Non-Renewal But Offered LOR

[Valvool]

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I am currently a CA-1. I successfully completed my PGY-1 year despite being considered deficient in the areas interpersonal/communications skills. In March of this year, my program director sent me to a psychiatrist of his own choosing; his position was that if the psychiatrist deemed me suitable for the residency program then they would renew my contract, if not, then they wouldn't. I signed a waiver giving him access to my psychiatric records. (The alternative was non-renewal--in fact I had already been given a non-renewal letter which was sort of put 'on hold'). I agreed and saw the psychiatrist. She sent me to a neuropsychologist for 7 hours of testing. All of this during an internal medicine month. The results of all the appointments and testing was a diagnosis of Asperger's. However the psychiatrist was of the opinion that I could be successful in the program.

My program director allowed me to stay, under the condition that I take medication and see an Asperger therapist weekly. At the end of April there was another threat of non-renewal; I weathered that one, and a subsequent one in the first week in June. The new agreement was promotion to PGY-2 year with a three month contract, with reevaluation of my deficiencies. Recently, after six weeks of general cases in the OR (for the last two weeks I managed cases solo), I was at last given the letter of non-renewal. Their position is that they will keep me on contract for the duration of the three month period, but no more patient care. I must show up at the hospital every day to work on something of my choosing.

I am also being offered LORs from my program director and multiple other attendings. My PD has said he will focus on my strengths and minimize my weaknesses, but when I broached the possibility of switching to another anesthesiology program he didn't seem supportive. The LORS will probably say that I am competent clinically, but have deficient social skills. I will say that there were no incidents with patient care; despite widespread concern that I was too Asperger's-ish to be safe managing patients in the OR, I did well managing cases solo and was told by two different attendings that my intraoperative management was on par with my level of training.

In my opinion the general knowledge among faculty at my program about my situation and psych diagnosis hurt me quite a bit in terms of block evaluations. The evaluations from the attendings who were privy to the Asperger diagnosis definitely have many more comments like, "She focuses on minute details and misses the big picture"...."She should seek a career in research or pathology, not anesthesiology". Some of the ones from attendings who knew nothing say my social skills are fine, but that I am clumsy with procedures, which is true. (In the beginning of June I started in anesthesia, which was my first exposure ever to the field as I had not done a rotation in anesthesia in medical school. I was quite clumsy at first but improved rapidly.) From PGY-1 year my evaluations were almost all good; the exceptions made reference to interpersonal skills, getting too attached to patients, and not being deferential enough to attendings, not recognizing my place in the heirarchy, and not paying attention during rounds when other people were presenting. The evaluations from anesthesiology attendings were overall negative, but those came after the information about my diagnosis was generally known.

I contacted the dean of my medical school today about my situation; he said forget moving into another anesthesia spot, you're stuck with path or family medicine now.

There was a CA-1 from last year who was released from our program in February; I tried to find out what she decided to do and how she fared afterward but there was no response to my emails. I never knew her personally. I asked my PD about her today and he said that she basically cut them off a few months ago and they have no idea where she is now.

I am not sure what to do at this point, what my options are, and if there is any hope for me in continuing somewhere else in anesthesia. There isn't really another specialty in which I am interested at this point.

Thanks in advance.

 

[chocomorsel]

Sounds to me like someone screwed you over. Not surprising, such is residency.
To force you to go see a psychiatrist and have an open medical record for them to use against you..... Well, can't say it's never been done before. You won't be the last.

What to do? How about attempt to contact every residency program there is, and see if there's anyone willing to take you? In the meantime could you get a lawyer to consult with and see what kind of advice you could get? Is it legal to use a a known diagnosis as a basis for termination if it doesn't interfere with patient care? I have known quite a few Aspergerish, socially awkward docs in all fields. Doesn't mean they are incompetent. How are you doing academically? That's all that should really matter. You don't have to be everyone's best friend.

Sounds fishy to me. I would seek counsel.

 

[CaliforniaBound]

This sounds terrible! Also sounds fishy, I would get legal counsel ASAP!

 

[IlDestriero]

Legal council or not, I'm sure you're done with anesthesia. They will likely say your personality and eccentricities are incompatible with anesthesia. I can't see a PD in anesthesia giving you a chance when you might be dangerous. Find a research job and take a year to explore your options. It sounds like they will support your transition to some non acute care field. Take them up on the offer. We lost one guy to PM&R. He couldn't handle the stress of a crisis situation. Anesthesia was a poor choice. He left on good terms and found a spot without much trouble.
Be honest with yourself and look into other careers. Only you know what your deficiencies really are and how they impacted your performance. I'm sure there's a career in medicine that you would fit into fine.

 

[Guillemot]

I dont know the situation exactly, but I think IIDest makes a good point. Think carefully before you get a lawyer. It might be better to move on to some other branch of medicine, and it sounds like your program will support you in this matter. There is more to life than being an anesthesiologist or any type of physician. Then again if you truly feel that you have been wronged there might be some recourse you could seek. I am not familiar with that process though.

 

[gasattack3]

I won't go into details as, but I have seen a similar situation. Not the same, but similar sounding.

My overall opinion is that anesthesiology is NOT for everyone. I would say that 98% of residents across a wide range of personality types and innate capabilities will push past the challenges unique to our field, but maybe 1-2% just can not and perhaps should not attempt to change something which may be meant to be.

I don't want to sound harsh or unsupportive, but I stand by that anesthesia is NOT for everybody.

On a more positive note, one could focus on their strengths, find a field in medicine (you have a lot invested thus far) which maximizes those strengths while minimizing your real or perceived weaknesses and go be the best of whatever that is that you can.

This field is not for everyone, and it shouldn't be assumed to be.

