is this true??

[markglt]

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do residency programs only sign your contract a year at a time, and if they dont like you at the end of the year, they can kick you out?

 

[Sneezing]

Yes, it is true.

That is partially why we shouldn't be too mean or hateful to GPs who just complete an intern year and practice medicine. Getting rid of this practice option only serves to enslave us to the medical machine for years. Be wary of any trends that advocate board certification as a bare minimum requirement to practice medicine. To be a trainee for 7 years minimum and knowing one mishap or political error could negate all your years of training even up until the last month of that 7th year would only further support the hodge podge stepping stone model of "advanced nursing practice."

 

[peppy]

do residency programs only sign your contract a year at a time, and if they dont like you at the end of the year, they can kick you out?

Yes, they can choose not to renew your contract at the end of the year, certainly, but you can be fired (or "strongly encouraged" to resign) at any time. It's really just like any other job, with the minor difference that getting fired from a residency is most often a death sentence for your entire career in the medical field.
Since this is the psych forum, it's also worth noting that some programs will abuse psychiatric evaluations to try to build a case for getting rid of a resident. Check out this story about a resident being fired because of alleged mental illness at Hopkins.

My view is that this is why when you go on interviews you really want to try to pay attention to what kind of atmosphere is at the program. Look for evidence that the program director is truly an advocate for the residents and that the residents seem happy. Pay attention to if it seems like there are more residents leaving the program than what you'd expect. Ask around to see what kind of reputation the PD has and pay attention to what the residents say between the lines about their PD. Having a good, friendly PD who is on your side makes a huge difference for the residency experience.

 

[peppy]

To be a trainee for 7 years minimum and knowing one mishap or political error could negate all your years of training even up until the last month of that 7th year would only further support the hodge podge stepping stone model of "advanced nursing practice."

At the very least, I believe that docs who have completed an internship but no residency should at least be able to function as midlevels. It makes no sense that doctors who have completed an internship (but not a complete residency) usually struggle to find any sort of clinical employment, yet NPs and PAs with far less training have their pick of lucrative clinical opportunities.
Anyone who can make it through medical school is an intelligent person with a lot of training and talent. Sometimes I think that gets missed when we think about people who didn't finish residency and those who "merely" graduated as a doctor feel like they're failures. That talent and education goes to waste if these people end up working at Starbucks or driving taxis because they had a conflict with the wrong person at their residency program or even just had a life situation that forced them to leave their residency (like a prolonged illness or complicated pregnancy).

 

[billypilgrim37]

It makes no sense that doctors who have completed an internship (but not a complete residency) usually struggle to find any sort of clinical employment, yet NPs and PAs with far less training have their pick of lucrative clinical opportunities.

Right, but the NPs and PAs have never had someone point them out and say "oh my god this person sucks so bad that they shouldn't be rehired at their residency program."

 

[whopper]

Unless the residency is malignant and has a rep for intentionally making their residents live in fear, I wouldn't worry about it.

Most programs are designed and led in a manner where they want their residents to advance.

There are so many things you encounter in your medical education that are firsts, and with each first experience, there's a lot of anxiety. Several medstudents I've seen over-worry things.

There are plenty of things that are worthy of generating some anxiety, IMHO-USMLE is one of them (unless you're just one of those types that do well on multiple choice exams, I wasn't). The contract thing is not unless you're a very bad resident or in a program dominated by fear.

(Edit: If the program is malignant: steer very clear of it. A very good friend of mine's career was destroyed by a malignant program. Despite the ACGME protections, I've still seen some programs get away with violating the rules from accounts of several friends. These are by far, an extreme minority of programs but they are still out there. I wouldn't worry about it unless I was in a malignant program, but if you're unfortunate to be caught in one, worrying about it is just going to make your situation worse because you'll have difficulty getting out of it other than dealing with it for 4 years and graduating.)

 

[CaMD]

Yes, it's year by year but for the most part it's a lot easier to let you continue each year than to replace you.

So barring doing something horrendous or finding yourself at a truly malignant program I wouldn't worry about it.

 

[Bakfiets]

Yes, it's year by year but for the most part it's a lot easier to let you continue each year than to replace you.

So barring doing something horrendous or finding yourself at a truly malignant program I wouldn't worry about it.

Totally agree... It is very rare to see the eject button pushed. PDs will withstand a lot of poor (and frankly dangerous) behavior before a contract is terminated. It should be more stringent than it is actually.

 

[billypilgrim37]

Given how bad one of my colleagues sucks, apparently you have to kill a patient on purpose to even get a slap on the wrist.

 

[235750]

A year ago at a hospital I worked at, about 1/4 of the residents of a department got sacked.

Basically, there was a tradition at this site of buying books on the department's tab and then returning them to pocket the cash. Study materials meant for step 3, etc, went straight to the residents' pockets.

This particular year some of them (the residents) got a little too comfortable and went to a nearby university bookstore all at once. It didn't take the manager long to figure out what happened, and she called their PD.

They should have known better, that's for sure, and I don't defend their actions. But the department shared some of responsibility in fostering an environment where this sort of thing was accepted for 4+ years. They also didn't fire the people who were months from completing their training, so I thought that was a little unfair.

Last time I heard one of them got into health insurance. Blue Cross/Shield, UnitedHealth, etc all offer jobs to docs with no residency. The only catch is, you have to spend your career trying to deny people treatment.

