Serious: Psychiatry Residency Programs to Steer Clear Of

[pbdoctor1]

I've also seen PD's try to strong arm their residents by threatening random UDS tests, although nobody seemed like they were obviously impaired at work. Such a blanket threat is likely more of a strong arm tactic to keep resident's, because if there truly was suspicion the PD could always test that individual resident without threatening everyone..

There are a few malignant residencies that force residents to ignore problems in their environments and not allow residents a choice to leave. This has been shown in other SDN threads through passive aggressive tactics to endlessly document anything like this from the PD or program faculty. Seems like a recipe for future physician burnout or worse suicide. I don't doubt that some of these places already have difficulty recruiting candidates and don't want to lose funding. Allowing residents to leave these programs could likely expose their bad behaviors and expose them.

There's a need to replace malignant PD and faculty leadership since they create these hostile work environments. However there is a reluctance in real oversight or transparency even among accreditation orgs or national residency education program leadership to root out these behaviors. It makes good residencies look bad and corrupt. The simplest alternative would be to genuinely support and accommodate residents by genuinely promoting and not just discussing wellness and leadership. That requires quality program directors and faculty and real self regulation.

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[MedMan80]

There are a few malignant residencies that force residents to ignore problems in their procedures and not allow residents to choose to leave that has been shown in other SDN threads through passive aggressive tactics like this from the PD or program faculty. Seems like a recipe for future physician burnout or worse suicide. I don't doubt that some of these places already have difficulty recruiting candidates and don't want to lose funding and allow residents to leave said program that will possibly expose their behaviors and look bad.

Seems like there's a need to replace malignant PD and faculty leadership since they create these hostile work environments. There is a reluctance in real oversight or transparency even among accrediation orgs or lack of national residency education program leadership to root out this behavior even though it makes the rest of good residencies in medicine look bad. The simplest alternative would be to genuinely support and accomodate residents especially with regards to wellness and facilitate leadership but that requires quality program directors and faculty and actual self regulation.

Thing is that most problems don't have a problem recruiting and operate within ACGME guidelines..so all is dandy except for resident wellbeing..

 

[Amygdarya]

Speaking of not allowing residents to choose to leave. When you hear that a resident left a program, make sure you find out the reason. A program that is supporting their resident in transferring to a different program because of resident's personal/family circumstances is far from malignant. (Case in point: my super supportive program administration has been very understanding and helpful with one of my coresident's transfer for family reasons. But I'm sure there'll be people jumping to conclusions and seeing it as a red flag.)

 

[pbdoctor1]

Speaking of not allowing residents to choose to leave. When you hear that a resident left a program, make sure you find out the reason. A program that is supporting their resident in transferring to a different program because of resident's personal/family circumstances is far from malignant. (Case in point: my super supportive program administration has been very understanding and helpful with one of my coresident's transfer for family reasons. But I'm sure there'll be people jumping to conclusions and seeing it as a red flag.)

You make a good point and this is ideally how programs should behave by supporting residents and acting within normal reason so that a resident can progress. Malignant programs are not normal and also lack transparency and accountability and don't do this.

Dealing with residents and people can be challenging at times but there should be an opportunity for both residents and residencies to move to programs that are a better fit and have better flexibility to do better. This is done quite often by residencies by simply not renewing a candidates contract and allowing residents an option to leave and proceed onto another program gracefully. However for malignant programs this is not what happens. There is a one sided approach by a few programs to indiscriminately gather enough "concerns" and blackball a candidate between each other from all programs based on gossip. Ultimately they can end a residents careers easily or worse use it to forcibly retain candidates at their subjective discretion based on politics or disliking them personally for any reason. It relates back to the lack of resident autonomy and too much control. This is cruel and corrupt and a contributor to physician burnout and suicide.

Real oversight and transparency on residency problems for new medical school applicants will one day be able to prevent career ending decisions or be forced to stick with abusive programs. Some threads mention that this stagnation is from a power indiscretion that favors residency programs and prevents accountability from residency directors to self regulate. This is why there are so many stories of outrageous malignant behaviors. Trainees sharing their stories helps clear this fog of disturbing authoritarian behavior.

 

[futuredo32]

There is no program to truly steer clear of in my opinion. It is better to match somewhere than nowhere at all.

I SO disagree. I went through hell transferring to what I thought was a good program. It was HELL. I didn't feel like a graduate, I felt like a survivor.

 

[Merely]

I SO disagree. I went through hell transferring to what I thought was a good program. It was HELL. I didn't feel like a graduate, I felt like a survivor.

Can you tell us what program was hell so that other students don’t fall in their trap and suffer like you did

 

[tellme_areyoufree]

Can you tell us what program was hell so that other students don’t fall in their trap and suffer like you did

Personally speaking, if people asked about my program (like in threads I've seen about Rush and U Hawaii before), I would respond openly and honestly. Granted, I've only got good things to say about my program. If I had bad things to say about my program, I might find it harder to talk about, and certainly harder to just offer up a name. Besides, my good or bad experience might not be good or bad for you... I love my program (couldn't be happier), but I know one upper level resident who hates it.

Just throwing it out there. If you actually have a question about a program, it might be a good idea to ask it. You'll get more and better information, I think, than if you ask people to volunteer their program's name for a good vs bad list.

 

[futuredo32]

Can you tell us what program was hell so that other students don’t fall in their trap and suffer like you did

Pm me, it's in Michigan, I wouldn't feel right posting but I will tell you in a pm. I did a TRI and I don't know if all TRIs are like this but it was the intern and the attending for IM rotations, no senior resident. Interns ran rapid responses. THAT was intense but not malignant.

