Terminated from IM residency (PGY-2)

[nirvana88]

I am/ was a resident in an IM residency program, recently dismissed for deficiencies of Professionalism and Patient Care. As of now, I am waiting for the appeal committee to evaluate the issue before the decision is final.

To cut a long story short, I had some trouble with a few attendings in January this (intern) year and had been on probation ever since. However my program found no reason to prevent my promotion to second year while keeping my probation status. Although most of the people I worked with liked me thereafter, every now and then, something minor would come up against me. There was no sudden event that triggered this dismissal, rather the recurrent reports of minor events directly to the administration. Most of these events involved delays in putting orders, following up on orders and forgetfulness. Here I would like to mention that I never caused any patient any harm in fact got a letter of appreciation from risk management for preventing patient harm in a case. Academically, I was ranked among the very best in the program for medical knowledge. While I have always agreed that I needed improvement, I never believed I was at a level that warranted dismissal. In fact my score for the Professionalism and Patient Care competencies on New Innovations have always been above average. The most recent reason for my mistakes was the fact that I had been extremely anxious because of the stress of repeated warnings of dismissal. I did ask the program for help and they had me seen by our on-campus psychologist. She diagnosed me with both anxiety and depression and referred me for treatment. However the program did not give me ample time to try to treat it.

When I asked my PD for help, they said "I think you're just cutting corners and exaggerating your mental issues".

When news of my dismissal got out, all attendings that I had worked with were shocked and said they would talk to the appeal committee.

Right now, I have a few questions and would appreciate help from people who have had similar experiences.

1. What are the chances that the appeal committee reverses the decision?

2. Should I pursue litigation?

3. What are the chances of me securing a PGY-2 spot? I am on a J-1 visa.

If nothing else, some words of encouragement might help.

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[chessknt]

You were dismissed mid-year? Someone or something must have happened that you are not recognizing or are down playing for them to take on such a scheduling catastrophe.

I personally would not bank on an appeal going through and try an appeal for mercy from the pd to get a positive recommendation for a pgy 2 spot somewhere else and find work somewhere that will sponsor your visa while hunting like mad for a spot in any program in the country.

You are in a very precarious situation as I am sure you are aware--the pd has absolute power over you. Appeals and lawyers are not going to help you become a be/bc physician, only your pd can do that. If your goal is try to get your debt paid off and go in to a new career then a lawyer might be helpful.

 

[nirvana88]

Like I said, there was no sudden event that triggered this. It's just that the PD was kind of on a witch hunt and had asked chiefs to pester attendings for dirt on me. Hence, they were always able to find little things like an order that was put in late or arguments that could be taken as insubordination. Almost all of my evaluations were not just good, they were outstanding. I'm attaching a screenshot of the last evaluation that I got from a senior faculty member. [REMOVED]

 

[chessknt]

Well you'll do what you want but the reality is that program directors don't want to exterminate their residents to create scheduling holes mid year for no reason. Something was wrong and you are more likely than not to never work as a physician in the USA if you don't approach this with the utmost caution and diligence your future demands.

I would delete that too if you want this to stay even remotely anonymous since that will identify you to your program.

 

[nirvana88]

As I said before, there was nothing too major triggered this. Two of the worst reported incidents were:
1. When I addressed a patient's weight, she got offended and reported to the clinic director that I called her "fat". Although I never used that term and apologized as much as I could, they did not forgive me for that.
2. A new patient came to the clinic and wanted a physical exam. As I was extremely anxious those days because of the threats of being fired, I missed chest auscultation in the patient, unknowingly. That patient reported me to the clinic director as well.

These are the two of the worst incidents but both of them were more than two months old. Nothing major happened after that. The people I work with told me they're hopeful that the appeal committee will rule in my favor. But I find it hard to believe they'd side with the resident. Do you know of any such incidents in which the appeal committee would overturn the dismissal?

Regardless, what do you believe are my chances of securing a PGY-2 spot elsewhere?

 

[chessknt]

Without your pd's positive support almost none. No program wants a problem resident and they will always believe the pd over you.

 

[ArteryStudyPainting]

"Two of the worst incidents"

Personally, it sounds like you're downplaying something here. You're a doctor. You've been taught to do this job like a doctor. I recognize that it's hard on you. Personally, it sounds like you're asking for a handout by having them cut you some slack and to do your job.