 

[chocomorsel]

Yeah, they also fed me the same type of bull****. Can't function well under stressful situations, can't get along with people, And almost pushed me out. Truth is I am not the kind of person who takes a lot of crap from people nor do I go out of my way to be "friendly". I am who I am, take it or leave it and most folk get along with me just fine. And because my dept got on my ass, I developed anxiety and couldn't perform under stress. Got that treated and performance improved. Got the hell out and don't need those drugs anymore.

The things that saved me where my grades, a resident union and the fact that there was already a lawsuit out against the dept. I suspect they weren't interested in another one.
A lot of that subjective crab is total bull****. You can piss of the wrong one to two people and word gets around and your reputation is ****ed.

Sounds to me like they are trying to screw you. And successfully most likely. Doesn't mean it's right. But you likely won't come out on top. It's a crappy situation how subjective **** can screw people over. Unless you are totally incompetent, placing patients in danger, coming to work constantly late, not doing your work, what does the other crap really matter?

Some people on this board are going to make you feel like ****. And the sad thing is, they are correct, in as there is nothing likely that you can do about it. But doesn't mean what your PD is doing to you is right.

Try your luck with the other programs before you hang it up. You might get lucky. Don't bet on it though. I would still seek counsel. Sounds like possible discrimination against a disability.

Residency sucks ass.

 

[cincincyreds]

That sounds really awful.

Unfortunately people are prejudiced. Did you do your work, show up on time to cases and lectures, and keep patients safe?

You said the other resident was female and you are female. Is that correct?

I mean god forbid you show some compassion for a patient who is about to be cut open for some aweful condition.

As far as the skills, the other residents may have a hand because they did the rotations as medical students. But the truth of the matter is you can train a monkey to do the physical skills we do. It is the decision making and diagnosis of problems we make the big bucks, not the fact we can put an IV in, push some white stuff, and shove an endotracheal tube down someone's trachea.

What I would suggest is rather than fight city hall, go to the pd. Tell him you have a lot invested in this including time and money. Ask him what he can do to help you out so you can succeed. Maybe he can make a phonce call to one of the type of programs that he sugggested, such as pm&r. I think the main issue is they are concerned with your skill level versus the other residents and they are using this Asperger's as an excuse.

Sorry about the situation

 

[jwk]

Sounds like an ADA claim in the making.

 

[nap$ter]

I did well managing cases solo and was told by two different attendings that my intraoperative management was on par with my level of training.

"She focuses on minute details and misses the big picture"...."She should seek a career in research or pathology, not anesthesiology". Some of the ones from attendings who knew nothing say my social skills are fine, but that I am clumsy with procedures, which is true. (In the beginning of June I started in anesthesia, which was my first exposure ever to the field as I had not done a rotation in anesthesia in medical school. I was quite clumsy at first but improved rapidly.) From PGY-1 year my evaluations were almost all good; the exceptions made reference to interpersonal skills, getting too attached to patients, and not being deferential enough to attendings, not recognizing my place in the heirarchy, and not paying attention during rounds when other people were presenting. The evaluations from anesthesiology attendings were overall negative, but those came after the information about my diagnosis was generally known.

I am not sure what to do at this point, what my options are, and if there is any hope for me in continuing somewhere else in anesthesia. There isn't really another specialty in which I am interested at this point.

Thanks in advance.

Sorry - without knowing ALL the details I would agree with your program - you should seek another field. In ten years you'll look back and it will seem like not such a big deal. You'll find another niche - there is a place in medicine for you - I'm sure of it. It's just not anesthesia.

I've seen some pretty sketchy residents graduated. I've seen some A-holes and quiet antisocial weirdos passed. You can have Asperger's and give good anesthesia. I've seen it. You don't need social skills to cut it in anesthesia residency.

The stuff highlighted in red makes you sound insubordinate, as if you ignored attendings' plans and went your own route. Only two attendings out of the whole bunch told you you were average?

Most concerning - "focussing on minute details and missing the big picture" means you're missing critical events ie hypotension, hypoxia, hypovolemia. Has that happened?

Count your blessings and make the most of it.

 

[Gern Blansten]

Sorry for your situation. All readers, however, must remember, we are only reading one side of the story. Having seen residents in all specialties who have struggled and seen and heard the stories from both sides in many situations, I can tell you that the stories rarely match each other. Residents that do poorly in whatever aspect of the six core competencies rarely have insight into the level of the problem. The resident could have 10:1 negative evals, multiple patient complaints, consistently late for work, use and abuse their colleagues, academic probation for low ITE scores and they will still claim they were treated unfairly despite numerous attempts by the program to address the issues.
I am not saying that is what has occurred here, I am just pointing out that this is one version of the story. It is human nature for a person to avoid listing the ways in which they may have contributed to the negative outcome. I think there are certainly occurrences where a person was let go unjustly, but I don't believe this is the norm.

 

[itwasalladream]

You have a few red flags. There are negative evals from intern year, which I'm assuming came from outside the anest dept, and before anyone had your diagnosis in front of them to color their evaluation of you. You mention 3 separate threats of non-renewal, followed by an official notification of non-renewal after psych eval and trial in the ORs. It sounds like your hospital/department was active in trying to give you early feedback, treatment options, multiple chances, and LORs for a change to a different specialty. There are many programs that will wait until you have invested much more time/effort before finally asking a resident to leave. Maybe it is better this happens earlier than later?

Obviously none of us can really comment on whether you are safe in the OR but even if you are, I would advise AGAINST getting legal counsel. You will burn bridges, poison your current work environment, and likely create a huge headache for yourself all while fighting a losing battle. I think you stand to lose a lot with this approach especially if your program is willing to help you find a position in another specialty. Finding a position in another anesthesia residency may be possible, but a different specialty seems more likely. As for ideas on how to find other positions, it can't hurt to start emailing program directors around the country and see what comes of it. You will probably have to put in a lot of legwork but hopefully something positive comes of it. Sorry you are going through it, and good luck.