 

[pbdoctor1]

Personally speaking, if people asked about my program (like in threads I've seen about Rush and U Hawaii before), I would respond openly and honestly. Granted, I've only got good things to say about my program. If I had bad things to say about my program, I might find it harder to talk about, and certainly harder to just offer up a name. Besides, my good or bad experience might not be good or bad for you... I love my program (couldn't be happier), but I know one upper level resident who hates it.

Just throwing it out there. If you actually have a question about a program, it might be a good idea to ask it. You'll get more and better information, I think, than if you ask people to volunteer their program's name for a good vs bad list.

You make a good point that the experience varies with each resident and both good and bad information is helpful for a medical school applicant to make their best informed deicision. Any insight about a bad programs poor education or worse abusive behaviors is better than none for a candidate so they don't end up learning nothing or worse getting fired or blackballed. It's just not worth the gamble.

Sticking to the focus of the OPs original question about malignant residencies, if no one openly discusses malignant behaviors in these programs in this anonymous forum then it's really difficult for a medical school applicant to even know who to ask to make an informed decision. It has been mentioned in this forum that there is a code of silence in medicine for tolerating unprofessional behaviors of attendings and program directors which hopefully SDN members can change by sharing their experiences (both good and bad) in this anonymous forum.

 

[splik]

the term "malignant" is way overused these days. it is very unusual for programs in psychiatry to be toxic. Those that are, people don't match into by choice, but because they have no other choice. So it is highly unlikely that someone would match into a "malignant" program by choice. That's just not a thing. What is much more common is toxic people. There could be a few bad attendings who sour your whole experience. Just as likely you could have some seriously disturbed co-residents who ruin your life. This kind of stuff happens more often. And it is much, much harder to predict because it is based on individual difference. The toxic people may only be toxic to you. My program was not "malignant" in the slightest, but I can tell you I was bullied and victimized by one or two attendings. It took me quite some time after finishing residency where I could even think about my experience without feeling very angry or upset. Other residents did not have the same experience as me, but some other people may have had other very upsetting experiences. This is the kind of thing that happens in the world of work. The hard thing about being a resident, is it of course much harder to escape an aversive situation, and the wrong move could ruin your career. But many of these things are unpredictable.

One thing, imo, that does make a difference is having a more seasoned program director. Younger residency directors tend not to have the cache or the same respect of the faculty (no matter how good they may be) to make changes happen or deal with rogue attendings. this is assuming the seasoned program director isn't a tyrant of course.

also this is not an anonymous forum. I can easily identify most of the regular posters on here with google and people can identify me. If you are posting grievances about a particular program, it does make it more likely that you can be identified. I think people are right to be cautious about what they write on a public forum, and some of this stuff might be better discussed privately.

 

[OldPsychDoc]

One thing, imo, that does make a difference is having a more seasoned program director. Younger residency directors tend not to have the cache or the same respect of the faculty (no matter how good they may be) to make changes happen or deal with rogue attendings. this is assuming the seasoned program director isn't a tyrant of course.

One thing I have enjoyed the most about being a PD is having gotten to know my fellow PDs. It is not typically a position favored by the power-hungry or malignantly narcissistic. Frankly, there isn't that much power (or money!) to be had. No one is trying to become a celebrity in this business. There may be a handful who govern from a sense of insecurity, and thereby don't deal with conflicts constructively--but most of us are choosing to do this because we believe in what we are doing and care about the welfare and careers of our residents, and in doing so need to balance the conflicting demands of residents, administrations, faculty, ACGME requirements, ABPN requirements, nursing complaints, patient advocates... It generally feels like the ultimate in middle management. None of us love toxic people, whether colleagues or residents, and most of us are doing our utmost to protect the educational culture of the programs we've been entrusted with.

 

[Crayola227]

I've come around to thinking a lot of it is a national systems issues both with the funding of healthcare itself, as well as the way residency training is structured and funded

it would be awesome actually if it were really the result of a few evil PDs, but in reality much of the resident harms wouldn't be addressed by changing the players. Gotta change the game.

 

[pbdoctor1]

the term "malignant" is way overused these days. it is very unusual for programs in psychiatry to be toxic. Those that are, people don't match into by choice, but because they have no other choice. So it is highly unlikely that someone would match into a "malignant" program by choice. That's just not a thing. What is much more common is toxic people. There could be a few bad attendings who sour your whole experience. Just as likely you could have some seriously disturbed co-residents who ruin your life. This kind of stuff happens more often. And it is much, much harder to predict because it is based on individual difference. The toxic people may only be toxic to you. My program was not "malignant" in the slightest, but I can tell you I was bullied and victimized by one or two attendings. It took me quite some time after finishing residency where I could even think about my experience without feeling very angry or upset. Other residents did not have the same experience as me, but some other people may have had other very upsetting experiences. This is the kind of thing that happens in the world of work. The hard thing about being a resident, is it of course much harder to escape an aversive situation, and the wrong move could ruin your career. But many of these things are unpredictable.

One thing, imo, that does make a difference is having a more seasoned program director. Younger residency directors tend not to have the cache or the same respect of the faculty (no matter how good they may be) to make changes happen or deal with rogue attendings. this is assuming the seasoned program director isn't a tyrant of course.

also this is not an anonymous forum. I can easily identify most of the regular posters on here with google and people can identify me. If you are posting grievances about a particular program, it does make it more likely that you can be identified. I think people are right to be cautious about what they write on a public forum, and some of this stuff might be better discussed privately.

