How does one's reputation precedes them?

[SpoiledMilk]

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They say that medicine is a small community and that one's reputation precedes them.

How does the small community of medicine "hear" or find out about one's reputation? e.g. lack of reference letters from faculty or PD of the residency, speaking with alumni of the residency who have had exposure with said job applicant, job recruiters "spreading the word," clinicians at prospective job speaking with other clinicians, etc

Are there actual instances where a resident has a had a difficult time getting a job for after graduation due their misbehavior or reputation for being "toxic" during residency?

Or does the shortage of physicians mean that resident will get a job no matter what even if they have a reputation for toxicity during residency?

 

[ThoracicGuy]

Maybe someone at the job knows someone from your training program and reaches out to them to hear about what's said behind closed doors. That could help or hurt you depending on what is said.

 

[DrMetal]

They say that medicine is a small community and that one's reputation precedes them.

How does the small community of medicine "hear" or find out about one's reputation? e.g. lack of reference letters from faculty or PD of the residency, speaking with alumni of the residency who have had exposure with said job applicant, job recruiters "spreading the word," clinicians at prospective job speaking with other clinicians, etc

Are there actual instances where a resident has a had a difficult time getting a job for after graduation due their misbehavior or reputation for being "toxic" during residency?

Or does the shortage of physicians mean that resident will get a job no matter what even if they have a reputation for toxicity during residency?

Your question is too general. If you can be more specific about your particular circumstance, you might get better advice.

In general, you look for a job, you apply, you get it, you start working, make money. Who cares about what anybody said about you in the past???
You quickly realize how high schoolish medical education and training was. Best to forget it and move forward.

And for God's sake: scan everyone and everything. The physical exam is useless

 

[Smurfette]

usually if we know someone who may have a connection to the applicant, we will ask them.

I've also received a phone call to discuss someone applying for a job because someone there had raised concerns based on prior experience in residency and they wanted a more updated assessment as I worked with the applicant more recently. I had no connections there; they reached out to me.

 

[Apollyon]

When I got near the end of residency, our PD told us to make an appt with the medical director of the ED. It was a 15 minute sit down to make sure we could be "normal" for that long, or, if he knew us (because, although a small group, there was always someone who, somehow, didn't get to know anyone), just fill in any gaps. Then, he told us (or, at least me) that I could use him as a reference for my first job.

 

[DrMetal]

When I got near the end of residency, our PD told us to make an appt with the medical director of the ED. It was a 15 minute sit down to make sure we could be "normal"

That's pretty deuchey. If you've been a resident in said program for 4 years, you've likely worked several shifts in that ED for that medical director. Based on that alone, he should give you a professional reference. And if you're graduating from the program, it's likely you performed well (or at least adequately).

If they feel negatively about you---to the extent that they would deny you a reference---then they shouldn't graduate you, or at least they should bring up their concerns with you, and make you remediate.

You shouldn't have to 'interview' for a reference.

I wonder if said ED medical director is as deuchey with the army of NPs he just hired to replace his physicians in the ER.

 

[Apollyon]

That's pretty deuchey. If you've been a resident in said program for 4 years, you've likely worked several shifts in that ED for that medical director. Based on that alone, he should give you a professional reference. And if you're graduating from the program, it's likely you performed well (or at least adequately).

If they feel negatively about you---to the extent that they would deny you a reference---then they shouldn't graduate you, or at least they should bring up their concerns with you, and make you remediate.

You shouldn't have to 'interview' for a reference.

I wonder if said ED medical director is as deuchey with the army of NPs he just hired to replace his physicians in the ER.

I probably described it poorly. For me, it was like being in the physician lounge - just being professional (that is, not casual or cursing).

Also, it was about 19.5 years ago, so, my recollection might be, of course, off.

 

[eyeeye_captain]

If you’re in a niche field like mine (~3k of us in the US), there’s maybe 2-3 degrees of separation from everybody. So if I don’t know who trained you, I know someone who knows someone who trained you.

The last time we were hiring, 2 of the applicants - one trained with my friend, another at a program I trained at. I reached out to my contacts, and *gasp* spoke to them on the phone. One had their CV thrown in the trash based on the feedback. Sadly the glowing review one joined a crappy private equity job for location reasons. Still got a good one, and wouldn’t you know it, I randomly ran into the big name at their program at a conference talking with one of my friends.

I doubt administrators care as much in larger fields, especially if you move out of region, but you’re still going to need some references to tell people you’re not a serial killer.

But come on, spill the tea. Something interesting is going on to prompt this post.

 

[mistafab]

You have to understand the idea of shrinking pools of people in local careers.

