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How common is it for an fm resident to get fired?

Discussion in 'Family Medicine' started by Yadster101, Jan 20, 2017.

  1. Yadster101

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    I was under the impression that this was extremely rare but after reading a few threads it seems that although it's uncommon, it could happen. If I'm a DO student that matches FM in the mid west, what are the chances of me being fired or not having my contract renewed? As long as I keep my head down and work as hard as I did in med school is there a 95% chance that I'll finish?

    I think my plan is to be especially cautious during intern year and not talk about devisive things like my political views, religious thoughts, etc. As long as I am on time and ready to work, should I be good?

    How many fm residents did you know that got fired and what was the reason for their termination?
     
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  3. hallowmann

    hallowmann SDN Lifetime Donor
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    I know 3 FM residents that got terminated. They all had warnings, and they all did things that pretty much warranted their termination (e.g. always showing up late, disappearing throughout the day with no explanation, not finishing notes-like repeatedly incomplete notes, and generally expressing zero interest and not taking advice/criticism well - like snapping back at your senior and/or attending when they try to gently correct something you did wrong or teach you something). All seemed unhappy for various reasons, some of which had to do with where they were in residency, some with personal issues, some with life in general.

    What I've gathered is that residency is hard, especially intern year. You will have to keep your head down, but what that means is really dependent on your program. It will be very difficult on you psychologically to spend that stressful year detached, hiding yourself, and not bonding with others in the program. You will work harder than you did in med school, but if you continue to work hard, do what you're supposed to do (show up ontime, see your patients, finish your notes, treat people with at least basic respect, and try to fix/learn from your mistakes when you make them) I imagine it will be very difficult to be terminated.

    I think one of the reasons we see a lot of people getting terminated in FM is because its residents represent a pretty broad group from people who have done very well in med school and have a dream of primary care and people who barely passed (or didn't pass at first) and ended up in it because of a lack of other viable options.

    Also, I highly doubt being a DO will put a target on your back. Most FM programs I've encountered treat us with neutrality at worst and intrigue at best (#bone_wizards) - but then again the programs that would view it as a major negative wouldn't have interviewed me... so...
     
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  4. JustPlainBill

    JustPlainBill Attending
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    Believe it or not, there are malignant FM programs out there -- be watchful for programs that never fill on the first round of the match (don't know what they call it now, it had just changed when I was graduating in 2013). In general, at a normal program, if you just show up, act halfway interested, and do your job, you'll be fine. Watch out being too cautious your intern year as you can get tagged as not wanting to participate or not being interested. I got slammed for being courteous and allowing female physicians and my seniors to walk ahead of me and holding doors open for others which caused me to walk at the back of the pack -- I was judged as not interested. Also got hammered for not having a Sanford's guide in my white coat pocket. Was told I was acting like a PA when I asked questions regarding medication orders I was about to write and was unsure of --- but the seniors were providing no guidance and were instead planning their weddings. I was timid and didn't want to be the one to shove a patient over the edge with a bad order and had the mentality of "Am I missing something obvious here or some interaction that's critical" -- in other words, I didn't want to harm a patient accidently and got penalized for it.

    The program had a reputation for picking one resident in each intern class and riding them hard until their either quit or could be fired. Found out later that the residency had the most lawsuits of all the residencies at the large academic center we were at. Heard that one resident actually contacted the ACGME regarding some thing in the residency and caused an audit which scared the bejeezus out of the administration and things straightened up for a while. But then again, this was the place that tried to put an intern on probation for lack of clinical judgement --- hello, interns, by definition, have no clinical judgement --- you get the idea......
     
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  5. Yadster101

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    Wow that must be difficult. I just got a pm from an sdn FM resident that lost a couple of people, over the course of a few years, from their residency.

    Lol I was under the impression that as soon as you matched all you had to do was just keep working hard and you were good. I never realized that getting fired, although not common, could happen.
     
  6. cabinbuilder

    cabinbuilder Urgent Care Physician
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    My residency had a few people who were asked to leave, but not fired. One was because he was openly gay and our PD is/was a staunch Christian and that didn't mold well with his views. He stood up in his opening speech as the new director, "I love my job, I love my Lord" type of guy. Another was asked to leave because our program was very ER heavy and the guy basically had panic attacks every time he was in the ER and made a lot of mistakes that could of ended in a patient death.

    There was one resident who was actually fired because he had multiple warnings about orders he had written, especially in ICU, and I believe ended up harming a patient because he didn't listen and was deemed "unteachable" because he went around already thinking he knew everything. Very bad mentality.
     
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  7. Yadster101

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    So would you say as long as one keeps working as hard as they did in med school, the chances of being fired are very low?
     