And personally, I wouldn't want a doctor who needs some slack in order to not receive disciplinary actions.

Question answering:

Don't burn bridges. If you think you won't, why not? Also, you're looking for confirmation of your own opinion, so you'll keep looking until you find someone who makes you comfortable about your course of action.

No litigation unless you have evidence, and I mean a paper trail. No heresay.

Couldn't tell you!

You sound like you care. If you're given the chance, you need to prove you care.

Sent from my SM-G900V using SDN mobile

 

[nirvana88]

I never said that I am free of blame. The program did give me a lot of time to improve and I tried my best. It's just that I never thought I was worthy of a dismissal. I always tried my best but I felt like I was making too many mistakes due to forgetfulness. My psychiatrist thinks it's because of untreated depression. But the program does not agree.

 

[ArteryStudyPainting]

I never said that I am free of blame. The program did give me a lot of time to improve and I tried my best. It's just that I never thought I was worthy of a dismissal. I always tried my best but I felt like I was making too many mistakes due to forgetfulness. My psychiatrist thinks it's because of untreated depression. But the program does not agree.

Also, I'm sorry that this happened to you, and really hope it all works out in the end for you. Just keep swimming!

 

[shiftingmirage]

Right now, I have a few questions and would appreciate help from people who have had similar experiences.

1. What are the chances that the appeal committee reverses the decision?

2. Should I pursue litigation?

3. What are the chances of me securing a PGY-2 spot? I am on a J-1 visa.

If nothing else, some words of encouragement might help.

1. Our program recently fired someone and one of the things I learned was it is quite difficult to terminate a resident. Because of that, I think it's unlikely the committee will reverse the decision.

2. I'm not a lawyer. I would think because it is difficult to fire a resident, the amount of information they have on why they terminated you must be substantial. I find it difficult to believe you were terminated because of the examples you have listed, but I went to a resident friendly program, and I know not all programs are the same. Based on what you have provided, I'm not sure why they didn't take less aggressive measures like asking you to repeat a year. Terminating a resident is a HUGE headache for the program. It's not something it takes lightly from its end either. I think the main thing you have to lose for pursuing litigation is money, and if you have it, it may not be a big deal.

3. As others have said, being terminated from a program is bad. Maybe the attendings who were going talk to the appeals committee have friends at other programs and can put in a good word for you. I think getting a spot at another program, even restarting as a PGY1 will be difficult without support of your PD and current attendings.

 

[nirvana88]

I guess the most important thing I want to know is, has anybody ever heard of an appeal committee revert a dismissal?

 

[el_duderino]

Like I said, there was no sudden event that triggered this. It's just that the PD was kind of on a witch hunt and had asked chiefs to pester attendings for dirt on me. [REMOVED]

That seems legit.

 

[hello1234!]

You mentioned some arguments that could be seen as insubordination. Maybe this was perceived by the program as an issue.

Remember to breath right now and take care of yourself. Wishing you the best.

 

[nirvana88]

You mentioned some arguments that could be seen as insubordination. Maybe this was perceived by the program as an issue.

Remember to breath right now and take care of yourself. Wishing you the best.

The arguments were not exactly heated. It's just that often times I would use logic to justify something I did and it was perceived as defiance or resistance to feedback.
Most of my colleagues liked this about me, but every now and then someone would present this as an irreparable issue.

 

[deleted480308]

The arguments were not exactly heated. It's just that often times I would use logic to justify something I did and it was perceived as defiance or resistance to feedback.
Most of my colleagues liked this about me, but every now and then someone would present this as an irreparable issue.

this is more likely the root cause here.....people will forgive a little incompetence if you can stay humble and likeable and do what you're told

you don't get to be subpar and argumentative.

You'll need to address the attitude portion to have any hope of getting back on track, if any even remains

 

[nirvana88]

this is more likely the root cause here.....people will forgive a little incompetence if you can stay humble and likeable and do what you're told

you don't get to be subpar and argumentative.

You'll need to address the attitude portion to have any hope of getting back on track, if any even remains

I see what you're saying. But the fact that most attendings liked this about me and gave me outstanding evaluations should have outweighed the few who thought I had an attitude problem, don't you think?

 

[deleted480308]

I see what you're saying. But the fact that most attendings liked this about me and gave me outstanding evaluations should have outweighed the few who thought I had an attitude problem, don't you think?

given the topic of the thread, I think your perception of how well liked you were is suspect.

