Reasons for dismissal

[Magyarzorag]

I’m not even a resident yet, but I was wondering what are typical reasons for dismissal and if a dismissal or being fired is truly an end to a medical career. I know if it was any other job, I can just look for another one one, but is it the same after a dismissal, or is it the end of the road.
What are some reasons that warrant dismissal. I understand if people get dismissed for bad things like HiPPA violations, felony convictions, or gross negligence, but why about more minor issues, such as showing up late all the time, oversleeping, incompetence, poor communication skills, or other minor things that can get someone normally fired?

---

Members don't see this ad.

 

[GoSpursGo]

Moving to Med students, since it appears you’re not particularly close to starting residency.

None of those things that you list as “minor” are seen as minor, or in any way normal for someone who is a professional with a doctoral degree. The vast majority of residents have none of those issues, and get by just fine. Don’t do any of those things. Seriously, you’re asking whether someone can be fired for “incompetence?”

To answer your other question, whether being terminated is the end of the road depends on a number of factors, including why you were dismissed, whether you are applying to a different field, and ultimately whether your old PD is willing to write a neutral or good LOR to you. They probably wouldn’t be willing to do so someone fired for any of the reasons you listed.

 

[deleted480308]

I’m not even a resident yet, but I was wondering what are typical reasons for dismissal and if a dismissal or being fired is truly an end to a medical career. I know if it was any other job, I can just look for another one one, but is it the same after a dismissal, or is it the end of the road.
What are some reasons that warrant dismissal. I understand if people get dismissed for bad things like HiPPA violations, felony convictions, or gross negligence, but why about more minor issues, such as showing up late all the time, oversleeping, incompetence, poor communication skills, or other minor things that can get someone normally fired?

You should eventually be fired for all those things, don’t do those things

 

[deleted1001426]

All of the minor things you listed were essentially just rewording “being terrible at your job” or “not showing up to your job”. Serious question, you ever work anywhere before? Those are things which would lose you a job at McDonald’s so yeah.. I assume you’d be dismissed for doing those consistently

 

[Schwifty]

I wouldn’t consider “incompetence” a minor issue... especially as a doctor

 

[Magyarzorag]

All of the minor things you listed were essentially just rewording “being terrible at your job” or “not showing up to your job”. Serious question, you ever work anywhere before? Those are things which would lose you a job at McDonald’s so yeah.. I assume you’d be dismissed for doing those consistently

If you lose a job at McDonalds, you can apply to another McDonalds or Burger King and your flipping burgers career may not be over. However, your career as a doctor is over if you get fired from residency?

 

[Goro]

If you lose a job at McDonalds, you can apply to another McDonalds or Burger King and your flipping burgers career may not be over. However, your career as a doctor is over if you get fired from residency?

Pretty much, yes

 

[Goro]

I’m not even a resident yet, but I was wondering what are typical reasons for dismissal and if a dismissal or being fired is truly an end to a medical career. I know if it was any other job, I can just look for another one one, but is it the same after a dismissal, or is it the end of the road.
What are some reasons that warrant dismissal. I understand if people get dismissed for bad things like HiPPA violations, felony convictions, or gross negligence, but why about more minor issues, such as showing up late all the time, oversleeping, incompetence, poor communication skills, or other minor things that can get someone normally fired?

Being unteachable is one reason residents get fired. Lying about paperwork is another.

 

[BigPikachu]

I’m not even a resident yet, but I was wondering what are typical reasons for dismissal and if a dismissal or being fired is truly an end to a medical career. I know if it was any other job, I can just look for another one one, but is it the same after a dismissal, or is it the end of the road.
What are some reasons that warrant dismissal. I understand if people get dismissed for bad things like HiPPA violations, felony convictions, or gross negligence, but why about more minor issues, such as showing up late all the time, oversleeping, incompetence, poor communication skills, or other minor things that can get someone normally fired?

In my time, things that usually get doctors dismissed or suspended from their job, and/or insofar as deregistered from the medical board:

1) Serious criminal offences
2) Consistently poor performance
3) Inappropriate relationship with a patient
4) Negligent care and deviation from standard practice of care
5) Practicing medicine while affected by alcohol or recreational drugs
6) Non-disclosed physical or mental ailment that directly impairs your practice

 

[GoSpursGo]

If you lose a job at McDonalds, you can apply to another McDonalds or Burger King and your flipping burgers career may not be over. However, your career as a doctor is over if you get fired from residency?

