The Mechanics of the DNR List

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I think its a matter of asking the right person in the right way.

And that's fine, but regardless of who was asked, it doesn't suggest she'll be hard to work with and "accommodate" isn't a legal term or whatever else nonsense the program used to justify it. This individual is a sparkling example of someone who has likely never worked and despite clinicals, doesn't understand the Chair doesn't make (or maybe even know?) the rules. But the program to draw such conclusions is the program's red flag, not the candidate's.
 
I think its a matter of asking the right person in the right way.

That said, as I pointed out previously I'm not sure this should land someone on a DNR list unless it was a particularly troublesome exchange.
Yeah. I mean no matter what the question is, if you’re harassing someone about something then you’re just being extremely inappropriate. But just asking a potential employer about benefits you’re entitled to should never land anyone on a DNR or even lower your position on the rank list. That’s potentially discriminatory, since they might be asking about maternity/paternity leave.
 
And that's fine, but regardless of who was asked, it doesn't suggest she'll be hard to work with and "accommodate" isn't a legal term or whatever else nonsense the program used to justify it. This individual is a sparkling example of someone who has likely never worked and despite clinicals, doesn't understand the Chair doesn't make (or maybe even know?) the rules. But the program to draw such conclusions is the program's red flag, not the candidate's.
I think the issue here, both legally and morally, has to be whether the reason they were DNRed was primarily about an excessive focus on benefits to the exclusion of other things, or whether it was primarily related to the fact that they were asking about maternity leave.

I’m not sure I would ever try to get someone DNRed for the first case, personally, but I can see how the right person in the right program culture might see it as DNR-able.

The second case, I think, is just wrong. I don’t think it matters who they asked about maternity leave. If they’re DNRing them because they asked about it, that’s wrong. It’s also illegal, which operaman has acknowledged.

From the legal side of this, programs like to think that nobody is going to be able to successfully fight a discrimination case of this sort, and they’re generally right. However, the consequences of such a case would be devastating. Obviously there is the whatever damages are recovered but more importantly there is the damage this would cause to the program’s reputation. Recruiting would be much more difficult after a scandal like this, and you better bet that every applicant will be scrutinizing how the program deals with that elephant in the room.

Also, as much as it is difficult to win employment discrimination cases like this, it’s not as far-fetched as it initially seems. The thing that makes these claims difficult is that the defendant can just claim that the decision was not based on consideration of any protected status. The thing is that this only works if everybody has their stories straight and nobody has verbalized the consideration of an individual’s protected class in the employment decision. In operaman’s example, it sounds like some faculty had expressed in a meeting that asking about maternity leave played a role in the decision. This is very bad for the program if they ever get sued because people are going to get deposed and, unless there is some sort of internal conspiracy regarding the testimony everyone will provide (which is a whole different, much bigger problem), somebody is going to mention the exact thing that operaman mentioned in this thread. Even worse would be if any of these conversations were even alluded to in emails, which is likely in this type of situation. I guess what I’m saying is that operaman’s program is lucky that whatever applicant this happened to did not find out about this, because it honestly sounds like it could be an unusually winnable discrimination case.
 
I think the issue here, both legally and morally, has to be whether the reason they were DNRed was primarily about an excessive focus on benefits to the exclusion of other things, or whether it was primarily related to the fact that they were asking about maternity leave.
Yes agreed. I was thinking of the second case but after reading @operaman points, i can see how the first case can be problematic. There's also the issue of tone in how the questions were raised (innocuously asking vs demanding programs to give them the benefits).
 
Yeah. I mean no matter what the question is, if you’re harassing someone about something then you’re just being extremely inappropriate. But just asking a potential employer about benefits you’re entitled to should never land anyone on a DNR or even lower your position on the rank list. That’s potentially discriminatory, since they might be asking about maternity/paternity leave.
Sure and we can only speculate about exactly how it went down, but the original post made it sound like more than just a question or two on the subject.
 
other than the recent discussion, these examples really make me wonder how on earth some of these folks made it into and through medical school?

@Goro
A few thoughts:

1) Interviewers tend to have good radar, but aren't perfect. Our all time worst student raised flags with 2/3 interviewers. The two who wrote down concerns didn't come the the Adcom meeting, and the 3rd was ambivalent, and so didn't go for a reject. Other interviewers are just natural sweeties, and thus like and admit any warm body they see. (side note: when Dr Sweetie rejects someone, you KNOW they were bad!)

2) In getting through med school, the student may have played the lawyer card and the school folded.

3) I've seen this happen at my school...negative comments about a student were outright censored, as the clinical Dean (no longer here) wanted all students to graduate

4) As an extension of #3, the school may have just wanted to get rid of the student, and have residency deal with him/her. The downside to this is that it can poison the well for the school at that program.