There may be tens of thousands of hospitalists... But what about hospitalists who staff ICU's in a single city? Now we are in a smaller pool. What about pure nocturnists that do that? Now we are less than a dozen. What about nocturnists who do great work, so the daytime folks who pick up the patients say "thank goodness it was Dr. X..." Now we're talking 1-2 people. All of a sudden everyone wants to hire Dr. X. Job is going to open? Let me shoot Dr. X a text and see if they're looking....

Reputation is extremely important. It opens and closes doors. The less mobile you are, the more reputation matters. I absolutely know psychiatrists who couldn't get jobs due to reputation alone. I absolutely know residents who raised stink and then no one wanted to touch them for employment. People in those buckets will have to move to a new area (i.e. find new victims) to get a shot if they have been black balled in an area. Word of mouth and reputation matters far more for being hired than your CV does. Everyone graduates basically and everyone is board certified. Nothing on your CV really matters except in academia (where reputation has more reach than non-academia).

Most specialties get very small very quick, even in a big city. Within a year or two you start to recognize everyone's name and start to know about the kind of work they do and how they get along with others. In academia, the circle is small enough that you know everyone in your field (academic specialty / subspecialty conference) essentially and by reputation alone could become untouchable (halo or outcast).

 

[Saddleshoes]

If you understand how the gossip mill works you can use it to your favor.
-- I don't know about others but I know I cultivate a certain kind of reputation.

 

[SpoiledMilk]

Racism is real. When it's not and false allegations are made, it delegitimizes real instances of actual discrimination.

A resident has made it a habit of accusing everyone (attendings, patients, fellow residents, faculty) of racism because they either disagreed with them or have criticized them. It's a default setting for the resident.

It's a huge mess and everyone is legitimately apprehensive to work with them due to not wanting to be accused of the "R" word.

 

[operaman]

My field of ent is similarly small such that it’s easy to find someone who knows someone. We’re currently recruiting and you can bet we are extremely picky and not only call references but also call anyone else we know who might have some inside scoop.

Coming right out of training in a larger field may be the easiest time to bypass a bad reputation, and even graduates in smaller fields can probably find a job desperate enough to give them a chance. They won’t get the really good jobs but they can usually find something somewhere.

It gets trickier in practice. The big giveaway is when someone bounces around constantly from job to job. You see a CV where someone stays for 1-2 years in each job and it’s pretty much assured they were the problem. There are exceptions of course - locums anesthesia docs making seven figures are usually good docs just milking the free market - but most docs in other fields tend to find a good thing and stay put for awhile.

For the OP’s example, the race card resident will probably graduate and get decent enough recs to get a job somewhere. Nobody is going to bend over backwards to help them land something great, but they will probably do enough to help them get that first job and then wash their hands of the crazy. After that’s it’s anyone’s guess. If the race card things is just a coping mechanism for the inevitable struggles of training but they’re actually a normal human and decent doc at heart, then they should do fine. If they’re really deficient, then they’re going to get bounced around and find it increasingly hard to find and keep something good.

 

[DrMetal]

Racism is real.

Ahh . . now you're talking. Perfect post-Christmas day hangover thread . . .

 

[SpoiledMilk]

The resident filed a complaint with HR against a faculty and this claim was investigated and the faculty was cleared of the baseless accusations. Faculty had to go on LOA.

Unfortunately the faculty has made a decision to resign since they do not want to deal with having to interact with the resident any longer. Our residency is losing a knowledgeable, experienced and compassionate faculty all because of the resident’s continued toxicity.

The resident even goaded leadership in an email to the entire residency questioning leaderships truthfulness and integrity. And yet no consequences have yet to be realized. The resident feels untouchable. The cancer is metastasizing and there seems to be no consequences or cure that is upcoming.

What kind of person goes around making baseless accusations without any inkling of remorse?

 

[wysdoc]

The resident filed a complaint with HR against a faculty and this claim was investigated and the faculty was cleared of the baseless accusations. Faculty had to go on LOA.

Unfortunately the faculty has made a decision to resign since they do not want to deal with having to interact with the resident any longer. Our residency is losing a knowledgeable, experienced and compassionate faculty all because of the resident’s continued toxicity.

The resident even goaded leadership in an email to the entire residency questioning leaderships truthfulness and integrity. And yet no consequences have yet to be realized. The resident feels untouchable. The cancer is metastasizing and there seems to be no consequences or cure that is upcoming.

What kind of person goes around making baseless accusations without any inkling of remorse?

@SpoiledMilk I think you are almost done with your residency and will soon look for jobs.
Keep your head down, work hard, and pay attention to your own business and your own patients so you can finish your residency in good status and get ready for your first job.

 

[dozitgetchahi]

Your question is too general. If you can be more specific about your particular circumstance, you might get better advice.

