Fired/dismissed from residency program in 51st week

[Arcan57]

Not in disagreement with you on the possibility that OP was not doing his/her job right. I am just tired of everyone always erring on the side of the resident being at fault in any firing situations on SDN. Like I said, the 3 official complaints listed above are not left field type issues. We see these things from a lot of medical personnel all the time in the hospitals. You guys are minimizing the implications of firing an intern; that is a life ruined or at least about to be. Certainly not something that should be done without due process or compassion. Again, if we cannot take care of our own decently why should anyone have any respect for us. Nurses or any of the other allied health workforce will never respond to a thread like this the way we do.

It's somewhat difficult to claim that anonymous internet posters are "throwing [someone] under a bus". Presumably that role (if it exists) would have fallen to the OP's actual colleagues. If you're distressed by the lack of sympathy, that's a legitimate gripe although one I disagree with in this case. This forum has numerous stories about residents being terminated, and this thread does not exist in a vacuum. The posting from the OP has very similar language to other posters that have exhibited lack of insight. I think this had lead to at least some degree of burnout among the SDN posters for sympathizing with someone who consistently made choices that we're not allowed to make and is now dealing with the consequences.

We, as doctors, cannot cede our moral authority to regulatory agencies when it comes to protecting the public from the harm caused by doctors that are not competent to practice medicine.

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[Doctor Bagel]

Firing a resident on his last week with your program is the similar to flying the said PFC to afghanistan and abandoning him/her in the hands of the taliban. The plan was not to punish or correct, but to ruin and destroy this indvidual. Nothing about that screams class, team, or dignity. Yes folks should be fired, but there must be due process. The message sent constantly by these erratic firings is that residents are walking on thin ice. Most of us have received that message and are willing to play the game, but some now assume thin ice is normal ground. We are a strange workforce, no one else does the kind of nonsense we do.

Unless the op's behavior was amazingly egregious, I've got to say I'm agreeing more with you than the others on this thread. This is destroying the op's entire career, causing him to lose out on his match in another specialty, because of performance in a field he's not even going into. I would hope that a program would truly believe that there's no other option and this the op is completely and entirely unfit to practice medicine before pulling this.

I think we all are assuming the op really deserved it because it makes us feel a little safer to think people don't get fired for weak reasons.

 

[Osteoimperfecta]

Unless the op's behavior was amazingly egregious, I've got to say I'm agreeing more with you than the others on this thread. This is destroying the op's entire career, causing him to lose out on his match in another specialty, because of performance in a field he's not even going into. I would hope that a program would truly believe that there's no other option and this the op is completely and entirely unfit to practice medicine before pulling this.

I think we all are assuming the op really deserved it because it makes us feel a little safer to think people don't get fired for weak reasons.

Best thing I have read on this thread. Are you a psychologist by chance

 

[Osteoimperfecta]

It's somewhat difficult to claim that anonymous internet posters are "throwing [someone] under a bus". Presumably that role (if it exists) would have fallen to the OP's actual colleagues. If you're distressed by the lack of sympathy, that's a legitimate gripe although one I disagree with in this case. This forum has numerous stories about residents being terminated, and this thread does not exist in a vacuum. The posting from the OP has very similar language to other posters that have exhibited lack of insight. I think this had lead to at least some degree of burnout among the SDN posters for sympathizing with someone who consistently made choices that we're not allowed to make and is now dealing with the consequences.

We, as doctors, cannot cede our moral authority to regulatory agencies when it comes to protecting the public from the harm caused by doctors that are not competent to practice medicine.

We always fall back on this argument when we throw our team members under the bus. I choose to use that phrase because that is really what I see it as. Physicians are a collective team, and I belong to the school of thought that our respect has dwindled because we disrespect our own selves. The regulatory agencies you speak of are proliferating in mass and they can literally dump any crap on physicians because they know we were trained with fear and live in fear. Again I am not supporting OP as much as I am asking that due process be applied in decisions of this nature.

 

[Arcan57]

We always fall back on this argument when we throw our team members under the bus. I choose to use that phrase because that is really what I see it as. Physicians are a collective team, and I belong to the school of thought that our respect has dwindled because we disrespect our own selves. The regulatory agencies you speak of are proliferating in mass and they can literally dump any crap on physicians because they know we were trained with fear and live in fear. Again I am not supporting OP as much as I am asking that due process be applied in decisions of this nature.

Respect for physicians dwindling have little to do with breaking omerta and much more to do with external factors such as third-party payors (the rise of HMOs in the 80's) and the association of doctors with the pharmaceutical industry as being motivated mainly by profit. I understand where you're coming from in terms of the team. But medicine is not the military, police, or fire deparment. Indiscretions that have nothing to do with performance on the job are covered up because of the team members value in critical situations. There are extremely few situations in medicine for which that argument supersedes our duty to the patients that put their trust in us.

 

[Law2Doc]

Respect for physicians dwindling have little to do with breaking omerta and much more to do with external factors such as third-party payors (the rise of HMOs in the 80's) and the association of doctors with the pharmaceutical industry as being motivated mainly by profit. I understand where you're coming from in terms of the team. But medicine is not the military, police, or fire deparment. Indiscretions that have nothing to do with performance on the job are covered up because of the team members value in critical situations. There are extremely few situations in medicine for which that argument supersedes our duty to the patients that put their trust in us.

Yeah, I respect your military notion of not leaving any man behind, but you have to appreciate that in medicine we actually have a duty to leave the unprofessional and incapable doctors behind. It's sort of like asking the military to promote someone who is a danger to the civilians he's sworn to protect. You put the locals at risk, you probably do get kicked out, even in the military. And the PD is not the enemy here, they are more the equivalent of a five star general in this analogy. They aren't out to screw over some enlisted guy, they probably only are aware of him if there's an issue, in which case they are going to back the ranking officer ( chief resident) over him most of the time. Folks aren't usually vindictive, just indifferent. You have to do a lot For them to not be willing to ignore the problem for the last week and let it resolve itself. Unless provoked, folks usually let the road with the least effort involved happen. Which here means folks were provoked.

