Probation, now what?

[anonymoose]

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I'm in a pickle. I'm a 3rd year IM resident and I have had recurrent major depression. I have never hid the depression from my residency program and have been very functional. I am also a loud mouth, and will speak out when something is wrong (I had written a letter 3 months earlier detailing how patient care was suffering due to inadequate resident staffing that made the CEO of the hospital very mad, which I think is why I've been put on probation.) I need some input.

I'm told I am on probation for three reasons- one instance of unprofessional conduct (I supposedly cursed at a nurse, which she deserved but I didn't do), misrepresenting an absence (I was at a psych eval requested by the program), and for failing to show up for a rotation (I changed the rotation because of a conflict, the program director was away on vacation and I didn't get her signature, but had everyone elses). I have been told there there is no question that I am a competent physician, that it is only my behavior that is a concern. I have never been allowed to address these issues.

The program is placing me on probation for 3 months, which will follow me for the rest of my career. I am required to see a psychiatrist (already am), and give the program COMPLETE access to my chart. They can have me re-evaluated at any time. They are also extending my residency by two weeks.

Do I have ANY leverage here? I have already told them that I will not allow them to have complete access to my chart, but that I will show compliance with seeing the psychiatrist. I will quit before I let them have complete access to my chart. I was told that this may not be acceptable to the committee, but the PD seemed to back down at my insistance for some privacy. My program is desperately short on residents. I don't mind the two extra weeks. Is there a way I can make this not follow me for the rest of my life? Is it time for a lawyer?

 

[Dire Straits]

I'm in a pickle. I'm a 3rd year IM resident and I have had recurrent major depression. I have never hid the depression from my residency program and have been very functional. I am also a loud mouth, and will speak out when something is wrong (I had written a letter 3 months earlier detailing how patient care was suffering due to inadequate resident staffing that made the CEO of the hospital very mad, which I think is why I've been put on probation.) I need some input.

I'm told I am on probation for three reasons- one instance of unprofessional conduct (I supposedly cursed at a nurse, which she deserved but I didn't do), misrepresenting an absence (I was at a psych eval requested by the program), and for failing to show up for a rotation (I changed the rotation because of a conflict, the program director was away on vacation and I didn't get her signature, but had everyone elses). I have been told there there is no question that I am a competent physician, that it is only my behavior that is a concern. I have never been allowed to address these issues.

The program is placing me on probation for 3 months, which will follow me for the rest of my career. I am required to see a psychiatrist (already am), and give the program COMPLETE access to my chart. They can have me re-evaluated at any time. They are also extending my residency by two weeks.

Do I have ANY leverage here? I have already told them that I will not allow them to have complete access to my chart, but that I will show compliance with seeing the psychiatrist. I will quit before I let them have complete access to my chart. I was told that this may not be acceptable to the committee, but the PD seemed to back down at my insistance for some privacy. My program is desperately short on residents. I don't mind the two extra weeks. Is there a way I can make this not follow me for the rest of my life? Is it time for a lawyer?

sounds like they may be getting all their ducks in a row to boot you from the program. you ticked off the wrong person(s) and this is one way they get back at you. i've seen it a bunch of times. they're leaving a paper trail so if/when they boot you, they can cover their ass if they have to back it up in court (i.e. he was "unprofessional", he had psychological issues for which he was seeing a psychiatrist, he was put on probation, etc). being the most competent doctor in the world doesn't matter if they're looking to get you out of their program for whatever reason. you're a resident, cheap labor, replacable. they can get rid of attending just as easily, so it's no surprise they can do the same with mere residents. pissing off the CEO was very bad. your PD answers to the CEO, so you pretty much pissed off the worse person possible. basically you have to watch your step while on probation and not give them more ammo to get rid of you, because you can bet they will be watching you. just do your job as best you can, don't be a loud-mouth complainer because your career is more important than whatever you're probably complaining about, and basically just STFU and don't give them another reason.

