General Surgery PGY-2 Contract non-renewal

Started by jason.lafluer
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contract non-renewal general surgery contract non-renewal residency contract non-renewal
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J ROD said:
not sure about "tons"
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Maybe over-exaggerated there. And aPD's point is well taken, that a number of those people wanted to switch because they couldn't handle the surgery lifestyle. However, I've seen 5 residents between my tmie as a med student/intern go to other specialties, and 4 of those were due to non-renewals/firings.
 
evilbooyaa said:
Maybe over-exaggerated there. And aPD's point is well taken, that a number of those people wanted to switch because they couldn't handle the surgery lifestyle. However, I've seen 5 residents between my tmie as a med student/intern go to other specialties, and 4 of those were due to non-renewals/firings.
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Thank you for your words of encouragement.
 
ThoracicGuy said:
I would contact her yesterday if you are able.

As for looking for a surgery prelim spot, like others have said, you are in a rough spot. You'll have problems getting a spot that could turn into something. What happens if you fail out of that? You'll have an even harder time landing something afterwards. And coming from another surgery program, the new PD will want to talk to the old PD...
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I appreciate your input. This situation wasn't necessarily a "fail out".
 
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jason.lafluer said:
I appreciate your input. This situation wasn't necessarily a "fail out".
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this...this is a problem...you do not seem to have accepted that there is an issue and the issues is yours and needs to be fixed. In general (despite what those who have had a contract not renewed and post here)programs do not terminate a resident easily... you were told 6 months into your internship that there were major issues with your progression and given a chance...and evidently you did not do all the things that were mandated by your remediation and not let go...what did you think the next step was if you failed to do the things require by your remediation, 3 months later?

You really should talk to the other intern that was dismissed and see what she did, but you also need to take ownership of your failure and be able to have a plan to fix the deficiencies you had at this program if you really want to do surgery at another program...you can, with your PD's support, spin that you did poorly in your program because you really didn't have your heart in surgery and another specialty is where you need to be, but that won't fly if you want to go back into surgery at another program.
 
rokshana said:
this...this is a problem...you do not seem to have accepted that there is an issue and the issues is yours and needs to be fixed. In general (despite what those who have had a contract not renewed and post here)programs do not terminate a resident easily... you were told 6 months into your internship that there were major issues with your progression and given a chance...and evidently you did not do all the things that were mandated by your remediation and not let go...what did you think the next step was if you failed to do the things require by your remediation, 3 months later?

You really should talk to the other intern that was dismissed and see what she did, but you also need to take ownership of your failure and be able to have a plan to fix the deficiencies you had at this program if you really want to do surgery at another program...you can, with your PD's support, spin that you did poorly in your program because you really didn't have your heart in surgery and another specialty is where you need to be, but that won't fly if you want to go back into surgery at another program.
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Thank you for emphasizing that I need to fully accept responsibility and I also agree about finding a plan to fix these deficiencies. To answer your question about what I thought the next step was - I thought the next step would be official probation with the stipulation if I did not remedy the deficiencies in a given amount of time then it would be contract non-renewal/dismissal/termination.
 
jason.lafluer said:
I appreciate your input. This situation wasn't necessarily a "fail out".
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As @rokshana said, this was a failout. Surgery programs are usually not in the business of canning their categorical residents after one year. There have to be significant issues that they feel can't be fixed to make that happen. They run the risk of not having a full complement of residents next year by not renewing you, so they can be hurt as well.

You don't know what you don't know. What I've typically seen from people that end up changing residencies or getting nonrenewed or fired, those people don't realize how exactly they are doing. Often they will think its just a few people against them and they turned the rest of the staff against them as well. Sometimes they think they are doing ok when they are performing at or below a 3rd year med student level. What might be worthwhile for you is to find one or two staff members or maybe chief residents that you trust to give you some honest feedback and that you feel you have at least a bit of support from and ask them what you did wrong and how they felt you could have improved. You probably won't like what they say and you might feel hurt afterwards. That's normal. But it might give you insight on why you failed out at residency and can help to guide you on your next step.

I worry about your ability to get into another surgery position, likely a prelim position, and impress people enough to actually make it into a categorical position. You'll be under a microscope if that happened and the least little thing that happened will be seen as a repeat of what lost your initial position. Once you get that reputation again, you are sunk. I can only imagine what that PD letter would read when you're trying to get a nonsurgery position.

Yes. This sucks. You feel your dream is being taken away from you. But in the end, maybe this will turn out better for you in the long run. Good luck.
 
ThoracicGuy said:
As @rokshana said, this was a failout. Surgery programs are usually not in the business of canning their categorical residents after one year. There have to be significant issues that they feel can't be fixed to make that happen. They run the risk of not having a full complement of residents next year by not renewing you, so they can be hurt as well.

