depend on your situation and how comfortable you are knowing that the battle lines have been drawn. You will not win the resident of the year award but at least you are somewhat protected during your residency.

 

[Perrotfish]

You could start a complaint with the ACGME before they make up something on you to get you kicked out.

I'm not sure what the basis of such a complaint would be, or what the ACGME would do to help.

 

[RadOncDoc21]

If anything it gets people to be on their best behavior.

 

[Crayola227]

this is so so sad hats off to Perrotfish as always for great advice and acknowledging this resident's problem as potentially real

the part about not seeing a mental health provider at program's request, *sigh, tears.*

you needed an attorney yesterday. it can be challenging to find one with any resident experience, you can find one that has employment/discrimination law experience, they will be good at helping you do what you need to do to cover your ass with documentation for a wrongful termination suit if it ever comes to one. just because now the PD seems to be held at bay by fear of suit does not mean that you should not be prepared to be able to back one up should the occasion arise. it deosn't have to come to that for the advice to be invaluable

as long as you keep the attorney the biggest secret ever you will not regret getting one

get that attorney to look over your contract and GME office & ACGME policy as well to help your strateg

what you said about the program picking a "pet problem resident" is true. It's a real and unfortunate problem not as uncommon as it should be.

medicine is full of big uptight egos. watch it around this one

 

[Law2Doc]

... I get told all the time that I'm a terrible person and terrible doctor even though my testing scores are higher than all of my classmates and I've done way more in the way of academic endeavors...

Not that this would ever justify singling you out to try and make you quit, but I note that the metrics you chose to emphasize are actually not those most of us would point to in terms of being a "good doctor". In truth if you are primarilly achieving on tests and academic pursuits rather than clinically, you could still be falling short on the things that actually matter to your program/PD.

I only mention this because I know someone who was not renewed for (good) cause, and throughout the process he couldn't seem to grasp why the PD kept focusing on his conduct on the wards rather than his above average inservice scores and research. So I wouldn't try and defend with that.

 

[Crayola227]

Not that this would ever justify singling you out to try and make you quit, but I note that the metrics you chose to emphasize are actually not those most of us would point to in terms of being a "good doctor". In truth if you are primarilly achieving on tests and academic pursuits rather than clinically, you could still be falling short on the things that actually matter to your program/PD.

I only mention this because I know someone who was not renewed for (good) cause, and throughout the process he couldn't seem to grasp why the PD kept focusing on his conduct on the wards rather than his above average inservice scores and research. So I wouldn't try and defend with that.

thank you law2doc I couldn't put my finger on what in the statement bothered me.... and I am first to jump in to defend these guys

OP - maybe you didn't quite word this the way you meant to, but what they really want is someone safe, fast, and pleasant, in that order.
Besides fast safe patient care and you being as unobtrusive as a mouse, being likeable is your #1 job at work
at the end of their 16 hr work day with you no one gives a rat's ass about your test scores

 

[jl lin]

You could start a complaint with the ACGME before they make up something on you to get you kicked out.

It really does depend on your situation and how comfortable you are knowing that the battle lines have been drawn. You will not win the resident of the year award but at least you are somewhat protected during your residency.

OK chiming in again where I "don't belong," b/c there is so much of this maliciousness through healthcare. I am speaking from a lot/loads of experience. Malignancies are not uncommon in HC, and I only wish to God they weren't, b/c dealing with life and death issues and patients' various stresses, and your ability to address them safely is more than enough to push anyone in over the edge. It just is.

People blow me away with their arbitrary ability to just "hate," and hate is an amazingly strong word. Arbitrary hate or hate for foolish, insecure reasons is just it's own level of mental illness IMHO.

At any rate, here's why I quoted the above poster, even though Parrotfish and others have given excellent advice.

People in a position of power within the workplace can easily find a reason to weed you out. My God, this definitely happens in nursing a lot, and I believe they are more protected, well, it depends, than residents. Since no one, no resident or even attending is perfect, something can be made out of nothing, and weeding out by way of pretext happens.

Seriously some of this stuff in healthcare work environments is like covert or inside terrorism. Sadly there are a number of people in influence or power positions that do NOT have the ability to be balanced and fair-minded. Frankly, they don't want to be--or perhaps they found that they had to endure such abuses and so they will target certain people w a negative form of sublimation and displacement. Who knows why they pick you? Sometimes it's generated from another favored individual w/i the group--and then group think takes over. Remember: When influencing others, position of the influencer and perception becomes the reality. When this is successful, chances of group acceptance diminish, and it becomes a lot easier for the targeted person to get screwed.

Again, since no one is perfect, issues can be whipped up like into a frenzy, and the hunt and documentation or harassment continues until they can oust the person or the person is beaten down by the stress and says, "Screw it."

So again, while all of parrotfishes recommendations are excellent, the truth is, if the "hate" or feelings of threat from you or what is causing the negative dynamic against you is strong enough, you can do all those things suggested, and still may find yourself out the door. The benefit in that case of what parrotfish still stands, b/c in effect you have worked to show by your own due diligence that you went out of your way to exceed expectations and adjust or remediate any issues.

I loathe mostly subjective evaluation systems. They are capricious and can mean nothing and destroy people's careers. People have the right to expect a reasonable level of fair play and that they will be treated in good faith. Capricious acts against people are not at all about fair play.

It takes work to develop more objective systems of evaluation; but they can be created. They won't be perfect, but they can be many times superior than what is often used in terms of clinical evaluations and such.

You really should also get feedback from some people that have shown you that you can trust them and that are fair-minded and caring. They may be able to show you certain things about attitude or presentation that may have rubbed people the wrong way.

Personally, I think if they are simply personality based and people read into them b/c of their own insecurity, and they thus say, "Oh you are annoying," that may well be a problem with them. You can't change your core personality. What is stated as annoying from them in many cases may well have to do with the insecurity of the individual/s that is/are resentful of your confidence or other good qualities.

I mean it depends, and that's why you need feedback from others that you can trust. But sure, there are a number of times, as I said, it's not really about you. It's about them and their issues, but they aren't clued into that and/or neither care to be.

It's easier to put down or go after or write off others than to step back and take another look at themselves and then the other person.You can't change everyone in the world, and no one is liked all the time by everybody, b/c to one degree or another, the world is imperfect and it's human constituents are as well.

So, after doing all of the great things parrotfish has shared, you still might need to take further steps. One thing I have seen in healthcare and the work environment over many years is if a dominant player and/or group want to weed out a person or persons, they can usually and quite easily succeed at doing it. Each person then has to carefully look out for their own career.

So I have to take what RadOnc and Crayola have said seriously as well; b/c if they want to find a pretext and drum it up into something, they can and will.

Meanwhile, those that they have not been targeted may have done the same things or worse, and somehow it's brushed aside. These cases of disparate treatment are tougher to win if you don't have something like EEOC-relevance to protect you.

It's perfectly legal, or at least ignored in many courts, when people have been disliked, treated with disparity that is not EEOC-based, and then ousted or weeded out. I mean people do try to take these cases to court, but they are expensive, time-consuming, and less that 10% of the cases on behalf of the plaintiff are won. Basically you can treat someone with unfairness and capriciousness and hurt their career or send them packing, and in most cases employers and administrators get away with it. I therefore have mixed feelings about At-Will-Employment, but the reality I have seen against employees makes me not favor it overall; b/c in practice, the potential for injustice from the employer is greater. I am the last person ever that would be called a socialist or a socialist sympathizer. My issue is the power goes mostly to the employer, b/c many feel that they don't actually have to act in good faith, and the courts support this. Something is very wrong there.