 

[Valvool]

Thanks for the input from everyone so far.

Yes, there is some truth to the criticism. I have never excelled in social skills, had trouble making friends as a kid, and even now I am happier on my own, doing my own thing, than being in a group. Sometimes when in a discussion with attendings, I forget the heirarchy and say what I think even if it disagrees with the view of my superiors. This has caused grief. Overall my intern year went well. There was one poor evaluation but it came after the Asperger diagnosis was known--and word got around the IM department as well, I discovered later.

I don't know what the right thing to do is. I have agreed to work with the pathologists in our hospital for a week to see if I enjoy that type of work. I am 'going with the program' in hopes of not burning bridges and having positive LORs. But I do enjoy patient contact--there have not been patient complaints about me and in general I have found that patients tend to be much more tolerant of any oddness in my personality than colleagues. One of the last patients I cared for had pseudocholinesterase deficiency and despite an overall horrible postoperative experience, he and his wife went out of their way to tell my attending that they had liked me and felt I had taken excellent care of him. Unfortunately that never made it into my evaluations. In any case, I do not feel it is fair to push me into pathology, totally away from patients. But I get the sense that unless I move toward pathology, or radiology, there won't be positive LORs.

And yes, this situation has been ongoing since February. I have been under the microscope since then. And though I am not habitually late, I was significantly late once in one year--exactly one time, thirty minutes late. And because I was under the microscope, much was made of it, and the fact that I was tardy was added to the list of reasons that the program should not keep me, and each subsequent letter mentioned it. Meanwhile the senior I was on with that month came in at least a half hour late on three different occasions and no mention of his tardiness was made by anyone.

So while there is some truth to the criticisms, I have also learned that how well one is liked counts more than anything else, at least in this program.

I think if I had not worked as hard as I did, my program would have gotten rid of me sooner. One of my attendings told me that was what was 'saving' me up until that point--that I obviously worked very hard.

 

[Orin]

Sorry to hear about this. It's rather disheartening but unfortunately residency programs are not looking for work. You sound like a person who could possibly make it in anesthesia, but it would take patience, guidance, and individualized training to overcome your weaknesses. Unfortunately, I don't think the majority of places are up for that.

I'd suggest you focus on the positive. See whether you prefer pathology or family medicine. Although the stereotype is that pathologist don't like patient interactions, there are niches in that field where you can interact with patients or other physicians frequently. The stereotypes suggest anesthesiologists don't interact much with patients either, which you've obviously learned a lot about.

Don't let it get you down.

That space between what is happening and how you react to it is what allows you to control your life. Steer the boat. Good luck.

 

[urge]

I am currently a CA-1. I successfully completed my PGY-1 year despite being considered deficient in the areas interpersonal/communications skills. In March of this year, my program director sent me to a psychiatrist of his own choosing; his position was that if the psychiatrist deemed me suitable for the residency program then they would renew my contract, if not, then they wouldn't. I signed a waiver giving him access to my psychiatric records. (The alternative was non-renewal--in fact I had already been given a non-renewal letter which was sort of put 'on hold'). I agreed and saw the psychiatrist. She sent me to a neuropsychologist for 7 hours of testing. All of this during an internal medicine month. The results of all the appointments and testing was a diagnosis of Asperger's. However the psychiatrist was of the opinion that I could be successful in the program.

My program director allowed me to stay, under the condition that I take medication and see an Asperger therapist weekly. At the end of April there was another threat of non-renewal; I weathered that one, and a subsequent one in the first week in June. The new agreement was promotion to PGY-2 year with a three month contract, with reevaluation of my deficiencies. Recently, after six weeks of general cases in the OR (for the last two weeks I managed cases solo), I was at last given the letter of non-renewal. Their position is that they will keep me on contract for the duration of the three month period, but no more patient care. I must show up at the hospital every day to work on something of my choosing.

I am also being offered LORs from my program director and multiple other attendings. My PD has said he will focus on my strengths and minimize my weaknesses, but when I broached the possibility of switching to another anesthesiology program he didn't seem supportive. The LORS will probably say that I am competent clinically, but have deficient social skills. I will say that there were no incidents with patient care; despite widespread concern that I was too Asperger's-ish to be safe managing patients in the OR, I did well managing cases solo and was told by two different attendings that my intraoperative management was on par with my level of training.

In my opinion the general knowledge among faculty at my program about my situation and psych diagnosis hurt me quite a bit in terms of block evaluations. The evaluations from the attendings who were privy to the Asperger diagnosis definitely have many more comments like, "She focuses on minute details and misses the big picture"...."She should seek a career in research or pathology, not anesthesiology". Some of the ones from attendings who knew nothing say my social skills are fine, but that I am clumsy with procedures, which is true. (In the beginning of June I started in anesthesia, which was my first exposure ever to the field as I had not done a rotation in anesthesia in medical school. I was quite clumsy at first but improved rapidly.) From PGY-1 year my evaluations were almost all good; the exceptions made reference to interpersonal skills, getting too attached to patients, and not being deferential enough to attendings, not recognizing my place in the heirarchy, and not paying attention during rounds when other people were presenting. The evaluations from anesthesiology attendings were overall negative, but those came after the information about my diagnosis was generally known.

I contacted the dean of my medical school today about my situation; he said forget moving into another anesthesia spot, you're stuck with path or family medicine now.

There was a CA-1 from last year who was released from our program in February; I tried to find out what she decided to do and how she fared afterward but there was no response to my emails. I never knew her personally. I asked my PD about her today and he said that she basically cut them off a few months ago and they have no idea where she is now.

