Imminent termination, need serious advice!!!

[Over9000]

OP, you're done at this program. Even if you're not in the wrong, you're done. They want you gone. Plan your exit as gracefully as possible. Consult a lawyer to help you map out a strategy that does not harm your chances of obtaining future residency employment.

...or you can just transfer to a pathology program. We take anyone.

---

Members don't see this ad.

 

[AStark]

These "Lawyer vs Lawyer" posts are too long for me to comment upon in any meaningful form. However:

1. MDesquire seems to be assuming that the resident's clinical performance is actually fine, when in fact his performance may be substandard. There's no way for any of us here to know the real truth. And there's no way any lawyer will be able to tell either.

2. If a resident's performance is substandard, then any assessment of them that I write will include that. It would be malpractice of me to do otherwise. Their final documentation should accurately reflect their performance in my program.

3. Any resident is welcome to hire a lawyer. But I don't talk to lawyers. I talk to my residents. Your lawyer is not invited to any meeting we have, and has no right to be there. This is not a court of law. This is a job.

4. It does sound like the OP didn't get good, timely feedback from the ICU. Or, perhaps they did, but it wasn't direct and concrete enough for them to "get it".

5. There have been several comments that the OP is being fired based on "heresay". Presumably the ICU faculty completed evaluations on OP. That isn't heresay. It's an evaluation of their performance by their supervisor.

I would say those posts are too long for any non-lawyers to comment upon in any meaningful form. But I think it serves to underline that the OP's situation seems to be about substandard evaluations. A resident's first ICU rotation is often a big step up in responsibility - at my centre it means covering med/surg and the post-op hearts, consults, and emerg, albeit with generally excellent staff backup. It's hard to know exactly what happened in this case, but it's clear enough that significant concerns about knowledge snowballed into concerns about safe decision-making.

And I have to laugh at the idea that comments on evaluations amount to "hearsay". They were nothing more and nothing less than comments from ICU staff, other residents, nurses, RTs, whatever. While I do think that IM programs in particular are not always very good at giving timely or sufficient feedback (at least mine isn't!), in this case the OP was already given a second chance and did not succeed.

We may all be learners, but most of the time we also need to be self-aware enough to anticipate whatever feedback we get. In my case, I certainly didn't start my ICU rotation feeling like I was working very efficiently, but by the end I'd figured out how to prioritize and, in general, work faster.

 

[MDesquire]

@aProgDirector Thats right the OPs performance may have been substandard. However when he gets blindsided and his PD mentions 'others' unidentifiable persons as being responsible for his termination, it does raise questions. And regardless whether or not his performance was substandard does not negate the fact that the systems in place disregard due process and prevent OP from confronting his accusers--a fact you didn't deny. We have no way of knowing. But don't we owe it to OP to at least make sure he is informed, no? "RE: This is not a court of law. This is a job" If that were true, there would be a lot of lawyers out of work. Malpractice, Wrongful Termination, Negligent Hiring, etc... the list is expansive. All causes of action that invoke any and all information exchanged at "private meetings" of the kind you reference. That information is not protected under any privilege that I am aware of unless it's doctor-patient. "RE: Presumably the ICU faculty completed evaluations on OP. That isn't heresay" The hell it isn't. These are statements being admitted into a tribunal (of sorts) whether written or oral (recall hearsay need not be spoken, it can be written) by a party that is not available to be questioned or confronted by the OP and it is being used to prove the fact that OP was incompetent. That is the definition of hearsay to a "T", less the formality of a courtroom jurisdiction. If you mean to imply that the evaluations are exempted from hearsay restrictions because they fall under the 'Records of regularly conducted activity' exception to the hearsay rule, I would disagree. how often are these evaluations completed? Bi-Monthly? Quarterly? I don't think they are written daily like most records that are admissible under this exception tend to be. [OP are you beginning to see my earlier point about removing a physician from his castle?...it can be a humbling experience]

@Law2Doc RE: Second, you are assuming that in his investigation the OP is going to find some evidence of wrong doing or inappropriate firing by the PD, and that's going to be your lynchpin..." No, i'm saying its possible that something will emerge. And no I'm not 'swayed'. Im covering the OP's bases. Even in the event that nothing surfaces, and the OP was terminated for incompetence, the OPs interests are still best protected by counsel. I never suggested that OP have his lawyer do his due diligence...c'mon Law2Guy, please don't misquote me... I suggested OP do this tactfully while he still has rightful access to these materials. His lawyer comes in when OP is ready for him to intervene, less he remains behind the scenes advising OP. RE: You don't really need your med school deans recommendations, good word, or willingness to sign off on things for the rest of your career the same way you do in residency..." I disagree. Dean's Letters are critical and married with academic transcripts and will follow every medical student and graduate for the remainder of their academic and professional career. Any dismissals will be elicited by any reasonably diligent future employer, licensures, etc. I had to disclosed my dismissal in order to be eligible for State Bar licensure. Its entirely relevant, but moreso for continuing the pursuit of becoming state licensed and board certified in a field of medicine. Im glad we are having this conversation, so at least we can educate the intern/resident community here on Sdn on how critical their evals of medical students can be. Without pushing a separate personal agenda, I beg to differ with your assertion, and hopefully we can agree to disagree and move on. The rest of your commentary, Law2Doc, appeared spot on. We don't know enough about the situation to advise OP, other than he could benefit from seeking counsel. And the decision to allow the attorney to intervene necessarily carries its own inherent risks (ie) mandatory invocation of risk management, etc.; Ultimately, the more information OP can provide his attorney the better. And don't rule out the use of a private investigator to uncover additional evidence. Its an expensive option, but can prove worthwhile in some situations.

OP, I'll say it again, the worst thing you can do in this situation is to do nothing. This is a critical event in your career, but not something that will bury you. You didn't commit a felony or perpetrate an act of moral turpitude. Those offenses can be damning. Whichever attorney you chose will likely be with you for a long, long time should this event ever be used as a basis for action against you in the future, so choose wisely. You may be parting ways with your current carrier, but you stand to make a life long agent and friend that you can confide in and who is obligated to look out for your best interests (assistance in transitioning to a new carrier). Here is a link to point you in that direction. You will find many MD-JDs in peer review defense to choose from who can best relate to your circumstances.

http://shop.americanbar.org/ebus/AB...ionDirectories/StateLocalBarAssociations.aspx
http://md-jd.info/jd-md.htm (scroll to peer review defense)

 

[deleted480308]

These "Lawyer vs Lawyer" posts are too long for me to comment upon in any meaningful form. However:

1. MDesquire seems to be assuming that the resident's clinical performance is actually fine, when in fact his performance may be substandard. There's no way for any of us here to know the real truth. And there's no way any lawyer will be able to tell either.

2. If a resident's performance is substandard, then any assessment of them that I write will include that. It would be malpractice of me to do otherwise. Their final documentation should accurately reflect their performance in my program.

3. Any resident is welcome to hire a lawyer. But I don't talk to lawyers. I talk to my residents. Your lawyer is not invited to any meeting we have, and has no right to be there. This is not a court of law. This is a job.

4. It does sound like the OP didn't get good, timely feedback from the ICU. Or, perhaps they did, but it wasn't direct and concrete enough for them to "get it".

5. There have been several comments that the OP is being fired based on "heresay". Presumably the ICU faculty completed evaluations on OP. That isn't heresay. It's an evaluation of their performance by their supervisor.

I had a variation of #3 in construction. Your union company was welcome to bid my projects but I don't talk to union reps. I talk the owner of the company I hired, my deal is with them.

 

[ThoracicGuy]

@aProgDirector Thats right the OPs performance may have been substandard. However when he gets blindsided and his PD mentions 'others' unidentifiable persons as being responsible for his termination, it does raise questions. And regardless whether or not his performance was substandard does not negate the fact that the systems in place disregard due process and prevent OP from confronting his accusers--a fact you didn't deny. We have no way of knowing. But don't we owe it to OP to at least make sure he is informed, no? "RE: This is not a court of law. This is a job" If that were true, there would be a lot of lawyers out of work. Malpractice, Wrongful Termination, Negligent Hiring, etc... the list is expansive. All causes of action that invoke any and all information exchanged at "private meetings" of the kind you reference. That information is not protected under any privilege that I am aware of unless it's doctor-patient. "RE: Presumably the ICU faculty completed evaluations on OP. That isn't heresay" The hell it isn't. These are statements being admitted into a tribunal (of sorts) whether written or oral (recall hearsay need not be spoken, it can be written) by a party that is not available to be questioned or confronted by the OP and it is being used to prove the fact that OP was incompetent. That is the definition of hearsay to a "T", less the formality of a courtroom jurisdiction. If you mean to imply that the evaluations are exempted from hearsay restrictions because they fall under the 'Records of regularly conducted activity' exception to the hearsay rule, I would disagree. how often are these evaluations completed? Bi-Monthly? Quarterly? I don't think they are written daily like most records that are admissible under this exception tend to be. [OP are you beginning to see my earlier point about removing a physician from his castle?...it can be a humbling experience]

Do you think that the PD should produce all of these attending physicians in a meeting to tell the OP to their face the accusations? What possible good would that have? That would only make an uncomfortable situation worse. The problem that most residents that end up being fired or nonrenewed is lack of awareness in their situation. They think everything is going well, but in reality its far from the truth. If the OP wasn't sitting down with his ICU attendings before the rotation and then regularly through the rotation, then the OP didn't really do everything possible to show that things were better the second time around. SDN is littered with stories of people that have gone through this and I've only heard of one story where the PD's decision ended up getting overturned via lawyer involvement.