I know it seems liking I'm picking on you here, but you clearly don't read the room well if you walked into this and still think you are incredibly popular there

 

[nirvana88]

given the topic of the thread, I think your perception of how well liked you were is suspect.

I know it seems liking I'm picking on you here, but you clearly don't read the room well if you walked into this and still think you are incredibly popular there

As crazy as it sounds, I did have outstanding evaluations overall. I had even given up arguments in the last few months. But it was actually forgetfulness in the last few months that got the better of me.
I know from the surface it looks like there's a lot of information that I'm trying to hide or ignore. But the fact of the matter is that my program did ignore the overwhelmingly positive feedback in light of a few mistakes every now and then. If you line up all those mistakes, you might agree with the dismissal. If fact, the biggest issue my PD had with me was that I kept making these mistakes despite being on probation and repeated threats of being dismissed. They never discussed my good evaluations with me.

 

[toastee]

I see what you're saying. But the fact that most attendings liked this about me and gave me outstanding evaluations should have outweighed the few who thought I had an attitude problem, don't you think?

Sorry, just to emphasize this point. You can be liked by everyone, but if your program director does not like you, you're going to have a bad time. While you may think people like you, do they like you enough to go to bat for you? Because those same people who like you probably like your program director as well. And when push comes to shove, they are more than likely going to back him/her rather than you. Again this goes back to your perceived likeness, it may be tainted.

 

[nirvana88]

Sorry, just to emphasize this point. You can be liked by everyone, but if your program director does not like you, you're going to have a bad time. While you may think people like you, do they like you enough to go to bat for you? Because those same people who like you probably like your program director as well. And when push comes to shove, they are more than likely going to back him/her rather than you. Again this goes back to your perceived likeness, it may be tainted.

That is plausible. However, I did get a phone call from one of my attendings who asked me to tell the appeal committee to talk to them so they can vouch for me.

 

[amberkre]

I'm not a resident yet, so take this with a grain of salt. My question is, do you really want to be at a program that is trying to kick you out? For whatever reason that may be, I would say to cut your losses and be amicable to everyone at this point. Try to ask someone (one of the attendings who gave you stellar evals) for a letter or help with searching for a new program and try for an open PGY-2 spot. Maybe you should look at this as a learning perspective. It's likely this program hasn't been a great fit for you especially given the fact that you seem to not have the support of your PD. Rather than litigating to fight to stay, its probably best to focus what you can do to move on somewhere that will be better for you as well. Good luck!

 

[nirvana88]

I'm not a resident yet, so take this with a grain of salt. My question is, do you really want to be at a program that is trying to kick you out? For whatever reason that may be, I would say to cut your losses and be amicable to everyone at this point. Try to ask someone (one of the attendings who gave you stellar evals) for a letter or help with searching for a new program and try for an open PGY-2 spot. Maybe you should look at this as a learning perspective. It's likely this program hasn't been a great fit for you especially given the fact that you seem to not have the support of your PD. Rather than litigating to fight to stay, its probably best to focus what you can do to move on somewhere that will be better for you as well. Good luck!

I agree. I don't wish to stay at this program any longer but depending on the result of the appeal and whether I can find a program willing to accept me to PGY-2, I would request my PD for a neutral letter at least.

 

[NotAProgDirector]

This is a very difficult situation for everyone, but obviously especially you.

We're missing lots of details here, and only hearing the story from your viewpoint. I expect the story might be very different from your program's view. In any case, I'll try to be helpful.

Being terminated for professionalism issues is somewhat different than being terminated for clinical problems. Clinical issues tend to be pervasive -- someone who is struggling clinically usually struggles on all of their rotations, and everyone sees it. Professional issues tend to be episodic - 95+% of the time everything is fine, and then 1-5% of the time something goes wrong. When it's a communication problem it tends to be how you say things, not the actual content. There's no problem if we disagree about a clinical decision and we debate it -- but it can be a problem if how you're perceived is aggressive, unwilling to compromise, and/or unable to see that your decision isn't correct. Sometimes it's an issue of "fighting for the patient" rather than "compromising and doing what the system will allow". Scores on your "professionalism" in your RMS are not helpful here. One attending offering to vouch for you is also missing the point -- everyone can find one person to vouch for them. Residents with professionalism / communication issues end up with a large minority of people who feel they have a problem -- and that's a problem. Just because a majority of people think you're "fine" doesn't mean that you're fine.