 

[Mirror Form]

If you're a 3rd year, then you've put waaayyyy to much effort into your IM program to get booted now. Now is not the time to be fighting the power. Just kiss their a$$es and do whatever they ask. Once you graduate you can write some more letters about how incompetent the CEO is. But until then you can't put your entire career in anymore jeopardy then you've already done.

BTW, Dire Straits is correct that right or wrong, they now have all the ammo that they legally need to fire you (probation, unprofesionalism, etc). So all it could take is one more reason for them to pull the trigger. Don't risk it!

 

[Dire Straits]

P.S. You do not want to be booted from a residency, especially in your last year. first of all, final year positions are hard to come by in any residency. so *if* you ever get into another program you may have to start back at PGY2. and i say *if* because the chances of getting into another program are slim because the PD from that program will want a letter from the PD of the program you were booted from, and you can imagine it's going to be less than glowing. and despite what you may hear, PDs do talk to each other, and the new PD will most likely call the old PD to see what's really up despite what's written in the letter. this is where they can talk one-on-one with no record kept, and you can just imagine what your old PD will say about you when it's off the record.

not only for residency, but when you apply for permanent licensing (if you haven't already got one) you're going to have to report all this and why you transferred to another program (ie you will already have to explain being put on probation). and it even goes beyond licensing, when you apply for malpractice insurance and hospital priveleges they will want to know your history while a resident. and if you by chance you ever get sued you can bet the lawyer is going to bring up the fact you were put on probation as a resident to make you look incompetent for the jury. worse if you got booted from the residency. man, it's a freaking nightmare that follows you for the rest of your career. so don't let it go beyond probation. do what you have to do to stay in the residency and finish up.

that being said, it's up to you if you feel like you need an attorney now, as you are on probation and can still make it through. if you get one, make sure you get one that is familiar with workplace law. going against a medical center is as tough as it gets legally. they have lawyers on retainer who deal with lawsuits from countless patients and companies on a daily basis for millions of dollars. so some legal action from a resident will not be a big deal for their lawyers as it will be for you...both financially and emotionally. man i've seen it happen to one of my buds before and it was a nightmare. they make you look like the biggest putz to ever earn an M.D. that it borders on cruel and unusual punishment. the same people you were working with and having christmas parties with turn on you like you wouldn't imagine when the hospital's reputation and money are on the line. you'll truley understand the meaning of the terms "people suck" and "every man for himself".

you're not the first to go through this and certainly won't be the last. as i've said already, the best outcome you can hope for is to get through probation with no more problems and just finish up your residency. good luck and pm me if you want to talk and i might be able to put you in touch with my bud who can give you some pointers (if he's willing to risk opening up old wounds and revisiting the PTSD he developed from all the crap he went through).

 

[beyond all hope]

Agree with previous posters. They're getting all of their paperwork ready to fire you if necessary. However, replacing you is a pain, so if you can convince them that you won't make any more trouble than you should be able to graduate.

I know all about being a loudmouth and getting burned for it. I had to change residencies myself. Residency is a medieval concept where you're basically a slave with no rights. Once you graduate, that all changes.

I would write a letter to the appropriate people (CEO, PD) about how sorry you are and how you intend to make up for it when you get back by being a perfect, quiet, subserviant resident. The stress got to you and you cracked. Make it seem like you're ready to play the game. Then suck up, kiss ass, keep on the down low, and graduate.

After that, light a fire under their collective bottoms. Once you have your diploma you're not untouchable but at least you can pack up and leave if things get too hot.

 

[Snoopy]

You've gotten good advice so far. A few things I would add . . .

As far as the requirement for counseling, I would consider finding a second psychiatrist/psychologist/counselor for whatever is required by your program. That way they can only require that you divulge what is said with that one therapist. This gives you complete control over what gets in the file and preserves the privacy you are entitled to with your existing psychiatrist. It also leaves you a place to vent.