@Law2Doc RE: Second, you are assuming that in his investigation the OP is going to find some evidence of wrong doing or inappropriate firing by the PD, and that's going to be your lynchpin..." No, i'm saying its possible that something will emerge. And no I'm not 'swayed'. Im covering the OP's bases. Even in the event that nothing surfaces, and the OP was terminated for incompetence, the OPs interests are still best protected by counsel. I never suggested that OP have his lawyer do his due diligence...c'mon Law2Guy, please don't misquote me... I suggested OP do this tactfully while he still has rightful access to these materials. His lawyer comes in when OP is ready for him to intervene, less he remains behind the scenes advising OP. RE: You don't really need your med school deans recommendations, good word, or willingness to sign off on things for the rest of your career the same way you do in residency..." I disagree. Dean's Letters are critical and married with academic transcripts and will follow every medical student and graduate for the remainder of their academic and professional career. Any dismissals will be elicited by any reasonably diligent future employer, licensures, etc. I had to disclosed my dismissal in order to be eligible for State Bar licensure. Its entirely relevant, but moreso for continuing the pursuit of becoming state licensed and board certified in a field of medicine. Im glad we are having this conversation, so at least we can educate the intern/resident community here on Sdn on how critical their evals of medical students can be. Without pushing a separate personal agenda, I beg to differ with your assertion, and hopefully we can agree to disagree and move on. The rest of your commentary, Law2Doc, appeared spot on. We don't know enough about the situation to advise OP, other than he could benefit from seeking counsel. And the decision to allow the attorney to intervene necessarily carries its own inherent risks (ie) mandatory invocation of risk management, etc.; Ultimately, the more information OP can provide his attorney the better. And don't rule out the use of a private investigator to uncover additional evidence. Its an expensive option, but can prove worthwhile in some situations.

What we have been saying is the fact that when you start doing this probing it is usually going to be unproductive and will usually only serve to annoy the PD and administration. Your biggest mistake, in the above section, is your equating medical school problems with residency problems. Yes, medical school problems can have some impact, but the biggest issue is with residency problems when it comes to finding a second residency position, a job, state licensure, etc. I can tell you that after my initial match for residency, no one asked or saw a Dean's letter. My fellowship program, nor my jobs have asked for that. Dismissals will be asked about, yes. But usually if you are dismissed from medical school, you go to another career and in the end it doesn't really matter. If you are fired from a training program, you are still a doctor and if you find another program that will take you, you will still have the prior program follow you anytime you want a state license, credentials in a hospital, or more. You are not as likely to find another career than medicine when you haven't finished residency. So no, they aren't really the same, and no you really don't have much insight in that as you never went through the residency process.

 

[thesauce]

I'm really sorry to hear about all this, OP. Best of luck to you in salvaging this situation.

 

[michaelrack]

" Dean's Letters are critical and married with academic transcripts and will follow every medical student and graduate for the remainder of their academic and professional career. "

Post-residency, Dean's letters aren't at all critical, and the only time I have been asked for my transcript is when I applied for an MBA program.

Regarding the peer review argument, that doesn't apply to the evaluation of med students or residents by attendings.

 

[MDesquire]

@michaelrack Why are we splitting hairs on this point? The assertion by TG was that I might not be qualified to comment because I am not a PGY2 or beyond. The reverberation by law2doc was "your experience at the med school level really doesn't translate to the issues at the residency level. You don't really need your med school deans recommendations, good word, or willingness to sign off on things for the rest of your career the same way you do in residency." I fail to see how the issue of reliance on an administrative recommendation for continuation of one's training is any different for an advanced medical student than for a green resident. That was the premise of a legal intervention--to salvage the career and facilitate the hurdle to a new carrier. Both situations rely upon the recommendation of the former carrier administrator. I fail to see the material difference between a 25 week wrongful termination vs a 32 week wrongful termination. They're both abortions, but for some exigent circumstances illegal, and have a similar result of arresting a career. Hoping we can stay on point here and put this issue to rest. RE: "Regarding the peer review argument, that doesn't apply to the evaluation of med students or residents by attendings." I was waiting for someone to bring your point about peer review. They relate all the same regarding a failure of due process. The Confrontation Clause of the 6th Amendment guarantees a party the right to confront his accusers. In both peer review, resident termination proceedings, and medical student dismissals it is notably absent. An administrative lawyer, MD-JD, with an understanding of peer review would be an ideal attorney in my humble opinion to address OPs concerns.

@ThoracicGuy "Do you think that the PD should produce all of these attending physicians in a meeting to tell the OP to their face the accusations? What possible good would that have?" That all depends on whether or not OP has an opportunity to confront them. If not (see my point supra) the difference is only that the accusers' identity is disclosed, allowing the OP to make important deductions and perhaps to eliminate some speculations and suspicions of any improper sources of critique. For example, If the PD in arriving at his decision to terminate OP relied upon a snap judgment by someone who didn't' work with OP with any frequency and whose role was administrative in nature, that should necessarily call into question the reliability of the source.

 

[BoardingDoc]

@michaelrack Why are we splitting hairs on this point? The assertion by TG was that I might not be qualified to comment because I am not a PGY2 or beyond. The reverberation by law2doc was "your experience at the med school level really doesn't translate to the issues at the residency level. You don't really need your med school deans recommendations, good word, or willingness to sign off on things for the rest of your career the same way you do in residency." I fail to see how the issue of reliance on an administrative recommendation for continuation of one's training is any different for an advanced medical student than for a green resident. That was the premise of a legal intervention--to salvage the career and facilitate the hurdle to a new carrier. Both situations rely upon the recommendation of the former carrier administrator. I fail to see the material difference between a 25 week wrongful termination vs a 32 week wrongful termination. Their both abortions, but for some exigent circumstances illegal, and have a similar result of arresting a career. Hoping we can stay on point here and put this issue to rest. RE: "Regarding the peer review argument, that doesn't apply to the evaluation of med students or residents by attendings." I was waiting for someone to bring your point about peer review. They relate all the same regarding a failure of due process. The Confrontation Clause of the 6th Amendment guarantees a party the right to confront his accusers. In both peer review, resident termination proceedings, and medical student dismissals it is notably absent. An administrative lawyer, MD-JD, with an understanding of peer review would be an ideal attorney in my humble opinion to address OPs concerns.

@ThoracicGuy "Do you think that the PD should produce all of these attending physicians in a meeting to tell the OP to their face the accusations? What possible good would that have?" That all depends on whether or not OP has an opportunity to confront them. If not (see my point supra) the difference is only that the accusers' identity is disclosed, allowing the OP to make important deductions and perhaps to eliminate some speculations and suspicions of any improper sources of critique. For example, If the PD in arriving at his decision to terminate OP relied upon a snap judgment by someone who didn't' work with OP with any frequency and whose role was administrative in nature, that should necessarily call into question the reliability of the source.

Do you talk like this in public? Listening to a lawyer rant is like watching someone try to masturbate with words.

 

[michaelrack]

1. I think the 6th amendment only applies to CRIMINAL prosecutions, but I will leave it to Law2Doc to further address this point. Also, even if the 6th amendment applied to civil matters, I think it would only apply if the OP was at a public rather than private residency program.

2. The difference between an 4th year medical student and an intern is that the medical student is a student; while residency has features of both employment as well as academia. And while legal tactics may allow a resident to keep his job/salary for a few more months, they aren't going to get the resident academic credit for finishing a rotation/PG year.

What do you mean by "carrier administrator"?

 

[dpmd]

Md esquire it isn't just for training that you need your pd to write something but for every license you get, board certification, and sometimes hospital credentialing. Your dean doesn't need to write anything about you for any of that, so yes it is different

 

[rokshana]

@aProgDirector Thats right the OPs performance may have been substandard. However when he gets blindsided and his PD mentions 'others' unidentifiable persons as being responsible for his termination, it does raise questions. And regardless whether or not his performance was substandard does not negate the fact that the systems in place disregard due process and prevent OP from confronting his accusers--a fact you didn't deny. We have no way of knowing. But don't we owe it to OP to at least make sure he is informed, no? "RE: This is not a court of law. This is a job" If that were true, there would be a lot of lawyers out of work. Malpractice, Wrongful Termination, Negligent Hiring, etc... the list is expansive. All causes of action that invoke any and all information exchanged at "private meetings" of the kind you reference. That information is not protected under any privilege that I am aware of unless it's doctor-patient. "RE: Presumably the ICU faculty completed evaluations on OP. That isn't heresay" The hell it isn't. These are statements being admitted into a tribunal (of sorts) whether written or oral (recall hearsay need not be spoken, it can be written) by a party that is not available to be questioned or confronted by the OP and it is being used to prove the fact that OP was incompetent. That is the definition of hearsay to a "T", less the formality of a courtroom jurisdiction. If you mean to imply that the evaluations are exempted from hearsay restrictions because they fall under the 'Records of regularly conducted activity' exception to the hearsay rule, I would disagree. how often are these evaluations completed? Bi-Monthly? Quarterly? I don't think they are written daily like most records that are admissible under this exception tend to be. [OP are you beginning to see my earlier point about removing a physician from his castle?...it can be a humbling experience]

@Law2Doc RE: Second, you are assuming that in his investigation the OP is going to find some evidence of wrong doing or inappropriate firing by the PD, and that's going to be your lynchpin..." No, i'm saying its possible that something will emerge. And no I'm not 'swayed'. Im covering the OP's bases. Even in the event that nothing surfaces, and the OP was terminated for incompetence, the OPs interests are still best protected by counsel. I never suggested that OP have his lawyer do his due diligence...c'mon Law2Guy, please don't misquote me... I suggested OP do this tactfully while he still has rightful access to these materials. His lawyer comes in when OP is ready for him to intervene, less he remains behind the scenes advising OP. RE: You don't really need your med school deans recommendations, good word, or willingness to sign off on things for the rest of your career the same way you do in residency..." I disagree. Dean's Letters are critical and married with academic transcripts and will follow every medical student and graduate for the remainder of their academic and professional career. Any dismissals will be elicited by any reasonably diligent future employer, licensures, etc. I had to disclosed my dismissal in order to be eligible for State Bar licensure. Its entirely relevant, but moreso for continuing the pursuit of becoming state licensed and board certified in a field of medicine. Im glad we are having this conversation, so at least we can educate the intern/resident community here on Sdn on how critical their evals of medical students can be. Without pushing a separate personal agenda, I beg to differ with your assertion, and hopefully we can agree to disagree and move on. The rest of your commentary, Law2Doc, appeared spot on. We don't know enough about the situation to advise OP, other than he could benefit from seeking counsel. And the decision to allow the attorney to intervene necessarily carries its own inherent risks (ie) mandatory invocation of risk management, etc.; Ultimately, the more information OP can provide his attorney the better. And don't rule out the use of a private investigator to uncover additional evidence. Its an expensive option, but can prove worthwhile in some situations.