Now, contrast this to how attendings are disciplined. A couple of months later at another nearby community site, an attending was confronted about his/her drug problem. This person stole DRUGS for his/her habit! He/she went to a program specifically for drug addicted docs, and eventually got his/her license back with no long term repercussions.

Sites are no longer desperate for qualified applicants. I've found that at some places, especially those with FMGs/IMGs, take advantage of the fact that they could replace any resident in a second. Fear is used to motivate, and it's devastating to see intelligent people worked to death under threat of expulsion.

Obviously I don't think all sites are like this (I personally haven't seen a psych residency as I have described above), and I completely agree with Whooper that the majority of places want their residents to do well. However, that doesn't mean that you aren't replaceable. Do not forget that!

 

[whopper]

They should have known better, that's for sure, and I don't defend their actions. But the department shared some of responsibility in fostering an environment where this sort of thing was accepted for 4+ years.

Being skilled in the biological sciences, graduating from medical school, being a resident, and almost everything in our medical training does not train us to be good leaders or managers. Having a 33 on your MCAT tells me nothing of your ability to run an organization of 50 people.

The one exception are programs where residents are made directly responsible for the residents and medstudents under them.

I was in student government in college and medschool. I noticed the leadership skills among medstudents in student government compared to college were extremely poor. I noticed the trend continue in residency, as an attending, and in several hospitals. There are several doctors who can score well on a test, but cannot understand the dynamics of running a team.

Not that there aren't good leaders in the medical field. Just expect far fewer of them vs. those who went through other forms of training such as business, and IMHO, psychiatry is going to attract more people who understand group dynamics better vs. most of the other fields of medicine.

The problem is when you see a program or team, where a doctor is running it, and doesn't have any basic leadership skills, and the staff can't do anything because if they complain about the attending doctor, the institution doesn't want to deal with it.

 

[Therapist4Chnge]

Not that there aren't good leaders in the medical field. Just expect far fewer of them vs. those who went through other forms of training such as business, and IMHO....

Sadly most professional training lacks true leadering AND business training, which is why many private practices struggle more than they should. Many Ph.Ds run departments and hospitals because they learn those skills, though they probably also know how to pull in large amounts of money (securing grants and funding).

 

[whopper]

Now, contrast this to how attendings are disciplined. A couple of months later at another nearby community site, an attending was confronted about his/her drug problem. This person stole DRUGS for his/her habit! He/she went to a program specifically for drug addicted docs, and eventually got his/her license back with no long term repercussions

There's been several identified cases where an institution, instead of firing someone or reporting them to the board, simply let the person go in a supportive or neutral manner when the person should've been fired or more.

E.g. there was a case in NJ of a nurse who killed dozens of patients. When the institution found out there were a string of deaths, the nurse either quit on his own or was asked to leave, but no reports were made to authorities such as the police or the state medical board.

http://en.wikipedia.org/wiki/Charles_Cullen

There was speculation that the institutions did not take much action because they did not want to be under the spotlight, and would rather let this person move-on, and let the next person deal with it. There's also theories that the doctors running the instutitions didn't know what to do (they don't teach this to us in medschool), and as a result took the path of least resistance.

I've noticed the same trend in several hospitals. There is one doctor I know of who has been accused of sexually assaulting several patients, in fact he's gone to court several times over it, and each time he is found not guilty with his license intact--why? Because the patients cannot prove it occurred. If a doctor sticks his finger in your rectum (and in this case, it was a psychiatrist), when there's no reason for him to do a rectal exam, and there's no signs of trauma, its the patient's word against the doctor's.

There was an NJ doctor I know of who lost his license because he had sex with his patients, and it took about 15 years for the state to do it. He actually was reported to have sexual relations with several of his patients, but each time it went to court, it was thrown out or he appealed it and delayed for the process to take several years. One patient actually stuck with it for 15 years, and he finally lost his NJ license.

Though, I wouldn't be suprised if he had a license in another state, and could just practice in that other state. I figured medical boards would've been more proactive with these types of things, but no, that is not the case. I actually wish they would be more proactive. IMHO being a doctor is like being a police officer. We have powers that, if not in the right hands, can make us dangerous.

In the above case, staff and attendings reported that the doctor was inappropriate with patients. E.g. he'd take out involutarily committed patients out to lunch, and they all happened to be attractive females.

I don't know if this trend exists everywhere, but I've seen in several places. To quote an attending of mine, "It's very hard to get a medical license, but once you have it, for better or worse, it's very hard to lose it."

 

[235750]

To quote an attending of mine, "It's very hard to get a medical license, but once you have it, for better or worse, it's very hard to lose it."

I just read that article on that nurse you posted, and..wow! I have heard of doctors getting off easy, but that is incredible. I guess you (and your former attending) are right

 

[whopper]

The latter two cases I know for a fact are in the local newspapers. I know the doctor's name who did the rectal examinations. The one in NJ who had sex with his patients, I don't remember his name, though if I really wanted to find it, I'm one phone call away from doing so.

I didn't put the websites in the latter 2 cases because they hit a little too close to home. I know people who worked directly with those two doctors, and, well let's just say those workers are convinced the accusers were telling the truth.

 

[nancysinatra]

Given how bad one of my colleagues sucks, apparently you have to kill a patient on purpose to even get a slap on the wrist.

Say more! Say more! What's going on?!

 

[billypilgrim37]

Say more! Say more! What's going on?!

Oh, I wish I could! My program director would already prefer I not be blathering about on the internet, even anonymously. 😉

 

[Rhayven44]

Pretty sure your contract is fairly safe if you use common sense. Of course, since that is not taught in medical school...