Now you have an advantage of some contract, which most nurses don't have. So that's helpful. Finding an excellent employment attorney is challenging--especially since many of them work for hospitals and such, and so they may not be able to represent you for conflict of interest. You'll have to do your research on this.

Good luck. I hope you get some fair feedback and that the suggestions made above by others is helpful to you. But at the end of the day, remember you have to protect your career and ability to work. If you can keep your head down and plow through, that's great; but sometimes, it requires something more. Why? B/c there are some screwed up people that play games at other peoples' expense, and indeed there are malignant and quite toxic people in the world. It's just that they have learned how to be that way subtly, on the down-low.

 

[jl lin]

Not that this would ever justify singling you out to try and make you quit, but I note that the metrics you chose to emphasize are actually not those most of us would point to in terms of being a "good doctor". In truth if you are primarilly achieving on tests and academic pursuits rather than clinically, you could still be falling short on the things that actually matter to your program/PD.

I only mention this because I know someone who was not renewed for (good) cause, and throughout the process he couldn't seem to grasp why the PD kept focusing on his conduct on the wards rather than his above average inservice scores and research. So I wouldn't try and defend with that.

Yes and this is precisely why people need the most objective evaluations and feedback that they can get. Personally, I think PDs need to be accountable for constructing the most objective systems of evaluation and prognostic indicators as possible. It would be beneficial to the whole program as well as the residents. And it would teach other residents how they should strive to fairly and effectively evaluate those under them; for often they do not, and it's easier to just respond capriciously.

 

[Law2Doc]

Yes and this is precisely why people need the most objective evaluations and feedback that they can get. Personally, I think PDs need to be accountable for constructing the most objective systems of evaluation and prognostic indicators as possible. It would be beneficial to the whole program as well as the residents. And it would teach other residents how they should strive to fairly and effectively evaluate those under them; for often they do not, and it's easier to just respond capriciously.

Well, a lot of being a "good resident" involves things that cannot be usefully distilled into objective measures (teamwork, bedside manner, dependability, diligence). This isn't a kind of training where you can say all I expect from you is to check the X, Y and Z boxes and score over W on your tests. You really truly are hiring residents with the expectation that they can make smart decisions in your absence, work well in both supervised and nonsupervised settings, implement plans, not cut corners, Etc.

Every year I was a resident, programs rolled out more detailed semiannual review forms relating to the ACGME milestones, with more and more boxes for supervisors to check, and frankly those additional criteria did nothing to help you as resident to understand where you weren't cutting the mustard, they just gave programs more opportunities to suggest a resident was lagging behind on some metric. Not buying that this works more as a shield than a sword, so IMHO you only think you want this, until you see it in action.

 

[jl lin]

Well, a lot of being a "good resident" involves things that cannot be usefully distilled into objective measures (teamwork, bedside manner, dependability, diligence). This isn't a kind of training where you can say all I expect from you is to check the X, Y and Z boxes and score over W on your tests. You really truly are hiring residents with the expectation that they can make smart decisions in your absence, work well in both supervised and nonsupervised settings, implement plans, not cut corners, Etc.

Every year I was a resident, programs rolled out more detailed semiannual review forms relating to the ACGME milestones, with more and more boxes for supervisors to check, and frankly those additional criteria did nothing to help you as resident to understand where you weren't cutting the mustard, they just gave programs more opportunities to suggest a resident was lagging behind on some metric. Not buying that this works more as a shield than a sword, so IMHO you only think you want this, until you see it in action.

Understood. But these can be written out in specifics. Example. Detail 4 explicit examples of how resident demonstrative effective teamwork. This can be done in the positive and the negative. This means you are requiring someone take the time to support how or how not someone met the expected behavioral/teamwork requirements. It can't be a checkbox, but that is what everyone wants out of ease. Expounded SMART criteria or the like can be used.

The reason why employers and the like do not like to have more objective means and measures is that they want the capriciousness; that is to say, they want the ability to play with pretext in order to oust someone that may not like for whatever reason--legitimate or not. If the standard becomes more objective, if gives those that hold the power less wiggle room from a legal standpoint. No one wants to address the realities on this. Sure there are people that don't cut the mustard for a number of reasons. But let's use fair play, consistently applied,objectively measurable systems, acting in good faith, and due diligence with teaching and evaluation. They go hand and hand. How else will you truly know if there is soundness or not room for improvement in a particular program of learning if you think that evaluation may not also be affected by the system of teaching. It can't be simply b/c 5/6 of this particular group are doing fine, but this odd ball is not. That indeed may be the case; but with the capriciousness of people and politics, that often enough is NOT necessarily the case. I am all for being likable; but this will vary, and in a world that claims openness to diversity, that should also include personality types and such. It can't be about polarizations and targeting individuals just because. Idiotic. And it happens far to often in the work world.

Also, by the way, to your last part Law, indeed I have seen it in action at a world renowned cardiothoracic recovery unit in which I worked. The system of evaluation and prognostic indicators were the best I have seen ANYWHERE hand down. And people influenced each other by following them and by example, such that the level of work and outcomes throughout were beyond excellent. Yes. It can and does work if it's smart and applied consistently and well. Of course, it takes work and consistency and people have to be trained in yet one more thing. "Oh no!" God forbid.

 

[Law2Doc]

Understood. But these can be written out in specifics. Example. Detail 4 explicit examples of how resident demonstrative effective teamwork. This can be done in the positive and the negative. This means you are requiring someone take the time to support how or how not someone met the expected behavioral/teamwork requirements. It can't be a checkbox, but that is what everyone wants out of ease. Expounded SMART criteria or the like can be used.

The reason why employers and the like do not like to have more objective means and measures is that they want the capriciousness; that is to say, they want the ability to play with pretext in order to oust someone that may not like for whatever reason--legitimate or not. If the standard becomes more objective, if gives those that hold the power less wiggle room from a legal standpoint. No one wants to address the realities on this. Sure there are people that don't cut the mustard for a number of reasons. But let's use fair play, consistently applied,objectively measurable systems, acting in good faith, and due diligence with teaching and evaluation. They go hand and hand. How else will you truly know if there is soundness or not room for improvement in a particular program of learning if you think that evaluation may not also be affected by the system of teaching. It can't be simply b/c 5/6 of this particular group are doing fine, but this odd ball is not. That indeed may be the case; but with the capriciousness of people and politics, that often enough is NOT necessarily the case. I am all for being likable; but this will vary, and in a world that claims openness to diversity, that should also include personality types and such. It can't be about polarizations and targeting individuals just because. Idiotic. And it happens far to often in the work world.

Also, by the way, to your last part Law, indeed I have seen it in action at a world renowned cardiothoracic recovery unit in which I worked. The system of evaluation and prognostic indicators were the best I have seen ANYWHERE hand down. And people influenced each other by following them and by example, such that the level of work and outcomes throughout were beyond excellent. Yes. It can and does work if it's smart and applied consistently and well. Of course, it takes work and consistency and people have to be trained in yet one more thing. "Oh no!" God forbid.

I cannot comment on your cardio thoracic evaluation system specifically, but have seen many iterations of what you describe in terms of the "detail 4 explicit examples" form of evaluation and I assure you that that same system is even better at documenting subjective failures than objective achievement. People only want this kind of feedback until they are on the negative end.

 

[jl lin]

I cannot comment on your cardio thoracic evaluation system specifically, but have seen many iterations of what you describe in terms of the "detail 4 explicit examples" form of evaluation and I assure you that that same system is even better at documenting subjective failures than objective achievement. People only want this kind of feedback until they are on the negative end.