OP, I'll say it again, the worst thing you can do in this situation is to do nothing. This is a critical event in your career, but not something that will bury you. You didn't commit a felony or perpetrate an act of moral turpitude. Those offenses can be damning. Whichever attorney you chose will likely be with you for a long, long time should this event ever be used as a basis for action against you in the future, so choose wisely. You may be parting ways with your current carrier, but you stand to make a life long agent and friend that you can confide in and who is obligated to look out for your best interests (assistance in transitioning to a new carrier). Here is a link to point you in that direction. You will find many MD-JDs in peer review defense to choose from who can best relate to your circumstances.

http://shop.americanbar.org/ebus/AB...ionDirectories/StateLocalBarAssociations.aspx
http://md-jd.info/jd-md.htm (scroll to peer review defense)

frankly the length makes my eyes glaze over, but no Dean's letter (i.e. the MSPE) does not follow you in regards to licensure and credentialing…your transcript is usually required and your diploma, but the MSPE is NOT part of the transcript….practically every licensure and credentialing application requires a letter from every PD of every training program you were in…and they can be time sensitive …they don't even have to write a bad letter…just not sending it in can kill the credentialing process…

and i think the point of "others" was to let the OP know that this wasn't just because of comments and evaluations from the ICU but a bit more extensive…i would imagine that they are truly not anonymous and could certainly be produced if needed.

 

[MDesquire]

1. I think the 6th amendment only applies to CRIMINAL prosecutions, but I will leave it to Law2Doc to further address this point. Also, even if the 6th amendment applied to civil matters, I think it would only apply if the OP was at a public rather than private residency program.

2. The difference between an 4th year medical student and an intern is that the medical student is a student; while residency has features of both employment as well as academia. And while legal tactics may allow a resident to keep his job/salary for a few more months, they aren't going to get the resident academic credit for finishing a rotation/PG year.

What do you mean by "carrier administrator"?

@michaelrack 6th amendment does specifically apply to criminal actions; However, 5th and 14th also invoke it. 14th especially regards procedural due process for a government taking of life, liberty, or your residency slot. And the laws of evidence that preclude most hearsay and preserve the right to cross-examine a witness extend into both criminal and civil procedure realms, and they are based largely on the confrontation clause that appears in the 5th, 6th and 14th Amendments. You still hung up on the 4YMS/PGY1 point...? Thanks for your 2 cents, hope we've moved beyond that now. By carrier administrator, i mean a PD, Dean or other executive with authority to produce an eval.

@dpmd/@rokshana both a negative Dean's letter and a negative PD letter can end a medical career. Can we agree upon that? I concede that a neutral PD letter can create substantially more undue burden for a resident than a neutral Dean's letter can for a MS, especially for a resident that is determined to become board certified and licensed in multiple states. Its the former scenario however that the OP should be most concerned about. You may be right about the nature of 'others', but for now its left to speculation.

 

[MDesquire]

Do you talk like this in public? Listening to a lawyer rant is like watching someone try to masturbate with words.

No, BoardingDoc, for Sdn medico-legal digest only... Do you routinely troll on these threads with jerky comments, or are we just graced this afternoon? Because nothing quite says "shreddin' crispy backcountry gnar" like a voyeuristic EM resident from Manhattan ... From my personal experience, the only snow manhattan EM docs see with any regularity is the traces their interns failed to wipe away completely. Do yourself a favor...don't go shakin' my tree when you haven't my degree.

 

[Law2Doc]

...You still hung up on the 4YMS/PGY1 point...? Thanks for your 2 cents, hope we've moved beyond that now...
@dpmd/@rokshana both a negative Dean's letter and a negative PD letter can end a medical career. Can we agree upon that? I concede that a neutral PD letter can create substantially more undue burden for a resident than a neutral Dean's letter can for a MS, especially for a resident that is determined to become board certified and licensed in multiple states. Its the former scenario however that the OP should be most concerned about. You may be right about the nature of 'others', but for now its left to speculation.

Um no, you aren't getting it. We aren't moving past this one issue because it's the most important one. Med school is much more of a one time interaction -- it absolutely won't follow you the same way and if you were further down the road you'd get that. Thats why everyone is getting fustrated with you here -- youre just wrong on this one enormous point and it's the crux -- we aren't going to concede this point. You are telling Mrs Lincoln to move past the whole "Wilkes Booth thing" and ask her to critique the play. Please.

Sometimes the smart thing to do is just admit that maybe others have more experience on a subject than you do. If you can't appreciate that a bunch of residents and attending might know a bit more about residency and the impact if your PD on your future career than you, who never got to that level, that's scary. Shows a Lack of insight similar to that we are presuming the OP might have.

This is the whole point here -- we are saying that sometimes it's better to take some lumps, even not deserved, to live and fight another day. The course of action you suggest ALWAYS has repercussions. It's fine if the OP wants to win for the principle and change careers, but it's not always the right path if his goal is to find and finish a residency someplace. Don't win the battle to lose the war. Your path is often not so fine if his goal is to just continue his medical career. It has to be handled delicately and a Lawyer might be exactly the thing that escalates the situation into something unsalvageable. A good lawyer will realize he sometimes is going to make a bad situation worse and step back. I'm not buying that you are very experienced in residency matters, and your focus on constitutional provisions (most which, as pointed out, don't even apply here) comes off as very first year law studenty.

Your lengthy now apparently banned posts on valueMD are fascinating and give a lot of context into your point of view and maybe why this path didn't work out for you, and IMHO make you exactly NOT the person from whom OP should be taking advice in how to extend his medical career. From those posts,you are precisely the expert at escalating and blowing things up I have been talking about. Forcing a program to threaten a countersuit isnt exactly smoothing things out. Plus you state that getting railroaded out of your Caribbean med school is a "blessing in disguise" but I kind of doubt OP ending up with no residency would feel the same. Just saying.

 

[michaelrack]

xxxxxxxx

 

[NotAProgDirector]

OP, I'll say it again, the worst thing you can do in this situation is to do nothing.

I totally agree. The main question is WHAT they should do.

The OP's story, if accurate, is somewhat concerning. Residents who are underperforming need to be informed of their deficiencies and have an opportunity to address them. In my program, this is done with written remediation plans which clearly spell out what the problem is, what the timeframe for improvement will be, how the resident will be assessed, and what the outcomes can be if the remediation is successful or not. It's not clear that the OP's program will have met the standard required, but again we only have 1/2 the story here.

@aProgDirector Thats right the OPs performance may have been substandard. However when he gets blindsided and his PD mentions 'others' unidentifiable persons as being responsible for his termination, it does raise questions.

I do agree with this. Residents should be able to see all of the evaluations submitted about them. We have evaluations "up the food chain" anonymous -- so students evaluating residents is anonymous, but residents evaluating students is not. This is reasonable as people earlier in training may be uncomfortable giving negative feedback to their superiors. But residents still should get to see all of their evaluations.

And regardless whether or not his performance was substandard does not negate the fact that the systems in place disregard due process and prevent OP from confronting his accusers--a fact you didn't deny. We have no way of knowing. But don't we owe it to OP to at least make sure he is informed, no? "RE: This is not a court of law. This is a job"

The Confrontation Clause of the 6th Amendment guarantees a party the right to confront his accusers. In both peer review, resident termination proceedings, and medical student dismissals it is notably absent.

Residents have no right to "confront their accusers". Residents are evaluated by those with whom they work. They are welcome to discuss those evaluations with their evaluator, or with me (PD). They are welcome to disagree with them if they want. But this is not a court of law and residents have no right, that I know of, to confront anyone. I'm not sure what due process you are referring to. Residency programs are usually held to "academic due process" which requires that the resident be given notice of their deficiencies, have a chance to discuss these deficiencies with the decision maker, and that any decisions be careful and deliberate (http://www.paeaonline.org/index.php?ht=action/GetDocumentAction/i/25431). "Laws of evidence" as you mention above do not apply, because as I have said before, this is not a court proceeding nor a trial. It's an evaluation of job performance.

If the OP (or any resident) takes their case to a grievence hearing, then there will be additional rules about what is allowed and what isn't. Those rules are determined by the institution that should have written policies defining what is allowed. Sometimes it allows for direct questioning of discussants. Sometimes the only people allowed to ask questions are the grievance panel itself. Although a grievance hearing may be "trial like", it's still not a legal court proceeding and is not held to court rules.

If that were true, there would be a lot of lawyers out of work.

Although outside the scope of this discussion, there in fact are many lawyers that are out of work. Take a look at jdunderground.com. Anyway, not really germaine to this discussion.

