Armydoctobe

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I have been let go by my ER Residency. Unable to finish the fourth year of a 4 year program. The reason was personality conflict and has nothing to do with my medical skills. Im an HPSP recipient with a 4 yr commitment. What happens now?:(
 

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I have been let go by my ER Residency. Unable to finish the fourth year of a 4 year program. The reason was personality conflict and has nothing to do with my medical skills. Im an HPSP recipient with a 4 yr commitment. What happens now?:(
You will need to inform your Army program director. I am assuming you are on deferment. You could attempt to move to another program, but the RRC typically has a minimum time in a given program to graduate. The Army may or may not give approval to switch programs. If they don't, they will cut you orders to active duty and you will be a GMO.
 

Armydoctobe

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What does it mean to be a GMO? Where are the spots available? Will I be able to try and finish my ER residency in the military after a GMO tour? If not will I be able to apply for another residency in the military?
 
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GMO = general medical officer. The military is basically the last bastion of the general practitioner who practices without specialization after finishing just an internship. Slots exist all over, but their available varies greatly.

If you're in the last year of your residency, then I would try like hell to finish your training before coming on active duty. I highly doubt that an Army EM residency program would accept you for a single year of training. If you graduated from an Army program following a GMO tour or two, not only would you have to repeat much of your training but your active duty obligation would be extended significantly.
 

Armydoctobe

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How much does an Army GMO make? Do I have to do this for four years continuously, or can I do this for a year and try to reapply to the Army Residency match next year? How long is a GMO tour?
 

BigNavyPedsGuy

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How much does an Army GMO make? Roughly 75-80K depending on housing allowance where you live (at least that's what a Navy GMO) makes). Do I have to do this for four years continuously, or can I do this for a year and try to reapply to the Army Residency match next year? How long is a GMO tour? Usually at least 2 years
You'll make substantially less if you can't finish your training (~50-75K/year).
 

The White Coat Investor

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That really bites since some EM programs are only 3 years. You need to have a frank discussion with head of Army EM. In the air force, we call this person the consultant. If you're not sure who it is, call one of the Army EM programs and talk to the PD.
 

Gastrapathy

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Its very atypical to be let go that far into training. What did they document in writing as the reason? Have you attempted any appeal within the school's GME structure? Do you want to finish residency? You need advice from a better source than this (ie the Army EM specialty leader).
 

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How much does an Army GMO make?
Presumably you'd enter as an O3 with 4 years of service, since time in a deferred residency program counts toward time in service. Annual salary - you'd collect O3 >4 pay ($57K), ASP ($15K), VSP ($5K), BAS ($2K), plus an untaxed housing allowance that will be $15-25K depending on locale and whether or not you have dependents. So about $100K. Once you're over 6 years VSP goes up to $12K.

Do I have to do this for four years continuously, or can I do this for a year and try to reapply to the Army Residency match next year?
You can apply for an Army ER spot, but the odds don't seem great if you've already been dismissed from one residency. The odds of being picked up after just one year (ie, an incomplete GMO tour) are especially low but it happens to some people. You might have better luck finding an Army residency spot in a less competitive field.

How long is a GMO tour?
Until you get into a residency, or your service obligation is up.


Truthfully, HPSP and GMO-land are probably the best thing that can happen to someone who gets dismissed from residency and can't find a place to finish up. You get paid reasonably well, have a secure job practicing medicine, have the opportunity to find another residency within the military, and if that fails, after four years of GMO service you may be in a decent position to find a civilian program that will give you another shot.
 

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Tired said:
It gets worse: he's coming out of a DO residency.
That sure hurts his odds out in the civilian world, but DOs have less of an uphill fight within military GME. I could see him doing a year or two as a GMO and finding a place in an unfilled Army program.

Have you spoken to a lawyer?
Why do you assume litigation is the answer?

I've got no horse in this race, and I'm inclined to give the OP the benefit of the doubt. But in reading these forums, whenever I see someone say they were dismissed from residency because of a "personality conflict" my first thought is that "poor insight and failure to recognize/admit deficiencies" is a safer bet than "good resident wronged by a dozen malicious attendings with frail egos" ...
 
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Perrotfish

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That sure hurts his odds out in the civilian world, but DOs have less of an uphill fight within military GME. I could see him doing a year or two as a GMO and finding a place in an unfilled Army program.
But would his 3 years at a DO residency transfer to an Military Allo residency? Are DO and MD residencies interchangable or would he need to start over?

