Terminating residents in psychiatry

[sporkster]

My god, does this happen in psychiatry to any significant degree?


http://forums.studentdoctor.net/showthread.php?t=562930

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[Anasazi23]

It definately happens.

Whether or not it happens "more" is questionable. Overall, I'd venture to guess that it would be less than other medical specialties. Then again, sometimes psychiatry does attract the odd bird - and they often have problems. You might think that psychiatry may tolerate it more, and in some cases they might. In other cases, definately not.

Like all things, it depends on the malignancy level of the program.

 

[marie337]

I know of one psychiatry intern who was terminated recently. I don't know the whole story, but I think they sort of convinced her that she not in the right field. So, in the end I think it was a mutual decision, but nevertheless she's no longer there. She was very nice and seemed to try hard, but it was also quite obvious that she was not up to par dealing with some pretty straightforward psych patients.

 

[whopper]

I've seen 2 residents terminated from my program, a few in others.

The 2 that were terminated deserved it. One was upset at an attending so he decided to not show up to work as if he had that option. That is technically not providing care & services he was bound to give. He never once tried to bring the issue up to higher channels or talk to the Chief Resident about it. His attitude the entire time he was in residency was "I don't care if they kick me out, I never wanted to be a doctor anyway". Well surprise surprise, he applied back to psychiatry residencies last year. Geez I thought he never wanted to be a doctor.

The other had combined Borderline, Histrionic & elements of Antisocial Personality Disorder. Why my program picked her out of the hundreds of other candidates who wanted in I may never know. Her application was red flagged by her medical school & they even cited in her records that she was someone who had several problematic issues. She came into work wearing a belly shirt, made sexual advances on patients, & falsely accused several of the attendings & her colleagues of activities that were not true.

In truth, I actually think 1 or 2 others deserved to get booted, but my program was actually IMHO slightly too lenient. One guy was about an hour late every single day and never got reprimanded for it, and he'd try to get sick days all the time claiming his kids were sick (which they weren't). I think what was going on is in general most residents are hard workers, and the program espoused an atmosphere of trying to use inspiration & the carrot instead of the stick--which works with good residents. However when it got a few bad residents (which every program will sooner or later), & because it wasn't expecting that, they didn't have the stick in place to react in time.

In general 2 issues I've seen that make termination a very touchy issue is several programs still espouse the unfair "abuse the resident because what won't kill them will only make them stronger" philosophy. IMHO this attitude is often times just an excuse for a bullying & narcissistic attending to exploit a resident to do his/her work & to get their kicks to satisfy their sadistic side.
The other is termination from a residency is a very big issue for a resident. Getting there is the culimation of years of hard work & may cause irreperable damage to a career where there is often times no back up. In several fields, you get fired, you just apply for another job. Its not like it for doctors still in training. Its all or nothing. This in turn may push the resident to fire back sue or threaten to sue a program whether that termination was justified or not.

And this creates a notion in some program directors & dept chairs to not push the issue too hard in getting a resident out of the program....
In others, they are on an OCPD drive to kick someone out to keep a good sense of fear in their residents-both of which IMHO are too much on the extremes of either side. In the former, I've seen bad residents be excused & keep to their bad behaviors knowing they will get away with it, in the latter, everyone, even the good residents lived in fear all the time.

 

[nancysinatra]

My god, does this happen in psychiatry to any significant degree?


http://forums.studentdoctor.net/showthread.php?t=562930

The thread, and the article it links to, focus a lot on the arbitrary and random firing and disciplining of residents, as opposed to disciplinary actions brought against residents who truly are not performing well or fitting in. I think these are two totally different subjects (although I can see them overlapping in individual cases). In the context of arbitrary disciplining of residents, the article gives a chilling description of a process called "disciplinary psychiatry." I'd never heard of this. Does this really exist? Wouldn't it be completely unethical to "work" for a residency program and essentially just "provide" psychiatric diagnoses of residents who have fallen out of the program director's favor? It was frightening to read! The person who wrote the article had complained about sexual harassment to her neurology program director. This was not well received, apparently. It instead landed her in a limbo where she was required to go for "mental therapy." Her attendance at "mental therapy" could then be used as grounds for firing her because it showed she was "unstable." I mean, is this kind of stuff really going on in residency land?? Isn't this a misuse of psychiatry?

It's a creepy thread!

 

[whopper]

A buddy of mine was in a FP program, was made to take Paxil by the program director, against his will because the guy thought he had ADHD (hey did this guy know Paxil's not for ADHD?). Then the program kicked him out.