Malpractice, Wrongful Termination, Negligent Hiring, etc... the list is expansive. All causes of action that invoke any and all information exchanged at "private meetings" of the kind you reference. That information is not protected under any privilege that I am aware of unless it's doctor-patient.

I agree. None of this is privileged. It's private (i.e. I shouldn't release anything without the resident's permission). All of this information should be available to the resident for review. None of what I am saying here should be interpreted that PD's should be allowed to fire residents for anything they want, nor especially for anything that is legally protected. But underperforming as a resident is absolutely grounds for dismissal.

"RE: Presumably the ICU faculty completed evaluations on OP. That isn't heresay" The hell it isn't. These are statements being admitted into a tribunal (of sorts) whether written or oral (recall hearsay need not be spoken, it can be written) by a party that is not available to be questioned or confronted by the OP and it is being used to prove the fact that OP was incompetent. That is the definition of hearsay to a "T", less the formality of a courtroom jurisdiction. If you mean to imply that the evaluations are exempted from hearsay restrictions because they fall under the 'Records of regularly conducted activity' exception to the hearsay rule, I would disagree. how often are these evaluations completed? Bi-Monthly? Quarterly? I don't think they are written daily like most records that are admissible under this exception tend to be. [OP are you beginning to see my earlier point about removing a physician from his castle?...it can be a humbling experience]

I continue to disagree with you. They are not heresay. They are an evaluator's assessment of the resident's performance. They are a biopsy in time. The resident is free to discuss them with me, or with their evaluator. They are free to disagree with them. But this is not a court of law, and I don't have to "prove" that the evaluations are true -- in fact, there's no real way to do that. Usually, I look for patterns. A single poor evaluation is probably a measure of some interpersonal problem. Multiple poor evaluations tends to suggest a deeper problem. And I'm not feeling particularly humbled. I have been deposed before, and have had to submit sworn testimony for complaints to regulatory bodies. It's not a problem, and none of my decisions have been overturned. They key is that I follow the rules -- and I'd like to think that because I follow the rules, we tend to make informed decisions.

My bottom line is this: The OP is free to get legal counsel if they would like. In general, legal counsel will be most helpful in pointing out procedural deficiencies in the remediation and termination process, and also to help assess whether the OP's termination was legal. I don't think that most of your arguments about "heresay" and constitutional amendments will be very effective, but I am not a lawyer. There is significant cost to using a lawyer, and I doubt many will take on a case like this on a contingency basis -- so the OP needs to decide whether hiring a lawyer is a wise financial investment. Ultimately, the OP's major goal should be to exit as gracefully from his/her current program and get a new spot. Getting a lawyer involved may or may not best advance that goal. No harm can come from the OP discussing their situation with a lawyer privately, other than the damage to their wallet. Much harm can come from getting a lawyer involved with your PD.

 

[MDesquire]

Um no, you aren't getting it. We aren't moving past this one issue because it's the most important one. Med school is much more of a one time interaction -- it absolutely won't follow you the same way and if you were further down the road you'd get that. Thats why everyone is getting fustrated with you here -- youre just wrong on this one enormous point and it's the crux -- we aren't going to concede this point. You are telling Mrs Lincoln to move past the whole "Wilkes Booth thing" and ask her to critique the play. Please.

Sometimes the smart thing to do is just admit that maybe others have more experience on a subject than you do. If you can't appreciate that a bunch of residents and attending might know a bit more about residency and the impact if your PD on your future career than you, who never got to that level, that's scary. Shows a Lack of insight similar to that we are presuming the OP might have.

This is the whole point here -- we are saying that sometimes it's better to take some lumps, even not deserved, to live and fight another day. The course of action you suggest ALWAYS has repercussions. It's fine if the OP wants to win for the principle and change careers, but it's not always the right path if his goal is to find and finish a residency someplace. Don't win the battle to lose the war. Your path is often not so fine if his goal is to just continue his medical career. It has to be handled delicately and a Lawyer might be exactly the thing that escalates the situation into something unsalvageable. A good lawyer will realize he sometimes is going to make a bad situation worse and step back. I'm not buying that you are very experienced in residency matters, and your focus on constitutional provisions (most which, as pointed out, don't even apply here) comes off as very first year law studenty.

Your lengthy now apparently banned posts on valueMD are fascinating and give a lot of context into your point of view and maybe why this path didn't work out for you, and IMHO make you exactly NOT the person from whom OP should be taking advice in how to extend his medical career. From those posts,you are precisely the expert at escalating and blowing things up I have been talking about. Forcing a program to threaten a countersuit isnt exactly smoothing things out. Plus you state that getting railroaded out of your Caribbean med school is a "blessing in disguise" but I kind of doubt OP ending up with no residency would feel the same. Just saying.

@Law2Doc you don't seem to understand is that I am not basing my advice for OP on my own personal experience as a MS, which it appears that is what you and others are implying. Yes, I said I might be more qualified to render OP advice, but solely from a point of empathy for having had to transition from one carrier to another. My personal experience was governed by a markedly different set of circumstances than OP and they don't pertain. In my situation there were admissions and restitution by the other party. You've done a fine job of misquoting me and putting words in my mouth Law2Doc and twisting these arguments to essentially stroke your ego. Whatever insight you claim I may be lacking regarding my ability to ascertain what I don't know about the importance of a PD evaluation, is more than compensated by the insight I have to respectfully disengage myself from you. I do not see anything productive coming from it. The OP has not offered any further information, and I have other more pressing obligations to tend to.

BTW, for you to suggest my strategic approach to a grievance against a fraudulent, dishonest, bad faith dealing, unaccredited offshore medical school for breach and conversion would be echoed in my handling of the OPs case, is simply foolish. I have nothing more to lose in that dispute. OP has everything to lose here. If anything, it tells me you may be the one lacking insight (IMHO). Feel free to bring your comments on that separate topic to its respective thread anytime Law2Doc, I look forward to schooling you when its not at the expense of the OP's imminent concerns.

@aProgramDirector you sound like a decent, level-headed and fair PD. I can understand why you may not see the applicability of my hearsay argument, and I don't fault you for it. Before we know it a proprietary robotic iPhone device will be rendering our performance evaluations. I hope you continue to be a voice of reason on this thread in my absence.

To the OP: I came on this thread to warn you that hindsight is 20/20, and your failure to act now could impact you for a long time to come. Don't get bogged down in the outcomes of mine or others' experiences, or what qualifies them to proffer a solution. No commentator here knows your specific circumstances. But the shock of the situation can often be paralyzing and in part my commentary is suggest to you that you don't have the luxury of remaining idle. The administrative powers that be are already preparing for the worst case scenario from you. If they have brought your termination in bad faith or under questionable circumstances, they began covering their tracks long ago. Keep a low profile, and retain counsel. Your attorney will be able to advise you best from here on out. Best of luck to you, and when you eventually find yourself a new carrier, be sure to come back to this thread and let us know how things are working out for you.

 

[rokshana]

@michaelrack 6th amendment does specifically apply to criminal actions; However, 5th and 14th also invoke it. 14th especially regards procedural due process for a government taking of life, liberty, or your residency slot. And the laws of evidence that preclude most hearsay and preserve the right to cross-examine a witness extend into both criminal and civil procedure realms, and they are based largely on the confrontation clause that appears in the 5th, 6th and 14th Amendments. You still hung up on the 4YMS/PGY1 point...? Thanks for your 2 cents, hope we've moved beyond that now. By carrier administrator, i mean a PD, Dean or other executive with authority to produce an eval.

@dpmd/@rokshana both a negative Dean's letter and a negative PD letter can end a medical career. Can we agree upon that? I concede that a neutral PD letter can create substantially more undue burden for a resident than a neutral Dean's letter can for a MS, especially for a resident that is determined to become board certified and licensed in multiple states. Its the former scenario however that the OP should be most concerned about. You may be right about the nature of 'others', but for now its left to speculation.

Actually no…other than a bad MSPE may decrease your chances of getting an interview for a residency spot(or a fellowship spot)…after that the MSPE has NO ROLE…its not asked for in the licensing process or the credentialing process…and no play in ABIM board certification (I don't know about other boards, but i seriously doubt that its asked for). I am both board certified and licensed in multiple states as well as credentialed in multiple hospitals…it can be a painful process with a ton of paperwork….but not once was i asked to have my MSPE sent.

 

[pathperson]

I never thought I would say this, but SDN needs to be more like twitter. Get to the freaking point.

And people say I'm long-winded. Jesus, Mary and Joseph.

Pipe down stupid lawyer!!! CRAM IT FOR THE LOVE OF GOD!!

I'm sure we all mean well, but sometimes the rest of us don't need our lives explained to us by lawyers and MBAs. Less is more.

 

[Law2Doc]

I never thought I would say this, but SDN needs to be more like twitter. Get to the freaking point.

And people say I'm long-winded. Jesus, Mary and Joseph.

Pipe down stupid lawyer!!! CRAM IT FOR THE LOVE OF GOD!!

I'm sure we all mean well, but sometimes the rest of us don't need our lives explained to us by lawyers and MBAs. Less is more.

To lawyers, especially newer ones, words are like foot soldiers -- when you are trying to win (an argument or a battle) you can never have too many
But to be fair to the long winded -caribbean-med-school-washout-turned-lawyer, aPDs last post was pretty darn long too.

 

[BoardingDoc]

No, BoardingDoc, for Sdn medico-legal digest only... Do you routinely troll on these threads with jerky comments, or are we just graced this afternoon? Because nothing quite says "shreddin' crispy backcountry gnar" like a voyeuristic EM resident from Manhattan ... From my personal experience, the only snow manhattan EM docs see with any regularity is the traces their interns failed to wipe away completely. Do yourself a favor...don't go shakin' my tree when you haven't my degree.

