PD refuses to let him leave!

[X620]

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Hi everyone,

Once again, I'm hoping to tap into your knowledge and get some ideas/solutions to this problem.....

My brother is finishing his first year of residency in NY, but wishes to relocate to Calfornia to be near our Mom who is undergoing multiple major surgeries. Doctor's say recovery will take more than a year at least and will require almost round the clock care and we need him to help when he can. My brother found an open spot for a PGY-2, has applied, and spoken with the California program director, who wishes to speak with his current program director. So, he informed his current program director of his necessitiy to switch to a program near home, however, because 3 residents have also switched out of this program recently, he is refusing to let my brother leave, citing the reason that it is too late in the game and that the program has too many unfilled spots at this point. How should this situation be handled now since he still intends to try to transfer, and is afraid his current PD will badmouth him to the PD in California to prevent his leaving? For the record, he has gotten nothing but excellent reviews from his attendings and superiors. Another physician colleague made him aware that there is the possibility that his current program can refuse to give him credit for the year of work he has already completed, and he faces the possibility of having to repeat the current year if he leaves?!! What's the best way to handle this situation now? What are some possible negative repurcussions he should be aware of?

For the record, it is incredibly disappointing to see a hospital's program's director behave so insecure and lowly. In order to meet his business goals, he makes it clear that a human being's health is irrelevant. And he's in the business of saving lives! He even sits on the Ethics Board of that hospital. God help us when people of this caliber take positions of power. No surprise why so many residents are switching out of this program.

 

[HansHolbein]

It is a rough situation for both your sister and the PD. In the final analysis, the PD cannot stop her. Although, it may be pertinent to try to find someone to transfer in to take her place to help the PD deal with the loss.

 

[dragonfly99]

First, I want to say that your brother does not have anywhere to go in California unless he has a signed contract in his hand. If he doesn't have that, the smartest thing to do is keep working hard at his current program and don't make the program director mad. The hard facts are that if this current PD wants to keep him from leaving, the PD probably can. If the PD wants to play hardball,he can say something bad to this new prospective PD. Or he can try not to give your brother credit for the PGY1 year. Without credit, he cannot progress to PGY2 at this new place.

I agree with the above comment that if he REALLY wants to leave, try to find someone who wants his residency spot. However, remember this has to be someone that the PD also wants...that may not be easy to find. The PD is holding the power here and don't forget that. It sounds like there are problems @your brother's program, else they wouldn't have lost as many as three residents lately. The PD may not believe the story about mom's illness...perhaps getting statements from her physicians would help, but it sounds like he just does not want to lose your brother as a resident. In that case, your brother may have to just spend as much time as he can during his vacations, etc. with your mom.

The hard facts are that your family may have to soldier on without your brother nearby for at least another year or two. You don't say what type of residency this is, but for a lot of residencies, even if your brother is in the same town/city as your mother, he probably will be working so much that he wouldn't have a ton of time to help out at home anyway, at least not on weekdays. Your brother may have to choose between keeping on with his medical training, or giving up his medical dreams in order to care for your mom - I totally think that families are important, but I also think that you (and he) may regret it if your brother is pressured into quitting residency. He also might not have any way to pay back his med school loans in that situation. He also might find it hard, or impossible, to get another residency later if he quits now. That would depend on what specialty he is in, and how strong a candidate he is. If it's just internal medicine and he had great grades and went to a well known med school, would not be likely to be hard to restart or start over later SOMEWHERE, maybe not the best place or anything, but if he's in surgery and he quits I don't think he'll ever get another surgical spot.

I am not without sympathy because I know people who had to deal w/family illnesses during residency...one of my cointerns couldn't get time off from her ICU month even though her sister was in a hospital in another state.

 

[Dimoak]

I prettymuch agree with what's been said so far. Don't view this as the PD being spiteful or uncaring; certainly, it's tragic that your family has hit a rough point, but your brother signed a contract, and so both parties must abide by it. Unfortunately, this isn't like school, where if you need to leave, you just apply elsewhere and transfer out; there are many people, including your brother's colleagues and patients, who depend on him to cover a share of the work, and a program can be strained (dramatically depending on the size of the housestaff) if even one person leaves. The PD, unless he or she is some sort of sociopath, isn't doing this to screw with your brother or to flex muscles; teaching hospitals depend immensely on their house staff, and if the program has already lost a few (speculation as to the reason aside), the PD really needs to put the facility first in ensuring there's enough staff to cover all the work. As dragonfly suggested, your brother's best bet would be to find someone to take his spot at the residency, and start working on that immediately! New York is a fairly desirable location to train, so he may have some luck there. I'm fairly certain that the PD would be willing to facilitate the "trade" if he had a capable resident to replace your brother with. I wish you and your family luck getting the best outcome possible. 🙂

 

[DarthNeurology]

Hi everyone,

Once again, I'm hoping to tap into your knowledge and get some ideas/solutions to this problem.....

My brother is finishing his first year of residency in NY, but wishes to relocate to Calfornia to be near our Mom who is undergoing multiple major surgeries. Doctor's say recovery will take more than a year at least and will require almost round the clock care and we need him to help when he can.

