How to deal with a malignant program director

[Icandoit_7]

Hello all
I am currently a first year resident at a community program. The program director hates me and I have no idea. He has this issue with picking on someone every year.
Few months ago, I was rotating with him and he gave me a very hard time, scream at me and scold me infront of the patients. And treat the other residents in a nice way. I asked my mentor to help me with that, she helped me and we sat with him and he said he has nothing against me.
Recently, I had my 6 months evaluation and he told me I was doing very good and continue my good work. however, last week I was rounding with him, he gave really hard time but he was noticing himself and he was treating the other interns very nicely. On the day before the last day of that rotation, I went to him, I asked him in a very nice way, I said “I believe communication is the best way to solve problems, I have feelings you are always waiting for me to make mistakes” he got angry, he said “you need a psychotherapy “ “you are accusing me of being sadistic” you are the first resident to ever say that to me, I said in a very nice way my only intentions was to come and talk to you with no people in between us and No borders between us. Anyway, next day he gave me a horrible terrifying day! He even asked me to go to his office after the rounds!
He said you did bad! today you were bad! And you were performing as a first month.
With the other residents he treats them well. He has tendency to treat FMG bad and there is not much of us.
I don’t know what to do and how can I communicate with him and how to make things better
I live now in a constant fear and anxiety! My mental health is bad! I can’t focus and it’s all because of him
I feel all the hard work I gave is very under appreciated! I had one of the highest scores in the ITE exam
The program director really targets FMG and I don’t know how to continue like this.
Please help!!! I feel whatever I do is seen very bad by him!

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[NGTY1991]

This is residency. You have to take it. Period. There will always be a scapegoat and unfortunately you are one. The only thing you can do is keep doing your job to the best of your ability and stop continuously asking him why.

 

[deleted480308]

I wouldn’t tell them they are bad at communication any more. You did it twice with poor results

 

[GoSpursGo]

Agree with above. Clearly he doesn't think there's a problem with communication, and even if there is one you're not going to convince him of that.

Keep your head down. If your mental health is truly suffering, then if it is available through the GME office and it will TRULY be confidential consider getting counseling (or look outside your institution if you're worried it would get back to your PD). Just focus on getting through the next 2 years.

 

[ThoracicGuy]

They can't stop the clock, but they can make it really hard for you. Don't make waves.

 

[Icandoit_7]

Anyone has similar experiences where the program director would yell and scream at you and let you feel so down?
Am I the only one who is experiencing this?
I need tips
Thank you

 

[Piebaldi]

Anyone has similar experiences where the program director would yell and scream at you and let you feel so down?
Am I the only one who is experiencing this?
I need tips
Thank you

Umm I've had plenty of malignant attendings, but have never had someone scream and yell in my face. That seems particular. Are you sure that is the case or is that your perception? Are you trying to find an excuse regarding you being a FMG for maybe having performance that is not great? I mean residents have to realize that they are ranked to be in the program, and certain PDs have a big say in the matter. So it would seem odd to me that PDs would pick residents and then yell at them for being foreign. Also I would not tell a PD/attending that their communication is poor or something like that. Have you considered perhaps that you have communication problems because it's a different country/culture than yours? Perhaps you should work on your communication

 

[AdmiralChz]

Anyone has similar experiences where the program director would yell and scream at you and let you feel so down?
Am I the only one who is experiencing this?
I need tips
Thank you

I experienced some of this during my surgical internship from a couple of particularly jaded and nasty surgeons. One was the assistant PD for the surgery residency so it was someone with some degree of power.

Some of it was comical in retrospect but definitely nasty - “Admiral, something about your voice makes me want to stab my eyes out” “Why do you talk so much with your hands are you trying to use sign langauge” “I know you’re in anesthesia but would it kill you to evaluate below the lungs” “Are you on a 1st grade reading level, seriously?” (At the end of the year, she asked if I was 3rd or 4th grade and I pointed out I made some big advances over the year... not a smart move on my end) Some of it got much more personal and brought in my girlfriend, heritage (which is weird because I’m a generic white dude from the South) and previous training.

You see this sort of crap much more commonly in the surgical realm. Thankfully most of the old, jaded guard is moving towards retirement but young folks can be just as nasty. Many institutions aren’t tolerating it as they did back in the day (DeBakey was a legendary, misogynistic jerk), but as with anything in life the more power the person has the more leeway he or she will get.

