Malignant PD won't let me transfer

[Jackwhite]

This has been discussed in a thread many years ago, but I was curious to find if anyone was aware of a resident (in the past few years) transferring residency programs without the support of their current program director. I am in a very small program/very malignant situation and have been informed that I could lose my position for even inquiring about transfer. I understand the risk but am in a desperate situation and want to know if there is any chance.

 

[nitemagi]

There is probably a chance, but a small one. PD's know each other, and don't like screwing each other over d/t the golden rule and professional respect (PD's don't want to have to fill a position a vacant position at the last minute). Seems contradictory to threaten to fire you for looking elsewhere, when likely the PD fears having to fill the position again.

 

[QofQuimica]

This has been discussed in a thread many years ago, but I was curious to find if anyone was aware of a resident (in the past few years) transferring residency programs without the support of their current program director. I am in a very small program/very malignant situation and have been informed that I could lose my position for even inquiring about transfer. I understand the risk but am in a desperate situation and want to know if there is any chance.

Without knowing the specifics of your situation, my advice is to keep your mouth shut and finish the program if at all possible. Your PD does have the ability to make it where you likely won't ever work in medicine again if he chooses. So assuming you want to continue on as a physician, it's best to avoid provoking him unless you have a good enough reason where you are willing to risk losing your career.

 

[Jackwhite]

Thanks for the responses. I suppose my question would then be how is it that some people can transfer when a program is not a good fit?

 

[blue2000]

Thanks for the responses. I suppose my question would then be how is it that some people can transfer when a program is not a good fit?

In my program, people transferred out of the specialty when it wasn't the right fit for them (which becomes pretty obvious pretty quickly) and, IIRC, in the last 10 years there was someone that switched into a different program in the same specialty due to extenuating family situations.

From my program (General Surgery) people switched into: Interventional Radiology (2), Derm, Anesthesia, and Preventative Medicine (that was a person who was really. not. cut. out. for the intensity of clinical medicine) that's all I can remember.

Honestly, my PD was very supportive of people switching, if they were not in the right place, as long as they were honest and forthright in their communication. Having people in the wrong field and being miserable in a field like surgery puts patients at risk. I was in a competitive field in a competitive program, and we had truly outstanding non-designated prelims in the programs, so it was pretty easy to fill those spots with excellent residents. In a less competitive field/program, I could see working harder to hang on to who you have.

 

[Buzz Me]

It will be hard since your new program will want a letter from your current PD...and this is where things could get uncomfortable for you if you've burned any bridges.

 

[QofQuimica]

Thanks for the responses. I suppose my question would then be how is it that some people can transfer when a program is not a good fit?

It's a lot easier to change programs/specialties if your PD isn't malignant and will support you, like the person above me said. But you said your program is malignant, and that you'd probably be fired for even bringing up the subject of wanting to transfer. Hence my suggestion that you not bring it up. Well, unless you'd rather be fired and go into a different career than stay at your current program.

 

[ForbiddenComma]

It will be hard since your new program will want a letter from your current PD...and this is where things could get uncomfortable for you if you've burned any bridges.

If you try to avoid/explain away a lack of a letter from your current PD, the other PD will look him up on FREIDA and have a little chat, at which point your GME career would be finished.

I agree with the others who say to suck it up and stick it out. You don't have much other choice if you want to become board-eligible.

The other alternative is to come up with a story on why you need to leave town that your PD would buy (family situation, etc) but the tone of your post suggests this is not an option.

 

[Groove]

Without knowing the specifics of your situation, my advice is to keep your mouth shut and finish the program if at all possible. Your PD does have the ability to make it where you likely won't ever work in medicine again if he chooses. So assuming you want to continue on as a physician, it's best to avoid provoking him unless you have a good enough reason where you are willing to risk losing your career.

Golden advice. It's a sad but true element of residency. Too many residents are blissfully unaware of just how precarious their professional situation can be within residency. You are a doctor, yes, but you aren't BC, and there is not a tremendous amount of legal protection for resident civil rights or anything to that effect. You can get black balled, you can get kicked out of your program, and then you are stuck with tons of debt....no residency and likely to encounter great difficulty in gaining another residency with limited GME funding, a PD that is pissed at you and likely to not have incentive to support you, and if you haven't been in long enough to get a state license... then you really are hosed. I scratch my head sometimes at seeing some of the resident posturing, presumptive arrogance, antics and willful subordination towards their staff, PD's, mentors and hospital hiearchy with so much to lose and such little to gain in their huffing and puffing about unfair treatment. We have 30 mins once a month as residents to talk with the chiefs during conference about "issues" and I oftentimes sigh and catch myself rolling my eyes at some of the complaints about unfair treatment. Some things are justified and worth fighting to change, but most just aren't in my opinion. I didn't go into residency thinking everything was going to be fair.

Malignant programs exist because they CAN exist and residents can do little about it other than suck it up and keep your head down and remind yourself that you are in training for a short while in the grand scheme of things. Many things in my opinion may piss you off but just aren't worth getting riled up over.

Risking losing your residency and not able to attain another is most definitely NOT worth it. My general advice to most people is that I really could care less how malignant the program is, others have made it through, so you can too... and rocking the boat and risking ejection from the aircraft at 10K feet so to speak with no parachute is not a very pragmatic or advisable option. Keep your head down, buck up, work hard and you'll make it through. No PD wants to have to deal with empty spots and to be perfectly honest, as a resident I don't like having to work more once a resident has lost their spot either. It's bad for everyone all around.

 

[Baps]

I will actually go against the majority and recommend you transfer to another program/ specialty if possible. I understand that there are malignant programs out there, some more than others, but at the end of the day residency will be tough no matter where you go. If you're getting so much grief now, it's only going to get worse! It's important to have a supportive environment and if you're not getting that from your program, especially the PD for that matter, it may be in your best interest to "lose" a year and do research, etc. and reapply the next interview season. Of course, it's a huge gamble and you'll be on your own. The inevitable and uncomfortable conversation will come up during interviews.

I would recommend that you have a letter written by your PD while you are still an active resident and withdraw from the program, which is much better than being terminated. I doubt every single program will ask for that letter and there are some PD's who have hearts and you may be given the opportunity to explain how this was a "learning experience" etc...

If you withdraw, you will be getting out of a bad situation and without know the details of your situation, I can't imagine how stressful your situation is, but could it get any worse and what do you have to lose? If you're a fairly competitive applicant, AMG with passing board scores, I'm sure there's a program that may give you another chance. I know I just rambled but I'm hypoglycemic right now... Anyway, stay encouraged and there is a light at the end of the tunnel. I'm sure things will work out for you 🙂 Be Blessed!

 

[nitemagi]

I will actually go against the majority and recommend you transfer to another program/ specialty if possible. I understand that there are malignant programs out there, some more than others, but at the end of the day residency will be tough no matter where you go. If you're getting so much grief now, it's only going to get worse! It's important to have a supportive environment and if you're not getting that from your program, especially the PD for that matter, it may be in your best interest to "lose" a year and do research, etc. and reapply the next interview season. Of course, it's a huge gamble and you'll be on your own. The inevitable and uncomfortable conversation will come up during interviews.

I would recommend that you have a letter written by your PD while you are still an active resident and withdraw from the program, which is much better than being terminated. I doubt every single program will ask for that letter and there are some PD's who have hearts and you may be given the opportunity to explain how this was a "learning experience" etc...