Why do you assume litigation is the answer?

I've got no horse in this race, and I'm inclined to give the OP the benefit of the doubt. But in reading these forums, whenever I see someone say they were dismissed from residency because of a "personality conflict" my first thought is that "poor insight and failure to recognize/admit deficiencies" is a safer bet than "good resident wronged by a dozen malicious attendings with frail egos" ...
Could be, but from his perspective that doesn't really matter. He's trying to negotiate his way out of a very crappy situation, and I would imagine good legal advice could put him in a better bargaining position (couldn't get worse, after all). Maybe he's really not at fault, or maybe they failed to properly document why he's at fault, or maybe they did document why he's completely at fault but litigation could reveal a number of the program's other improprieties and they'd be anxious to avoid that. In any event, I'd say give the lawyer a call before accepting the hospital's judgement. If they say there's nothing they can do there's nothing they can do.

Also, yeah, if there was no clear misconduct and he was let go in his 4th year that seems pretty horrible. If there was a personality conflict, even if the conflict was that he was a jackass who wouldn't listen to anyone, shouldn't they have recognized that before year 4? How often do people get fired from the 4th year of residency without a major event (sexual harassment or something)? at the center of it? Maybe it's more common than I think it is?
 

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Also, yeah, if there was no clear misconduct and he was let go in his 4th year that seems pretty horrible. If there was a personality conflict, even if the conflict was that he was a jackass who wouldn't listen to anyone, shouldn't they have recognized that before year 4? How often do people get fired from the 4th year of residency without a major event (sexual harassment or something)? at the center of it? Maybe it's more common than I think it is?
Obviously I know nothing about this individual or the circumstances, so this is not intended to apply to this poster.

Regarding residents getting canned in their final year. This is not that rare and this is not always the failing of the program to identify problems with their performance (although usually lack of honest painful feedback often is an issue with many attendings). This usually comes down to the realization that although the individual might succeed month to month in various rotations while supervised, they don't have what it takes to be able to practice safely autonomously. The program director has an obligation to patients and society to make sure a dangerous doctor doesn't graduate.
I don't believe we fail enough. Medicine is a high stakes profession and some despite their best efforts are just not up to it.
 

IgD

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If you were released from your program there was almost certainly a review committee where attendings reached a consensus about making the decision.

Did you get any candid feedback from your program director?

This situation is best handled at the lowest level. If you feel you have a case, I would argue that you made a mistake but it doesn't merit release from the program.

You could talk with the ER department head who is probably above your program director in the organizational hirearchy. I agree with the other poster above, you should talk with the GME director/dean and ask for a candid assessment of the situation.
 

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Obviously I know nothing about this individual or the circumstances, so this is not intended to apply to this poster.

Regarding residents getting canned in their final year. This is not that rare and this is not always the failing of the program to identify problems with their performance (although usually lack of honest painful feedback often is an issue with many attendings). This usually comes down to the realization that although the individual might succeed month to month in various rotations while supervised, they don't have what it takes to be able to practice safely autonomously. The program director has an obligation to patients and society to make sure a dangerous doctor doesn't graduate.
I don't believe we fail enough. Medicine is a high stakes profession and some despite their best efforts are just not up to it.

Interesting.

I would hope programs would adopt the best practices of industry if they want to resort to dismissal more frequently. Quarterly reviews, face-to-face, not just after-the-fact summary reviews, counseling vis-a-vis documented deficiencies with written warnings, etc., opportunities to redress and appeal.

Deficiencies in the dismissal process are inherent indictments of the program itself. It ought to be a double-edged sword, one that puts the program on notice (residents aren't paid with their money, after all). Dismiss a resident and get the program on probation as a result. Dismiss more than one, and draw an immediate outside inspection and review process that may result in suspension of the program and its director. The job of the residency training program is to train qualified specialists, not just to provide a low-cost hospital workforce at the government's expense. Dismissal is an indicator that they are failing to do so. Firing residents is an indication that you have either failed in your diligence to choose candidates well or to properly form those you have chosen.
 

