Is it ok to take a mental health day off from residency?

[Matthew9Thirtyfive]

With all due respect, as an MS 1, please don't tell me what residency is like, just as I wouldn't tell you what the military is like.

Fair enough. Not trying to tell you what residency is like. I’ve worked in healthcare for a while including around residents, so basing my thoughts on that experience. But obviously that is limited. Clearly it’s not totally off though given that some physicians agree with it.

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[Vandalia]

Yeah, and sometimes patients transfer....I’m not morally obligated to be available 24/7

No, but you are required to be available when you are required to be available.

 

[deleted480308]

No, but you are required to be available when you are required to be available.

Yep, and if I have a day off available then I am not required.

This is not a difficult concept

 

[Vandalia]

Your attendings couldn’t see patients if you were sick as a resident? Come on. I’m in a very much life or death type of field and our attendings cover for each other and the fellows if they have something going on all the time.

Medical training instills this BS bravado in people that inflates their self importance... unless your colleagues and attendings suck (which is possible sure) you should not alone be required for operation of the hospital. For the record I don’t want a sick neurosurgeon operating on anyone I know.

First, this "BS bravado" may be psycho-protective. It is interesting that the suicide rate among physicians appears to be rapidly increasing. In the "no excuses" era when I trained while suicides did occur, they occurred far less frequently than today. Could a more relaxed attitude be what is causing the increasing suicide rate? I am going off memory here, so I will admit I am wrong if I am, but suicides among the military, police, fire, EMS, etc. rapidly increase shortly after retirement. By the reasoning proposed here, they should actually decrease with less stress and more time off. If physicians (or retired police) are told that what they are doing is not critical, does that lead to an increase in suicides?

Second, sure in training it is easy to get someone to cover for you and that is great for a couple of years, but that is not the real world. It used to be that residency was far tougher than actual independent practice, now the reverse may be true. In the real world while a colleague might cover for you if your kid is in the hospital or your spouse died, asking someone to take a second consecutive night of call coverage because you feel down is a good way to get fired. You may not like that, but it is irrelevant, and it is also true. I have been doing medical staff and credentialing work probably before you were born, but that is the reality.

Medicine is an unforgiving profession. (Surprisingly when it was more unforgiving physicians seemed happier, but I digress.) It is far better to find that out in residency - or medical school - than to get a rude awakening after graduation.

The goal of a residency is simple: to prepare a physician for independent practice. There are many different aspects to that task. Just know what you are getting yourself into.

 

[Vandalia]

Yep, and if I have a day off available then I am not required.

This is not a difficult concept

That is my point. How receptive would you be to coming in on your day off to cover for a colleague who says they want to take a mental health day?

 

[deleted480308]

That is my point. How receptive would you be to coming in on your day off to cover for a colleague who says they want to take a mental health day?

If they have that day off available to them as part of their contract and me covering for callouts is part of mine? Just fine. It’s stupid to offer days off as part of a contract and then not allow them.

As a larger concept, If we’re specifically talking about in residency, residencies should be staffed without regard to residents and attendings should be able to cover. A service that can’t function without residents is not appropriately staffed.

Also as part of general philosophy, I don’t like “types” of days off. An employee should be given x number of at will days for not showing up. If they blow those ok vacation and then get sick they eat the check for their overage. But this saves the stupid process of trying to prove you were sick

 

[Dr.LeoSpaceman]

For the record I don’t want a sick neurosurgeon operating on anyone I know.

How much neurosurgery (or surgery in general) have you been exposed to? I can say for certain that there are situations where I would personally prefer (for myself or others) a sick expert over healthy "whomever else is available". If you don't agree with that, then I'd question your first hand experience of how that can play out.

 

[Piebaldi]

Your attendings couldn’t see patients if you were sick as a resident? Come on. I’m in a very much life or death type of field and our attendings cover for each other and the fellows if they have something going on all the time.

Medical training instills this BS bravado in people that inflates their self importance... unless your colleagues and attendings suck (which is possible sure) you should not alone be required for operation of the hospital. For the record I don’t want a sick neurosurgeon operating on anyone I know.

would agree with this. A lot of the time prevention of sicks days, personal days, electives, etc are because attendings simply don't want to see patients themselves without residents. it's not that they can't, they simply don't want to. clearly it's far easier to have a resident present, discuss a plan, have them write a note and then sign off than to do the work yourself.

If a resident is truly ill or needs. a day off as long as it's legit there is no reason an attending couldn't see patients on his/her own.

 

[IMreshopeful]

How much neurosurgery (or surgery in general) have you been exposed to? I can say for certain that there are situations where I would personally prefer (for myself or others) a sick expert over healthy "whomever else is available". If you don't agree with that, then I'd question your first hand experience of how that can play out.

I’m currently in my 7th year of post grad training in a field where we do invasive procedures that require immense amounts of expertise - some higher risk than many surgical procedures. I fully appreciate the need for an expert operator, your condescension not withstanding. If you had a doctor with the flu or some other infectious agent operating on you, I’m not sure you would appreciate it either. You can take as many hygiene measures as you want, there’s still a risk of transmission. Last I checked, perioperative infections can still be deadly.

Unless someone is gravely ill and dying immediately without someone else who can operate or procedurize them besides the sick doc, I’m not sure I believe that you can’t find someone else to operate on them unless you’re in some terrible practice situation where you’re literally the only person for a hundred plus mile radius who can do it. In which case, that situation needs to be reassessed.