If you withdraw, you will be getting out of a bad situation and without know the details of your situation, I can't imagine how stressful your situation is, but could it get any worse and what do you have to lose? If you're a fairly competitive applicant, AMG with passing board scores, I'm sure there's a program that may give you another chance. I know I just rambled but I'm hypoglycemic right now... Anyway, stay encouraged and there is a light at the end of the tunnel. I'm sure things will work out for you 🙂 Be Blessed!

I think the point is that the OP is already not in the good graces of the PD, is unlikely to be supported in transferring, and thus unlikely to be able to get a position elsewhere without the blessing of the PD. People aren't saying better to stick it out to be miserable, they're saying better to stick out a bad residency than quit or risk getting fired and have no chances at any other programs.

 

[mcl]

I will actually go against the majority and recommend you transfer to another program/ specialty if possible. I understand that there are malignant programs out there, some more than others, but at the end of the day residency will be tough no matter where you go. If you're getting so much grief now, it's only going to get worse! It's important to have a supportive environment and if you're not getting that from your program, especially the PD for that matter, it may be in your best interest to "lose" a year and do research, etc. and reapply the next interview season. Of course, it's a huge gamble and you'll be on your own. The inevitable and uncomfortable conversation will come up during interviews.

I would recommend that you have a letter written by your PD while you are still an active resident and withdraw from the program, which is much better than being terminated. I doubt every single program will ask for that letter and there are some PD's who have hearts and you may be given the opportunity to explain how this was a "learning experience" etc...

If you withdraw, you will be getting out of a bad situation and without know the details of your situation, I can't imagine how stressful your situation is, but could it get any worse and what do you have to lose? If you're a fairly competitive applicant, AMG with passing board scores, I'm sure there's a program that may give you another chance. I know I just rambled but I'm hypoglycemic right now... Anyway, stay encouraged and there is a light at the end of the tunnel. I'm sure things will work out for you 🙂 Be Blessed!

I'm reasonably sure that the PD letter is an ACGME requirement and must be provided when a resident joins another program. I know that for our last site visit I had to have both the letter for a resident who transferred to another program and the letter for a resident we accepted to fill a vacant spot. The letter doesn't have to be glowing, but it does have to state the resident's level of competency. I hesitate to offer advice one way or the other, but don't make a decision based on a hope that someone somewhere may take you without a PD letter. It's not very likely.

 

[Jackwhite]

I am in good standing and have excelled at my program (despite my program director's issues with me). Faculty have given me the advice to leave. They advise that while the PD may be (crazy), that person is not vindictive enough to force me out of my job. My PD is an incredibly unprofessional person who would likely give me a poor review, but I would be able to get contrary statements from others (including the head of medical education). Would this work?

 

[Groove]

I am in good standing and have excelled at my program (despite my program director's issues with me). Faculty have given me the advice to leave. They advise that while the PD may be (crazy), that person is not vindictive enough to force me out of my job. My PD is an incredibly unprofessional person who would likely give me a poor review, but I would be able to get contrary statements from others (including the head of medical education). Would this work?

Look, if you can stay....stay. "Liking you" is not a requirement from your PD for graduation. I imagine most PD's just want hard workers who keep their mouth shut and do what their told. Listen to yourself, your other option is to apply to another program and risk a poor letter and the difficulties in finding a new program. You assume you could get all sorts of additional letters that would offset the PD letter and dramatically change your situation. You are "assuming" much. I tell you what. Imagine the worst case scenario which would be not being albe to secure a transfer and getting kicked from your program in the entire process. You'd be out 1 to 2 years and if lucky, able to land some lowly competitive spot in a place that never fills. Uhoh, they never fill because it's a) undesirable location, b) malignant, c) really malignant and everyone knows it.

So, now you're out 2 years of residency, possibly starting over in another specialty and in a worse malignant program than the one you started out in. That's a worst case scenario other than never being able to match in anything which is probably unlikely as you could prob always grab an empty FP spot unless you got busted for drugs or a HIPAA violation or something.

Personally, I consider those worse case alternatives to be much more unpleasant than the one you're painting for us.

Also, by all means please be honest with us so we can offer solid advice. You mention earlier that you started getting bad evals from your staff, some of which were valid. You're now giving the impression that most of the staff are all on your side and think the PD is "crazy" and state you have "excelled" in your program (I'm assuming compared to our peers.) Well, which is it? If you got bad evals from the staff, other than your PD, were they valid or not? If they were, then you haven't excelled. How did you do on ITE scores and other metrics compared to your peers, etc.. It's just very odd for a resident with little problems to suddenly be at such odds with their PD and in an endangered situation such as you're describing.

 

[MassiveAttack]

I am sorry but I find it appalling that a lot of individuals here are telling you to stay or else your entire career is over. This is exactly the type of medicine we should all be working against. We should be fighting for the individual.

If you are unhappy there, what is the point in staying? Your happiness comes first. These after are the prime years of your training and education. Being in an abusive and toxic atmosphere will help nobody, not you, not the patient, nobody.

I am here as an advocate saying you should fight for what you feel is right. To sit silent will be continuing the perpetual cycle of abuse.

I speak from personal experience and from friends who were in similar situations.

Some thoughts for you...

- get an advocate, perhaps someone who knows you best and who would advocate for you, perhaps someone from your medical school who could also give you advice on what to do
- most programs have a person or program that you can go to who is not associated with the people in charge or the residency directors and who you can voice your grievances and issues to
- seek out your friends and family for now to give you support and positive energy, I cannot imagine how difficult it must be for you to be in such an environment
- consider getting letters of recommendation, just simple ones from attendings you have worked with, you need NOT mention you want to switch, just state that since you had a good working experience with the attending, you'd like to keep one on file, e.g. for fellowship or future job opportunities. I would ask them to send it to your medical school coordinator so that they have on file there, most med school coordinators will also read the letter and hint if it is in any way negative.
- I think if you want to switch specialities however that your program director might be more willing to help you out, I am unclear if this is the situation you are in.

and please stay optimistic and fight for your rights!!

 

[ForbiddenComma]

I am in good standing and have excelled at my program (despite my program director's issues with me). Faculty have given me the advice to leave. They advise that while the PD may be (crazy), that person is not vindictive enough to force me out of my job. My PD is an incredibly unprofessional person who would likely give me a poor review, but I would be able to get contrary statements from others (including the head of medical education). Would this work?

No. It would not. I am sorry.

Your PD has almost unlimited power over your career. Even his own superiors have very limited influence compared to the power of his letter over your career, because the only trump card they have is to fire him. And that is never going to happen. You need to realize that every single program -- and more importantly, every single state licensing board -- is going to request a letter from the person who holds the specific title of "Program Director." This is a very specific requirement, and the person who holds that specific title has the power of life and death over your career.

You could get Barack Obama to write you a letter and it wouldn't hold a candle next to the power of the letter written by your PD. You could line up a hundred LORs from attendings other than your PD -- even attendings that outrank him -- and they would not be worth toilet paper if the PD says something else. That is just how it is.

I continue to recommend that you stick it out if possible, unless you can get a position in an urgent care clinic.

 

[Baps]

I stand by my original statement. If the OP has performed at an adequate level and can obtain LORs from attendings who could support his performance despite the PD's ultimate negative letter, I'm sure there are some programs out there that would want to hear about his journey and learning experience ( without obviously bashing his prior program) if/ when he gets interviews. That's why I said the OP should get the letter now to withdrawing from the program and reapplying for the next cycle.
The OP states that his own PD is not supportive and is currently in a malignant program. Things aren't going to get better especially if the PD is not on your side so i think it may be in the OP's best interest to withdraw and start with a clean slate. Hindsight is always 20/20 but you have to go with your gut instincts even if that means starting over/ transferring. There are a number of people who have transferred to different programs and have done well.
Make sure you have an advocate/mentor from your med school or someone you trust in your program to advise you during this difficult period and make sure you surround yourself with the support of fam/friends. Keep your head up!

