Imminent termination, need serious advice!!!

[TexasPhysician]

I met a resident who went through a "threatened termination". She lawyered up fast. The result was that she agreed to leave in exchange for the program helping to set-up a transfer. Not wanting a legal battle, the program quickly helped her transfer out.

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[dpmd]

OK, noted.

Let me ask you a couple of questions. Plain and simple. No sarcasm, I really want your honest answers.

1. What lesson should I have learned from this?
2. Is it right to fire residents without remediation or feedback?
3. Would you ever advance a resident to a PGY 2 position and then fire them after one month?
4. Do residents often get fired for medical knowledge deficits? If so, how do you determine their deficits?

Please, I want an honest answer for each of these. That is all.

1. That if you are told your knowledge is deficient you need to work on that knowledge instead of expecting to be taught everything you need to know. Actually in general people need to understand that residency is not meant for staff and seniors to teach you everything. It is supposed to let you practice the lifelong learning you can expect in the future. I still don't know everything I need to know to do my job and I am done with training. I do however know what I don't know and seek out the knowledge I need. I don't wait for someone to teach it too me.
2. No, however you were given remediation and failed it.
3. I don't run a program, but I can see where a marginal resident would get advanced with the caveat that they need to improve (I actually have seen this happen, however the residents involved stepped up their efforts and were allowed to stay in the program) because that is less disruptive to the program. In most cases advancement is automatic and the schedule/rotations are all made with the expectation of x amount of second years and x amount of interns. Holding a resident back really screws with that so I can see why it is avoided.
4. A resident who remains deficient despite remediation should be fired but I don't know how often it occurs. It is assessed by the faculty and senior residents working with said resident. It isn't that hard to figure out which residents seem to always be struggling to understand what to do or what is going on with patients versus those that have their **** together. The ones in the middle are harder to figure out, but then in training exams might help with that.

 

[Chicago2012]

 

[AStark]

1.) If you feel you may not be doing a great job or if you feel "watched", ALWAYS keep your head low and minimize your exposure to the people who you feel may not like you. It is truly "out of sight, out of mind."

I'm not sure what this means in practice.

2.) Whatever attending you work with, do everything exactly the way they do it; even if you disagree. If they call cardiogenic shock sepsis, then you take the attending's side EVERY time. Figure out how your attending ticks; figure out what drugs they like to use, who they like to consult, etc. It does not matter who is right, it is about pleasing that attending.

I strongly disagree with this. It is always reasonable to offer your opinion, but of course you also need to ask reasonable questions and have a good sense of the strengths of your knowledge base. While there are many things that end up as judgement calls - even in the ICU (and you can certainly have both cardiogenic shock and sepsis at once) - it's also about recognizing the superior and more extensive experience of the staff. It's not because your attending is "always right", but they're certainly more experienced.

3.) Being compassionate, caring and nice to the nurses and patients has absolutely no bearing on success as a resident. I found myself doing this more than anything else. I always wanted to spend extra time speaking with families, laughing with nurses and just having a great sense of humor. This, in retrospect, is the worst idea ever. Get your work done, do not spend extra time with patients, do not worry about their families. If they need compassion, call a social worker or tell the nurse. However, NEVER be rude. Being rude is just as bad. Just be indifferent to both patients and staff; everything should be matter of fact and do not spend extra time learning names.

I don't think there's really a trade-off here. When you're more efficient, you have more time for this kind of stuff.

(Not that I pretty much ever want to spend extra time speaking with families...)

 

[Over9000]

I strongly disagree with this. It is always reasonable to offer your opinion, but of course you also need to ask reasonable questions and have a good sense of the strengths of your knowledge base. While there are many things that end up as judgement calls - even in the ICU (and you can certainly have both cardiogenic shock and sepsis at once) - it's also about recognizing the superior and more extensive experience of the staff. It's not because your attending is "always right", but they're certainly more experienced.

You have to know your audience.
It's generally a good idea to go along with the attending, even if they're dead wrong. If you think you can be slick and get them to consider your point of view by asking questions, then be careful about it, but if they're the type that frowns upon questions, then don't ask. In the end, they're the ones who hold the final word on their patients' care (do they also hold full legal responsibility?) and no amount of trying to convince them otherwise will change anything. It will only make you a new enemy.

 

[johndoe44]

You have to know your audience.
It's generally a good idea to go along with the attending, even if they're dead wrong. If you think you can be slick and get them to consider your point of view by asking questions, then be careful about it, but if they're the type that frowns upon questions, then don't ask. In the end, they're the ones who hold the final word on their patients' care (do they also hold full legal responsibility?) and no amount of trying to convince them otherwise will change anything. It will only make you a new enemy.