IgD

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Firing residents is an indication that you have either failed in your diligence to choose candidates well or to properly form those you have chosen.
Well said. Hopefully the original poster will fill in the blanks about what happened. I can think of a few cardinal sins that would result in an on the spot firing but have never seen it happen. I would think the resident would be put on probation first and given an opportunity to correct deficiencies.
 

Gastrapathy

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Interesting.

I would hope programs would adopt the best practices of industry if they want to resort to dismissal more frequently. Quarterly reviews, face-to-face, not just after-the-fact summary reviews, counseling vis-a-vis documented deficiencies with written warnings, etc., opportunities to redress and appeal.

Deficiencies in the dismissal process are inherent indictments of the program itself. It ought to be a double-edged sword, one that puts the program on notice (residents aren't paid with their money, after all). Dismiss a resident and get the program on probation as a result. Dismiss more than one, and draw an immediate outside inspection and review process that may result in suspension of the program and its director. The job of the residency training program is to train qualified specialists, not just to provide a low-cost hospital workforce at the government's expense. Dismissal is an indicator that they are failing to do so. Firing residents is an indication that you have either failed in your diligence to choose candidates well or to properly form those you have chosen.
I couldn't disagree more. Holy [email protected], I agree with A1. We don't fail enough residents/interns. There is a lot of pressure to pass people. A stick in the eye for the PD for failing 1-2 residents would only serve to raise the bar even higher to the detriment of patients.

I do think failing someone in a nonsurgical program after 3 years is uncommon. Surgery PGY2s and 3s can sometimes hide their deficiences that become apparent as chiefs but an EM resident is basically doing the same thing from day 1.
 

orbitsurgMD

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I couldn't disagree more. Holy [email protected], I agree with A1. We don't fail enough residents/interns. There is a lot of pressure to pass people. A stick in the eye for the PD for failing 1-2 residents would only serve to raise the bar even higher to the detriment of patients.

I do think failing someone in a nonsurgical program after 3 years is uncommon. Surgery PGY2s and 3s can sometimes hide their deficiences that become apparent as chiefs but an EM resident is basically doing the same thing from day 1.
Considering how serious a handicap dismissal of a resident in the middle of training places on the fired resident, unemployability (except for the military, go figure), difficulty in obtaining another training position, inability to repay loans, it could really be professionally devastating. And what is the cost to the program? Nothing, really. They paid nothing for the resident and got lots of free work in exchange. Considering the inherent inequity of medical trainees compared to their trainers and the fact that we are not talking about factory jobs for high-school graduates but a field where everyone has nine or more years invested, all of which come with many vetting procedures and countless evaluations before getting to a residency, you really should be under a great burden to show why dismissal is necessary. Your own program should have to demonstrate substantial effort at fulfilling its duty to teach, as in unimpeachable. Residency programs are making the last facets on the gem. No screwups, please.

And I am all-for punishing programs that fail in this regard. I think they should have to repay the government all of the monies paid for that resident up to that point, and with interest, not just the salary, but the whole allotment, which as you know is 2-3x the salary paid per year, on average. Residencies are not entitlements to draw cheap labor on the taxpayer's dime and pretending to be protecting the public by dismissing residents deemed deficient is no excuse. You have a duty to teach and train and you should take that seriously. I know many residency programs that don't. Part of that duty is to choose carefully and to make sure those choices aren't wasted.

In fact, I would favor dismissal of a residency director that fired residents on grounds that they show poor judgment in choosing, were not good stewards of department resources, and exposed the department to liability.
 

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Wow. What about the patients? I see residency, particularly PGY1, as more than polishing the gem. To me, its the bulk of the process. As a medical student, you never have responsibility for a patient. People can slide by. If you punish programs, you ultimately punish patients because they will be even less inclined to let bad residents go. Trust me, its hard to fail someone. Not all medical schools have equal rigor.

As for choosing poor candidates, you are in a highly competitive field, try a primary care PGY1 class on for size and you'll see that the quality is extremely variable. What are they supposed to do?

I agree that this is a number that should be tracked and programs with a pattern of dismissal should be examined. I think this particular person needs to get the Army specialty leader to call the PD directly to get the straight scoop. That is likely to be more effective than hiring a lawyer.
 

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Wow. What about the patients?
Ultimately, patients are the responsibility of the attending teachers while residents are under their supervision. I hope your example encourages those you supervise.