 

[peerie]

It is naive to think that one should always live or work in happy healthy environments, that is just not realistic. There is much craziness out there, and unfortunately it seems to thrive around power and money. Especially around unlimited power and money. That would be medicine.

In our personal lives yes, we should strive for health and wellness and good boundaries and self-respect as well as mutual respect among caring others. In medicine, give up that dream - it will not happen. The power differentials between program directors and residents is obscene and way greater than among regular employees and employers. It is very sad but true, and it will not change just because it is the 'right thing to do.'

Yes, your director might be crazy and unethical but do not give up your spot. Do whatever you can to quietly pass through and move on. You will not receive a good hearing from other programs and you will most likely not find any other spot. The competition is too great now and the dynamics too distorted - the system is broken. Some programs do regularly force residents out, some programs really do need to fault the resident and those programs leave a trail of ex-residents that really reflect poorly on that program more than anything. It's a disturbed system - what can we do? listen to the good advice here and quietly work to get through. Take it just one day, one minute at a time - try and see it as a powerful learning experience.

 

[Jackwhite]

Is it possible for your PD to refuse to write a letter stating that you completed the minimum requirements? I have concrete personal reasons for wanting to transfer (and can obtain documentation supporting it), but wanted to stress that I am dealing with an unreasonable person. this isn't a situation of someone simply being "mean", this person has made racist, gender-based and verbally abusive remarks to me (I am the only male in a field characteristically filled by women). I am not trying to "fight back", I am trying to transfer to some place I will not be harrassed. What if this is my PD's way of trying to "get rid of me"?Because things have been so bad, I am willing to do whatever it takes to make an effort to transfer into open spots in the same field at the end of my current year. I have already signed a renewal contract but understand that people can get released from them (is that true)?

 

[Baps]

I doubt your PD can refuse to write a letter for you. In fact, he/she may want to write a letter stating why you would be an "incompetent" physician and not give you any credit for the months of your residency. I know it will suck if that happens but you have to look at the whole picture. It's a no win situation either way so either continue in such a malignant environment that has its fair share of stresses on top of what's expected with residency vs. (best case scenario) repeating your residency elsewhere and starting with a clean slate.
I know of people who started mid year at a different program because they switched specialties, but I'm not sure about whether you can break your contract. I can imagine it is possible if you give your PD enough notice and withdraw from the program if there are open slots elsewhere or reapply ...Trust your instincts... and remember that you are not alone as there are a number of residents who have dealt with a similar situation.
Best of luck!

 

[QofQuimica]

Is it possible for your PD to refuse to write a letter stating that you completed the minimum requirements? I have concrete personal reasons for wanting to transfer (and can obtain documentation supporting it), but wanted to stress that I am dealing with an unreasonable person. this isn't a situation of someone simply being "mean", this person has made racist, gender-based and verbally abusive remarks to me (I am the only male in a field characteristically filled by women). I am not trying to "fight back", I am trying to transfer to some place I will not be harrassed. What if this is my PD's way of trying to "get rid of me"?Because things have been so bad, I am willing to do whatever it takes to make an effort to transfer into open spots in the same field at the end of my current year. I have already signed a renewal contract but understand that people can get released from them (is that true)?

Breaking your contract is not the problem from the resident's perspective; I could go into my PD's office today and tell him I'm outta here. Maybe technically the hospital could sue me for it, but what good would that do? I have no assets for them to go after. You likely don't, either. The real fallout from doing this for the resident would be that they'd likely never work in medicine again. This is because the PD would not write a letter of support to get them into a new program (and likely would do the exact opposite, given that quitting on a dime like that is grossly unprofessional behavior).

I'm guessing that you're in OB, and yeah, that's a tough specialty with a tough training environment. I'm sure some OB programs are more touchy-feely than yours seems to be, but that doesn't change the reality that we're all trying to tell you: if your PD won't help you find a new spot, you almost certainly won't be able to transfer into another program in *any* specialty. The people who do manage to transfer programs/specialties almost always do it with their PD's blessings, either because the PD is being practical and wants to avoid the hassle of having a miserable resident in their program, or because the PD actually cares about their residents as human beings and wants what's best for them. Neither of those scenarios seems to apply for you: your PD doesn't like you, and he doesn't care that you're miserable, to the point that he will likely fire you if you even broach the subject of transferring with him. You can't force him to like you, and you can't force him to do right by you if he's a nasty person who doesn't want to help you (or even worse, has it in for you).

So again, your realistic options are to either hunker down and get through your residency so that you can go practice somewhere else where people appreciate you, or else to quit the program and go do something else with your life. Whistleblowing if he's illegally discriminating against you based on race and gender is also a possibility, but it's essentially the same thing as choosing option #2. You may well help someone else, which is certainly noble, but you're unlikely to help your own situation in terms of continuing on with a medical career.

I doubt your PD can refuse to write a letter for you.

Of course he can refuse. Just how do you think the OP could force him to write a letter if he doesn't want to write one?

I don't think any of us are arguing that the OP's situation doesn't royally suck, or that he deserves to be treated the way he's being treated. It does suck, and no one deserves to be abused by their superiors. Unfortunately, he's not living in a Disney movie where the bad guys get their comeuppance at the end. If his PD is as awful as he says, then realistically it comes down to whether he wants to be a physician or not. I wouldn't at all blame him if he decided to quit medicine altogether rather than continue on in his program, but he needs to understand the likely ramifications of forcing this issue with such a malignant PD.

 

[razzrad]

There may be difficulties with securing funding for transfer so be careful with it. Usually funding is tied to a specific resident and if you give up your spot, there may be no funding to take you in another program.

 

[Jackwhite]

With the upcoming match, does anyone know how I can look into finding an open position without applying to ERAS?

I am two years in. I don't think that I will have the support of my PD either way, but I have few options, it's an unbearable situation. I can't imagine the years one spends trying to get through this process only to have it ended by a monster who dislikes you for illogical reasons. As one attending said, "it's unfortunate, but (the PD) does not get along with men and runs this place like a tyrant, everyone is afraid of (the PD) and can do nothing to stop it."

 

[Baps]

QofQuimica, you must be in Peds. Obviously residency is tough wherever you go. It's not going to be a walk in the park. However, there are programs out there that are less malignant and the PD does not an attempt to make your life miserable and is ...wait...supportive. You must be living in Disney thinking that all people are saints but hate to break it to you, there are ruthless people out there. There is no right or wrong answer for the OP. When you're in such situation as the OP, you tell me how easy it is "stick it out".

Yeah, funding is an issue and the OP will probably have to look for a PGY2 spot if he were to switch and that's if he finds a spot. It's an uphill battle to find a spot but you act like it's never been done before. On the other hand, he can just suck it up and go to work everyday where his PD is intentionally trying to make his life miserable. It's a no win situation either way. I hope that everything works out for you. Hang in there!

It's too late to apply via ERAS but you can call programs, or go to findaresident.com or residentswap.org.

 

[psymed]

You can transfer. Its a contract at will that can be terminated by either you or your program anytime. Residents have a lot more rights than they are aware of.

 

[blue2000]

You can transfer. Its a contract at will that can be terminated by either you or your program anytime. Residents have a lot more rights than they are aware of.