This shouldn't be a surprise. If someone is incompetent as a burger flipper, someone's burger tastes a little worse. An incompetent doctor kills people.

It should be mentioned, being dismissed after starting residency is pretty rare because there's a pretty steep vetting process at the level of med school admissions and then passing your clerkships. Most people who would have problems with any of the things you describe would get caught at one of those stages. So if you were accepted to school, I wouldn't worry about this--just learn as much as you can, and chances are you won't be incompetent.

 

[hallowmann]

Being unteachable is one reason residents get fired. Lying about paperwork is another.

FTFY.

 

[operaman]

Yeah agreeing that those “minor” things are not minor at all. For anyone who thinks they are, just wait til someone you love dearly has a serious illness or needs surgery and suddenly you care very deeply about how professional and competent their physicians are.

In my limited experience, the firings I’ve seen have been mostly for professional issues but also for competence. Some of these have been grads of top tier Ivy League medical and undergraduate schools!

So far I’ve seen it be a career ended once though that person is now working in some tech startup. Another did research for awhile and eventually worked their way into a residency in another field that they are currently in. Another went directly from dismissal to starting another residency in a different field.

The competence dismissals seem to be the easiest to save in terms of career. I think PDs recognize that sometimes a field or even a program is not a good fit and that someone may be much happier elsewhere. One I’m thinking of was dismissed after pgy2 year and went directly to a residency in another field and got incredible support from the PD who felt they would probably thrive with a different Pace and workflow and with a fresh start. Turns out to be true as they are doing really well, even winning awards in their new program.

The professionalism ones are another story and tend to represent behavior and character issues that may be past the point of rehabilitation. If you haven’t learned not to lie by the time you’re 28 and a physician, I’d say your chances of picking that up now are slim. Even so, sometimes people are pushed by circumstance past their ability to cope and they turn to lying or substances or other behaviors that land them in hot water. Sometimes these people can salvage a medical career with time and hard work, but it’s rare.

 

[CyrilFiggis]

The real question is, OP, what spawned this post?

 

[Goro]

The real question is, OP, what spawned this post?

If you look through his post history, OP has a lot of anxiety about entering the medical profession.

 

[Ho0v-man]

If you lose a job at McDonalds, you can apply to another McDonalds or Burger King and your flipping burgers career may not be over. However, your career as a doctor is over if you get fired from residency?

Yes. That’s why one would hope someone who managed to get through 4 years of medical school would have a superior work ethic to someone who is a bad burger flipper.

If you’re jealous of the lower standards a burger flipper is held to compared to a doctor, McDonalds is always hiring.

 

[CherryRedDracul]

One thing to note is residents do get a lot more leeway than the average working person. The hospital system and the residency program have a vested interest in keeping a resident by putting them through remediation to hopefully fix them up. A resident is free labor and, in most cases, a source of Medicare money. Firing a resident doesn't look good on a program either.

Most residents get fired because of severe behavioral and professionalism issues. From my experience, I have more than a handful of stories about residents who did things at work that would have gotten them fired from any other normal job.

IMO, residents get too much leeway, and this leeway permits the graduation of attendings who should not be taking care of patients in the first place.

 

[RangerBob]

My internship PD shared a story about one IM resident who started doing a bedside debrident of a 1 day post-op thoracotomy patient (of the thoracotomy incision). The CT surgeon fortunately walked in and physically pulled the resident away.

So show up on time, don’t lie, don’t be incompetent, and don’t do bedside surgery when you’re not a surgeon.

 

[ace_inhibitor111]

There are definitely residencies out there that fire a resident every year or force them to resign. Sure, bad residents exist, but there are also bad residencies that make it easy to get targeted or fall behind.

I also doubt $60k a year Medicare money is enough incentive for a residency to make an extended effort to remediate a resident. It seems easy for them to put a resident on probation for the rest of the year, then when they are able to find another set of hands, simply not renew their contract. Once a resident is under the microscope, they can gather evidence of any and every mistake and protect themselves from any lawsuit.