Please help me understand why objective systems of evaluation are not more beneficial to the person under evaluation? How can they not help him/her hone in on what is really a true issue in terms of performance--social as well as otherwise? How is depending on the easier/lazier, capricious approach better? The only people non-objective systems help are those that desire the freedom to BE CAPRICIOUS. They do not want to validate their objections, b/c they know they are BS. This of course is not true in all cases/situations, but often enough, it certain is so. Just b/c the world is unfair in general doesn't mean we should embrace the unfairness b/c "that's just the way it is." If you can know to do better, you definitely should.

 

[Law2Doc]

Please help me understand why objective systems of evaluation are not more beneficial to the person under evaluation? How can they not help him/her hone in on what is really a true issue in terms of performance--social as well as otherwise? How is depending on the easier/lazier, capricious approach better? The only people non-objective systems help are those that desire the freedom to BE CAPRICIOUS. They do not want to validate their objections, b/c they know they are BS. This of course is not true in all cases/situations, but often enough, it certain is so. Just b/c the world is unfair in general doesn't mean we should embrace the unfairness b/c "that's just the way it is." If you can know to do better, you definitely should.

The problem is the people doing the evaluation have already made subjective decisions about the trainee, so these objective measures aren't being done to "help" the trainee improve so much as document failures.

 

[dozitgetchahi]

Well, a lot of being a "good resident" involves things that cannot be usefully distilled into objective measures (teamwork, bedside manner, dependability, diligence). This isn't a kind of training where you can say all I expect from you is to check the X, Y and Z boxes and score over W on your tests. You really truly are hiring residents with the expectation that they can make smart decisions in your absence, work well in both supervised and nonsupervised settings, implement plans, not cut corners, Etc.

Every year I was a resident, programs rolled out more detailed semiannual review forms relating to the ACGME milestones, with more and more boxes for supervisors to check, and frankly those additional criteria did nothing to help you as resident to understand where you weren't cutting the mustard, they just gave programs more opportunities to suggest a resident was lagging behind on some metric. Not buying that this works more as a shield than a sword, so IMHO you only think you want this, until you see it in action.

Totally agreed.

The milestones are largely nebulous and based on subjectivity anyway. There's nothing actually 'objective' about them.

It's as if you asked a group of liberals and a group of conservatives to 'assess the milestones' of Obama's development as a president by checking a bunch of boxes on a form. You think those assessments are going to be similar between the two groups?

 

[jl lin]

The problem is the people doing the evaluation have already made subjective decisions about the trainee, so these objective measures aren't being done to "help" the trainee improve so much as document failures.

Which is why people need to look at the objective measures and discipline themselves to follow them. It's like you are saying you can't teach people to evaluate things in an evenhanded, unbiased manner. No one is talking perfect. I am speaking of purposeful striving for objectivity--as in making pains to lean more in that direction than in a subjective, biased, and capricious direction.

Professional evaluations should be meted out objectively, free of favor or fear or power or associations, or financial favor. Like justice, it should be dispensed with a striving toward a blind justice and impartiality. In order to do this, we must strive to establish objective measures and learn the discipline of their sound application.

Now Law2Doc, I honestly respect your input at SDN, but since you are lawyer as well as a physician, I am sure you see this. Whether you choose to go the way of, "Oh hell. It's can't be done perfectly so why take pains with it?" or not is something only you know. I hope that is not so.

 

[jl lin]

Totally agreed.

The milestones are largely nebulous and based on subjectivity anyway. There's nothing actually 'objective' about them.

It's as if you asked a group of liberals and a group of conservatives to 'assess the milestones' of Obama's development as a president by checking a bunch of boxes on a form. You think those assessments are going to be similar between the two groups?

They totally needn't be. People haven't invested enough in striving for this. And there are people and forces that like being able to be capricious, and greater subjectivity gives them more license to do this. It's vile to take such a haphazard approach w/ someone that has invested so much time, energy, money, and their lives. In fact, it's morally wrong. People that allow for this IMHO have no business working or teaching in a field that requires care, concern, respect, objectivity, thoroughness, and sound ethics--things that are needed in dealing with people's lives.

 

[Perrotfish]

If anything it gets people to be on their best behavior.

I'm not sure it would. A resident's only real defense against the subjective and random nature of residency evaluations is that there are a LOT of evaluators, most of whom don't talk to each other very much. You can bury a hater under dozens of good reviews. Doing something like filing a complaint with the ACGME can make a lot of people who otherwise might have written generic or good evaluations see you as a problem child, and once you start getting bad feedback from all of them the PD has 'objective' data to use against you.

If you think you have something really egregious and concrete for the ACGME to act on it might still be worth it, but I would only light the fuse if you're pretty sure you can sink the person who is harassing you. I don't think you want this particular shot going across the bow.

 

[Gastrapathy]

Scrutinize all your evaluations to this point (every single one). If there isn't paper to get your fired, you really can't be fired. You can, however, just not be renewed year by year. Take a hard look at the policies from your overseeing GME office for resident termination/non-renewal. If you have 1-2 years left, you should try to finish. Otherwise, you may consider transferring before the hammer drops but that is a risky proposition.

Test scores and academic accomplishments are meaningless in this process.

Do you still want to practice this residency?

You have no basis for an ACGME complaint. You might have a basis for an equal opportunity complaint if the PD singled you out. Hold onto those cards (take detailed notes on who told you what and when).

 

[RadOncDoc21]

I'm not sure it would. A resident's only real defense against the subjective and random nature of residency evaluations is that there are a LOT of evaluators, most of whom don't talk to each other very much. You can bury a hater under dozens of good reviews. Doing something like filing a complaint with the ACGME can make a lot of people who otherwise might have written generic or good evaluations see you as a problem child, and once you start getting bad feedback from all of them the PD has 'objective' data to use against you.

If you think you have something really egregious and concrete for the ACGME to act on it might still be worth it, but I would only light the fuse if you're pretty sure you can sink the person who is harassing you. I don't think you want this particular shot going across the bow.

A PD can make your life a living hell and can trump all the other evaluations. All I can say is that by Having the ACGME and GME in the department changes the culture if not to "waste" the PD's time. I've seen it where it allowed the resident to never have to be in the same room as the PD for the rest of their residency training.

I think if the OP feels he/she rather go through that, although extreme, it may be worth it. I've seen witch hunts and they can turn out ugly. I believe it's better to act now then later... The best defense sometimes is a real good offense. You have more power than you realize if what you claim can be supported as stated by the previous poster above.

 

[jl lin]

Scrutinize all your evaluations to this point (every single one). If there isn't paper to get your fired, you really can't be fired. You can, however, just not be renewed year by year. Take a hard look at the policies from your overseeing GME office for resident termination/non-renewal. If you have 1-2 years left, you should try to finish. Otherwise, you may consider transferring before the hammer drops but that is a risky proposition.

Test scores and academic accomplishments are meaningless in this process.

Do you still want to practice this residency?

You have no basis for an ACGME complaint. You might have a basis for an equal opportunity complaint if the PD singled you out. Hold onto those cards (take detailed notes on who told you what and when).

That's only if the person meets one of the criterion in question under EEOC. If he/she is, say, a white American, and it's just a matter of someone not liking her for stupid reasons, s/he has a long, hard, separate battle. Again, this is why programs should maintain objective evaluations w/ full clarification specifics at each point. Also, the evaluations should be done IMHO no less than every 2 mo.s. Going into even a quarter is too long to get sound evaluation feedback. I am talking formally, and not immediate feedback occurring in each situation per day or week. Point is, no resident should be shellshocked or unaware of their standing. Time is needed to make appropriate adjustment, and IMHO, at least in many places in the HC work world, the put off or wait way to long to give formal feedback w/ a plan and time to re-evaluate.