Can he break his contract? Yes. Can he get the institutional support that transferring requires? Much bigger, thornier question. Residents have "rights" but those "rights" don't have a lot teeth with a malignant PD. You are oversimplifying things.

 

[Groove]

Good grief people, it's just a few years and then you're done. You put up with med school and so much other crap, put up with residency. Why risk anything if you don't have to. Pacify you're PD and just do your work and don't complain. Most PD's aren't "out to get" people. There is no incentive for kicking people out and worrying about an empty spot and GME funding, along with gaining a reputation of resident turnover... It's really simple. You're obviously doing something they don't like, so change it. Fairness is out the window in my opinion. This is a transient period in time that will pass and be water under the bridge. You can endure it. Don't do anything stupid.

Not 5 threads down is one entitled "Former resident in Virginia suing residency program". Do you want to be that guy?

 

[ForbiddenComma]

Good grief people, it's just a few years and then you're done. You put up with med school and so much other crap, put up with residency. Why risk anything if you don't have to. Pacify you're PD and just do your work and don't complain. Most PD's aren't "out to get" people. There is no incentive for kicking people out and worrying about an empty spot and GME funding, along with gaining a reputation of resident turnover... It's really simple. You're obviously doing something they don't like, so change it. Fairness is out the window in my opinion. This is a transient period in time that will pass and be water under the bridge. You can endure it. Don't do anything stupid.

Oh, how I wish I lived in a universally fair and impartial world like the one you describe. I also suppose yours is a world where wishes come true, all little children are on Santa's nice list, and unicorns who fart rainbows prance in the meadows. Can I book a vacation there? Do they do group rates?

In my less fortunate reality, PDs, just like every other type of human being, do things for reasons other than pure logic, because they are not Vulcans. Some are quite willing to leave gaps in their rosters in order to kick around people they don't like with impunity, because after all, who has to pick up the slack for missing classmates at the end of the day... the PD, or the other residents? And who has to deal with the scheduling nightmares... the PD, or the chief resident?

A residency program, at least in the world I must inhabit, is not like the Step 3. A PD is not like a computer giving a test. A given answer is not always correct or incorrect for all people, no matter who they are. You can't just sit down and study off of one set of standardized materials and then succeed, because in the world most of us are unfortunate enough to be stuck with, people -- even PDs!!! -- can be biased, illogical, hateful, or mentally compromised, and they can like some people and dislike others for no good reason at all. They can pass anyone they desire, no matter how incompetent, and fail anyone they please, no matter how skilled, with a divine right that would have made Louis XIV proud.

Still, I am very glad your world is not like that. Please advise your fellow SDN posters how we may leave our tired old world and join yours. It does sound really nice. How's the housing market there for newcomers?

 

[Groove]

Oh, how I wish I lived in a universally fair and impartial world like the one you describe. I also suppose yours is a world where wishes come true, all little children are on Santa's nice list, and unicorns who fart rainbows prance in the meadows. Can I book a vacation there? Do they do group rates?

In my less fortunate reality, PDs, just like every other type of human being, do things for reasons other than pure logic, because they are not Vulcans. Some are quite willing to leave gaps in their rosters in order to kick around people they don't like with impunity, because after all, who has to pick up the slack for missing classmates at the end of the day... the PD, or the other residents? And who has to deal with the scheduling nightmares... the PD, or the chief resident?

A residency program, at least in the world I must inhabit, is not like the Step 3. A PD is not like a computer giving a test. A given answer is not always correct or incorrect for all people, no matter who they are. You can't just sit down and study off of one set of standardized materials and then succeed, because in the world most of us are unfortunate enough to be stuck with, people -- even PDs!!! -- can be biased, illogical, hateful, or mentally compromised, and they can like some people and dislike others for no good reason at all. They can pass anyone they desire, no matter how incompetent, and fail anyone they please, no matter how skilled, with a divine right that would have made Louis XIV proud.

Still, I am very glad your world is not like that. Please advise your fellow SDN posters how we may leave our tired old world and join yours. It does sound really nice. How's the housing market there for newcomers?

Sarcasm noted and not even worth my time in coming up with a creative and sarcastic quip, as I don't care enough. You sound very much like the typical physician who goes through college, medical school, residency, then becomes an attending and never really has to live out in what people like me call "the real world". This panacea of residency and ivory tower "fairness" is a mirage. All people in management positions and authoritative control over others are easily given to behave just as you described. And your point....?

Look, I was kicked out of the house at 16, lived a rough life, thrived after grad school in a successful career and clawed my way up to management before jumping ship to yet another career....medicine. What you describe is human nature. Some people just don't like you. So what? Deal with it. Do whatever is necessary to minimize that person's wrath. You're acting like a PD has no checks and balances. He has just as many, if not more, checks and balances as I had as an IT director. Did I have employees that I didn't like and probably let know it? Sure. However, you can't just go firing people for the hell of it with no rhyme or reason without it biting you in the ass. PD's don't have an incentive to give their program a bad reputation as a malignant program. They don't have an incentive to have residents with horrible morale who technically can all band together and complain to the rest of the staff, chief of the department, take matters before GME committee, and countless other options to make issues more difficult for the PD. The other staff don't want a PD who is doing nothing but creating terribly unhappy residents who complain all the time and make their shifts less enjoyable. PD's can be replaced by the department with internal or external pressure in a myriad of ways. That's just politics. The ubiquitous facts are that someone, in general, always wants your job. Likely, others wouldn't mind the title of PD, so there is a natural incentive to be a relatively or even subjectively "good" PD and like any job, you are judged on metrics. You answer to someone who assesses how well a job you are doing. If you aren't doing a great job, and someone else jockey's for your job and stabs you in the back in the process, then out you go and in with the new. That's life. Yes, there are always exceptions, but by and large, it works just like it works out in the real world. If a malignant leader is so malignant that he loses employee's morale and increases turnover, a company will replace him. The PD is no different in the setting of residency and has absolutely no natural incentive to create a wide sense of disharmony among all the residents.

You sound like having a fair boss is a right... lol, I can tell you that it isn't. You've got to wake up and smell the coffee at some point and realize that not everything in life is supposed to always be fair.

The facts are that as a resident, you are protected legally much less than say... an employee of a corporation. You have MUCH more to lose by pissing off your boss and quitting or attempting to change jobs. The risk of not being able to continue your residency education vastly outweighs the potential gain of a boss who is "more fair" than the last one.

I would be very careful before you encourage residents to transfer at whim and lose sight of the inherent risks involved. You would be doing them no favor if they were unable to gain another residency spot and lost their career in medicine simply because of your naiveté. The OP already stated that he had begun to get poor reviews from other staff. So, what are we dealing with here... Simply a malignant PD who is getting other staff on board in their plan to sabotage the one lone resident's career?? World domination next? lol... Unlikely, my friend. The PD has much more to worry about. That still leaves the question of what the poster can do to improve his situation and I would continue to encourage him/her to reflect inwards and do whatever necessary to change the situation regardless of if there is rampant malignancy.

As I stated, and I'll say it more clearly.... Others have survived, and others who were hated by their PD survived. The OP can too.

 

[ForbiddenComma]

You're acting like a PD has no checks and balances. He has just as many, if not more, checks and balances as I had as an IT director.

I'll just stop right there for a big ol' *smh*.

I suggest stopping by some of the other threads to see how this assertion holds up to reality. Unfortunately, there is pretty much no check nor balance on a PD's power over his residents. The resident committee you may be referring to is made up mostly of... guess what? That's right, PD's, from other programs of that institution. Who are they going to throw under the bus, one of their own or some random guy?