My cousin did an IM residency and was placed on probation. He got hassled a lot from the program and at times it seemed like it would be a miracle if he would graduate. He too was required to see a psychiatrist. He managed to satisfy the terms of the probation, graduated, and landed a hospitalist position at a VERY prominent Boston hospital. So while things may seem grim now and the situation does create some problems for your immediate and distant future, this is not the end of the world. Suck it up, do what you have to do, graduate, and you'll have a medical career. If you truly are a competent physician you should have no problem in IM.

Best wishes.

 

[wastoute]

Man does this bring back nightmares. I was a PGY6 in neurosurgery at Northwestern when I was dismissed in '90. You really need a good lawyer right away and there really aren't many who can handle this. Wish I could give you a name, but I can't. The last thing you want your program to know is that you have representation. This needs to be kept completely to yourself. Don't even tell your wife. That way when the ____ hits the fan you will have someone already up to speed and won't have to wate a lot of sweat in a hurry. As the other poster has pointed out, they already have lawyers.

You really need to do everything you can to finish, but it is probably too late already. I knew one guy at UMDNJ Camden in '85 who hired a real maddog lawyer who scared the crap out of the program and they let him finish. I hear he was disbarred several years later, perhaps for being too much of a maddog. It does happen, but as my lawyers told me, all they have to do is go into court and claim they are protecting the populace from bad docs like you. You can't win it.

Good Luck and God Bless, but get a lawyer up to speed quick and search hard now for one that has done this kind of thing before and preferrably one that has succeded (very rare). 🙁

 

[Dire Straits]

Man does this bring back nightmares. I was a PGY6 in neurosurgery at Northwestern when I was dismissed in '90. You really need a good lawyer right away and there really aren't many who can handle this. Wish I could give you a name, but I can't. The last thing you want your program to know is that you have representation. This needs to be kept completely to yourself. Don't even tell your wife. That way when the ____ hits the fan you will have someone already up to speed and won't have to wate a lot of sweat in a hurry. As the other poster has pointed out, they already have lawyers.

You really need to do everything you can to finish, but it is probably too late already. I knew one guy at UMDNJ Camden in '85 who hired a real maddog lawyer who scared the crap out of the program and they let him finish. I hear he was disbarred several years later, perhaps for being too much of a maddog. It does happen, but as my lawyers told me, all they have to do is go into court and claim they are protecting the populace from bad docs like you. You can't win it.

Good Luck and God Bless, but get a lawyer up to speed quick and search hard now for one that has done this kind of thing before and preferrably one that has succeded (very rare). 🙁

wastoute, i sent you a private message.

 

[wastoute]

http://biotech.law.lsu.edu/cases/schools/Shaboon_v_Duncan_brief.htm

Here is a taste of what you are in for. I couldn't find a lawyer on the 'net that specializes in helping residents, which is too bad 'cuz they really need it.

Personally I don't think a program should be able to dismiss a resident without first precipitating a site visit from the Board of the Specialty and the RRC, but that is just me. I really would like to get a job someday doing that, being the guy they bring in to see just what is what.

I NS they said I was unfit, but I went on to get Top Block evals in the Army for 5 years and was asked to stay on and help as a civilian when I got out. The guy that screwed me proceeded to preside over the melt down of his dept. and lost every attending in 6 months and the PD that let it happen got the boot the following year, went to Long Island to practice and had his licensed yanked for gross misconduct the next year. You tell me who the "bad docs" were, but there it is.