Scrutinize all your evaluations to this point (every single one). If there isn't paper to get your fired, you really can't be fired. You can, however, just not be renewed year by year. Take a hard look at the policies from your overseeing GME office for resident termination/non-renewal.

How is the non-renewal determined? How much of that is subjective rather than more objective? Can it work just like At-Will-Employment:
PD or some just don't like you, so we won't renew you." Given that will never be said or stated; but if there is more subjectivity than objectivity, pretext can be worked up in a system that leans more toward subjective systems of evaluation.

 

[jl lin]

I'm not sure it would. A resident's only real defense against the subjective and random nature of residency evaluations is that there are a LOT of evaluators, most of whom don't talk to each other very much. You can bury a hater under dozens of good reviews. Doing something like filing a complaint with the ACGME can make a lot of people who otherwise might have written generic or good evaluations see you as a problem child, and once you start getting bad feedback from all of them the PD has 'objective' data to use against you.

If you think you have something really egregious and concrete for the ACGME to act on it might still be worth it, but I would only light the fuse if you're pretty sure you can sink the person who is harassing you. I don't think you want this particular shot going across the bow.

That's the problem. Group influence and group think. My God, it is easy enough to see bullying behavior here online on forums. People talk and influence. It really depends on how influential the hater/s are and how much pull they have on others. Again, this is why weeding out is relatively simple. You just need to know how to influence others and have some clout or something "special" whereby people will feel more inclined to buy into your perceptions. It's basic politics.

I agree, I wouldn't necessarily jump to ACGME complaint; but if the cards are unfairly stacked against you, you have to protect your career--especially one as painstaking and expensive as becoming a physician. Don't get me wrong. There are plenty of great people out there; but one also can never underestimate the d!c% factor that's out there.

 

[jl lin]

A PD can make your life a living hell and can trump all the other evaluations. All I can say is that by Having the ACGME and GME in the department changes the culture if not to "waste" the PD's time. I've seen it where it allowed the resident to never have to be in the same room as the PD for the rest of their residency training.

I think if the OP feels he/she rather go through that, although extreme, it may be worth it. I've seen witch hunts and they can turn out ugly. I believe it's better to act now then later... The best defense sometimes is a real good offense. You have more power than you realize if what you claim can be supported as stated by the previous poster above.

Yes I agree. But I also am not saying OP is necessarily at this point yet. It really depends upon all the specifics. Clearly we are NOT privy to all the specifics.

 

[RadOncDoc21]

Yes I agree. But I also am not saying OP is necessarily at this point yet. It really depends upon all the specifics. Clearly we are NOT privy to all the specifics.

No doubt, I agree and not recommending this for anyone to be a knee-jerk reaction. It's up to the individual to make the right decision and to understand the ramifications of his/her actions. In my experience, the resident had no choice and it worked out to protect not only him but other residents who came down the line who felt the same way.

 

[jl lin]

No doubt, I agree and not recommending this for anyone to be a knee-jerk reaction. It's up to the individual to make the right decision and to understand the ramifications of his/her actions. In my experience, the resident had no choice and it worked out to protect not only him but other residents who came down the line who felt the same way.

Yea, if she is completely innocent in this, she would be allowing something that was unjust for her to potentially happen to someone else. These kinds of posts are troubling, b/c you really can't get the nitty-gritty details. So you want to get all fizzed off and fight for justice, but then you're like, "Wait. What is missing her?"

A PD can make your life a living hell and can trump all the other evaluations. All I can say is that by Having the ACGME and GME in the department changes the culture if not to "waste" the PD's time. I've seen it where it allowed the resident to never have to be in the same room as the PD for the rest of their residency training.

I think if the OP feels he/she rather go through that, although extreme, it may be worth it. I've seen witch hunts and they can turn out ugly. I believe it's better to act now then later... The best defense sometimes is a real good offense. You have more power than you realize if what you claim can be supported as stated by the previous poster above.

So, your example is yet another of any number of such occurrences that can happen. People can be grossly unfair. It's not OK to just sit back and listen to, "Well dear. Life is unfair," if the person in the OP's situation is completely innocent. Most of us know firsthand how unfair life can be; but where it needs to be made right, it should be, period. If she's completely innocent, she should also have the right to fight for damages. But there are these ifs, and there are also insecure people that just need to be j.o.'s. If anyone has lived long enough, they have had the displeasure of interacting with these people that abuse their position and power for ill/malice or politics. And no one should be promoting being a suck-up, kiss jazz in this field either. There is something pathological about promoting such a mentality.

 

[NotAProgDirector]

It is highly unfortunate that the PD is acting this way, assuming that the side of the story documented here is the "truth". PD's should be committed to supporting and training the residents under their supervision. Of course, it's quite possible that there is more to the story -- it's possible that the OP's performance was actually suboptimal. Even if that's the case, telling that to other residents in order to push someone out is unacceptable.

In any case, the question is what to "do" about it. Let's be 100% clear on what won't work: Complaining to the ACGME. From their website:

Concerns cannot be used to adjudicate individual disputes between individual persons and residency/fellowship programs or sponsoring institutions regarding matters of admission, appointment, contract, credit, discrimination, promotion, or dismissal of faculty members, residents, or fellows.

You can complain to the ACGME about how your program is not meeting an ACGME standard. But the ACGME does not get into individual situations, and getting the ACGME involved will only raise tempers and not help you at all.

Although I would love a completely objective evaluation system, I don't think one exists. The "best" objective assessment we have are written tests -- there's no question about what answers are right and wrong, and you get a score that's 100% reproducible (i.e if I score the exam again, or someone else scores the exam, you get the same result). But when I choose some cutoff, ultimately there's a difference of one question between passing and failing. And we all know that the person who just fails by one question has basically the same performance as the person who just passes by 1 question. No matter what objective measure we try to use, there's always a transition point like this.

It doesn't matter what aspect we're looking at. If a single nurse complains about your performance, that's probably a fluke. If all of the nurses refuse to work with you, then you get fired. But at what point does it become a problem? 2%? 5%? 10%? And it would presumably depend upon what was being complained about -- and how am I supposed to "measure" that?

 

[jl lin]

So if a dominant group of nurses get together and complain that said resident treats them in a condescending manner, even if it is not at all true, the resident gets fired? Maybe it is possible that there is some serious level of unawareness re: how people and indeed nurses can group-act and rally against someone and get them ousted. I am a nurse, so I won't say they shouldn't be heard necessarily. But I have had to comment and get on nurses that were only to happy to slam the intern and make him or her feel like crap. Of course all nurses are not like that. But there is some weird % of nurse antics within certain places that are just, well, toxic. It happens more than people know. I have also seen a number of good to great nurses get weeded out b/c of this kind of cultural illness. That is not the kind of culture anyone should be OK with having. No one is asking for a perfect world. But when there is the potential to objectively do better and impart the discipline and commitment to a more objective system and it's application, that is what needs to happen.

Thank you for the quote from ACGME. Regardless of what they do, if it is called for, and I have no idea if that is so in this case, they should be made aware. Why? B/c it reflects something that can ripple throughout the system.