Point is, many residencies have their own agenda and are NOT looking out for their residents. You have to be really careful not to piss anyone off, and cover your ass whenever possible by sharing responsibility. I remember a story posted on here of an intern who was inserting a central line for the first time and accidentally left the guide wire in when the chief who was watching him left the room to handle something else. He was fired, the chief was adamant that he “lied” by not telling anyone about the guidewire, but it is just as likely he didn’t know he was supposed to pull it out. People can and will assume things based on how they look. If that intern had just not even bothered to put the central line in and deferred to his senior he would have been safe.

Safety, covering your ass, appearing competent by doing things you know you’ll succeed in >>> trying to make an impression or being too eager at doing new things. That’s an important lesson for both wards and residency.

 

[CherryRedDracul]

There are definitely residencies out there that fire a resident every year or force them to resign. Sure, bad residents exist, but there are also bad residencies that make it easy to get targeted or fall behind.

I also doubt $60k a year Medicare money is enough incentive for a residency to make an extended effort to remediate a resident. It seems easy for them to put a resident on probation for the rest of the year, then when they are able to find another set of hands, simply not renew their contract. Once a resident is under the microscope, they can gather evidence of any and every mistake and protect themselves from any lawsuit.

Point is, many residencies have their own agenda and are NOT looking out for their residents. You have to be really careful not to piss anyone off, and cover your ass whenever possible by sharing responsibility. I remember a story posted on here of an intern who was inserting a central line for the first time and accidentally left the guide wire in when the chief who was watching him left the room to handle something else. He was fired, the chief was adamant that he “lied” by not telling anyone about the guidewire, but it is just as likely he didn’t know he was supposed to pull it out. People can and will assume things based on how they look. If that intern had just not even bothered to put the central line in and deferred to his senior he would have been safe.

I know of many residents who left a residency to pursue another one. I am not aware of any residency firing or forcing a resignation of a resident in any regular manner.

The advantages of employing a resident are not just about the Medicare money. It's about the free labor. The fact is that residents are far more cost effective than an advanced care practiotioner (e.g. NP, PA) in your typical hospital setting.

Hospitals get money for having a resident to do the grunt work; factor in salary and other administrative things, the hospital may make a little money, lose a little money, or break even: the numbers aren't clear. On the other hand, you need to pay a PA or NP a handsome salary for the same work. The choice is obvious to any hospital administrator.

But I do agree that there are many subpar residencies who do not look out for their residents simply because they think they can get away with it. If residents report their own residencies for inhospitable work conditions, violation of work-hours and such, they put their own jobs on the line and risk becoming orphan residents who will have to find another hospital to pick them up. Look at what's happening to the University of New Mexico neurosurgery program. They're scrambling to find advanced care practitioners for all the neurosurgery residents they're losing.

 

[operaman]

There are definitely residencies out there that fire a resident every year or force them to resign. Sure, bad residents exist, but there are also bad residencies that make it easy to get targeted or fall behind.

I also doubt $60k a year Medicare money is enough incentive for a residency to make an extended effort to remediate a resident. It seems easy for them to put a resident on probation for the rest of the year, then when they are able to find another set of hands, simply not renew their contract. Once a resident is under the microscope, they can gather evidence of any and every mistake and protect themselves from any lawsuit.

Point is, many residencies have their own agenda and are NOT looking out for their residents. You have to be really careful not to piss anyone off, and cover your ass whenever possible by sharing responsibility. I remember a story posted on here of an intern who was inserting a central line for the first time and accidentally left the guide wire in when the chief who was watching him left the room to handle something else. He was fired, the chief was adamant that he “lied” by not telling anyone about the guidewire, but it is just as likely he didn’t know he was supposed to pull it out. People can and will assume things based on how they look. If that intern had just not even bothered to put the central line in and deferred to his senior he would have been safe.

Safety, covering your ass, appearing competent by doing things you know you’ll succeed in >>> trying to make an impression or being too eager at doing new things. That’s an important lesson for both wards and residency.

I’d bet any amount of money that intern was already a problem resident and the line was a last straw. You have to take any dismissal story posted here with a huge grain of salt.

 

[GoSpursGo]

There are definitely residencies out there that fire a resident every year or force them to resign. Sure, bad residents exist, but there are also bad residencies that make it easy to get targeted or fall behind.