If you find yourself firing a resident, do you ask yourself what it was that you missed that could have avoided that situation? Were you as thorough as you could have been in your selecting that resident, especially with regard to detecting deficiencies that would merit firing after his selection? Did you monitor him early in the process to identify his faults before they became so serious as to warrant termination? I really don't think academic faculty are held to very many significant standards as concerns their teaching duties, save for a few mandatory lectures to be given and staffing resident clinic cases.

And a program that can't fill its class with applicants who are adequately trainable or who are otherwise unable to find morally or intellectually adequate applicants should downsize or close.

Bringing up protecting "the patients" is besides the point. There are many mechanisms for that: USMLE, board examinations, Dean's letters, licensing authorities, hospital staff committees, JCAHO, NPDB, and of course, the malpractice bar. Protecting patients does not make a blanket excuse for programs that can't or won't exercise due care at selection, won't devote adequate resources to teaching, won't monitor and supervise at a level necessary to produce a good end product where that result would otherwise be possible. You do have a duty to protect patients, but as concerns your duty as a faculty member, as a teacher, "protecting patients" is not a free pass for throwing in the towel on a resident. Frankly, I think programs should be held accountable for their failures, and firing a resident is a failure.



I see residency, particularly PGY1, as more than polishing the gem. To me, its the bulk of the process. As a medical student, you never have responsibility for a patient. People can slide by. If you punish programs, you ultimately punish patients because they will be even less inclined to let bad residents go. Trust me, its hard to fail someone. Not all medical schools have equal rigor.

As for choosing poor candidates, you are in a highly competitive field, try a primary care PGY1 class on for size and you'll see that the quality is extremely variable. What are they supposed to do?
Downsize, or close altogether. Really.

I agree that this is a number that should be tracked and programs with a pattern of dismissal should be examined. I think this particular person needs to get the Army specialty leader to call the PD directly to get the straight scoop. That is likely to be more effective than hiring a lawyer.
In this particular case, from what little is posted, that might not be a bad idea. I think litigation should be a last resort.
 

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Wouldn't most requirements for becoming board eligible have been met, and a transfer to another program with an empty PGY4 slot be possible? (I'm unfamiliar with DO 4 yr programs.)

If close to completion, the Army consultant might be inclined to agree to allow transfer and be finished rather than add to the GMO ranks and delay training. At least make the request as to be in the Army's interest.

To be let go near the finish line raises many questions.
The current Army consultant is COL Wedmore at Madigan.
 
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BigNavyPedsGuy

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This is an interesting debate. I think that the onus is on the program to do anything they can to educate said resident and document it. This is actually an RRC requirement. I was on an internal review panel for another program and we went through their annual evals, their quarterly evals, etc. If a resident is just not up to snuff - which does happen then it should all be backed up by a long paper trail that illustrates a history of problems.

The point about being held liable for choosing is an interesting one. In the military and in the NRMP programs forego their right to ultimately choose and agree to go with the mercy of the system. Especially in the military, candidates can be forced into training they (and the program) didn't want for them. In these cases a resident can suck and deserve failure.

There does need to be accountability for the programs to prevent resident exploitation, but if a resident is expected to succeed, then failure has to be an option. It's kind of like saying all of the elementary school track meet kids deserve the ribbon - not just the winners. except there's a lot more at stake and we're not kids.
 

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I would like to say that I did not complete my first year with this ER program. I did a transitional year (required by the state) for DO licensing at another institution which did not have an ER program. I then transferred into this program as a PGY-2 to start. I have received one evaluation in 2yrs as a resident, and we are supposed to be evaluated every six months. We have had 2 resident meetings in 2 yrs as a resident, and are supposed to have at least quarterly meetings every year. There is almost no teaching that happens in our ER program in the ER. We go to lectures held by another close by residency program once a week. Our attendings do not lecture to us, except for our program director who gives a 1 hr. lecture per month. I never received a copy of the residency handbook until 8 months ago, and one was only made because we were having a reaccredidation visit from the AOA for our particular residency.

