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.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'll make substantially less if you can't finish your training (~50-75K/year).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
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.How much does an Army GMO make?
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.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?
Until you get into a residency, or your service obligation is up.How long is a GMO tour?
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.Tired said:It gets worse: he's coming out of a DO residency.
Why do you assume litigation is the answer?Have you spoken to a lawyer?
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?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.
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.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" ...
Obviously I know nothing about this individual or the circumstances, so this is not intended to apply to this poster.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.
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.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.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.
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.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.
Ultimately, patients are the responsibility of the attending teachers while residents are under their supervision. I hope your example encourages those you supervise.Wow. What about the patients?
Downsize, or close altogether. Really.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?
In this particular case, from what little is posted, that might not be a bad idea. I think litigation should be a last resort.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.
GET AN ATTORNEY.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.
Agree. If the facts above are true, then you need an attorney. Look for an attorney with employment law experience.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)
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?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?
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 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.)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?
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 terribleNot 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.
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.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.
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.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.
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).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.
I know. That **** blows my mind.Knowing that you violated your hours because of moonlighting, why in the world would anyone report their hours accurately?
That's just craziness.
I'm sorry but you apparently haven't seen the quality or lack thereof of many medical school graduates in America.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.
Fixed that for youI'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.
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.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.