 

[Osteoimperfecta]

Respect for physicians dwindling have little to do with breaking omerta and much more to do with external factors such as third-party payors (the rise of HMOs in the 80's) and the association of doctors with the pharmaceutical industry as being motivated mainly by profit. I understand where you're coming from in terms of the team. But medicine is not the military, police, or fire deparment. Indiscretions that have nothing to do with performance on the job are covered up because of the team members value in critical situations. There are extremely few situations in medicine for which that argument supersedes our duty to the patients that put their trust in us.

Where in this thread did you guys figure out this danger OP poses to patients? I guess you can make some type of 3 step argument how arguing with the chief will eventually kill a patient, but jeez guys! From what I gather this is simply a case where OP clashed with the wrong people and got canned. I dare say OP will still be on staff if he was nice to the chief resident and PD while arguing constantly with patients(which is very common btw). We all know the prelim intern about to go start derm/rads/optho or whatever else is not popular among internal med folks is not on anyone's favourites list. But firing on the last week of the year? You have to have a better reason than what OP described IMO. We exploit the argument of patient safety way too much. There was a time when physicians physically abused trainees and hid behind this same argument. It is time we call it what it is.

 

[Law2Doc]

Where in this thread did you guys figure out this danger OP poses to patients? ...

I think it's the only reasonable inference to make when a program feels so strongly that an individual shouldn't be allowed to finish out the last week of his prelim year. Honestly 3 letters in his file in under a year and sit downs with his PD where he was apparently warned to shape up or else, is a lot more significant than you seem to be giving credit for. I think enough of us have experience with hardnose PDs to know that you don't get the carpet pulled out of your career in this way for something merely mild. In my experience, folks downplay their issues when posting on SDN, and so when a track record sounds as bad as an OP describes it, that probably means it was even worse. I also think a lot of us are comparing OPs situation to the interns we have known personally who haven't done adequately -- a lot of us know folks who didn't have contracts renewed, and there was always a lot more to the story if you asked the people who had to cover for them, rather than what they themselves claimed was going on. But inevitably there was some variation of OPs not being able to be professional 365/24/7 argument, ie a bogus copout. So yeah, a lot of us are giving the presumption to the PD over the resident. Why? Because in most of these situations, the resident is the one not acting reasonably. There might be bad PDs out there, but they usually don't pounce on one random prelim one week before he goes on to another program. The fact that OP concedes he has multiple complaints filed against him, and that he was personally warned by the PD ( whether he appreciated the import at the time or not) suggests that he has been digging a hole for a while, and for whatever reason, the program felt uncomfortable allowing him to move on. There was a reason, something they felt justifiable. They could be wrong, but I think be the OPs own admissions, they get the presumption here.

 

[JelloBrain]

This is destroying the op's entire career, causing him to lose out on his match in another specialty, because of performance in a field he's not even going into. I would hope that a program would truly believe that there's no other option and this the op is completely and entirely unfit to practice medicine before pulling this.

I have been following this thread without comment so far, but have to disagree with the bolded part.

As per my understanding, the OP got fired for inter-personal issues, not clinical incompetency in Internal Medicine. That performance-dealing with other people-is there in every field, every walk of life, whether you are a janitor or some hot-shot executive. And it is an art, not everyone has it, but if you don't have it, then you should try to cultivate it-it is always good for you regardless of profession.

This deficiency of inter-personal skills, coupled with the lack of insight into the said deficiency, is what caused all this in my opinion. Now I don't know if the punishment is appropriate for the crime, but I hope the OP gets a valuable life lesson and everything works out.

 

[Perrotfish]

Osteo,
if a PFC ignored or argued with his lieutenant, argued and fought with locals in a town he was stationed in, didn't follow orders when given directly that showed clear dereliction of duties, that wouldn't be grounds for reprimand if not discharge from the military?.

OPs situation aside, I would just like to say that I laughed my ass off at the idea of a newly minted Marine being booted for running his mouth and acting like an idiot in town.

 

[Law2Doc]

I have been following this thread without comment so far, but have to disagree with the bolded part.

As per my understanding, the OP got fired for inter-personal issues, not clinical incompetency in Internal Medicine. That performance-dealing with other people-is there in every field, every walk of life, whether you are a janitor or some hot-shot executive. And it is an art, not everyone has it, but if you don't have it, then you should try to cultivate it-it is always good for you regardless of profession.

This deficiency of inter-personal skills, coupled with the lack of insight into the said deficiency, is what caused all this in my opinion. Now I don't know if the punishment is appropriate for the crime, but I hope the OP gets a valuable life lesson and everything works out.

Agreed. I would also suggest that advanced programs require prelims precisely because they want their categoricals to obtain this kind of seasoning. In other words, the experiences of being an intern are deemed integral to being good at this other field, or they wouldn't require it. You are going to be dealing with chief residents, nurses, patients and PDs in every advanced specialty. So shortcomings in your intern year ARE shortcomings in your specialty training path. You can't just say, I am not going into IM so I'm not going to take it seriously. Your advanced program takes it seriously. If they didn't think it was worth it, they would do away with it.

 

[Law2Doc]

OPs situation aside, I would just like to say that I laughed my ass off at the idea of a newly minted Marine being booted for running his mouth and acting like an idiot in town.

More likely this would have been dealt with internally the way it was in "a few good men".

 

[Perrotfish]

I think it's the only reasonable inference to make when a program feels so strongly that an individual shouldn't be allowed to finish out the last week of his prelim year. .