I'm sorry to hear splik and many other suffering memories of abuse during residency in silence. There's simply too many stories of bullying, threats, intimidation and abhorrent toxic behavior by PDs and attendings on SDN and other residency forums. This means it is more common that it is rare. Burnout and suicide may be due to these toxic behaviors. It is only unpredictable if no one calls out the truth of harassment or if there is no justice. Patterns of abusive behaviors perpetuate if no one knows or willing to stop it.

It mirrors the history of racism and sexual harassment which was previously unacknowledged, silenced, and ignored as if they didn't exist from colleagues or bosses. Today these toxic behaviors are vehemently rejected in the workplace as abnormal and illegal and taken seriously in normal work conditions.

The sheer lack of recourse, retaliation, blacklisting, and ruining a career in residency should be given more gravity since it is not the same as work. Residency as mentioned by OldPsychDoc is a privileged position to teach future physicians and should be protected from toxic behaviors by abnormal or incompetent program directors, colleagues and residents. Residency is not employment which is why allowing abusive behaviors with impunity is a problem.

Crayola227 more power to you!

 

[MacDonaldTriad]

Employers are not allowed to abuse power or be racists and harass, but residency is a form of employment and not an extension of medical school. I believe that not getting this is the source of some of this miss match in expectations.

 

[pbdoctor1]

Employers are not allowed to abuse power or be racists and harass, but residency is a form of employment and not an extension of medical school. I believe that not getting this is the source of some of this miss match in expectations.

This is precisely the point that it is not like employment. In a regular employment you can complain about harassment, file a complaint, and still have career intact or can quit and switch jobs.

With residency if you do this you'll be labeled a trouble maker, be "under the radar", and be blackballed should you leave because you'll need your PDs letter of recommendation to "allow" you to leave.

 

[MedMan80]

This is precisely the point that it is not like employment. In a regular employment you can complain about harassment, file a complaint, and still have career intact or can quit and switch jobs.

With residency most likely you'll be labeled a trouble maker "under the radar" and be blackballed should you leave because you'll need your PDs letter of recommendation to "allow" you to leave.

More importantly so if programs are afraid about losing attending's/sites, they are much more likely to listen to complaints from faculty rather than residents. It's much easier to label/get rid of a resident than it is an attending, these days programs are getting hundreds of applications per spot and there is a load of residents wanting to get into psych out of the match. Add to this many PD's would rather maintain their relationship with specific sites and their attending's, why jeopardize this when the resident will be gone in a few years anyways? All of this is a toxic situation and leads to abuse, i absolutely agree that the system needs to change. I implore residents who's application gives them more of a choice of programs to look at the culture at the program, make sure that the program is well funded and not beholden to get funding from different sites where the resident can be floated too. Really ask these questions (indirectly) during the interview/dinner process!!

 

[Leestudent99]

UVA psych had 3 residents leave/dismissed and 1 attending put on probation in the past 2 years.

 

[Mass Effect]

UVA psych had 3 residents leave/dismissed and 1 attending put on probation in the past 2 years.

I wonder what an attending had to do to be placed on probation.

 

[Mad Jack]

I interviewed at Duke and ranked them highly. Clinical hours may be on the higher side, but their teaching and technology they use are fantastic. Faculty were very personable. Certainly not a program that I would avoid.

I know a guy that trained there who was less than fond of the program and discouraged me from applying, said it was too much misery for the name and I was better to look elsewhere

 

[Mad Jack]

Current Duke resident here. It's surprising (and unfortunate) how some of the common misconceptions about the program from when I was applying are still circulating --- Duke has definitely been a front-loaded program historically and I wouldn't call the first 2 years easy by any means, but I'm not aware of anyone that has left the program since I've been here for anything other than personal reasons (i.e. spouse finds job on west coast, program supports resident in transitioning to another program). That said, I don't think the first two years are significantly more difficult than your average psych program and in the last ~5 years or so, the residents and PD have driven a ton of change to promote wellness...you can probably find the exact call schedule/hours/etc on another thread but it typically averages to ~40-50% of weekends off the first 2 years and then >90% of weekends off as an upper level. I averaged around 50 hrs/week my first 2 years (now it's more like 30-40). Definitely wouldn't describe the program as "unsupportive" - in fact I'd argue the opposite as we have a PD who is a proponent for resident wellness and is constantly looking for mechanisms to improve the resident experience.

Happy to answer more specific questions, but I'd definitely come back if I had to choose again

Sounds like they've changed a good deal

 

[clausewitz2]

I wonder what an attending had to do to be placed on probation.

Hit someone, came to work drunk/high or had a pattern of harassment so severe they couldn't look the other way.

 

[whackamole21]

UVA psych had 3 residents leave/dismissed and 1 attending put on probation in the past 2 years.

Interviewing there later this season...any more information on what happened?!

 

[pbdoctor1]

More importantly so if programs are afraid about losing attending's/sites, they are much more likely to listen to complaints from faculty rather than residents. It's much easier to label/get rid of a resident than it is an attending, these days programs are getting hundreds of applications per spot and there is a load of residents wanting to get into psych out of the match. Add to this many PD's would rather maintain their relationship with specific sites and their attending's, why jeopardize this when the resident will be gone in a few years anyways? All of this is a toxic situation and leads to abuse, i absolutely agree that the system needs to change. I implore residents who's application gives them more of a choice of programs to look at the culture at the program, make sure that the program is well funded and not beholden to get funding from different sites where the resident can be floated too. Really ask these questions (indirectly) during the interview/dinner process!!