  8. cabinbuilder

    cabinbuilder Urgent Care Physician
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    As long as you are on time, not too cocky, take constructive criticism, make an effort to learn you will be ok. And never never ever put a patient in danger. If you dont' know what to do, it's better to feel like a fool than have someone die because you are too proud to ask.
     
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  9. Natividad Resident

    Natividad Resident FM resident

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    I think there should be more discussion about the basics of having a job for new grads. The norm is for fresh MD/DOs to be in their first job in residency. FM draws a lot of nontrads, but new grads with no work resume are still the norm. Which means a nontrad with a decade+ of work experience can be subject to supervision by an R3 who has only 2 years of work experience, and is in their very first ever supervisory role, and might have no talent for management. And that lack of talent for management is the norm in any job.

    Residency is a job. You can get fired in any job. When you start residency you'll sign a contract. In the contract there will be all the things you can get fired for. Generally you'll be nauseated by the list of things they have to spell out in a contract, because any fool with a shred of common sense isn't going to hit on mentally ill patients or steal or lie or go AWOL or generally do stuff you learn not to do in kindergarten. In most jobs you're subject to a review process. Residency is a daily review process. Make friends with the review process. It's okay if you hate it while you get used to it. But get used to it.

    A lot of what's being discussed above is dereliction of duty. Before you get fired, you get warned. If you shrug off the warnings, you're digging your own grave. If you get pissed off for getting negative feedback, you're a fast grave digger. If you blame the person giving you the negative feedback, if you get angry, then you're a fast, pretty much unemployable, grave digger. (How to take negative feedback that pisses you off and might be total BS: say "thank you" without sarcasm. Forget about the messenger, forget about the delivery, step away, and take apart that feedback like somebody handed you a dirt clod that has a big possibly career-preserving chunk of gold in it.)

    Yes, there are toxic residencies. Getting fired by a toxic residency for something beyond your control is a thing that happens very very very VERY rarely because lawyers. Occasionally on SDN there are horror stories about egregious malfeasance from a residency. Usually those stories get torn to shreds. Quickly. There's always, always, ALWAYS a key piece of the story that the aggrieved fired resident leaves out. IMHO there's always a whiff of un-self-aware entitlement in the first line of the story.

    irrelevant
    midwest is irrelevant
    Nonzero. Very small. Worry about other things like how to research programs before/while applying/interviewing/ranking. (My 2 clutch data points at an interview: do the residents like each other, based on hugs, laughter, etc when they see each other? what is the look on the face of the resident interviewing you when you ask how many of the residents they'd invite to their wedding? obviously data point 3 is getting to meet several residents.)
    More like 98%.
    That's not caution, that's professionalism. Any time you talk about politics or religion in any workplace you're taking a risk. But again, if you make a misstep, you get warned, you correct, you move on.
    That's 90% of it. You also have to study and pass step 3 and make progress on yearly inservice exams and stay organized (regardless of whether the residency is organized) and be a team player. Which sounds like a lot, but everybody in your class does it together. (See previous about noticing whether residents like each other.)
    The Natividad contract is available by googling Monterey County MOU. Residents are group R. The things that are spelled out in this contract as fireable offenses are nearly generic to any professional job.

    If you're a 4th year med student worrying about getting fired in residency, without a specific reason why you might get fired, you're wasting the glorious freedom of 4th year. There are 35,000 4th year med students about to start residency in 5 months, and the overwhelming majority get through residency without getting fired.
     
  10. Yadster101

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    Thanks. I think I'm just the classic over worrier. I'm confident i can be a good resident but just the thought of being kicked out of medicine in the final 3 years scared me.
     
  11. oscardagrouch

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    I would say it is pretty difficult to be terminated as a resident. During my residency, there were 2 residents who were let go, but quite a few of them placed on probation ( for bad behavior mostly). One of the resident was let go because he truly had a hard time following directions, which lead to errors affecting patients. The other one was let go after he w as accused of unsavory behavior towards a nurse ( who happened to be an attending's girlfriend) and a few patients. He was let go, but then came back a year later and was allowed to finish the program. None of us knew the real story behind this resident, but no one really cared as we all were trying to stay afloat and get through residency.

    The best advice I was given when I started was to keep my head down, do my work and never lie. Best advice ever!
     
  12. NeurologyHopeful2018

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    Being fired for being gay? Also fired for being anxious in ED in a FM residency program? I hope those programs get sued.
     
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  13. VenusinFurs

    VenusinFurs I am tired, I am weary

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    I think if you are this concerned about being fired before even starting you will be fine. Most residencies that are NOT terrible will give you plenty of warnings and opportunities for improvement before they fire you.

    I hope that program director that asked a resident to resign over being gay got sued into the ground.
     
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