5) Some sociopaths can be very charming.
 
4) As an extension of #3, the school may have just wanted to get rid of the student, and have residency deal with him/her. The downside to this is that it can poison the well for the school at that program
Why not expel them? Judges can't force schools how they enforce professionalism standards
 
To follow up on Goro's thoughts:
- The two worst medical students I ever met both had physicians as parents. One's father was a big-wig at the program, and apparently during one of his many professionalism meetings he told the faculty "what are you going to do? My dad is your boss." After being held back a year, he got his act together. The other worst student had many, many complaints filed against him from faculty and other students. Nothing was ever done until a patient's family complained. I think schools may sometimes hope to just "pass someone through."
- In many programs evaluations from residents can get removed from MSPE upon request. This can mean that even fairly serious criticisms don't make it though.
- I'm assuming few med students have had a conversation with their faculty members after several drinks.

Why not expel them? Judges can't force schools how they enforce professionalism standards
See here, where a judge ruled exactly that. Granted that the case was later reversed, but the initial ruling essentially stated that an otherwise exceptional student cannot be dismissed for being a bad person. The actual appeals case is worth a read.
 
Too many people to reply to but in a nutshell:

1) I’m still referring to the initial poster who gave the DNR example. This wasn’t a scenario from my own program even if I certainly agree with DNRing the applicant in question.

2) the legality thing is interesting. I’m not sure it’s technically illegal to DNR someone who asks about parental leave so long as you aren’t doing it on the basis of sex or some other protected class. I would likely DNR a male applicant hounding me about how I’m going to accommodate his paternity needs too. I don’t believe future parental status is a federally protected class, no?

3) accommodations is definitely a legal term, pulled directly from the ADA specifically, but often applied to other areas. It’s a term that would catch anyone’s ear and invite extra scrutiny.

4) big difference between asking about basic benefits like sick days and parental leave. It’s another to push the issue and start asking how the program is going to cover your calls if your child has a last minute issue, or how they handle if you want to extend your leave to the point you have to extend your training, or if you can be dismissed early from clinical duties for childcare reasons, can you get out of call or not have to take more physically strenuous calls out of xyz concern for the pregnancy, etc. I don’t know how down the rabbit hole this girl went, but it was apparently far enough that the chair didn’t want to deal with the headache.

It’s never been an issue for me and my world, but I know friends at other programs when residents went kinda nuts and made exceptional demands that made everyone else miserable and of course they never tried to make it up after delivery. We all know this type of person and by golly I will blackball them every single time. Life is too short to deal with that crap.
 
This has been a very interesting discussion.

To add a bit more info, the girl who brought up faculty diversity was definitely being a bit aggressive about it. The all white male faculty (with the exception of the division chief) was something the residents had brought up before, and it was something we all wanted to be addressed. But the way she asked (and interacted with a lot of people) rubbed him the wrong way.

The girl who asked about maternity, according to him, came off as entitled. But none of us were in the room. I think the more likely scenario is that he didn't want to deal with yet another maternity leave in the program (three of us ladies had babies in a three year period).

That being said, the guy is also a real jerk.
 
The girl who asked about maternity, according to him, came off as entitled. But none of us were in the room. I think the more likely scenario is that he didn't want to deal with yet another maternity leave in the program (three of us ladies had babies in a three year period).
And that is the problem. Not sure why everyone always wants to jump to the defense of the program and assume the applicant is the one in the wrong when there are plenty of examples of residencies being like this.
 
2) the legality thing is interesting. I’m not sure it’s technically illegal to DNR someone who asks about parental leave so long as you aren’t doing it on the basis of sex or some other protected class. I would likely DNR a male applicant hounding me about how I’m going to accommodate his paternity needs too. I don’t believe future parental status is a federally protected class, no?

The Pregnancy Discrimination Act extended Title VII protections on the basis of sex to pregnancy and pregnancy-related conditions. It is definitely illegal to refuse to hire someone because they intend to become pregnant. This is why it is policy at most places (and forbidden by the Match) to ask about an applicant’s reproductive plans. While these questions aren’t technically illegal, they strongly suggest an intention to discriminate based on gender/pregnancy. Similarly, while it is not illegal to mention questions about maternity leave in a meeting about whether not to rank an applicant, I do think that such questions strongly suggest an intention to discriminate based on gender/pregnancy.

The actual language of the PDA specifically links pregnancy to the protected class of sex, not disability. Given that sex is a permanent characteristic, I think that it’s a stretch to interpret the law as saying that people are only protected from discrimination based on current pregnancy. My (non-lawyer) read of it is that pregnancy is considered part and parcel of sex for the purposes of Title VII discrimination. Given that it was clearly the legislative intent to prevent discrimination against women via their pregnancy status, I suspect that most courts would recognize that not extending those protections to women intending to become pregnant would clearly subvert the intent of the law. To be honest, though, I don’t know about the case law in this area. I might update this later if I find a relevant case.