In general, with professionalism issue I tell the resident what needs to change in their behavior, and tell them that the change needs to happen immediately. There isn't a grace period, or time built in for improvement. You just need to change. So, if you're late to conference all of the time, I tell you that you need to start being on time immediately. For clinical or MK issues, there might be some period built in for improvement. I also don't add training time for professionalism issues -- if the unprofessional behavior continues, we simply end your training. Adding time doesn't tend to help.

Remediation does create the problem of increased scrutiny. Then, as you mention, things that "everyone" may be doing get picked up and commented upon. Small things may get blown out of proportion. Then again, maybe these things are not being done by "everyone". And you should be aware that you'll be under the microscope, and work to change your behavior to match.

The major question reviewed at the appeal is whether the program followed their rules, and whether the decision is capricious / arbitrary. Appeal hearings are really tough for me -- I have to paint the resident in the worst light possible.

The J visa is a huge problem for you. Assuming the dismissal is not overturned, once you actually lose your job you'll have a 30 day grace period, and then your visa ends. To continue your J visa you'll need a new clinical job, or you could be on a research J. Your chances of getting a new clinical job in 30 days is zero. It's simply going to take longer than that, and there's a reasonable chance you won't get a new job at all. So you need a plan B -- either returning to your home country, or switching to a visitor visa (if you can do that at all).

I'm going to agree with @sb247. Your posts here demonstrate that you don't "get it", which is why you're being fired. The problem is not a couple of minor incidents. It's a pattern of repeated incidents that you're classifying as "minor" but the program feels are major. I expect you're correct that there wasn't a new, large sentinel event that triggered this -- but a repeated pattern of minor but significant issues without improvement will lead to the same outcome. Programs won't wait until something bad happens and someone gets injured.

As for next steps, you should probably start looking for PGY-1 positions. Starting as a PGY-2 in a new program where you don't know the systems / people AND when you have this problem is a really bad idea. Find a PGY-1 position for 3-6 months. That's the safest way to proceed. Get a PGY-2 position and run into problems and for certain, your career is over.

 

[nirvana88]

I appreciate your input, thanks a lot.
I would like to mention here that I never said I was free of blame. I always accepted the feedback given and tried my best to improve. But in the last few months, the anxiety of the threat of being fired took over me. I was forgetting minor details about patients or orders. I was in a vicious cycle. I had asked my PD for help. They actually doubted the realness my mental issues.
I do appreciate your suggestion of starting all over as a PGY-1 but I feel I can try looking for PGY-2 spots first.

 

[rokshana]

I see what you're saying. But the fact that most attendings liked this about me and gave me outstanding evaluations should have outweighed the few who thought I had an attitude problem, don't you think?

apparently they do...

the problem seems to be your inability to see what you see as "logic" or "small" issues as the bigger problems than they are.

you seem to have a skewed idea of what "outstanding" evaluations are...even that eval that you posted earlier demonstrated issues that you needed to address.

until you sit down and reassess the problems that you have and your responsibility in getting to the place you are now, you are not going to have much success in getting another position...since you most likely will not have the support of your PD in you finding another spot...and you will need his support.

 

[rokshana]

If fact, the biggest issue my PD had with me was that I kept making these mistakes despite being on probation and repeated threats of being dismissed. They never discussed my good evaluations with me.

HOW do you not realize that THIS is the problem?? you kept making the SAME mistakes...it doesn't matter if you got good evals, they fact that you can't learn is the problem...if you can't be taught, then why would the keep you?

 

[nirvana88]

HOW do you not realize that THIS is the problem?? you kept making the SAME mistakes...it doesn't matter if you got good evals, they fact that you can't learn is the problem...if you can't be taught, then why would the keep you?

I do realize that this is the critical issue. But these mistakes were mostly due to forgetfulness, which as I mentioned was due to the anxiety of the repeated threats. This was a vicious cycle for me. I never tried to deceive my program and was always honest with them.

 

[rokshana]

I do realize that this is the critical issue. But these mistakes were mostly due to forgetfulness, which as I mentioned was due to the anxiety of the repeated threats. This was a vicious cycle for me. I never tried to deceive my program and was always honest with them.

you make it sound like "forgetfulness" is some sort of legitimate excuse for the problems that you are having...i find that to be even more of an issue...if you think (or thought) that your mental health issues are so significant that they keep you from being able to perform your duties as a resident, then you needed to have asked for a LOA to be able to address the issue...you may then have had a leg to stand on.