 

[calvnandhobbs68]

Welcome to emergency medicine. While I would not say it is routine to have an attending trailing an IV pole and vomiting after every patient, it is also not exactly rare. Surprisingly, when patients are asked "Would you rather have a physician who looks like death, or die from your MI?", they generally say "I will take the physician who looks like death."

Wait man you forgot the 3rd option "I'd rather have a doctor who isn't sick".

Nobody is gonna die from their MI if you call in sick. Get over yourself. You're not the only ED doc in the whole city.

 

[calvnandhobbs68]

First, this "BS bravado" may be psycho-protective. It is interesting that the suicide rate among physicians appears to be rapidly increasing. In the "no excuses" era when I trained while suicides did occur, they occurred far less frequently than today. Could a more relaxed attitude be what is causing the increasing suicide rate? I am going off memory here, so I will admit I am wrong if I am, but suicides among the military, police, fire, EMS, etc. rapidly increase shortly after retirement. By the reasoning proposed here, they should actually decrease with less stress and more time off. If physicians (or retired police) are told that what they are doing is not critical, does that lead to an increase in suicides?

Holy crap you just literally made all that up right now out of nothing. Could ancient aliens be causing the increased suicide rate lately? After all, I never heard about them until the history channel started reporting on them a few years ago!!!

 

[Raryn]

First, this "BS bravado" may be psycho-protective. It is interesting that the suicide rate among physicians appears to be rapidly increasing. In the "no excuses" era when I trained while suicides did occur, they occurred far less frequently than today. Could a more relaxed attitude be what is causing the increasing suicide rate? I am going off memory here, so I will admit I am wrong if I am, but suicides among the military, police, fire, EMS, etc. rapidly increase shortly after retirement. By the reasoning proposed here, they should actually decrease with less stress and more time off. If physicians (or retired police) are told that what they are doing is not critical, does that lead to an increase in suicides?

Second, sure in training it is easy to get someone to cover for you and that is great for a couple of years, but that is not the real world. It used to be that residency was far tougher than actual independent practice, now the reverse may be true. In the real world while a colleague might cover for you if your kid is in the hospital or your spouse died, asking someone to take a second consecutive night of call coverage because you feel down is a good way to get fired. You may not like that, but it is irrelevant, and it is also true. I have been doing medical staff and credentialing work probably before you were born, but that is the reality.

Medicine is an unforgiving profession. (Surprisingly when it was more unforgiving physicians seemed happier, but I digress.) It is far better to find that out in residency - or medical school - than to get a rude awakening after graduation.

The goal of a residency is simple: to prepare a physician for independent practice. There are many different aspects to that task. Just know what you are getting yourself into.

Is there an increasing suicide rate amongst physicians or is there more awareness of a pre-existing problem?

Burnout rate among physicians is at a ~8 year low at the moment - and dropping.

 

[Merely]

First, this "BS bravado" may be psycho-protective. It is interesting that the suicide rate among physicians appears to be rapidly increasing. In the "no excuses" era when I trained while suicides did occur, they occurred far less frequently than today. Could a more relaxed attitude be what is causing the increasing suicide rate? I am going off memory here, so I will admit I am wrong if I am, but suicides among the military, police, fire, EMS, etc. rapidly increase shortly after retirement. By the reasoning proposed here, they should actually decrease with less stress and more time off. If physicians (or retired police) are told that what they are doing is not critical, does that lead to an increase in suicides?

Second, sure in training it is easy to get someone to cover for you and that is great for a couple of years, but that is not the real world. It used to be that residency was far tougher than actual independent practice, now the reverse may be true. In the real world while a colleague might cover for you if your kid is in the hospital or your spouse died, asking someone to take a second consecutive night of call coverage because you feel down is a good way to get fired. You may not like that, but it is irrelevant, and it is also true. I have been doing medical staff and credentialing work probably before you were born, but that is the reality.

Medicine is an unforgiving profession. (Surprisingly when it was more unforgiving physicians seemed happier, but I digress.) It is far better to find that out in residency - or medical school - than to get a rude awakening after graduation.

The goal of a residency is simple: to prepare a physician for independent practice. There are many different aspects to that task. Just know what you are getting yourself into.

What field r u in

 

[NotAProgDirector]

As a larger concept, If we’re specifically talking about in residency, residencies should be staffed without regard to residents and attendings should be able to cover. A service that can’t function without residents is not appropriately staffed.

I'm going to disagree somewhat. When I work with a resident in hospital medicine, they cover less patients than I would cover if I worked on my own. There's time for educational conferences and teaching built into the day. So, I am assigned two teams -- and the combination is more than I would handle on my own. From a financial standpoint this makes it feasible -- if my census with and without residents was the same, and I'm paying the resident, this doesn't work financially.

Plus, if you make a system where residents are completely disposable -- whether they come or not the work just gets done -- what tends to happen is the experience becomes a shadowing experience. It becomes easier to just do the work yourself.

 

[deleted480308]

I'm going to disagree somewhat. When I work with a resident in hospital medicine, they cover less patients than I would cover if I worked on my own. There's time for educational conferences and teaching built into the day. So, I am assigned two teams -- and the combination is more than I would handle on my own. From a financial standpoint this makes it feasible -- if my census with and without residents was the same, and I'm paying the resident, this doesn't work financially.

Plus, if you make a system where residents are completely disposable -- whether they come or not the work just gets done -- what tends to happen is the experience becomes a shadowing experience. It becomes easier to just do the work yourself.