Malignant bosses happen in any field. I fully agree. That's life. But the thing is, if a malignant boss happens to you in IT... you can just jump on over to a new firm. Your old department head cannot end your career. One person does not have the power of life-and-death over your IT career.

But imagine if they did. Imagine if your very first department manager (and nobody else -- only the guy with the very specific title of "department manager") straight out of IT school will always be the #1 reference all future employers call for the rest of your career... imagine if that same manager gets to OK (or not OK) every state license for you to work at your job (let's pretend for this example that you would require an "IT license" to work in any state). Also, let's pretend that the word of this one, individual person holding the specific title of "department manager" is a trump card that invalidates any other reference that you might have obtained. The CEO himself could write you a glowing letter and make the right phone calls, but it does not matter if one particular department manager decides to torpedo your career because he didn't like the way you parted your hair.

You might call this insane, and you would be correct. But that is how medicine is built. There is nothing like this in any other field of work in the USA, not law, not IT, not marketing, not engineering, not even the military.

Yes, sucking up to the PD can save some residents. I was actually telling the OP to do this, and stick it out because it is better than the alternative. But sucking up won't save them all. My PD decided that I had to go the moment he laid eyes on me (I obviously didn't interview with him, unfortunately for all involved -- how I wish that the University of Nevada had never ranked me!)

And anyway, that's beside the point. One individual should not even get to play God over careers like this to begin with, should they?

 

[Groove]

I'll just stop right there for a big ol' *smh*.

I suggest stopping by some of the other threads to see how this assertion holds up to reality. Unfortunately, there is pretty much no check nor balance on a PD's power over his residents. The resident committee you may be referring to is made up mostly of... guess what? That's right, PD's, from other programs of that institution. Who are they going to throw under the bus, one of their own or some random guy?

Malignant bosses happen in any field. I fully agree. That's life. But the thing is, if a malignant boss happens to you in IT... you can just jump on over to a new firm. Your old department head cannot end your career. One person does not have the power of life-and-death over your IT career.

But imagine if they did. Imagine if your very first department manager (and nobody else -- only the guy with the very specific title of "department manager") straight out of IT school will always be the #1 reference all future employers call for the rest of your career... imagine if that same manager gets to OK (or not OK) every state license for you to work at your job (let's pretend for this example that you would require an "IT license" to work in any state). Also, let's pretend that the word of this one, individual person holding the specific title of "department manager" is a trump card that invalidates any other reference that you might have obtained. The CEO himself could write you a glowing letter and make the right phone calls, but it does not matter if one particular department manager decides to torpedo your career because he didn't like the way you parted your hair.

You might call this insane, and you would be correct. But that is how medicine is built. There is nothing like this in any other field of work in the USA, not law, not IT, not marketing, not engineering, not even the military.

Yes, sucking up to the PD can save some residents. I was actually telling the OP to do this, and stick it out because it is better than the alternative. But sucking up won't save them all. My PD decided that I had to go the moment he laid eyes on me (I obviously didn't interview with him, unfortunately for all involved -- how I wish that the University of Nevada had never ranked me!)

And anyway, that's beside the point. One individual should not even get to play God over careers like this to begin with, should they?

I'm not so sure that we disagree on very much. No, it's not fair that a PD exerts that much control over a residents career, but it's the reality. You seem to encourage "fighting the man" so to speak, and rebelling at the unfairness of it all. I simply recognize the reality of the situation and take the perspective that this is a somewhat ubiquitous element of leadership hierarchy when one has control over others. There are many more draconian dictators demonstrating abuse of powers throughout history than benevolent dictators. I just don't see the benefit in fighting against a system that is not going to change while the resident is in training. I "think" we agree on that much. Where we probably disagree is in our view of the PD's limitations and political constraints that affect his actions against residents. You are correct though that the PD wields entirely too much power in this role and it can definitely be abused. Again, though... This is the way it's been for a very long time and will likely remain that way. I think that residents would be wise to realize just how much control the PD has over their career and keep that in mind when they begin residency. My mentality has always been this... "keep your head down so as to make yourself less of a target, don't rock the boat, work hard, complain as little as possible."

After looking at a few of your prior posts, it seems that you were a victim of the same situation and lost your residency and chance at BC. However, it seems that you've survived and done well for yourself and as much as I'm sure there were plenty of elements of unfairness in your situation, I'd again caution you to objectively, not subjectively, offer advice to residents that find themselves in similar situations that you probably found yourself in.

I'm referring to the hospital GME office, not the ACGME or RRC. Anyway, this really isn't something to argue over. The OP has been educated and advised enough to make their own decisions and weigh the risks/benefits.

 

[ForbiddenComma]

True, the OP and people in his boat should stay quiet and try to survive. I don't want him/her to go through what I did. Any potential fix to the GME system would come too late for most current residents. And you are very correct that I am not an unbiased observer here.

But overall we who are outside the GME system should still try to make an effort to fix a broken system. Work hour restrictions were put in place after a concerted campaign... I firmly believe that real oversight of problem program directors can come about the same way.

 

[3dtp]

You can transfer. Its a contract at will that can be terminated by either you or your program anytime.

Absolutely true. Happens more than many realize.

Residents have a lot more rights than they are aware of.

Absolutely untrue. Residents have virtually no rights. You pay ERAS hundreds of dollars to send your resume/application to a few programs/employers, Something I did with a computer, a printer and a digital photo and a few dollars in stamps and envelopes in the "pre-ERAS" days. You then pay the NRMP hundreds of dollars to put your name in the hat and wait for the auctioneer to put your number up on the podium and the ERAS computer goes down the list of programs bidding on you. If you're lucky you match and start your slavery residency. PDs and Programs answer to no one. Occasionally they will succumb to peer pressure, like if the PDs boss is the chair and likes you a lot, but do not depend on it.

No. It would not. I am sorry.

Your PD has almost unlimited power over your career. Even his own superiors have very limited influence compared to the power of his letter over your career, because the only trump card they have is to fire him. And that is never going to happen. You need to realize that every single program -- and more importantly, every single state licensing board -- is going to request a letter from the person who holds the specific title of "Program Director." This is a very specific requirement, and the person who holds that specific title has the power of life and death over your career.

You could get Barack Obama to write you a letter and it wouldn't hold a candle next to the power of the letter written by your PD. You could line up a hundred LORs from attendings other than your PD -- even attendings that outrank him -- and they would not be worth toilet paper if the PD says something else. That is just how it is.

I continue to recommend that you stick it out if possible, unless you can get a position in an urgent care clinic.

What he said!

I am sorry but I find it appalling that a lot of individuals here are telling you to stay or else your entire career is over. This is exactly the type of medicine we should all be working against. We should be fighting for the individual.

Agreed. I am now working on it, quietly and behind the scenes, but it takes time, and there are land mines everywhere. Even for attendings desiring to change this mess. Prince Frederick the Wise of Saxony once said, "when someone who has power over you wishes you to do something you do not wish to do, you have three options: do what he wants and smile, ignore him and pretend you do not hear and go about your business, or fight him, and if you decide to fight you must be able to win." Sound advice in feudal Germany of 1520, even sounder in GME in the US today. This is a battle you cannot win by direct confrontation. The powers behind and supporting the entrenched GME are too powerful. There is too much money and too much power at stake. Those in power are loath to voluntarily relinquish it.

If you are unhappy there, what is the point in staying? Your happiness comes first. These after are the prime years of your training and education. Being in an abusive and toxic atmosphere will help nobody, not you, not the patient, nobody.