I am not sure what to do at this point, what my options are, and if there is any hope for me in continuing somewhere else in anesthesia. There isn't really another specialty in which I am interested at this point.

Thanks in advance.

Pathology. You are done with Anesthesiology.

I just wonder how were your med school clinical evaluations.

 

[urge]

I would advise AGAINST getting legal counsel. You will burn bridges, poison your current work environment, and likely create a huge headache for yourself all while fighting a losing battle. I think you stand to lose a lot with this approach especially if your program is willing to help you find a position in another specialty.

OP,

Legal advice is never wrong. Doesn't mean your are going to sue them. It's just to make sure you are being treated according to standards. I would check with the union or GME office. If not, then a private one.

You have to realize that there must have been so many complaints in your pgy1 year for your program director to send you for psych eval.

Don't think your bad evals stem from your psych report. You had bad evals and that's why you went to psych.

 

[dotcb]

It sounds like you're probably too little, too late. The time to successfully get legal counsel to fight this was months ago. You should probably get counsel, but it sounds like you will likely fail. It sounds like the amount of evidence the program has against you is significant, and you likely won't be able to undo that. If they don't want to train you or allow you to advance, they don't have to.

You can look for an alternate anesthesia position, but it sounds like it's time to think about another career option.

 

[itwasalladream]

Maybe getting counsel is the right way to go. I can't say for sure. But think carefully about it. I had a close friend bring counsel to a meeting in a similar situation, and it completely changed the feel of the discussions she had with the administration. They viewed it as a hostile action, and they accordingly became more hostile toward her even though she did not sue. The end result was much worse for her than it could have been had she just acquiesced to their requests. Everything has consequences. It's not like a lawyer will swoop in, sort it out in a week, and have you back at work like nothing happened. Even if you don't sue, your program will know you've got a lawyer and of course they will treat you differently. You (and maybe Urge?) think your program director/department, when they find out you've got a lawyer, will not change their attitude toward you in anyway? Good luck with that. To say that getting a lawyer will just simply make sure you're being treated according to standard (without any fallout) is not in line with my experience. That's why I say you stand to lose a lot by getting a lawyer if your program is willing to help you find other employment.

 

[countingdays]

Right now you are losing your training spot but have people willing to help you find another.

If you make a stink you will still lose your anesthesia spot and will be way less likely to find anything else.

 

[gasattack3]

Right now you are losing your training spot but have people willing to help you find another.

If you make a stink you will still lose your anesthesia spot and will be way less likely to find anything else.

Yep, no program WANTS to do this kind of thing. They need to save face also. If they are willing to help you find another spot in another specialty, I would play nice with them and start addressing the reality that you are done with anesthesiology. I hate to sound so harsh but it's now your reality. It's up to you, now, to make the best of it.

 

[deleted87051]

Surgery is a team sport so communication skills, interpersonal skills, and leaderships skills are vitally important to being an effective anesthesiologist. This is under recognized by many considering the field, but an anesthesiologist can set the tone for the operating room....and team building skills can make even the gnarliest cases a joy. It is literally a question of love. Do you care about your surgeons, your nurses, your scrub techs, your patients? If you take an interest and engage with your coworkers, it can be the difference between a day of drudgery or a day of play.

For the OP....approach your PD about taking a leave of absence. During the year you can work to address your deficiencies which don't sound like they are cognitive or technical, but like you said.....interpersonal and communications issues. Perhaps enter therapy, get a coach, develop a spiritual practice, anything to change the dysfunctional patterns you have formed during your life. If you don't address them the same issues will continue to haunt you even if you go into pathology or FP.......guaranteed. Being an effective professional is a lot more than knowledge and technical skills.......it also requires high level of personal development. It was not realistic for your PD to expect changes to lifelong issues after a couple months of therapy. It is hard work and difficult to do while also dealing with the challenges of residency.

 

[Taurus]

Dear OP:

1) Asking you to go see a psychiatrist is the oldest trick in the book before a medical school or residency wants to terminate you. Chances are, they picked the psychiatrist for you and most likely that psychiatrist works for the medical institution. Can someone say highly biased? So the cards were already stacked up against you before you even knew it. At the very least, you should have requested to pick a psychiatrist of your own choosing, ie, not affiliated with the medical institution. Furthermore, before or concurrently as you were seeing the psychiatrist, you should have obtained legal advice.

Whenever red flags like this pop up, especially ones that may severely harm your career, you need to seek legal advice. To answer other people's questions, there's a big difference between asking for discreet legal advice and letting other people know that you have obtained a lawyer. If my lawyer told me that the residency was following proper rules and your rights were not infringed, then I would never let anyone know that I had talked to a lawyer. However, if the lawyer tells me that what the program is doing is illegal, then I would also discreetly let the program know and let them decide the next steps.

Here's that famous Oscar Serrano case about a former Johns Hopkins surgical resident who sued his former residency program.

2) If you have poor communication skills, strongly consider pathology or radiology. Your chances to stay in that residency is poor and it's unlikely they will help you secure another one.

 

[urge]

You (and maybe Urge?) think your program director/department, when they find out you've got a lawyer, will not change their attitude toward you in anyway?

That's why I say you stand to lose a lot by getting a lawyer if your program is willing to help you find other employment.

Attitudes change when lawyers are involved. They go from "let's screw this guy", to "we better be careful or we will end up screwed." I have sat in those meetings...

Who's is guaranteeing that they will actually help her? Who knows what they will write in those letters. I recommend a lawyer to take care of this.

 

[pgg]

I'm with urge, get an attorney. SDN is great but we can't help you.

Whatever the outcome of your disagreement with your program, you get exactly one chance to exit the other side in the best possible shape. You have already waived some rights you maybe shouldn't have (eg making your psych eval available to the PD), and a lawyer will help you not make further errors, and help guarantee that the program respects all of your rights going forward.