I'm not disagreeing that many places staff like you say, I'm disagreeing that they should be staffed that way

Attendings should be staffed appropriately for the patients needing to be seen. The addition of residents should disperse some of that work off the attending and allow for them attending and residents to spend some time teaching/learning. Any hospital that ends up with patients not getting care if a resident calls out is not staffed appropriately.

 

[Mass Effect]

Welcome to emergency medicine. While I would not say it is routine to have an attending trailing an IV pole and vomiting after every patient, it is also not exactly rare. Surprisingly, when patients are asked "Would you rather have a physician who looks like death, or die from your MI?", they generally say "I will take the physician who looks like death."

No one is going to die from an MI because you called out sick, unless the hospital needs to be shut down for being incompetent enough that one physician being out leads to patient deaths. No patient wants a physician who looks like death and vomited before their meeting and will vomit after. Also, not for nothing, but while we can debate showing up when you're sick, having an IV in your arm, etc, dragging an IV pole around from patient to patient screams personality disorder to me.

There are some specialties where you can take a week off at random and no one will really notice you are gone. There are other specialties where if you don't show up people will die

Again, I'm sorry that you've ever had to work at such hospitals. They probably shouldn't be up and running. No hospital I've ever worked at has been that weak in staffing that one call-out leads to deaths.

If I call the on-call neurosurgeon and say "I have a patient who is herniating" and they respond with "Sorry, I am taking a mental health day"... that will not end well

Actually, what that neurosurgeon is likely to say is "there's a reason my pager is off. Call the person covering and leave me alone."

First, this "BS bravado" may be psycho-protective. It is interesting that the suicide rate among physicians appears to be rapidly increasing. In the "no excuses" era when I trained while suicides did occur, they occurred far less frequently than today

More likely, they were talked about less frequently. Your logic makes no sense to me.

In the real world while a colleague might cover for you if your kid is in the hospital or your spouse died, asking someone to take a second consecutive night of call coverage because you feel down is a good way to get fired

Where? Please let us know the hospital that will fire a physician for calling in sick.

How much neurosurgery (or surgery in general) have you been exposed to? I can say for certain that there are situations where I would personally prefer (for myself or others) a sick expert over healthy "whomever else is available". If you don't agree with that, then I'd question your first hand experience of how that can play out.

I wonder what your hospital's risk management and occ health would say about neurosurgeons performing surgery with a GI bug.

Is there an increasing suicide rate amongst physicians or is there more awareness of a pre-existing problem?

Burnout rate among physicians is at a ~8 year low at the moment - and dropping.

Source please? I looked but couldn't find it.

 

[Dr.LeoSpaceman]

I wonder what your hospital's risk management and occ health would say about neurosurgeons performing surgery with a GI bug.

They wouldn't say anything, otherwise you'd be making a case for flu testing each surgeon before they walk in the OR everyday. I guarantee at your hospital there are surgeons operating with some form of contagious disease on a regular basis...GI bug, cold, or whatever else. To think otherwise is divorced from reality.

Unless someone is gravely ill and dying immediately without someone else who can operate or procedurize them besides the sick doc, I’m not sure I believe that you can’t find someone else to operate on them unless you’re in some terrible practice situation where you’re literally the only person for a hundred plus mile radius who can do it. In which case, that situation needs to be reassessed.

I won't apologize for coming off as condescending. The way you phrased the response had a certainty that suggested either lack of exposure or hyperbole for the sake of argument. Yeah, of course, we'd all prefer a healthy expert if given the option. But it's not too hard for me to think of situations where I'd take the sick expert over the healthy "next best guy". On the list of things I'm concerned about when choosing a proceduralist "What if they get me sick?" is pretty far down the list. I'm much more concerned about their technical expertise, and I trust the people I would consider experts to know if they are too ill to provide the standard of care which patients have come to expect from them. This being one of the reasons I would choose them. Sure, there are other people within 100 miles that can do a Whipple. But there is one guy I'd want to do it, and I wouldn't be asking for a rundown of his health status or how much he slept the night before (which is more relevant, and a more imminent threat than a GI bug).

 

[rokshana]

would agree with this. A lot of the time prevention of sicks days, personal days, electives, etc are because attendings simply don't want to see patients themselves without residents. it's not that they can't, they simply don't want to. clearly it's far easier to have a resident present, discuss a plan, have them write a note and then sign off than to do the work yourself.

If a resident is truly ill or needs. a day off as long as it's legit there is no reason an attending couldn't see patients on his/her own.

Have you actually precepted residents and med students? It like teaching a toddler to do something... I can do that work in a lot less time... as a teaching attending, I am not seeing a pt for the first time with the resident team, nor am I depending on the team to tell me about what is going on or what the plan is with the pt when we round...do that and something bad is bound to happen.

 

[Raryn]

Source please? I looked but couldn't find it.

There's a number of surveys, but Is Physician Burnout on the Decline? is the first one that came up

Based on those partial MBI scores, 43.9 percent of all physicians in the survey reported at least one symptom of burnout in 2017, compared with 54.4 percent in 2014 and 45.8 percent in 2011. Notably, fewer physicians reported high depersonalization scores in 2017 than in the previous two survey years, and the percentage of physicians reporting a high emotional exhaustion score in 2017 (38.7 percent) was down nearly to the level seen in 2011 (37.9 percent).

Others show the same - it's gotten better over the last few years. Probably as the growing pains with EMR have been slowly improved.

 

[Asteroid Body]

This news could send shockwaves throughout residency training programs... but... If you have a medical condition as simple and commonplace as "anxiety" diagnosed by a mental health professional, then you could be eligible for something called intermittent FMLA, meaning you can take as much time off as you need in a calendar year up to 12 weeks, as long as you give enough notice and arrange coverage, and your employer cannot fire you or retaliate against you for doing so. It's federal law.