This was my experience. You think you are slick and might add a word or two or ask a question that you believe is showcasing your talent but in reality you look like a pretentious ass (even if you are right). Point is, best to just speak when spoken to and answer questions without excessive elaboration. Answer any question directly, to the point and then zip it.

 

[johndoe44]

I'm not sure what this means in practice.

Not in private practice but in residency. What I am trying to say is it would be advisable that while you are an intern or resident, to avoid speaking with attendings unless it is unavoidable and if you do say as little as possible. No words are better than stupid words. Also, even though you can "sit down with your PD" or discuss things with faculty, it is probably best to try and completely avoid the office altogether.

"out of sight, out of mind" plays a huge role in your evaluation. If you are not seen often but you get your work done, it is likely no one will have anything negative to say. Just a fact and a part of human nature.

 

[Chicago2012]

Yeah that's still a horrible suggestion

Wouldn't you think having a dialogue with those that are in charge of evaluating you would be the best option? smh

 

[dpmd]

Wouldn't you think having a dialogue with those that are in charge of evaluating you would be the best option? smh

I suppose the point is if you are just going to say ignorant or wrong things it is better to be quiet so they don't notice how bad you really are.

 

[johndoe44]

Wouldn't you think having a dialogue with those that are in charge of evaluating you would be the best option? smh

LOL, yeah you would; ironic right?

 

[colbgw02]

Thousands of residents manage to graduate and matriculate annually while occasionally verbalizing disagreements with their attendings. If you're in a malignant program or you're a marginal resident, then I can see the utility in simply doing as you're told. But the idea that the advice of "out of sight, out of mind" is categorically applicable is horribly misguided.

 

[Chicago2012]

I suppose the point is if you are just going to say ignorant or wrong things it is better to be quiet so they don't notice how bad you really are.

Obviously that's true, but that applies to anything. If you are so ignorant you can't go through a professional conversation without being ignorant, medicine is not the field for you

 

[Chicago2012]

Obviously that's true, but that applies to anything. If you are so ignorant you can't go through a professional conversation without being ignorant, medicine is not the field for you

I am aware of the irony of my avatar picture in this regard lol

 

[dpmd]

Obviously that's true, but that applies to anything. If you are so ignorant you can't go through a professional conversation without being ignorant, medicine is not the field for you

Yeah, I wouldn't advise the 'just stay ignorant and keep your mouth shut' approach to residency. I would go with the try not to actually be ignorant approach.

 

[Over9000]

Yeah, I wouldn't advise the 'just stay ignorant and keep your mouth shut' approach to residency. I would go with the try not to actually be ignorant approach.

I would advocate that it depends on who your attending is. Some are great, some have chips on their shoulders from day one. Pick your battles and your comments, otherwise, like Littlefinger, Cersei will sick her Kingsguard cronies on you, even if you are the smartest guy in Westeros.

Littlefinger: "Knowledge is power"

Cersei, after cornering Littlefinger with her guards' weapons: "No. Power is power"

Another thing to add is that the OP is certainly commenting from a place of extreme cynicism and distrust. Though I would say that most of us disagree with his extreme suggestions, I wonder if we'd feel similarly it were any of us in the same boat.

 

[colbgw02]

Another thing to add is that the OP is certainly commenting from a place of extreme cynicism and distrust. Though I would say that most of us disagree with his extreme suggestions, I wonder if we'd feel similarly it were any of us in the same boat.

That's sort of the point. Most residents aren't and will never be in this situation, so the idea that johndoe is in any way qualified to dispense advice to the greater GME community is pretty laughable.

 

[Chicago2012]

I would advocate that it depends on who your attending is. Some are great, some have chips on their shoulders from day one. Pick your battles and your comments, otherwise, like Littlefinger, Cersei will sick her Kingsguard cronies on you, even if you are the smartest guy in Westeros.

Littlefinger: "Knowledge is power"

Cersei, after cornering Littlefinger with her guards' weapons: "No. Power is power"

Another thing to add is that the OP is certainly commenting from a place of extreme cynicism and distrust. Though I would say that most of us disagree with his extreme suggestions, I wonder if we'd feel similarly it were any of us in the same boat.

Sounds like OP should change his name to Reek, but unfortunately it does not rhyme anything applicable here

 

[johndoe44]

Sounds like OP should change his name to Reek, but unfortunately it does not rhyme anything applicable here

WTF does that even mean? You HAVE to be a virgin, jesus man.

Anyway, truth be told you can either use my experience and learn from it or not. I wrote this for others who are going through similar issues; not for the monday morning quarterbacks in the peanut gallery.

