Razorback,
how could they terminate a resident without written warning of any kind? It seems legally risky from the program's point of view.
Perhaps, but at some programs it is done frequently, (or at least less than rarely). This is a topic I know something about. A program terminated two residents quietly the year before I went there, affluent community hospital, prestigious town, etc. The year I arrived, it terminated 5 more. Of these, two were justified.
At least two of the residents were ordered to see a hospital appointed psychiatrist who found "issues." One of the residents was concerned about program mis-information meant to induce residents to rank the program, another about rules violations and a third just complained at the wrong time following a prolonged on-call time (over 40 hours on duty).
One of the residents called me after a final year contract was signed and a week later he was terminated on Christmas Eve. The phone call I got frightened me enough that I insisted this resident come over for dinner. Suffice it to say, that had I not interceded, another UW story would have been repeated.
I worked with these residents, know their stories, know the hospital's side, and know the truth.
In each of these cases, the program's actions were precisely the same. It was though they were reading from the same comic book, only the names of the residents were changed. Four of these residents went on to get into other programs, although it took between 2-4 years to move on. They have all completed their next residencies and are in practice and doing well. I am privy to things that would curl your hair, and lead you to wonder why anyone would ever consider medicine as a career.
A resident at another program in the same system reported to me that "program directors have a meeting where they learn how to 'punish' residents who displease them." [Language tidied.]
Fortunately, I have met with many residency directors at professional meetings, regional medical society meetings and in other forums, who are honest, dedicated and diligent. In discussing these concerns with them, they universally decry such behavior, but when asked if they would work to help remediate such residents, nearly all are at least somewhat reluctant to help residents on the outs with a program. In the words of one PD, "...these guys need to be stopped. They make us all look bad." But, people are afraid that residents with "problems" may actually have problems.
The "nuclear option" is not viable. In many states, the legal protections for residents are non-existent. The courts, the medical boards, feel that "protecting the public" from "bad doctors" trumps the individual. They defer to the program directors and the hospitals who employ them, in all but the most egregious cases. This, coupled with the NRMP match and expectations that once in a program, no matter how bad, no matter how misled one was in selecting a program, you will finish in that program and nowhere else.
This leads to a situation ripe for abuse, human nature being what it is. I agree with above posters who think we need some form of independent, unbiased review with teeth, particularly in light of the ACGME's repeated unwillingness to call abusive programs to task. The ACGME states it will not intercede on behalf of individual residents, the NRMP says it is only a "matching" operation and once the contract is signed, its role is consumated.
This situation was, in part, the basis for the NRMP lawsuit by Paul Jung and company. Not only is the NRMP anti-competitive, it also deprives every single person in residency of a freedom to move from one position to another.
This is not likely to change, as it benefits the hospitals and the government, in that residents are economically and physically restricted from seeking better positions, thus allowing bad programs to continue unabated with little to no incentive to improve. And the powerful will not voluntarily relinquish their power.
I had no idea.
