Termination of PGY1 contract

[Taurean]

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[PsychFuture]

I am very surprised that this could happen. Why would your program do this to you?

 

[Yasergale]

you have a good chance of winning the appeal if you do it and if there has been no written prior warning that you have not been performing well.

amazingly this is happening more and more often.

remember we're nothing more than cash from the government and cheap labor.

 

[blue2000]

My contract with the residency was terminated two days prior to the end of the internship year without any chance for remediation within a program and obviously no place to go as this came as a surprise. Because they failed me, I do not have a certificate of the completion of internship. I am appealing the decision and would like to ask if anybody had a similar experience and whether the outcome of the appeal was successful. I realize that every case is different, but I would like to ask for help and support from our student doctor community network in my upcoming struggle. It would be helpful if people shared their experiences or gave me helpful hints and suggestions on what to do/not do, etc. As I don't know many people in the area where I am at, I will be doing most of the work myself (i.e. drafting letter of appeal, gathering evidence, etc). As I cannot afford a lawyer, I guess, I'll get to practice my own skills, unless somebody is willing to give me a "free" legal advice here. 🙂

Thank you all in advance for your responses.

you need to contact a lawyer, and if you have to beg, borrow or steal to do it, you should. You wouldn't attempt surgery on yourself, you shouldn't try to represent yourself. If the situation is as described, you need to have someone who understands the game playing with you.

 

[Taurean]

you have a good chance of winning the appeal if you do it and if there has been no written prior warning that you have not been performing well.

amazingly this is happening more and more often.

remember we're nothing more than cash from the government and cheap labor.

I did not pass one of my rotations during the course of the year, so in a way I had a prior warning, but I was working with the program director on ways to remediate that rotation and that was supposed to happen in July at the beginning of the second year with the idea that if I pass, I will receive a 2nd year contract and continue. The next thing is they fail me in my other rotation in June without any warnings in the process and, according to policy, you cannot continue with two failed rotations. They didn't even offer me an opportunity to repeat the whole year when I asked. What's interesting is that on paper I look good: all my evaluations, except for one, have marks between satisfactory and stellar, yet I am failed by allegedly unanimous decision at the executive faculty meeting. Some of those faculty only worked with me on a couple of occassions. It looks to me like some kind of a plot. They even hired an extra R2 resident prior to the end of the year, which looks like they anticipiated my departure. So, I will fight...

 

[16846]

you need to contact a lawyer, and if you have to beg, borrow or steal to do it, you should. You wouldn't attempt surgery on yourself, you shouldn't try to represent yourself.

Totally agree. Representing youself is the a surefire way to lose. If you can't get money for a lawyer, plead your case for pro bono assistance. I am sure you can find someone who is willing to help you.

 

[edinOH]

Most programs have a method of due process and appeal through the educational institution they are affiliated with. Have you investigated this? They should have well-documented your short-comings throughout the year as well as your signed acknowledgement of them as well as steps you and the program were going to take to fix them. If none of this was done, I think you would have a strong case through an institutional appeal.

Of course there may be associated legal aspects to this situation which none of us are really qualified to explain. I agree with the other posters that you should seek legal advice. I'm sure a lawyer could help you determine what institutional policies are in place for these situations.

Good luck.

 

[Justin4563]

first off you need to tell us what specialty.. IF its in a primary care field.. t wont be too difficult for you to find something else... seriously.. go somewhere else.. if its in a tougher specialty like ent or orthopedics.. your career in one of t hose specialties are pretty much caput.. but if its not its obvious that you had a personality difference with the program.. try to see if you can do something so that they could at least grant you credit for t he year then move on.. go to the next program try your best.. and sue the pants off the first institution for not giving you ample time to remediate.. not giving you ongoing feedback into how you were doing.. IF you dont know you are doing something wrong you cant fix it.. thats the job of the program.. so let us know

 

[hello23]

Just curious. How does one fail rotation as intern/resident? There is no exam at the end of the rotation as far as I know, right? Or by ditching, etc? Thx

 