Med Schools may be swimming in MS applicants today, but looking at so many factors, and the major time, energy, and huge money investment to become a part of the medical profession, applicants will only opt to do something else, especially if capricious measures are a big enough part of the MS or GME systems. Given all the overwhelming burdens of the process, it may indeed just be too much for more and more people. There are a number of MS grads that have openly spoken here and elsewhere that they would not repeat the process if they had it to do all over again. Some of that may have been due to a lack of awareness about what medicine is about--they didn't get nearly enough upfront, clinical exposure. But the other part may be people have felt a bit too much abuse in a very long, demanding system that may really need to be improved. It would be foolish for people to keep their heads in the sand about this kind of thing. Also, credentials alone do not make good leaders, and that's what a PD is, a leader; is it not?

Again this particular situation is very unclear, and no one can really give a completely intelligent perspective on it. Still, I have seen this kind of abuse occur. Poor resident performance should not be tolerated, but neither should poor systems of evaluation and capricious nonsense be allowed to destroy someone's career--especially after so much time, energy, money and such have already been invested. I have to be honest in saying that I have seen downright unethical handling of people b/c of inside politics and such in HC.

Again, if this woman in this case is truly innocent, she definitely should not run away with her tail between her legs and heed the words of "Tough luck. Life is not fair." It takes courage to seek justice.

 

[hamstergang]

So if a dominant group of nurses get together and complain that said resident treats them in a condescending manner, even if it is not at all true, the resident gets fired?

That's not what was said. I get the feeling from your posts that you're misrepresenting and exaggerating things, and this is just one clear example where I can see how you took something someone said and turned it into something else.

 

[dozitgetchahi]

So if a dominant group of nurses get together and complain that said resident treats them in a condescending manner, even if it is not at all true, the resident gets fired? Maybe it is possible that there is some serious level of unawareness re: how people and indeed nurses can group-act and rally against someone and get them ousted. I am a nurse, so I won't say they shouldn't be heard necessarily. But I have had to comment and get on nurses that were only to happy to slam the intern and make him or her feel like crap. Of course all nurses are not like that. But there is some weird % of nurse antics within certain places that are just, well, toxic. It happens more than people know. I have also seen a number of good to great nurses get weeded out b/c of this kind of cultural illness. That is not the kind of culture anyone should be OK with having. No one is asking for a perfect world. But when there is the potential to objectively do better and impart the discipline and commitment to a more objective system and it's application, that is what needs to happen.

Thank you for the quote from ACGME. Regardless of what they do, if it is called for, and I have no idea if that is so in this case, they should be made aware. Why? B/c it reflects something that can ripple throughout the system.

Med Schools may be swimming in MS applicants today, but looking at so many factors, and the major time, energy, and huge money investment to become a part of the medical profession, applicants will only opt to do something else, especially if capricious measures are a big enough part of the MS or GME systems. Given all the overwhelming burdens of the process, it may indeed just be too much for more and more people. There are a number of MS grads that have openly spoken here and elsewhere that they would not repeat the process if they had it to do all over again. Some of that may have been due to a lack of awareness about what medicine is about--they didn't get nearly enough upfront, clinical exposure. But the other part may be people have felt a bit too much abuse in a very long, demanding system that may really need to be improved. It would be foolish for people to keep their heads in the sand about this kind of thing. Also, credentials alone do not make good leaders, and that's what a PD is, a leader; is it not?

Again this particular situation is very unclear, and no one can really give a completely intelligent perspective on it. Still, I have seen this kind of abuse occur. Poor resident performance should not be tolerated, but neither should poor systems of evaluation and capricious nonsense be allowed to destroy someone's career--especially after so much time, energy, money and such have already been invested. I have to be honest in saying that I have seen downright unethical handling of people b/c of inside politics and such in HC.

Again, if this woman in this case is truly innocent, she definitely should not run away with her tail between her legs and heed the words of "Tough luck. Life is not fair." It takes courage to seek justice.

I agree with the spirit of what you're ranting about, but the fact of the matter is that subjectivity and capriciousness are well-known factors in the evaluation of employees in any number of 'mission-critical' fields. Several points on this:

- The problem is not necessarily the subjectivity and capriciousness itself but rather the fact that as residents we have zero rights and can't simply switch jobs/transfer to a different location/whatever if it continues.

- Succeeding in many different careers means knowing how to successfully navigate subjectively graded 'playing fields'. Somebody who has trouble with this consistently probably has much more fundamental issues than the quality of the management above them.

- When you know the deck is stacked against you, there's a time where it's definitely better to buck up, shut up, hang low and just muddle through. Causing trouble by filing complaints and lawsuits and generally stirring the pot is like heading off to war in a neon yellow jumpsuit - you're just making a gigantic target out of yourself.

 

[jl lin]

That's not what was said. I get the feeling from your posts that you're misrepresenting and exaggerating things, and this is just one clear example where I can see how you took something someone said and turned it into something else.

Actually I am not, but feel free to feel any way you would like.

 

[jl lin]

I agree with the spirit of what you're ranting about, but the fact of the matter is that subjectivity and capriciousness are well-known factors in the evaluation of employees in any number of 'mission-critical' fields. Several points on this:

- The problem is not necessarily the subjectivity and capriciousness itself but rather the fact that as residents we have zero rights and can't simply switch jobs/transfer to a different location/whatever if it continues.

- Succeeding in many different careers means knowing how to successfully navigate subjectively graded 'playing fields'. Somebody who has trouble with this consistently probably has much more fundamental issues than the quality of the management above them.

Not sure what you are trying to communicate here. That's an honest statement. Indeed, we have no knowledge that this was at all the case with the individual in the OP. At least I haven't read that. But if you are suggesting that behavior cannot have a more objective system of evaluation, I would respectfully disagree with you. Again, it's not about being perfect. It's about limiting the subjectivity w/ sound objective measures and learning the discipline of how to apply this--and then seeing that it is consistently applied. Yes. It's more work. There is the rub.

When you know the deck is stacked against you, there's a time where it's definitely better to buck up, shut up, hang low and just muddle through. Causing trouble by filing complaints and lawsuits and generally stirring the pot is like heading off to war in a neon yellow jumpsuit - you're just making a gigantic target out of yourself.

I don't necessarily disagree.

Again the problem here is that we don't have the solid details. All I am saying is IF the person was truly innocent and falsely sentenced w/ academic dishonesty, she needs to fight it, b/c this will happen to someone again, and it sets the tone if left alone to continue and negatively affect the profession. Plus she indeed has a legitimate right to seek justice. If she is not innocent, she's screwed.

If seeing people over many years being treated capriciously and unjustly causes me to rant, I apologize. I have a firm sense of fairness and justice. At the same time, there are clearly people that consistently show they aren't really cutting it, and so they are rightfully weeded out. The latter is just and sensible. The former is injustice that should be given justice. I think when we lose this sense of things, we are in big trouble.

 

[jl lin]

That's not what was said. I get the feeling from your posts that you're misrepresenting and exaggerating things, and this is just one clear example where I can see how you took something someone said and turned it into something else.

Actually I am not, but feel free to feel any way you would like.

Also, I wonder now that you have ever seen subtle but still serious bullying behavior. It's allowed in an unspoken sense in many places. OTOH, some people say it doesn't happen, b/c sadly they are a part of such things--or they have learned, "If you can't be them, join them," and they want to feel OK about it. Not saying this applies to you, b/c I honestly don't know. But I have seen these behaviors over the years. As a nurse manager I have seen them, and as a staff nurse I have seen them. Leadership makes a big difference, but it takes courage and great care, as in carefulness, to address these things or you will undermine what you are trying to achieve--acceptance, respect, peaceful cooperation, unity, and limiting the polarization of others against others--all things required for strong teamwork, along w/ esprit de corps. Even covert malicious behavior is indeed a malignancy.

 

[chocomorsel]

Jl Lin, sometimes you are too much. And you clearly don't understand the life of a resident.