I feel like this is sort of circular. You're basically saying that such an extreme action was warrented mainly because it was such an extreme action. It's certainly one possibility, but the other equally likely possibility is that this happened out of spite: senior members had a bad personal relationship with the OP, but they also knew he WAS a competent physcian and didn't want to deal with the hole that would be left when they dismissed him, so they waited until he was almost graduated so that they could use his talents as a Prelm almost for duration of his contract and then screw him anyway. If he was a danger to himself and/or others it seems like they would have hurled him out the door long before week 51

I have to admit, this process seems pretty awful to me. Any individual associated with the program, even the f-ing nurse, is allowed to make a 'formal complaint' about the physician that goes in his file without any kind of oversight appeals process. Other trainees, only a year ahead of the physician, are also allowed to evaluate him and those evaluations are used as evidence of his competence (like an MS3 being reviewed by an MS4). No one feels any need to have any formal counseling sessions, or to document hs deficiencies in writing. Everything about this sounds like its set up to make firing someone for a genuine deficiency indestinguishable from firing someone for personal reasons.

Like I said, my suspicion is naturally high becuse he was a prelim. If he was one year into a catagorical residency the strongest evidence of his incompetence would be the fact that the program was willing to do without a senior resident rather than keep him. We don't have that here, they really had no reason other than common decency not to screw him over.

 

[Law2Doc]

I feel like this is sort of circular... It's certainly one possibility, but the other equally likely possibility...

I have to admit, this process seems pretty awful to me. Any individual associated with the program, even the f-ing nurse, is allowed to make a 'formal complaint' about the physician that goes in his file without any kind of oversight appeals process. Other trainees, only a year ahead of the physician, are also allowed to evaluate him and those evaluations are used as evidence of his competence (like an MS3 being reviewed by an MS4). No one feels any need to have any formal counseling sessions, or to document hs deficiencies in writing. Everything about this sounds like its set up to make firing someone for a genuine deficiency indestinguishable from firing someone for personal reasons.

I agree there's some circular reasoning, but I disagree that the other possibility you cite is "equally likely". Doing nothing is what a PD normally does in week 51 to get rid of a prelim. And he goes away in 1 weeks time. The inertia to do something is simply not there. You have to do something significant to create the kind of inertia to start what clearly is going to involve the PD in an appeals process and maybe subsequent legal or ACGME inquiry for months to come. So yeah, the punishment here suggests the crime. There simply has to be more to this story. The OPs lack of insight in having been warned, and his 3pm the record complaints support this notion as well.

As far as the process being frightening in terms of complaints and being judged by your seniors, I absolutely agree. Some nasty nurse who doesn't like how you snapped at her at 3am can put something in your permanent record. Which is why you learn quick to play nice. Most residents will get one such complaint over the course of a 3+ year residency. In most cases it's not significant. The PD won't call you in for a sit down. If he does, it may be to hear your side of the story after which he says don't worry about it. In most cases it won't even warrant a separate sit down, and will simply be something he mentions in your semiannual review. In this case it wasn't one instance in the course of a residency, it was three in less than a year. And the PD had a special sit down with the resident and certainly didn't say don't worry about it. So that already should send up a red flag that we aren't talking about the normal minor snafu.

As far as seniors being your bosses, you get used to it. In a lot of ways it's a better system, because they remember being in your shoes, and know that if they have your back, they pretty directly earn your loyalty. When residents work as a team, they all cover for each other, a united front against the attending. The attending can be annoyed at an intern, but when the chief steps in and says, yeah he told me about that and I told him to go ahead (whether true or not) the wind often goes out of that sail pretty quickly. And that culture can make a residency a pretty nice place to work even if it means you stay an extra hour here and there to make sure your senior doesn't have to, or can tell the attending with a straight face that it's getting done. The catch is that when a resident doesn't "get it" or tries to abuse the system at the expense of his teammates, he can easily find himself outside of the tight family.

 

[jdh71]

I think we all are assuming the op really deserved it because it makes us feel a little safer to think people don't get fired for weak reasons.

I mean getting canned before the LAST week of internship? That's one pretty sick and twisted program or, and I think the more obvious and correct explanation, OP was just THAT bad and sadly didn't realize it.

I see these types all the time, though as a matter of degrees much less than I assume the OP to be - the radiology or gas prelim with a BIG chip on their shoulder who doesn't want to do any of this medicine intern "bull****" because this isn't what they want to do and some day they're going to be making BANK working 10 hours a week, blah, blah, blah . . . you've all heard these guys . . . I've actually had to supervise these guys - answering multiple pages and find them asleep in the call room. Almost all of the time you breath enough fire up their ass and the bad behavior corrects itself. I bet OP thought he could coast and tried his luck ONE last time too many.

 

[dragonfly99]

I agree w/the psych person who stated that it's easy for a lot of us to pile on because it makes us feel safer and that such things would never (or could have never) have happened to us while we were interns. It's kind of a natural defense mechanism. I also agree that whatever personality conflicts happened were a lot more serious than the OP realized, or were at least perceived by others as a lot more serious than he realized. We really don't have enough information to know who was right and who was wrong. It does disturb me that there are quite a few people who are clinically not so competent who are allowed to move on and keep on practicing medicine, but that people with even somewhat minor personality issues end up canned. Not that people shouldn't work on these issues, but people who just have a poor knowledge base or very poor decision making skills, or who don't care that much about patients but are good at making people like them/being "cool" often take the path of least resistance and go on to practice.

 

[Doctor Bagel]

I have been following this thread without comment so far, but have to disagree with the bolded part.

As per my understanding, the OP got fired for inter-personal issues, not clinical incompetency in Internal Medicine. That performance-dealing with other people-is there in every field, every walk of life, whether you are a janitor or some hot-shot executive. And it is an art, not everyone has it, but if you don't have it, then you should try to cultivate it-it is always good for you regardless of profession.

This deficiency of inter-personal skills, coupled with the lack of insight into the said deficiency, is what caused all this in my opinion. Now I don't know if the punishment is appropriate for the crime, but I hope the OP gets a valuable life lesson and everything works out.

Overall, yeah, you're probably right. I can sympathize for the OP, though, because doing a year in a field you're not going into is pretty miserable. You're not part of the club, which means you're more likely to be singled out for some of this inter-personal type of stuff. And honestly, keeping morale up can be hard, which might make you seem more grumpy than usual. Again, this doesn't excuse grossly unprofessional behavior, but a prelim resident has a harder time than a categorical in lots of ways.