What is truly laughable, is why I am compelled to continue to write on this forum. WTF am I doing? This is like a safehaven for miserable people. I am no longer going to continue this conversation. Life is way too short to deal with such pedantic pricks.

 

[calvnandhobbs68]

Wow actually doing your job matters more to attendings and programs than "laughing with the nurses and having a great sense of humor"....who knew?

Getting pissed and trying to insult someone by calling them a virgin is pretty ripe coming someone who got kicked out of his program. Don't throw stones when you live in a glass house anyone?

 

[jl lin]

johndoe44,

Seriously yours was/is a nightmare. Sadly I have seen this happen to people in healthcare--especially in certain areas, like critical care areas. I am sorry you didn't retain the right kind of lawyer, if for nothing more, sound advice or mediation and guidance. It's a shame b/c someone else stands to fall prey to this kind of thing. People think that it doesn't happen enough, but it does.

My position is that this is why frequent, objective evaluations need to be the biggest part of the process. Everything gets lost in the hearsay. No one here, with any accuracy, can say anything for or against your residency competence or behavior, b/c nothing even a little bit measureable and objective was given. For a science-based profession, I find this incredible.

Good luck. I hope the best for you. Please do whatever you can to not allow this to make you bitter. Rather, allow it to make you better--as trite as it sounds. This will pass, and you will move on; however, how you choose to do that--with toxicity or with positive insight--well, that's totally up to you.

And if only you could share what the name of this malignant program is, but I know you can't. I'm leaning that way by giving you the benefit of the doubt, b/c no specifically measured/evaluated indicators of performance were given. Without such, any place or program can be as capricious and toxic as it wants to be--especially with someone that does not fall under a EEOC protected status.

 

[Chicago2012]

WTF does that even mean? You HAVE to be a virgin, jesus man.

Anyway, truth be told you can either use my experience and learn from it or not. I wrote this for others who are going through similar issues; not for the monday morning quarterbacks in the peanut gallery.

What is truly laughable, is why I am compelled to continue to write on this forum. WTF am I doing? This is like a safehaven for miserable people. I am no longer going to continue this conversation. Life is way too short to deal with such pedantic pricks.

Actually married ten years, and the reference was a continuation of the Game of Thrones reference right before to a character that was tortured, but you know what, maybe I was wrong about you going through something terrible that maybe you didn't totally deserve. Go to hell

 

[rokshana]

What is truly laughable, is why I am compelled to continue to write on this forum. WTF am I doing? This is like a safehaven for miserable people. I am no longer going to continue this conversation. Life is way too short to deal with such pedantic pricks.

lets see how long that lasts....i think 2 days....

 

[Chicago2012]

WTF does that even mean? You HAVE to be a virgin, jesus man.

Anyway, truth be told you can either use my experience and learn from it or not. I wrote this for others who are going through similar issues; not for the monday morning quarterbacks in the peanut gallery.

What is truly laughable, is why I am compelled to continue to write on this forum. WTF am I doing? This is like a safehaven for miserable people. I am no longer going to continue this conversation. Life is way too short to deal with such pedantic pricks.

Theon Greyjoy[edit]
Theon Greyjoy is the only living son, and heir apparent of Balon Greyjoy. He is the third-person narrator for thirteen chapters throughout A Clash of Kings and A Dance with Dragons. He is arrogant, cocky, and proud. Ten years before the events of the series, he was taken hostage by Eddard Stark to be executed if Balon displeased the king. Theon was raised at Winterfell with the Stark children and became a close friend of and almost a brother to Robb Stark. He wants to be a Stark, but he realizes that the Starks will never accept him. He receives only mockery and scorn from his own family. In A Game of Thrones, he fights at Robb's side when Robb rebels. He is sent to the Iron Islands in A Clash of Kings to seek a Stark alliance with the Greyjoys. However, the Greyjoys reject him and Robb's proposal. Theon betrays Robb and attacks the north. He ignores his father's orders to raid the shores and instead captures Winterfell. When Bran and Rickon escape, Theon kills two common-born boys and tells Westeros that the Stark boys are dead. Because of this, the northmen dub him Theon Turncloak. His requests for aid are ignored by his family, and he is captured by Ramsay Snow.
By A Dance of Dragons he has been tortured, flayed, and mutilated; it is strongly implied that he has been castrated. Traumatized, Theon is forced to assume the identity of Reek, Ramsay's serving man known for his stench. Because he fears Ramsay, he tries to reaffirm his Reek identity to please Ramsay and attempts to forget that he is Theon Greyjoy. When reminded of his true identity, he breaks down and insists Theon died. When Ramsay is betrothed to Arya Stark, Theon recognizes her as Jeyne Poole and is sympathetic to her plight, though he is unable to help her. He comes to regret his decision to betray Robb and hopes for a quick death. With the aid of Mance Rayder, Theon helps Jeyne escape from Winterfell and reach the army of Stannis Baratheon.
Theon Greyjoy is portrayed by Alfie Allen in the television adaptation of the novels.[

After being tortured into thinking his real name was Reek, He starts rhyming that name with things. "Reek, Reek, it rhymes with..." and its usually apropos to the situation so weak, meek, etc.