I am here as an advocate saying you should fight for what you feel is right. To sit silent will be continuing the perpetual cycle of abuse.

No disagreement there. But to speak out when you could get your head handed to you on a silver plate, complete with trimmings and make no change to the system is the height of folly. Better to bite your tongue until you are no longer in harm's way and then work to right the system. Not only is it safer, it is far more effective. It will take a lot of us to right this capsized mess we call GME. Career suicide is not an effective means of achieving the dream.

I speak from personal experience and from friends who were in similar situations.

So do I.

Thanks for the responses. I suppose my question would then be how is it that some people can transfer when a program is not a good fit?

It is a delicate process and one that will take some significant finesse, but it can be done, with out the objections of your present PD. When I was a chief resident in a disintegrating program, one of my first year residents told me she was going to look for a new position. Fortunately for her, I am very supportive of the liberty to change positions, which is contrary to the express NRMP desires, and of course the programs. I cautioned her as I have above to be exceedingly discrete, to use me as a reference and to have a target program call me at home, I provided her a letter of reference, and she identified a program and she was offered a position. Her new PD did speak with me, and I told him the circumstances. I assured him she would do well at the present program, but given the state of the program (3 chairs in 3 years, complete turnover in teaching faculty in 2 years, etc), I felt she would be better trained at the best possible program and be an asset to the profession, which is exactly what happened.

She came to me a few weeks later with offer in hand, needing a PD letter, and together we went to the PD and got the letter, not that it mattered what the letter said, as it was a necessary formality, since she was going to get the position no matter what. Just do it privately, carefully and discretely. Trust no one, as you don't know the behind the scenes dynamics and who is buddies with whom and what they are saying.

 

[lkjhg]

Any law firm to use when we our PD is a jerk and is wrongfully abusing the residents?please pm me.

 

[ThePedoncle]

This has happened to me. I can only hope that my story helps someone else:
I am an IMG, was prematched into a smal FM program; my first year was uneventful except that my director at the time left three months after I got in because the small county hospital was sold to a corporation. I did well, saw 40% more pathients than any other PGY-1, bla-bla...As I started my PGY-2 the director (ex-assistant) became very malignant, criticizing my European accent (I speak with an English accent), my discharge summaries from the year before, etc. This guy used to like me! Sudddenly I was accused of anything under the sun. I caved in, worked and worked extra hard but he did not stop harassing me for months. He served me a letter of counselling with false statements and accusations. He did the same to another PGY-2.
Since this was a tiny program I went to see a lawyer to discuss my options, not many of them. The PD put the other PGY-2 on probation then he announced that he was going to repeat his entirely second year...This is when I thought that I would submitted to the same treatment.
My undertsanding is that the director was being squeezed between the new administration requesting 24/7 hospital coverage by the residents when the 2011 new duty hour regulations for the PGY-1 were taking place. In a program of 4 per year, it was merely impossible to offer 24/7 coverage hence the need to have 2 PGY-2 double up their year so the program has a bridge of 6 PGY-2 at one point to face every need, giving time to the PD to get himself up to speed. Anyway, this was my asumption.
I resigned from the program and left the hospital at 20/36 months, in good standing despite of all.
Nobody ever helped me even though I was quite liked in the hospital and I never faced any difficulty. My performance letter was a compilation of horrible statements and false accusations; I was totally shocked, I never thought that a PD could do such a thing: liying.
I launched complaints after complaints (ACGME, civil rights, joint commission, ect) but it lead nowhere. My lawyer was useless and he did not want to face the corporation's lawyers.
I fought for a year until I recently got a letter of threat from a TN lawyer telling me that his client (my ex-PD and hospital) will take Court action against me if I was to launch another complaint again.
I never got a chance to resume residency even with my step3, etc. When I applied to the WI medical board my ex-PD actually lied on the paper saying that I had been put on probation, was in bad standing, and complaints had been lodged against me by staff and patients...all false!
I managed to get a copy of what he wrote so I have evidence; this is when I got threatened by the hospital lawyer.
I have stopped fighting because I do not have any money. I have to look at my options to leave the US and get back to Europe because I feel our life here is over.
I have found out that since inception the program has lost one resident per year, average, through termination (mostly), transfer or resignation. I spoke to the resident they kicked out for me to get in and she was indeed treated very poorly.
If you are in a large program do go and see the DIO (designated institution official) OR go straight to HR and lodge a massive complaint so you will have a case no matter what.
Do not deal with your director on your own; avoid the ACGME; secure yourself, go for the kill through HR. You will not win against a PD.
I never did anything wrong and I resigned to protect my medical education and training.
My wife and I have lost everything. I have been black balled.
...I think it is time to create a list of malignant programs so people stay away from them.
The reason why residents have no rights in the US and that PD have so much power is just another way for the Establishment to function using abuse, bullying and threatening techniques. It is very disturbing and this will never make medicine better.
Worst of all is that Medicare money is ised by those bozos so they can behave like sociopaths, because that's what they are.

 

[NotAProgDirector]

Stories like this are heartbreaking.

Unfortunately, it's not clear that there's a great solution. According to you, you're a fine doc who got totally screwed by the system. If we ask your PD, they'd say that you're the problem, that you blame other people, etc. Who's telling the truth? There's no way to really know. I guess we could try to have some sort of national review board of some sort, but in the end your PD would line up all sorts of evidence of your problems, and it would be impossible to tell where the truth is.

Don't take this the wrong way -- I'm not accusing you of lying. Your story could certainly be true.

I'd like to think that I'm a nice person, that I run a program fairly, etc. I rarely fire people, and when I do I try to help them with whatever the next stage of their career will be. All that said, I've had two residents in the past that have railed against my unfair treatment of them. One graduated, one didn't. They appealed every decision I made. They posted what I felt were very biased reviews of my program and myself, here on SDN and elsewhere. Part of their pathology was blaming others for their own failings.

Residency training is not guaranteed success. If a resident does not meet standards, we need to have a system that allows programs to terminate them. Finding a way to fairly balance programs' responsibility to society to safeguard the quality of their graduates vs. residents' right to be treated and evaluated fairly.

In (perhaps) some good news, some of the changes at the ACGME might address issues like this. In the past, programs were evaluated individually, usually every 4-6 years with a site visit. In the new system, all institutions will be visited every 18 months. Hence, if a program is treating residents badly, the ACGME is likely to find out about it more quickly. In addition, the ACGME now does annual resident surveys which are theoretically anonymous. None of this is a perfect solution, though.

 

[cowme]

Lol at the "anonymous" surveys. I accidentally marked that I violated a duty hour rule (which, on the follow up question, I clarified that I did no such thing). I had to meet with the chairman of medicine and program director for an hour convincing them that it was an honest mistake.

 

[NotAProgDirector]

I can tell you that they are actually anonymous. All I get is a global summary. How your chair/PD figured out it was you is not clear. Perhaps they had the same discussion with everyone. Perhaps they know some "trick" that I don't.

 

[Trauma Surgeon]

"In the new system, all institutions will be visited every 18 months. Hence, if a program is treating residents badly, the ACGME is likely to find out about it more quickly. In addition, the ACGME now does annual resident surveys which are theoretically anonymous."
Then what? What exact power do ACGME have to solve the situation? To my understanding programs rarely get "punished" by them? Can they help the resident(s) in question to find a new spot?
Sorry for interrupting your conversation since I'm not in a US residency, just curious.