The above is also just the federal law regarding the issue. Just as with HIPPA, the PDA is really just the minimum protections against discrimination on the basis of pregnancy. Many states and cities have laws that provide even stronger protections.

Aside from the discussion on this point of law, you can imagine how poorly the argument you’re suggesting would go over with a jury. It is very likely that many, if not most, members of a jury will be employed working people. I highly doubt that the argument of “We didn’t decide not to hire her because she was pregnant. We only decided not to hire her because we thought she might try to become pregnant while she was working for us.” would be very persuasive. I think that most juries would reactively despise any defendant who made that argument.
 
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The Pregnancy Discrimination Act extended Title VII protections on the basis of sex to pregnancy and pregnancy-related conditions. It is definitely illegal to refuse to hire someone because they intend to become pregnant. This is why it is policy at most places (and forbidden by the Match) to ask about an applicant’s reproductive plans. While these questions aren’t technically illegal, they strongly suggest an intention to discriminate based on gender/pregnancy. Similarly, while it is not illegal to mention questions about maternity leave in a meeting about whether not to rank an applicant, I do think that such questions strongly suggest an intention to discriminate based on gender/pregnancy.

The actual language of the PDA specifically links pregnancy to the protected class of sex, not disability. Given that sex is a permanent characteristic, I think that it’s a stretch to interpret the law as saying that people are only protected from discrimination based on current pregnancy. My (non-lawyer) read of it is that pregnancy is considered part and parcel of sex for the purposes of Title VII discrimination. Given that it was clearly the legislative intent to prevent discrimination against women via their pregnancy status, I suspect that most courts would recognize that not extending those protections to women intending to become pregnant would clearly subvert the intent of the law. To be honest, though, I don’t know about the case law in this area. I might update this later if I find a relevant case.

The above is also just the federal law regarding the issue. Just as with HIPPA, the PDA is really just the minimum protections against discrimination on the basis of pregnancy. Many states and cities have laws that provide even stronger protections.

Aside from the discussion on this point of law, you can imagine how poorly the argument you’re suggesting would go over with a jury. It is very likely that many, if not most, members of a jury will be employed working people. I highly doubt that the argument of “We didn’t decide not to hire her because she was pregnant. We only decided not to hire her because we thought she might try to become pregnant while she was working for us.” would be very persuasive. I think that most juries would reactively despise any defendant who made that argument.
Interesting! I'm not a lawyer either but I definitely enjoy reading about this stuff. Since the program didn't ask the questions though, I wonder how not hiring her for asking them herself would be construed. In this case the program isn't displaying any intent to discriminate, but the applicant is providing information not usually part of their hiring process, not to mention displaying poor judgement and possibly a poor attitude that suggests she isn't going to be much of a team player in any regard.

With the update above, it does seem this program had hired a number of young women who were either pregnant or became so during training, so at least on paper they seem to have been pretty welcoming. I would imagine those women were a little more tactful in how they broached the topic. It also means this applicant had at least 3 people with firsthand knowledge she could have asked that would have given her better info while not ticking off the chair.

The legal nerd in me also wonders: if pregnancy is linked to sex discrimination, and the program would equally DNR a man or woman who stated an intent to maximize their parental leave, they're essentially treating both sexes the same, no? Probably not any good case law in this area but would be interesting to see!
 
Interesting! I'm not a lawyer either but I definitely enjoy reading about this stuff. Since the program didn't ask the questions though, I wonder how not hiring her for asking them herself would be construed. In this case the program isn't displaying any intent to discriminate, but the applicant is providing information not usually part of their hiring process, not to mention displaying poor judgement and possibly a poor attitude that suggests she isn't going to be much of a team player in any regard.

With the update above, it does seem this program had hired a number of young women who were either pregnant or became so during training, so at least on paper they seem to have been pretty welcoming. I would imagine those women were a little more tactful in how they broached the topic. It also means this applicant had at least 3 people with firsthand knowledge she could have asked that would have given her better info while not ticking off the chair.

The legal nerd in me also wonders: if pregnancy is linked to sex discrimination, and the program would equally DNR a man or woman who stated an intent to maximize their parental leave, they're essentially treating both sexes the same, no? Probably not any good case law in this area but would be interesting to see!

