Termination

[Lostin_space]

As @Winged Scapula has said this conversation has gotten circular and isn't really benefiting OP at this point.

However, for the last time. It was a forgery. There is no "right" or "philosophically correct".

There are some relatively firm rules in life. DON'T ALTER OR FALSIFY DOCUMENTATION IN YOUR APPLICATION OR CREDENTIALING is about as clear cut of one as there is.

I agree with that, I just simply think OP should have gotten another chance. Sometimes out of desperation people do stupid things - not because they are evil, nefarious, dishonest awful people, but out of anxiety, stupidity, fear, etc. As someone who has been on the board of discipline hearings for some time at a number of institutions, I have been on the more "kind" side of "let's not destroy this person" and give them a chance - at least once. Most of those people have corrected their errors, and have had successful careers where they do a lot of good and are excellent physicians.
I think OP got a terrible deal.

That's all I'll say about that

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[Lostin_space]

I appealed and during my appeal provided strong evidence that I was the only surgeon in well over 300 cases as well as character reference letters from former attendings, former chief and co-residents and former medical school classmates but termination was upheld.
I never defended my actions during the hearing, apologized, acknowledged responsibility and accountability and agreed to be placed on probation. But no cigar.

really sorry dude. My heart really goes out to you. I would encourage you to see if you can find another spot in another program with your PDs support. I don't think your career is over, and I think you have honestly learned from your mistake.

 

[Iahmdid]

As @Winged Scapula has said this conversation has gotten circular and isn't really benefiting OP at this point.

However, for the last time. It was a forgery. There is no "right" or "philosophically correct".

There are some relatively firm rules in life. DON'T ALTER OR FALSIFY DOCUMENTATION IN YOUR APPLICATION OR CREDENTIALING is about as clear cut of one as there is.

As @Winged Scapula has said this conversation has gotten circular and isn't really benefiting OP at this point.

However, for the last time. It was a forgery. There is no "right" or "philosophically correct".

There are some relatively firm rules in life. DON'T ALTER OR FALSIFY DOCUMENTATION IN YOUR APPLICATION OR CREDENTIALING is about as clear cut of one as there is.

I like that you want to end the argument and have the last word with an almost "Ten Commandments" style proclamation about what is right or wrong.

Im not just a sheet of paper. I made a mistake (and we can argue back and forth about how bad of a mistake it was indeed) but the ramifications far exceed the intention of someone who wanted to represent themself accurately in an application and I can only say yes I did it the wrong way so many times.

 

[Iahmdid]

I like that you want to end the argument and have the last word with an almost "Ten Commandments" style proclamation about what is right or wrong.

Im not just a sheet of paper. I made a mistake (and we can argue back and forth about how bad of a mistake it was indeed) but the ramifications far exceed the intention of someone who wanted to represent themself accurately in an application and I can only say yes I did it the wrong way so many times.

I also love the use of captions when making a point. Its like I didn't agree before but shoot now that its in caps I am totally on board.

 

[Iahmdid]

If you want to whine about what's fair or not, I suggest you keep on going in this thread.

If you want another shot, you need to absolutely own this. No whining, no excuses. Moving forward, the only attitude you can take is that this was a huge mistake on your part and that you realize what a lapse in judgment you made.

That I can agree with.

 

[rokshana]

I understand what you are saying in regards to the "forgery" as you call it, but I think some of us see it differently. It's not really a "forgery" if it's in fact true. I think firing someone without giving them a chance to remediate their mistake especially after they acknowledged they made a mistake and have not had an issue before is way harsh. People who commit serious crimes are given more of a chance!

Are you saying OP should not at least have gotten probation?

that you put "forgery" in quotes shows that you don't get it...without authorization, he changed an official document...there is no gray here...it is black and white...he forged papers, period.

now whether this act should have resulted in termination...that can be a point of debate...maybe the program saw this as a big red flag in the character of the OP...if he is capable of doctoring this kind of paperwork, what else would he be capable of altering...medical records? prescriptions? for the OP's PD and program it was such an egregious error in judgement that THEY determined that the punishment would be termination and not probation...if he was at another program maybe he would have gotten a different punishment.

 

[hello1234!]

I had a two year old report that was inaccurate and could not be changed unless I was back in residency which I likely would not be able to with a report that said I did 15 cases in two years.

This kinda shows that you were trying to be deceitful because you knew this would look bad and didn't own up to it right away.

Gaining the privilege to operate is a big deal. As a patient and as a doctor I want hospitals to take credentialing seriously, and lying on an application about the number of cases that are listed on a report is a really really big deal.

I still think you will be able to match again. But only if you own up to the seriousness of this mistake.

 

[Lostin_space]

that you put "forgery" in quotes shows that you don't get it...without authorization, he changed an official document...there is no gray here...it is black and white...he forged papers, period.

now whether this act should have resulted in termination...that can be a point of debate...maybe the program saw this as a big red flag in the character of the OP...if he is capable of doctoring this kind of paperwork, what else would he be capable of altering...medical records? prescriptions? for the OP's PD and program it was such an egregious error in judgement that THEY determined that the punishment would be termination and not probation...if he was at another program maybe he would have gotten a different punishment.