[Taurean]

first off you need to tell us what specialty.. IF its in a primary care field.. t wont be too difficult for you to find something else... seriously.. go somewhere else.. if its in a tougher specialty like ent or orthopedics.. your career in one of t hose specialties are pretty much caput.. but if its not its obvious that you had a personality difference with the program.. try to see if you can do something so that they could at least grant you credit for t he year then move on.. go to the next program try your best.. and sue the pants off the first institution for not giving you ample time to remediate.. not giving you ongoing feedback into how you were doing.. IF you dont know you are doing something wrong you cant fix it.. thats the job of the program.. so let us know

It IS a Family Practice program and I started a similar thread in the FP forum with a little more detail. Part of the problem WAS a personality issue with the faculty and personnel. I guess, I was just so different they couldn't tolerate it. For example, MAs at the clinic didn't like the fact that I was somewhat formal in my communication with them, they therefore thought I was "talking down to them," or drawing the line between us. I am an FMG, but I have been living in the US for the last 12 years. I still speak with an accent because I immigrated at 23 and obviously have cultural traits that are different from American ones. For example, it is in my culture to call someone who is older or more superior in position than you by Mr./Mrs./Dr. and I cannot address the attendings or even my older patients by their first name, although it is very common here, on the West Coast. It just doesn't come out, but people had hard time understanding that it was what I grew up with and it was hard to change. I was actually fine with MAs calling me by my first name, but they spread the rumor that I insisted they called me Dr. ___. The main point, however, is that the issue was never brought up to me till 2 days prior to the end of PGY1, although MAs complained to clinic director on a few occasions.

The faculty haven't even given me feedback on my clinical performance, but when I was on the in-patient service in June, they started saying that I was not ready to become a senior, even though my medical knowledge was good, but I was "not taking more ownership of the patients, not taking more charge in my actions and couldn't accept patient care responsibility at the level of R2", etc. Well, if this is true, they have to extend my intern year and give me some time to become more "confident," can't they? This is not the reason for terminating a contract, just like personality difference isn't.

So, I will sue them and will try to get into a different program. There are a couple of IM residencies in the area and one has many FMGs, perhaps I will be better understood there.

 

[Taurean]

Just curious. How does one fail rotation as intern/resident? There is no exam at the end of the rotation as far as I know, right? Or by ditching, etc? Thx

By evaluation of the faculty on your performance.

 

[Justin4563]

sue them for wrongful termination and throw in discrimination to boot.. Even if you dont win any money they will be sorry they wrongfully terminated you. Get a copy of the acgme residency guidelines and comb through it. Make sure you know what they did wrong, which t hey did.. It should be interesting..

 

[docB]

I recommend holding off on any suits until you figure out what you want to try to do next. If you're hoping to pick up with a different program you may want to see if your old program will at least help you do that by providing your records and so forth. Once you sue them they'll clam up and you'll be totally on your own. If you already have another option or they have said they won't help you move on or if you just want revenge ASAP then go for it.

 

[southerndoc]

Just curious. How does one fail rotation as intern/resident? There is no exam at the end of the rotation as far as I know, right? Or by ditching, etc? Thx

Some of our rotations have exams (i.e., EMS).

 

[Taurean]

Most programs have a method of due process and appeal through the educational institution they are affiliated with. Have you investigated this? They should have well-documented your short-comings throughout the year as well as your signed acknowledgement of them as well as steps you and the program were going to take to fix them. If none of this was done, I think you would have a strong case through an institutional appeal.

Of course there may be associated legal aspects to this situation which none of us are really qualified to explain. I agree with the other posters that you should seek legal advice. I'm sure a lawyer could help you determine what institutional policies are in place for these situations.

Good luck.

When directors gave me a written notice of termination, they also gave me a single sheet of paper that indeed outlined due process policy, according to which I can appeal the decision to CMO, who is actually friends with the PD. So, my question is whether to go through the institutional appeal, or consult an attorney and take the matter straight to court. The fact is, the program doesn't have well documented short-comings and ways to fix them, i.e. there is NO formal probation letter signed by me, or steps the program and I were going to take, except for one - the acknowledgment on the part of the program that they would try to find a placement for me to remediate my OB rotation. I guess I will have to consult a lawyer regardless of what I'll do next. Even if I appeal through institution, he/she will help me draft an appeal letter properly. Any other comments?

