UTSW Austin Psych Program - Scary Story

[Texasishome]

I'm an Austin native, but moved to Boston for med school. I was hoping to return to Austin to complete my psychiatry residency at UTSW-Austin. A friend of a friend is currently a PGY-4 in that program, so I called up that PGY-4 yesterday to get an insider's perspective on applying, interviewing, working conditions, etc.

I was shocked to learn that one of the PGY-4's classmates was fired (contract not renewed) after PGY-3! Even more surprising, none of the other residents understood the firing. The belief is that he was fired for reasons unrelated to competence or any sort of medical error. The PGY-4 suspected that the termination was "politically motivated," suggesting that he "didn't have the best relationship" with a couple people running the program.

What? Fired for not having a good relationship?!?! Does that not seem absurd when we're talking about someone who made it through 4 years of med school and the first 3 years of a 4 year residency program? The PGY-4 stated that this wasn't the first time a resident had been let go from UTSW-Austin under similar circumstances. Apparently, the common belief among residents is that the program administrators take themselves waaay too seriously and look for ways to get rid of residents who fall out of line or out of favor in any minor, seemingly inconsequential way.

Has anyone else heard of UTSW-Austin being a potential toxic program? I really want to be back in Austin for family reasons, but I don't know if I can even rank this program now. The PGY-4 "couldn't, in good conscience, recommend the program to me."

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[atsai3]

I'm an Austin native, but moved to Boston for med school. I was hoping to return to Austin to complete my psychiatry residency at UTSW-Austin. A friend of a friend is currently a PGY-4 in that program, so I called up that PGY-4 yesterday to get an insider's perspective on applying, interviewing, working conditions, etc.

I was shocked to learn that one of the PGY-4's classmates was fired (contract not renewed) after PGY-3! Even more surprising, none of the other residents understood the firing. The belief is that he was fired for reasons unrelated to competence or any sort of medical error. The PGY-4 suspected that the termination was "politically motivated," suggesting that he "didn't have the best relationship" with a couple people running the program.

What? Fired for not having a good relationship?!?! Does that not seem absurd when we're talking about someone who made it through 4 years of med school and the first 3 years of a 4 year residency program? The PGY-4 stated that this wasn't the first time a resident had been let go from UTSW-Austin under similar circumstances. Apparently, the common belief among residents is that the program administrators take themselves waaay too seriously and look for ways to get rid of residents who fall out of line or out of favor in any minor, seemingly inconsequential way.

Has anyone else heard of UTSW-Austin being a potential toxic program? I really want to be back in Austin for family reasons, but I don't know if I can even rank this program now. The PGY-4 "couldn't, in good conscience, recommend the program to me."

There is a difference between being fired and not having your contract renewed.

On its face, the story doesn't make sense. If a program director fires, or does not renew the contract of, a resident then she has to find another resident to pick up the coverage (unless the PGY4 year is completely outpatient-based and there are no ward service requirements).

SDN is rife with conspiracy stories about big bad program directors who apparently have nothing better to do with their time than fire residents for no good reason. It would be more helpful to SDN if you could call up that PGY4 again and get the name of the resident who was "fired".

 

[daru1]

There is a difference between being fired and not having your contract renewed.

On its face, the story doesn't make sense. If a program director fires, or does not renew the contract of, a resident then she has to find another resident to pick up the coverage (unless the PGY4 year is completely outpatient-based and there are no ward service requirements).

SDN is rife with conspiracy stories about big bad program directors who apparently have nothing better to do with their time than fire residents for no good reason. It would be more helpful to SDN if you could call up that PGY4 again and get the name of the resident who was "fired".

The resident was non-renewed, PGY-4 is all outpatient at UTSW-Austin. Hope this clears it up for you, atsai3.

 

[Texasishome]

There is a difference between being fired and not having your contract renewed.

On its face, the story doesn't make sense. If a program director fires, or does not renew the contract of, a resident then she has to find another resident to pick up the coverage (unless the PGY4 year is completely outpatient-based and there are no ward service requirements).