My friend is a very good person who works very hard, so 3 possibilities went through my mind. Either he didn't have what it took despite his best efforts or they screwed around with him or something in the middle.

He gave me some horror stories of the program, and he mentioned things similar to what was mentioned above, such as being diagnosed, even medicated at the whim on the director.

I wasn't at that program so I didn't witness it first hand, but my buddy is of the type of character where he wouldn't make it up. Since he was removed from that program he hasn't been able to get into another program because of being red flagged.

Lo & behold, last year, I told a resident in my program of the same horror story but I intentionally didn't mention the program's name because I didn't witness the thing firsthand. She said "the same thing happened to a friend of mine at ______, its a family practice residency." It was the same program, and her friend was not my friend. Turned out this program director had done it to several people. I went from 80% convinced it happened to 99% convinced. Unfortunately though, it was out of my hands to do anything about it.

I double checked the thread and the person who started it mentioned..

Each of them was told that "Every year a resident is picked as a Scape Goat" And that they were the scape goat for that period. And every scape goat was eventually terminated. What does that say about a residency in Family medicine.

That's exactly what my buddy said. I'm starting to wonder now if its the same program.

 

[MBK2003]

I think what becomes hard as a resident/fellow/soon-to-be attending is when you see residents who are clearly not cut out to be psychiatrists (more specifically, to work with people) for a variety of reasons. I personally think that those failures come down to the training directors, who may be eager to fill positions or make someone "a special project."

 

[maybepsych]

This is super scarey. I can't believe this stuff is allowed to happen.

Does it seem like most of these programs are in family medicine? Is there any reliable way to get information on programs that do this type of thing?

Maybe if they did have their name smeared all over SDN they would rethink some policies. Maybe not.

 

[shrinkknit]

I have seen it happen. It reflects poorly on the program.

 

[Spiderwoman]

I was in family practice residency program. They matched me, many others were there because of relations or being bilingual. I am IMG, spent most my adult life in US. In that program, I felt like a minority in some other country, not US. Residents were from two main groups, each speaking their language, not english. They would speak in their non-English native language in morning report, and yes sometimes with attendings too. Few people were interested in learning, the rest just wanted to pass time and graduate. Some would say who cares, we just sreen and send the patient to specialist. It was killing me. I am an older graduate, but from an excellent Medical school. The best in the country were dreaming to get accepted there. Then my USMLE scores were all over 90. Not that these numbers define me, but the difference between residents was obvious. I could not get a better offer since I was an older applicant. Any way, the chief resident hated me, since his wife had a problem with me. He even told me he would make me miserable for this. I had good relationship with my PGY-1 friends and many seniors. They witnessed the unfair situation. Chief resident would dump his new admissions on me. For winter Holidays, I offered being oncall for Christmes eve and in return making sure To be home on New Years eve, my son's birthday. They gave me calls for both, actually more calls in between those. The residents from their home country got a week off. Chief resident told me you don't celebrate christmes anyway, it is not your Holiday. I talked with PD. He said he knows it is not fair but he has to support his resident. They put me in a bad position. I was crying all the time. According to attending's semiannual evaluation I was on time all the time, I took a caring care from my patient, I was knowledgable, in in-sevice exam I got the highest score in the program, and I was pushed to a corner. So I left. The PD gave me a letter of good standing, he mentioned I passed my rotations satisfactory. All attendings evaluations I received is 4.5-5 from 5.

I can only hope that people who review my application this year guess that it is not the same story for all people who leave a program( I was not fired, or asked to resign).

 

[Boyder]

So I would like to know, PLEASE tell me, are there any programs that tend toward this in the midwest. I do not want to end up in a place like this.

 

[BabyPsychDoc]

So I would like to know, PLEASE tell me, are there any programs that tend toward this in the midwest. I do not want to end up in a place like this.

Take my words with a pinch of salt, but:

1) Midwest is not exactly the most competitive area of the US and
2) Psych is not the most competitive specialty that however requires
3) Special mindset and skill set that would (ideally) make you more tolerant of others' weaknesses (to an extent) and more willing to lend a helping hand, from which it follows that

the theoretical probability of a malignant psychiatry programme in upper midwest is reduced compared to (say) the theoretical probability of a malignant neurosurgery/ophthalmology/fill in the blank programme on either Coast.

FM is slightly different, as FM is frequently seen as the "last resort" specialty for weak applicants, so less than reputable programmes pretty much view their residents as cannon fodder with "so what are you going to do" attitude towards those who are unhappy with that kind of treatment.