It was horrible and demoralizing but I CERTAINLY wasn’t alone as others were targeted as well. Unfortunately all I could really do was put my head down and get through it. When it came time for anonymous program-wide evaluations, I make sure to detail what happened very carefully. Neither of those folks work at that institution anymore. It sucks, but hopefully you won’t have to work with that person directly too much.

 

[Piebaldi]

I experienced some of this during my surgical internship from a couple of particularly jaded and nasty surgeons. One was the assistant PD for the surgery residency so it was someone with some degree of power.

Some of it was comical in retrospect but definitely nasty - “Admiral, something about your voice makes me want to stab my eyes out” “Why do you talk so much with your hands are you trying to use sign langauge” “I know you’re in anesthesia but would it kill you to evaluate below the lungs” “Are you on a 1st grade reading level, seriously?” (At the end of the year, she asked if I was 3rd or 4th grade and I pointed out I made some big advances over the year... not a smart move on my end) Some of it got much more personal and brought in my girlfriend, heritage (which is weird because I’m a generic white dude from the South) and previous training.

It was horrible and demoralizing but I CERTAINLY wasn’t alone as others were targeted as well. Unfortunately all I could really do was put my head down and get through it. When it came time for anonymous program-wide evaluations, I make sure to detail what happened very carefully. Neither of those folks work at that institution anymore. It sucks, but hopefully you won’t have to work with that person directly too much.

Same here. I made painfully long descriptions of issues I had with attendings and a wide number of issues on my evals. At least one of those people no longer work there either.

 

[Crayola227]

I'm going to be frank, and say that reading these posts, there are some issues with written communication. Possibly there are some in verbal communication.

OP, always be open to the idea that you are the problem, your perception is the problem, your communication skills are the problem. That doesn't mean that the PD isn't being something of a dick to you. That just happens, and yes, what you're describing happens to thousands of residents every single year, AMG or FMG or not.

Again, I don't mean to be rude, but possibly he is harder on the FMGs in the program because they may be the ones having the most/certain type of struggle in the system compared to their peers. Not saying that anyone deserves abuse or counterproductive strategies of getting residents to improve.

It could all be as you say, but it could be a combination of your struggles and the PD's frustration, and everyone actually is doing their best. Sometimes our best just isn't good enough.

I ditto seeking any assistance you can that will be discreet.

And while @ThoracicGuy is right that they can't stop the clock, they can make things harder, they actually can stop the clock by firing you. So no, don't make waves. Don't poke the bear.

What happened is that you criticized the PD's criticisms of you. If he really believes what he says has merit, and he probably does, you can probably see why he didn't take kindly to being criticized for "being right" about you. Don't ever argue an upper's perception of you, unless there's a true, and objective measure to point to that really matters (eg No, I didn't kill that patient last week, the notes show he saw his PCP yesterday. I would like to understand your concerns about my performance, though). Otherwise treat it as the word of God and just apologize and move on.

 

[Gastrapathy]

Did you call him a sadist? To his face?

Sometimes “barriers to communication” are appropriate. Self preservation is an excellent barrier.

 

[rokshana]

Anyone has similar experiences where the program director would yell and scream at you and let you feel so down?
Am I the only one who is experiencing this?
I need tips
Thank you

You HAVE been given tips...keep your head down, don’t keep telling your Pd he doesn’t know how to communicate and get through residency...and hopefully he will lose interest in you.

 

[DarkHorizon]

Seems like you were turning things around and then you imploded when he was hard on you again. You actually told your PD that his communication skills were a problem after he rode you.... as an intern. I can’t even tell you how dumb that is. You don’t know jack**** as an intern, you do what you’re told, and you definitely don’t confront an attending like this, much less your PD. Have you ever thought that he actually cares about your learning and progress and may be that’s why he’s hard on you? Perhaps he sees your potential and wants you to change your ways? I’m not defending him, but many attendings are like that. I much rather have that than some attending who barely cares about you, hardly communicates with you, and then slams you in your evals and pushes for your dismissal behind the scene.

You need to buckle up and do whatever you can to not be confrontational like that with an attending. Figure out how he wants you to communicate and get to his level. And don’t ever do anything dumb like that again.

Also, always remember, no one cares if you do a solid job at something. It’s your job to be a good intern. If you make mistakes, people will remember that. Fair or not, that’s just how people are in medicine. I had to learn this the hard way.

 

[neoexile]

Anyone has similar experiences where the program director would yell and scream at you and let you feel so down?
Am I the only one who is experiencing this?
I need tips
Thank you

I laugh it off. Honestly. The thing is as an intern, you start out INCOMPETENT. You aren't gonna do everything right. You WILL make mistakes and you will get yelled at. But you figure out what you did wrong and improve on that. Ya, there are bad personalities, but I mean its not like it's safe for us to be making medical decisions that could drastically impact a patient's life either.