I would also like to say that after every ER shift we are evaluated on 8 different aspects of performance, satisfactory or non-satisfactory. I have NEVER gotten even 1 unsatisfactory. I did get put on probation for inadequate lecture attendance a year ago. Conditions for that probation were that I have 100% lecture attendance for 3 months and continuously maintain above 90% lecture attendance which I have done. Also, the program director gave me a written warning not to violate the AOA workhours policy because I was not in compliance during August 2008 because I was moonlighting. I HAVE NOT violated it again- this I can prove. The program director states I made a shift change that caused the ER not to have a resident(though there was an attending covering) for 5 hrs (from 3 am to 7am- not a busy time for our ED). I admitted at the time that I was at fault and formulated a plan to minimize the damage which I cleared with the program director and the attending in the ER at the time the mix up occurred. This is what he says he is firing me for.

I clearly admitted that it was my fault at the time and that I had made a mistake. I took 100% responsibility. I am not saying I am the very best resident that ever came into the ER. Clinically, however, I am 100% competent. I have never been accused of otherwise. I also have never been accused of academic dishonesty, or sexual harassment, or anything else I feel should get me fired from my program. That is why I termed the reason "personality conflicts" . Now that you know the details you can tell me what you think.
 

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Also, what does everyone think of asking the Army to deploy me for the months I need to finish my residency. The American Osteopathic Association will count that time towards completion of my residency and the program doesn't have a choice but to accept. They haven't written a formal letter firing me and they refuse to even have a face to face meeting with me. All I had was a conversation on the phone with the program director.
 

i want out

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Also, what does everyone think of asking the Army to deploy me for the months I need to finish my residency. The American Osteopathic Association will count that time towards completion of my residency and the program doesn't have a choice but to accept. They haven't written a formal letter firing me and they refuse to even have a face to face meeting with me. All I had was a conversation on the phone with the program director.
GET AN ATTORNEY.

Don't walk, run to get an Attorney to hash this out. If they are trying to fire you without just cause, then they need to have their butt's handed to them.

i want out (of IRR)
 

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GET AN ATTORNEY.

Don't walk, run to get an Attorney to hash this out. If they are trying to fire you without just cause, then they need to have their butt's handed to them.

i want out (of IRR)
Agree. If the facts above are true, then you need an attorney. Look for an attorney with employment law experience.
 

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This sounds like total nonsense from your program. You're fired but they won't put anything in writing or have a face to face meeting? And you're a chief? Fishy fishy stuff. Do you still report to work?
This is an interesting point. If they never formally fire you, could they hold you responsible for not showing up after they 'fired' you over the phone and then officially fire you for that? Can you call them and record the phone call confirming that they don't want you in the ED again?

Anyway, good luck OP. It sounds like you deserve to win here.

Originally Posted by Armydoctobe
Also, what does everyone think of asking the Army to deploy me for the months I need to finish my residency. The American Osteopathic Association will count that time towards completion of my residency and the program doesn't have a choice but to accept. They haven't written a formal letter firing me and they refuse to even have a face to face meeting with me. All I had was a conversation on the phone with the program director.


Also definitely ask the lawyer this.
 

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Taking all of this at face value, you need to request a meeting in writing with your PD and the hospitals gme director. I would get the army involved asap. They can be strong advocates for you. Whether or not to bring a lawyer is a tough call, one you ought to make with the advice of a lawyer.

Orbitsurg, the programs can't close, most marginal candidates end up doing well. I've spent many hours helping some make it. But not everyone can. All the mechanisms you mention are there to catch the people who passed inappropriately, the primary level is us. I hate when someone fails, but it has to be allowed to happen sometimes.
 

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I know that the time spent in an active duty deployment can count towards an ER Residency- in a DO program there are precedents about soldiers who have been deployed and that time was counted towards their ER residency. I am just wondering since my program hasn't officially fired me yet (No meeting with the Director of Med Ed, no letter, just an e-mail and phone call from the program director) would the Army be wiling to deploy me in order to help me force my program to let me finish?
 

IgD

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I know that the time spent in an active duty deployment can count towards an ER Residency- in a DO program there are precedents about soldiers who have been deployed and that time was counted towards their ER residency.
Never heard of this and highly skeptical.
 

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I know that the time spent in an active duty deployment can count towards an ER Residency- in a DO program there are precedents about soldiers who have been deployed and that time was counted towards their ER residency. I am just wondering since my program hasn't officially fired me yet (No meeting with the Director of Med Ed, no letter, just an e-mail and phone call from the program director) would the Army be wiling to deploy me in order to help me force my program to let me finish?
I asked this very question about the Army ER residencies 6 months ago, and it is specfically opposed by the current EM leadership. They can always change their minds. But, there is not a need to deploy anyone earlier from residency, and to deploy people in theater has all kinds of bureaucratic implications for residency accreditation, as well as the GME process. So, why bother causing a problem, when instead they wait until residents graduate then deploy them. (I would like to go, but don't tell my wife. I have to wait.)