Not from Manhattan. I do appreciate the fact that you got riled up enough to go digging through my post history for dirt though. I also thoroughly enjoy the irony of your tree shaking comment given that you've spent this entire thread giving advice about residency when you have yet to graduate medical school.

 

[Dodgers75]

Lolz...

Once a MS pretending to 'know' what is going in the residency world and firmly believing that his/her arguments are absolutely and undoubtedly correct. Incredible. Priceless SDN moments. Just wow.

 

[johndoe44]

Well guys, I actually just got back on this site after may 4 days and wow, cannot believe what I have stirred up. Again, I appreciate all of the comments, support, feedback, "insight" and everything else. I honestly do. I guess you all should know the outcome:

Obviously I cannot address everything that has been said above as it would take a lifetime. I am a US IMG so I do not have to leave the country or anything; I am staying here. My original intention was to appeal the process with the documentation from my evaluations. I was encouraged to appeal because I showed the evaluations openly to other attending physicians and they agreed that based on my performance as a whole, I was at or above expectations. I don't want to keep reiterating my points because I know that is irritating. Basically, it came down to a BIG MEETING with several important people in the room and I attempted to make a case with my evaluations and the specifics in my contrast to show that the proper procedure was not followed; I was asked to stop speaking by the PD because this was not "the proper forum" for appealing my case. In the end, I was notified that I would be terminated and given 20 days to appeal. Once everyone left the room I had a frank conversation with my PD and I told him I knew how this would likely end for me and he agreed. Long story short, PD stated that if I left a resignation letter with today's date by the end of the workday he would forward it to HR and would accept my resignation "personal family issues beyond my control." He was very happy I chose to do this and he is writing a letter of recommendation for me and there is minimal damage to my reputation. We left on professional terms and that was that.

I have been now letting my wife, friends and family know about what had happened and I expected the worst. They have all been nothing but supportive. I had a meet with just the residents and they were all shocked and confused. I let them know how much I appreciated the opportunity to work with them and that I will miss them all. Lots of tears, a lot of frustration but I am happy that I will be missed. I will now be moving on and getting ERAS ready to go for the next chapter with the support of my friends and family. I apologize for any language I used in any of my posts as I was not myself. I am going to take this opportunity to do some other work and there are some research opportunities that I will try to get involved in during interview season.

I think the hardest thing about all of this is the "loss of control" or feeling that you are not in control of your life. To this point, everything has worked well with very few hiccups along the way. I guess its only a matter of time before you need something like this to happen to help you realize that life is crazy and you just have to do the best you can under the circumstances and continue to move forward, even when you feel as awful as I do.

I am actually very glad I started this thread because I hope it will be of some use to others in the future who are certainly going to be facing similar circumstances. I still have my degree, my intern year has been completed, I did not do anything illegal or anything that would tarnish my reputation and I did the best I could. I don't know if there was anything else I would have done different. Again, thanks everybody. You all are great and wish everyone the best.

 

[pathperson]

It sounds like you are trying to make the best of a bad situation. If you are able to take it as a lesson learned and truly think about how to not have this happen next time, I think it will work out for the best.

The worst things that happen in life are a shock. There's nothing you can do to prepare for such things. If you have a good head on your shoulders and good support system you can roll with the punches.

Try to think deeply about the role you played in the outcome, both good and bad. It doesn't sound like it was all your fault, nor was it all the PD fault either. Nothing in life is black and white. We all become entrenched in our opinions, and seek out others who share our opinions bc it makes us feel better and less alone.

As I've gotten older I've realized that sometimes others will never see what is obviously wrong with them. I can also appreciate that I'm not perfect, and maybe other people think I'll never realize what is wrong with me. I've met people in my training who think they're simply wonderful human beings, while frankly I find them intolerable. Perhaps they think the exact same of me. Who knows.

Medicine is strange bc the training is so intimate, yet also so...distant. It's a bizarre psychological experiment. We had a few real specimens in my program at one time, thankfully they're gone. Sometimes personalities just don't mix.

Move on, find a new place. Do not let this happen again, or it means they were right about you, and you cannot function as a physician.

And remember: those bitches don't own your soul unless you let them.

The absolute most important thing is that you have your health. As long as you're healthy, you'll find some job, somewhere, doing something. Do not take this simple fact for granted.

 

[Law2Doc]

Well guys, I actually just got back on this site after may 4 days and wow, cannot believe what I have stirred up. Again, I appreciate all of the comments, support, feedback, "insight" and everything else. I honestly do. I guess you all should know the outcome:

Obviously I cannot address everything that has been said above as it would take a lifetime. I am a US IMG so I do not have to leave the country or anything; I am staying here. My original intention was to appeal the process with the documentation from my evaluations. I was encouraged to appeal because I showed the evaluations openly to other attending physicians and they agreed that based on my performance as a whole, I was at or above expectations. I don't want to keep reiterating my points because I know that is irritating. Basically, it came down to a BIG MEETING with several important people in the room and I attempted to make a case with my evaluations and the specifics in my contrast to show that the proper procedure was not followed; I was asked to stop speaking by the PD because this was not "the proper forum" for appealing my case. In the end, I was notified that I would be terminated and given 20 days to appeal. Once everyone left the room I had a frank conversation with my PD and I told him I knew how this would likely end for me and he agreed. Long story short, PD stated that if I left a resignation letter with today's date by the end of the workday he would forward it to HR and would accept my resignation "personal family issues beyond my control." He was very happy I chose to do this and he is writing a letter of recommendation for me and there is minimal damage to my reputation. We left on professional terms and that was that.

I have been now letting my wife, friends and family know about what had happened and I expected the worst. They have all been nothing but supportive. I had a meet with just the residents and they were all shocked and confused. I let them know how much I appreciated the opportunity to work with them and that I will miss them all. Lots of tears, a lot of frustration but I am happy that I will be missed. I will now be moving on and getting ERAS ready to go for the next chapter with the support of my friends and family. I apologize for any language I used in any of my posts as I was not myself. I am going to take this opportunity to do some other work and there are some research opportunities that I will try to get involved in during interview season.

I think the hardest thing about all of this is the "loss of control" or feeling that you are not in control of your life. To this point, everything has worked well with very few hiccups along the way. I guess its only a matter of time before you need something like this to happen to help you realize that life is crazy and you just have to do the best you can under the circumstances and continue to move forward, even when you feel as awful as I do.

I am actually very glad I started this thread because I hope it will be of some use to others in the future who are certainly going to be facing similar circumstances. I still have my degree, my intern year has been completed, I did not do anything illegal or anything that would tarnish my reputation and I did the best I could. I don't know if there was anything else I would have done different. Again, thanks everybody. You all are great and wish everyone the best.

Given the circumstances, resigning for "personal family issues" and with a positive recommendation from your PD is a home run. You would not have done better if you "lawyered up", tried to force your PD into mediation or get him to sign an agreement not to talk about you -- in fact you would likely have done a lot worse if you showed up with counsel, guns blazing. You should be able to find someplace to give you another chance and hopefully will not hit the same snags. Congrats.

 

[Taurus]

I'll echo what others have said.

Residency is not like other jobs. You need their help every time you apply for a state license or privileges at new hospital. It is a very critical stage of your medical training and you need to proceed carefully with it. If you burn bridges badly, then they can become passive aggressive and get back at you later. This is different than medical school or working as a an attending. Once you get a residency or are done with residency, you are not as dependent on your medical school or old place of work. You only need your medical school to verify you graduated from there and most times that is taken care by the registrar. If you burn bridges at an old place of work, you can present your side of the story when you apply for privileges at a new place.

Even if you intimidate your residency with a lawyer, it's a Pyrrhic victory because it will only get them to extend you a few months longer or until the end of your annual contract at best. They can choose to not renew your contract. This is the best outcome possible. Most noncompetitive residencies like IM, FM, peds, pscyh, etc will give people a second and usually final chance. If you screw up again, you most likely are done. So figure out how to not repeat the mistakes by identifying what specialty is best suited for your abilities and personality.

I always advise to get legal counsel when it's you versus them situation. However, you and your counsel need to know how to play the game to get the best outcome. MDesquire's counsel would be considered terrible and he would have cost you your medical career. That he refuses to listen to others who have already gone down this road is a huge red flag.

 

[ThoracicGuy]

Once everyone left the room I had a frank conversation with my PD and I told him I knew how this would likely end for me and he agreed. Long story short, PD stated that if I left a resignation letter with today's date by the end of the workday he would forward it to HR and would accept my resignation "personal family issues beyond my control." He was very happy I chose to do this and he is writing a letter of recommendation for me and there is minimal damage to my reputation. We left on professional terms and that was that.

At this point it would be worthwhile to meet with the icu staff and also some staff that you trust and ask what you can do better in a future residency and prevent the same problems from happening. Sounds like you've got the best outcome that you could from this bad situation.

 

[Gastrapathy]

Get the letter written and put in your training file before you walk away. The manufactured time pressure is really unfair and was designed to get you to quit. Much easier than the risk of an appeal and a lawsuit. Go back and tell him you need the letter before you leave.


Sent from my iPhone 6 using Tapatalk

 

[TexasPhysician]

Get the letter written and put in your training file before you walk away. The manufactured time pressure is really unfair and was designed to get you to quit. Much easier than the risk of an appeal and a lawsuit. Go back and tell him you need the letter before you leave.


Sent from my iPhone 6 using Tapatalk

Agreed. I as well am still concerned for the OP. Verbal agreement means nothing unless everyone voluntarily sticks to their word......not always so.

