If you ever interview at a program where several people have been let go, I suggest you scratch them off your list. I can't imagine a bigger red flag than that, except perhaps a public flogging.
Excellent point. There is one program that I know that instituted a night float without insuring that there would be adequate backup coverage for the night float intern. This particular program "lost" six residents that I was personally aware of. While the reasons were varied, and in at least two cases, justified, the others were, from the information I have, completely unjustified. These folks have gone on to prosper in new programs. I helped several find new residencies, but it took a long time and they have large and undeserved blemishes on their records.
I agree with yaah that in most ordinary circumstances, particularly in larger, well run programs, that there are checks and balances. I'm not so sure how vanishingly rare this is. This is as it should be. I know of at least three programs where these checks and balances are non-functional. At one of these programs, changes have been made at the executive level, and I'm not sure, but I think with the encouragement of the ACGME.
I am aware of comments from several different former residents of a number of programs in the same state that the program directors have an annual session where they, in the words of one former resident, now faculty in another state, "learn how to punish residents they don't like." I'm not sure what exactly was meant by that, but it was consistent with some of the retaliatiory behaviors I observed directly and learned about. It is also consistent with what others on this board have either directly posted or hinted at.
I also agree with you that a program director who leaves interns on their own on a night float should be fired. There should be no room in medical education for this type of person. Yet, there are a few. At a regional meeting some years ago, one of the program directors there lamented that we need to do something about people like this, because has he said it, "they make us all look bad." Graduating medical students of a well respected medical school near one of these programs strongly discourages their students from considering this particular residency.
As for benjee's question, what to do about it? Keep your mouth shut, head down, and look at figures like program completion rates, ask questions of med students who have rotated through those hospitals you're are considering.
And, most of all, take excellent care of your patients, document the dickens out of everything. If this means reviewing the full medical chart including old records when you get called on a cross cover that is different, do it, even though it is 4AM, you've been running straight for 22 hours and the last thing you want to do is grab the old chart of the puzzling patient that has tanked. And if you, as an intern cannot get a hold of your senior, keep calling up the chain, even if you have to call the attending. At least you can document that you've discussed the problem with someone who is responsible.
Benjee, I hope the program you refer is one of the ones I know about. I used to hope that there was only one like it, but from your description, it sounds astonishing similar to the one I know about.