Having said that: if you can get deployed as a GMO and then have the AOA consider it acceptable to graduate, then all power to you?

Good luck. You are 6 months out from graduation, so it is better to fight and get it done. Getting the Army involved, as well as a labor lawyer, is very sound advice. You are on better ground of the PD has not documented any problems and is not using proper disciplinary/education remediation.
 
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1. Legal options -- your legal options are really limited to two paths: 1) find a "legal flaw" in your firing, or 2) scare them with a lawyer, even though they did nothing wrong. Either path can lead to one of two good outcomes for you: 1) continued training, or 2) some sort of letter/recommendation that allows you to get additional training elsewhere.

From a legal standpoint, there's really only one question: did your program follow due process? There are potential other issues -- mainly discrimination -- but for this discussion let's focus on due process. Due process = a specific set of legal steps required to terminate an employee. Residency programs are held to a standard of academic due process, which requires:

  1. The resident be notified of the nature of the problem and it's potential impact on their career
  2. The resident must be given an opportunity to review the concerns and express opinions about these concerns.
  3. The decision must not be arbitrary or capricious

An important item to keep in mind is that the courts consider residents incompetent until judged by the profession to be competent. So arguing that your evaluations were "just fine" will get you nowhere.

Your story suggests that due process might not have been followed. However, I could image a PD pointing out that you had a professional issue earlier (conference attendance), were warned about future professionalism issues, were put on probation, told that if another professional violation occured (even of a different type) that you would be terminated, and then this ED shift thing occurred, and bam, you're fired. So you see, it depends on the whole story. That being said, you really can't fire someone without sending them something in writing, and it's usually done in person.

2. Someone earlier in this thread mentioned "cardinal sins". From your short description, you made a shift change -- residents often swap shifts, but it sounds like you tried to "change shifts" and so there was a shift with no resident. This falls into my definition of a cardinal sin. You can't simply shift around your schedule to fit your life. We all have personal lives, and emergencies, and presumably your program has a system in place to deal with this. If not, then that's too bad and you chose poorly. Regardless, simply leaving one of your shifts uncovered is unacceptable. If you were a PGY-1 I might chalk it up to a newbie mistake, but as a PGY-4 it appears, from the outside, to be a major problem. Again, I'm sure I don't have all the details so perhaps the story is more complicated (and it probably is).

3. As someone else mentioned earlier, residents are rarely terminated for a single event. I expect there were many minor events, many which did not lead to a major "probation" event. Most of the residents in my (IM) program who have had professionalism issues have been fine clinicians -- and their evaluations were usually fine -- except for the few times where their professionalism or communication skill problem created a huge issue.

4. You will get NO credit at an allopathic program for any of your osteopathic training, unless your program(s) were dual accredited.

5. I find it very hard to believe that GMO time, which is completely unsupervised (I assume), would count towards your EM boards. However, I am only versed in the allopathic rules, and the osteopathic web sites are not very helpful in this regard. You mention that you're sure this has been done, but I wonder if the details were different in some way. I recommend getting this in writing should you decide to pursue it.

6. On the more global question of residents being terminated somehow counting "against" the program, either financially or via accreditation, this is a two edged sword. If programs were forced to pay back GME money for residents who were terminated, it would either incent programs to 1) simply graduate incompetent physicians; 2) not renew a contract at the end of the year, rather than taking a chance on further training of a marginal candidate (one might consider this the same as firing a resident for this purpose); 3) not take any more marginal candidates, which might leave many good people floundering for a job, etc. Interestingly, the ACGME has started to track this specifically for site visits -- they want to know the ultimate fate of every resident who trained with me for the prior 5 years. But, you can already see that there is no agreement even here on SDN about what the "right" attrition rate is -- some say it should be zero and that the "system" should have weeded out all of the problems already and anyone not graduating is a program failure, and those who think we are not failing out enough people and should fail more. What's the correct failure rate? 0%? 5%? 10%? More?