Do I recommend this? Not necessarily.

 

[dpmd]

They wouldn't say anything, otherwise you'd be making a case for flu testing each surgeon before they walk in the OR everyday. I guarantee at your hospital there are surgeons operating with some form of contagious disease on a regular basis...GI bug, cold, or whatever else. To think otherwise is divorced from reality.



I won't apologize for coming off as condescending. The way you phrased the response had a certainty that suggested either lack of exposure or hyperbole for the sake of argument. Yeah, of course, we'd all prefer a healthy expert if given the option. But it's not too hard for me to think of situations where I'd take the sick expert over the healthy "next best guy". On the list of things I'm concerned about when choosing a proceduralist "What if they get me sick?" is pretty far down the list. I'm much more concerned about their technical expertise, and I trust the people I would consider experts to know if they are too ill to provide the standard of care which patients have come to expect from them. This being one of the reasons I would choose them. Sure, there are other people within 100 miles that can do a Whipple. But there is one guy I'd want to do it, and I wouldn't be asking for a rundown of his health status or how much he slept the night before (which is more relevant, and a more imminent threat than a GI bug).

For your first point it seems like some people are really unclear on disease transmission especially that of gi illnesses (where your feces may be able to cause illness for up to 2 weeks following resolution but in general doctors should not really be exposing their patients to their feces and certainly those of us doing procedures would not be exposing ththeththem during the procedure without some pretty serious breaks in technique.

For your second point it seems some people are extrapolating their redundancy and figuring it is the same for all specialties and all treatment.

 

[dpmd]

This news could send shockwaves throughout residency training programs... but... If you have a medical condition as simple and commonplace as "anxiety" diagnosed by a mental health professional, then you could be eligible for something called intermittent FMLA, meaning you can take as much time off as you need in a calendar year up to 12 weeks, as long as you give enough notice and arrange coverage, and your employer cannot fire you or retaliate against you for doing so. It's federal law.

Do I recommend this? Not necessarily.

Have fun answering yes on every licensing and credentialing application for the rest of your career when they ask if you have a condition that can impair your ability to do your job.

 

[Raryn]

This news could send shockwaves throughout residency training programs... but... If you have a medical condition as simple and commonplace as "anxiety" diagnosed by a mental health professional, then you could be eligible for something called intermittent FMLA, meaning you can take as much time off as you need in a calendar year up to 12 weeks, as long as you give enough notice and arrange coverage, and your employer cannot fire you or retaliate against you for doing so. It's federal law.

Do I recommend this? Not necessarily.

Your employer cannot fire you or retaliate against you for taking FMLA for your anxiety.

Of course, your individual supervisors can, in an absolutely unrelated action, document your poor medical knowledge, unreliability, and poor communication skills. Or even just your lack of support for other members of the team.

When you get disciplined, it will be for the latter, not the former.

 

[Piebaldi]

Have you actually precepted residents and med students? It like teaching a toddler to do something... I can do that work in a lot less time... as a teaching attending, I am not seeing a pt for the first time with the resident team, nor am I depending on the team to tell me about what is going on or what the plan is with the pt when we round...do that and something bad is bound to happen.

Perhaps you don't but many attendings do. You don't have to agree with me - I have my own set of experiences, which are right and true for me, the same they are for true and right for others. You are not the "all ever correct one" on everything btw. Many attendings cannot survive without residents, reason why it's such a big deal to have resident coverage.

 

[IMreshopeful]

First, this "BS bravado" may be psycho-protective. It is interesting that the suicide rate among physicians appears to be rapidly increasing. In the "no excuses" era when I trained while suicides did occur, they occurred far less frequently than today. Could a more relaxed attitude be what is causing the increasing suicide rate? I am going off memory here, so I will admit I am wrong if I am, but suicides among the military, police, fire, EMS, etc. rapidly increase shortly after retirement. By the reasoning proposed here, they should actually decrease with less stress and more time off. If physicians (or retired police) are told that what they are doing is not critical, does that lead to an increase in suicides?

Second, sure in training it is easy to get someone to cover for you and that is great for a couple of years, but that is not the real world. It used to be that residency was far tougher than actual independent practice, now the reverse may be true. In the real world while a colleague might cover for you if your kid is in the hospital or your spouse died, asking someone to take a second consecutive night of call coverage because you feel down is a good way to get fired. You may not like that, but it is irrelevant, and it is also true. I have been doing medical staff and credentialing work probably before you were born, but that is the reality.

Medicine is an unforgiving profession. (Surprisingly when it was more unforgiving physicians seemed happier, but I digress.) It is far better to find that out in residency - or medical school - than to get a rude awakening after graduation.

The goal of a residency is simple: to prepare a physician for independent practice. There are many different aspects to that task. Just know what you are getting yourself into.

The reasons for why there’s more physician suicides is a complex thing that I’m not going to get into. This is not the point I was making. My main issue was that doctors and trainees cover for each other all the goddamn time. I’ve seen it at several ins

Also the mental gymnastics it requires to say that “being more relaxed causes more mental illness” is unbelievably ridiculous

They wouldn't say anything, otherwise you'd be making a case for flu testing each surgeon before they walk in the OR everyday. I guarantee at your hospital there are surgeons operating with some form of contagious disease on a regular basis...GI bug, cold, or whatever else. To think otherwise is divorced from reality.