 

[TexasPhysician]

Lol at the "anonymous" surveys. I accidentally marked that I violated a duty hour rule (which, on the follow up question, I clarified that I did no such thing). I had to meet with the chairman of medicine and program director for an hour convincing them that it was an honest mistake.

As a rule of thumb, never believe that surveys are anonymous. If someone knows you, they could probably figure out which comments were yours even without a name attached. The smaller the program, the easier this would be.

 

[ThePedoncle]

I totally agree that residency is not guaranteed success and it should not be because this is about medical safety and proper standards.
Yet there are modern ways to enforce those parameters in the middle grounds of education and training in the field.
My taste of residency has been extremely bitter because in a small program, in the boonies of "O", where IMGs are treated poorly compared to AMGs, where non-US citizens are considered to be "less" than others. Perhaps this is also what happens when religion spreads all over from the director's views of life, death and some odd Baptist views of sexuality.
Far from being the best resident I was nevertherless very safe, very productive, a good team player, hard-working and very much liked by my patients and staff. From my previous background in medicine I was able to generate impulse in musculoskeletal medicine and a better management of occupational disorders.
My point is about the ability of the system to damage residents when they have no course of action to protect themselves against lies and dishonesty. When the only reachable entity is the ACGME (my PD was also Chair and DIO) and when the place is so bloody small that HR is not even an option, how can residents survive?
Personally I was not even aware of a GME because no-one even told us who composed it and we were totally left apart from knowing anything about the functioning of the residency program. By keeping residents in complete ignorance the PD had total control over everything.
I have discussed the matter with friends in Europe, OZ, NZ, Canada...they all have a system in place that guarantees fairness and prevents one's totalitarian views from destroying residents' lives. Residents there feel protected; they become good doctors too.
When one has such considerable power over a group of individuals that has spent years in training, borrowed so much money, and invested everything they (and families) have into medicine, a system should be in place that guarantees safety for trainee physicians.
Also anyone in education should attend special training to be able to teach and to know the pit-falls of training others. So far, anyone can be an attending or a PD without any test.
Anyone with so much influence over residents and patients should be assessed by the proper medical and educational authorities before having the privilege of teaching medics.
The system is not just "unfair' it is dangerous because it relies on abuse, harassment and discrimination of all sorts to break residents into doing things as taught by predecessors; it is the opposite of the concepts of medicine.
As for ethics...where are they?
I resigned but have paid a very heavy price of slander and defamation against me. It is the lowest form of punishment against a resident or a physician.

Stories like this are heartbreaking.

Unfortunately, it's not clear that there's a great solution. According to you, you're a fine doc who got totally screwed by the system. If we ask your PD, they'd say that you're the problem, that you blame other people, etc. Who's telling the truth? There's no way to really know. I guess we could try to have some sort of national review board of some sort, but in the end your PD would line up all sorts of evidence of your problems, and it would be impossible to tell where the truth is.

Don't take this the wrong way -- I'm not accusing you of lying. Your story could certainly be true.

I'd like to think that I'm a nice person, that I run a program fairly, etc. I rarely fire people, and when I do I try to help them with whatever the next stage of their career will be. All that said, I've had two residents in the past that have railed against my unfair treatment of them. One graduated, one didn't. They appealed every decision I made. They posted what I felt were very biased reviews of my program and myself, here on SDN and elsewhere. Part of their pathology was blaming others for their own failings.

Residency training is not guaranteed success. If a resident does not meet standards, we need to have a system that allows programs to terminate them. Finding a way to fairly balance programs' responsibility to society to safeguard the quality of their graduates vs. residents' right to be treated and evaluated fairly.

In (perhaps) some good news, some of the changes at the ACGME might address issues like this. In the past, programs were evaluated individually, usually every 4-6 years with a site visit. In the new system, all institutions will be visited every 18 months. Hence, if a program is treating residents badly, the ACGME is likely to find out about it more quickly. In addition, the ACGME now does annual resident surveys which are theoretically anonymous. None of this is a perfect solution, though.

 

[smq123]

I can tell you that they are actually anonymous. All I get is a global summary. How your chair/PD figured out it was you is not clear. Perhaps they had the same discussion with everyone. Perhaps they know some "trick" that I don't.

Many programs now have "practice surveys," where they make the residents do a trial run of the ACGME survey before the ACGME survey is formally done. My program did; other people in the Lounge who are residents have posted similar things.

 

[NotAProgDirector]

Then what? What exact power do ACGME have to solve the situation? To my understanding programs rarely get "punished" by them? Can they help the resident(s) in question to find a new spot?
Sorry for interrupting your conversation since I'm not in a US residency, just curious.

The ACGME will not help anyone get a new spot. Interestingly, residents (and those here on SDN) seem to think that the ACGME doesn't punish programs. PD's feel that they are often draconian -- coming in for a brief review, making sweeping judgements of how you run your program, and then generating citations that you need to deal with. The "new" ACGME is supposed to be more PDSA friendly, helping institutions improve by assessing them more globally, more frequently. But this assumes that the programs are well meaning, it's unclear how the ACGME will address or even assess whether programs are truly malignant.

I totally agree that residency is not guaranteed success and it should not be because this is about medical safety and proper standards.
Yet there are modern ways to enforce those parameters in the middle grounds of education and training in the field.
My taste of residency has been extremely bitter because in a small program, in the boonies of "O", where IMGs are treated poorly compared to AMGs, where non-US citizens are considered to be "less" than others. Perhaps this is also what happens when religion spreads all over from the director's views of life, death and some odd Baptist views of sexuality.
Far from being the best resident I was nevertherless very safe, very productive, a good team player, hard-working and very much liked by my patients and staff. From my previous background in medicine I was able to generate impulse in musculoskeletal medicine and a better management of occupational disorders.
My point is about the ability of the system to damage residents when they have no course of action to protect themselves against lies and dishonesty. When the only reachable entity is the ACGME (my PD was also Chair and DIO) and when the place is so bloody small that HR is not even an option, how can residents survive?
Personally I was not even aware of a GME because no-one even told us who composed it and we were totally left apart from knowing anything about the functioning of the residency program. By keeping residents in complete ignorance the PD had total control over everything.
I have discussed the matter with friends in Europe, OZ, NZ, Canada...they all have a system in place that guarantees fairness and prevents one's totalitarian views from destroying residents' lives. Residents there feel protected; they become good doctors too.
When one has such considerable power over a group of individuals that has spent years in training, borrowed so much money, and invested everything they (and families) have into medicine, a system should be in place that guarantees safety for trainee physicians.
Also anyone in education should attend special training to be able to teach and to know the pit-falls of training others. So far, anyone can be an attending or a PD without any test.
Anyone with so much influence over residents and patients should be assessed by the proper medical and educational authorities before having the privilege of teaching medics.
The system is not just "unfair' it is dangerous because it relies on abuse, harassment and discrimination of all sorts to break residents into doing things as taught by predecessors; it is the opposite of the concepts of medicine.
As for ethics...where are they?
I resigned but have paid a very heavy price of slander and defamation against me. It is the lowest form of punishment against a resident or a physician.

Again, another heartbreaking story. Again, we only hear one side of it, so impossible to decide whom is right vs wrong. But I do agree that some sort of check and balance is needed. Most big institutions have that built in via an independent GME office, but smaller institutions (especially those with only a single program) clearly face challenges.

I'm not certain what the best plan forward would be. I'm not a fan of the UK/Aus system of "attachments" where residents rotate from site to site every 6-18 months. I do think that smaller institutions (where there are only 1-3 programs, for example) could have some sort of appeals process that was independent. The devil is in the details, of course.