As for those commenting that PD's should be able to figure out who's not going to do well in the application process -- that's impossible. All LOR's mention that the applicant is in the top 5% of all students they have ever worked with. Some Dean's letters are helpful, but many are vague enough or edit out any negative comments such that they are not believable. USMLE scores do help predict to some extent, but are by no means perfect and are useless for professional issues. It's a bit of a crap shoot on our end.

On a personal note, I do consider any resident who fails out of my program my responsibility to address -- I help them figure out what is coming next, by helping them find a new program in the same or different field, help them assess their deficiencies and find a field more suited to their skills, and help by working with other PD's to find a good fit. But some residents have poor insight into their issues, and this discussion usually starts with "I was fired for no good reason, and all of my evaluations are fine"
 
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colbgw02

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Not speaking specifically about this situation, but it can take years to make a case to dismiss a resident, so we shouldn't be too surpirsed about a senior level resident getting let go. I'm at a five year residency, and not too long ago we had a resident kicked out 3 months before graduation. In reality, the decision had been made 2 years prior, but they had to make sure their ducks were in a row to avoid litigation.
 

Perrotfish

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Not speaking specifically about this situation, but it can take years to make a case to dismiss a resident, so we shouldn't be too surpirsed about a senior level resident getting let go. I'm at a five year residency, and not too long ago we had a resident kicked out 3 months before graduation. In reality, the decision had been made 2 years prior, but they had to make sure their ducks were in a row to avoid litigation.
THAT is a problem that needs to be fixed, whatever you think the proper rate for attrition is. What you're saying is that they willfully wasted 2 years of that resident's life and at least 200K of taxpayer money. Maybe it was the fault of the legal system instead of the hospital, but it's still a problem that needs fixing and absolutely terrible
 

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aProg, have you ever given any consideration to writing a how-to manual for residency? Your posts are always valuable and I imagine that they could be transformed into a book.
 

Mirror Form

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I couldn't disagree more. Holy [email protected], I agree with A1. We don't fail enough residents/interns. There is a lot of pressure to pass people. A stick in the eye for the PD for failing 1-2 residents would only serve to raise the bar even higher to the detriment of patients.
Well I couldn't disagree with you and A1 more. The bottlenecks to get into medical school and then residency afterward are already very tight. It's pretty rare for anyone to make it that far, (especially in a field like EM that can be competitive) and not at least be moldable into a competent physician.

Also, considering how disasterous the consquences of getting fired are to a resident, I know I would never have ranked a residency with a history of firing people.
 

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Also, the program director gave me a written warning not to violate the AOA workhours policy because I was not in compliance during August 2008 because I was moonlighting.
Ouch, you violated the ACGME work hours while moonlighting? And that was with an upcoming reaccredidation visit from the AOA? Well, that can certainly land you on your PD's "people to kill" list.
 

Gastrapathy

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Well I couldn't disagree with you and A1 more. The bottlenecks to get into medical school and then residency afterward are already very tight. It's pretty rare for anyone to make it that far, (especially in a field like EM that can be competitive) and not at least be moldable into a competent physician.

Also, considering how disasterous the consquences of getting fired are to a resident, I know I would never have ranked a residency with a history of firing people.
Interesting. I'm surprised how people feel about this. I really think its primarily a difference in the quality of the bottom 10% of primary care trainees versus the bottom 10% in more competitive fields. We get everyone who's left (particularly in the Navy, IM and FP internships are dumping grounds on occasion) and some of these people just shouldn't be doctors. I wouldn't have wanted to fail either and I don't want to give the impression that I think we should have a set attrition rate. I just think, as aProg described, the bar is already high enough (if not a little too high).

BTW, getting fired as an intern is a disaster, after that, from what I've seen, people usually get a second shot somewhere else.
 

sethco

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Knowing that you violated your hours because of moonlighting, why in the world would anyone report their hours accurately?

That's just craziness.
I know. That **** blows my mind.

On another subject, the OP's description of his residency program mirrors many people's perception of AOA residencies (including other DOs), in general (i.e. Poor didactics, scant teaching, small patient census, less regulation/feedback, shady leadership, etc.). I don't understand why MD students wonder why the DO students are applying to ACGME residencies? If MD students were given the opportunity to apply to AOA residencies, why the hell would they want to?
 

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Ultimately, patients are the responsibility of the attending teachers while residents are under their supervision. I hope your example encourages those you supervise.