 

[Milo]

Sounds pretty fishy to me. They're firing you because of your accent and your rapport with MAs? I'm dubious.

Why exactly did you fail a rotation? malpractice, negligence? Surely you won't have us believe that you failed a rotation because the MAs didn't like you. What steps did you take at that point to remediate? What are you leaving out?

 

[Taurean]

Sounds pretty fishy to me. They're firing you because of your accent and your rapport with MAs? I'm dubious.

Why exactly did you fail a rotation? malpractice, negligence? Surely you won't have us believe that you failed a rotation because the MAs didn't like you. What steps did you take at that point to remediate? What are you leaving out?

I thought I mentioned the reasons why they failed me, but in any case, there was no malpractice or negligence; the MA's feedback was just adding to the issue. And I couldn't take any steps to remediate anything because I was never informed of existing or potential problems. I don't know what it is with this particular program, but there seems to be an absolute lack of timely and/or direct feedback from the fellow residents, faculty or director, even a good one! Those residents who went on to continue as R2 didn't even have their evaluations discussed with them at the end of the first year, at least not yet.

It almost looks like they fired me out of convenience, because by the end of June they found out that they couldn't arrange an OB rotation in July, as planned earlier, so perhaps they wanted to avoid a headache of dealing with me in the future.

 

[f_w]

Three small bits of advice:
- talk to an experienced employment attorney before you do anything else
- talk to an experienced employment attorney before you do anything else
- talk to an experienced employment attorney before you do anything else

Seriously, you might still be able to fix at least part of this rotten situation. The least you can require from them is to stick to their own policies. But before you go through the 'appeals' process, make sure to get good legal advice. If there is some sort of meeting, have a witness or your attorney present. A letter with 'Esq' and 'LPA' in the letterhead often puts the fear of god into unruly program directors. If they have the paper trail to show that you are incompetent or unprofessional and that attempts at remediation have failed, there won't be too much you can do. But if you can show that they didn't stick to their own process (and they rarely do), you can fix this.

I wouldn't want to stay at a place that treats me like this anyway. But at least you have to get an 'honourable discharge' and credit for the 'time served' out of them.

If allowed to stand, this firing from your residency will cost you lots of time, money and jobs in the future. Even a substance abuse history won't do as much damage to your career as getting fired from residency. If you allow this to stand unchallenged (or if you make it worse by trying to fix it on your own), this will be a huge black mark on your professional CV.

(And no, I don't think it is bc you speak with an accent and address the MA's as 'Mr' or 'Mrs'.)

 

[f_w]

And I couldn't take any steps to remediate anything because I was never informed of existing or potential problems.


This is where you can get them. Get out that dusty copy of your 'residency handbook' or 'housestaff manual' they gave you during orientation. It should spell out the process for discipline and firing of residents. If you sucked on your OB rotation, they should have given you an opportunity to repeat it (and document so). If your interpersonal skills with the ancillary personnel were indeed an issue, they need documentation that this was addressed with you and that a period of probation and remedial counseling failed to improve it. If your 'sense ownership of patients' was an issue, there should be documentation to that effect including the programs attempts to remedy it.

They need copies of 'insufficient' evaluations with your signature on them. They need minutes from meetings with you were a plan for improvement was discussed. If they don't have that, you have a chance to fight it successfully (successful in this context means that you can leave the program with credit for PGY-1 and that your 'official' evaluation on file says that you performed 'satisfactory'. Your informal evaluation given by the PD over the phone will allways be scathing, but this is not what a credentialing committee would get to see 15 years down the line)

In my limited experience of having seen a few residents leave programs, it is actually quite difficult to fire someone (at least at the academic institutions I trained at).

There are only few things that can get you fired without much recourse (violations of laws that can be expensive for the hospital e.g. HIPAA) or sexual harassment.
Everything else is A. not immediate (it is a monthlong process) B. can usually sucessfully fought with a good attorney.