OP, good luck child. I was in your shoes for two straight years. We got a new PD mid training who was an evil bitch. A rabid dog. She made my life a living hell for two years. I developed a horrible reputation. Followed by severe anxiety and to this day, I still have to explain my probation to
Credentialing committees and still fight the remnants of anxiety.

Look up my posts circa 2010 thru 2012.

Thankkfully, I found a mentor who thought I was awesome and agreed I was being railroaded by the higher ups, saw a shrink and got on meds, fought with the help of the Union against the planned extension of residency and won, and graduated.

Keep your head down, don't be too vocal like I was about the maltreatment and you can persevere.

FYI, last night I had a nightmare about the evil bitch. More than three years later I still dream about her. That's how much she affected my life.

 

[Crayola227]

Jl Lin, sometimes you are too much. And you clearly don't understand the life of a resident.

OP, good luck child. I was in your shoes for two straight years. We got a new PD mid training who was an evil bitch. A rabid dog. She made my life a living hell for two years. I developed a horrible reputation. Followed by severe anxiety and to this day, I still have to explain my probation to
Credentialing committees and still fight the remnants of anxiety.

Look up my posts circa 2010 thru 2012.

Thankkfully, I found a mentor who thought I was awesome and agreed I was being railroaded by the higher ups, saw a shrink and got on meds, fought with the help of the Union against the planned extension of residency and won, and graduated.

Keep your head down, don't be too vocal like I was about the maltreatment and you can persevere.

FYI, last night I had a nightmare about the evil bitch. More than three years later I still dream about her. That's how much she affected my life.

My God chocomorsel, I feel ya. I feel ya. THIS **** HAPPENS UNFAIRLY. IT DOES.

Jl lin, I don't know where academic dishonesty came up in this thread with the OP.
You're right in theory about social change etc, but the stakes are too high in residency. You can't really fight city hall on this one.

I remember back in history where factory and agriculutural workers (a la some Steinbeck novels) started to Unionize and stand up the poor treatment from employers, people working 16 hour day forced to live in way too expensive boarding houses that saw to it they would never save enough to escape to the country to buy land to farm, and what it took for sweeping social change. Strikes can see people homeless. In those times, that sort of social protest saw people DEAD. Union assasinations and the like.

Before I get accused of drama, I mean to say that residency is not as bad to motivate a large movement whereby residents revolts and ditch the hospital on strike, risking making their medical degree worthless without training, financially ruined for life 2/2 debt, and just generally unemployed as it happens. It' s not so atrocious and that people keep coming to work. As far as death, hospital strikes don't happen often cuz yeah, strikers might not die but when depending how much the hospital runs off residents could be a major shut down. Closed hospitals lead to deaths.

People put their head down, get to attending, and the "resident cause" never acted on, because the med students are just worried about getting there and attending is very busy and people just get on with their lives.

 

[jl lin]

Jl Lin, sometimes you are too much. And you clearly don't understand the life of a resident.

OP, good luck child. I was in your shoes for two straight years. We got a new PD mid training who was an evil bitch. A rabid dog. She made my life a living hell for two years. I developed a horrible reputation. Followed by severe anxiety and to this day, I still have to explain my probation to
Credentialing committees and still fight the remnants of anxiety.

Look up my posts circa 2010 thru 2012.

Thankkfully, I found a mentor who thought I was awesome and agreed I was being railroaded by the higher ups, saw a shrink and got on meds, fought with the help of the Union against the planned extension of residency and won, and graduated.

Keep your head down, don't be too vocal like I was about the maltreatment and you can persevere.

FYI, last night I had a nightmare about the evil bitch. More than three years later I still dream about her. That's how much she affected my life.

Amendment: This thread ran closely w/ another one re: discharge of a MS for wrongly accused academic dishonesty--and a career-killing judgment was given. That one was hard too, b/c the details were not in place. I don't have that feature on anymore that alerts you right away when someone has responded to your response in a thread. I turned it off, but it was getting annoying to me, and I just want to feel a bit more like I can come and go as I please here. So, I think I got a lot of those details twisted in this thread. The same theme is there though, IF things can be taken or vague, face value. The devil is always in the details, so...
At any rate, that person appears to be ousted, and presumably the ousting is completely unjust. Again, don't know if that is so, b/c of lack of details.

But I will still let my response below stand. I am a firm believer that people should be sent packing for measurable, objective cause--and yes, behavioral evaluations get sketchy b/c of their subjective nature; but they certainly can be less so, and this has been done in the workplace in a number of settings. I am pretty darn conservative on a great many things, but I have come to the conclusion that At-Will-Employment is mostly a joke and favors primarily the employer, period. And I do understand that the resident has a contract, but I don't think, particularly since the residency is part of the necessary GME and so forth, that residents should be treated capriciously, especially since, in reality, they are learning and really are functioning under a stipend. I mean you can't have it both ways. You can't say, they are employees, and we can just thrown them the hell out or not renew their contract for weak reasons, especially since this is a vital and imperative part of their education.

Anyway, below is my original reply back to you. Sorry for the confusion.

Well, how does this go against anything I have said? If anything, your situation helps illustrate the importance of my point. Note nuances. I never said jump to any severe response/s. In fact I said I am not at all sure jumping to a severe response was in order, b/c we clearly don't have all the details. I totally understand about the head down thing.

So you would recommend then that people be treated capriciously in an evil, out and out malicious manner, during their education-work experience, with so much on the line? People should just tolerate the Hitlers, even when they have nothing to lose but fight? Although I don't know the gory details of this situation, I think when you have nothing to lose, you have to do what you have to do--especially when the accusation and formal judgment is completely false and there are very limited objective measures in place or there have been pretexts set in place. That's all I am saying.

Other than that, I feel terribly for what you and others have had to go through. I wish I could stop people in positions of power from being total j.o.s. Clearly in the world you can't. When you have to stand and fight, however, particularly if you have nothing left to lose, that's what you have to do.


I am seriously happy you made it through the other side. Abusive, malignant environments destroy learning and negatively impact the profession and those within it When we can do better, we should. All I am saying. Good luck to you.

 

[jl lin]

My God chocomorsel, I feel ya. I feel ya. THIS **** HAPPENS UNFAIRLY. IT DOES.

Jl lin, I don't know where academic dishonesty came up in this thread with the OP.
You're right in theory about social change etc, but the stakes are too high in residency. You can't really fight city hall on this one.

I remember back in history where factory and agriculutural workers (a la some Steinbeck novels) started to Unionize and stand up the poor treatment from employers, people working 16 hour day forced to live in way too expensive boarding houses that saw to it they would never save enough to escape to the country to buy land to farm, and what it took for sweeping social change. Strikes can see people homeless. In those times, that sort of social protest saw people DEAD. Union assasinations and the like.

Before I get accused of drama, I mean to say that residency is not as bad to motivate a large movement whereby residents revolts and ditch the hospital on strike, risking making their medical degree worthless without training, financially ruined for life 2/2 debt, and just generally unemployed as it happens. It' s not so atrocious and that people keep coming to work. As far as death, hospital strikes don't happen often cuz yeah, strikers might not die but when depending how much the hospital runs off residents could be a major shut down. Closed hospitals lead to deaths.

People put their head down, get to attending, and the "resident cause" never acted on, because the med students are just worried about getting there and attending is very busy and people just get on with their lives.

Yes, and as I said above, not knowing all the gory details in this situation, any advising is difficult.