Im an intern and I'll get yelled at too. Could the PD be less mad? Maybe. But the bigger question is "Could I have done better?" and 99.9999999999999% of the time the answer will be yes. My interest is for the patient and if I'm making mistakes, especially big mistakes in my communication or suggestions, I would much rather take a yelling from the PD than have those mistakes impact my patient's life. I can go home and go take my temper out on the gym. I'm sorry, but hurt feelings should not prioritized over making sure that the care that a patient is receiving is safe and effective. The patients and their families are trusting us with what is literally their lives.

 

[OrthoTraumaMD]

Criticizing a resident’s performance is not malignancy.

 

[Aurora_Black]

Same here. I made painfully long descriptions of issues I had with attendings and a wide number of issues on my evals. At least one of those people no longer work there either.

My program doesn't offer evals for residents to evaluate peers or the faculty. We have the yearly ACGME survey and 4 question wrap-up surveys where we can say what's good and bad about the service we just finished, but there is no anonymous way to report specific concerns with people. Does it vary from place to place? Is there a national or institutional eval that's sent out? It would be nice to document what happens, but I'm not sticking my neck out when there's no protection. Answers are appreciated, thanks in advance.

 

[siliso]

To be frank, if you speak like you write, your English communication skills are subpar and will hinder your clinical and interpersonal performance. Look into some health professional specific language training. And if psychotherapy has been recommended then go ahead and get evaluated - there may also be culture clash issues that need addressed.

 

[Piebaldi]

My program doesn't offer evals for residents to evaluate peers or the faculty. We have the yearly ACGME survey and 4 question wrap-up surveys where we can say what's good and bad about the service we just finished, but there is no anonymous way to report specific concerns with people. Does it vary from place to place? Is there a national or institutional eval that's sent out? It would be nice to document what happens, but I'm not sticking my neck out when there's no protection. Answers are appreciated, thanks in advance.

I think that's an ACGME requirement - that you are able to evaluate attendings at least one a year? Someone more academically inclined please correct me on this if I am wrong? But I think it is. I don't know about the peer evals though.

 

[evilbooyaa]

I think that's an ACGME requirement - that you are able to evaluate attendings at least one a year? Someone more academically inclined please correct me on this if I am wrong? But I think it is. I don't know about the peer evals though.

Yes. ACGME requirement to be able to evaluate faculty (not co-residents) at least once per year (assuming you work with them). If you aren't experiencing this then write it on the ACGME survey that is done yearly.

 

[Kissmyabjj]

The absolute best things that you can do are: show up early, know all of your patients backwards and forwards, review any strange labs or physical exam findings that you might get pimped on before the attending arrives, and work hard on improving your English communication.

The last one is tough, especially as an intern. If you have a friend in the program that you trust that is a native English speaker, ask him or her to discretely correct you when you make grammatical mistakes (after rounds of course). You can also ask him or her to proofread your notes from time to time. I have done this for residents in the past. This attending may very well get annoyed by FMG's that aren't native speakers. It's kind of messed up, but I have seen it happen. If you really make an effort to improve your English, you may be able to get on his good side.

 

[Mass Effect]

And if psychotherapy has been recommended then go ahead and get evaluated

As a psychiatrist, I totally disagree with this. Seeking therapy for a flip comment made by the PD or even a strong suggestion is a bad idea. Unless you're required to seek therapy, don't do it unless it's your idea and it's to benefit yourself. Do not seek therapy for them. You will always have to report it to the licensing board if you do and they may require they see your therapy records.

 

[siliso]

I do mean for personal benefit given the part about “My mental health is bad!” There may be other things that would help more. I defer to your expertise except to say that reporting mental health counseling is not required by licensing board in my state ‍♀️

 

[IM-2019]

As a psychiatrist, I totally disagree with this. Seeking therapy for a flip comment made by the PD or even a strong suggestion is a bad idea. Unless you're required to seek therapy, don't do it unless it's your idea and it's to benefit yourself. Do not seek therapy for them. You will always have to report it to the licensing board if you do and they may require they see your therapy records.

Isn't this state-dependent? A lot seem to dropping the more intrusive psych history questions and limit to asking only about conditions that impair the ability to practice medicine.

 

[Mass Effect]

Isn't this state-dependent? A lot seem to dropping the more intrusive psych history questions and limit to asking only about conditions that impair the ability to practice medicine.