 

[AStark]

Not in private practice but in residency. What I am trying to say is it would be advisable that while you are an intern or resident, to avoid speaking with attendings unless it is unavoidable and if you do say as little as possible. No words are better than stupid words. Also, even though you can "sit down with your PD" or discuss things with faculty, it is probably best to try and completely avoid the office altogether.

"out of sight, out of mind" plays a huge role in your evaluation. If you are not seen often but you get your work done, it is likely no one will have anything negative to say. Just a fact and a part of human nature.

I meant "in practice" in the sense of "in reality" or "in daily work life".

Anyway, if I didn't talk to my staff, who *would* I talk to? I'm at the sort of program where most of the time you're not working with any kind of "senior" (which I am now anyway), so there really is no intermediary between me and staff. It wasn't really that different as an intern either.

Similarly, a few weeks ago my staff made a point of asking me about my intern's performance, namely because he was worried about him. He did his work and got stuff done, but was otherwise very quiet and the staff was saying that it makes him seem less engaged in rounds. Maybe it's because I'm simply not in a "malignant" program, but what you're saying does not hold true everywhere or even (I'd hope) most places.

I would advocate that it depends on who your attending is. Some are great, some have chips on their shoulders from day one. Pick your battles and your comments, otherwise, like Littlefinger, Cersei will sick her Kingsguard cronies on you, even if you are the smartest guy in Westeros.

Littlefinger: "Knowledge is power"

Cersei, after cornering Littlefinger with her guards' weapons: "No. Power is power"

I think it's worth remembering just exactly where Cersei ended up (due to her own incompetence and stupidity) at the end of A Feast for Crows, while Littlefinger had successfully maneuvered himself as stepfather to the (newly motherless) Lord of the Vale.

Another thing to add is that the OP is certainly commenting from a place of extreme cynicism and distrust. Though I would say that most of us disagree with his extreme suggestions, I wonder if we'd feel similarly it were any of us in the same boat.

True. But I would add Varys' riddle for consideration here:

“In a room sit three great men, a king, a priest, and a rich man with his gold. Between them stands a sellsword, a little man of common birth and no great mind. Each of the great ones bids him slay the other two. ‘Do it,’ says the king, ‘for I am your lawful ruler.’ ‘Do it,’ says the priest, ‘for I command you in the names of the gods.’ ‘Do it,’ says the rich man, ‘and all this gold shall be yours.’ So tell me – who lives and who dies?”

 

[colbgw02]

This thread needs spoiler alerts now.

 

[Arcan57]

This thread needs spoiler alerts now.

Everyone you care about dies.

 

[jakeislove]

I've somehow manage to avoid watching Game of Thrones and Sons of Anarchy.

You doo doo brains are making me regret it, LOL!

 

[colbgw02]

Everyone you care about dies.

I've read all of the published books, so I already know that's not true, at least not yet. Was mostly for others.

 

[Arcan57]

I've read all of the published books, so I already know that's not true, at least not yet. Was mostly for others.

It's the not yet qualifier that's important in your post.

 

[colbgw02]

It's the not yet qualifier that's important in your post.

So do you have an advanced copy or something?

 

[Shikima]

lets see how long that lasts....i think 2 days....

It has been more than 2 days...

 

[Chicago2012]

It has been more than 2 days...

More than 3 days

 

[dozitgetchahi]

You have to know your audience.
It's generally a good idea to go along with the attending, even if they're dead wrong. If you think you can be slick and get them to consider your point of view by asking questions, then be careful about it, but if they're the type that frowns upon questions, then don't ask. In the end, they're the ones who hold the final word on their patients' care (do they also hold full legal responsibility?) and no amount of trying to convince them otherwise will change anything. It will only make you a new enemy.

In situations where you think you're right and they're off, simply raise your points but be very agreeable and implement whatever plan they desire. If you really are correct, then it will often become clearer as the patient's care progresses and usually (if you're working with a good attending) there will be a point where the staff goes 'wow, looks like you were right' etc. You instantly will earn a ton of respect that way, and you didn't step on anyone's toes.