I think that the fact that you DNRed a person who asked these questions is not a problem. There are all sorts of reasons why someone might have been DNRed which are not related to pregnancy. What I do think could be problematic is that it seems like some faculty were discussing her asking about maternity leave in the context of deciding not to rank her. I think that such a discussion would be viewed as very suspicious by a court or jury. Like, yes you can claim that it was the way she was asking and not what she was asking that led to her effectively not being hired, but I think that’s going to be an uphill argument if the plaintiff’s attorney can basically wave around a deposition where some faculty member admits that there was a discussion about how the applicant asked about maternity leave during the meeting where they decided not to rank her. Not only will they wave that around, but they will probably use that to impeach every witness for the program. I imagine this could go something like:

“Dr. PD, you said that you did not consider pregnancy in your decision not to rank applicant X, but isn’t it true that you discussed the fact that applicant X asked about maternity leave when you decided to place her on the DNR list?”

Or

“Dr. PD, do you consider Faculty Member Y to be a trustworthy person?”

“Of course. We work together frequently. They are a very good doctor and they are very trustworthy.” (Very unlikely a program director would malign a fellow faculty member from the stand, regardless of any personal beef they might have)

“In his deposition, Faculty Member Y stated that you had discussed that Applicant X was asking about maternity leave in the meeting where you placed her on the DNR list. Is this true?”

Basically, this is going to put people in the position where they’re either going to have to call fellow faculty members liars or admit that they basically discussed the applicant’s interest in maternity leave and DNRed her in the same breath. This would be very uncomfortable for all involved and would make the program look terrible.

I do think that the program would probably try to use a record of supporting pregnant residents in their defense. I just think that defense is more likely to work in a case where the link between the pregnancy issue and the employment decision is tenuous and less explicit. Like, I think that might be more effective if it was a case where some pregnant faculty member claimed that she was not promoted because of her pregnancy, and the reasons she believed this were the fact that she had been working there for a while and had a bunch of publications, but there were no comments made that implied that her pregnancy was considered. There, I think that the fact that they had promoted other women who had become pregnant during the course of employment would be a pretty strong defense. Here, the issue is that there potentially might be evidence that issues relating to potential pregnancy were discussed when deciding whether or not to rank the plaintiff. If I was the plaintiff’s attorney and the defense made a similar argument in that case, I would probably argue something along the lines of “the defendant is trying to excuse their behavior in this case by offering you many examples of instances where they did not discriminate against applicants, but it doesn’t matter how many times they followed the law in the past because they didn’t in this case. If I walked out of this courtroom right now and punched somebody in the face, the fact that I walked by dozens of people today and didn’t punch them in the face wouldn’t excuse my behavior.”

With regard to your last question, I’m also not sure. Paternity leave is relatively new (and the courts often lag behind social changes by several years). I suspect that the problem there would be that such practices might be construed as interfering with employees exercising their rights under the FMLA. Section 105(a) of the FMLA states:

  • (1) EXERCISE OF RIGHTS.--It shall be unlawful for any employer to interfere with, restrain, or deny the exercise of or the attempt to exercise, any right provided under this title.
  • (2) DISCRIMINATION.--It shall be unlawful for any employer to discharge or in any other manner discriminate against any individual for opposing any practice made unlawful by this title.

By the way, I don’t even disagree that it’s possible for applicants to ask these questions in ways that demonstrate poor interpersonal dynamics worthy of a DNR regardless of the pregnancy issue. I just think that any program making this decision has to be really careful because, if they’re not, the paper trail might look a lot like discrimination even if their motives were pure.
 
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3) accommodations is definitely a legal term, pulled directly from the ADA specifically, but often applied to other areas. It’s a term that would catch anyone’s ear and invite extra scrutiny.

Just because the ADA used it does not make it a legal term. The origin of the word predates the ADA by like centuries. It doesn't become a legal term just because it's used in a law. Any program who is afraid of the word is revealing their own red flags. In fact, I'd say they're shouting it from the rooftops.

4) big difference between asking about basic benefits like sick days and parental leave. It’s another to push the issue and start asking how the program is going to cover your calls if your child has a last minute issue, or how they handle if you want to extend your leave to the point you have to extend your training, or if you can be dismissed early from clinical duties for childcare reasons, can you get out of call or not have to take more physically strenuous calls out of xyz concern for the pregnancy, etc. I don’t know how down the rabbit hole this girl went, but it was apparently far enough that the chair didn’t want to deal with the headache.

Wait, you're just assuming that. Yea she went far enough that the Chair didn't want to deal with it, but the Chair also could have just been a jerk and had no tolerance for any such question. It isn't like that's unheard of.
 
The girl who asked about maternity, according to him, came off as entitled. But none of us were in the room. I think the more likely scenario is that he didn't want to deal with yet another maternity leave in the program (three of us ladies had babies in a three year period).

We had 3 in one year (4 if you consider an adoption with paternity leave). The walls did not crumble. Programs that discriminate suck.
 
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