Exactly my point. If you go when you're advised to by your boss, then it does imply that something was affecting your ability to practice. That's why it was recommended. If you go on your own for your own well-being, then no one can make the case that it impaired you. Also, yes, the more intrusive questions are state dependent, but I'd argue that your intern year, you have no idea where you'll eventually end up and if you end up in one of those intrusive states, you will have to go along with what they require OR (and I hope someone does this) sue. Until states realize they have no right to know about mental illness unless it impairs ability to practice, doctors won't seek help.

 

[Merely]

Hello all
I am currently a first year resident at a community program. The program director hates me and I have no idea. He has this issue with picking on someone every year.
Few months ago, I was rotating with him and he gave me a very hard time, scream at me and scold me infront of the patients. And treat the other residents in a nice way. I asked my mentor to help me with that, she helped me and we sat with him and he said he has nothing against me.
Recently, I had my 6 months evaluation and he told me I was doing very good and continue my good work. however, last week I was rounding with him, he gave really hard time but he was noticing himself and he was treating the other interns very nicely. On the day before the last day of that rotation, I went to him, I asked him in a very nice way, I said “I believe communication is the best way to solve problems, I have feelings you are always waiting for me to make mistakes” he got angry, he said “you need a psychotherapy “ “you are accusing me of being sadistic” you are the first resident to ever say that to me, I said in a very nice way my only intentions was to come and talk to you with no people in between us and No borders between us. Anyway, next day he gave me a horrible terrifying day! He even asked me to go to his office after the rounds!
He said you did bad! today you were bad! And you were performing as a first month.
With the other residents he treats them well. He has tendency to treat FMG bad and there is not much of us.
I don’t know what to do and how can I communicate with him and how to make things better
I live now in a constant fear and anxiety! My mental health is bad! I can’t focus and it’s all because of him
I feel all the hard work I gave is very under appreciated! I had one of the highest scores in the ITE exam
The program director really targets FMG and I don’t know how to continue like this.
Please help!!! I feel whatever I do is seen very bad by him!

What country are you from?

 

[Marasmus1]

I recommend that you keep a low profile. Residency, like it or not, is slavery with improved rights. In no other professional field your whole career is in between the lips of your boss. Know your shortcomings, improve on them, never argue with anybody in the program including but not limited to attending, PD, Assoc PD, social worker, nurse, nurse tech etc. Know that as a resident you have absolutely no leverage against anybody even the security officer at the front desk if your PD does not back you up. So improve on your deficiencies let your PD yell or swear at you or whatever non physical thing he wants to do. Apologize, seek for an opportunity to improve and move on.

 

[deleted1017841]

I recommend that you keep a low profile. Residency, like it or not, is slavery with improved rights. In no other professional field your whole career is in between the lips of your boss. Know your shortcomings, improve on them, never argue with anybody in the program including but not limited to attending, PD, Assoc PD, social worker, nurse, nurse tech etc. Know that as a resident you have absolutely no leverage against anybody even the security officer at the front desk if your PD does not back you up. So improve on your deficiencies let your PD yell or swear at you or whatever non physical thing he wants to do. Apologize, seek for an opportunity to improve and move on.

This is so true. Its advice that very easy for many to see but some others can't. It does not matter how high your in service scores are or how much research you publish. If a program decides to destroy you, it will be very hard to fight back. unfortunately as a resident you have just so very little power and you dont realize how little you have until you have to fight dor your career and they have bazookas and a sophisticated army and you have a frayed slingshot and your shadow

 

[Piebaldi]

This is so true. Its advice that very easy for many to see but some others can't. It does not matter how high your in service scores are or how much research you publish. If a program decides to destroy you, it will be very hard to fight back. unfortunately as a resident you have just so very little power and you dont realize how little you have until you have to fight dor your career and they have bazookas and a sophisticated army and you have a frayed slingshot and your shadow

Sorry I actually laughed out loud at the last part - "they have bazookas and a sophisticated army and you have a frayed slingshot and your shadow" - sad but true. In residency if it gets really really bad,the only true action to take is to quit - but hopefully someone has a new spot by then. Otherwise indeed keeping a low profile is typically best. I don't agree that it's the way it should be, and medicine culture should really change about this, but currently the program has the power to destroy you. IT's interesting, just like these people are this"fellowship" I was doing tried to discredit me after resignation, in residency all sorts of new issues tend to come up once a complaint is made. Not the way it should be but typically is.