Of course, this is dependent on having attendings that are willing to really discuss patients and engage in some push/pull over what's going on. Most of my attendings are this way, and most WANT good input and plans from the residents; after all, a senior resident who isn't able to deliver good plans of care, differentials etc is definitely deficient after a certain point in training. A bad program that is just using the residents for grunt work may have attendings with different priorities, in which case I guess keeping your mouth shut is the best option.

 

[princess_leia_647]

i think it's crazy that the OP went to his program director to talk about a bad evaluation. The program director said he would bring it up at the next meeting.... if the OP never said anything to his PD, the subject of the OP's performance might not have been brought up the meeting and maybe none of this would have happened ... ...

 

[Attending1]

That's sort of the point. Most residents aren't and will never be in this situation, so the idea that johndoe is in any way qualified to dispense advice to the greater GME community is pretty laughable.

Hi, the OP is/ was in a difficult situation, and gave advice that he thought was right. And his advice sounds logical, from his point of view

Sadistic glee at the OP is totally uncalled for!

 

[AgentN1]

Which kind of lawyer should this resident be specifically looking for? There are many different lawyers and it's difficult to know which kind to look for in these circumstances.

 

[johndoe44]

I felt a follow up would be appropriate since match is done and can now reflect on everything in it's entirety. If you want to reread all the prevous posts, have at it but I can give you the summary. I got a poor eval but was promoted to PGY 2 then asked to resign... I followed much of the advice on this thread with mixed results.

I will definitely agree that looking back, deciding not to "lawyer up" was a pretty good idea and it is doubtful if it would have improved the situation. I will say that there were many irrelevant legal rants which added little to the discussion and a fair share of trolling but all in all, I ended up matching at a university program close to home but there were things I should have done better.

Keep your heads up and PM me if you have any questions. This place can be pretty toxic and it can be difficult to differentiate the PD propaganda vs good advice.

 

[MDesquire]

So, I took to this forum for advice and it was definitely clear that when you either get fired or resign from a residency program, the same advice was the same from multiple sources:

1.) Go peacefully; don't raise hell...

The answer is not clear. It was definitely true that trying to sue a program or threaten a program is a bad idea because nothing scares away programs faster than litigious residents. So, I agree that I made the right decision on that part. But otherwise, everything went to hell in a handbasket. I did get a "neutral" letter but I found out later that it was a pretty terrible letter and pointed out all of the comments made about me in the ICU. I had already sent this letter out to other programs in "good faith" because my PD assured me he wanted me to have a second chance and I just believed him/her. I left peacefully and that did not help my situation either because if they know you will cower down then they know they have the upper hand....

5.) If you resign or are terminated, YOU MUST under ALL circumstances, somehow get a positive letter of recommendation from your PD and make sure you read every single line of it and don't be afraid to suggest changes and omissions. This was without a doubt my biggest mistake. Do NOT believe the PD will write a "fair or neutral letter." No matter what you do, you get a good letter of recommendation and you make sure you read it word for word and make sure there is nothing negative on there.

To end all this, in summary; even though I will likely be in another residency program and lost a year, unfortunately this could have all went much much better. Just having a good letter of recommendation from the PD is crucial because if a program has that, they will most likely not reach out and contact the program and you can write your own narrative about why you left.

I ended up matching at a university program close to home but there were things I should have done better.
.

Congratulations on your match and getting through this difficult time. By 'legal rants' Johndoe44, I presume you were referencing my earlier commentary in this thread. You said in an earlier post that the answer is "not clear." You state one should "Go Peacefully, not raise hell", and then in the same breath you state "I left peacefully and that did not help my situation either because if they know you will cower down then they know they have the upper hand." These two comments appear contradictory. Perhaps I am misinterpreting your conclusory hindsight, but it sound as if you would have wanted to participate more actively in the crafting of your PD letter. Southern Surgeon pointed out that he knew of an instance where a terminated resident was successful in facilitating their successful transition to a new carrier, impliedly the PD letter was tailored. Sounds like her 'lawyering up' was effective and did not amount to filing a claim. Perhaps we are not giving the legal profession enough credit. Despite what we may see in Hollywood, the overwhelming majority of claims never see a courtroom and are settled. Many comments here regarded 'seeking counsel' and 'guns blazing' as one and the same. Far from it IMHO. I'm hopeful some of my 'rants' might prove useful to others who are going through a similar situation. In fact, I was just contacted through this forum by another resident facing termination. Perhaps you could reference some of the more relevant posts that were made earlier in this thread that corroborate your deductions. Especially regarding the critical nature of your PD letter and what other options besides walking away or waging war exist for someone in your shoes.