P.S. I am not saying that midwestern programmes would not terminate residents if it was really warranted. I am only saying that I have not heard about "MALIGNANT" psychiatry programmes in midwest, similar to the programme described by Spiderwoman, which seems to damn near go out of the way to mistreat residents.

 

[whopper]

Does it seem like most of these programs are in family medicine?

Well I don't know if most of these programs are FP. Actually I'd doubt it. Just that the ony guy I know who was majorly screwed over was in a FP residency. I've seen several in others (IM, surgery) get screwed as well. I know of 1 particular malignant psychiatry program but since I can be accused of libel for mentioning them, I won't.

Is there any reliable way to get information on programs that do this type of thing?

No.

The program will not advertise that they are malignant. You think they're going to admit to their faults when trying to get a new candidate in?

However some clues I've seen that a program is malignant are..
1) they don't let you talk to the residents about how the residents feel about the program, or don't let you talk the residents while you are alone with the residents
2) the program is not part of a university hospital. Reason why that is important is because university hospitals sponsor several residencies and since there are several, the GME of that hospital will have more eyes looking upon it & it upon those programs--they're more likely to follow the ACGME rules. Its easier for a program to be malignant that is operating with only a few people looking over it vs hundreds. Also being part of a UH puts several dozens if not hundreds of residents together, all of differing programs. If someone in 1 program X gets out of line, you bet the residents will complain and it'll spread to the other program directors. More programs together mean more eyes & ears, more residents being able to see the grass on the other side, more cross comparison.
3) the program does not give the residents the ability to complain directly to their GME without fear of backlash. Programs are required by ACGME (if I remember correctly) to provide this option. My own program did. It was called the "resident workaround" & it allowed a resident to anonymously report inappropriate actions being done by their program.
4) The program is a lower tier program. More of the malignant programs I've seen were a lower tier, non-university program. However there are some lower-tier, non university programs that are not malignant I have also heard of some of the higher tier programs being malignant as well, however it seemed the lower tiered ones were more likely to be malignant.
5)The program is in a hospital that is in a very poor urban area with a lot of crime. Hospitals like this are more likely to use residents for scut to save money. Then add to that, because its a poor area, they're more likely to be underfunded & underserving. One hospital I saw in a particularly bad area didn't have enough nurses covering the patients--so the nurses were overworked & made the residents do a lot of the work they were supposed to do-such as start IVs, take blood samples for labs. The GME there didn't seem to care. It was rampant and everyone knew it was going on but nothing was being done about it. The attendings had a "if the nurse can't do it, you better or you're dead" attitude. Several of the nurses also abused the residents & didn't even attempt to do their work. The rule was they had to try at least 3x before they gave up on an IV. Several of them claimed to do so, but when the resident came in & asked the patient, the pt denied the nurse made an attempt & there was no signs of an attempt.
6) one of the interviewers during your interview/tour day does a stress interview on you. Indicates possible OCPD traits on the part of that interviewer.

The best way to find out if a program is malignant is 1-if you know someone in the program, ask them. 2-if you don't know someone in the program, ask the residents under the table what they really think of the program. Not what the program is trying to sell to the candidates. 3-the general look of the residents at the program during your interview & tour.

Also ask around. Some residents know what's going on in neighboring programs because they have some interaction with that program.

 

[Spiderwoman]

Whopper is absolutly right. My FP program had all of them. I should have paid attension to #6. In my interview, one of them opened a politics and religion discussion, obviously has nothing to do with FP. And I thought it is illegal. He turned out to be Not so Normal. I never had problems with him but he used to turn morning reports into psych unit. For your friends interested in FP, the program is closed this year.
Such a shame that my hard earned career might be closed because of it, too. How can I convince programs I am not malignant, trouble maker? I left for personal reasons. But I guess they say that for most excused ones too?
I find psychiatrists realy balanced. I would find it hard to see a prgram such as mine( FP) in psychiatry residency. Hard work and long hours is not always the same as abuse.

 

[whopper]

I had a stress interview at a particular NYC program. Whatever...I had several programs that interviewed me, its not like I was between a rock & a hard place.

So it didn't bug me much, though I of course ranted on it on the board (I'm sure its still here if you want to search & read it). In short, the guy started yelling at me, did a lot of name calling, hit his fist against the desk a few times, said my work in student government in college & medschool was a waste of time & a sign of narcissism among several other pretty idiotic things.