This kinda shows that you were trying to be deceitful because you knew this would look bad and didn't own up to it right away.

Gaining the privilege to operate is a big deal. As a patient and as a doctor I want hospitals to take credentialing seriously, and lying on an application about the number of cases that are listed on a report is a really really big deal.

I still think you will be able to match again. But only if you own up to the seriousness of this mistake.

I think he's already done that, no point in destroying him. And he did not lie about the # of cases since he had proof.

 

[Iahmdid]

This kinda shows that you were trying to be deceitful because you knew this would look bad and didn't own up to it right away.

Gaining the privilege to operate is a big deal. As a patient and as a doctor I want hospitals to take credentialing seriously, and lying on an application about the number of cases that are listed on a report is a really really big deal.

I still think you will be able to match again. But only if you own up to the seriousness of this mistake.

You are right about that. It was wrong and egregious.

 

[RadOncDoc21]

This kinda shows that you were trying to be deceitful because you knew this would look bad and didn't own up to it right away.

Gaining the privilege to operate is a big deal. As a patient and as a doctor I want hospitals to take credentialing seriously, and lying on an application about the number of cases that are listed on a report is a really really big deal.

I still think you will be able to match again. But only if you own up to the seriousness of this mistake.

I respect the credentialing process but you have to admit, the admins can be a little cray cray... i.e. Explain to them why you took a month off after residency to move across the country and study for boards. Off topic, I know and apologize.

 

[sazerac]

It is clear in this case that they forged the number of surgeries performed, and it's also clear that they demonstrated an entirely unreasonable approach to getting that number fixed. They showed some serious unprofessionalism here. Honestly, I'm surprised they weren't punished to a much greater extent than what was reported in this thread. I'm not advocating for the complete termination of their careers, but perhaps the ACGME should pay a substantial fine or even go a year without pay while they ponder what kinds of changes need to be made in the future to avoid situations like this.

 

[Iahmdid]

It is clear in this case that they forged the number of surgeries performed, and it's also clear that they demonstrated an entirely unreasonable approach to getting that number fixed. They showed some serious unprofessionalism here. Honestly, I'm surprised they weren't punished to a much greater extent than what was reported in this thread. I'm not advocating for the complete termination of their careers, but perhaps the ACGME should pay a substantial fine or even go a year without pay while they ponder what kinds of changes need to be made in the future to avoid situations like this.

Nope I didn't forge the number of surgeries performed , those were accurate. but I did have an unprofessional approach after I thought I exhausted my options but I didn't think to ask my PD write a supplement letter explaining the descrepency and I should have. That was a big mistake. I don't know what you think is worse than a termination but Im quite exhausted by the back and forth defense on my part because clearly now folks are interested in emphasizing punishment.

I came on initially to share, seek support and was hoping others may have some helpful advice but maybe that was unrealistic.

Peace.

 

[rokshana]

I don't know what you think is worse than a termination...

being banned by the ACGME and NRMP to participate in the Match....

 

[sazerac]

Nope I didn't forge the number of surgeries performed , those were accurate. but I did have an unprofessional approach after I thought I exhausted my options but I didn't think to ask my PD write a supplement letter explaining the descrepency and I should have. That was a big mistake. I don't know what you think is worse than a termination but Im quite exhausted by the back and forth defense on my part because clearly now folks are interested in emphasizing punishment.

I came on initially to share, seek support and was hoping others may have some helpful advice but maybe that was unrealistic.

Peace.

Oh no, my friend! I must apologize; my humor can be a bit "rye" if you are not used to it...

Please carefully reread my post again... I kept saying "they" behaved incorrectly, but by "they" I meant the ACGME itself! The ACGME reported false information. The ACGME ought to be punished. Etc.

I have the utmost respect for a colleague with 5 years experience more than me, and I wish you all the best during this very difficult time. At the very least you are able to get a medical license in some, if not all US states. But I hope you get board certified too.

Waʿalaykumu s-salām

 

[RangerBob]

I can understand the OP's need for venting--I'd be pretty frustrated too (especially with myself) if I were in the same situation. Sometimes we just need time to process this kind of huge change. But ultimately there's no point in complaining or getting upset about the things we have no power over. That's one of the keys to happiness and preventing cynicism.

I think the other surgeons in this thread gave the advice the OP needs--ultimately there's really nothing that can be done about the termination (whether it's perceived as fair or not) because the OP already exhausted all appeals/options short of getting a lawyer and taking legal action (which would probably be a long shot given the circumstances, and would also likely back-fire at it would vastly worsen relations with the program that future programs will want to talk to to understand the circumstances of the termination. Still, everyone has the right to legal counsel if they want it).

OP--it's time to move forward to try to re-start your career. Reach out to both your PD's (the former program and the one from the program you were terminated from) and ask if they would support your application to another residency program. I don't know if this situation is the kill-stroke for any surgical residency--the only way to find out is to try. People leave programs all the time, so you may be able to find openings now. But you can certainly find other residency programs if gen surg is out of the picture.