I won't apologize for coming off as condescending. The way you phrased the response had a certainty that suggested either lack of exposure or hyperbole for the sake of argument. Yeah, of course, we'd all prefer a healthy expert if given the option. But it's not too hard for me to think of situations where I'd take the sick expert over the healthy "next best guy". On the list of things I'm concerned about when choosing a proceduralist "What if they get me sick?" is pretty far down the list. I'm much more concerned about their technical expertise, and I trust the people I would consider experts to know if they are too ill to provide the standard of care which patients have come to expect from them. This being one of the reasons I would choose them. Sure, there are other people within 100 miles that can do a Whipple. But there is one guy I'd want to do it, and I wouldn't be asking for a rundown of his health status or how much he slept the night before (which is more relevant, and a more imminent threat than a GI bug).

I’m not sure if you have ever had influenza infection (I sure have) but if you get it, vaccine notwithstanding, you feel miserable. It’s hard to stand, let alone operate. It’s immensely contagious. I can bet if you have a conscientious surgeon they won’t be operating on a patient when they think they can get them sick.

A Whipple is not an emergency procedure. If we are using your analogy, if the surgeon was up all night doing lap appys and was running on two hours of sleep, I would be okay with postponing the surgery for a day or two. If they had a horrendous GI bug I would be okay with waiting a few days for the surgeon to recover. I may want the best surgeon but I also don’t want them doing a crap job.

It’s clear that we aren’t going to agree on this and there is, again, a sense of bravado that makes you think that holding a scalpel makes you superhuman and not prone to issues that may, god forbid, require you to take a day off.

 

[Dr.LeoSpaceman]

It’s immensely contagious. I can bet if you have a conscientious surgeon they won’t be operating on a patient when they think they can get them sick.

It's contagious, but transmission is reduced by 70-80% with simple hand hygiene and masks. If I felt well enough to be at work, I'd feel comfortable that universal precautions would provide protection to the patient. Being conscientious doesn't mean you don't show up to work anytime you think you're sick. It means taking the appropriate precautions to prevent transmission. Like I said, if your benchmark is complete abrogation of risk, you better start doing health screenings before anyone walks into the OR for work.

A Whipple is not an emergency procedure. If we are using your analogy, if the surgeon was up all night doing lap appys and was running on two hours of sleep, I would be okay with postponing the surgery for a day or two. If they had a horrendous GI bug I would be okay with waiting a few days for the surgeon to recover. I may want the best surgeon but I also don’t want them doing a crap job.

You're right, we won't agree. Because as to my original point, you're speaking from an area of general--but not specific--knowledge. In cases I'm referencing there is no "delaying a day or two". Not because of acuity, but because clinical schedules often don't allow it. It's more like weeks.

And I specifically said I would choose someone that I trust would know when they weren't capable of providing the level of care expected. If they can't, then yes, I expect they would take a sick day.

And it's not bravado. It's a sense of duty to the patient who trusts that I'll be there when their operative date rolls around. I'm telling you that some of us believe it takes more than the sniffles or a GI bug to impact the level of our care. If it got to the point that my care was impaired, I wouldn't be there.

 

[Asteroid Body]

Have fun answering yes on every licensing and credentialing application for the rest of your career when they ask if you have a condition that can impair your ability to do your job.

No kidding. But just wanted employers reading this post, as well as the OP, to be aware of their opportunity to take days off of work just like their patients do.

 

[nofliesonme]

A professional can do his/her best work even when they don't feel like working.

 

[Asteroid Body]

Your employer cannot fire you or retaliate against you for taking FMLA for your anxiety.

Of course, your individual supervisors can, in an absolutely unrelated action, document your poor medical knowledge, unreliability, and poor communication skills. Or even just your lack of support for other members of the team.

When you get disciplined, it will be for the latter, not the former.

They could, but they won't. FMLA is very clearly understood by the hospital's counsel, but probably not by your program director.

 

[VA Hopeful Dr]

They could, but they won't. FMLA is very clearly understood by the hospital's counsel, but probably not by your program director.

Pretty sure you missed the point.

Google Stephanie Waggel to see how this plays out.

 

[Mass Effect]

And I specifically said I would choose someone that I trust would know when they weren't capable of providing the level of care expected. If they can't, then yes, I expect they would take a sick day.

And it's not bravado. It's a sense of duty to the patient who trusts that I'll be there when their operative date rolls around. I'm telling you that some of us believe it takes more than the sniffles or a GI bug to impact the level of our care. If it got to the point that my care was impaired, I wouldn't be there.

Which is exactly the point. You may feel comfortable with going in with vomiting and diarrhea, but many people likely wouldn't and they should not be judged for taking a sick day. Thank you for proving the point.

Pretty sure you missed the point.

Google Stephanie Waggel to see how this plays out.

Have you read the Stephanie Waggle court documents? I have. Stephanie was not terminated for having cancer or taking FMLA. Stephanie was terminated, according to court documents, for several egregious errors that she copped to, including allegedly carrying out a hands-on restraint solo. That, by itself, is enough to get a psychiatry resident on probation if not terminated. Add to that she missed shifts and numerous other lapses in judgment and the case was very well made for termination. It had nothing to do with FMLA being cloaked in subjective claims of lack of knowledge, etc. She was given multiple chances, but ultimately, it was objective errors that she made, admitted by multiple people, including herself, that sealed her fate.

 

[Asteroid Body]

Don't know about Stephanie Waggle... FMLA is still the law, that is the point. If you need mental health days as a resident, you can get it.

