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:
- The resident be notified of the nature of the problem and it's potential impact on their career
- The resident must be given an opportunity to review the concerns and express opinions about these concerns.
- 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"