 

[lobelsteve]

Lawyer up.

I had a similar situation in residency with "battered resident" syndrome.
I met with an attorney, the dean's office frequently, and the then head of the ACGME for lunch.
I graduated, PD got fired. Stuff happens.

 

[Arch Guillotti]

Interesting thread. Some people are just not "cut out" for anesthesiology. I hate to say it but I think you may be one of them, especially considering the fact that it was not your choice of specialty and you scrambled in. Good luck with everything.

I wouldn't be surprised at a residency railroading someone though. I have seen it happen before and it isn't pretty.

 

[Valvool]

In order to be allowed to proceed to PGY-2 year, I had to meet a list of expectations, one of which was visits to an Asperger therapist every other week. So I have been to therapy and continue going. I was also required to see the psychiatrist they chose for me every other week. Yes, they chose her for me. She had worked with the medical school for a long time in past years although currently she is not affiliated with them. She was known among faculty and well-regarded. While they did choose the psychiatrist, I did not feel--and still do not feel--that she was biased against me or that she did not give me a thorough evaluation. I think she was fair; moreover I felt she was on my side, and much more an advocate for me than anyone else. She sent me to a neuropsychologist of her own choosing who conducted eight hours of testing--one of the tests, for example, was me sitting in front of a computer monitor for an hour, with different letters and numbers flashing on the screen in all different sizes, colors, fonts; at the same time there were voices saying numbers and letters out loud in all different accents, both men and women; I was only supposed to click the mouse when I SAW a 5, or HEARD a 3...it seemed simple at first until it went on for an hour. The neuropsychologist also conducted an IQ test; I had to put puzzles together under time constraints, find patterns in pictures, tell him what was missing from a photograph, etc. He asked me to list as many animals, fruits, vegetables as I could in one minute. He asked me to copy a drawing by hand, then later asked me to draw it again from memory. Etc. He wrote a 14 page report that my department had access to that included his diagnoses, my IQ level, and things he observed during the testing. It was he who ended up diagnosing me with the Asperger's, not the psychiatrist. Ultimately, her view was that the autism spectrum disorder was mild and that I am capable (from what she could see) of completing an anesthesiology residency. My department wanted her to tell them whether I could potentially be a danger to anyone. She could tell them that I wasn't homicidal, suicidal, or psychotic, but beyond that she couldn't definitively say anything--that was what she said to my PD.

My PD has only been a PD for two years. He's non-renewed at least two other residents that I know of. He is very strict and militaristic in his expectations--other residents mentioned to me that they too get a horrible feeling whenever they see they have a text from him. In June I was a day late with my timecard and I received an email from him, warning me not to 'test' him...

Having said that I also feel that he is decent at heart and truly wants to do the right thing, even if he is an ass in how he goes about things sometimes. For example, the first meeting they ever had with me, he handed me a non-renewal letter. This was in Feb. I was stunned. I said very little. The letter outlined his reasoning, which was based on tardiness with paperwork, complaints from secretaries that I was 'aloof' and 'abrasive' and the fact that I did not return a page once, back in Sept. He said during that meeting that it was his view that I simply wasn't right for the program. Part of it was the fact that I had scrambled into the program, and it was generally suspected that I did not actually want to be there--there was a rumor amongst the other residents that I had actually said that at some point. I think he interpreted the aloofness, the fact that I avoided parties or hid out in the bathroom during parties, etc--he interpreted that behavior as evidence of my disdain for the program, as evidence that I did not want to be there.

But as I left the room that day, not saying much, I saw that he was looking at my face in a searching way, and he had a confused expression on his face. Later I learned that he and the chair had a discussion after I left the room, in which my PD said it was almost as though I didn't mean to be rude--he felt I wasn't doing it on purpose, that maybe I had Asperger's...

Anyway, about an hour after I left that meeting, I texted my PD the words "You made a mistake." He responded immediately, asking me to come see him the following week. I asked why, since he had said that the decision to not renew was final. I texted him the question, "Is the decision still final?" but he wouldn't give me an answer. During the next week I met him alone in his office. I told him that I very much wanted to be part of the program. I told him that me being aloof and not attending social functions was not because I did not like the program, that that was just my personality. I mentioned the fact that a psychiatrist I had seen during medical school had mentioned the possibility of an autism spectrum disorder--I did not think that my social issues rose to the level of a diagnosis but the lack of small talk, my avoidance of parties--it wasn't a deliberate attempt to be rude.

In retrospect I realize it was a mistake to bring up the opinions of the previous psychiatrist. My PD was instantly very interested in that, asked me a lot of questions about why I had seen a psychiatrist, and if I knew why the psychiatrist had thought the way he did. I told him what I knew, that this other psychiatrist raised the possibility based on what I had told him about my sensory issues--the fact that I tend to wear the same clothes, prefer to watch the same movie over and over again, prefer bland foods, the same foods, certain types of lighting, etc. (I did not have social problems in medical school, though I only had one friend; I honored four clinical rotations and high passed the rest.)

My PD actually seemed excited and happy when I told him about the psychiatrist in medical school--later I realized why, because he had already suspected something like Asperger's, had brought it up with my chair at the meeting the week before.

Anyway, that was the start of everything. My PD asked me to sit tight, then the next day presented the deal: I would see a psychiatrist of his choosing, if she deemed me competent, the program would keep me....

I don't think there was a conspiracy, or even a desire to harm my career or hurt me...I think my PD is super-zealous about having residents that are the perfect fit for the program, and likewise he now seems zealous about finding the specialty that is the 'perfect' fit for my personality.

But I don't see why it has to be this way. He should not get to dictate my career. I should not be forced into a specialty I don't want because others feel it is perfect for me....right? Shouldn't I get to choose, even if the path is more difficult than other paths might be?