 

[nirvana88]

you make it sound like "forgetfulness" is some sort of legitimate excuse for the problems that you are having...i find that to be even more of an issue...if you think (or thought) that your mental health issues are so significant that they keep you from being able to perform your duties as a resident, then you needed to have asked for a LOA to be able to address the issue...you may then have had a leg to stand on.

In retrospect, I should have done that. I just thought that since I am a good doctor, I could just "power through" this phase and would be able to get rid of the cause i.e. the probation. Thinking I could do that was my biggest mistake.

 

[keindo]

I appreciate your input, thanks a lot.
I would like to mention here that I never said I was free of blame. I always accepted the feedback given and tried my best to improve.

So, I just want to say that it really doesn't matter whether you are accepting of feedback and trying to improve. Several posters on this thread felt like you were deflecting blame--so whatever your internal perspective is you are coming off as trying to blame others through your communication.

 

[bronx43]

Man, that's rough and I'm sorry to hear that. Hope you the best of luck.

 

[hello1234!]

The arguments were not exactly heated. It's just that often times I would use logic to justify something I did and it was perceived as defiance or resistance to feedback.
Most of my colleagues liked this about me, but every now and then someone would present this as an irreparable issue.

For further reference, when u are corrected by a superior, unless you feel there is serious harm to patient care, accept what they say, research the topic, then present what u learned to them.

 

[Domperidone]

Agree with much of what's already been discussed.

I've no idea how much you want to stay at your program, or what it's like. It may not be a bad idea to cut your losses and move on, as suggested above.

It is concerning that they would rather let you go and face a workforce gap mid way into a year.

Whatever you do decide, at least start building an application now rather than wait for the appeal and it's outcome. Then re-evaluate your own performance. You already have insight into many of the things that you could have done better or improved on. Figure out how you can change your own habits or behaviors - because that's at least within your control. That's the next step.

Remediation does create the problem of increased scrutiny. Then, as you mention, things that "everyone" may be doing get picked up and commented upon. Small things may get blown out of proportion. Then again, maybe these things are not being done by "everyone". And you should be aware that you'll be under the microscope, and work to change your behavior to match.

This part is so true, and as mentioned above. it does translate into, 'change now, not later. '
It's an important thing for students and interns to be aware of. So many start off having no idea that this stuff happens. Is it fair, I don't know, but 'who says life is fair'. Everyone's human, you, the PD, other residents and attendings.

Being under the microscope is anxiety inducing and it always means you have to work twice as hard as usual in order to change. That's if you're with a supportive team. They expect that you'll able to control that anxiety and work harder to get back to at least a neutral opinion of you. Because, this whole career can be anxiety inducing if you choose to stick to the hospital setting. it's high pressure, it's a conveyor belt of impossible situations that come up all the time. If you're crumbling now, it's possible that also forms a point of concern to someone on the outside - they'll start to wonder how you will be with more responsibilities down the line.

You've mentioned forgetfulness of patient details, order and following them up. Bringing up this point to try to help you, whether you stay with your program or move on. So much of being an intern and junior resident is learning how to juggle all those small things or small responsibilities. Mastering 'scut work' and the practical side to medicine. it starts off 'small', but gradually they layer on the bigger things. Clinical knowledge is important, that goes into one box. execution of things is in another. churning the knowledge into actual results for the patients.

Working on teams in a hospital environment has it's own set of challenges. if people delegate things to you they will expect them done. it's also easier if you're not questioning everything. To work safely, yes occasionally you should speak up or ask if something is unclear. It does hinder the work flow to things if you're constantly 'logically' arguing points. As pointed out above, if you're already 'subpar', it's not really the time to argue points either. If you're really going to do it, at least complete all your own responsibilities first.

If your reliability is in question because of constant forgetfulness, that's a problem. It's not a small one for your level. For someone more senior, it means they may not be able to trust you. They'll have to look over your shoulder more or get another resident to do your work on top of theirs. Yes, it's more difficult to 'power through' with anxiety, without question. However, the first step is recognition of this, the next, is coming up with strategies around this. (simple things like keeping a note book or making checklists, writing things down, coming in extra early to familiarize yourself with patients etc.). Or as remarked above, you should have taken time off to address the problem if it was really impacting your ability to work. That again, means you're addressing the situation professionally.

