Imminent termination, need serious advice!!!

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I can't believe this.

Not sure what you can't believe, but it's all possible.

Some good students don't do well as residents.

Getting back into a training program after being terminated isn't easy.

Physician suicide is a real problem. Whether it's more of a problem in physicians or not is perhaps debatable, but it's still a problem.

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The typical phrasing, to me, seems to put the focus on the "good students." Perhaps the programs didn't do well with those students.
 
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The typical phrasing, to me, seems to put the focus on the "good students." Perhaps the programs didn't do well with those students.

It’s definitely possible and I’d be surprised if a resident suicide didn’t engender a period of self reflection in the program. Not that I know you, but from your posts it seems like you’ve had to take an unflinching look into yourself and adjust some of the internal machinery. Not everyone can be honest with themselves, and among those that are relatively few are going to be in a position to make changes that matter.

We typically hold leaders responsible for the systems they head, but most academic department heads are going to be firmly in what would be considered in the corporate world as middle management. They have input but are limited in terms of selecting their employees are, they’re at the mercy of the hospital in terms of nursing and ancillary staff support, and they may have limited power to directly address bad behavior by their attending colleagues. None of this excuses the system when it fails, but it makes it understandable that most people are going to take a look at the effort to change the system vs the effort to change the individual and come down on the side of modifying the individual.
 
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It’s definitely possible and I’d be surprised if a resident suicide didn’t engender a period of self reflection in the program. Not that I know you, but from your posts it seems like you’ve had to take an unflinching look into yourself and adjust some of the internal machinery. Not everyone can be honest with themselves, and among those that are relatively few are going to be in a position to make changes that matter.

We typically hold leaders responsible for the systems they head, but most academic department heads are going to be firmly in what would be considered in the corporate world as middle management. They have input but are limited in terms of selecting their employees are, they’re at the mercy of the hospital in terms of nursing and ancillary staff support, and they may have limited power to directly address bad behavior by their attending colleagues. None of this excuses the system when it fails, but it makes it understandable that most people are going to take a look at the effort to change the system vs the effort to change the individual and come down on the side of modifying the individual.
I completely agree with this. I'd like to think that I have, with reflection and engagement on SDN, grown in my views about training, so thank you for that.

I've come to realize that the issue of resident training failure is multifactorial and that the adversarial view is not helpful. In another thread we discuss psychopathic PDs. I don't think that's common, nonetheless I'm inclined to believe that dysfunctional leadership for whatever the cause, is one real issue among many. Regardless of what the issue is or how common, I'm inclined to believe a few things:

There are bad apples. There are problems that aren't a result of "bad guys," as well. Speaking out about abuses, while understandably trying to avoid retaliation, whether from individuals or systems, is what we all owe one another in the profession to address these issues.

Residency training failures, in the absence of serious professional or character issues (I am quoting more than one PD here), are multifactorial. There are likely interventions at the medical school and program level that might improve outcomes. I believe most medical school graduates, lacking issues not felt to be "non-remediatable", can be remediated into practicing clinicians of one sort or another, and many are not. Note, I am not speaking of jerks who get let go. I cannot say what proportion of residents let go "deserve" to have their clinical career ended vs those who could be "saved." But the goal should always be to get those who can get there safely, to get there. I believe that is what programs want. We lack the tools right now to salvage all the ones I think could be salvaged, and that is not the fault of most programs, actually. Which to my mind makes it more tragic, and more difficult to address.

However, I don't think we'll get anywhere until we address how the practice of medicine is funded, because I agree that is what ties the hands of most schools regarding the quality of physician-student educational interactions, and programs in remediating their residents or those residents being able to move on to another field.

I believe major change will be top down if at all. OTOH, it is up to us grunts on the ground to try to change the culture by speaking out, and doing our best to go above and beyond supporting the education and well-being of our students and fellow physician in any way we can.
 
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I can't believe this.

Why? For some (many?), medicine is a vocation moreso than a career. One that they may have made various sacrifices to achieve, and something that becomes at least a part of their own personal identity. If that's taken away without recourse, is it so hard to believe that they would despair to the point of contemplating suicide? Bleak, but not unbelievable.

As a side note, based on your other recent posts, you seem to have an issue with "not believing" things said by people with more practical experience than you. I'll be so presumptuous as to advise you to work on this before you start residency, because it's going to be a limiting factor in your success.
 
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Burnout is a huge problem in medicine both during and after residency but are we addressing it realistically. Malignancy in training programs are the culmonation of these issues. Should we be training physicians to fall in line and keep quiet about malignant programs and abusive behaviors? Suck it up which becomes a learned behavior that continues even after residency and eventually burnout in practice. How does that prepare any real leadership in medicine especially with encroachment with insurers and physician replacements. We've all experienced our share of abusive attendings but should we consider that normal and good way to train physicians?

There's little to no recourse for residents if they land into malignant programs. Residency program leaders lack of self shaming or self policing to stop malignant programs with ACGME is simply not there. Worse there is also blackballing of residents. To top it off many applicants don't know if a program is malignant and abusive prior to applying. We need more transparency of these malignancy instead of hiding it so applicants can self select out these programs.

Some bad behaving attendings normalize it as a "rite of passage" or blame residents for tolerating their unprofessional behavior. Worse part is some physicians carry this abusive behavior forward creating more abusive physicians. The sense of hopelessness to the point of suicide for a trainee who has dedicated so much of their life is a big sign that this is a problem. We should not tolerate this as an avenue for any resident. The failure in leadership among physicians is the problem. No one is willing to stand up since many of us were trained not to say no to these behaviors.

I wonder how much nurse practitioners and PA mistreat each other to losing their livelihood or worse their lives. Medicine is a much longer road and physician need to stop accepting abusive unprofessional physicians that are leading to suicide of future physicians. We need to self reflect on how we can help empower and support trainees to lead in the field instead of falling in line because once you finish residency you will be doing the same.
 
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keep in mind why the US anti-trust laws were passed, and what the employment practice were like then

I hope everyone is aware that the Match system by any definition you like, is a monopoly system of employment

we will never get anywhere until we make it easier for residents to negotiate or get new training spots
 
Why? For some (many?), medicine is a vocation moreso than a career. One that they may have made various sacrifices to achieve, and something that becomes at least a part of their own personal identity. If that's taken away without recourse, is it so hard to believe that they would despair to the point of contemplating suicide? Bleak, but not unbelievable.

As a side note, based on your other recent posts, you seem to have an issue with "not believing" things said by people with more practical experience than you. I'll be so presumptuous as to advise you to work on this before you start residency, because it's going to be a limiting factor in your success.
To be fair maybe he meant "I cant wrap my head around such tragedy happening"
Anyway it is sad that an otherwise healthy young adult takes own life, some people will say: "bla blah depression, blah blah suicidal, prone to, blah just cant keep'em safe"
We need to put and end to this circumstances.
 
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To be fair maybe he meant "I cant wrap my head around such tragedy happening"
Anyway it is sad that an otherwise healthy young adult takes own life, some people will say: "bla blah depression, blah blah suicidal, prone to, blah just cant keep'em safe"
We need to put and end to this circumstances.

Well put. I think the first step is for there to be transparency of malignant programs both to medical applicants and to program directors in their annual meeting to openly recognize malignant programs and have actionable steps for replacing abusive physician leadership and make ACGME follow through with it seriously. I'm sure we've seen abusive behavior in certain normal work places but at least in those situations one can just change jobs.

Hiding this stuff is borderline pathological by protecting these abusers while lamenting suicides among trainees as a personal mental health issue is problematic to say the least. Isn't this how the whole #metoo movement came about?
 
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