I had a friend who went to the program where the guy gave me the stress interview. She told me that about 2 years later the guy was removed from teaching residents because he was accused of assaulting a resident. Several other residents from the program told me they felt bullied by the guy but were powerless to do anything because he was an attending, & they only a resident. They also mentioned he had several OCPD traits, like if you were 1 minute late for his lectures, he'd blow up in anger, but he was late to his own lectures a few times, but of course that's alright if he's late.

 

[notdeadyet]

In short, the guy started yelling at me, did a lot of name calling, hit his fist against the desk a few times, said my work in student government in college & medschool was a waste of time & a sign of narcissism among several other pretty idiotic things.

May I ask who ends up ranking these programs? Do they end up getting filled by people who lack any other options?

I can't imagine someone walking away from an interview situation like that thinking "wow, great fit."

 

[Spiderwoman]

Good question. As was mentioned before by some one, these programs are not high rank ones. In my FP programs, most people were there since they had no other choice. FMGs with bad scores, AMGs with worse scores, Visa issues, breifly not a good CV. My situation was a little different. I have myself to blame. Research in US, high scores ( all in 90s ), US citizen, but old graduate, more than 5 years out of school at that time. I decided to raise my children and stay home, which I do not regret at all. Still, I would not change that for a world. I wanted to stay in my city, to be close to my family. It was my priority and still is. My mistake was choosing FP. I thought I should have US experience and see how is every field in US. I did not know switching speciality, if you can call FP a speciality, could cost me.
So usually people who have not much of choice end up in this situation. But they usually tolerate it, since this is their last hope.
I was subject to many illegal actions, things that are illegal in any job environement in US. Some residents were encouraging me to sue the program, something they wish they could do themselves. My lawyer friends said I definitly have a case. But this is not me. I just want my career back, and I will. I focus on future. Those people, as I heard, have massy life with adultery, and worse. Low moral life is their punishment. And of course, the program is closed and non of them has been offered any position in the new program. World is fair afterall.

 

[whopper]

I can't imagine someone walking away from an interview situation like that thinking "wow, great fit."

Well I know of 2 university programs where this type of thing happened too, but not to the extreme of this 1 program. I wouldn't even call them stress interviews, which I consider to be extreme & the guy is intentionally doing everything to tick you off. I mention them because the interviewers did something pretty below the belt, but for the most part were nice during the interview.

At one university program the PD's last words to me were, "congratulations, you've made your parents mandate". Implying that I went to medschool simply to satisfy their wishes when I never said I did, nor was that ever my intention, and his assumption was purely based on my race.

At another, the PD accused me of lying. He asked me what I did during my year off from medschool. I told him I day-traded, made a lot of money & lived life as a single guy in my 20s, in a manner I couldn't do as a medstudent. The guy asked me how much money I made, I told him, and he called me a liar. He was sitting right next to a computer that was hooked up to the net, so I told him, "if you don't believe me, kindly go onto tdameritrade.com, I'll open my account & show you my account records, it'll only take about 1 minute". The guy said no & kept onto his insistance that I was a liar.

Same program--friend of mine told me the same PD told her "you see this personal statement you wrote?, you know what I think of it? I'm going to line my birdcage with it".

My PD at the program I attended, well he knew this other PD from the program above and was under that same guy when he trained, and told me the same PD berated him too. That PD said, "don't worry James, this is between you & me, he's a prick."

The last time I got a stress interview was for fellowship, but I didn't give a darn. I had several interviews, and several programs told me they wanted me. So when this top tier fellowship gave me the stress interview, it didn't scare me. Heck if anything, a program a few blocks away already told me they wanted me & the curriculum was the same-including the same lectures & such. I also interviewed dozens of medstudents who wanted into my residency program by then & knew the game they were playing.

And I know pretty much all of us are past this, but many more people I know got a stress interview or condescending comment laid out to them for medschool interviews much more than residency. Medschools are in a much better position hundreds to thousands of applicants for each spot vs the dozens in residency. Trust me, its rare for this to happen when interviewing for residency.

Stress interviews can happen anywhere--just that I notice they tend to happen a bit more at malignant programs. I interviewed at one malignant program and every interviewer was very nice. My reccomendation doesn't fit all programs--its a generality.

I was subject to many illegal actions, things that are illegal in any job environement in US. Some residents were encouraging me to sue the program, something they wish they could do themselves. My lawyer friends said I definitly have a case. But this is not me. I just want my career back, and I will. I focus on future. Those people, as I heard, have massy life with adultery, and worse. Low moral life is their punishment. And of course, the program is closed and non of them has been offered any position in the new program. World is fair afterall.