 

[nirvana88]

Thank you so much guys for the insight and advice provided. I hope I am able to get through this phase in one piece.

 

[NotAProgDirector]

I have seen this vicious cycle before. Problems --> increased scrutiny --> anxiety about making mistakes --> making more mistakes / losing self confidence --> increased program concerns --> repeat cycle. Unfortunately, as a program director, I can't tell how much of the issue is the increased scrutiny, and how much is a real problem.

Taking an LOA can help, if there is an un/under treated psych or medical issue that is playing a role. I realize it's too late for you, but wanted to support that option in case someone else is reading this.

I do wish you the best with all of this. If you do decide to try to find a PGY-2 spot, don't underestimate how difficult the transition can be. Ask if you can "buddy" with a current PGY-2 for a month or 2.

 

[nirvana88]

I have seen this vicious cycle before. Problems --> increased scrutiny --> anxiety about making mistakes --> making more mistakes / losing self confidence --> increased program concerns --> repeat cycle. Unfortunately, as a program director, I can't tell how much of the issue is the increased scrutiny, and how much is a real problem.

Taking an LOA can help, if there is an un/under treated psych or medical issue that is playing a role. I realize it's too late for you, but wanted to support that option in case someone else is reading this.

I do wish you the best with all of this. If you do decide to try to find a PGY-2 spot, don't underestimate how difficult the transition can be. Ask if you can "buddy" with a current PGY-2 for a month or 2.

Thank you for your advice. Do you think the appeal committee can reverse the decision if they actually believe there was a vicious cycle?
Also, what do you mean by "buddy with a current PGY-2"?

 

[DrMetal]

1. Our program recently fired someone and one of the things I learned was it is quite difficult to terminate a resident. Because of that, I think it's unlikely the committee will reverse the decision.

2. I'm not a lawyer. I would think because it is difficult to fire a resident, the amount of information they have on why they terminated you must be substantial. I find it difficult to believe you were terminated because of the examples you have listed, but I went to a resident friendly program, and I know not all programs are the same. Based on what you have provided, I'm not sure why they didn't take less aggressive measures like asking you to repeat a year. Terminating a resident is a HUGE headache for the program.

This is spot on. It's hard enough for a program to just discipline (say by adding on more time) to a resident's curriculum....to kick someone out requires a lot of admin, a lot of crossing t's and dotting i's to make sure you (as the PD) are doing the right thing. I've only seen it happen in the case of sexual harassment and equal opportunity complaints. Even in some cases of gross negligence, I've seen some trainees allowed to continue with little to nothing for punishment.

 

[nirvana88]

This is spot on. It's hard enough for a program to just discipline (say by adding on more time) to a resident's curriculum....to kick someone out requires a lot of admin, a lot of crossing t's and dotting i's to make sure you (as the PD) are doing the right thing. I've only seen it happen in the case of sexual harassment and equal opportunity complaints. Even in some cases of gross negligence, I've seen some trainees allowed to continue with little to nothing for punishment.

What do you mean when you say you've only seen "it" happen? Reversal of the decision?

 

[DrMetal]

What do you mean when you say you've only seen "it" happen? Reversal of the decision?

No, I meant the termination of a trainee

 

[SterlingMaloryArcher]

I residency not just accredited/programized employment? Do state employment laws not apply to residencies?

 

[gutonc]

I residency not just accredited/programized employment? Do state employment laws not apply to residencies?

Not sure I understand your question.

Yes, state employment laws will apply to residents. And all residents also have a contract with the hospital that will explicitly state the amount of notice required for the program or resident to terminate the contract.

Do you have an actual question about this case as it relates to employment law? Or are you just trying to stir s*** up?

 

[SterlingMaloryArcher]

Not sure I understand your question.

Yes, state employment laws will apply to residents. And all residents also have a contract with the hospital that will explicitly state the amount of notice required for the program or resident to terminate the contract.

Do you have an actual question about this case as it relates to employment law? Or are you just trying to stir s*** up?

Haha it's so funny how people on SDN will always have a crappy reply. I know you guys don't talk to people like that in person so why here?

I ask because employment law, especially what you can terminate somebody for, is my specialty; but if there are other policies at play when it comes to residencies then I would admit any suggestions are beyond what I know before I even think about this case.