SDN is rife with conspiracy stories about big bad program directors who apparently have nothing better to do with their time than fire residents for no good reason. It would be more helpful to SDN if you could call up that PGY4 again and get the name of the resident who was "fired".

I'm a 4th year med student, so I don't know what the significant distinction is between being fired and not having a contract renewed. I guess maybe it comes into play when trying to find another program to latch onto. Nevertheless, I'm quite certain I don't want to be either fired or non-renewed.

How would posting the name of the resident who was "fired" be helpful to SDN?

I can't verify the veracity of the story, but I don't have any reason to believe the PGY-4 was lying to me either.

@daru1: Can you tell me anything more about UTSW?

 

[classof2011]

I agree that its a little OFF that a resident could be easily "let go" as a PGY-4. There is clearly much more to the story than has been disseminated. After 3 years they know well the resident's work ethic, performance limitations, and in most cases, the resident's personal life (depending on how nosey vs. involved the Administration is with their residents). And I would hope that as a 4th year you'd be taking more seriously as a colleague (to the PD) rather than some disposable worker that is there to serve with learning as primary compensation.

What would be more concerning is a program's judgement as operating a business model that would allow a decision (such as letting a resident go in a stage that may require reinforcements of folks who they may have to offer more incentive for cover outpatient clinics such as attendings or PGY-4s who were guaranteed allowance of their own interests.)

Bottom Line: Anybody with any professional work experience can smell that "something aint right" with this story. The result may be the firing of the resident but the cause is unclear.

 

[BobA]

This is all here-say.

 

[daru1]

I'm sorry, but I've been asked not to divulge any more information at this time.

 

[Sneezing]

I thought there was a problem when I read "texas is home." Yikes! There are 49 other states to chose from.

 

[Doctor Bagel]

Couple thoughts. One, firing and not renewing a contract are about the same in my book. In both, you're out of a job, and it's not your choice. It creates differences from the program's perspective, but I think it works out the same for the resident.

Two, programs that fire (or don't renew the contract of) 3rd/4th years scare the crap out of me. That's it. Of course, more likely than not, they've got a good reason to do it. It's still scary. Actually, firing any resident is scary.

Three, it's also a little concerning that your 4th year friend said he couldn't recommend the program. Even if he doesn't know the official word on the guy who was ousted, his feel means something. It doesn't mean everything, but I wouldn't discount it either.

Four, 4th years here don't do any call except backup, so they're pretty expendable from a labor perspective. I'm guessing that's true with more programs than not. Not saying this gives any sinister meanings to the firing, but you know, maybe that's why firing 3rd/4th years is scary.

 

[flash]

My program is picking up a current PGY1 from UTSW Austin next July as a PGY2 from the rumor mill. Don't know her story or reason for seeking transfer/change laterally, but FYI.

 

[F0nzie]

On the upside... Austin is a GREAT city

 

[Doctor Bagel]

On the upside... Austin is a GREAT city

I think I'm in the minority, but I'm not an Austin fan. Hot, sprawly, not that friendly. Good food, though.

 

[Texasishome]

Well, thanks for the feedback everybody. I have decided to go forward with an interview at UTSW-Austin if I can fit it in during my trip to Central Texas. Given what I have learned about UTSW-Austin though, I don't anticipate ranking it anywhere near the top of my list...if I rank it at all.

I'll try to post an update after my interview.

 

[Texasishome]

Just one more thing. I'd like to encourage any residents out there to be forthcoming with information such as terminations/non-renewals or program drop-outs/transfers when you meet with applicants. While I'm sure there are pressures not to do so, I don't think there is a more telling piece of information about a residency program than how many people are leaving it, either by choice or against their will.

Retention rate/graduation rate should really be a published stat for residency programs. Not only would it provide potential residents with a valuable piece of information, but it would hold program directors somewhat accountable for pushing residents out the door.