Being "trapped" seems to be an awful situation!

Absurd that this is happening and is unacceptable. Be weary future applicants and be smart in your decisions! You may think that having any residency program is better than none until you read stories of multiple residents that have quit, banned/blacklisted, or worse fired permanently from these places. Find a place with a program director that is genuine, supportive, empathetic, and values you and your wellness.

SDN members are standing up, speaking up, and supporting a better future for trainees! The existing leaders have yet to do so.

We can change and end this toxic culture of silence and learned helplessness from abusive people. Let's create a new norm and a better reality for future docs.

 

[Crayola227]

Employers are not allowed to abuse power or be racists and harass, but residency is a form of employment and not an extension of medical school. I believe that not getting this is the source of some of this miss match in expectations.

Actually, re: the Match and residency, a lot of the things that make residency different than regular employment and allows a lot of things that would otherwise be illegal for other employers, stems from the fact that residency is considered legally considered a special category of training and not a full-fledged employment scenario with all of its legal protections.

Legally speaking, residency is neither school nor a job. It's in a middle ground that strips privileges and protections one would legally have in either school or a job.

This is essentially verbatim from an attorney that specializes in ADA and employment law, that was handling a resident's case, said to my face. Take that for what anyone will. It's worth noting that with research on this topic this attorney was able to achieve a positive result in the case they were handling, so I'll take that as a sign they were not too far off the mark in their work.

 

[splik]

Legally speaking, residency is neither school nor a job. It's in a middle ground that strips privileges and protections one would legally have in either school or a job.

This will be state dependent. When I was a resident, the hospital tried to stop us from unionizing by arguing we were not employees and thus did not have the right to collectively bargain. We essentially took them to court. They ruled in our favor finding that resident physicians are employees and entitled to all the rights afforded to employees included the right to collectively bargain. although resident physicians are in very precarious state because if they dont finish their training, there options to practice medicine are severely limited, they actually have it a lot better than many employees because of the limited protections employees enjoy in the US.

 

[Mass Effect]

This will be state dependent. When I was a resident, the hospital tried to stop us from unionizing by arguing we were not employees and thus did not have the right to collectively bargain. We essentially took them to court. They ruled in our favor finding that resident physicians are employees and entitled to all the rights afforded to employees included the right to collectively bargain. although resident physicians are in very precarious state because if they dont finish their training, there options to practice medicine are severely limited, they actually have it a lot better than many employees because of the limited protections employees enjoy in the US.

This. It's been said other places as well. Also, residents also have protection under Title IX. A resident who is abused or mistreated/harassed by PD or by attendings/chiefs/colleagues can take his/her complaints to the EEOE or diversity office at the hospital or affiliated medical school, depending on which employs said resident. He/she can also seek help in the community under EEOE.

 

[MedMan80]

This. It's been said other places as well. Also, residents also have protection under Title IX. A resident who is abused or mistreated/harassed by PD or by attendings/chiefs/colleagues can take his/her complaints to the EEOE or diversity office at the hospital or affiliated medical school, depending on which employs said resident. He/she can also seek help in the community under EEOE.

I think the problem comes in that we are indentured servants essentially, until we get enough hours needed for licensing/boards. So 'sub-threshold' harassment is usually tolerated under the guise of "surviving" obviously any outright harassment can be noticed by EEOE and higher powers, lower level harassment is usually tolerated lest we "make waves"..this is especially true for IMG's who have had to accept little recourse all the way since clinicals..

 

[Mass Effect]

I think the problem comes in that we are indentured servants essentially, until we get enough hours needed for licensing/boards. So 'sub-threshold' harassment is usually tolerated under the guise of "surviving" obviously any outright harassment can be noticed by EEOE and higher powers, lower level harassment is usually tolerated lest we "make waves"..this is especially true for IMG's who have had to accept little recourse all the way since clinicals..

But isn't the point made in this thread that no harassment should be tolerated? And if that's the case, it's important to know there are resources out there that can help.

 

[clausewitz2]

But isn't the point made in this thread that no harassment should be tolerated? And if that's the case, it's important to know there are resources out there that can help.

As someone who for a time worked for a law firm specializing in representing federal employees in EEOC complaints, while obvious retaliation for filing a complaint is definitely a no-no and will land the employer in serious hot water, if management wants to get back at you they certainly can get away with it if they are reasonably creative. It is true that a potential and not infrequent remedy is reinstatement, however, so if you are terminated at some point for discriminatory reasons or being threatened with this it is probably a good move. One thing that you should do if you think you need to go down this road is get whatever data you can on people who have been subject to similar sanctions/punishments - demonstrating disparate impact (i.e. some protected class is impacted more than everyone else) is one way to try and show discrimination in the absence of very obvious prejudicial statements.

Remember, protected classes are race, color, biological sex, religion, ethnic/national origin, age (if over 40), disability and genetic information.

EEOC applies to many places outside of academia, really at most large employers. So don't think that just because Title IX doesn't apply to your work setting that you are hosed on this.

 

[clausewitz2]

Not just biological sex- the EEOC interprets sex under Title VII to include transgender individuals and also discrimination for sexual orientation. this puts them at odds with the justice department which under the trump administration no longer recognizes protection for transgender individuals.

Good to know, my direct experience was roughly a decade ago so before the point at which they arrived at that interpretation.

 

[GloryVA]

UVA psych had 3 residents leave/dismissed and 1 attending put on probation in the past 2 years.

Just ditto-ing whackamole21. @Leestudent99 , I'll be interviewing there later in the season too. Can you fill us in on what went down? I tried googling for info but came up short.