 

[VA Hopeful Dr]

Which is exactly the point. You may feel comfortable with going in with vomiting and diarrhea, but many people likely wouldn't and they should not be judged for taking a sick day. Thank you for proving the point.



Have you read the Stephanie Waggle court documents? I have. Stephanie was not terminated for having cancer or taking FMLA. Stephanie was terminated, according to court documents, for several egregious errors that she copped to, including allegedly carrying out a hands-on restraint solo. That, by itself, is enough to get a psychiatry resident on probation if not terminated. Add to that she missed shifts and numerous other lapses in judgment and the case was very well made for termination. It had nothing to do with FMLA being cloaked in subjective claims of lack of knowledge, etc. She was given multiple chances, but ultimately, it was objective errors that she made, admitted by multiple people, including herself, that sealed her fate.

I did before posting that, and you're proving the exact point being made: yes you are legally entitled to time off under FMLA but in residency you can be punished with poor reviews that lead to termination.

 

[Asteroid Body]

I'll repeat what I said before. FMLA is the law.

 

[VA Hopeful Dr]

I'll repeat what I said before. FMLA is the law.

Has anyone said otherwise?

 

[rokshana]

Perhaps you don't but many attendings do. You don't have to agree with me - I have my own set of experiences, which are right and true for me, the same they are for true and right for others. You are not the "all ever correct one" on everything btw. Many attendings cannot survive without residents, reason why it's such a big deal to have resident coverage.

So that would be a no...
And generally I post on the things I know and rarely give input on things I have no experience on...you may want to consider using the disclaimer that crayola used to use...

 

[Mass Effect]

I did before posting that, and you're proving the exact point being made: yes you are legally entitled to time off under FMLA but in residency you can be punished with poor reviews that lead to termination.

LOL, you and Dr. Waggle are the only ones who don't seem to get that it wasn't punishment. Her termination would have happened regardless of her cancer and time off. She was just that bad, objectively.

 

[VA Hopeful Dr]

LOL, you and Dr. Waggle are the only ones who don't seem to get that it wasn't punishment. Her termination would have happened regardless of her cancer and time off. She was just that bad, objectively.

You can't know that. And the same could be said of almost anyone if the program wanted to.

 

[deleted480308]

You can't know that. And the same could be said of almost anyone if the program wanted to.

I have to with VA. Almost any resident could be justifiably fired with very selectively (and still arguably accurate) directed documentation

 

[NotAProgDirector]

@Asteroid Body is correct that FMLA is the law, and it's easy for employers to screw it up. Residents can always take their allotment of FMLA time.

Theoretically, programs should not hold that against residents. It's tricky because when looking at the ADA (another legal quagmire), regular and consistent attendance for work duties is considered an "essential function" for medical professionals so it's difficult to claim ADA protection if your accommodation is multiple days off, especially if that impacts patient continuity. FMLA has no such stipulation.

But:

FMLA is leave. You don't get paid (in most states). You don't get credit for training. So theoretically your residency can be extended by as many FMLA days that you take. (This is specialty specific, there are exceptions)

Leave is reportable on your employment documentation. So if you take multiple FMLA days, your summary of your employment experience will document this. That might have negative effects going forward.

Interns may not qualify, usually you have to work there for a year before you qualify. This is also state and employer specific.

Whatever you miss while on leave, your employer can make you "make up", especially since this is an educational curriculum.

 

[Mass Effect]

You can't know that. And the same could be said of almost anyone if the program wanted to.

In Dr. Waggle's case, there were several indisputable facts that even she agreed to that would have gotten a resident terminated. She was also given multiple chances, according to testimony, so no, I don't think it's comparable to just any resident. Most of us get through residency without doing egregious things that would otherwise cause our termination "if the program wanted to."

I also must point out that residents come to these forums all the time to vent that their program targeted them and they're going to be terminated. The discussion always leads to the resident's own deficiencies with defense of the program and how 99% of programs would never do that. Yet, when the topic of taking sick days comes up, suddenly it's a realistic possibility that programs are malignant enough that they'd manipulate evaluations in order to get a resident terminated. Seems like a hypocritical message to me with the motivation of discouraging residents from using sick time.

 

[enalli]

In Dr. Waggle's case, there were several indisputable facts that even she agreed to that would have gotten a resident terminated. She was also given multiple chances, according to testimony, so no, I don't think it's comparable to just any resident. Most of us get through residency without doing egregious things that would otherwise cause our termination "if the program wanted to."

I also must point out that residents come to these forums all the time to vent that their program targeted them and they're going to be terminated. The discussion always leads to the resident's own deficiencies with defense of the program and how 99% of programs would never do that. Yet, when the topic of taking sick days comes up, suddenly it's a realistic possibility that programs are malignant enough that they'd manipulate evaluations in order to get a resident terminated. Seems like a hypocritical message to me with the motivation of discouraging residents from using sick time.

I remember reading about this resident a few years ago so you got me curious about it. I just took a look at one of the court documents that lays out the program's case against the resident, and I have to say that I gotta agree with @VA Hopeful Dr and @sb247 that I can see how this could have all been selectively reported by the residency program to single her out. I am not saying that's what they did, but it is not far-fetched to think so.