If you find yourself firing a resident, do you ask yourself what it was that you missed that could have avoided that situation? Were you as thorough as you could have been in your selecting that resident, especially with regard to detecting deficiencies that would merit firing after his selection? Did you monitor him early in the process to identify his faults before they became so serious as to warrant termination? I really don't think academic faculty are held to very many significant standards as concerns their teaching duties, save for a few mandatory lectures to be given and staffing resident clinic cases.

And a program that can't fill its class with applicants who are adequately trainable or who are otherwise unable to find morally or intellectually adequate applicants should downsize or close.
I'm sorry but you apparently haven't seen the quality or lack thereof of many medical school graduates in America.
Especially with the DO schools, many of which send us graduates who are functioning well below their MD peers. The DO interns often come in aware of their deficiencies but some have zero insight.

Don't forget the significant number of MD's with with personality disorders, pathologic lying, amazingly poor work ethics, lack of integrity and there are always residents which should NEVER practice medicine despite the best efforts at coddling them by program directors.

As alluded to in an earlier post, you cannot willy nilly fire a resident especially in a military program. It takes months of remediation, then probation and finally termination. This actually can take years, and if the resident is a minority, look out b/c they will always play the race card. It is ugly and most program directors and teaching staff would rather give a luke warm eval and avoid the litigation and other headaches which come from the process.

Lastly, you mention supervision. Well what happens at 1am when that dysfunctional resident is admitting patients to your service? You can't trust what he/she is telling you over the phone, so do you ever go home? Also what invariably happens is that for your and the patient's protection you end up dictating all the decisions to the resident thus covering up their deficiencies. Trust me, I am not impressed with the caliber of many of our HPSP accessions, be they DO's or MD's. And as others have alluded to, we have to take them even if as a program we never ranked them. There is a unwritten pass the trash rule so everyone gets a DO board failure in their program to share the wealth.
 

sethco

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I'm sorry but you apparently haven't seen the quality or lack thereof of many medical school graduates in America.
Especially with the MD schools, many of which send us graduates who are functioning well below their DO peers. The MD interns often come in aware of their deficiencies but some have zero insight.
Fixed that for you ;)
 

haujun

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I'm sorry but you apparently haven't seen the quality or lack thereof of many medical school graduates in America.
Especially with the DO schools, many of which send us graduates who are functioning well below their MD peers. The DO interns often come in aware of their deficiencies but some have zero insight.

Don't forget the significant number of MD's with with personality disorders, pathologic lying, amazingly poor work ethics, lack of integrity and there are always residents which should NEVER practice medicine despite the best efforts at coddling them by program directors.

As alluded to in an earlier post, you cannot willy nilly fire a resident especially in a military program. It takes months of remediation, then probation and finally termination. This actually can take years, and if the resident is a minority, look out b/c they will always play the race card. It is ugly and most program directors and teaching staff would rather give a luke warm eval and avoid the litigation and other headaches which come from the process.

Lastly, you mention supervision. Well what happens at 1am when that dysfunctional resident is admitting patients to your service? You can't trust what he/she is telling you over the phone, so do you ever go home? Also what invariably happens is that for your and the patient's protection you end up dictating all the decisions to the resident thus covering up their deficiencies. Trust me, I am not impressed with the caliber of many of our HPSP accessions, be they DO's or MD's. And as others have alluded to, we have to take them even if as a program we never ranked them. There is a unwritten pass the trash rule so everyone gets a DO board failure in their program to share the wealth.
1. Although this may be aberration from the norm I know a military resident who was terminated within 6 months onset of problem during his first year. I think he was terminated because he lacked both insight and integrity. Poor work ethic do not mix well with poor integrity. I think most interns (if not all) are deficient in a sense that they are finally learning to become a doctor. Some may need more to learn than others. Sometimes it may be difficult to know when particular individual is beyond remediation. For example a Drill Sergeant will just allow some soldiers to graduate even though he thinks that they will not become a good soldier. I guess the similar momentum to just graduate someone in GME exists whether in civilian or military.

2. Personality disorder may not be so bad when it drives you to excel from underlying... (narcissitic or obsessive-compulsive disorder) However medical admission process, board examination do not adequately weed out medical students with poor integrity, compassion, or personality disorder and I guess they shouldn't.?
 
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