When is enough enough?

[SpoiledMilk]

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When should a resident be told that they are a detriment to the field, their present and future patients and colleagues, and be let go from the residency?

The resident is apathetic, has no passion for the field, rarely if ever takes part in resident/group activities, has horrible reviews from rotation attendings (telling those attendings they do not want to be in the field and does not take part in the specifics of the rotations), thinks that the field does not require further "studying" ie CMEs etc, is lazy, buried in their phone during didactics and all the time, does not contribute to helping out their other residents, sits apart from the group during mandatory get-togethers, has taken advantage of the leave of absence policy and taken too many months off meaning everyone else has to pick up their patient panel and schedules had to be rearranged to accommodate their LOA, left their first residency for unknown reasons, and their reason for such behavior is that their are an introvert.

We, a few fellow residents, have grown bored of their behavior but leadership continues to coddle and enable them.

 

[Sardonix]

When should a resident be told that they are a detriment to the field, their present and future patients and colleagues, and be let go from the residency?

The resident is apathetic, has no passion for the field, rarely if ever takes part in resident/group activities, has horrible reviews from rotation attendings (telling those attendings they do not want to be in the field and does not take part in the specifics of the rotations), thinks that the field does not require further "studying" ie CMEs etc, is lazy, buried in their phone during didactics and all the time, does not contribute to helping out their other residents, sits apart from the group during mandatory get-togethers, has taken advantage of the leave of absence policy and taken too many months off meaning everyone else has to pick up their patient panel and schedules had to be rearranged to accommodate their LOA, left their first residency for unknown reasons, and their reason for such behavior is that their are an introvert.

We, a few fellow residents, have grown bored of their behavior but leadership continues to coddle and enable them.

Depends on your admin/leadership. They are either:

1. Totally spineless or don't care and will just push the resident through. Some basically hope the resident will fail boards or get sued into oblivion and never work.

2. Are documenting everything to a point of excess so that when they pull the trigger the problem resident cannot cry and sue.

My program had an unfortunate example of both. We had an absolutely terrible, arrogant, and incompetent resident who refused every intervention possible. Didn't wish them poorly but they should have been fired within months of starting as an intern. It took until 3rd year for the program to confront him. Despite the veritable biblical amount of infractions they documented, this individual still tried to sue for wrongful termination. Also had the guts to accuse the admin that this "came completely out of nowhere"... though that may have been yet another testament to their complete lack of insight/foresight/self-preservation.

 

[Ironheme]

When should a resident be told that they are a detriment to the field, their present and future patients and colleagues, and be let go from the residency?

The resident is apathetic, has no passion for the field, rarely if ever takes part in resident/group activities, has horrible reviews from rotation attendings (telling those attendings they do not want to be in the field and does not take part in the specifics of the rotations), thinks that the field does not require further "studying" ie CMEs etc, is lazy, buried in their phone during didactics and all the time, does not contribute to helping out their other residents, sits apart from the group during mandatory get-togethers, has taken advantage of the leave of absence policy and taken too many months off meaning everyone else has to pick up their patient panel and schedules had to be rearranged to accommodate their LOA, left their first residency for unknown reasons, and their reason for such behavior is that their are an introvert.

We, a few fellow residents, have grown bored of their behavior but leadership continues to coddle and enable them.

Do you trust your admin/leadership team? How well written is your duties/code of conduct handbook? Is your faculty team great about documenting, giving feedback, good and bad?

Apathy alone isn't enough. "Horrible reviews" saying they don't want to be in the field, while not great, is not enough. Are they failing their rotations? I've seen attendings write 'terrible' things about residents but will still pass them. Screwing over other residents, while it sucks (I sympathize), is not enough to fire. Using LOA isn't a reason to fire, and could actually put the program under scrutiny.

It takes courage to fail people. Much easier for most to pass the buck.

Things that do result in resident being fired: Not showing up repeatedly, threat to patient safety, failing multiple rotations, not passing Step 3 repeatedly. A lot of the things you've listed sounds like while annoying, isn't enough, and likely you aren't privy to this resident's extenuating circumstances nor what the CCC is doing about it. So while a lot of us understand, at this point you just have to survive this co-resident, unfortunately pick up the slack so patients don't suffer, and remember that residency is a long game of which there is a time limit.

 

[dozitgetchahi]

The truth (unfortunately) is that this is not your decision to make - it’s that of dept admin/attendings.

Remember that politics/nepotism may be at play here too.

Elsewhere on SDN, I’ve posted at length about a horrible, lazy, and nasty nursing assistant that I dealt with at my first job. I put up with this person’s incompetence for about a year before I took it up the food chain and started complaining to senior admin folks. It wasn’t clear to me why admin seemed to be “ok” with her behavior, until a patient mentioned to me that this office staff and my office manager had been best buddies in high school years earlier - and apparently the office manager told her she would “have her back” for her questionable “health issues”. My office manager was also really good friends with upper management, so when I started complaining about this office staffer, the office manager told them that she was a “really good employee” and I was a problem. I was then on the receiving end of a ton of reindeer games and BS from admin, until I quit the job about 6 months later.

Bottom line: at least as an attending, I could quit the job and move on. As a resident, you can’t. So be careful how much you complain about this person. Nepotism is surprisingly widespread in academia, and this person may be related to (or otherwise has some sort of relationship with) someone important that you don’t want to mess with. Keep your head down and finish residency. Know that in the future, you can speak up and/or quit jobs and move on over issues like this - but not yet.

 

[cabinbuilder]

Agreed, if you are a resident, learn the best you can, graduate and move on. Doctors get fired all the time in the real world. Their time will come.

 

[FrustratedFamDoc]

Agreed, if you are a resident, learn the best you can, graduate and move on. Doctors get fired all the time in the real world. Their time will come.

This 1000%. This is only a few years of your life. There is likely much more involved than you realize. Disarming a bear trap for the good of others can cause loss of limb. Sometimes it’s better to just walk around it and continue on your way.

The LAST thing you want is to get on the radar as the ‘complainer’ or any other such adjectives. This can only end up poorly for you. Residency politics is funny business.

 

[cabinbuilder]

When should a resident be told that they are a detriment to the field, their present and future patients and colleagues, and be let go from the residency?

The resident is apathetic, has no passion for the field, rarely if ever takes part in resident/group activities, has horrible reviews from rotation attendings (telling those attendings they do not want to be in the field and does not take part in the specifics of the rotations), thinks that the field does not require further "studying" ie CMEs etc, is lazy, buried in their phone during didactics and all the time, does not contribute to helping out their other residents, sits apart from the group during mandatory get-togethers, has taken advantage of the leave of absence policy and taken too many months off meaning everyone else has to pick up their patient panel and schedules had to be rearranged to accommodate their LOA, left their first residency for unknown reasons, and their reason for such behavior is that their are an introvert.

We, a few fellow residents, have grown bored of their behavior but leadership continues to coddle and enable them.

I will tell you there was a female resident in our group who I despised and I knew was a danger to patients. The ONLY REASON she was there was because she could get a nearly perfect score on any standardized test she took and our director wanted her there to keep our "numbers up". As chief resident I took it upon myself to protect the patients from her. Instead of giving cough syrup she would give nebulized lidocaine!!! I basically told her to face that she was to NEVER touch or write orders on any of my patients and when she was on call the nursing staff knew just to call me, i didn't care if I wasn't on call. Thankfully no one died because of her. We all have been there and had "one of those lazy jerks who didn't deserve to be there". As it has been said, they are someone's pet, sleeping with the right person, etc. It's only a matter of time that their incompetence comes out in the real world and they won't be able to hold a job as their license gets yanked from killing people.