 

[shopsteward]

I should not be forced into a specialty I don't want because others feel it is perfect for me....right? Shouldn't I get to choose, even if the path is more difficult than other paths might be?

The problem is that, until you have completed residency, your choice is dependent on others agreeing with you. Unless you can get either your current or another PD to agree with you that you should be allowed to complete anesthesia training, you have no choice.

You should go and see a lawyer privately to see if you have a case for staying. But don't tell your PD, or anyone in your program, that you are seeing a lawyer and have legal advice. If your lawyer has useful advice for you, use that in negotiations. So don't say "my lawyer says you have to keep me on" say, eg "you haven't followed proper procedures". And remember that while your lawyer will be trying to make your case look as good as possible, the program's lawyer will be able to make their case look as good as possible, and that is what your PD will be relying on - no legal case is entirely one sided.

You can only stay where you are by changing your PD's mind. Put yourself is his position: what can you do that will change his mind? You might have an incontrovertible legal case. Or you might demonstrate to him that you have changed your behaviours and attitudes in a way which removes every one of the concerns previously expressed about you. (For instance, if a certain individual has complained about your behaviour, you could go and talk to that individual, apologise and ask how you can avoid causing a problem in the future. Then spend the next three months putting your new behaviours into practice.) Do you have any attendings who would advocate for you? The chief resident? A program advisor? You need to gather about you any allies you can.

I think it is an uphill struggle for you to stay where you are: you only have six weeks of a three month contract left, so it is easier for the program just to let that expire rather than give you a new contract. Plus your program has been expressing concerns for 6 months or more that you have not satisfied them on, so your chances of changing sufficiently to satisfy them in the next 6 weeks are not good.

That means that you need to now start looking for a new program. There is no harm in you looking for a new anesthesia program, but you should also look for any other acceptable options. You can look for opportunities coming up now, but should also be putting things together for this autumn's match - you only have a few weeks until that process starts. You need to network, too - ask for help finding a new place, and do it while you are still at the program. Also, wwork out what you might do in any gap between leaving your current program and finding a new one.

Also, you need to line up everything you will need from your program in the future (PD's letter, reference letters from other attendings) before you leave. I can't stress enough how important this is - once you have walked out of the door for the last time, you have no leverage and will quickly be forgotten. You need the best possible references from as many people at the program as you can, and you need to get them lined up before you have left.

 

[pgg]

That was quite a wall of text.

But I don't see why it has to be this way. He should not get to dictate my career. I should not be forced into a specialty I don't want because others feel it is perfect for me....right? Shouldn't I get to choose, even if the path is more difficult than other paths might be?

To be clear, I am sympathetic to your plight.

But, as shopsteward wrote, this isn't really correct. Not everybody gets to choose to be an astronaut, NFL quarterback, or anesthesiologist. There are standards to be met, hurdles to be jumped, and other people to be convinced. Part of the process is unavoidable subjective, and all of us have had to convince teachers, professors, deans, attendings, and program directors that we could do the job safely.

There are definitely some malignant program directors out there. Some are petty, spiteful, grudge-nursing jerks who feast on the pain and woe of others. But I do have to believe that nearly all of them want their residents to successfully complete their programs and graduate to be safe and proficient anesthesiologists, and that nearly all of them take their responsibility to train and educate residents seriously. I have no doubt that the occasional need to cut people from their programs weighs heavily on them.

The truth is, some people just aren't cut out for anesthesia. Hopefully programs identify residents at risk as soon as possible so that remediation efforts can be made early. Ideally when a resident has to be dismissed, the program will help the resident find another program in another specialty. It's not so much that the PDs want to dictate someone else's career as it is a desire to help them find some medical specialty where they can thrive and safely practice.


It must suck to be judged as lacking. But consider that it would suck more to be allowed to finish and step out into the world all alone as a sub-par or unsafe anesthesiologist ... someone who puts patients at risk and is a series of malpractice claims waiting to happen. That's not a good outcome, even if anesthesia is your first and only love.

Good luck, and seriously ... consult an attorney so you can guarantee that your rights are respected, whether or not you stay or leave your current program.

 

[Valvool]

I do appreciate all the comments and suggestions. I neglected to mention earlier that I did consult with an attorney about this situation and he even attended one of the many official meetings we had regarding my progress. The attorney is certainly willing to help, but I don't have it in me at this point to expend lots of energy, time, money, emotion, etc., in suing anyone, especially when I don't believe the actions of my PD were based on gender, race, or anything like that--the ADA covers autism spectrum diagnoses like Asperger's but historically judges have tended to side with the institution in cases involving Asperger residents. Also I don't believe I am being non-renewed because of the Asperger's. It's hard for me to believe he would not renew someone based on the diagnosis alone; it's impossible to believe he wouldn't renew me because I am female or a minority. I know that kind of discrimination exists but I don't feel like that is what happened in my case. I'm fairly sure that the PD is doing what he thinks is right for both the program and for me. He's wrong about me--I KNOW I could be successful if given the chance. I don't think I can successfully sue anyone for judging me wrongly though, if the judgment is in the context of someone trying to do what he thinks is the right thing.

I do feel that I made much progress, and that many of my strengths and the positive things I did never made it into evaluations; the unfairness of certain things that have happened over the past seven months stings--still bothers me a lot. But as some of you have pointed out, my future is in part dependent on the (subjective) judgment of others; a majority of the faculty in this program have decided I'm unsuited for anesthesia. So I guess that is that. It isn't anything I ever saw happening--until now I never failed to do anything I really wanted to do, academically speaking.