In general, you look for a job, you apply, you get it, you start working, make money. Who cares about what anybody said about you in the past???
You quickly realize how high schoolish medical education and training was. Best to forget it and move forward.

And for God's sake: scan everyone and everything. The physical exam is useless

In my experience, all of this is generally true in medicine.

I’ve worked with a few doctors who are so bad clinically that there’s no way they didn’t have some sort of “reputation” preceding them…and yet they have been able to find new jobs easily. Consider examples like Christopher Duntsch…he was a well known problem child in training, and then he subsequently went through multiple jobs where his clinical performance was atrocious. Despite this, positive recommendations were written and he kept finding new jobs until he was finally stopped.

When I’ve been interviewing, I’ve been surprised at how many jobs just seem to be looking for “any warm body” in the specialty to fill the position. I had at least one previous job where I know my references weren’t checked, because they all said nobody called them.

I think some of it depends on how easy it is to recruit a doctor for a particular job. Looking at a job in a highly desirable locale? Yes, they will be more picky about who they choose…whereas a job in the middle of nowhere that has had few applicants will be much more likely to overlook any negative past history just to get someone in the position. Regardless, I’ve encountered a surprising number of doctors with histories of board actions, who are in the state PHP, etc etc and they just seem to keep cruising along finding jobs in this profession.

I’d also like to make the point that the opinion your residency/fellowship held of you in training isn’t really the be all end all of your qualities as a doctor. I’ve encountered physicians I knew during training who were given a hard time by various attendings, and turned out to be very good doctors. I’ve encountered others who functioned really well in the weird/stilted/artificial environment of an academic training program, and then foundered badly when they were out in the real world of community medicine. If I’m recruiting for a job and some doctor applies who has been practicing for 20 years, I frankly don’t care too much about what happened during residency. That’s ancient history at that point. How are they performing *now*?

 

[NotAProgDirector]

The story you're relating is not what I expected this thread would actually be about.

Unfortunately, this is where the pendulum has swung. In the not-so-distant past, if a trainee complained about a supervisor's behavior it would just be ignored, swept under the rug, or someone would have a "talk" with the supervisor and that would be the end of the complaint. But, often whatever the behavior was would continue unabated.

Now, especially when the complaint is framed as a Title IX issue, it's very different. Even if everyone "knows" the issue is bogus, a full investigation needs to be done. People are often put on paid admin leave while the investigation progresses -- this is to separate the accused from those they might pressure to support them. If the investigation finds nothing, the person is returned to work -- on paper "no harm done", but it takes a huge toll and most people are never quite the same afterwards. No retaliation is allowed against the person whom filed the complaint - even if negative. And if someone files multiple complaints, there's nothing anyone can do. And you can't include that in any of their future credentialing / licensing etc. It's very easy to weaponize, and there's nothing anyone can do.

Unfortunately a system that supports actual victims will inherently also be subject to abuse like this. If there were consequences to a complaint being unfounded, it would deter true victims from reporting.

Also, it's very likely that the resident involved truly believes that every time someone disagrees with them, it's because of their race. It's certainly not true in all cases, but might be true in some. It's very likely they see themselves as actually trying to do good.

 

[dozitgetchahi]

@SpoiledMilk I think you are almost done with your residency and will soon look for jobs.
Keep your head down, work hard, and pay attention to your own business and your own patients so you can finish your residency in good status and get ready for your first job.

Exactly…

OP, this frankly isn’t your issue to address or be concerned with. Walk on by, shake your head at it if you must, but keep your eyes on the prize of finishing training and moving on to your own career.

 

[comp1]

Some jobs, like state/federal will do a very lengthy background check. Any lawsuits or formal complaints a potential applicant was involved in, plaintiff/accusor or defendant/accused, will come up pretty fast. That's one way. It's also usually pretty easy to read between the lines on any references from former supervisors/training sites. The large majority of residents are actually liked a good deal for example, so anything resembling a neutral reference is in fact an extreme red flag. That's why such letters are often required as opposed to just providing three random references. All that said, the extreme desperation for physicians in many fields and many areas is indeed very real. So none of it may matter depending on your job and location.

 

[hallowmann]

I would agree with others. Keep your head down and worry about yourself finishing, don't be so concerned about others.

While plenty of jobs exist and even bad graduates get jobs, they rarely stay at those jobs long term. Most struggle interpersonally or professionally the same way they do in training. It's usually predictable.

The resident filed a complaint with HR against a faculty and this claim was investigated and the faculty was cleared of the baseless accusations. Faculty had to go on LOA.

Unfortunately the faculty has made a decision to resign since they do not want to deal with having to interact with the resident any longer. Our residency is losing a knowledgeable, experienced and compassionate faculty all because of the resident’s continued toxicity.