You will have to go through the institutional process first before you can go to court. But be sure to have good counsel for the institutional process. The courts don't like to touch these academic type cases. They defer to the qualifications of the PD to decide on academic matters.

The only way you might be able to get them in court is by showing that they failed to stick to their own process and that your firing is therefore 'capricious' and 'arbitrary'.

Having counsel and 'threatening to sue' are two different things. 'Threatening to sue' might be helpful at times, but it just works so much better if it comes on gold-embossed letterhead rather than screamed at the PD through a half-open office door.

 

[Taurean]

Thank you, f_w for your detailed reply. It was very helpful and encouraging. I should be very hopeful now.

 

[odieoh]

Sounds pretty fishy to me. They're firing you because of your accent and your rapport with MAs? I'm dubious.

Why exactly did you fail a rotation? malpractice, negligence? Surely you won't have us believe that you failed a rotation because the MAs didn't like you. What steps did you take at that point to remediate? What are you leaving out?

I must agree this sounds like there is more to the story than we're hearing. There is absolutely no advantage to the program to fire a resident unless that resident was posing a threat to patient care/safety. Firing a resident for any reason hurts programs because word gets out and then less people apply to the program because who wants to go somewhere where residents get booted. . . especially in a primary care residency where many spots go unfilled. So really there has to be something more going on. I'd be very interested to hear the program's side of the story.

 

[Taurean]

There is absolutely no advantage to the program to fire a resident unless that resident was posing a threat to patient care/safety. Firing a resident for any reason hurts programs because word gets out and then less people apply to the program because who wants to go somewhere where residents get booted. . . especially in a primary care residency where many spots go unfilled. So really there has to be something more going on.

Would it be helpful for you to know that they fired another intern 2 weeks before they fired me!? That person did not fail any rotations except CLINIC (throughout the year) by not being able to finish the tasks on time secondary to ADHD, and with the totally computerized system it was a bit challenging. The tasks, such as clinic notes, were eventually completed, but with a significant delay (days). The program at least made attempts to help the intern in question by providing biweekly counseling sessions, suggestions on how to improve the work space, etc. However, no actual changes were made to help the person succeed. No certificate of completion of PGY1 was provided either.

So, I don't know whether this program is crazy or too strict, but I guess it doesn't care about word getting out when they "boot" the residents.

 

[docB]

One thing about this board is that it's a annoymous as the poster wants it to be. One sided stories are the rule, not the exception. In this situation the OP can let on as much or as little as they want. If the OP is looking for advice, as this one is, they have an incentive to be as candid as possible so that the advice will be better. Maybe the OP doesn't know about any other problems that precipitated the termination. It sounds like if nothing else the communication at that program is not good. Sometimes you have to take the info you're given and go with it. Trust me, I'm an ER doc.

 

[Taurean]

It sounds like if nothing else the communication at that program is not good.

My point exactly!

 

[APACHE3]

Which state is the program in? I'm applying to FM programs, so send me a private post of what program this is to AVOID at all costs! Thanks 😱 PS and I think some sound advice has been given to you. Without proper documentation by the program, you should be able to beat this rap! GL

 

[ORBITAL BEBOP]

I have seen some programs take in-training exams results very seriously-to the point to flagging weaker residents, trying to remediate them, and then not renewing their contract.

Anyone else notice this with intraining exams?

 

[8744]

Face it folks. Your residency program has you by the short ones.

 

[kauai]

Yes, some residency programs do use in-training exams to identify weak residents which can result in a non-renewal of contract. Some programs have actual set scores that a resident must achieve or be subject to some type of remediation, probation etc. Other programs use it as a guide to assist residents who are having problems and make a sincere effort to help those residents so they can graduate from the program and pass the Boards. It is my understanding that there are studies that have concluded that scores on in-training exams are often a predictor of how a resident will ultimately do on the Boards and thus the reason why programs are concerned about in-training exam scores. I don't think that when most people are interviewing for residency that they know much about in-training exams or what the policy of specific programs they are interviewing at might be.