 

[Crayola227]

The Match is specifically where rules about residency fall outside of what applies to other types of employment. This attorney that specialized in employment law found the system totally bizarre. And it is. I think there is only one other industry where employment is handled similarly and exempted from typical anti-trust laws.

Yes there are Federal laws that govern residency programs' conduct towards trainees. But not all of them. And as stated, some of the ones that do apply, programs have ways of circumventing because of the way the residency job market is governed.

 

[kopftonmd]

The Match is specifically where rules about residency fall outside of what applies to other types of employment. This attorney that specialized in employment law found the system totally bizarre. And it is. I think there is only one other industry where employment is handled similarly and exempted from typical anti-trust laws...

But what's the other industry?

 

[MacDonaldTriad]

The Army? Maybe the NFL? NASA astronaut?

 

[Crayola227]

I think the other industry had something to do with long distance trucking, but I could be very very wrong.

 

[pbdoctor1]

The Match is specifically where rules about residency fall outside of what applies to other types of employment. This attorney that specialized in employment law found the system totally bizarre. And it is. I think there is only one other industry where employment is handled similarly and exempted from typical anti-trust laws.

Yes there are Federal laws that govern residency programs' conduct towards trainees. But not all of them. And as stated, some of the ones that do apply, programs have ways of circumventing because of the way the residency job market is governed.

Sounds like it's ripe for exploitation or willful apathy. No wonder these attending and program directors harass so readily. They know they can operate with impunity if they are cunning. If true, it only encourages abusive behaviors since collective silence and obedience is trained in medicine. Does "special employment" lead to the inability to remove toxic leaders or it is because collectively not knowing the "degree of harassment" normalizes it and leads to inaction and denial of its prevalence?..............

SDN members passionately discuss rampant veiled narcissism, sexism, racism, and other transferences of harassment to come out when there is limited oversight or if no one knows. If it is true, can collective knowledge with SDN discussions be a way to help remove these PD and attendings from teaching? (since they are doing more harm by creating burnout and needless internalization for physicians)

Best of luck friends!

 

[Amygdarya]

Just to keep this thread fair, most psychiatry residencies are non-malignant and, in fact, supportive of their trainees. Applicants should keep their eyes and ears open of course but I think this thread is negatively skewed.

 

[ryerica22]

One thing I have enjoyed the most about being a PD is having gotten to know my fellow PDs. It is not typically a position favored by the power-hungry or malignantly narcissistic. Frankly, there isn't that much power (or money!) to be had. No one is trying to become a celebrity in this business. There may be a handful who govern from a sense of insecurity, and thereby don't deal with conflicts constructively--but most of us are choosing to do this because we believe in what we are doing and care about the welfare and careers of our residents, and in doing so need to balance the conflicting demands of residents, administrations, faculty, ACGME requirements, ABPN requirements, nursing complaints, patient advocates... It generally feels like the ultimate in middle management. None of us love toxic people, whether colleagues or residents, and most of us are doing our utmost to protect the educational culture of the programs we've been entrusted with.

Couldn't agree more! I appreciate everything my PD does. I honestly could never imagine doing what he does everyday. I'm very appreciative.

 

[pbdoctor1]

Just to keep this thread fair, most psychiatry residencies are non-malignant and, in fact, supportive of their trainees. Applicants should keep their eyes and ears open of course but I think this thread is negatively skewed.

Good point but OP is talking about places to avoid so naturally it may appear negative. It can serve as a healthy balance for us to collectively care and learn but also provide insight and reason if everyone engages with any positive or negative information.

There are many good programs but there is value in having an open dialogue to help applicants, even if it "feels" uncomfortable or taboo but rational. Harassment is difficult to face but it exists with obscurity. Discussions help improve knowledge, rational thought, create progress, and reduce the culture of silence. Internalization has led to increasing numbers of burnout and suicides by doctors and may also suggest more widespread harassment. How can we learn about a problem and fix it if there is not an honest discussion?

No one is denigrating the challenges of good programs directors and faculty and hopefully talking doesn't trigger a misplaced defense mechanism. Contrary, everyone hopes good programs become universal but hope we care enough about the malignant and incompetent behaviors of colleagues and more importantly correct for it collectively. Dealing with people is never easy because we are all individuals and not replaced with mindless robots (yet).

The question is why the call to action to fix these issues falls mainly on reigning in "problem residents" but almost none given towards the same toxic or incompetent colleagues and faculty, especially given the gravity of their role? Is it a reflection of the group culture that it's easier to minimize this issue since residency reinforces and self selects agreeing and obedient behaviors? And is an acceptable consequence that physicians are not trained enough on how to freely think and stand up proactively but rather learn to accept failures (personally and systemically) and internalize it despite changes in healthcare and pervasive burnout? I'm not sure. res ipsa loquitur

Most are good programs and collectively we can help all to be!

 

[ryerica22]

I want to add, that any program will give you good training and make you an excellent Psychiatrist if you have the right attitude.

 

[NickNaylor]

One thing I've learned as a chief and hearing many complaints from residents is that reports of "malignancy" and "toxicity" are almost always off base. Situations in which there is a clear wrong or harm done are very rare. Many of the complaints are simply misguided interpretations of situations or perceptions of being wronged that, in many cases, are inaccurate to varying degrees. That's not to say that these complaints don't warrant a response or investigation, but often the situation as reported by a resident or the perceived wrongs described by a resident are only one part of the overall story.