 

[NinerNiner999]

Make your own paper trail and CYA. Pint and save every email correspondence related to this issue that you have EVER recieved - ever. Write letters to your PD as suggested above, and send carbon copies to other faculty in your program. In your letter ask for constructive criticism and encourage faculty to give you written suggestions for ways to improve your standing. Ask to see your file so you know what is in it (every residency program keeps a file of evaluations, letters, test scores, etc). Get everything you need to protect yourself in case the ultimate decision to boot you is made, and then, if your paper trail in any way validates your innocence, you will have recourse. Most importantly, if they decide to terminate you or make you conditions infair for whatever reason, present your paper trail to the ACGME liason, who will investigate the matter and prevent your termination. In fact, they may be able to overturn your "probation" and have it exponged from your record. It is a HIPAA violation for them to request your medical record, and an ethical violation for them to hint that your employment is conditional upon your private medical record...

 

[EMApplicant]

It is a HIPAA violation for them to request your medical record, and an ethical violation for them to hint that your employment is conditional upon your private medical record...

I don't know whether or not it's a HIPAA violation or not (they are asking him to consent to them viewing his records, right?)...but, it sure as hell seems sketchy to me. It's one thing for them to require that you seek professional help, however, they should, in turn, be willing to accept that professional's assesment of your condition without demanding to see all of the actual records - wtf, that just smells fishy...

 

[f_w]

- get a good attorney familiar with this type of cases (easier said than done). We might not like them, but faced with this type of a career-threatening legal situation you have to do this. Getting legal representation is not equal to 'threatening to sue'. Right now you have to deal with something outside of your (and our all) field of expertise. So get the consultant you need to deal with this.

- they can't fire you for being depressed. It is a medical condition and firing you for this would probably run afoul of the ADA.

- talk to your attorney whether they can force you to give access to your chart. A well worded letter from your attorney replying to the issues raised in the probation would probably put an end to this part of their demands.

- do everything you can to get rid of the unprofessional conduct issue because this is the only thing they can boot you for. Profusely apologize to the nurse in writing (and btw. it doesn't matter whether you actually cursed at her or not). For the rest of your time there, shut up, even if you have to bite your tongue off. If someone screws up, let them go ahead and don't yell at them. If conditions in your department are unsafe, don't care. It might suck, especially for the patients, but the system is rigged in a way that it requires you to not care for the time being.

- the misrepresenting of an absence should be an issue easy to clear up.

- profusely apologize for the unauthorized changing of a rotation. It might seem a minor issue to you, but for them it is one of the few 'hard' problems they can stick you with.

- you might want to take a couple of months of medical leave/short term disability to get your psych situation taken care of. It will also allow things at the program to cool off and keep you from getting into more trouble. Your perception of your level of functioning might be a bit different from theirs. Unfortunately, their perception is the more important one in this setting.

 

[CattleprodSurg]

Shut it and go to work.
There are thousands of people around the world who would love to do your job, are smarter than you and are begging for a chance.

 

[toofache32]

Shut it and go to work.
There are thousands of people around the world who would love to do your job, are smarter than you and are begging for a chance.

Nice. And how is this relevant? This can be said for any job. And there are starving people in Africa. Do you send them food?

Thanks for the constructive input.

 

[Strength&Speed]

Agreed. Guilt doesnt get you very far in this situation.

Nice. And how is this relevant? This can be said for any job. And there are starving people in Africa. Do you send them food?

Thanks for the constructive input.

 

[billydoc]

Hey!
Just suck it up, and stay low for now. This situation,unfortunetely, is not that unique. It could happen at any work place anytime. But the stress from residency could only be understood by those who have done it ( and I admit I'm not a resident yet). Please, for your own sake just stay low. And I see some are cheering you on to tell them off once you graduate. DO NOT DO IT. Just forget them, and go on your marry way. You are not going to prove anything to a big corporate world. It ain't nothing they've seen before...and not only from residents. Believe me everybody from Big Docs to te housekeepers are replacebale. Don't "piss" in a cup from which you may have to drink again. Just realize it as a bad moment in your life, but from now on it will get better. If you need some meds and therapy to be functional do it. Just don't do it at the hospital you're at right now. Nothing is worth loosing what you've worked so hard for, for so long. 🙂
Good Luck and stay strong