Please remember that in any adversarial situation, you often need to have equitable means of force in order to move most swiftly to a resolution. Your PD was either directly or indirectly being advised by counsel who have dictated your carrier's administrative policies. Trust that you're not the first resident they've asked to resign. In fact through all of this, I'm somewhat surprised that you didn't discover others like yourself who were treated similarly by your admin. By crafting that letter, your PD essentially covered his/her ass at your expense. Im sorry you had to discover that fact the hard way. I recall you mentioning that your PD lead you to believe that your letter would be neutral. Its always your "friends' who betray you. L Betrayal is a part of life, and the sooner you realize it will happen again, the better prepared you'll be to deal with it. If you do have a moment, I'd appreciate it if you'd reread some of the earlier posts about your interests, and give credit to those whose advice turned out to be on point.

I tended to this thread back in August 2014 when you had some imminent and critical decisions to make. You decided to take matters into your own hands and walk away. They let the door hit you on your way out. You went through a lot of stress, expense and limbo hoping to match. But in the end you succeeded in continuing your training. You are very fortunate. Not everyone gets a second chance. At this point, I am trying to determine the extent of your injuries. A year lost, a few grey hairs I'm sure, and a PD letter that although detrimental did not prevent you from continuing. The rest is up to you now. Should you finish strong and stay off the radar, this will all seem like a bad dream. However, should you find yourself in trouble in the future, you can almost be sure that your PD letter could become a source of further injury. There may be ways to limit your exposure and possible seek to amend that letter. The better you perform with your new carrier, the better your case with your former PD. Now your success not only serves your career interests but it doubly serves to discredit your harshest critics. Best wishes.

 

[PinkBeta]

johndoe44 PM me please. I have some questions

 

[Gastrapathy]

Congrats.

 

[JMKP]

Hi johndoe44, please pm me. i'm in a similar situation and have some questions. thx

 

[johndoe44]

@MDesquire , I apologize if my last post came across as derogatory but regardless of the "ranting, banter, etc." all of it had merit and value. I appreciated everyone's input throughout the course of this thread and, as expected, there were some stark differences but it made this thread applicable to many people and there is no doubt this will serve to aid people who are most definitely going to find themselves in these problems.

The truth is, there is no "right" way to handle a termination and those who find themselves at that junction have to find advice most applicable to their situation and the support their program provides.

I will reiterate that lawyering up, in my opinion, adds very little benefit to the situation and there are many other steps you can take (that I did not) before you resign. I think THE BEST, thing I could have done was speak frankly with my program director at the time to arrange for a transfer to another program or seek help finding another program as soon as I was told about my situation. I was also naïve, I will admit it, to believe that my PD would write a good letter of recommendation as he stated and I had no reason to feel otherwise; unfortunately this was not the case. My letter was far from neutral and if anything, exaggerated many of the problems I was having. The entire letter was basically quotes from my ICU attending's evaluation forms. This letter haunted me the entire year. Months afterwards, I had been in contact with at least 10 programs via phone or email asking me to interview and every time they spoke with my PD it was like the program disappeared and I never heard from them again.

I got extremely lucky to even have a position anywhere given the circumstances and getting past all of the rejections one after another after another after another.... it wears on you emotionally and when you are not getting any support from your previous program, it can almost feel like your career is over. I can tell you that is definitely not the case and if I was able to match and overcome all these obstacles then I know anyone can; you just have to constantly be on the phone, sending emails, calling all contacts and asking for advice; but I can tell you opportunities will come and be gone in a millisecond so you have to be on your toes and be your own advocate.

Sorry for the length, but it is imperative that you get over the fact that you have been fired and instead of feeling sorry for yourself (which I did way more than I should have) you have to take a step back and realize that you have been through hell to get where you are and that some people are dinguses and their children will be dinguses and you want no part in that. Come hell or high water, you will get a residency position. Keep your head up, learn from your mistakes but most importantly let the bitterness go and move on to the next opportunity.

 

[Crayola227]

i think it's crazy that the OP went to his program director to talk about a bad evaluation. The program director said he would bring it up at the next meeting.... if the OP never said anything to his PD, the subject of the OP's performance might not have been brought up the meeting and maybe none of this would have happened ... ...

Hardly. While I usually do not err on the side of ascribing good or neutral motives to the admin, they did not fire a resident because he went to their office to talk about an eval. If they did, it is because it is a malicious program, and if they are that malicious then they probably would have gone after him anyway.

Which kind of lawyer should this resident be specifically looking for? There are many different lawyers and it's difficult to know which kind to look for in these circumstances.

Suggest a worker's rights lawyer, or lawyer familiar with representing healthcare workers, and anytime you ask a lawyer if they can help and they don't know, you can always ask if they have a suggestion of where to look for one who can.