I say this just to say that it can be very challenging to determine if a residency is "malignant" or not without actually experiencing it for yourself and getting all of the necessary information to make a judgment, which is often impossible. Reports of "malignancy" or "toxicity" are rarely straightforward. It's one thing to hear consistently about a program or from numerous people that a program is toxic. It's hard to dismiss a clear trend from multiple sources of information. On the other hand, single reports of a "toxic" training environment should be viewed with some degree of skepticism - not dismissed outright because there is likely some meaningful basis for a reported concern, but simply placed in the context of one person's perspective out of many. Interestingly, in my experience it is often the most vocal residents that voice the most complaints about their training experience who tend to be the residents with the most concerns about legitimate professionalism issues or weak clinical skills. Again, this doesn't invalidate the complaints. Often the feedback they provide is helpful and worth some kind of intervention. But these individuals tend to represent a very vocal but small minority that doesn't reflect the general impression of residents.

tl;dr: It is very hard to get an accurate impression of whether a program is "malignant" or "toxic" as an outsider and without enough information - information that is often inaccessible to you as an outsider. Rumors and general impressions can be helpful to some degree, but I would be cautious about accepting them as gospel.

 

[Mass Effect]

Just to keep this thread fair, most psychiatry residencies are non-malignant and, in fact, supportive of their trainees. Applicants should keep their eyes and ears open of course but I think this thread is negatively skewed.

This is so true. "Problem residents" do exist and they are often terrors who then complain about unfairness when they get called on their problematic behavior.

One thing I've learned as a chief and hearing many complaints from residents is that reports of "malignancy" and "toxicity" are almost always off base

This is true too. And as chief, you're vilified if you try to bring this perspective to some of these residents.

 

[pbdoctor1]

This is so true. "Problem residents" do exist and they are often terrors who then complain about unfairness when they get called on their problematic behavior.

We agree that toxic residents exist and yes they can be fired or removed. I think the discussion is focused on toxic program directors and attendings that also exist but not known and they are very hard to fire or replace. It may be a widespread this problem if they suppress by threatening retaliation of vocal residents given our unspoken code of silence. We are talking about helping candidates know about residencies that have abuse or an environment that can lead to burnout.

Let's give credit that candidates are adults and smart enough to make their own decisions rationally. We all understand the spectrum of behaviors exists both among residents and program faculty. The consequences however are fairly substantial and different for malignant program directors and attending vs residents.

 

[Mass Effect]

We are talking about helping candidates know about residencies that have abuse or an environment that can lead to burnout.

Except that no one has named any with the exception of something vague about UVA, so I'm not seeing how it's being helpful to candidates. I'm also not sure it would be helpful if programs were named. Have you seen some of the court documents related to some of the very stories posted here on SDN? The posts on SDN would have you believe these residents were the target of a conspiracy and when you read the court documents, it turns out it was anything but. So I'm not sure how good it does. But if you are trying to help candidates, then maybe some of the people posting should name specific programs or at least states that these programs are in. Otherwise, how would anyone be helped by these posts?

 

[pbdoctor1]

Except that no one has named any with the exception of something vague about UVA, so I'm not seeing how it's being helpful to candidates. I'm also not sure it would be helpful if programs were named. Have you seen some of the court documents related to some of the very stories posted here on SDN? The posts on SDN would have you believe these residents were the target of a conspiracy and when you read the court documents, it turns out it was anything but. So I'm not sure how good it does. But if you are trying to help candidates, then maybe some of the people posting should name specific programs or at least states that these programs are in. Otherwise, how would anyone be helped by these posts?

True but that is up to people to feel safe and empowered enough to do that.

Dissuading or denying it as a problem seems counterintuitive to having an open discussion especially when we know burnout and suicides are occurring.

 

[deleted736562]

I think the problems that people are talking about are structural and spread out across residency programs. The fact that the reassurance seems to go back to the character of the PDs is the problem itself; there's a very large imbalance of power and the safety net very small.

True if you're not a "problem resident" (that term is awful btw) you'll get along just fine, but that does not diminish the actual issues.

Frankly discerning medical students would have figured it out by now. it's not like medical student culture is that much better.

I find that much like a lot of issues, Americans live in their own bubble and this also applies to residency. The system is internalized and people think this must be the norm because it just is. My eyes were opened when I spent a year in Europe and saw the very different approach to clinical training there.

 

[pbdoctor1]

I think the problems that people are talking about are structural and spread out across residency programs. The fact that the reassurance seems to go back to the character of the PDs is the problem itself; there's a very large imbalance of power and the safety net very small.

True if you're not a "problem resident" (that term is awful btw) you'll get along just fine, but that does not diminish the actual issues.

Frankly discerning medical students would have figured it out by now. it's not like medical student culture is that much better.

I find that much like a lot of issues, Americans live in their own bubble and this also applies to residency. The system is internalized and people think this must be the norm because it just is. My eyes were opened when I spent a year in Europe and saw the very different approach to clinical training there.

Very well put and questions current ethical values. A program director's character is important since they set the culture and most are good but some are very bad. This concept of "problem resident" can broadly apply to anyone in any program and be misused vs a "problem program director" which is too uncomfortable to suggest. Let's not magically pretend that narcissism and schadenfreude doesn't exist among our colleagues simply because of experiential blindness or worse willful denial to maintain a bubble of self interest.

