Residency Program Problems

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A friend of mine is having some problems with his current residency program. He wants to leave the program but the program will not agree. I was wondering if anyone has been in any similiar situation and if so what was the outcome.

beyond all hope

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I had a friend in a similar situation. He was in a bad resideny with a bad program director who used his power unscrupulously to keep residents from leaving. He's found a new program, far better than his one, and he's happy he left.

Most PDs will dislike you leaving, but won't really try to hinder you. Don't expect any help from them, though. Very few PDs are enlightened enough to help you leave their program.

The worst programs tend to want to hold onto their candidates most strongly. Residency programs regularly abuse residents, but they have no power to keep the resident who wants to leave.

Some even use scare tactics and other below-the-belt intimidation in order to hold onto residents. First they say you're disloyal, then they say no other program will touch you, then they try to get you fired. Many tell you that changing residency programs will make it difficult to find a job later. It's just not true: people change residencies all the time now, for good reasons.

Program directors have a lot of power but they're not omnipotent. If the PD or any other attending threatens the resident, the resident can always go to the school's GME office or directly to the ACGME.

Most programs that accept transfers want a letter from the former program director. The PD is REQUIRED by ACGME rules to write a letter of recommendation whenever the resident wants.

Other hints:
1) There will be at least one attending who is willing to help you. Get help from him/her. Ask about what happened to previous residents who tried to leave.

2) Any conversation you have behind closed doors can always be denied by an unscrupulous person. Any conversation that you want to be recorded, you should write them a letter and keep a copy, or email them and CC someone important (The GME office, ACGME, etc).

3) Don't mention ANYTHING to ANYONE in your program you can't absolutely trust until you've found someone else willing to hire you. News travels fast, especially juicy news about someone leaving, and the PD will probably hear about it. When you've found a new spot, ask the old PD for a letter or have the new PD call the old one.

The old PD might badmouth you to the new one, but everyone knows that PDs get mad when residents leave, so a certain amount of that is expected. Just get good letters from other faculty members, and most of it will be ignored.


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I don't know anyone who has been in this position but I would recommend your friend hiring a lawyer. Most programs are contracted year to year and programs are allowed to let you go if they feel you are not performing up to standards (rare but can and does happen). Therefore, by the same logic, a resident cannot be forced to sign a contract if he/she does not want to. The biggest problem with this is that you may become black listed in the medical community meaning it may be hard to get a different residency position. Get a lawyer, most likely one who specializes in labor law, and get some options. My guess is that once a lawyer gets involved the hospital will probably give in but your friend has to finish the time left on their contract...just a thought...


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MY friend just switched from Family Med to Psychiatry. The Old PD actually wrote her a descent LOR. Her biggest problem was not knowing whether to hold out for a better position to open up or to take the ones available to her then. I think that switching is easier if it is done between specialties because the PDs won't take it so personally. (i.e. the resident didn't like the specialty, not the program.) Switching for really serious personal consequences are usually tolerated fairly well. (like death in family, etc.) (Marriage/relationship can be a little rough)

I agree with above posts that keeping your mouth shut until the very last possible moment is the best thing to do. Also, be careful who you choose to trust.

Also, your friend may be able to get help from his/her med school.

Anyways, I wish your friend luck.


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Mar 17, 2004
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Excellent post from beyond all hope. The only things I would add, however are:

1) PDs are not omnipotent, BUT they do have unofficial powers of a great scope. A PD may not actively or officially stop you from leaving, but once you do they can - especially if you left with bad feelings - hinder you in a number of ways.

1a) A PD can prevent you from getting lists of programs who are looking for residents. The GME office at our institution stated that they needed a password from our PD to access those lists and that password was never given out.

1b) A PD will generally know where you are applying to because your resources are often directly or indirectly linked to the residency office. From there, they can just call up the new PD and let them know 'what I think' of you as a resident. (Wink, wink)

1c) A PD may have to write a letter for you (I don't know, but I'll take beyond's word for it), but there's nothing that says that it can't badmouth you up and down the yard. And while people know that will happen, that does not mean they will take it with a grain of salt. A lot of these PDs know each other fairly well and will definitely listen to their buddy before they listen to you or your side of the story.

Your best bet if you are leaving a program is to do so with as little warning as possible and BEFORE you make waves. This may sound skeevy, but trust me the PDs are not above being skeeves and they are not having any compunctions about deep sixing you. (Sorry to generalize - I know there are probably some decent PDs out there, but residencies run a business too, and this is the reality of the business.)

Other than than, read beyond's post. It is right on. You need allies who are attendings that will help you. You need help from independent sources - your med school might be a place to start. You need DOCUMENTATION of ANY interaction or it will be your word against theirs and you WILL lose that battle.

Good luck for your friend. Hope this helps.

P.S. Dreamer: PM me if you want some help. I have experience in this issue and will be happy to discuss this privately.

P.P.S. Beyond: where did you get so knowledgeable about all this? PM me if you care to.


Hi there,
It is very difficult to leave a program if you have a program director who wants to keep you there. A good program director wants happy residents and will pave the way for an unhappy resident to leave if the residency program is not a good fit. In fact, a good program director will assist the resident in finding a good fit program if two things are true: 1. The resident has been a strong hard worker who is doing a good job 2. The resident is not leaving because of disciplinary reasons. Good program directors know that sometimes residents are just not happy with their choice of residency or location. There can be a variety of reasons from just finding out that you hate medicine, surgery etc. or because of marriage, illness etc.

Program directors know each other and will contact the original program for an evaluation. Most of the general "a--h---s" are known by other program directors (word or mouth). Program directors also know which programs are in trouble for whatever reason. If your friend has a poor relationship with their PD, moving is going to be very difficult but not impossible. Your friend should be very honest with any prospective PDs and let them know exactly why they are leaving one program for another. They should let the prospective PD know if the relationship is strained with the previous PD.

As I said above, good PDs do not want to hold onto residents who are truly miserable and will go out of their way to make sure that their residents get what they need. While residency can be somewhat extreme at times, it should not be downright torture.

Good luck to your friend and if all else fails, your friend may have to seek legal advise. Residency is a legal contract and your friend may need to find the another way to break this contract.

njbmd :)