Questions On Resident Chart

[medpsych1]

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I looked at this chart ( link: http://www.acgme.org/acWebsite/annRep/an_2008-09AnnRep.pdf ) and had some questions:
1) I can see why residents might transfer (total of 1532) to another program but why do more than ten times as many residents withdraw (1065) rather than taking a leave of absence (85)?
2) What are the typical reasons for residents to withdraw and to be dismissed?
3) What do all the dismissed (279) and withdrawn not transferred (1065) residents typically do for a living?
4) Are most of the deaths (28) from car wrecks from driving after no sleep? Do hospitals provide taxis to take residents home after a 30 hour shift with no sleep?

 

[LizzyM]

Rough estimate:

About half of all deaths are due to unintentional injuries of all kinds including auto crashes. Of the other half: suicide, homicide would be most common followed by cancer and heart disease. Perhaps one or two due to complications of pregnancy or HIV or other infection.



http://dhhs.nv.gov/Suicide/DOCS/US_Leading_Causes_of_Death_2005.pdf

Some people who leave a program that has become unworkable for them will land on their feet and find another program that will take them in (just as the program they leave will try to fill the position). Someone who leaves mid-year, takes time off and starts at another program on July 1 might be called a withdrawal rather than a transfer. I don't have any first hand knowledge of dismissals from residency but I do know of dismissal from med school during clerkship that can turn out ok with eventual admission to another school. Some pretty bad situations aren't alway the end of the line for physicians in training.

I think that some of the "withdrawals" are voluntary in situations where the alternative is to be dismissed. (Similar to resigning rather than being fired.) Again, it may be a situation where one has lost the ability to trust hospital staff with one's life and license and where bad outcomes get laid at the resident's feet when part of the problem may be hospital staff and/or policies that make it impossible to do one's job. (I'm thinking of situations where patients become violent -- and not just "psych" patients).

 

[Catalystik]

3) What do all the dismissed (279) and withdrawn not transferred (1065) residents typically do for a living?

They may take a year off, do research, apply for a PGY-1 spot through ERAS again, or eventually find another residency spot on their own (but not have contiguous training). Or, if they completed at least one year of residency, they may be eligible to take the Step III and qualify for an independent license to practice and write prescriptions. Many jobs will not be open to someone who is not Board Eligible (ie, completed a residency program). Many malpractice insurance companies will not insure such a person, and many hospitals won't give them admitting privileges. One could still potentially work in a walk-in clinic, a private clinic, or a government facility (eg, VA, military, Native American reservation) practicing medicine. Some might stay in research or work for pharmaceutical companies, teach, among other possibilities. Some will completely change their career path, having found that medicine is not right for them.

 

[tremulousNeedle]

All good responses, here are some personal situations I have encountered.

Regarding withdrawal, some interns realize that being a physician isn't for them. I know of a resident who went the MD/PhD route and midway through a miserable internship, he realized that he wanted to solely do research and never practice medicine, so he withdrew from the residency program (and found his dream job, I think). Another was MD only and felt the same way.

Of the dismissals that I know of, the residents simply weren't reliable. This led to inadequate patient care, which is no good for anyone.

 

[deleted357625]

I looked at this chart ( link: http://www.acgme.org/acWebsite/annRep/an_2008-09AnnRep.pdf ) and had some questions:
1) I can see why residents might transfer (total of 1532) to another program but why do more than ten times as many residents withdraw (1065) rather than taking a leave of absence (85)?
2) What are the typical reasons for residents to withdraw and to be dismissed?
3) What do all the dismissed (279) and withdrawn not transferred (1065) residents typically do for a living?
4) Are most of the deaths (28) from car wrecks from driving after no sleep? Do hospitals provide taxis to take residents home after a 30 hour shift with no sleep?

Damn, that's like almost 30 residents who died??? how... geez

 

[Winged Scapula]

Damn, that's like almost 30 residents who died??? how... geez

Out of 40,000 residents, that's less than the average death rate for US citizens age 25-34 (which is about 1%).

 

[Wakesc]

Out of 40,000 residents, that's less than the average death rate for US citizens age 25-34 (which is about 1%).

I'm glad you made that point, because I was wondering what the statistic was.

 

[LizzyM]

Out of 40,000 residents, that's less than the average death rate for US citizens age 25-34 (which is about 1%).

No the death rate in the US for people 25-34 years of age is 100 per 100,000 per year or about 0.1%.

So, among 40,000 residents we'd expect 40 deaths and we observe 28 which is not surprising given the "healthy worker" bias as well as greater weath, education, and access to health care among residents as compared with all 25-34 year olds. Also the ethnic groups under-represented in medicine tend to have higher death rates then whites and asians.