 

[NOsquid]

Where in this thread did you guys figure out this danger OP poses to patients? I guess you can make some type of 3 step argument how arguing with the chief will eventually kill a patient, but jeez guys! From what I gather this is simply a case where OP clashed with the wrong people and got canned. I dare say OP will still be on staff if he was nice to the chief resident and PD while arguing constantly with patients(which is very common btw). We all know the prelim intern about to go start derm/rads/optho or whatever else is not popular among internal med folks is not on anyone's favourites list. But firing on the last week of the year? You have to have a better reason than what OP described IMO. We exploit the argument of patient safety way too much. There was a time when physicians physically abused trainees and hid behind this same argument. It is time we call it what it is.

Yeah, I'm not a fan of the rather childish system of conflict resolution in hospitals that breeds these situations (of course it isn't limited to the medical precession). All this run-and-tell-the-teacher, mostly anonymous junk. It always amazes me how doctors and nurses who are so comfortable discussing difficult topics like death and dying can't simply confront a colleague and say "hey, this is BS." They have to run and tell a supervisor, there have to be meetings, it gets magnified on the way up the ladder and in the end it always comes down to cryptic crap like "professionalism" and "team player." Mostly meaningless words but they can call into question someone's character and jeopardize their career - perfect scapegoating tools.

My girlfriend got all kinds of unnecessary **** as a prelim. She was smart, *loved* by her patients AND nurses, she just pissed off the wrong people and bruised their egos. And every time they called her in to discuss anonymous, vague, BS complaints it was the same garbage about "team player" and "professionalism."

That being said, IMO the OP sounds like the stereotypical entitled/uninterested prelim to me, who thought they didn't have to walk on eggshells anymore because med school was over. I could be wrong, hard to judge tone online. I still think the 51st week firing is more likely vindictive than anything else though.

I also agree with the poster who noted that inept shmoozers get by way too often, and decent docs who don't bow down and kiss the ring get in trouble. We shouldn't pile onto a stranger and make assumptions based on the false premise that the system is just, even if that makes us more comfortable.

 

[Arcan57]

Is being fired at the 51st week worse than being fired at the 42nd week? Once you've missed the deadline for applying to the match, what is the balance between continuing to draw a paycheck and looking for a new position earlier?

 

[Law2Doc]

Is being fired at the 51st week worse than being fired at the 42nd week? Once you've missed the deadline for applying to the match, what is the balance between continuing to draw a paycheck and looking for a new position earlier?

It is worse because you don't have an opportunity to fix things, use the internal appeals process and otherwise try to straighten things out with your advanced program at 51 weeks. You might have some room to work at 42 if it's something a scary letter from your lawyer might fix.

 

[nitemagi]

Usually when someone is called into the PD's office to discuss a complaint, that's an opportunity to try to fix things. So there were multiple opportunities (multiple meetings with the PD on individual complaints).

The program might have done better by putting the problems down in writing and spelling out a remediation plan and clear consequences.

 

[Doctor4Life1769]

Usually when someone is called into the PD's office to discuss a complaint, that's an opportunity to try to fix things. So there were multiple opportunities (multiple meetings with the PD on individual complaints).

The program might have done better by putting the problems down in writing and spelling out a remediation plan and clear consequences.

I would have thought this would be the standard for all programs. Is this not the case?

This is all quite frightening. Piss off the wrong people (even accidentally) a few times and you get the axe-hammer? Really? I'm with Doctor Bagel/Osteo on this one.

 

[Smurfette]

Keep in mind that the vast majority of the time, pissing someone off does *not* result in getting written up. For someone to be worked up enough about your actions to actually report you is highly unusual. I've seen some pretty egregious behavior go unreported, including a MICU intern trying to take a swing at my (then) senior surgery resident in the middle of the MICU. (He got chewed out by his seniors/fellows, but did not get 'reported' to his PD, though he should have). Most people will get irritated, roll their eyes, or mention it in passing to others, but won't bother filing a formal complaint. There is a LOT of bad behavior that is tolerated or ignored at the time, so for every write up, there are likely numerous unreported incidents as well. So 3 in one year for an intern probably means that there were far more 'reportable' incidents that didn't result in further action.

It's HARD to fire a resident. You need documentation supporting your decision, and such negative action gets reviewed by the RRC and other groups to maintain accreditation. For a program to pull the plug with one week left is actually more work for them; firing someone for spite is too painful, because if the resident wants to fight it, it will draw the process out for months rather than just 'get rid of them', and they risk the firing being overturned and having to allow them to complete the year.

 

[142348]

I mean getting canned before the LAST week of internship? That's one pretty sick and twisted program or, and I think the more obvious and correct explanation, OP was just THAT bad and sadly didn't realize it.

I see these types all the time, though as a matter of degrees much less than I assume the OP to be - the radiology or gas prelim with a BIG chip on their shoulder who doesn't want to do any of this medicine intern "bull****" because this isn't what they want to do and some day they're going to be making BANK working 10 hours a week, blah, blah, blah . . . you've all heard these guys . . . I've actually had to supervise these guys - answering multiple pages and find them asleep in the call room. Almost all of the time you breath enough fire up their ass and the bad behavior corrects itself. I bet OP thought he could coast and tried his luck ONE last time too many.

So you're one of those medicine residents that start off with negative perceptions about prelims/TY because they are going into a so called lifestyle specialty and you're not? What about all the medicine residents who do subspecialty/clinic rotations their last few months so they can relax and prep for their boards and are pretty much checked out. Obviously that's alright because they paid their dues the first 2 years and change, right? Prelims/TY are forced to complete the year to move on to their specialty training and in many cases very little of what is learned in that year is applicable to their future careers. Whlie good inter-personal skills are always a plus why should they fire the OP with a week to go, it's obvious he/she is not a danger to their patients, only to the egos of the chief and nurse he got written up by.