To be honest, I think I was thinking of another malicious situation about I think a MS that was thrown out of school for academic dishonesty.
I come and go in these forums and threads, type quickly (notice my many typos), and so I think I got that situation and this one confused. At any rate, right. If it is not completely over for the resident, duck, cover, and move along indeed may be the best approach.
OTOH, sometimes these things mean the writing in on the wall, and they will be screwed over anyway.
I am talking about if the person has no recourse, and there is all just capricious hate, dislike, whatever, and the person has no other choice.

If you have no other choice but to fight, then that is what you have to do--given the fact that you spent so much money and time and energy and have given up a nice chunk of your life for this.

Sorry about the mix up. I loath capriciousness in evaluating people. It's the epitome of injustice. But yes. I agree with you and the poster above you. If you aren't at the point of actually being pushed off the cliff, then you may have to document things and take the softer approach. I think it depends entirely on the situation. But also, harassment is a great evil. Sometimes I think people perpetuate it b/c it was done to them. It's like, "Since I had to endure the hazing, so should you." Yea, that's a dysfunction position to take.

 

[chocomorsel]

Jl lin, I meant you are too much as in, good God you type a hell of a lot. Of course I don't advocate for malignant behaviors in programs, but they happen.

The subjective crap is mostly what gets people ousted, fair or not. You can piss of the wrong attending and word spreads like wildfire how horrible you are then of course, everybody puts you under the microscope looking for only the negative ****. Evaluations are such bull****. We should be only graded by how we serve our patients, and how well we know the material. Everything else is fraught with possible drama. If a resident is not running around killing or maimingpatients, and knows the material and shows up to work daily without shirking responsibility, they should not be fired.

A lot of the **** we endure that leads to "Unprofessionalism" issues is just a bunch of ass kissing quite frankly. If you aren't kissing enough of it, brown nosing enough, are a straight forward person like I was, you can rub folk the wrong way and possibly be fired. And of course, if you are a male and Caucasian, you can not show up to work, be a total a sshAt, and still be given the benefit of the doubt much much more than women and minorities especially in the surgical fields.

I had the highest scores on the yearly exam my last two years, was not endangering patients, showed up to work every day on time, did my work, but got lots of negative evaluations because EVERY MISTAKE I MADE was documented, and was looked out for. But like I said, I had a great mentor, and some other attending son my side that really helped me.

It sucks when those higher ups have so much power and can literally ruin your whole life. It happened to a friend of mine. And almost happened to me. One of the reasons they didn't oust me was because she was in the midst of her lawsuit against the department. I doubt they wanted to fire one resident right after another especially when my case wasn't so cut and dried.

 

[Perrotfish]

Amendment: This thread ran closely w/ another one re: discharge of a MS for wrongly accused academic dishonesty--and a career-killing judgment was given. That one was hard too, b/c the details were not in place. I don't have that feature on anymore that alerts you right away when someone has responded to your response in a thread. I turned it off, but it was getting annoying to me, and I just want to feel a bit more like I can come and go as I please here. So, I think I got a lot of those details twisted in this thread. The same theme is there though, IF things can be taken or vague, face value. The devil is always in the details, so...
At any rate, that person appears to be ousted, and presumably the ousting is completely unjust. Again, don't know if that is so, b/c of lack of details.

But I will still let my response below stand. I am a firm believer that people should be sent packing for measurable, objective cause--and yes, behavioral evaluations get sketchy b/c of their subjective nature; but they certainly can be less so, and this has been done in the workplace in a number of settings. I am pretty darn conservative on a great many things, but I have come to the conclusion that At-Will-Employment is mostly a joke and favors primarily the employer, period. And I do understand that the resident has a contract, but I don't think, particularly since the residency is part of the necessary GME and so forth, that residents should be treated capriciously, especially since, in reality, they are learning and really are functioning under a stipend. I mean you can't have it both ways. You can't say, they are employees, and we can just thrown them the hell out or not renew their contract for weak reasons, especially since this is a vital and imperative part of their education.

Anyway, below is my original reply back to you. Sorry for the confusion.

Well, how does this go against anything I have said? If anything, your situation helps illustrate the importance of my point. Note nuances. I never said jump to any severe response/s. In fact I said I am not at all sure jumping to a severe response was in order, b/c we clearly don't have all the details. I totally understand about the head down thing.

So you would recommend then that people be treated capriciously in an evil, out and out malicious manner, during their education-work experience, with so much on the line? People should just tolerate the Hitlers, even when they have nothing to lose but fight? Although I don't know the gory details of this situation, I think when you have nothing to lose, you have to do what you have to do--especially when the accusation and formal judgment is completely false and there are very limited objective measures in place or there have been pretexts set in place. That's all I am saying.

Other than that, I feel terribly for what you and others have had to go through. I wish I could stop people in positions of power from being total j.o.s. Clearly in the world you can't. When you have to stand and fight, however, particularly if you have nothing left to lose, that's what you have to do.


I am seriously happy you made it through the other side. Abusive, malignant environments destroy learning and negatively impact the profession and those within it When we can do better, we should. All I am saying. Good luck to you.

Where are you at in this process? Are you a resident? An attending? Which specialty are you in?

 

[jl lin]

Jl lin, I meant you are too much as in, good God you type a hell of a lot. Of course I don't advocate for malignant behaviors in programs, but they happen.

The subjective crap is mostly what gets people ousted, fair or not. You can piss of the wrong attending and word spreads like wildfire how horrible you are then of course, everybody puts you under the microscope looking for only the negative ****. Evaluations are such bull****. We should be only graded by how we serve our patients, and how well we know the material. Everything else is fraught with possible drama. If a resident is not running around killing or maimingpatients, and knows the material and shows up to work daily without shirking responsibility, they should not be fired.

A lot of the **** we endure that leads to "Unprofessionalism" issues is just a bunch of ass kissing quite frankly. If you aren't kissing enough of it, brown nosing enough, are a straight forward person like I was, you can rub folk the wrong way and possibly be fired. And of course, if you are a male and Caucasian, you can not show up to work, be a total a sshAt, and still be given the benefit of the doubt much much more than women and minorities especially in the surgical fields.

I had the highest scores on the yearly exam my last two years, was not endangering patients, showed up to work every day on time, did my work, but got lots of negative evaluations because EVERY MISTAKE I MADE was documented, and was looked out for. But like I said, I had a great mentor, and some other attending son my side that really helped me.

It sucks when those higher ups have so much power and can literally ruin your whole life. It happened to a friend of mine. And almost happened to me. One of the reasons they didn't oust me was because she was in the midst of her lawsuit against the department. I doubt they wanted to fire one resident right after another especially when my case wasn't so cut and dried.

LOL You speak truth.

I take it that your friend didn't win his/her case, or was there some other fall-out?

 

[chocomorsel]

Where are you at in this process? Are you a resident? An attending? Which specialty are you in?

I believe he/she is an RN.

 

[QofQuimica]

I believe he/she is an RN.

Yes, she is an RN.

To get back to the topic, OP, listen to what Perrotfish said. Your MD or DO is essentially worthless without a residency completion certificate. So although your work environment is undeniably unpleasant, and most of us can certainly empathize with you, don't stab yourself in the back just to spite this PD. Keep your trap shut, lower your head, and gut it out, ESPECIALLY if you're in your last year and seven more months of residency is all that's standing between you and that certificate. You've gotten this far. You can take it for a little while longer. Oh, and consider applying for jobs in another region of the country where your PD won't be besties with a lot of people in your field (and you won't run into her at all the small local conferences). Then move on with your life and be happy and successful. Best of luck to you.