It has been previously questioned if enough or any malignant "problem program" exists to warrant a discussion or concern. A review of past SDN threads actually show a few examples and that problems persist and are quite troubling:

East Tennessee State University is the only psychiatry residency on probation in the country according to ACGME. Discussions on SDN state that ETSU psychiatry had a pattern of issues with ACGME accreditation in the past even losing a program director. It looks like the current program director put the program back on probation with ACGME, which is a concerning sign. (ACGME is hesitant to follow up on repeated complaints by multiple residents or patterns of extreme behaviors to warrant an investigation, let alone actual probation)

LSU Shreveport psychiatry was also mentioned earlier in this thread and a quick search shows a history of problems of harassment and abuse that still persist. Multiple residents and graduates of the program discussed threats, retaliation, disorganization, manipulation and general hostility towards residents. Strangely they aren't on probation with ACGME but they mentioned a continued culture of fear and toxic behaviors set by the same program director and attendings.

When multiple residents warn about a program then its not an individual "problem resident" issue it's a disturbing sign of abuse or incompetency. Does anyone know how long and how much harassment happened in these "problem programs" before there was any accountability? How many residents were fired or on probation by the harmful impact of these programs? And have the program directors or leaders been replaced once exposed? Sure seems like most of the same people stay.

These are questions for applicants to ask, considering it is impossible to change a culture with the same people in charge. Just look how long and how egregious it took for sexual harassment, racial discrimination to have a real response. So many colleagues were defending, denying, or tolerating these behaviors in the past (or continue to) "normalize" it and blame the victims with a false equivalency. It is morally questionable at best or downright misathropic to ignore and be complicit with it at worst.

Good luck everyone. Becoming physician is a long road and supporting each other with integrity is important.

 

[Mass Effect]

Very well put and questions current ethical values. A program director's character is important since they set the culture and most are good but some are very bad. This concept of "problem resident" can broadly apply to anyone in any program and be misused vs a "problem program director" which is too uncomfortable to suggest. Let's not magically pretend that narcissism and schadenfreude doesn't exist among our colleagues simply because of experiential blindness or worse willful denial to maintain a bubble of self interest.

It has been previously questioned if enough or any malignant "problem program" exists to warrant a discussion or concern. A review of past SDN threads actually show a few examples and that problems persist and are quite troubling:

East Tennessee State University is the only psychiatry residency on probation in the country according to ACGME. Discussions on SDN state that ETSU psychiatry had a pattern of issues with ACGME accreditation in the past even losing a program director. It looks like the current program director put the program back on probation with ACGME, which is a concerning sign. (ACGME is hesitant to follow up on repeated complaints by multiple residents or patterns of extreme behaviors to warrant an investigation, let alone actual probation)

LSU Shreveport psychiatry was also mentioned earlier in this thread and a quick search shows a history of problems of harassment and abuse that still persist. Multiple residents and graduates of the program discussed threats, retaliation, disorganization, manipulation and general hostility towards residents. Strangely they aren't on probation with ACGME but they mentioned a continued culture of fear and toxic behaviors set by the same program director and attendings.

When multiple residents warn about a program then its not an individual "problem resident" issue it's a disturbing sign of abuse or incompetency. Does anyone know how long and how much harassment happened in these "problem programs" before there was any accountability? How many residents were fired or on probation by the harmful impact of these programs? And have the program directors or leaders been replaced once exposed? Sure seems like most of the same people stay.

These are questions for applicants to ask, considering it is impossible to change a culture with the same people in charge. Just look how long and how egregious it took for sexual harassment, racial discrimination to have a real response. So many colleagues were defending, denying, or tolerating these behaviors in the past (or continue to) "normalize" it and blame the victims with a false equivalency. It is morally questionable at best or downright misathropic to ignore and be complicit with it at worst.

Good luck everyone. Becoming physician is a long road and supporting each other with integrity is important.

I'm impressed by your passion. This has been a hot topic for me for many years and while I do like to point out the problem resident scenario, I do agree with you that there is a pervasive culture in medicine that has been tolerated and defended for too long. Trainees have been subjected to abuse, certainly, and there is a power differential that allows it. The trick is sifting through the complaints and determining what is and what isn't the result of a corrupt abuse of power on the part of the powers-that-be and, after identifying the programs that truly fall victim to this, what to do about it. Any thoughts? I'm sincerely curious.

 

[MacDonaldTriad]

I think this thread needs a little perspective. I sit in a lot of meetings with a lot of psychiatry training directors. I also go to meetings with training directors from all specialties and hear about their assumptions and feelings about utilizing progressive discipline on trainees when they feel it is appropriate. I understand the power differential and the need for checks and balances. This is a chronic issue that if neglected can decay into bad situations. On the other hand, if there were an accurate and valid way to measure "malignancy", I would be surprised if any other specialty would come out looking better than psychiatry. The vast majority of psychiatry training directors are very well meaning and introspective thoughtful people who would feel terrible if they were proven to have been unfair in how they handled a conflict within their program. I know a lot of chief residents who developed a change of perspective on this as they became middle management. The underlying reason this will never go away completely is that training is very hard. I'm not talking about hours or case loads. The transition from medical student to specialist isn't comfortable.

 

[pbdoctor1]

I think this thread needs a little perspective. I sit in a lot of meetings with a lot of psychiatry training directors. I also go to meetings with training directors from all specialties and hear about their assumptions and feelings about utilizing progressive discipline on trainees when they feel it is appropriate. I understand the power differential and the need for checks and balances. This is a chronic issue that if neglected can decay into bad situations. On the other hand, if there were an accurate and valid way to measure "malignancy", I would be surprised if any other specialty would come out looking better than psychiatry. The vast majority of psychiatry training directors are very well meaning and introspective thoughtful people who would feel terrible if they were proven to have been unfair in how they handled a conflict within their program. I know a lot of chief residents who developed a change of perspective on this as they became middle management. The underlying reason this will never go away completely is that training is very hard. I'm not talking about hours or case loads. The transition from medical student to specialist isn't comfortable.