Give the OP a break. Maybe he made a few mistakes but from what has been said it sounds like his fund of knowledge if fine. Pissing off a chief should not merit getting fired. Many of us have completed internship and I for one can say I have seen situations where a) the chiefs got pisseed at another intern/resident when it really wasn't a huge deal but this lead to huge conflicts down the line and b) where a nurse wrote up an intern/resident for some trivial thing. Why is it so unreasonable to believe the same for this intern?

 

[Osteoimperfecta]

Agreed. I would also suggest that advanced programs require prelims precisely because they want their categoricals to obtain this kind of seasoning. In other words, the experiences of being an intern are deemed integral to being good at this other field, or they wouldn't require it. You are going to be dealing with chief residents, nurses, patients and PDs in every advanced specialty. So shortcomings in your intern year ARE shortcomings in your specialty training path. You can't just say, I am not going into IM so I'm not going to take it seriously. Your advanced program takes it seriously. If they didn't think it was worth it, they would do away with it.

I disagree, most PDs I talked to will tell you their ultimate goal is to convert all their advanced programs to categorical. Makes recruiting easier, but there is also word out there that internal med has been hostile to prelims heading to some other specialties. This program in question could have done something prior to week 51, but they protected their schedule and waited to fire the intern when it was logistically feasible while screwing up OP's advanced program's schedule. OP's advanced program will not be thanking them for preventing an "incompetent" physician from moving ahead, they probably know it was a hit move. Simple as that. The lesson the advanced programs are learning from nonsense like this is to wrestle that first year away from the hands of internal med, or they might screw you over. I don't mean to make this a war between specialties, but for as long as we are being honest, we all know this is a real problem in our community. I can't tell you how many times I have seen a derm intern victimised for no obvious reason except for what I think is jealousy or dislike. Derm intern coughs and it is a display of the chip on his/her shoulder. Same thing happens when internal med or fam med is rotating on some specialty or surgical service, and they are perceived to be sub-par by default for no good reason. In fac,t I have seen the best family med resident in a program rack up multiple bad evals and warnings on a surgery rotation mostly because she pissed the wrong(singular) person off. Again, I am not sure what specifically OP did, but I am not ready to accept the argument that a week 51 firing = OP must have sucked real bad.

I am a strong advocate for physicians sticking together from all specialties for the purpose of keeping our profession viable, and preventing the impending onslaught from government, midlevels and whatever other tsunami is brewing. This cannot happen if we don't learn to respect ourselves. That is why I asked the question: if we can't take care of our own and respect each other, why should anyone respect us?

 

[peppy]

Again, I am not sure what specifically OP did, but I am not ready to accept the argument that a week 51 firing = OP must have sucked real bad.

Actually, I think a 51 week firing shows that the resident probably wasn't THAT bad. If someone is truly that bad, it should not take all year to figure it out. And *if* the person is terrible yet allowed to stay on til the 51st week, you could argue that it shows the program is recklessly endangering patients' lives by allowing someone incompetent to carry on taking care of patients (without any extra supervision or probation) all year before finally doing something about it. Imagine explaining to a family member whose loved one died from a medical error that you had to let that incompetent intern carry on because, you see, it would have been so inconvenient to make the other interns cover his call.
No, I don't think incompetence was the issue here. It's certainly possible that this intern is an abrasive person and the residents and nurses truly did have bad interactions with him - but even then, it's odd that the attendings he worked with thought he was doing fine.

I wonder why we bother having attendings evaluate residents if the nursing staff and other residents are the ones who get to decide if a resident stays or goes. I would think that an attending physician would probably be in a better position to judge an intern than a fellow resident or nurse.

Here's some advice for the interns starting in July: Don't bother trying to read during internship. Just make sure you buy donuts for the nurses.

 

[justaregularmed]

lol @ where this discussion has gone. Hope something works out for the op.

 

[Doctor4Life1769]

Actually, I think a 51 week firing shows that the resident probably wasn't THAT bad. If someone is truly that bad, it should not take all year to figure it out. And *if* the person is terrible yet allowed to stay on til the 51st week, you could argue that it shows the program is recklessly endangering patients' lives by allowing someone incompetent to carry on taking care of patients (without any extra supervision or probation) all year before finally doing something about it. Imagine explaining to a family member whose loved one died from a medical error that you had to let that incompetent intern carry on because, you see, it would have been so inconvenient to make the other interns cover his call.
No, I don't think incompetence was the issue here. It's certainly possible that this intern is an abrasive person and the residents and nurses truly did have bad interactions with him - but even then, it's odd that the attendings he worked with thought he was doing fine.

I wonder why we bother having attendings evaluate residents if the nursing staff and other residents are the ones who get to decide if a resident stays or goes. I would think that an attending physician would probably be in a better position to judge an intern than a fellow resident or nurse.

Here's some advice for the interns starting in July: Don't bother trying to read during internship. Just make sure you buy donuts for the nurses.

Probably the wisest thing I've read on this thread. I'd seen it all the time on my away rotations. Resident/Intern buys the staff pizza or donuts, or whatever, and all of a sudden the resident/intern is their fave. Throw a few rosy compliments and oh my imagine how much the nursing staff does for you.

Getting fired at 51 weeks is a travesty. I'm fortunate my program has a categorical program set up, and I ranked ONLY categorical slots. It was risky, but at least I'd know I wouldn't have to put up with malignant IM or surg internships that I'd have to seek out in the scramble.

 

[reno911]

This is somewhat of an aside, as I've only skimmed this thread.

The problem with posting stories like these on this forum, is that the dismissed resident is pretty much always presumed guilty. Someone could post a story of the most egregious, indefensible resident firing, and a large percentage of posters who respond will say something like "There's got to be something more to the story that this guy is not telling us" and interpret everything that was posted in the most negative (for the resident) way possible.

I'm not saying that's what's going on in this thread, since I've only really skimmed it. It's just a general observation.

Carry on.