You don't know what you don't know. What I've typically seen from people that end up changing residencies or getting nonrenewed or fired, those people don't realize how exactly they are doing. Often they will think its just a few people against them and they turned the rest of the staff against them as well. Sometimes they think they are doing ok when they are performing at or below a 3rd year med student level. What might be worthwhile for you is to find one or two staff members or maybe chief residents that you trust to give you some honest feedback and that you feel you have at least a bit of support from and ask them what you did wrong and how they felt you could have improved. You probably won't like what they say and you might feel hurt afterwards. That's normal. But it might give you insight on why you failed out at residency and can help to guide you on your next step.

I worry about your ability to get into another surgery position, likely a prelim position, and impress people enough to actually make it into a categorical position. You'll be under a microscope if that happened and the least little thing that happened will be seen as a repeat of what lost your initial position. Once you get that reputation again, you are sunk. I can only imagine what that PD letter would read when you're trying to get a nonsurgery position.

Yes. This sucks. You feel your dream is being taken away from you. But in the end, maybe this will turn out better for you in the long run. Good luck.
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Thank you. I look forward to the challenge of overcoming this.
 
evilbooyaa said:
Maybe over-exaggerated there. And aPD's point is well taken, that a number of those people wanted to switch because they couldn't handle the surgery lifestyle. However, I've seen 5 residents between my tmie as a med student/intern go to other specialties, and 4 of those were due to non-renewals/firings.
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Thanks for your input. Do you know what specialties they went on to?
 
evilbooyaa said:
Mostly anesthesia, one went to radiology I think.

All this being said, most of these residents were later on in their training, either PGY-2 or PGY-3 when they got canned, so possibly not the same situation as you find yourself in.
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You raise a good point.
 
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I am wondering if I should request a Due Process hearing which is outlined in my contract. Would that make matters worse?
 
ThoracicGuy said:
You'll likely burn any goodwill your PD may have for you by doing this. As you said, he was willing to support you to switch to another field. You want that.
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Yes, I don't want to do that. But there are a few things about this that don't feel accurate/just. It's a new program. They terminated a resident last year. Making be repeat intern year could be a more reasonable/deserved option. Or even putting me on probation and actually calling it that with the understanding that lack of progress means contract non-renewal or termination.
 
jason.lafluer said:
Yes, I don't want to do that. But there are a few things about this that don't feel accurate/just. It's a new program. They terminated a resident last year. Making be repeat intern year could be a more reasonable/deserved option. Or even putting me on probation and actually calling it that with the understanding that lack of progress means contract non-renewal or termination.
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If they are willing to cut the cord now, if they put you on probation, what will happen is that you will end up get nonrenewed or terminated at the end. You won't be able to remediate to the point of saving this position. Any frankly, do you want to be in an environment where you will be under the microscope 24/7? Even if something goes wrong and it was out of your control, you'll likely be blamed. This would be a very toxic place for you in that situation. In the end you won't get a very good letter from your PD. It's better to accept it, take the best letter you can get and whatever support possible.

Now if you were a PGY4, I would say do what you can to get one more year, but as a PGY1, it's better to cut your losses now.

Have you talked with the intern from last year yet?
 
ThoracicGuy said:
If they are willing to cut the cord now, if they put you on probation, what will happen is that you will end up get nonrenewed or terminated at the end. You won't be able to remediate to the point of saving this position. Any frankly, do you want to be in an environment where you will be under the microscope 24/7? Even if something goes wrong and it was out of your control, you'll likely be blamed. This would be a very toxic place for you in that situation. In the end you won't get a very good letter from your PD. It's better to accept it, take the best letter you can get and whatever support possible.

Now if you were a PGY4, I would say do what you can to get one more year, but as a PGY1, it's better to cut your losses now.

Have you talked with the intern from last year yet?
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That is very good advice. When put that way I'm more at ease with this. I haven't talked to them yet. I didn't know him/her that well and none of my co-residents know about this yes. I'd like to wait until at least my meeting tomorrow with the PD and director of GME to get a sense of their tone. The intern who got terminated last year is pretty good friends with one of my co-residents and would likely relay my situation on to them before me. Just trying to keep the chatter and drama down at this point. It's a relatively small program and Hospital. Haven't even told my parents yet.
 
jason.lafluer said:
Yes, I don't want to do that. But there are a few things about this that don't feel accurate/just. It's a new program. They terminated a resident last year. Making be repeat intern year could be a more reasonable/deserved option. Or even putting me on probation and actually calling it that with the understanding that lack of progress means contract non-renewal or termination.
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you were put on probation when your PD talked to you 6 months in... if you weren't on probation, they can't terminate you, per ACGME guidelines.

plus IMHO, you should have talked to that intern before you go into the meeting...m/l she too had this same meeting and knowing how it went and what she did/said during her meeting can only help you.
 
rokshana said:
you were put on probation when your PD talked to you 6 months in... if you weren't on probation, they can't terminate you, per ACGME guidelines.

plus IMHO, you should have talked to that intern before you go into the meeting...m/l she too had this same meeting and knowing how it went and what she did/said during her meeting can only help you.
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Nothing in the meeting or documentation explicitly said anything about probation. They gave me a notice of deficiency. I had 2 months to make necessary steps to meet expectations and submit and individualized learning plan for program review that outlines the steps I would take.
 
evilbooyaa said:
Tons of surgery prelims/washouts transition to anesthesia or radiology. The competitiveness of those specialties, especially in the below average programs, is not a serious issue for anybody who managed to match into most surgical residencies.
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The below avg programs are below avg for a reason, especially in anesthesia.
They have reduced teaching, more malignant environment, higher wash out rates.
 