 

[shopsteward]

OP: I'm sorry the meeting didn't go better for you. It sounds as though you were bounced into it with no back-up and little idea of what your employers intended its purpose to be. The PD bouncing you into resigning the same day was bad.

I agree with others: you need the PD's letter of recommendation in your hand as soon as possible. I would also suggest that if there are other attendings at your program who might be willing to give you a good reference, set that up with them now - it will serve you well to have several references in hand from your PGY1 year. If you can, get them from attendings doing the type of work you want to undertake in your new residency.

You will need to explain at interviews your reasons for resignation, and in such a way that it does not conflict with whatever your program says about you and minimises the potential worry that those reasons might reoccur. Good luck with the potential research opportunities, and I hope your applications to get back into residency go well. You should be looking out for off-cycle positions as well as applying through ERAs for positions starting next June. On ERAs, remember to look for "R" codes, which are positions starting PGY2 next June, which would mean only one year out and not having to repeat your intern year.

 

[MDesquire]

Not from Manhattan. I do appreciate the fact that you got riled up enough to go digging through my post history for dirt though. I also thoroughly enjoy the irony of your tree shaking comment given that you've spent this entire thread giving advice about residency when you have yet to graduate medical school.

Because in BoardingDoc's world of trolls, OP came to this forum seeking some friendly advice on how to improve his ICU skills and impress his PD. Get some rest, son.

 

[johndoe44]

Just a follow-up for everyone:

Again, I can't appreciate you all enough for the support. I am still going up to the hospital; I was told that my LoR from the PD has already been dictated and typed up Friday by the secretary and PD will just need to look at it Tuesday and I will be able to glance over it quickly. We have an agreement of what to say if during itherviews I am asked why I resigned so that our responses will match but at the same time will not be lying about the situation.

I have 3 outstanding LoR from attending physicians already and they have been nothing but supportive so I am just hoping that my board scores, transcripts and letters of Rec will help me get into another spot. I can't change what happened but I guess through all this its the best outcome I can have.

I also am looking every day for PGY 2 spots that periodically open up. If any of you guys hear of any openings feel free to PM me and let me know. Again, thanks for t the help through all this.

Thanks again.

 

[MDesquire]

I'll echo what others have said.

I always advise to get legal counsel when it's you versus them situation. However, you and your counsel need to know how to play the game to get the best outcome. MDesquire's counsel would be considered terrible and he would have cost you your medical career. That he refuses to listen to others who have already gone down this road is a huge red flag.

@Taurus really has a way with words. "Residency is not like other jobs" How profound. Nobody to my knowledge has previously stated that the best case scenario would be for OP to have his contract terminated by periodicity. Thats an original thought credited to Taurus alone, and by far the most naive of the 'best possible scenarios' forwarded yet. While he is entitled to his opinion, Taurus shouldn't come on this thread allegedly reiterating the advice I have rendered prior about the risks of disclosing counsel, and in the same breath say my advice would have cost the OP his medical career. It makes him look incredibly foolish, especially as someone who advertises themselves as an attending physician. Read the thread from start to finish, like the OP and all the other contributors here have, and then come back and comment appropriately. "MDesquire's counsel would be considered terrible" Really? Interesting use of a conditional statement without a condition. Way to take responsibility for your opinion. You sound like a squid with a pen. Your assertion that I have not been "listening" is humorous coming from you. Termination without cause has redundant elements no matter what the industry or executive level therein. The crux of my entire post and one you failed to even touch upon, is that the OP need to protect his interests in the event that he was wrongfully terminated. @aProgramDirector I believe was the only commentator who was willing to go there, albeit reluctantly.

@Taurus "RE: I always advise to get legal counsel when it's you versus them situation." What the hell is that supposed to mean? OP aims to earn a living for himself and his family by completing a residency, and his PD, ICU Staff and "others" are saying that he is not competent to do so and are enjoined to write an eval that could potentially end his career. Whether or not his incompetency was due to family matters or otherwise does not negate the fact that PD felt he was a danger to his patients. Those are damning words irrespective of the causation. OP presumably has hundreds of thousands invested into his medical education and specialized training. His carrier is not saying that he would be a better fit elsewhere or in another specialty. OP did not disclose that his PD intends to see him transition into a new carrier. There were no such assurances disclosed on this forum. OP made it sound as if he was blindsided by his PD and 'others.' It's necessarily an adversarial situation. The OP and his carrier now have competing interests. Whether or not the adversarial relationship becomes hostile or actionable is largely up to the parties involved. But don't try and sugarcoat the hose that OP is getting. It's a disciplinary and punitive measure as much as it is a measure to protect the interests of OPs carrier.

Recall that another presumed PD claimed that that he had no choice--no free will in fact-- whether or not to invoke legal counsel if he was so much as approached by other counsel. He didn't suggest a law suit, he stated the mere disclosure of the OP having retained counsel would require him to invoke his legal department, less he might lose his job. I recommend the OP find out if that's policy at his carrier. If so, that will tell you that many of the proud residents and physicians urging him to exercise restraint, ironically have not the authority to restrain themselves. Hypocrisy at its finest.

To the OP: It sounds from the new information you provided "RE: personal family issues beyond my control" that your termination may be explanatory and absolve you of any negligence. However, the way your final letter is worded is critical. I still suggest you retain counsel. Any ambiguous insinuation that you were a danger to your patients could be damning. There have been several good suggestions posted recently that call for your proactive solicitation of constructive criticism, letters of rec, etc from your colleagues as well as to have that PD letter composed prior to your departure. All very sound advice that echo my initial posts here. You weren't clear in your post whether or not you submitted your resignation. If so be certain that you resignation is not a release and waiver, but merely expresses your desire to resign for "personal family issues beyond your control". If otherwise I suggest you bring it to the attention of your counsel. If indeed it later surfaces that you were wrongfully terminated, your rights to recover will not be extinguished granted you did not release the other party and waive them. Craft that resignation letter carefully. Keep it short and to the point. Make your last days on the job the best ones yet, and have a good attitude. At the end of the day it is your character, not an isolated ill-performance, that will follow you through your life and career. Please keep that in mind, and resolve to do a better job in the future of protecting your interests. Make it a point to befriend others at your workplace who know you well and can render honest objective assessments of your performance before its too late. They could be your best defense against a repeated failure. Please keep us posted if there are any new developments, and I am glad you took away something from these commentaries. Yes, you are right they will be here for others who find themselves in a similar situation to peruse, although like the pen names of their creators--and in the spirit of free thought and free speech--they will remain anonymous.

 

[michaelrack]

To the OP: It sounds from the new information you provided "RE: personal family issues beyond my control" that your termination may be explanatory and absolve you of any negligence. However, the way your final letter is worded is critical. I still suggest you retain counsel. Any ambiguous insinuation that you were a danger to your patients could be damning. There have been several good suggestions posted recently that call for your proactive solicitation of constructive criticism, letters of rec, etc from your colleagues as well as to have that letter composed prior to your departure. All very sound advice that echo my initial posts here. You weren't clear in your post whether or not you submitted your resignation. If so be certain that you resignation is not a release and waiver, but mere expresses your desire to resign for "personal family issues beyond your control". If otherwise I suggest you bring it to the attention of your counsel. If indeed it later surfaces that you were wrongfully terminated, your rights to recover will not be extinguished granted you did not release the other party and waive them. Craft that resignation letter carefully. Keep it short and to the point. Make your last days on the job the best ones yet, and have a good attitude. At the end of the day it is your character, not an isolated ill-performance, that will follow you through your life and career. Please keep that in mind, and resolve to do a better job in the future of protecting your interests. Make it a point to befriend others at your workplace who know you well and can render honest objective assessments of your performance before its too late. They could be your best defense against a repeated failure. Please keep us posted if there are any new developments, and I am glad you took away something from these commentaries. Yes, you are right they will be here for others who find themselves in a similar situation to peruse, although like the pen names of their creators--and in the spirit of free thought and free speech--they will remain anonymous.

"If indeed it later surfaces that you were wrongfully terminated" - what would you recommend the OP do in this case- file a lawsuit for the remainder of his PGY2 salary - 85% of 50k or $42,500??? After attorney fees he would net maybe 30k. If he ends up losing his career (can't find another residency) and gives up on getting a residency, I guess this would be an option but it would definitely close the door on his medical career.

 

[BlondeDocteur]

@johndoe44 are you hoping to stay in IM?

 

[MDesquire]

"If indeed it later surfaces that you were wrongfully terminated" - what would you recommend the OP do in this case- file a lawsuit for the remainder of his PGY2 salary - 85% of 50k or $42,500??? After attorney fees he would net maybe 30k. If he ends up losing his career (can't find another residency) and gives up on getting a residency, I guess this would be an option but it would definitely close the door on his medical career.

That's a very good question, and a lot will depend on OPs efforts to mitigate his damages. There are very complex algorithms and case law precedents to determine the expectation damages that one can recover from wrongful termination or wrongful death for that matter. For families of the victims of the 9/11 attacks the amounts were astounding, particularly for those like the OP with advanced degrees and promising careers. Sorry OP for the gravity of the analogy, but it is one of the most influential bits of actuarial case law in recent times that I am familiar with. I know that one physician who had been terminated about a decade ago, and has been battling in the courts ever since, finally settled his case with his former carrier for around 10M. He was a practicing ObGyn. Depending on the nature of the wrongful termination, ie) if malicious, he may recover punitive damages as well. I would estimate the recovery to be significant. OP would have the burden of proving causation (linking the termination to his inability to continue his training), which brings me back to my original point about good faith effort to find an alternate carrier, and chosen career path beyond the scope of medical practice. Plenty of other pursuits available to the OP beyond practice of medicine that fall under 'medical career'.