 

[NotAProgDirector]

So the question now is how to move forward. There is no easy answer.

First, the OP obtained a PGY-3 surgery position after two prelim years and 2 research years. This suggests some other issue with their application, likely an IMG. Or weak USMLE's. Or weak ABSITE. In any case, most people don't volunteer to do 2 prelims and then 2 research years. I mention this because getting that PGY-3 position probably wasn't easy, and now getting another will be a challenge.

Second, the whole termination decision might have been out of the PD's hands. The GME office may have decided this, and there's not much I can do if they do.

The OP's best chance is back at their home program. But I worry about that also -- they had 4 years to take the OP as a categorical and chose not to.

So, options:

1. Look again for a PGY-3. Hopefully the program you've just been terminated at still speaks well of you. If you've owned up to this as you've said, they probably will. It's going to be a seriously uphill battle.

2. Choose a new field, and apply -- something less competitive.

3. Try to get back into your original PGY-1/2 program. If they have no spots, and want to take you, they could consider taking an extra prelim and one less categorical this year. Then, you join their program as a PGY-2 next year. This means you repeat your PGY-2 but at this point, you don't have many options.

4. Try to get back into the program that just terminated you. This is probably hopeless, but a well worded letter of apology to the GME director and PD might go a long way. You could offer to talk about your professionalism lapse to your colleagues, these types of discussions can be very helpful. I seriously doubt this will be an option, but a letter costs nothing but a stamp.

 

[Winged Scapula]

If the OP has a good relationship with the former PGY-3 PD, it would be worth asking (if not already known and not revealed here) about the specific reasons for the termination.

As APD notes, it may have been the GME office making the decision in which case you may have a shot elsewhere.

However, the American Board of Surgery (ABS) takes a "zero tolerance" policy toward unprofessionalism and unethical behavior and they specifically mention falsifying information. Most programs will not train/continue to train residents who cannot be board eligible. If this was the reason that the appeal failed, then the OP is unlikely to find another surgical program who will take a change on him.

It probably doesn't need to be said but if the OP does manage to get into another surgery program, that its his last chance. Frankly, that's probably true for any specialty.

 

[mimelim]

This thread hurts my head. I mean its ****ing 4am and I'm still waiting for my cold leg to roll back, so that might be contributing, but **** this thread is painful.

 

[MediCane2006]

This thread hurts my head. I mean its ****ing 4am and I'm still waiting for my cold leg to roll back, so that might be contributing, but **** this thread is painful.

Ah, I do not miss vascular surgery

 

[hello1234!]

OP, are you having any luck in your search for a new program? I'm rooting for you to find something.

 

[fhockey13]

1. The ACGME case log system is a cluster. People are constantly inadvertently logging procedures incorrectly because of this. Then finding out chief year the cases they did intern year "didnt log properly" because they didnt log the "right" procedure for major credit. This system issue causes so many problems for everyone concerned
2. There is so much sketchy logging that residents do to get their numbers that I'm surprised you got such a harsh sentence for a similar offense --all be it yes I get the forgery issue
3. Unfortunately yes once its an official document that you altered it becomes a bigger deal. That being said, your intent was to correct a document (again not the best way to do so obviously). Its not like you were forging a medical record, forging your attendings signature etc--- all of which have more malignant intent.

 

[fhockey13]

You have to keep generating those reports every few months and compare it to your own log because inevitably theres something that should have been logged differently. Especially to get scope numbers. and compare it to your log because you generate that report and then look at your log theres invariably one or two things you have to go back and change The sketchy logging I was referring to was more in terms of role in the case. actually doing 30% to log it as surgeon jr/sr, resident/fellow double scrubbing).

Re: #1 - I disagree. Maybe it's different for other specialties but for general surgery it's really easy to use. You can break down the CPTs by defined category or frequently used. It also VERY CLEARLY says if a CPT is not for major credit or not a defined category. We do a "how to log" session for interns and don't have many problema after that. Also if you are being personally responsible for your logs - it's very easy to export the defined category report (that's the "definitive" report for your graduation numbers) and make sure things are on track. Hopefully if your PD is good they are doing the same...but it's your ass on the line so you should take responsibility.

Re #2 - do so at your peril. ABS/ACGME can audit

By sketchy logging I was referring more to how accurately people report their role in the case (actually doing 30% to log as surgeon jr/sr, actually walking the junior through most of the case to log chief resident role etc.) And fellow/resident double scrubbing with an attending on a case and both logging it. Which I thought wasn't technically allowed because cases had to either be resident or fellow.

 

[bannie22]

Any luck OP? Sounds like a very unfair trial, or lack of one.

Being a surgeon or not has nothing to do with comprehending something so simple.
OP logged cases, ACGME report was erroneous, OP called ACGME who told OP that this cannot be fixed within the system at this time. OP submitted application with corrected report of cases.

How OP could be fired for this is baffling.

You could say equally that all surgical residents who "exaggerate" their position in the case or complexity of the case also be unprofessional. Or those that forgot to log, as similarly unprofessional. Or those that forgot to log, and now log something "approximately" correct as equally unprofessional.
Anyone, then can be fired... just pick.