Probation during residency

[dream303]

I need an advice regarding my current situation. I am PGY-5 and already have a fellowship lined up for this upcoming year. I failed my boards and my program director just informed me that I will be put on probation. He is not using failed board score as a reason, but it is obvious that it would not be in discussions if I passed. He presented me with the group evaluation (according to him it is a consensus of the 3 attendings) which ranks my performance in 1s and 2s. This eval does not match my rotation evaluations, which are not perfect but nowhere near to what he is claiming now. There has been no written/verbal warning. I have been on remediation in the past after I failed in-service exam, but was consequently removed after I passed another version provided by the program director. In my contract it states that I have to be given a warning prior to probation, so I feel that legally my PD is wrong. However, I don’t want to start a war, since I am afraid of retaliation and fear that he will not graduate me. I also worry about the long-term implications of the probation. Will it prevent me from getting licensed or obtaining employment? What should I do at this point?

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[colbgw02]

You need to find out if this is something you can recover from or if their minds are already made up to kick you out and this is just the first step. As staff at a residency program, I can tell you that this may have been years in the planning, even if you were kept relatively in the dark. Have a frank conversation with your PD. If this is a legitimate probation designed to get you to self-correct, then embrace it. You're just six months from the end, so grin and bear it, and knock the core retest out of the park. If you sense they're determined to end your radiology career, then digging in and hiring an attorney may be the way to go, understanding that they may succeed anyway and you'll have burned all of your bridges. What bridges you ask? Like the possibility of repeating R4 year, even if it's unfunded. It's important to have a long-term perspective here. Swallowing your pride for six months or living off of loans for a year is nothing if it permits you to have a decades long career.

 

[dream303]

Thank you for your reply. I was offered to repeat a year. Do you think it is a reasonable option? I am afraid that they will create a very hostile working environment and then get rid of me anyway.

 

[colbgw02]

If they're offering to have you repeat, then it doesn't sound like they intend on letting you graduate on time, regardless of whether you go along with it. The good news is if they thought there was no hope for you, then they probably wouldn't have made the offer. I would take it and then work very hard to rehabilitate your reputation in their eyes. Again, it's just one year, which is not that much balanced against your entire career. It may be difficult for you, but that won't matter 18 months from now if you've got a residency graduation certificate.

 

[tco]

Thank you for your reply. I was offered to repeat a year. Do you think it is a reasonable option? I am afraid that they will create a very hostile working environment and then get rid of me anyway.

I don't think they'd offer you a repeat year if they wanted to give you the boot.

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[dream303]

but PD also said that if he was me he would take probation, since I have a fellowship spot.

 

[Age Appropriate]

What subspecialty is the fellowship in?

PD has an interest in getting you out in May so he doesn't have to pay you but probably wants to offer an extra year to help you out. Don't take legal action, or you risk a bad rep for a long time. The job market is tight enough without having to worry about a call to your old PD who all of a sudden cannot provide any comment, and the PD's and board writers are a tight-knit community nationally. They rely on each other for featured guest lecturers and the like.

No program is under any obligation to graduate residents or even promote them. Most resident contracts are year-to-year, so your current "contract" probably ends in June anyway.

I say take the extra year. Worry about fellowship later.

 

[dream303]

Thank you your input has been very helpful.

 

[Shifty B]

Wait, I'm not sure this is clear. Were you offered an extra year OR probation?

If that's the case, take probation and tell them you are willing to work your ass off to make up for it. Then try to get out the door and take your fellowship spot. At worst, say you would like to be on probation and reconsider whether you need an extra year later in the spring (say, April or May). If you can just get your residency certificate and pass the core exam, chances are this doesn't affect you too much down the line.

 

[colbgw02]

Yeah, I'm confused now, too. Considering that doing nothing and holding course doesn't sound like an option, I'm not sure why you would choose to repeat a year if probation (and potential on-time graduation) is a viable, alternative choice.

If you go on probation, then you'll likely have to disclose it on license and privileging questionnaires. But, if you graduate - particularly on time - then it won't be a big deal at all. There are plenty of licensed, practicing physicians who were placed on probation in residency for one reason or another.

 

[deleted544182]

Why would you be placed on probation for failing your board exam? It should be your choice whether you even want to get board certification or not.

 

[Age Appropriate]

The concern appears to be that probation starts down a path that may end in termination prior to graduation, and it seems unlikely that someone can graduate while on probation. If there has been prior probation, any state licensing board will already take a second look at everything before granting either a training permit or a full license, particularly in states with strict boards like California.

The reason I asked about subspecialty is because ACGME-accredited training programs like ped's, neuro, IR, and nucs will have to treat you like they treat their residents which means they sign all of your reports, and a full license and board eligibility are not needed.