 

[Taurus]

@Taurus really has a way with words. "Residency is not like other jobs" How profound. Nobody to my knowledge has previously stated that the best case scenario would be for OP to have his contract terminated by periodicity. Thats an original thought credited to Taurus alone, and by far the most naive of the 'best possible scenarios' forwarded yet. While he is entitled to his opinion, Taurus shouldn't come on this thread allegedly reiterating the advice I have rendered prior about the risks of disclosing counsel, and in the same breath say my advice would have cost the OP his medical career. It makes him look incredibly foolish, especially as someone who advertises themselves as an attending physician. Read the thread from start to finish, like the OP and all the other contributors here have, and then come back and comment appropriately. "MDesquire's counsel would be considered terrible" Really? Interesting use of a conditional statement without a condition. Way to take responsibility for your opinion. You sound like a squid with a pen. Your assertion that I have not been "listening" is humorous coming from you. Termination without cause has redundant elements no matter what the industry or executive level therein. The crux of my entire post and one you failed to even touch upon, is that the OP need to protect his interests in the event that he was wrongfully terminated. @aProgramDirector I believe was the only commentator who was willing to go there, albeit reluctantly.

@Taurus "RE: I always advise to get legal counsel when it's you versus them situation." What the hell is that supposed to mean? OP aims to earn a living for himself and his family by completing a residency, and his PD, ICU Staff and "others" are saying that he is not competent to do so and are enjoined to write an eval that could potentially end his career. Whether or not his incompetency was due to family matters or otherwise does not negate the fact that PD felt he was a danger to his patients. Those are damning words irrespective of the causation. OP presumably has hundreds of thousands invested into his medical education and specialized training. His carrier is not saying that he would be a better fit elsewhere or in another specialty. OP did not disclose that his PD intends to see him transition into a new carrier. There were no such assurances disclosed on this forum. OP made it sound as if he was blindsided by his PD and 'others.' It's necessarily an adversarial situation. The OP and his carrier now have competing interests. Whether or not the adversarial relationship becomes hostile or actionable is largely up to the parties involved. But don't try and sugarcoat the hose that OP is getting. It's a disciplinary and punitive measure as much as it is a measure to protect the interests of OPs carrier.

Recall that another presumed PD claimed that that he had no choice--no free will in fact-- whether or not to invoke legal counsel if he was so much as approached by other counsel. He didn't suggest a law suit, he stated the mere disclosure of the OP having retained counsel would require him to invoke his legal department, less he might lose his job. I recommend the OP find out if that's policy at his carrier. If so, that will tell you that many of the proud residents and physicians urging him to exercise restraint, ironically have not the authority to restrain themselves. Hypocrisy at its finest.

To the OP: It sounds from the new information you provided "RE: personal family issues beyond my control" that your termination may be explanatory and absolve you of any negligence. However, the way your final letter is worded is critical. I still suggest you retain counsel. Any ambiguous insinuation that you were a danger to your patients could be damning. There have been several good suggestions posted recently that call for your proactive solicitation of constructive criticism, letters of rec, etc from your colleagues as well as to have that PD letter composed prior to your departure. All very sound advice that echo my initial posts here. You weren't clear in your post whether or not you submitted your resignation. If so be certain that you resignation is not a release and waiver, but merely expresses your desire to resign for "personal family issues beyond your control". If otherwise I suggest you bring it to the attention of your counsel. If indeed it later surfaces that you were wrongfully terminated, your rights to recover will not be extinguished granted you did not release the other party and waive them. Craft that resignation letter carefully. Keep it short and to the point. Make your last days on the job the best ones yet, and have a good attitude. At the end of the day it is your character, not an isolated ill-performance, that will follow you through your life and career. Please keep that in mind, and resolve to do a better job in the future of protecting your interests. Make it a point to befriend others at your workplace who know you well and can render honest objective assessments of your performance before its too late. They could be your best defense against a repeated failure. Please keep us posted if there are any new developments, and I am glad you took away something from these commentaries. Yes, you are right they will be here for others who find themselves in a similar situation to peruse, although like the pen names of their creators--and in the spirit of free thought and free speech--they will remain anonymous.

Sorry, I and most people did not read your long-winded posts. If I need a cure for insomnia, I now know where to go.

Like some other people on SDN, I had a career before medicine. I made a six figure income. I even had to retain legal counsel when I got screwed over. And now I've gone through the residency process. So I'm in a good position to comment on this case. Good or bad, medicine has a different culture than most other professions. If you want to successfully complete residency and have a long medical career, then you have to know how to play the game. Know when to pull the legal nuclear bomb. You don't pull it at the first chance. Most noncompetitive residencies will give you a second chance.

As dismissed medical student and year 1 or 2 law student, I don't expect you to know that. I think you like to hear yourself talk and think that we are impressed by all your references to constitutional law. We are not. However, your presence has been helpful. It shows other people WHAT NOT TO DO.

 

[johndoe44]

@ Blonde Doc, I would love to stay in Internal Medicine and I actually wouldn't even mind repeating my intern year. Whether that can happen I'm not sure? At this point, I would be happy doing anything whether is be family medicine, hospitalist, sports medicine, psychiatry; you name it. But I do intend to reapply to IM. I figure it can't hurt to see if there are other programs out there who may like a candidate who has all three steps passed and a year of internship under his belt. However, how I phrase the resignation is something I am trying to figure out. Me and the PD came to an agreement that we would not lie but we would make sure that our responses are exactly the same if someone where to call him. Still, its hard to explain a resignation due to "personal reasons" but I will work on it.

If you know of any IM programs that would give a guy like me a second chance let me know. I think my board scores and GPA and letters of rec from my attendings will be great however I know the question will come up.

Again, I can't believe the response to this thread, pretty heated debate. I have to say though that I am glad I resigned and I am glad that me and my PD are on speaking terms and that he is holding up his end which I appreciate.

 

[anes]

Medicine is a brutal field. I agree with the above poster that you have to play the game.

OP as several people have stated before, you are done with this program. Based on your next several moves you may be done with clinical medicine completly. Try to leave on good terms and secure a spot in any specialty. You should probably start looking for alternate medically related careers as well.

Edit - just saw your post. You did the right thing and have significantly improved your chances of staying in clinical medicine. Good move.

 

[MDesquire]

Sorry, I and most people did not read your long-winded posts. If I need a cure for insomnia, I now know where to go.

Like some other people on SDN, I had a career before medicine. I made a six figure income. I even had to retain legal counsel when I got screwed over. And now I've gone through the residency process. So I'm in a good position to comment on this case. Good or bad, medicine has a different culture than most other professions. If you want to successfully complete residency and have a long medical career, then you have to know how to play the game. Know when to pull the legal nuclear bomb. You don't pull it at the first chance. Most noncompetitive residencies will give you a second chance.

As dismissed medical student and year 1 or 2 law student, I don't expect you to know that. I think you like to hear yourself talk and think that we are impressed by all your references to constitutional law. We are not. However, your presence has been helpful. It shows other people WHAT NOT TO DO.

Who elected you as spokesman for "most people" on this thread Taurus? You seem to be doing that a lot--speaking on others behalf without actual authority to do so. Do you think your physician counterparts here on Sdn are so mindless that they will come to your defense solely because a lawyer may have stuck it to them at some point in their medical career?

Unlike yourself, many commentators have evidenced a sound understanding of the issues at hand and did not make offensive judgmental generalized assessments about others' advice like you did. You apologized for not reading my posts in their entirety, Tuarus, yet you stopped there. To me that evidences a serious character flaw on your part. Do you routinely bash others based on the merits of hearsay when their original content is readily available to you? Remind me not to elect you as my physician when my prospective treatment will be based in part on my pertinent medical history.

Furthermore, you now assert that I am a 'dismissed' medical student and a 1st or 2nd year law student. Also gross assumptions not based in fact. Your posture and metaphor of a legal intervention to a nuclear bomb is kafkaesque and almost sinister. Please restrain yourself from making assumptions and criticisms on a thread you haven't even bothered to digest. Your a detriment. Glad you see this situation as a 'game'. I can assure you the OP likely doesn't see it that way.

RE: "Like some other people on SDN, I had a career before medicine. I made a six figure income. I even had to retain legal counsel when I got screwed over... So I'm in a good position to comment on this case." Really? Because making a C level salary and retaining a lawyer for a tort undoubtedly qualify you to tender advice on wrongful termination and procedural due process. Its clear as day. You must have also slept at a Holiday Inn Express last night doc. Your commentary is insensitive to the OP and self-serving.

 

[IlDestriero]

Your advice sucked. It was ignored and the best possible outcome for this resident was reached.
Deal with it.
P.S. OP, don't leave without a copy of the PD's letter in hand. Good luck. Don't make the assumptions that many dismissed residents do (it was them, they are malignant, I did nothing wrong, they had it out for me, it was because I'm an IMG, etc.). It was you. It sounds like what you thought was adequate prep was not. Read more, read about others patients, read about the interesting cases for the conference, read about stuff you know is coming up at M&M/CQI. Just read.

 

[MDesquire]

Your advice sucked. It was ignored and the best possible outcome for this resident was reached.
Deal with it.
P.S. OP, don't leave without a copy of the PD's letter in hand. Good luck. Don't make the assumptions that many dismissed residents do (it was them, they are malignant, I did nothing wrong, they had it out for me, it was because I'm an IMG, etc.). It was you. It sounds like what you thought was adequate prep was not. Read more, read about others patients, read about the interesting cases for the conference, read about stuff you know is coming up at M&M/CQI. Just read.