I felt a follow up would be appropriate since match is done and can now reflect on everything in it's entirety. If you want to reread all the prevous posts, have at it but I can give you the summary. I got a poor eval but was promoted to PGY 2 then asked to resign... I followed much of the advice on this thread with mixed results.

I will definitely agree that looking back, deciding not to "lawyer up" was a pretty good idea and it is doubtful if it would have improved the situation. I will say that there were many irrelevant legal rants which added little to the discussion and a fair share of trolling but all in all, I ended up matching at a university program close to home but there were things I should have done better.

Keep your heads up and PM me if you have any questions. This place can be pretty toxic and it can be difficult to differentiate the PD propaganda vs good advice.

I agree wholeheartedly with the bulk of your advice. Head down. No waves. Be invisible. Being "efficient" way more valued than spending time with patients.
I disagree with the lawyering up bit. I've read other posts, and there was someone who did and they were able to muzzle the program and get a good letter. Another said that apparently litigious residents don't even get looked at when they re-enter the game, but giving the Program Director free reign to badmouth you is probably just as damaging. Don't lawyer up and put an OK situation into the toilet, but if you're already drowning in said toilet without one a lawyer may be the only one to pull you out.

Sometimes it's not as acrimonious as this. Sometimes a resident loses a leg and has to resign, and everyone parts on good terms with nothing but a handshake and the PD is nice by choice not by contract when they reapply elsewhere.
I know too many stories of residents who went nicely and quietly and "with full support" from the PD, only to get stabbed in the back.
Consult a lawyer in secret, play nice-nice, but when it becomes apparent they're committed to ruining you, better whip out that lawyer and to have a nice neat confidentiality agreement in place and a negotiated neutral to positive letter. You didn't have that and it hurt you.

Thank you for sharing your experiences. I know people who have benefited greatly from similar advice. The powers that be want to scare you into not getting a lawyer so they say and can do whatever they want. A lawyer is your only defense against that.

 

[Crayola227]

And to answer questions here, they want a resignation because that is "voluntary" on your part, meaning you give up various legal rights in fighting losing your job, because you can't say "I was unfairly fired from a job I signed a legal paper saying I voluntarily left." So it ensures that you can't make this a legal nightmare for them. The benefit to doing that, is that by not fighting losing your job (which is an almost impossible battle to win, typically if they want you gone you will be gone) is that now they will not have to go to the trouble of a formal get together creating documents for anyone to read painting the worst possible picture of you to justify cutting you, and painting that nasty picture for a termination which you could fight strengthens the case against you if you fight it. So that is trouble you do not want them going to, which is why resignation is better for you.

Basically, if you agree to just leave and lose your right to sue wrongful termination, they will not be forced to badmouth you to get you gone. Win-win for everyone except you who has lost your job either way. But you just lost it a less damning way which is what they are holding out to you. They can take the stick to you to get you gone or the knife, you choose.

So for practical purposes, you will leave the program either way 1) termination 2) resignation. There is really no choice, you resign.

Now the question is, "before I give up legal rights to fight or control this at all by resigning right away with no legal counsel or agreement, while I am still an employee not yet terminated with some rights, do I just sign on the dotted line or have an attorney help negotiate the resignation." The leverage of that is that you're saying, "I'm willing to resign and put a period on sentence of my life, but this will have to be negotiated with some terms and put in black and white," and that if they don't play ball, then there will be more attorney playtime on their end and yours. They could go down the termination path instead of playing ball. They pay counsel too, and as soon as you got a lawyer theirs was brought to the party too. So in the interest of getting it done, they will let you go with a confidentiality thingie and negotiated letter to secure your resignation, rather than terminate and have you sue with your lawyer (you may not do that if it goes down that path due to expense, but the picture I'm painting at this point is that is a possibility with termination, but they can avoid the whole thing by you resigning with a few caveats.) The part of the resignation they will demand from your attorney is releasing them from any further claims. So they do this because they know it's end game and there's less attorney expense and legal liability on their end handling a resignation vs a termination. Their legal counsel will tell them that the hospital stands the best chance on saving lawyer money expense and protecting from claims by doing this, and hospital legal counsel gives no ****s what the PD wants but what will protect the hospital from claims and save money.

So that is how one may resign, and not be at the mercy of the PD.

 

[Crayola227]

Yes, the PD will still have to cooperate with credentialing and such, and you could say that is where they will try to stick it to you, but again, their legal counsel and HR is going to tell them to just sign whatever and move on. That or they can risk your attorney doing so. It's a no brainer. They got rid of you with little pain, just signed a few forms, and will likely just continue that strategy.