The residents don't want to blow the whistle because they're scared & want to graduate, the PD knows this & exploits it. Its funny because so many residents who get into lower tier programs are so scared of their programs. If someone leaves, the residents in the program suggest the person who left sue--but they won't do anything out of fear.

That's not a way to live, & it violates the ethics we are supposed to live by as doctors.

 

[DebbieNicole]

In short, the guy started yelling at me, did a lot of name calling, hit his fist against the desk a few times, said my work in student government in college & medschool was a waste of time & a sign of narcissism among several other pretty idiotic things.
quote]

I know it wouldn't be a good thing to do, but, did you laugh?

 

[whopper]

I should've.

At the time I didn't know how the politics were between the programs. I feared that since this was a NYC program, if I blew the guy off, it could have repercussions at the other NYC programs.

I know now that is not the case. Didn't know it then.

After that stress interview, I had an interview with the actual program director, & he mentioned that he really wanted me there. He said he liked my leadership credentials & such. I didn't mention the guy who gave the stress interview because I figured these 2 guys probably worked together for years. I'm not going to give his colleague a bad rap which would just make me look bad.

 

[emeth23]

what options are available for a resident who is force to resign or face termination in the middle of their pgy-3 year in psychiatry. unfortunately to be board eligible for psychiatry you have to have "2 consecutive years of training in the same program." I only have a year and a half, and my program director is not willing to allow me to finish the remaining six months. as a consequence, I effectively could never practice psychiatry as a profession.

 

[Doc Samson]

what options are available for a resident who is force to resign or face termination in the middle of their pgy-3 year in psychiatry. unfortunately to be board eligible for psychiatry you have to have "2 consecutive years of training in the same program." I only have a year and a half, and my program director is not willing to allow me to finish the remaining six months. as a consequence, I effectively could never practice psychiatry as a profession.

You could, but you'd have to do 2 full years in your next program - i.e., repeat the first half of PGY-3 along with doing the second half and PGY-4.

 

[Faebinder]

what options are available for a resident who is force to resign or face termination in the middle of their pgy-3 year in psychiatry. unfortunately to be board eligible for psychiatry you have to have "2 consecutive years of training in the same program." I only have a year and a half, and my program director is not willing to allow me to finish the remaining six months. as a consequence, I effectively could never practice psychiatry as a profession.

Just repeat the third year, that simple. It's not too difficult to find a PGY3 position, but if your record looks ugly from what hapened before, you might have some difficulty. Meanwhile, moonlight away....

 

[cleareyedguy]

Some of the PD stories seem unbelievable, but people do weird things.

In my experience, we bend over backwards to encourage residents.

Terminations are very rare and basically limited to instances of dishonesty and blatant unprofessionalism.

 

[OldPsychDoc]

Some of the PD stories seem unbelievable, but people do weird things.

In my experience, we bend over backwards to encourage residents.

Terminations are very rare and basically limited to instances of dishonesty and blatant unprofessionalism.

Nevertheless, dishonesty and blatant unprofessionalism have been known to happen, and are unfortunately not as rare as they should be. That's why my PD in residency started off every year with the reminder "Don't have sex with your patients!"

 

[psychattending]

what options are available for a resident who is force to resign or face termination in the middle of their pgy-3 year in psychiatry. unfortunately to be board eligible for psychiatry you have to have "2 consecutive years of training in the same program." I only have a year and a half, and my program director is not willing to allow me to finish the remaining six months. as a consequence, I effectively could never practice psychiatry as a profession.

Several things:
1) In theory you should have some type of formal process where you can contest the termination issue. Of course you only want to do that if you believe the action the program is taking is unfair/unjust. All training programs should have your rights spelled out it a document. You should familiarize yourself with it.

2) Unless you transfered between your first and second year, you still should have two years that are consecutive.

3) Remember you need to at least have some clinical exposure where you are seeing outpatients for one consecutive year.

4) The psych boards do not look kindly on people doing a "split year" (i.e. doing a PG year in two different programs). If you do not clear it with them first, then you might not be board eligible.

5) Realize that PDs are routinely asked by Boards and other organizations whether a resident in their program functioned adequately and whether the resident was terminated or had his/her privelages reduced.

 

[Regnvejr]

One asked about midwest relaxed programs? My program in South Dakota was laid-back and everybody were helpful. Not much stress there.