 

[jl lin]

Yes, she, I mean, I am. These dynamics are all over workplaces everywhere, but I can honestly say, I have seen the most malignancy in the healthcare industry to both nurses and residents. The thing is, the nurse can more easily move elsewhere, with MUCH less to lose in terms of total investment: time, education, energy, stress, MONEY, etc. This makes this whole idea of capriciousness and maliciousness more toxic and unacceptable for those going in and through medicine.

If I gain entry into a medical school w/i the next year or so, I will be a medical student, who is not "just" a nurse. LOL. Big deal. But I never felt that I was "just" anything, and I don't identify who I am as a whole person with what I do. But I think this gets harder to do when one puts as much into getting into and being a part of the field of medicine as physicians are required. And again, that is what perturbs me so about the entire situation in the OP.

Yes, she is an RN.

To get back to the topic, OP, listen to what Perrotfish said. Your MD or DO is essentially worthless without a residency completion certificate. So although your work environment is undeniably unpleasant, and most of us can certainly empathize with you, don't stab yourself in the back just to spite this PD. Keep your trap shut, lower your head, and gut it out, ESPECIALLY if you're in your last year and seven more months of residency is all that's standing between you and that certificate. You've gotten this far. You can take it for a little while longer. Oh, and consider applying for jobs in another region of the country where your PD won't be besties with a lot of people in your field (and you won't run into her at all the small local conferences). Then move on with your life and be happy and successful. Best of luck to you.

This will depend, will it not, on whether or not the PD has it in for the OP? You have to be wise to know when the writing in on the wall. I mean, at least be ready so that it doesn't hit you out of nowhere. Whatever steps that can be taken to mitigate the damage, that's what definitely should be done. What that actually means with regard to this case is unclear, but ducking, covering, and moving onward may be the best approach. I agree with Parrotfish's advice. It's great. Just don't know how far this thing has gotten with this person. If she speaks w/ a lawyer for advice, w/o things getting out to anyone, how can it her her or him? (Sorry. I forget if it's a him or her.)

I have seen some major unfair (to the point of being immoral) BS come down on people for stupid reasons. I cannot lie about this. Healthcare is full of enough power trips and ridiculous abuse at times. Again, it's already hard enough w/o the needless BS.

I hope all does work out well for the OP.

I believe he/she is an RN.

Not that it matters either, but I am a she.

Thanks for letting me play.

 

[jl lin]

Also, @chocomorsel, it's a shame if things didn't work for you friend. It's a red flag to me that w/ so much riding on moving through residency, this kind of thing can go on w/o some accountability on the program and it's leadership.

Looking out for number one is fine; but when there is nothing to lose, there is no reason to suck up the massive loss of education costs and time and energy investments. My God. It's not like losing a job at MacDonald's and then moving over to BurgerKing or wherever. Programs and the profession want physicians to be accountable and responsible. Well then, that definitely needs to go both ways.

I read so much gloom and doom here re: the process and the profession, I would be lying if I told you that I haven't been shaken a little about continuing forward in the endeavor.

 

[Perrotfish]

Also,
Looking out for number one is fine; but when there is nothing to lose, there is no reason to suck up the massive loss of education costs and time and energy investments.

There is never 'nothing to lose' in this process. Even a resident forced out of residency will have the opportunity to reapply, and many such residents are successful in obtaining second and even third residency positions. I have worked with a resident on his third residency in a relatively good academic program. Even if you no longer have any chance for another residency slot you still have to guard your ability to obtain and renew a state license to practice as a GP, which if you've been fired from a residency will necessarily require an investigation by the state medical board. Its not just matter of your program director hating you, its a matter of how much time and energy he/she is willing to put into pursuing you. Even if you really have no chance of salvaging your current residency (which isn't really the case for the OP) you can normally keep your PD from putting much more effort into blackening your name, once you're gone from the program.

Its also not like you have any other real options. Residency is structured to make it almost impossible for aggressive actions, like a lawsuit or an ACGME complaint, to yield any concrete results. As far as the government is concerned you are an employee with a 50K/year salary and a one year contact, protected by the same state specific labor laws as everyone else in this country. There are no special laws to protect you and no real chance of a significant victory in civil court. Residency might one day be changed by an act of congress, or by an uprising among board certified doctors, or maybe a general residents strike, but its not going to change because one nearly-fired resident starts to make empty threats on the way out the door. By throwing that fit you could, however, brand yourself as a troublemaker that all other residencies and medical boards are afraid to touch.

 

[QofQuimica]

I think it's hard sometimes for premeds and med students to see these kinds of threads and not feel fear. You start wondering, wow, could I put in all those years of work and have it amount to nothing because some PD with a personality disorder is out to get me? So I don't fault premeds/students for joining in this thread. They have a vested interest in understanding how the system works. That being said, bashing the system does nothing to help solve the OP's problem. The fact remains that the OP absolutely, positively NEEDS a residency completion certificate if s/he is going to be a physician. The path of least resistance is for OP to finish his/her current program, especially if OP is already a PGY3 in a three year specialty.

And to answer the question for you premeds/med students out there, yeah, there are some residents who get fired. Most are for good cause, although probably a few are more for personality differences. But most residents do make it through, and the odds of you being fired by a nutcase PD for no reason are low.

 

[jl lin]

There is never 'nothing to lose' in this process. Even a resident forced out of residency will have the opportunity to reapply, and many such residents are successful in obtaining second and even third residency positions. I have worked with a resident on his third residency in a relatively good academic program. Even if you no longer have any chance for another residency slot you still have to guard your ability to obtain and renew a state license to practice as a GP, which if you've been fired from a residency will necessarily require an investigation by the state medical board. Its not just matter of your program director hating you, its a matter of how much time and energy he/she is willing to put into pursuing you. Even if you really have no chance of salvaging your current residency (which isn't really the case for the OP) you can normally keep your PD from putting much more effort into blackening your name, once you're gone from the program.

Its also not like you have any other real options. Residency is structured to make it almost impossible for aggressive actions, like a lawsuit or an ACGME complaint, to yield any concrete results. As far as the government is concerned you are an employee with a 50K/year salary and a one year contact, protected by the same state specific labor laws as everyone else in this country. There are no special laws to protect you and no real chance of a significant victory in civil court. Residency might one day be changed by an act of congress, or by an uprising among board certified doctors, or maybe a general residents strike, but its not going to change because one nearly-fired resident starts to make empty threats on the way out the door.[B][I] By throwing that fit you could, however, brand yourself as a troublemaker that all other residencies and medical boards are afraid to touch[/I][/B].

I agree with you, and I have acknowledged this ^.

Only the OP knows if the writing in on the wall or not. If it's not, definitely take the more conservative approach. Good on it. It would be highly dependent on the particular and where exactly the resident stood as to how far she would have to go.

As it is, I've on this topic and thread. Keeping head down and moving forward the best she can may be the best approach in her situation, as I have stated repeatedly. There are times, however, when seeking justice is in order and where indeed certain things need to come out into the light of day.
If she has thin skin and became very highly overreactive, well, she has to figure out this will work against her.

Whatever the situation, I wish the person the best. Still, I don't think residents should put up w/ grossly unfair, capricious nonsense; but I also think, as is true in all of life, you have to use wisdom and discretion in fighting your battles.

You original advice to OP was excellent, and I commend you on it.

 

[RadOncDoc21]

Hopefully my last comment on this topic but my advice again is to analyze your situation and make the best decision on what you know and feel is the right thing to do.

I described above where a resident had the GME/ACGME involved and it worked. I will not go into details about that situation but just know that there could be another option versus tolerating an injustice. I know many don't want to hear this but discrimination still exists in America.

Does this relate to the OP situation, althogh highly unlikely but something to consider.