In larger centers, sometimes non-ACGME fellows (MSK, body, chest, breast, women's, MRI, etc.) are required to cover evenings on their own license; and some fellowship programs are only partially funded with the expectation that you make up the difference moonlighting on your own license. If you are in this position, you have to make everything tip-top before you leave your current program. What's more, you will not have achieved board eligible status before you start under any scenario right now.

First thing to probably do is make sure your fellowship knows what is going on and maybe see what input they have. Their GME office will get wind of everything you have discussed here eventually unless you lie on your application paperwork.

If you take a defensive litigious position right now, everything up until now goes on the record for any medical board you encounter for the rest of your life, your PD will be forced to stop evaluating you immediately, and you will have basically no chance to right the ship. You will get one roll of the dice to even get a shot at completing your program, and your name will be associated with this process forever.

You may try to contact a dean at your school, but they often like to kick these things back to the department level.

If everything was completely clean up until now, you may have some recourse, but it looks like there have been problems before that have contributed. Here is the minimum I want from my program in this job market: I need my program officials to tell people that I am a good hire. Without that, I am doing insurance physicals to feed my family. This is why I would do as above, learn from the experience, and ask how I can please prove myself over the next 18 months. This is not something that you can just afford to bank on flying under the radar for 6 months. You are on the radar. Your PD has the upper hand. Residency is not a democracy.

 

[colbgw02]

Why would you be placed on probation for failing your board exam? It should be your choice whether you even want to get board certification or not.

The OP is being cryptic, purposefully or not, but I don't think this is the case. It's more likely that the failed exam is simply the last straw, as in they were using the exam as an external litmus test to confirm or refute their own conclusions. As I mentioned earlier in the thread, these processes can be years in the making, even if the resident remains relatively clueless about just how on-the-brink they are. From a resident's perspective, it can appear that things pop-up out of nowhere and proceed pretty quickly in the last six months, when - in reality - the program leadership has had the resident on their radar for a long-time, hoping for a self-course correction, and they're finally acting because graduation is imminent.

 

[dream303]

than you for your time to respond. I guess repeating a year would be the best option.

 

[mohammad1975]

Probation, sounds to me like an old British term. A term which is equal to torturer and death penalty after that. Kind of stories that you see in books. You program director, I am talking to you on this ,when you put a resident on probation, basically you are showing your anger and dislike towards him. You are getting your revenge by putting him/her down. If your personality is like this, why you do not join a support group to control your anger or resolve your bad attitude towards others. What kind of joy and pleasure do you get by putting some under your boots. If you are like this, you are not even eligible to take care of people's life. First, go treat yourself with medication or psychotherapy and then start medicine, so you will not be a disaster to people who come to your hospital to fulfill their future and face someone like you who starts going after their life. I guess it is time for ACGME to take this matter in hand and stop brutality. If you unleash a dog, does not matter how you well treated him, when gets a chance, will bit some one. Do not let brutality take over. There are lots of sad stories here. I do not know if these stories get publish to public people, what kind of reaction would it have, people definitely lose their trust in medicine.

 

[colbgw02]

Probation, sounds to me like an old British term. A term which is equal to torturer and death penalty after that. Kind of stories that you see in books. You program director, I am talking to you on this ,when you put a resident on probation, basically you are showing your anger and dislike towards him. You are getting your revenge by putting him/her down. If your personality is like this, why you do not join a support group to control your anger or resolve your bad attitude towards others. What kind of joy and pleasure do you get by putting some under your boots. If you are like this, you are not even eligible to take care of people's life. First, go treat yourself with medication or psychotherapy and then start medicine, so you will not be a disaster to people who come to your hospital to fulfill their future and face someone like you who starts going after their life. I guess it is time for ACGME to take this matter in hand and stop brutality. If you unleash a dog, does not matter how you well treated him, when gets a chance, will bit some one. Do not let brutality take over. There are lots of sad stories here. I do not know if these stories get publish to public people, what kind of reaction would it have, people definitely lose their trust in medicine.

If we had a nominate function, then I'd use it on this post.

 

[auburnO5]

Probation, sounds to me like an old British term. A term which is equal to torturer and death penalty after that. Kind of stories that you see in books. You program director, I am talking to you on this ,when you put a resident on probation, basically you are showing your anger and dislike towards him. You are getting your revenge by putting him/her down. If your personality is like this, why you do not join a support group to control your anger or resolve your bad attitude towards others. What kind of joy and pleasure do you get by putting some under your boots. If you are like this, you are not even eligible to take care of people's life. First, go treat yourself with medication or psychotherapy and then start medicine, so you will not be a disaster to people who come to your hospital to fulfill their future and face someone like you who starts going after their life. I guess it is time for ACGME to take this matter in hand and stop brutality. If you unleash a dog, does not matter how you well treated him, when gets a chance, will bit some one. Do not let brutality take over. There are lots of sad stories here. I do not know if these stories get publish to public people, what kind of reaction would it have, people definitely lose their trust in medicine.