I also doubt $60k a year Medicare money is enough incentive for a residency to make an extended effort to remediate a resident. It seems easy for them to put a resident on probation for the rest of the year, then when they are able to find another set of hands, simply not renew their contract. Once a resident is under the microscope, they can gather evidence of any and every mistake and protect themselves from any lawsuit.

Point is, many residencies have their own agenda and are NOT looking out for their residents. You have to be really careful not to piss anyone off, and cover your ass whenever possible by sharing responsibility. I remember a story posted on here of an intern who was inserting a central line for the first time and accidentally left the guide wire in when the chief who was watching him left the room to handle something else. He was fired, the chief was adamant that he “lied” by not telling anyone about the guidewire, but it is just as likely he didn’t know he was supposed to pull it out. People can and will assume things based on how they look. If that intern had just not even bothered to put the central line in and deferred to his senior he would have been safe.

Safety, covering your ass, appearing competent by doing things you know you’ll succeed in >>> trying to make an impression or being too eager at doing new things. That’s an important lesson for both wards and residency.

To be fair, if you don’t have enough experience to put in a central line unsupervised, it’s on you to speak up. As a senior resident I certainly didn’t know which procedures my interns were or weren’t signed off on, and while I probably would have asked my intern whether they’ve done the procedure before, that intern needs to speak up. Yes, there’s a culture of “figure it out” in medicine, but ultimately you need to know your limits.

 

[VA Hopeful Dr]

There are definitely residencies out there that fire a resident every year or force them to resign. Sure, bad residents exist, but there are also bad residencies that make it easy to get targeted or fall behind.

I also doubt $60k a year Medicare money is enough incentive for a residency to make an extended effort to remediate a resident. It seems easy for them to put a resident on probation for the rest of the year, then when they are able to find another set of hands, simply not renew their contract. Once a resident is under the microscope, they can gather evidence of any and every mistake and protect themselves from any lawsuit.

Point is, many residencies have their own agenda and are NOT looking out for their residents. You have to be really careful not to piss anyone off, and cover your ass whenever possible by sharing responsibility. I remember a story posted on here of an intern who was inserting a central line for the first time and accidentally left the guide wire in when the chief who was watching him left the room to handle something else. He was fired, the chief was adamant that he “lied” by not telling anyone about the guidewire, but it is just as likely he didn’t know he was supposed to pull it out. People can and will assume things based on how they look. If that intern had just not even bothered to put the central line in and deferred to his senior he would have been safe.

Safety, covering your ass, appearing competent by doing things you know you’ll succeed in >>> trying to make an impression or being too eager at doing new things. That’s an important lesson for both wards and residency.

My program fired one person every year I was there, but I know the details behind 2 of them and they were both absolutely deserved and given multiple changes to improve.

 

[hallowmann]

I know of many residents who left a residency to pursue another one. I am not aware of any residency firing or forcing a resignation of a resident in any regular manner.

The advantages of employing a resident are not just about the Medicare money. It's about the free labor. The fact is that residents are far more cost effective than an advanced care practiotioner (e.g. NP, PA) in your typical hospital setting.

Hospitals get money for having a resident to do the grunt work; factor in salary and other administrative things, the hospital may make a little money, lose a little money, or break even: the numbers aren't clear. On the other hand, you need to pay a PA or NP a handsome salary for the same work. The choice is obvious to any hospital administrator.

But I do agree that there are many subpar residencies who do not look out for their residents simply because they think they can get away with it. If residents report their own residencies for inhospitable work conditions, violation of work-hours and such, they put their own jobs on the line and risk becoming orphan residents who will have to find another hospital to pick them up. Look at what's happening to the University of New Mexico neurosurgery program. They're scrambling to find advanced care practitioners for all the neurosurgery residents they're losing.

I actually know multiple residents that were fired or non-renewed from a few programs, many of which most people wouldn't call "subpar residencies". It definitely happens, but I agree that it's generally uncommon. All of the residents had deficiencies of some kind, but to be completely honest, different programs have different thresholds for remediation and dismissal, and a lot of those people went to other programs, sometimes in the same specialty and did fine.

Also the degree to which a single dismissal a year costs a residency is pretty dependent on the program. The biggest offender program that I'm closely aware of simply spreads the extra call, night float, patients, and work across the remaining residents, and the chiefs absorb the rest if schedules/duty hrs don't allow it. It basically sucks for the other residents, but the attendings, department, and certainly the hospital don't feel it at all.