They list 12 points:
1. She missed ED grand rounds (7-9 a.m.) as part of an off-service ED shift
2. She submitted health paperwork late
3. She restrained an agitated patient
4. She failed Neuroscience and Psychotherapy courses led by her faculty
5. She did not set up a timely meeting to discuss remediation and did not provide a list of her supervising physicians for her rotation
6. She was removed from call duties because of the above issues
7. She misrepresented her academic standing to other faculty members
8. She did not provide a list of her supervising physicians
9. The program took issue with her assertion that an attending persecuted her because she gave them a poor evaluation
10. She misrepresented her academic standing to faculty and was unprofessional when talking to others in the department about her plan to sue
11. Her interaction with a patient and his family was "odd and potentially damaging to them int their vulnerable circumstances"
12. She misrepresented when her FMLA leave began

I think item 12 is the worst, where she supposedly lied about when her FMLA leave was approved to get extra days off. Otherwise, they range from mistakes/poor performance (though nothing jumps out as egregious to me), to nitpicking (submitting health paperwork late), to the program grasping at straws (she didn't provide a list of her supervisors, seriously?), to the program double-counting "issues" (5 and 8, 7 and 10, 6 and literally every other point).

I am 100% confident that my program could have made a longer, scarier-sounding list about most people in my residency class if they chose to do so.

 

[VA Hopeful Dr]

In Dr. Waggle's case, there were several indisputable facts that even she agreed to that would have gotten a resident terminated. She was also given multiple chances, according to testimony, so no, I don't think it's comparable to just any resident. Most of us get through residency without doing egregious things that would otherwise cause our termination "if the program wanted to."

I also must point out that residents come to these forums all the time to vent that their program targeted them and they're going to be terminated. The discussion always leads to the resident's own deficiencies with defense of the program and how 99% of programs would never do that. Yet, when the topic of taking sick days comes up, suddenly it's a realistic possibility that programs are malignant enough that they'd manipulate evaluations in order to get a resident terminated. Seems like a hypocritical message to me with the motivation of discouraging residents from using sick time.

So you're saying you've never seen a resident with similar issues get successfully remediated? Because I have. I've also seen residents with similar issues get terminated.

I'm not saying that every program is ready to screw a resident over for taking sick leave. This entire tangent came from this one comment:

Your employer cannot fire you or retaliate against you for taking FMLA for your anxiety.

Of course, your individual supervisors can, in an absolutely unrelated action, document your poor medical knowledge, unreliability, and poor communication skills. Or even just your lack of support for other members of the team.

When you get disciplined, it will be for the latter, not the former.

In fact I suspect such a thing is thankfully quite rare. But it's possible. That is the only point I'm making.

 

[AMEHigh]

I will own that I will never understand mental health or if one day off will fix things b/c I never had an issue with this.

If you say that someone could be fired for taking a week off and going to vegas, how can you prove they didn't go to vegas for a Mental health week?

If my program gave me 7 mental health/sick days off and I didn't use it, why would I be stupid enough to not take it? I would gladly take a week off and stay home "sick" or go to the beach somewhere for a mental health week.

This just seems fraught with abuse. All it takes is one or two residents to take a week off for "mental health" for the rest of the residents to do the same.

I have never missed a day of work in my life. If one of my residents took all 7 dys off in the year and I had to pick up the slack (yes someone has to see the patients and it will not be the attending first) I sure as heck would take my 7 days off too. I would be dumb to show up for work when people are taking their full sick days.

We were paid about $700/wk, why in the world would I go to work for 80-100 hrs for the week for $700?

Research shows that employers who offer unlimited sick/vacation days have less turn over and people actually take LESS days off. So no most people working in the professional world aren’t abusing their employees sick day policies.

I’ve never had kidney stones or an ear infection but I still understand them. Why is it so difficult to understand mental well being, especially as physicians?

 

[calvnandhobbs68]

I remember reading about this resident a few years ago so you got me curious about it. I just took a look at one of the court documents that lays out the program's case against the resident, and I have to say that I gotta agree with @VA Hopeful Dr and @sb247 that I can see how this could have all been selectively reported by the residency program to single her out. I am not saying that's what they did, but it is not far-fetched to think so.

They list 12 points:
1. She missed ED grand rounds (7-9 a.m.) as part of an off-service ED shift
2. She submitted health paperwork late
3. She restrained an agitated patient
4. She failed Neuroscience and Psychotherapy courses led by her faculty
5. She did not set up a timely meeting to discuss remediation and did not provide a list of her supervising physicians for her rotation
6. She was removed from call duties because of the above issues
7. She misrepresented her academic standing to other faculty members
8. She did not provide a list of her supervising physicians
9. The program took issue with her assertion that an attending persecuted her because she gave them a poor evaluation
10. She misrepresented her academic standing to faculty and was unprofessional when talking to others in the department about her plan to sue
11. Her interaction with a patient and his family was "odd and potentially damaging to them int their vulnerable circumstances"
12. She misrepresented when her FMLA leave began

I think item 12 is the worst, where she supposedly lied about when her FMLA leave was approved to get extra days off. Otherwise, they range from mistakes/poor performance (though nothing jumps out as egregious to me), to nitpicking (submitting health paperwork late), to the program grasping at straws (she didn't provide a list of her supervisors, seriously?), to the program double-counting "issues" (5 and 8, 7 and 10, 6 and literally every other point).

I am 100% confident that my program could have made a longer, scarier-sounding list about most people in my residency class if they chose to do so.

The restraining an agitated patient without proper training is absolutely a serious offense in psychiatry. I'll tell you if one of our residents restrained a patient they would be disciplined (likely put on probation and let go if anything else popped up). If you're engaging an agitated patient in any way besides in self defense because they're attacking you, it's a serious policy violation in most hospitals unless you had documented training on physical holds and restraints. It's essentially on the same level as the HIPAA violation that was being discussed in another thread before, maybe worse.