 

[SterlingMaloryArcher]

I am/ was a resident in an IM residency program, recently dismissed for deficiencies of Professionalism and Patient Care. As of now, I am waiting for the appeal committee to evaluate the issue before the decision is final.

To cut a long story short, I had some trouble with a few attendings in January this (intern) year and had been on probation ever since. However my program found no reason to prevent my promotion to second year while keeping my probation status. Although most of the people I worked with liked me thereafter, every now and then, something minor would come up against me. There was no sudden event that triggered this dismissal, rather the recurrent reports of minor events directly to the administration. Most of these events involved delays in putting orders, following up on orders and forgetfulness. Here I would like to mention that I never caused any patient any harm in fact got a letter of appreciation from risk management for preventing patient harm in a case. Academically, I was ranked among the very best in the program for medical knowledge. While I have always agreed that I needed improvement, I never believed I was at a level that warranted dismissal. In fact my score for the Professionalism and Patient Care competencies on New Innovations have always been above average. The most recent reason for my mistakes was the fact that I had been extremely anxious because of the stress of repeated warnings of dismissal. I did ask the program for help and they had me seen by our on-campus psychologist. She diagnosed me with both anxiety and depression and referred me for treatment. However the program did not give me ample time to try to treat it.

When I asked my PD for help, they said "I think you're just cutting corners and exaggerating your mental issues".

When news of my dismissal got out, all attendings that I had worked with were shocked and said they would talk to the appeal committee.

Right now, I have a few questions and would appreciate help from people who have had similar experiences.

1. What are the chances that the appeal committee reverses the decision?

2. Should I pursue litigation?

3. What are the chances of me securing a PGY-2 spot? I am on a J-1 visa.

If nothing else, some words of encouragement might help.

I agree there is probably more to the story but personal agendas are a thing, I've seen them happen. It's really dirty. Management finds out something about someone that they don't like/can't see past, or they just generally don't percieve that person well, but isn't a good reason to fire them, so they look for reasons.

Even I have had it out for employees because of their prior performance and maybe a year later realized I wasn't the most fair with them in initiating the discipline which ultimately cost them their job and (somewhat) regretted it. While ultimately I think it IS on the employee for being "too late" to turn it around, I have to ask myself "Is this about the matter at hand, or is it really about that thing from a week ago...?"

OP, Yes, there's a really good chance that lately your PD is nitpicking, but it's probably from something else from a while ago they still havn't gotten over. It's really hard to change a superiors perception of you, so when you're attempting to do so, the improvement has to be NIGHT AND DAY.

 

[gutonc]

Haha it's so funny how people on SDN will always have a crappy reply. I know you guys don't talk to people like that in person so why here?

I ask because employment law, especially what you can terminate somebody for, is my specialty; but if there are other policies at play when it comes to residencies then I would admit any suggestions are beyond what I know before I even think about this case.

Actually, I pretty much would have said the same thing to your face. My "crappy reply" was just asking you for clarification.

 

[NotAProgDirector]

Thank you for your advice. Do you think the appeal committee can reverse the decision if they actually believe there was a vicious cycle?

The appeal committee is unlikely to overturn a decision because of something like this. Remember that a key part of the vicious cycle is your behavior / response to the issue. if putting your performance under a microscope makes it look worse, it's possible that your performance was simply that bad all along, and only after they focused on it did they see how bad it was..

Also, what do you mean by "buddy with a current PGY-2"?

What I mean is that instead of putting you into a PGY-2 position (i.e. overseeing 1-2 interns on an inpatient service), they first put you and another PGY-2 (or even a PGY-3 which would be better) into the same position. That way, there's someone to show you the ropes and get you settled. The problem is that it's inefficient -- it means I need to use two people to fill a position that is usually filled by one.

 

[Successor12]

I had a friend who faced possible termination as a PGY1, was not promoted until 2 months after her second year started and for three consequative months was on floors! Thought that was excessive! Their issue with her as she told me were a combination of professional /clinical skills concerns and she never thought that she that they were fair to her and actually thought her pgy2 peers way worse not sure how much of that was truth Vs lack of insight

Her faculty were definitely nitpicking at one point but just going through her story it was really difficult to stay objective and I wonder how the program can be actually fair to residents in this situation!

I wish you find a way out of this difficult situation

 

[nirvana88]

The appeal committee is unlikely to overturn a decision because of something like this.

How unlikely would you say, per your experience? Do you know of any appeal ever ending in the resident's favor?