The most he could do for your mother during residency is provide emotional support as he can not both help with round the clock care as well as be a resident. I have had family members with multiple problems during medical school and residency and it can be very draining, they think you are a doctor so you can help provide care and emotional support for hours each day. In the end your brother has a obligation to thousands of patients that he will be seeing as a PGY-2 and really can't provide the type of care you want him too. Sure, emotional support perhaps when post-call but he shouldn't be pressed into duty for the family in this manner and also be expected to be a PGY-2. Residency is the same as being in the army and you have to be devoted to it 24/7 to do a good or even passable job.

 

[dragonfly99]

The most he could do for your mother during residency is provide emotional support as he can not both help with round the clock care as well as be a resident. I have had family members with multiple problems during medical school and residency and it can be very draining, they think you are a doctor so you can help provide care and emotional support for hours each day. In the end your brother has a obligation to thousands of patients that he will be seeing as a PGY-2 and really can't provide the type of care you want him too. Sure, emotional support perhaps when post-call but he shouldn't be pressed into duty for the family in this manner and also be expected to be a PGY-2. Residency is the same as being in the army and you have to be devoted to it 24/7 to do a good or even passable job.

I totally agree with this. Your brother isn't really even a qualified doctor yet, or that close to being one. He needs this training that he is getting in order to ever be able to practice medicine. Once he is done, he would be in a position to help your family financially and in other ways. Right now he is doing something that is very intense, not like a "normal job" and which requires a great degree of intensity and a certain degree of focus, almost to the point of being single-minded. It sounds harsh but it's the truth.

 

[surgicalskills]

A lot of people don't realize that these type of problems in residency can be solved by threatening to sue and hiring a lawyer. It has worked twice in my program in one single year. Both residents won. The PD lost.

It's incredible that residents have to put up with this type of bull****. It is really abuse. If he really wants to leave and has a spot secured (after signing contract) then he can and the PD will NOT be able to stop him. I promise you that. He can get legal representation and show just cause for his need to switch residencies. As for not getting credit for the year, that would be a difficult thing to do at this point. The PD would have to show a paper trail as proof of incompetence which doesn't sound like the case. All this can be fought. I am speaking from experience in our program. Lawyers can do wonderful things.

Being in a NY program, I can tell you that these sons of b i t c h e s PDs have residents by the balls but there is hope through the legal system. Fight to the end, I say.

 

[NotAProgDirector]

I agree with most of the above.

First, this is very sad from all angles -- the person who is ill, the family member who is separated, and the PD which (by your description) appears to have little empathy.

Ideas:

1. To be fair, it is very frustrating to PD's when residents leave without much notice. I totally understand that in some situations (perhaps like this one) there wasn't any notice but remember that your leaving the program does affect everyone else, and part of being professional is to do everything you can to help mitigate that ripple effect. This would me more true if the PD was treating you with more respect.

So, if this was happening in my program, I would look at it this way:

1. Is there an acute need to leave for medical reasons? i.e., if the person is very ill and undergoing medical/surgical treatment and you need to be there NOW, then I would put you on leave and let you go. You would be expected to return to work after the acute crisis resolved.

2. If there is a chronic need to leave -- i.e. in the long term you need to be there for support -- then I would suggest that you offer to complete the first 3-4 months of the next year and then leave. This would strike a reasonable balance -- your PD would have 3 months to find a replacement or to otherwise adjust the schedule to mitigate the loss. In fact, your contract probably has a clause in it to this effect -- whatever timeframe your contract states should suffice.

3. If you sense "badness" from your PD, you could basically say you are staying, wait until the first block of your PGY-2, then submit your reisgnation. This would have the same result as #2 (as you'd have to give a few months notice of your resignation, whatever your contract states) except that since you completed your PGY-1 and were promoted to PGY-2, you'd be sure to have complete credit for the PGY-1.

4. As others have mentioned, I worry that you could be overwhelmed by work and home care. That being said, I also understand that you may simply need to be closer to home for your own mental / social health.

5. Although I commonly state that getting a lawyer to help you not get fired from a program tends to be a losing strategy, it turns out that using a lawyer in this case is a reasonable plan, as the goal is to leave with a clean record. That being said, it should be your last resort. Remember that the benefit is only seen if the threat works -- if not, and the program fights back, even if you win the time involved in fighting the case will put your career on hold (as, if you do not get PGY-1 credit, the other program will not take you. Also, PD's are often wary of taking resident who are suing their last employer for the obvious reasons)

 

[deleted21609]

If the PD wants to play hardball,he can say something bad to this new prospective PD. Or he can try not to give your brother credit for the PGY1 year. Without credit, he cannot progress to PGY2 at this new place.

Exactly. He needs to have the certification of the intern year in hand before pushing things too far. There are probably plenty of incomplete evaluations here an there through the last year that could suddenly be filled out now and create a long history of poor evaluations after the fact. People suck. Get the internship completion certificate in writing first. Or he could repeat some of the intern year, not the end of the world, but it would be noticable on any future applications.