The resident even goaded leadership in an email to the entire residency questioning leaderships truthfulness and integrity. And yet no consequences have yet to be realized. The resident feels untouchable. The cancer is metastasizing and there seems to be no consequences or cure that is upcoming.

What kind of person goes around making baseless accusations without any inkling of remorse?

This doesn't make a ton of sense to me. The only way I see a faculty member leaving after an accusation like that and it truly having no merit, is if they saw toxicity in how they were treated by their colleagues. No attending leaves because of not wanting to interact with 1 resident. If that faculty felt abandoned and railroaded by the institution or department based on only those claims, then I could see not wanting to work there anymore.

On the other hand, I have seen plenty of people with absolutely egregious behavior decide to resign or "retire" after "no wrongdoing was found" following accusations.

 

[SpoiledMilk]

I am trying keep my head down and finish in good standing. But it's hard to not be distracted when this resident continues to let their temperament disrupt our learning.

@NotAProgDirector The resident got upset because the faculty was at a meeting during clinic. The faculty is resigning soon but also have their own patients to see. The resident then just left for the day without seeing any of their scheduled patients. After reading our residency contract, I believe that the resident violated the terms of the contract, and a dismissal might be forthcoming.

 

[NotAProgDirector]

Whether or not your co-resident is dismissed is completely out of your control. That's on the program, and you should steer clear of it.

In general, faculty are required to be available for resident supervision. Usually this means being in clinic with the resident, often with a reduced schedule of some sort so there is built in time for review. However, it would be completely legal (from an ACGME standpoint) to have the resident seeing patients on their own with the faculty member not there, if the resident was deemed competent to do so. So just because the faculty member wasn't there, it's not necessarily a problem. Billing, on the other hand, requires physical presence and no patients if billing under the PC exception rule. If they are having the residents bill independently, then it doesn't matter.

The resident leaving and not seeing any patients seems egregiously wrong. But details matter - if the faculty had all sorts of patients scheduled and just expected the resident to see them all, that also seems very wrong.

Anyway: Not your circus. Stay out of it.

 

[gutonc]

Anyway: Not your circus. Stay out of it.

It took 22 posts to get there, but this is really the only thing that needs to be said.

Head down, do your work, stay out of anybody else's business (unless patient safety is at risk), graduate and move on.

 

[Neuronix]

This doesn't make a ton of sense to me. The only way I see a faculty member leaving after an accusation like that and it truly having no merit, is if they saw toxicity in how they were treated by their colleagues. No attending leaves because of not wanting to interact with 1 resident. If that faculty felt abandoned and railroaded by the institution or department based on only those claims, then I could see not wanting to work there anymore.

On the other hand, I have seen plenty of people with absolutely egregious behavior decide to resign or "retire" after "no wrongdoing was found" following accusations.

I have been in this position with my prior employer. I can't go into details for obvious reasons, but I was always treated as guilty until proven innocent. I am in an interracial marriage with biracial children, and I felt strongly that I was being accused of racism with no clearance of me in the end. It was the most ridiculous and insulting situation I could have suffered. The resident involved faced no repercussions that I'm aware of, despite my early involvement of the chair and program director in the situation, and clear evidence and documentation I provided about the issues involved.

Ultimately, the resident was allowed to graduate despite clear ethics and knowledge concerns. I wrote that I believed the resident should have repeated my rotation with someone else because they didn't show up to most of my rotation (and never complained until the bad review came at the end), did not know the fundamentals of what I do, and ultimately they were allowed to have full research time (producing nothing). The program overrode my review and gave them credit for the rotation anyway because they would not have had enough time in clinic per ACGME to graduate if I had failed them.

All I got was "we cannot have accusations like this in our department," and I was sent to weekly mandatory hour-long counseling for two months. The topic kept coming up at every annual review as well. The institution prides itself on building a file on its faculty members so they have cause to let anyone go at any given time.

This was not just me that things like this happened to. Several other faculty I'm aware of got caught in things like this as well. They encourage resident surveys to report every single little complaint no matter how trivial so faculty can improve, then they come down on faculty with weekly mandatory counseling for months and get put under a microscope for things as simple as "faculty texted me too many times" and "faculty kept me here until 7 PM" (I'm not exaggerating). "We cannot have anything but perfect resident surveys."

The culture at that institution was so incredibly toxic, it's hard to even explain or imagine until you've experienced it. Turnover was high, resignations were rampant, and they just pull new grads and unsuspecting junior faculty to replace them. The residency interviews are tightly controlled with a small number of residents and faculty involved only in group settings to ensure that nobody talks honestly and they fill after several years of going unfilled. Now that I'm out after 10 years of abuse it's hard to even explain it to people without them thinking there's something wrong with me.