I'm all for getting rid of incompetent or chronically lazy residents, but, if a program is losing a lot of residents, I tend to believe it has more to do with the program than with the residents who are being let go.

 

[psychattending]

I understand the fear that residents or residents-to-be might have about programs and PDs. As a PD, I would like to make several general comments/observations that I would hope would help assuage some of those fears:

1) Programs have to report to the psychiatry RRC every resident that transfers out of the program, resigns, or does not complete the program. These numbers are looked at when we are site visited.

2) Programs are required to have policies in place to deal with residents who are not performing adequately. I can't speak to the specifics of each program out there but usually there has to be noticed given to the resident and attempts have to be made to remediate the issue. In addition, once a program has decided to terminate or non-renew a resident, the resident has the ability to appeal to the local GME as well as to the national people to seek redress.

3) PDs are in the business of being a PD because they like to teach and train people. We tend to look for ways of helping our residents overcome problems.

4) PDs in general do not want to have residents transfer from their program, be dismissed, or non-renewed, as it causes substantial administrative hassles and takes away from our time doing what we like to do which is teach and take care of patients.

5) PDs can't disseminate information about what really is going on with a resident to his/her colleagues. While we might want to do so since it would help deal with other's concerns we can't for ethical (If you were the resident having problems, would you really want your PD going around and telling your colleagues about it?) and legal reasons. Instead we are stuck saying "no comment."

 

[whopper]

I know of plenty of toxic programs that avoided the radar. Just to give you an examples, I know of a program where over 95% of the residents are from one particular country. What's going on is all the graduates from the program basically want the program to admit their relatives, and the PD, being from that same country, is all to eager to please these graduates who are now his colleagues. Things operate that way in that other culture.

So here's the problem, besides the toxic level of incest. The PD openly tells residents to work hours over the ACGME guidelines because that's how it's done in their home country. The residents, most of them fresh from the other country, follow-in-line. Yeah well I guess if these people are willing to take the abuse, so be it, but what if you're one of the few residents in that program who's not from the old country? You're screwed.

As for lunches, they always serve food from that country. A friend of mine in that program asked if they could once in awhile have food from other cultures and she was told something to the effect of "If you wanted to eat something from your culture, you should've joined another residency."

While they are not the norm, programs do exist that regularly break rules. Somtimes breaking the rules is something the residents don't mind. Several of the ACGME guidelines meant to protect residents can actually make work more cumbersome for them.

In any case, one of the only ways to get the word out is on a forum like this, but once that's done, it's difficult to verify if it's true. Sometimes residents are kicked out, and they deserved to be but out of bitterness, they'll claim a program is toxic.

 

[psychattending]

Whopper,

I was aiming my comments at the specific issue in this thread which was terminating/non-renewing a resident. Your comments are aimed at a more general issue about quality. I agree that there are some less than ideal programs out there.

 

[masterofmonkeys]

3) PDs are in the business of being a PD because they like to teach and train people. We tend to look for ways of helping our residents overcome problems.

For the record, none of this is directed at you personally, but a general reflection on the culture of academia. I also would have made these comments before I left my program.

One of my frustrations, since I first knew I was headed for a career in teaching/research (of some sort), is that the bureaucracy and power structure of academia has little to nothing to do with teaching.

For example, well, more than half of the people with the title of 'professor'. Many care little to nothing about student education, and their advancement prospects aren't particularly predicated on dedication to teaching. In fact it's notable that as one moves up the chain, generally less rather than more of their career is dedicated to teaching. Which seems somewhat counterintuitive given that the end goal is the title of 'full professor'. To profess. To teach. Not to avoid students. Or so I thought.

This is perhaps nowhere more true than when it comes to residents, with our limited legal protections, the limited number of training spots, and the guild system that puts us at the mercy of the establishment for a minimum of 5 years (clinical years of med school plus residency) and in some cases up to a decade in order to get their 'blessing' to practice medicine.

We're among other things excellent revenue generators and for unscrupulous attendings, do indeed make their lives considerably easier if they choose not to teach.