 

[BolderNewfy]

Before we filled out out survey we had a big meeting where the program director basically told us how to answer the survey, and that he would know how we answered and not to rock the boat. We had until a certain date, and every day at morning report he would list the names of the residents that had not completed the "anonymous" survey. He was able to get an idea of how people were answering questions by seeing who had completed the survey since he last checked and how the responses had changed in that interval. He scared everyone into just keeping their head down.....

The ACGME seems to do the bare minimum to keep up the APPEARANCE of monitoring residency programs. Here is an example. Duty hour reporting..... We have a system of "self reporting" hours. I log on to a website and self report how much I have worked. If I violate a alert is sent immediately to my PD, and within a day I am called in to basically get reamed out for reporting the hour violation. Its gotten to the point where residents are advised to just lie unless they want to get in trouble. violations are blatant. Now If the ACGME truly wanted to regulate the amount of hours residents are working would they really rely on self reporting? of course not. It would be so easy to track when a person first logs in to the computers at the hospital and when they log off. or just have us just clock in like normal employees do. In other fields where human lives are at stake such as air traffic control, large truck drivers etc, they do not rely on self reporting because it is not an objective or accurate way to track how much we work. it is obvious that the ACGME is not legitimately trying to monitor duty hours. They also did not heed the large scientific study or the IOM report recommending reducing duty hours.

 

[mcl]

Before we filled out out survey we had a big meeting where the program director basically told us how to answer the survey, and that he would know how we answered and not to rock the boat. We had until a certain date, and every day at morning report he would list the names of the residents that had not completed the "anonymous" survey. He was able to get an idea of how people were answering questions by seeing who had completed the survey since he last checked and how the responses had changed in that interval. He scared everyone into just keeping their head down...

Although the PD can see a list of who has not completed the ACGME resident survey, he/she cannot see the survey results until the program hits the 70% participation threshhold. Hopefully that will help with the anonymity issue.

Not every survey you are asked to complete is the ACGME survey. Residents are required to evaluate the education program and each faculty member they have worked with at least once per year. PDs have much more leeway in monitoring these department-level surveys and may have more cause to do so since the responses may affect promotion or funding. They definitely want the chair and/or DIO to see happy residents in a well-functioning program.

 

[Paddington]

If you don't match where you want to (or are stuck in a program you don't like), your options are pretty limited. Although people do transfer from program to program, it's quite difficult to do so. You need the support of your current PD. But then he's going to be short a man, and may be resentful. You also need to find a position of your own rank which opens up, in a place you actually want to go to (and with a curriculum that's comparable to your own, otherwise you end up repeating stuff). That can be extremely, extremely difficult, for all of those stars and planets to line up so to speak.

If you're not happy with where you're at, but the program is tolerable then the best thing often is to just suck it up and finish it out. Even at crap programs usually the final year or two is not too bad.

 

[member0007]

Many programs now have "practice surveys," where they make the residents do a trial run of the ACGME survey before the ACGME survey is formally done. My program did; other people in the Lounge who are residents have posted similar things.

Don't divulge any information at these surveys. In fact, state that they are the greatest program ever and wait until the ACGME arrives to make factual statements about how horrible the program is.

 

[member0007]

Before we filled out out survey we had a big meeting where the program director basically told us how to answer the survey, and that he would know how we answered and not to rock the boat. We had until a certain date, and every day at morning report he would list the names of the residents that had not completed the "anonymous" survey. He was able to get an idea of how people were answering questions by seeing who had completed the survey since he last checked and how the responses had changed in that interval. He scared everyone into just keeping their head down.....

The ACGME seems to do the bare minimum to keep up the APPEARANCE of monitoring residency programs. Here is an example. Duty hour reporting..... We have a system of "self reporting" hours. I log on to a website and self report how much I have worked. If I violate a alert is sent immediately to my PD, and within a day I am called in to basically get reamed out for reporting the hour violation. Its gotten to the point where residents are advised to just lie unless they want to get in trouble. violations are blatant. Now If the ACGME truly wanted to regulate the amount of hours residents are working would they really rely on self reporting? of course not. It would be so easy to track when a person first logs in to the computers at the hospital and when they log off. or just have us just clock in like normal employees do. In other fields where human lives are at stake such as air traffic control, large truck drivers etc, they do not rely on self reporting because it is not an objective or accurate way to track how much we work. it is obvious that the ACGME is not legitimately trying to monitor duty hours. They also did not heed the large scientific study or the IOM report recommending reducing duty hours.

ACGME doesn't do anything to even enforce their so-called policies. The organization is without purpose at this point. They will claim to be impartial and such but guess who pays them to keep their lights on... your program. We also know that there is a lot of free money that is given to program to supposedly teach you and so on but let's face facts, we are just slave labor to programs and private organizations and hospitals that benefit from cheap professional work.

 

[member0007]

Before we filled out out survey we had a big meeting where the program director basically told us how to answer the survey, and that he would know how we answered and not to rock the boat. We had until a certain date, and every day at morning report he would list the names of the residents that had not completed the "anonymous" survey. He was able to get an idea of how people were answering questions by seeing who had completed the survey since he last checked and how the responses had changed in that interval. He scared everyone into just keeping their head down.....

The ACGME seems to do the bare minimum to keep up the APPEARANCE of monitoring residency programs. Here is an example. Duty hour reporting..... We have a system of "self reporting" hours. I log on to a website and self report how much I have worked. If I violate a alert is sent immediately to my PD, and within a day I am called in to basically get reamed out for reporting the hour violation. Its gotten to the point where residents are advised to just lie unless they want to get in trouble. violations are blatant. Now If the ACGME truly wanted to regulate the amount of hours residents are working would they really rely on self reporting? of course not. It would be so easy to track when a person first logs in to the computers at the hospital and when they log off. or just have us just clock in like normal employees do. In other fields where human lives are at stake such as air traffic control, large truck drivers etc, they do not rely on self reporting because it is not an objective or accurate way to track how much we work. it is obvious that the ACGME is not legitimately trying to monitor duty hours. They also did not heed the large scientific study or the IOM report recommending reducing duty hours.

ACGME doesn't do anything to even enforce their so-called policies. The organization is without purpose at this point. They will claim to be impartial and such but guess who pays them to keep their lights on... your program. We also know that there is a lot of free money that is given to program to supposedly teach you by medicare but let's face facts, we are just slave labor to programs and private organizations and hospitals that benefit from the cheap professional work. The expectation is also that you are a slave and they will take any illogical action against you because they can and they are the almighty.

Duty hours are meant to protect patients but there is such a backlash against it, despite the fact, medicine is practiced similarly with such restrictions across the world and with good results and better outcomes for patients. Things are not going to change till the older folks that run the game retire and get a taste of their own medicine. I am just imagining the CEO or some dean being subjected to healthcare at their own teaching hospital... yeah right. You know they will be going to the nice non-teaching safe hospital that has better standards of care and a record to match.

 

[member0007]

Although the PD can see a list of who has not completed the ACGME resident survey, he/she cannot see the survey results until the program hits the 70% participation threshhold. Hopefully that will help with the anonymity issue.

Not every survey you are asked to complete is the ACGME survey. Residents are required to evaluate the education program and each faculty member they have worked with at least once per year. PDs have much more leeway in monitoring these department-level surveys and may have more cause to do so since the responses may affect promotion or funding. They definitely want the chair and/or DIO to see happy residents in a well-functioning program.

Wow. So, the PD can keep a running tally of survey as the results are coming in after the 70% threshhold? That's creepy and dangerous opportunity for predator PD.