I agree that some of the other stuff is really reaching. Missing ED grand rounds and submitting health paperwork late...if that's a crime lock me up.

 

[Mass Effect]

I remember reading about this resident a few years ago so you got me curious about it. I just took a look at one of the court documents that lays out the program's case against the resident, and I have to say that I gotta agree with @VA Hopeful Dr and @sb247 that I can see how this could have all been selectively reported by the residency program to single her out. I am not saying that's what they did, but it is not far-fetched to think so.

They list 12 points:
1. She missed ED grand rounds (7-9 a.m.) as part of an off-service ED shift
2. She submitted health paperwork late
3. She restrained an agitated patient
4. She failed Neuroscience and Psychotherapy courses led by her faculty
5. She did not set up a timely meeting to discuss remediation and did not provide a list of her supervising physicians for her rotation
6. She was removed from call duties because of the above issues
7. She misrepresented her academic standing to other faculty members
8. She did not provide a list of her supervising physicians
9. The program took issue with her assertion that an attending persecuted her because she gave them a poor evaluation
10. She misrepresented her academic standing to faculty and was unprofessional when talking to others in the department about her plan to sue
11. Her interaction with a patient and his family was "odd and potentially damaging to them int their vulnerable circumstances"
12. She misrepresented when her FMLA leave began

I think item 12 is the worst, where she supposedly lied about when her FMLA leave was approved to get extra days off. Otherwise, they range from mistakes/poor performance (though nothing jumps out as egregious to me), to nitpicking (submitting health paperwork late), to the program grasping at straws (she didn't provide a list of her supervisors, seriously?), to the program double-counting "issues" (5 and 8, 7 and 10, 6 and literally every other point).

I am 100% confident that my program could have made a longer, scarier-sounding list about most people in my residency class if they chose to do so.

I think Item 3 is the most egregious and is enough to get even a model resident in huge trouble, let alone one that's already struggling.

So you're saying you've never seen a resident with similar issues get successfully remediated? Because I have. I've also seen residents with similar issues get terminated

I think what some of you are missing in this case is the egregiousness of some of her actions as it pertains to psychiatry and her painful lack of insight into her own deficiencies. If you read the entire testimony, you will find that this resident was remediated multiple times. Over and over again, she made the same mistakes and even worse, she had no insight into the fact that they WERE mistakes, which is really career damaging in psychiatry. I'm not just talking about missing grand rounds. If you read the documents, there were multiple errors that she made and multiple times when she was reportedly less than honest about things and when confronted she had no idea that what she did was wrong. That's a problem, especially in a field where you're entrusted with helping patients gain insight into their own behaviors.

If you want more detail on this case, check out Operman's post with the attached documents in this thread (and by the way, when the story first came out, I was outraged that she was terminated and believed that her program had targeted her on purpose, but in reading the documents, it's clear that isn't what happened).

Malignant Psychiatry Residency Programs

“Some” psych residents. I didn't do psych as my internship.

forums.studentdoctor.net

This resident would have been terminated with or without time off.

 

[Raryn]

I think Item 3 is the most egregious and is enough to get even a model resident in huge trouble, let alone one that's already struggling.



I think what some of you are missing in this case is the egregiousness of some of her actions as it pertains to psychiatry and her painful lack of insight into her own deficiencies. If you read the entire testimony, you will find that this resident was remediated multiple times. Over and over again, she made the same mistakes and even worse, she had no insight into the fact that they WERE mistakes, which is really career damaging in psychiatry. I'm not just talking about missing grand rounds. If you read the documents, there were multiple errors that she made and multiple times when she was reportedly less than honest about things and when confronted she had no idea that what she did was wrong. That's a problem, especially in a field where you're entrusted with helping patients gain insight into their own behaviors.

If you want more detail on this case, check out Operman's post with the attached documents in this thread (and by the way, when the story first came out, I was outraged that she was terminated and believed that her program had targeted her on purpose, but in reading the documents, it's clear that isn't what happened).

Malignant Psychiatry Residency Programs

“Some” psych residents. I didn't do psych as my internship.

forums.studentdoctor.net

This resident would have been terminated with or without time off.

Holy ****. The letter from the Northwestern PD summarizing how badly that resident screwed up and they gave her not one, not two, not four, but five chances to improve? I feel so bad for her program (and former program director) for how they've been reamed in the press over this case.

 

[enalli]

That's a pretty damning letter by the Northwestern PD.

 

[BoardingDoc]

Holy ****. The letter from the Northwestern PD summarizing how badly that resident screwed up and they gave her not one, not two, not four, but five chances to improve? I feel so bad for her program (and former program director) for how they've been reamed in the press over this case.

Wow. That was a long read but interesting. For those that aren't interested in reading it all, it's 136 pages of play by play events over 2 years of her residency where she basically demonstrated one **** up after another. This is either a masterful work of fraud, or (more likely) this resident was terrible, was given a million chances to improve, didn't, and absolutely deserved to be fired a long time ago.

 

[calvnandhobbs68]

Home - Improve Life PLLC | Dr. Stephanie Waggel, MD, MS | Therapy, Medication Management and Wellness Strategies serving Northern Virginia. Mental Health Care for Reston, Herndon, Sterling, Great Falls, McLean, Tysons Corner, Lansdowne, Vienna, Leesb

We provide therapy, medication management and wellness strategies to adolescents, young adults, and women of all ages in Northern Virgini

improvelifepllc.com

Hey for all you worrying that your program will kick you out for taking too many mental health days you can always get kicked out of residency and go open up a private practice charging 300 bucks an hour.