As a side note, when I brought the attorney to the meeting, I did it without forewarning; my PD, chair, and the others at the meeting didn't know I had an attorney until he walked into the room. They were surprised but the overall tone of that meeting remained friendly; they even invited him to subsequent meetings. If they were angry about me having consulted with an attorney they didn't show it. Then again my motivation in bringing the attorney was a desire for an ally at these horrible meetings--not a desire to sue or cause legal problems for the program. Maybe they got a sense of that.

 

[CambieMD]

No one can accurately make the assessment that the OP is not cut out for anesthesia. One outspoken angry vengeful attending on a mission can destroy a resident.I came to anesthesia outside of the match. I did not schedule an anesthesia while is was in medical school. I came to anesthesia very green. I spent my first or second week working with a CA-3 who had an anger management problem. Everything pushed him over the edge, it was amazing. This guy tortured me for a week. He was critical of me and showed his disdain for me openingly. When he saw me in the hall he would make comments about my defficiencies to anyone who would listen. My self confidence was in the toilet. Thank God I told others about my situation with this particular resident. I learned that he was considered a big ***** and not well liked. I eventually got my footing and my self confidence as well as my skills improved. Some months later this guy was my senior on trauma nights. A major trauma came up to the OR just when the case that I was doing was about to end. The covering senior and attending were tied up with major trauma. I was given tthe green light to wake up my patient and extubate him once he meet criteria. I woke up my patient and extubated him without incident. For my next case I woke up and extubated my patient without calling my senior. He was pissed at me. The patient was a young ASA 1 with a simple fracture. The CA-3 complained to the attending who asked me why I extubated the patient on my own. I told the attending that he let me extubate the previous patient on my own. The attending chuckled and said," the circumstances were different we were busy." The attending understood that I was sending a message to my senior resident. I am not broken and I do not respect you. Put that in your pipe and smoke it.I may not have gone about this the right way but I made my point. I discovered that the indiot who could have made me quit was a particularly poor resident who had verbal altercations with surgeons.

My point is that we often are wrong in our judgements about others. This is the case in life in general. Some people may think that I am socially awakward at times, so what.

If you are approached by your program, employer or anyone else about a possible termination, consult an attorney

One of the greatest surgeons in history, I cannot remeber his name, overhead his attending telling a group of surgeons that he would not make it because he was not cut out for surgery. This guy was quiet and shy. He went on to develop several new techniques and invented new retractors and modified scissors.


Be careful with who you write off. Many careers have been needlessly ruined

 

[G0S2]

Great article and have witnessed it many times:

http://mobile.journals.lww.com/anes...ewer.aspx?year=2010&issue=05000&article=00005

 

[G0S2]

Not saying the article is you at all. Just the snowball effect that can happen.

 

[pgg]

No one can accurately make the assessment that the OP is not cut out for anesthesia.

Well, certainly none of us can make that assessment. But his program director (+/- other attendings on whatever promotion committee setup his program has) ought to be able to.

 

[pgg]

Great article and have witnessed it many times:

http://mobile.journals.lww.com/anes...ewer.aspx?year=2010&issue=05000&article=00005

So true. The first 6 months of my residency were kind of rough. Often felt like I could do nothing right. Then I took the AKT-6, put up a good score, got the "smart one" label, and overnight I was treated better. From then on, if I boned something up, I got the benefit of the doubt. This is why I tell people to study for the ITEs and AKTs.

 

[blindpass]

Hello, I do not mean to derail this thread. Deepest sympathies to the OP. But I find it very interesting. I am a 3rd year medical student and I believe that I am autistic and socially deficient and can tell that in some programs and some occupations (in medicine or outside) I would not succeed because of these deficiencies. I am undecided as to specialty. So if you would please rate these specialties from most to least autistic friendly:
Anesthesia, Gen Surgery, Family Medicine outpatient, Hospitalist, Cardiologist, Radiologist, Pathologist, Psychiatrist, Ophtho, PMR.

Also if you would please give your thoughts on some of these specialties other than "path/rads -avoid human contact=good". Thank you.

 

[gasattack3]

Hello, I do not mean to derail this thread. Deepest sympathies to the OP. But I find it very interesting. I am a 3rd year medical student and I believe that I am autistic and socially deficient and can tell that in some programs and some occupations (in medicine or outside) I would not succeed because of these deficiencies. I am undecided as to specialty. So if you would please rate these specialties from most to least autistic friendly:
Anesthesia, Gen Surgery, Family Medicine outpatient, Hospitalist, Cardiologist, Radiologist, Pathologist, Psychiatrist, Ophtho, PMR.

Also if you would please give your thoughts on some of these specialties other than "path/rads -avoid human contact=good". Thank you.

If you can be guaranteed enough work in the future (which nobody can do), then some surgical specialties could work for you. I've seen some super poor social skills amongst some surgeons.

I do NOT think that there's a huge future in the guy/gal with social skills deficiencies in anesthesia. Those days, I believe, are gone. There's a range of course. A spectrum of personalities, but being "awkward" is going to be a challenge to anybody choosing anesthesia. I really believe that.

Being mindful that you're not "Joe Charisma" may be 1/2 the battle for you, but suffice it to say this training process (any specialty) can be brutal and indeed rely more than any of us want on others' opinion of you. Personality matters a lot, IMHO.

Really, if you think you have "issues" then radiology, pathology etc. would be just fine. You made it this far, so it can't be THAT bad, no?

******Why try inserting a square peg in a round hole?? That makes no sense. If you're aware that you have some relative "weaknesses" then choose something that minimizes them as much as possible! If you choose wisely, maybe your being introverted, super smart/nerdy or whatever, but not so great making small talk in the clinic may be totally irrelevant when you develop the reputation of the guy with the BEST technical surgical skills or the best diagnostic skills (path/rads) etc. etc. So be it!