 

[Domperidone]

I agree there is probably more to the story but personal agendas are a thing, I've seen them happen. It's really dirty. Management finds out something about someone that they don't like/can't see past, or they just generally don't percieve that person well, but isn't a good reason to fire them, so they look for reasons.

Even I have had it out for employees because of their prior performance and maybe a year later realized I wasn't the most fair with them in initiating the discipline which ultimately cost them their job and (somewhat) regretted it. While ultimately I think it IS on the employee for being "too late" to turn it around, I have to ask myself "Is this about the matter at hand, or is it really about that thing from a week ago...?"

OP, Yes, there's a really good chance that lately your PD is nitpicking, but it's probably from something else from a while ago they still havn't gotten over. It's really hard to change a superiors perception of you, so when you're attempting to do so, the improvement has to be NIGHT AND DAY.

They are a thing, but it's rare.
Very generally, people know how hard you work to get into residency. they know you're training. They remember what it's like. But all things in balance. you have to consider how much giving more chances impact other residents, other staff - like nurses, and patient care. The work load doesn't just stop, it has to go somewhere. If you have your resources stretched thin, how long till you wait for an adverse event? (which has been touched on earlier in the thread too). It's not always that simple. these things can have lasting effects on everyone involved.

But yes, would agree. Occasionally you will run into people who will form their initial opinion of you and it's impossible to change that, no matter what you do to crawl out from under that rock. Or they develop agendas. Impossible to tell from this if their PD happens to be this type. However, OP has said they've essentially fallen into the vicious cycle or collapsed under the scrutiny. They've been under the microscope since January, so it wasn't a snap decision. Regardless, still an unfortunate situation. To be honest, I don't know how acknowledging that point really solves much for them, other than may be reinforcing the idea that they're not likely to win the appeal some more.

 

[Redpancreas]

As crazy as it sounds, I did have outstanding evaluations overall. I had even given up arguments in the last few months. But it was actually forgetfulness in the last few months that got the better of me.
I know from the surface it looks like there's a lot of information that I'm trying to hide or ignore. But the fact of the matter is that my program did ignore the overwhelmingly positive feedback in light of a few mistakes every now and then. If you line up all those mistakes, you might agree with the dismissal. If fact, the biggest issue my PD had with me was that I kept making these mistakes despite being on probation and repeated threats of being dismissed. They never discussed my good evaluations with me.

Wow. You had even given up arguments? What a magnanimous gesture.

I appreciate your input, thanks a lot.
I would like to mention here that I never said I was free of blame. I always accepted the feedback given and tried my best to improve. But in the last few months, the anxiety of the threat of being fired took over me. I was forgetting minor details about patients or orders. I was in a vicious cycle. I had asked my PD for help. They actually doubted the realness my mental issues.
I do appreciate your suggestion of starting all over as a PGY-1 but I feel I can try looking for PGY-2 spots first.

OP, your lack of insight is so transparent that its comical. Are you trolling? In case you're not, let me rephrase to you what AProgDirector was nice enough to phrase as a "recommendation". You need to restart at PGY-1 because its difficult enough to start PGY-1 at a new setting. PGY-2s are expected to be leaders *in addition to* learners. Not doing so means there's a high chance you'll struggle elsewhere and have two terminations on record. This isn't a gamble where best case you don't have to repeat a year, worst case you have to wait an additional year to repeat PGY-1. You're setting yourself up for what would be the beginning of the end of the career you've dedicated the last 8-10 years of your life to.

 

[CatFactorial]

Wow. You had even given up arguments? You say that like it's a magnanimous gesture as if arguing with superiors is something you are entitled to.



OP, your lack of insight is so transparent that its comical. Are you trolling? In case you're not, let me rephrase to you what AProgDirector's saying. You need to start at PGY-1 unless you're an all-star (which you're not). Not doing so means there's a high chance your medical career will be over. PGY-2s are expected to be leaders, not learners. This isn't a gamble where best case you don't have to repeat a year, worst case you have to wait a year to repeat PGY-1. This decision would be the beginning of the end of the career you've dedicated the last 8-10 years of your life to.

Settle down kiddo. Why don’t you first finish medical school and actually try your hand as a resident before telling someone what a PGY2 is expected to be (hint—they also are expected to be learners, just like everyone else, attendings included)?

OP, your situation sounds rough and I hope you can sort it out to your satisfaction.