 

[Law2Doc]

This is somewhat of an aside, as I've only skimmed this thread.

The problem with posting stories like these on this forum, is that the dismissed resident is pretty much always presumed guilty. Someone could post a story of the most egregious, indefensible resident firing, and a large percentage of posters who respond will say something like "There's got to be something more to the story that this guy is not telling us" and interpret everything that was posted in the most negative (for the resident) way possible.

I'm not saying that's what's going on in this thread, since I've only really skimmed it. It's just a general observation.

Carry on.

The reason for this is that we all have seen crummy interns who were or should have been be fired. Few to none of us have seen programs act as vindictively as the PD would have to be doing in this case. So from our own experiences when we see a thread like this we know the intern is most likely leaving a bit out. Sure we could be wrong, but the odds are pretty darn good for those of us who are prone to wager.

 

[Law2Doc]

I disagree, most PDs I talked to will tell you their ultimate goal is to convert all their advanced programs to categorical. ...
I am a strong advocate for physicians sticking together from all specialties for the purpose of keeping our profession viable, and preventing the impending onslaught from government, midlevels and whatever other tsunami is brewing. This cannot happen if we don't learn to respect ourselves. That is why I asked the question: if we can't take care of our own and respect each other, why should anyone respect us?

first, I have to say that most PDs I know feel that the prelim path is important, so it really depends on who you talk to. I actually know someone who is a PD in a categorical field who is pushing very hard to make his field an advanced field precisely because he feels it's hard to duplicate the training you get by doing a prelim first. Folks will differ on views, but one certainty is that the advanced programs have not done away with the intern year in any serious way, and there isn't much push to do so.

Second, you don't blindly support someone just because he has MD after his name. The surest way to destroy physicians is to tether them to folks who don't live up to the expected standards. When you have a rotting apple in the barrel, you discard it before it taints the rest.

Frequently on here folks who get thrown out of med school/residency come on SDN and talk about uniting. It's always a bad idea, because some people may be blameless, but many aren't, and you will basically be tying your rowboat to a big anchor. You don't want to be judged based on others unless these others live up to certain standards. The way the field protects itself and it's integrity is to not let folks who don't meet the standards hide behind the profession.

 

[Doctor4Life1769]

Actually.

At least for anesthesiology, can't speak for other specialties, the trend is to go categorical, with an in-house transitional year that is well-rounded and designed to better prepare the anesthesia residents for when they go on to the ORs, etc.

At the very least, this would be a better way to check on your future residents, and the PD would be very familiar with the workings of the IM, surg, etc. programs within their own hospital.

 

[Doctor Bagel]

It's HARD to fire a resident. You need documentation supporting your decision, and such negative action gets reviewed by the RRC and other groups to maintain accreditation.

Is this really true? My understanding is that it's pretty easy to not renew a contract provided you give notice early enough. I don't know how it works with actually firing someone who wouldn't be renewed anyway, though. It seems like programs honestly have a lot of discretion with this stuff. I'm at a program that fires residents, though (probably with good reason), so maybe my perspective is a little different.

About the communication issue, it's a two way street. We're putting all the blame on the op here for not getting the message, and I think that's probably partly appropriate. However, the PD probably should have been a little more frank in his discussion with this resident and probably should have started putting stuff in writing. In these situations, it's appropriate to be very black and white and specify exactly what will happen if another issue arises.

 

[Perrotfish]

The reason for this is that we all have seen crummy interns who were or should have been be fired. Few to none of us have seen programs act as vindictively as the PD would have to be doing in this case. So from our own experiences when we see a thread like this we know the intern is most likely leaving a bit out. Sure we could be wrong, but the odds are pretty darn good for those of us who are prone to wager.

Do you think that bias might be at least partially because the majority of residents that we all know are catagoricals?

 

[NotAProgDirector]

Conflict of Interest:
aPD: I really enjoyed your insight over past few years. Just a question if PD at other program happened to be your buddy or someone you know, where will be your pledge of allegiance. or this particular person happen to be coming to your institution for PGY2 or even apply here for repeat PGY1 if things don't work out, what will be your reaction.

We all give opinion/advice online assuming being anonymous but we never know if we encounter them in real life.

Somewhat OT now, given the turns this thread has made, but I wanted to respond to this.

If someone were to tell me what program they were at in PM, I'd keep that confidential. I don't see any conflict of interest issues -- as I have no duty to report things to other program directors. I guess if someone told me they were doing something illegal, then perhaps I'd need to do something.

Once, I became worried that someone I was PM'ing with was actually a resident in my own program. If that were to happen, I'd be certain to let them know.

 

[Smurfette]

Is this really true? My understanding is that it's pretty easy to not renew a contract provided you give notice early enough. I don't know how it works with actually firing someone who wouldn't be renewed anyway, though. It seems like programs honestly have a lot of discretion with this stuff. I'm at a program that fires residents, though (probably with good reason), so maybe my perspective is a little different.

About the communication issue, it's a two way street. We're putting all the blame on the op here for not getting the message, and I think that's probably partly appropriate. However, the PD probably should have been a little more frank in his discussion with this resident and probably should have started putting stuff in writing. In these situations, it's appropriate to be very black and white and specify exactly what will happen if another issue arises.

you're right that non-renewal is a way to fire someone. However, in my post, I meant "fired" as in not allowed to even finish the contract year (like what happened to the OP), not in the non-renewal sense. To fire somebody before they finish their contract is hard (most programs have a formal process by which a resident needs to go through before being fired, including warnings/probation/etc.). It is also much easier to fight early termination given that if the formal process was not followed, the resident has some legal ground to fight the decision and try to be reinstated based on the terms of their contract.

Non-renewal is different and certainly is not that difficult for a program director to do. Residency contracts are typically only one year, so there is nothing legally obligating them to offer you a contract for the next year, or obligating you to sign a contract for the next year. Non-renewal generally only applies to categoricals, as prelims only get a 1 year contract before they are expected to move on to another program.