I will say that Medicare pays a lot more than $60k/yr for residency spots. If you include the unallocated money given, its closer to $160k/yr per resident to support the infrastructure. For some bigger institutions, they already exceed their cap, so they get a bit less.

Completely closing a program is very different than firing one resident. You're absolutely right that a program completely closing will spend much more paying midlevels and new-hires to replace the work of their residents.

I'm saying all this not to imply that it's very common for programs to drop residents, but simply that it's not particularly rare either. Your experience will vary highly depending on your specific program, not even just your hospital/university.

The best advice I can give to everyone is to try and get along with everyone, don't lie, do your work, communicate with those around you, and adjust to the culture of your program or team as much as possible.

 

[alprazoslam]

OP isn’t a med student yet and posted how to pass step before med school elsewhere

 

[alprazoslam]

My internship PD shared a story about one IM resident who started doing a bedside debrident of a 1 day post-op thoracotomy patient (of the thoracotomy incision). The CT surgeon fortunately walked in and physically pulled the resident away.

So show up on time, don’t lie, don’t be incompetent, and don’t do bedside surgery when you’re not a surgeon.

Not even one coronary ?

 

[alprazoslam]

One thing to note is residents do get a lot more leeway than the average working person. The hospital system and the residency program have a vested interest in keeping a resident by putting them through remediation to hopefully fix them up. A resident is free labor and, in most cases, a source of Medicare money. Firing a resident doesn't look good on a program either.

Most residents get fired because of severe behavioral and professionalism issues. From my experience, I have more than a handful of stories about residents who did things at work that would have gotten them fired from any other normal job.

IMO, residents get too much leeway, and this leeway permits the graduation of attendings who should not be taking care of patients in the first place.

Only things with more leeway are MIDLEVELS

 

[Mass Effect]

It's difficult to fire a resident and when it happens, it's almost always deserved. Sometimes, the ones who get terminated could have been remediated while in other cases, a resident who, to everyone who's seen the person in action, should be terminated, doesn't get terminated because again, it's difficult to fire a resident.

 

[BigPikachu]

Triad of workability and professionalism:

1) Intelligent, competent and safe practitioner of medicine; not an idiotic quack
2) Good personality; confident, likeable, humbled; not a pissy arrogant dickhead
3) Good work ethic; sees patients, makes contributions, turns-up on time; not a lazy slacker who always calls in sick and doesn't do any work

Generally if you have at least TWO of the above three characteristics, most people have no issues working with you or keeping you on staff. This is not just in healthcare, but I would imagine in any field of work.

I can put-up with someone who is still junior and naive, but has a good personality and works hard and is prepared to learn and receive feedback.
I cannot stand working with someone who thinks they're a hot shot genius, but is an arrogant asshat which doesn't see any paitents or do any work.

If you don't want to be fired: Work hard but don't burnout, take intiatives but know your limits, be confident but not arrogant, listen to your seniors and help your juniors, properly care for your patients and don't get sued.

That's my two cents.

 

[alprazoslam]

Triad of workability and professionalism:

1) Intelligent, competent and safe practitioner of medicine; not a idiotic quack
2) Good personality; confident, likeable, humbled; not a pissy arrogant dickhead
3) Good work ethic; sees patients, makes contributions, turns-up on time; not a lazy slacker who always calls in sick and doesn't do any work

Generally if you have at least TWO of the above three characteristics, most people have no issues working with you or keeping you on staff. This is not just in healthcare, but I would imagine in any field of work.

I can put-up with someone who is still junior and naive, but has a good personality and works hard and is prepared to learn and receive feedback.
I cannot stand working with someone who thinks they're a geniuss, but is an arrogant asshat which doesn't do any work and is too oblivious to realise it.

The feel as they are genius people are the worst. Lol I feel dumb every time I open the most brief text on xyz IM subspecialty for fourth year electives

 

[Oedipa Maas]

The feel as they are genius people are the worst. Lol I feel dumb every time I open the most brief text on xyz IM subspecialty for fourth year electives

One of my attendings described a surgical resident as “always sure, sometimes right, often wrong”. It was chilling.