We know many programs have good training directors with well-meaning intentions within your own programs. This is not talking about them and let's not whitewash or normalize this problem. We can absolutely measure malignant programs just like we can measure toxic residents. It's that we don't do anything about malignant program directors or attendings no matter how toxic it is. Training is hard if no one enforces unprofessional behavior from above and allows toxic environments to persist. Also midlevels and nurses don't have to deal with this level of harassment and toxic behaviors from these same doctors. It's hypocritical to treat our trainees this way as a way to "teach" or normalize a cycle of abuse.

We want everyone to care about the integrity of residency training and ensure we help ALL programs be as just as good. We can start by enforcing honesty, competency, and professionalism with those in charge, not just residents. There needs to be real action, not words of comfort.

Let's lighten things up a bit with some fictional humor. We can go through a hypothetical thought process of an applicant with a satirical response. This is an exaggeration.


1. Are most programs and directors reasonable?

Most likely yes. Some are amazing!

2. So there's no harassment or malignant program directors?

No....but it feels good to know WE don't.

3. But does that stop the abuse in other places?

Um probably not. (yeah nope)

4. How bad is the abuse?

Not that ba…......actually some are really, really, really awful. Shhhhhh! (plugs ears)

5. But what happens to "bad residents"?

Yep they suck. We can get rid of them all the time (no annual contract renewal, blacklist, fired) if they annoy us.

6. Why are there still so many bad residents or malignant people?

We try our best to get rid of as many "bad residents" we don't like. There are some "(toxic) residents" that a program may tolerate. If they have important qualities (acceptable race, gender, obedience, secretly harass, sociopathic or manipulative personality, kiss butt, etc) then it doesn't matter how abusive or incompetent they are, to you. Directors can discriminately chose those "bad residents" they don't like and get rid of them. Programs can also keep toxic residents under their good graces should they choose to. Their job isn't to protect medicine from toxic graduates, its to protect the discretion of the program, grow up!

7. Does that mean some normal residents get in trouble too?

Yeah it happens all the time and it kind of sucks for them. Nothing we (want to) can do about it sadly. It's the "normal" part of the process. Plus, we heard from our colleagues they became "problem residents" so it's ok if they lose their careers. We are mostly FAIR and NICE to our residents, so everything is fine.

8. What kind of trouble happens to normal "problem residents" in those places?

Well some get casually threatened warned and recklessly documented while "under the microscope" (they need to learn respect). Some less-resilient residents burn out and get traumatized or suicidal. Some quit. Some get fired. Some get black listed when we gossip about them. Also, you know other stuff, like an informal psych evaluation, discrete harassment, etc. We don't do that and this is making me feel uncomfortable.

9. Can't they just leave to another program?

Not if you don't have a letter of support from the training director. We have to make sure you're not the problem and they say it's ok, even if they don't allow you to leave!
Have some faith in our fellow PD or attendings, most almost never lie or act unprofessionally to a subordinate.

10. Wait, wait, wait does that mean toxic colleagues and directors get fired too?

Yea.....Maybe? It's hard and complicated ok..........(thinking probably not. actually never)

11. Would you or someone in your program do that (abuse) if I get burned out?

No way. Not in my program! God no. We know some places do that but we're not them.

12. Do these malignant directors ever get in trouble?

Maybe? But only if it's really, really, really bad and someone (not me) does something about it (no one does).
Abuse is too rare for it to be an issue. We don't have enough pinpoint accurate, extremely precise, 100% valid, and definitive data to prove abusive directors exist, like we do for "problem residents".

13. But I see on SDN the same malignant directors and places are still there?

Shhhhhh! Look they had it rough dealing with so many "problem residents", we get it. That's their business, not ours. Plus, we don't do that. Good luck if you match there, it'll be fine! Stay positive and just be "good".

14. But you mingle with them and talk a lot together even knowing this?

Probably. We just chit chat as close colleagues all the time over random things. It's just about our strategies to deal with “problem residents”. We hate hearing rumors (about our toxic colleagues) unless it's about these residents they suggest we should blacklist. We need to protect fellow PDs no matter what. Let's not talk about that ok.

15. Are you really not going to do anything to get rid of those guys?

No. Stop being making things uncomfortable for me. (They are one of us, no matter how toxic or incompetent they are). I'm beginning to feel that residents like you are the problem! (starts documenting).

16. Oh no I'm sorry! What can an applicant do about this, I heard there's a ton of burnout?

NOTHING, just be quiet and stop asking questions. It's a "normal" part of any training program to get used to a million patients and potentially be harassed. Maybe too many residents have "undiagnosed" personality disorders and "preexisting" mental illness need to learn it is hopeless. They need to get treatment by our in-house staff.

17. Do you think any of this is from abuse from program directors or attending?

It's unlikely any of this is related to harassment by our unprofessional colleagues. No one can prove it with 100 percent certainty this is an issue. Program directors and attendings are the real victims.
We're still leaning towards all those incoming undiagnosed mentally ill applicants. We're mostly nice and now there are lectures on wellness to help (minimize our liability from trainee suicides) So all is well, yay!

17. Ok. But what if I get stuck in a dealing with a malignant PD or attending?

Just apply. You're fine, it won't happen to you. Most programs are good! Just go to those places. Stop being so negative and take it as a learning opportunity!

Good luck!!


Res, non verba. (Actions not words)