 

[45408]

He got in trouble for not returning pageS. Not "a page". We are left to our own experiences how insidious you have to be to get reported for this.

I once checked my pager after a 5 hour fem-pop (that started as an embolectomy). When I had changed my pager battery, I had switched it from "Vibrate then ring" to "Vibrate only." The OR nurse had only been answering about half my pages, and my pager was flashing a gazillion missed pages. Whoops. Never heard anything about that day though.

 

[MrBurns10]

I once checked my pager after a 5 hour fem-pop (that started as an embolectomy). When I had changed my pager battery, I had switched it from "Vibrate then ring" to "Vibrate only." The OR nurse had only been answering about half my pages, and my pager was flashing a gazillion missed pages. Whoops. Never heard anything about that day though.

The paging feature of my pager stopped working for a 24 hr period once, despite otherwise functioning properly. I didn't get any pages in the afternoon, and none the next morning. The only reason I was actually able to figure this out was because I tried to page myself out of walk rounds... I had to get it replaced.

 

[Buzz Me]

The OR nurse had only been answering about half my pages, and my pager was flashing a gazillion missed pages. Whoops.

When I was a junior resident and would get paged a lot more often...this would happen to me during many OR cases...even when my pager was not on silent mode.

 

[45408]

When I was a junior resident and would get paged a lot more often...this would happen to me during many OR cases...even when my pager was not on silent mode.

The floor nurses would meet the OR nurses in the parking lot for a throwdown if that happened.

 

[Osteoimperfecta]

Second, you don't blindly support someone just because he has MD after his name. The surest way to destroy physicians is to tether them to folks who don't live up to the expected standards. When you have a rotting apple in the barrel, you discard it before it taints the rest.

Pretty harsh description of OP IMO. Again, I do not see anything on this thread strongly supporting that conclusion. Unless you know something about OP that I don't know, it is hard for me to wrap my mind around how you are able to reach these conclusions about him/her. I don't know OP either, I am just going off of the information on the thread. I have no issues with anyone getting fired for proven "bad apple" behaviour, but you are going the round about way of saying that the firing itself is proof of this type of behaviour, which is where I am confused.

I don't know about you, but I cannot sleep at night if I feel like I ruined a life without thorough justification and true attempts at correction. I certainly feel a week 51 firing is one devoid of compassion and class, and we should be more afraid of an organisation of this nature destroying our profession than OP.

 

[jdh71]

So you're one of those medicine residents that start off with negative perceptions about prelims/TY because they are going into a so called lifestyle specialty and you're not?

No. I wonder where I said that? Reading comprehension and not making jump-the-shark presumptions will be helpful to you while in residency. This is just a friendly and free piece of advice from your uncle jdh71.

My favorite intern this year is headed to rads. Not all of you are complete intolerable lazy douchebags. Go figure.

What about all the medicine residents who do subspecialty/clinic rotations their last few months so they can relax and prep for their boards and are pretty much checked out. Obviously that's alright because they paid their dues the first 2 years and change, right? Prelims/TY are forced to complete the year to move on to their specialty training and in many cases very little of what is learned in that year is applicable to their future careers.

Whlie good inter-personal skills are always a plus why should they fire the OP with a week to go, it's obvious he/she is not a danger to their patients, only to the egos of the chief and nurse he got written up by.

Give the OP a break. Maybe he made a few mistakes but from what has been said it sounds like his fund of knowledge if fine. Pissing off a chief should not merit getting fired. Many of us have completed internship and I for one can say I have seen situations where a) the chiefs got pisseed at another intern/resident when it really wasn't a huge deal but this lead to huge conflicts down the line and b) where a nurse wrote up an intern/resident for some trivial thing. Why is it so unreasonable to believe the same for this intern?

Firing someone before their last week is a BIG deal, especially if no credit it awarded. So we are either dealing with one sick and twisted program OR, and the most likely explanation, OP is a hug raging, entitled douchebag that thought he could continue getting away with nonsense, after being repeated warned. Well . . . pwned. It's an object lesson to anyone who shows up to internship with a huge chip on their shoulder. As has been pointed out medical knowledge is just one of SIX core competencies as spelled out by the ACGME, which means being deficient in one even if fine in others is simply not acceptable.

So why should he be fired? If he's not up to snuff and has demonstrated a complete lack of the ability to be teachable and introspective, then they did the correct thing.

 

[jdh71]

The reason for this is that we all have seen crummy interns who were or should have been be fired. Few to none of us have seen programs act as vindictively as the PD would have to be doing in this case. So from our own experiences when we see a thread like this we know the intern is most likely leaving a bit out. Sure we could be wrong, but the odds are pretty darn good for those of us who are prone to wager.

echos my sentiment exactly

 

[142348]

No. I wonder where I said that? Reading comprehension and not making jump-the-shark presumptions will be helpful to you while in residency. This is just a friendly and free piece of advice from your uncle jdh71.

My favorite intern this year is headed to rads. Not all of you are complete intolerable lazy douchebags. Go figure.







Firing someone before their last week is a BIG deal, especially if no credit it awarded. So we are either dealing with one sick and twisted program OR, and the most likely explanation, OP is a hug raging, entitled douchebag that thought he could continue getting away with nonsense, after being repeated warned. Well . . . pwned. It's an object lesson to anyone who shows up to internship with a huge chip on their shoulder. As has been pointed out medical knowledge is just one of SIX core competencies as spelled out by the ACGME, which means being deficient in one even if fine in others is simply not acceptable.

So why should he be fired? If he's not up to snuff and has demonstrated a complete lack of the ability to be teachable and introspective, then they did the correct thing.

No problems with reading comprehension. Based on what is bolded above and the same type of comments in your previous points, I don't think the presumption is that far off the mark. You seem to not see the parallel between medicine or other residents blowing off the last few months of their residency which is just as much a deficit in professionalism as what the OP is accused of I would argue.