As far as future phone calls from other PDs, I don't know what's worse, PD says "I say blah blah blah" as dictated by the agreement which they can't mention (that can be a term of the agreement) or "I hate this resident and whatever the **** I want to say because I can". The tone might be the same, maybe it tips off the other PD some **** went down and an attorney put an end to it, hopefully whoever is considering you understands that **** goes down, there's two sides to a story, and if they're considering a resigned resident, they clearly have some eyeball tolerance of the scarlet letter on your chest to begin with.

 

[notinkansas]

Perhaps what happened is that you started out doing reasonably well, but didn't grow at the pace of your peers, so then fell behind. While "needs to read more" can be a catch all comment, the added comments that your are not performing at the level of your peers might have been the red flag that you didn't notice.

 

[Giic]

@MDesquire , I apologize if my last post came across as derogatory but regardless of the "ranting, banter, etc." all of it had merit and value. I appreciated everyone's input throughout the course of this thread and, as expected, there were some stark differences but it made this thread applicable to many people and there is no doubt this will serve to aid people who are most definitely going to find themselves in these problems.

The truth is, there is no "right" way to handle a termination and those who find themselves at that junction have to find advice most applicable to their situation and the support their program provides.

I will reiterate that lawyering up, in my opinion, adds very little benefit to the situation and there are many other steps you can take (that I did not) before you resign. I think THE BEST, thing I could have done was speak frankly with my program director at the time to arrange for a transfer to another program or seek help finding another program as soon as I was told about my situation. I was also naïve, I will admit it, to believe that my PD would write a good letter of recommendation as he stated and I had no reason to feel otherwise; unfortunately this was not the case. My letter was far from neutral and if anything, exaggerated many of the problems I was having. The entire letter was basically quotes from my ICU attending's evaluation forms. This letter haunted me the entire year. Months afterwards, I had been in contact with at least 10 programs via phone or email asking me to interview and every time they spoke with my PD it was like the program disappeared and I never heard from them again.

I got extremely lucky to even have a position anywhere given the circumstances and getting past all of the rejections one after another after another after another.... it wears on you emotionally and when you are not getting any support from your previous program, it can almost feel like your career is over. I can tell you that is definitely not the case and if I was able to match and overcome all these obstacles then I know anyone can; you just have to constantly be on the phone, sending emails, calling all contacts and asking for advice; but I can tell you opportunities will come and be gone in a millisecond so you have to be on your toes and be your own advocate.

Sorry for the length, but it is imperative that you get over the fact that you have been fired and instead of feeling sorry for yourself (which I did way more than I should have) you have to take a step back and realize that you have been through hell to get where you are and that some people are dinguses and their children will be dinguses and you want no part in that. Come hell or high water, you will get a residency position. Keep your head up, learn from your mistakes but most importantly let the bitterness go and move on to the next opportunity.

CONGRATULATIONS!!!!
I was reading through this long thread and rooting for you. Glad you found something. I hope it has been going well in the last 6 months, and you can learn from prior mistakes. Resilience is the best.

 

[RecumbentChair]

I can see both sides of the coin here. On the one hand, past performance as a student is not necessarily a good predictor of future performance as an employee. It usually is, but not always. And the jump from studenthood to genuine responsibility is a jump that most of us-- but definitely not all of us-- can make.

There are people who were perfectly adequate medical students who are very poor residents. It's one thing to have a skillset which revolves around reading, memorizing and taking exams, then around a very limited number of directed patient interactions where every single step of your 'management' is directed and double-checked by someone else. It's quite another to have a panel of patients, to be alone in a hospital at night, etc. And I think the reason so many people falter towards the end of internship is that so many of the skills that are prized early on in internship-- efficiency, multitasking, being pleasant and so forth-- don't carry you when you get to the stage where your genuine medical decision-making becomes important.

I personally know of four resident firings, all in surgery, from the inside. All were deserved, on the merits. One dragged out three years longer than it should have until the program was absolutely forced to let the resident go-- it was for completely unreliable & unprofessional conduct and extremely poor medical/surgical skills. One was due to an insufficient level of proficiency in English (fired mid-year). One was due to an inability to function in a harsh, hostile medical climate in addition to a dramatic personality mismatch (she lawyered up, is suing her hospital in federal court, and has thermonuclearly destroyed her US medical career as a result). And one was a friend from medical school who was an inefficient, slow, insecure resident but who was deeply dedicated to her job; she was fired ten months into internship. She spent a year trying to get back into medicine, found all the doors closed, and killed herself.

I can't believe this.

 

[Arcan57]

I can't believe this.

Med school has a lot of counseling resources available and their default position is to try and get you to graduate if at all possible. Residency has counseling resources while you're in residency, but it's a different relationship and being terminated ends access to those resources.

 

[ThoracicGuy]

I can't believe this.

Solid 4 year bump.