I'd just hate to see someone set themselves up for failure when it's SOOOO unnecessary. Medical specialties are very diverse and I'm sure you can find a field in which you'll be perfectly well suited. Maybe anesthesia isn't one of them, though.

 

[blindpass]

If you can be guaranteed enough work in the future (which nobody can do), then some surgical specialties could work for you. I've seen some super poor social skills amongst some surgeons.

I do NOT think that there's a huge future in the guy/gal with social skills deficiencies in anesthesia. Those days, I believe, are gone. There's a range of course. A spectrum of personalities, but being "awkward" is going to be a challenge to anybody choosing anesthesia. I really believe that.

Being mindful that you're not "Joe Charisma" may be 1/2 the battle for you, but suffice it to say this training process (any specialty) can be brutal and indeed rely more than any of us want on others' opinion of you. Personality matters a lot, IMHO.

Really, if you think you have "issues" then radiology, pathology etc. would be just fine. You made it this far, so it can't be THAT bad, no?

******Why try inserting a square peg in a round hole?? That makes no sense. If you're aware that you have some relative "weaknesses" then choose something that minimizes them as much as possible! If you choose wisely, maybe your being introverted, super smart/nerdy or whatever, but not so great making small talk in the clinic may be totally irrelevant when you develop the reputation of the guy with the BEST technical surgical skills or the best diagnostic skills (path/rads) etc. etc. So be it!

I'd just hate to see someone set themselves up for failure when it's SOOOO unnecessary. Medical specialties are very diverse and I'm sure you can find a field in which you'll be perfectly well suited. Maybe anesthesia isn't one of them, though.

Thank you for your reply. I completely agree with you that it's a mistake to try to go into a specialty where nobody wants you. In fact, medicine in general has been a very hard road for me, I took multiple attempts to get in and so on just because my parents who are not clinicians told me how great it is. I might've been much happier in a field with technical challenges that requires merely BS or MS such as engineering or comp science. I would've been working for almost 10yrs now instead of being a student. Right now I am content in my 3rd year, great step1, but I want to eliminate certain specialties. So anesthesia is out... I had experience in surgery and I agree that it has various personalities. And if you do your thing well in surgery you shouldn't have any conflicts. I liked suturing but did not like that I was less useful and less proficient than a nurse in the OR. And I'm not really interested in GS anyway. General surgery requires too much effort, not for me. And subspecialties are too competitive. I feel you should not have any deficiencies if you want to be an ENT.. I also eliminated ER for the same reason as anesthesia. How about any specialties besides Path/Rads. Just trying to see if I should concentrate on radiology or still seek interest in things PMR, cardiology, hospitalist (I haven't done rotations in those fields yet).

 

[gasattack3]

It's really hard to say. A great Step 1 will open up some doors.

Again, if you really have found social stuff to be pretty rough, and are having doubts about career paths in general, then frankly, I'd try finding out which of the specialties require the LEAST amount of social interaction/skills possible.

If you are flexible and realize that medicine is a means to an end for most of us, then you can be good and have a rewarding career. Pathology might be great for you. Seriously. Maybe even an academic program doing research even?

Nobody on here can tell you as we don't know you. I do think you need to leverage your STRENGTHS and find something where your weaknesses won't be as big a burden as they may be in some fields more than others.

Maybe talk to an experienced Doc that you trust about this? (versus a useless counselor). I feel that the vast majority of people would respect that you are identifying a possible weakness (which you CAN always improve upon) and thinking about it's impact on your career choices.

 

[blindpass]

It's really hard to say. A great Step 1 will open up some doors.

Again, if you really have found social stuff to be pretty rough, and are having doubts about career paths in general, then frankly, I'd try finding out which of the specialties require the LEAST amount of social interaction/skills possible.

If you are flexible and realize that medicine is a means to an end for most of us, then you can be good and have a rewarding career. Pathology might be great for you. Seriously. Maybe even an academic program doing research even?

Nobody on here can tell you as we don't know you. I do think you need to leverage your STRENGTHS and find something where your weaknesses won't be as big a burden as they may be in some fields more than others.

Maybe talk to an experienced Doc that you trust about this? (versus a useless counselor). I feel that the vast majority of people would respect that you are identifying a possible weakness (which you CAN always improve upon) and thinking about it's impact on your career choices.

Thank you. This advice has been very helpful and I'll just know to eliminate ER and Anesthesia.

 

[guitarguy]

I'm going to take a different spin on this. I think you are way ahead of the game and absolutely should not rule out a career in anesthesia. You are ahead of the game because you are aware of your potential weaknesses and you appear motivated to find ways to compensate and mitigate these weaknesses. Let's face it, many people go into anesthesia who are not the most socially outgoing. Many people choose anesthesia because they like the idea of being 'behind the scenes' and they are comfortable with the fact that they don't have the biggest egos in town. I've known several anesthesiologists (in practice and in training) who without a doubt were on the autism/asperger's spectrum. You didn't need training in psychiatry to recognize this…and so it was well known by their colleagues. Regardless, they had other strengths, were excellent clinicians, were respected widely, and enjoyed successful careers. Everyone has strengths and everyone has weaknesses. People run into trouble when they don't recognize their weaknesses. This certainly doesn't appear to be the case with you.

You can absolutely be successful in a career such as anesthesia. Yes, you will be needed to be a leader in the OR and communication skills are very important especially during critical events…but with residency training and a concerted effort by yourself for self-improvement, you can certainly learn how to be an effective leader in this environment. Having a good rapport with your colleagues is first and foremost about treating people with respect and it's certainly not rare to find people in anesthesiology who have trouble with this basic principle - and they oftentimes are not even cognizant of this weakness.

As long as you are clinically safe and can get along with people on a basic level, I don't see that this will be a major impediment.

The biggest mistake for you would be to choose a field that you aren't intellectually interested in and you do not enjoy.