There are a lot of incentives for resident abuse, very few disincentives against it, and few incentives for dedicated teachers to do so. Now, of course, I'm speaking strictly of external incentives here, not internal ones. But the truth is that even in medicine there are very few idealists.

Structures like ACGME and the various RRCs attempt to codify and structure what a 'good' residency program should look like. But I'd posit that important things to the training process such as 'non-exploitive', 'supportive', and 'teaching over service', and 'teaching quality' are nigh-on impossible to obectively measure outside of vague answers to the ACGME annual survey. Even then, when forced to compare negative resident impressions of a program to 'compliance' with written guidelines, the bureaucratic entity will usually side with the program. And then again, even in the ACGME's admitted attempts to look at 'softer' factors, there remains the substantial risk of retaliation by the administration against discontents. Anyone who believes that 'anonymity' is anything but a fiction in such things, or who believes that a capricious bureaucrat is unwilling or unlikely to lash out against a whole residency class should rethink their unfortunate verisimilitude to Polyanna.

As a game theoretician, I'm forced to conclude that the threat of inimical an malignant residency programs is not only likely, but in some ways selected for by an external reward and punishment system that places little to no reward on the 'meat' of resident welfare and education, few costs to antagonistic or dismissive behavior toward residents, and considerable reward for exploitation of residents (whether 'passive' through failure to invest time, energy, and quality into the educational aspects, or 'active' through creating a structure maximizing resident work, time, and billing while minimizing attending effort). This is made all the worse by market failure for graduating medical students and residents still in training.

Again, I've had some amazing attendings and professors along the way, and some of those attendings are helping me find a new training spot as we speak. I aspire to be one of those inspiring educators myself someday. But the system that we work and live in hardly selects for such people.

 

[whopper]

Psychattending,

My post was not meant as a retort to yours. Actually I agree with you. Most programs I've seen want to follow the rules.

A problem with residency in joining or leaving is it's not as liquid and fluid as a simple job where one could quit and simply look for another job. I just wanted to add what I did as a type of reminder that there's plenty of good ones out there but it'd be prudent to be on the look-out for potentially toxic ones. If a resident ends up getting into one they're screwed. It's not like they can just quit and leave. Such an act could prevent them from getting into another program ever again.

 

[daru1]

This was one of the faculty members supervising residents:

http://www.statesman.com/news/local/doctor-at-austin-state-hospital-accused-of-child-1974447.html

 

[Therapist4Chnge]

I know of plenty of toxic programs that avoided the radar. Just to give you an examples, I know of a program where over 95% of the residents are from one particular country. What's going on is all the graduates from the program basically want the program to admit their relatives, and the PD, being from that same country, is all to eager to please these graduates who are now his colleagues. Things operate that way in that other culture.

So here's the problem, besides the toxic level of incest. The PD openly tells residents to work hours over the ACGME guidelines because that's how it's done in their home country. The residents, most of them fresh from the other country, follow-in-line. Yeah well I guess if these people are willing to take the abuse, so be it, but what if you're one of the few residents in that program who's not from the old country? You're screwed.

As for lunches, they always serve food from that country. A friend of mine in that program asked if they could once in awhile have food from other cultures and she was told something to the effect of "If you wanted to eat something from your culture, you should've joined another residency."

While they are not the norm, programs do exist that regularly break rules. Somtimes breaking the rules is something the residents don't mind. Several of the ACGME guidelines meant to protect residents can actually make work more cumbersome for them.

In any case, one of the only ways to get the word out is on a forum like this, but once that's done, it's difficult to verify if it's true. Sometimes residents are kicked out, and they deserved to be but out of bitterness, they'll claim a program is toxic.

I couldn't help but think, "darn you Americans and your 'merican food!! Corn dogs, french fries, and soda pop!" This obviously wasn't your intent, but it is worth considering some of the more subtle (and not so subtle) influences the larger local culture can have on the hospital culture.