Nothing like a monday morning quarterback trying to earn respect. Quoting IlDestriero, "I think that the true purpose of what is now known as Obamacare is to drive up the price of private insurance over the next 10-20 years. The system will than prove itself to be "unsustainable" and a "failure". That opens the door for the government to step in and make whatever brutal changes are needed.." A wild conspiracy theorist 'told ya so', to boot. Deal with what exactly IlDestriero? That the PD felt inclined to come up with a 'script' and voluntarily limit his disclosures to prospective carriers? That was exactly the endpoint I suggested the OP aim for. The fact that he may have been able to achieve that without counsel is an exceptional outcome IMO. Hindsight is 20/20 "Ether Man."

However, we can't be sure the OP didn't retain counsel, now, can we? If the OP knows what is best for him, he's better of not disclosing those details on this or any public forum. Time will ultimately tell whether or not my suggestions were prophylactic or not. To assert otherwise at this point would be foolish.

"RE: OP, don't leave without a copy of the PD's letter in hand." As if OP is in any position to demand production of a sensitive internal document. That's really insightful. Maybe the PD will just drop a copy off a copy when he swings by the OPs family BBQ to catch some of the game and have a few beers.

OP despite my prudence and suggestion to prepare for the worst case scenario, I sincerely hope your PD is willing to furnish a copy of his eval within a reasonable period of time. I don't grasp the importance of it being shared with you prior to your leaving. It can be amended at any time. But clearly it would behoove you to request your academic file/employee file as soon as possible, and of course prior to your attempts to procure another carrier. If indeed your PD chooses not to share that letter with you, when in fact he is willing to narrowly tailor his speech, that would be cause for concern and something you and your legal counsel should promptly address.

 

[Law2Doc]

Nothing like a monday morning quarterback trying to earn respect. Quoting IlDestriero, "I think that the true purpose of what is now known as Obamacare is to drive up the price of private insurance over the next 10-20 years. The system will than prove itself to be "unsustainable" and a "failure". That opens the door for the government to step in and make whatever brutal changes are needed.." A wild conspiracy theorist 'told ya so', to boot. Deal with what exactly IlDestriero? That the PD felt inclined to come up with a 'script' and voluntarily limit his disclosures to prospective carriers? That was exactly the endpoint I suggested the OP aim for. The fact that he may have been able to achieve that without counsel is an exceptional outcome IMO. Hindsight is 20/20 "Ether Man."

However, we can't be sure the OP didn't retain counsel, now, can we? If the OP knows what is best for him, he's better of not disclosing those details on this or any public forum. Time will ultimately tell whether or not my suggestions were prophylactic or not. To assert otherwise at this point would be foolish.

"RE: OP, don't leave without a copy of the PD's letter in hand." As if OP is in any position to demand production of a sensitive internal document. That's really insightful. Maybe the PD will just drop a copy off a copy when he swings by the OPs family BBQ to catch some of the game and have a few beers.

OP despite my prudence and suggestion to prepare for the worst case scenario, I sincerely hope your PD is willing to furnish a copy of his eval within a reasonable period of time. I don't grasp the importance of it being shared with you prior to your leaving. It can be amended at any time. But clearly it would behoove you to request your academic file/employee file as soon as possible, and of course prior to your attempts to procure another carrier. If indeed your PD chooses not to share that letter with you, when in fact he is willing to narrowly tailor his speech, that would be cause for concern and something you and your legal counsel should promptly address.

It's over Johnny.


The OP got the best possible result. He did so by going it alone and not letting things escalate by showing up with legal counsel. I think EVERY resident and attending on this thread has now pressed upon you that you really aren't grasping the differences in approach needed in handling a med school versus residency dismissal.

Good luck with your legal career. You should probably stick to med students dismissed for discriminatory reasons -- that seems to be your wheelhouse. But for the resident being let go who needs to salvage a career, not win a lawsuit, know that your aporoach is often his absolute worst enemy. Screaming about protected classes and demanding mediation might be a way to win a case, but it could easily end his career.

Hope you learned something here, because this situation and the end result do give a bit of insight in how these things sometimes play out at the residency level, and differ from the med school level.

 

[IlDestriero]

Hindsight isn't 20/20. There was no way he was going to continue with that eval history, so termination one way or another is a given. The best outcome is an amicable one. Escalation of forces applies here as on the battlefield. You don't need to go on guns blazing when you're going to get what you want by asking.
Of course if you ask an attorney if they should be involved, and you can pay, they will always say yes.
PS my "conspiracy theory" is a widely held view. They could not legislate a national healthcare system 20 years ago and they couldn't do it now. However Obama care will destabilize the existing system, costs will continue to rise, more and more people will qualify for ever more expensive government assistance and then they will finally be able to make a case for creating a national health care system.
I hope you enjoyed reading my old posts looking for something you can try to spin to enhance your argument. You will be an exceptional attorney. For future reference, I use a lot of sarcasm, so it should be easy to take things out of context and crucify me.

 

[rokshana]

can we all just stop feeding the lawyer in training?
OP i'm glad you too the high road here, sounds like you got the best of a crappy situation…
hopefully you will land a spot for next year (look for off cycle spots or unexpected openings)
spend this time reading and building your fund of knowledge….ask do try to see what you can do differently so these mistakes don't happen again.

 

[MDesquire]

It's over Johnny.


The OP got the best possible result. He did so by going it alone and not letting things escalate by showing up with legal counsel. I think EVERY resident and attending on this thread has now pressed upon you that you really aren't grasping the differences in approach needed in handling a med school versus residency dismissal.

Good luck with your legal career. You should probably stick to med students dismissed for discriminatory reasons -- that seems to be your wheelhouse. But for the resident being let go who needs to salvage a career, not win a lawsuit, know that your aporoach is often his absolute worst enemy. Screaming about protected classes and demanding mediation might be a way to win a case, but it could easily end his career.

Hope you learned something here, because this situation and the end result do give a bit of insight in how these things sometimes play out at the residency level, and differ from the med school level.

Thanks for the Swayze comparison, I'll take it, however I hardly see myself as an outlaw in this scenario. I hope for the OPs sake, what you assert is true, but I think its still early to be feeling confident. My approach would be the same for both scenarios, and we can agree to disagree on this. Hopefully at the very least this thread has served its intended purpose of directing the OP to counsel and the importance of soliciting everything he can for documentary and self-improvement purposes. As an ancillary benefit it exposed some of issues that are brewing at the AMA/AMSA and State legislative level. There's a good quote by Osler that comes to mind, regarding your sentiment...

"He who knows not and knows not he knows not: he is a fool - shun him. He who knows not and knows he knows not: he is simple - teach him. He who knows and knows not he knows: he is asleep - wake him. He who knows and knows he knows: he is wise - follow him.”

Thank you for your good wishes.

 

[deleted480308]

you are exhausting mdesquire...you will do better when you play better with others

I've had my share of situations fall apart in life, that trend drastically changed when I realized I was the common denominator and worked on changing me. I'm trying to react to you like you are teachable, although you are acting like you want to be in the shunning category.

 

[MDesquire]

Hindsight isn't 20/20. There was no way he was going to continue with that eval history, so termination one way or another is a given. The best outcome is an amicable one. Escalation of forces applies here as on the battlefield. You don't need to go on guns blazing when you're going to get what you want by asking.
Of course if you ask an attorney if they should be involved, and you can pay, they will always say yes.
PS my "conspiracy theory" is a widely held view. They could not legislate a national healthcare system 20 years ago and they couldn't do it now. However Obama care will destabilize the existing system, costs will continue to rise, more and more people will qualify for ever more expensive government assistance and then they will finally be able to make a case for creating a national health care system.
I hope you enjoyed reading my old posts looking for something you can try to spin to enhance your argument. You will be an exceptional attorney. For future reference, I use a lot of sarcasm, so it should be easy to take things out of context and crucify me.

Please read Post #28 in its entirety, and then see how you feel about your commentary. I don't agree with your insinuation about rainmaking--although if it was meant to be humorous, I'm still at "your advice sucked, deal with it". Any attorney who is asked whether or not they should be involved should render sound advice with their clients best interest in mind. Its remarkable how little most MS and residents know about their rights and the law. These are knowledge deficits by which many administrations avail themselves; And, perhaps a good case for the integration of administrative law and medical jurisprudence coursework in MS.

I didn't use your old post to spin anything. I used it to discredit you. You jumped on this forum making offensive and snap judgments without supporting evidence. The Sdn platform is designed to keep us all honest here. Your theory on the ACA in my opinion, much like your prior comment was not well supported. Conspiracy theories hardly ever are. You are suggesting that the government has ulterior motive aimed at destabilizing a broken system instead of reforming it. Those are loaded assertions, and whether "wildly held" or not, not well supported. I don't intend to digress from the topic at hand. This is still a very delicate situation for the OP in my opinion, and your Monday morning qaurterbacking did necessarily leave you open to a fair degree of ridicule. I'll keep your disclosures in mind moving forward.

 

[IlDestriero]

That's not a conspiracy theory, that's politics. If you can't legislate the change you want, you find an alternative plan to lead you to the same endpoint.
And your advice, unless I misread it, was to leave quietly and have your attorney become a thorn in the PDs side and negotiate on your behalf. A costly and unnecessary error, one that could immediately close the door on an amicable split. When your attorney starts talking to the PD, the Hospital's and/or University's attorney takes the wheel and the focus changes from amicable agreement to protection from liability, and the University attorney doesn't care at all what happens to some dismissed resident with a history of bad evaluations. In fact they would almost certainly advise the PD to NOT write a vague or even neutral LOR because it could be used in the presumed forthcoming lawsuit to prove you were in fact terminated without cause and entitled to significant damages. I'm not sure why you don't see that.