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ThoracicGuy said:
If they are willing to cut the cord now, if they put you on probation, what will happen is that you will end up get nonrenewed or terminated at the end. You won't be able to remediate to the point of saving this position. Any frankly, do you want to be in an environment where you will be under the microscope 24/7? Even if something goes wrong and it was out of your control, you'll likely be blamed. This would be a very toxic place for you in that situation. In the end you won't get a very good letter from your PD. It's better to accept it, take the best letter you can get and whatever support possible.

Now if you were a PGY4, I would say do what you can to get one more year, but as a PGY1, it's better to cut your losses now.

Have you talked with the intern from last year yet?
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Those clowns would not give him credit to be able to move on as a PGY-5, rather they would extend another 6 months. That's how it goes, even for PGY-4s.
 
OP, I worry you don't have the drive to get into the best situation possible, which is in another residency. If you don't understand the issues that led to non-renewal nor do you understand that you had issues that need to be corrected, I'm not sure how this will work out. When you interview with another program, they will ask what happened and you will need to find the right spin. Find that spin and memorize it Rubio style (not in his robot tone though) and embrace your future opportunities.
 
I agree with the others, should have contacted that girl. Honestly, who cares if your classmates know. If anything, you would garner much needed support. They would support you when you're down, not kick you. If anything, there is probably more drama brewing and folks probably avoiding you as people do talk, including faculty. They are the biggest offenders when it comes to gossip.
 
11378859-no-spin-zone.jpg
 
Doctor4Life1769 said:
Yes. PM me if interested in more info.
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Doctor4Life1769 said:
OP, I worry you don't have the drive to get into the best situation possible, which is in another residency. If you don't understand the issues that led to non-renewal nor do you understand that you had issues that need to be corrected, I'm not sure how this will work out. When you interview with another program, they will ask what happened and you will need to find the right spin. Find that spin and memorize it Rubio style (not in his robot tone though) and embrace your future opportunities.
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I have the drive.
 
jason.lafluer said:
Yes, I don't want to do that. But there are a few things about this that don't feel accurate/just. It's a new program. They terminated a resident last year. Making be repeat intern year could be a more reasonable/deserved option. Or even putting me on probation and actually calling it that with the understanding that lack of progress means contract non-renewal or termination.
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Unfortunately the stone has been cast. You will NOT change your PD's opinion. He has made the decision and has offered you an alternative which you should take.

To be honest, if I was in his shoes I would also have reservations about keeping you around. This is a new residency And (unfortunately) reputation is everything. His job depends on getting good residents. If he has multiple residents leaving or on probation it raises an eye. It's a catch 22 really. Does he turn a blind eye or do what he's doing? In one case you can argue no one is leaving but on the other hand you'd argue patient outcomes are below national averages or the residency is relatively weak at producing qualified residents for the job force.

Not to keep hitting you while you're down, but I question 'patient safety' not being an issue. If you can't manage patients postoperatively or through discharge safely then there is a patient safety issue. Maybe not directly, but definitely indirectly.

I wish you the best of luck but recommend you take your PD's advice.
 
jason.lafluer said:
Nothing in the meeting or documentation explicitly said anything about probation. They gave me a notice of deficiency. I had 2 months to make necessary steps to meet expectations and submit and individualized learning plan for program review that outlines the steps I would take.
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Op you seem to be a smart, honest and articulate person but and I don't want to beat you up but I don't think you've reflected enough on your situation. You were fired from your residency for a failure to manage the floor, some of the most basic tasks of intern year. Did you not care? Were you not interested? Are you literally not able to do the work? Were you burnt out? Did you have too much/something else going on? I understand if you don't want to talk about it and I'm not sure you were really asking about it but I don't see where you comprehend what went wrong in the first place. Earlier in the thread somebody suggested you find a friendly face in the program and have them give it to you straight and they were being kind about it but your only setting yourself up for failure if you don't figure this out. The next step is hard part of accepting the problem and trying to fix it.
 
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jason.lafluer said:
Thanks for your interest. The GME director is going to talk with the PD further. It was not a definitive meeting at all. He talked to me about, and basically encouraged me to pursue a due process review. I also expressed my willingness to be evaluated for a learning disorder as this was a suggestion at our first meeting that I stiff-armed because frankly I didn't want the hassle.
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A due process review will end pretty much any goodwill your PD will have for you. Do not go this route. Don't make a bad situation worse.
 
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