You may think they did the right thing but I would give the OP a break, if they are "the douchebag" you assume, don't you think their advanced program would recognize this and take care of it shortly? I find it hard to believe that the program all of sudden decided on this at 51 weeks unless something really big happened that we are not privy to or if this simply retribution from higher ups like the chief who had the ammo to do it without ruining their call schedule/work flow.

 

[jdh71]

No problems with reading comprehension. Based on what is bolded above and the same type of comments in your previous points, I don't think the presumption is that far off the mark. You seem to not see the parallel between medicine or other residents blowing off the last few months of their residency which is just as much a deficit in professionalism as what the OP is accused of I would argue.

You may think they did the right thing but I would give the OP a break, if they are "the douchebag" you assume, don't you think their advanced program would recognize this and take care of it shortly? I find it hard to believe that the program all of sudden decided on this at 51 weeks unless something really big happened that we are not privy to or if this simply retribution from higher ups like the chief who had the ammo to do it without ruining their call schedule/work flow.

Your presumtion is way off the mark son. Just so you know. I wouldn't want you to be running around being wrong.

Ummmmm . . . surely you appreciate the difference between a few kickback elective months prior to the end of residency and someone trying to blow off internship responsibilities? You weren't actually seriously trying to make that equivalent were you? You're just messing with me right? Hahaha! You got me! You had me going there for a second. Strongly played.

As has been pointed out by myself, law2doc, and others who regularly deal with prelims, we have seen many sub-par interns get passed off to their respective categorical residencies (good riddence), no problems. The MOST LIKELY explanation here is that there was something more than merely annoying the cheif resident going on here. Could this guy merely be the poor pawn in some sick, tiwsted, and sadistic game? I guess so; it's not impossible, but I think it's pretty niave and silly to suggest that in light of what is the most likely explanation. Which is this guy was repeatedly warned, had multiple written complaints, and seemed to ignore them, and then did something that was the final straw. To bad, so sad. Normal people don't have that happen to them. I can't think of anyone ever heard of this happening to, so it must have been a big deal. This should be a fairly simply and straight forward.

 

[Mattchiavelli]

isn't it possible that the OP was kind of a mild douche AND the PD was kind of vindictive, instead of all one or the other? The two things I would be curious to know in f/u are
1) if the OP was really so unprofessional as to be a danger to patients, why weren't they let go in may when they said they had their third incident instead of weeks later in mid june?
2) the OP did say they were receiving around a high average/low excellent on all their evals which took into account competencies, which would include professionalism (save for one eval). If they were really that unprofessional, why were people not evaluating the OP poorly on that competency after multiple evals? Maybe the program was so blase about administrative stuff that everyone got automatic high average/low excellent unless they cured cancer or punched a nurse.

Although, to be clear, I do agree that the OP was having some issues wrapping their head around the severity of the incident. I just think this was a two-way clusterf*ck.

 

[J-Rad]

This thread is occasionally bordering on personal sniping. A reminder: keep it civil.

 

[PharmaTope]

There is no reason you can't take both roads aPD suggests. I would ask to sit down with the PD to discuss options (maybe with an attending that likes me) and apologize without admitting anything.

If that does nothing, I would appeal on every angle possible (both procedural and others). If you are female, a minority, disabled in the slightest way, then claim bias. Claim retaliation for the prior argument. Formally request access to phone records to prove that you didn't miss pages (most pagers are like mobile phones and this info is available). They will probably say no but that just make it seem less justified when this ends up in court.

Pay an employment attorney to do the talking for you. Explain the harm to you if you lose your PGY2 slot. Your entire career and millions of dollars in lifetime income are at stake and it only matters to you. What is a $10,000 lawyer bill compared to that?

I know others have argued that you deserve this based on your track record. The bickering above is irrelevant to your situation. Who cares? You can't. If you make it through this, then you can spend some time working on gaining insight into why this happened.

FIGHT!

100% lawyer up. id get some of the best i could find to be honest. look at their ratings. a 5.0 is GREAT. you want to find out what experience they have had handling these types of issues as well. FIGHT THIS!!!!!!!!!!!!!

If you don't win, i say go over the guy's house and beat the hell out of him.

 

[Substance]

Whether you are a douchebag or not is irrelevant. You got ****canned and you want advice on how to at least gain credit for your work. I know we aren't getting the whole story, so we can't really judge your character or the situation accurately. So we will work with what we have...

For a program to dump you on week 51, barring severely dangerous or unprofessional behavior(ie sexual harrassment, violence, racial discrimination etc), it shows that they are low on the class scale and will resort to petty tactics like this.

First I would consult a lawyer and ask them what to do. If it involves meeting with your PD to discuss options, DO NOT tell your PD that you have a lawyer. Do not mention the presence of a lawyer until your own personal efforts fail, and even then let the lawyer mention his own presence through a summons or what have you. And never admit to anything - this isn't a trial in a court of law. In some cases apologies can be construed as guilt, so ask your lawyer.

(personally I don't think meeting with your PD will have any effect on anything. He's already proven he's a douche)

I wonder if you had saved all of your personal and professional correspondence with your staff, chief, and anyone else from your program? If so, find them and hold on to them. From now on, save everything anyone ever says to you about anything while on hospital grounds. You are going to need this.

Appeal heavily as described above.

I second the other above point: obtaining specific instances from the correct sources about exactly WHEN you presumably did not answer your pages, and the details therein ie when you were paged, who paged you, where they paged you from. Settle that matter objectively.

I've seen medical students and residents get canned because they pissed off the wrong admin type or dean or whatever. Usually its over petty stuff ie "professionalism"(notice the quotation marks), and the programs try to make examples of the victims. If you get a good lawyer you might have a long road ahead of you but it will likely work out.

Start now.

 

[Law2Doc]

Pretty harsh description of OP IMO. Again, I do not see anything on this thread strongly supporting that conclusion. Unless you know something about OP that I don't know, it is hard for me to wrap my mind around how you are able to reach these conclusions about him/her. ...

and yet you are comfortable labeling a PD "devoid of compassion and class". Sounds like a similar leap in the other direction.