When should you take legal action or just suck it up and move on?

[lsres]

The post by Prets has caused me to bring up this question – in reality when would it be better to take legal action or let it go if treated unfairly by a residency program? Without going into too much detail I was forced out of a PGY 1 position after a few months because I “was not performing as expected”. However I feel my work was comparable to the other residents and the PD director lied to me about several things. The program director gave me the choice of resigning. In my situation figured it would be best not to fight it and leave a bad situation and apply to other positions in the match. I am now unmatched after no interviews and am not sure what I am going to do about my huge financial debt from loans. I called the program and the secretary said that nobody has contacted them about me and my advisor there said that when asked I should say I left for personal reasons. My feeling is that pursuing legal action will only make things worse in trying to get another position which is what I want more than anything. But so far I am not getting anywhere.

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[ORBITAL BEBOP]

Did you take the intraining exam by any chance? I think they do use that for promotion (to flag a resident).

I hate the fact they push you out of residency instead of getting a "redo". Meds have invested too much time and money to not finish residency.

 

[Annette]

would it be better to take legal action or let it go if treated unfairly by a residency program? . . .“was not performing as expected”. However I feel my work was comparable to the other residents and the PD director lied to me about several things. The program director gave me the choice of resigning. . . . I called the program and the secretary said that nobody has contacted them about me and my advisor there said that when asked I should say I left for personal reasons.

Was "not performing as expected" the only reason they gave you, with no further explination? That sounds awefully weak. Have you looked at your file? Did you ask for further explanation?

Apparently, legal action doesn't produce much of a result against residencies. However, I think it would depend on what kind of documentation of your "poor performance" and how they tried to remediate it. Your resignation won't look good. Lawyers are often worth the money even if you don't take legal action. Check with a lawyer that specializes in employment practices, and is NOT affiliated with the hospital in anyway.

If you were sucessful in getting your program to let you back in, would you want to be there? Retaliation is a real thing, and the program director usually has the final say in all things regarding the residents.

 

[BKN]

The post by Prets has caused me to bring up this question – in reality when would it be better to take legal action or let it go if treated unfairly by a residency program? Without going into too much detail I was forced out of a PGY 1 position after a few months because I “was not performing as expected”. However I feel my work was comparable to the other residents and the PD director lied to me about several things. The program director gave me the choice of resigning. In my situation figured it would be best not to fight it and leave a bad situation and apply to other positions in the match. I am now unmatched after no interviews and am not sure what I am going to do about my huge financial debt from loans. I called the program and the secretary said that nobody has contacted them about me and my advisor there said that when asked I should say I left for personal reasons. My feeling is that pursuing legal action will only make things worse in trying to get another position which is what I want more than anything. But so far I am not getting anywhere.

Before you read this post, please understand, I don't know you and I have no opinion at all about whether your separation was appropriate on clinical ground. I'm just answering a question from the viewpoint of a PD who has been involved in a bunch of this, mostly on grievance appeal committees.

ACGME accredited residencies must have a nondiscriminatory grievance policy in place. This sets out the steps in firing a resident. Most require documentation and a period of probation prior to a firing. If the probation period goes badly, the PD can then fire the resident. The resident usually can appeal, it often goes to a committee that advises the Institutional Representative (usually called th dean for medical education or similar title). If the recommendation is for the ex-resident the fun begins. The PD and the resident can look forward to a very uncomfortable time. If it goes against the ex-resident, the firing is then final.

At that point, you can sue, but:
Medicine sets its own standards for entry to membership and qualifies it's practitioners. That's the privilege and duty of a profession under law. It's done that way because a profession is assumed to have special knowledge that the government takes note of. Government acts through the licensing boards at the other end of the training process, but even so the majority of the members are MDs and DOs.

For these reasons, the courts will usually only look at two things:
1. Did the institution follow it's own policy?
2. Is there evidence that the firing was discriminatory?
If the answer to the first is yes and the second is no, that's the end of it. The law assumes that the medical institutions should make the decisions about competence, not the courts. If you try to go to court without going through the grievance process, the judge will just send it back to the institution. Note that even if you win, the courts can't force the institution to take you back, they only direct financial damages.

As I understand your post, you made it easier for the PD by resigning, thus sidestepping the process. If he was sure of his ground, he may have felt he was doing you a favor by not giving you a firing for cause on your record. Or he may have failed to document his case and been unsure he could uphold it.

Obviously, he did you no favors. The reason is that no PD is going to hire a resident who has left another program without a thorough understanding of the circumstances. He'll have visions of stupidity, substance abuse or horrific interpersonal skills. Without exception he'll want a letter from the previous PD and it better say this is a great Doc who decided he didn't want to practice this specialty.

He also did society no favors. If he thought you incompetent, he should go through the process in order to make the reason for termination clear and to make it very hard for you practice. He should have to demonstrate the reasons for firing to the real jury of peers, which is the grievance committee.

We have enough bad/dangerous doctors out there.

Could you go back to the institution, claim that the resignation was coerced and go through the grievance process? Perhaps. Would it do any good?Perhaps. Only you know the circumstances well enough to make the decision. If you're considering this, a first step is to demand to review your file.

Anyway, good luck. PM me if you like.

p.s. You'll notice that mostly I agreed with Annette. The exception is that I don't think hiring a lawyer at this point is likely to help very much. They are by their training argumentative and unqualified to pass on medical competence. Plus, there is too much baggage between the professions. Medicine is deliberative and nonconfrontative. I have observed that they tend to annoy the grievance committee. Time enough if you decide to go to court.

 

[APACHE3]

Man this is scaring me! What exactly does it mean "not performing as expected"??? You dont answer pages? you cant start an art line? you treat the nurses like, sh^&? call in sick?? Cant discuss azotemia on rounds ???? what will kill an intern?? This is driving me crazy..

 

[BKN]

Man this is scaring me! What exactly does it mean "not performing as expected"??? You dont answer pages? you cant start an art line? you treat the nurses like, sh^&? call in sick?? Cant discuss azotemia on rounds ???? what will kill an intern?? This is driving me crazy..

It's not something that any PD wants to do. It's painful and depressing. I will go to almost any lengths to try to remediate a resident who wants to succeed and is willing to take direction. My experience is that for most residenices, more than 95% finish and of those who do not, it was the resident who pulled out for personal reasons more often than not.

What's "not performing as expected?" Examples off the top of my head (not exhaustive).

1. Not showing up for work (your allowed to be ill of course, but it better not be malingering)
2. Not answering pages
3. Being argumentative and/or nontherapeutic
4. Substance or Alcohol abuse.
5. Severe infopenia evidenced by:
a. Poor performance on intraining exams.
b. repeated failure of MLE part 3
c. faculty consensus that the resident doesn't know basic information expected of the resident's level.
6. OK information base, but unable to apply it leading to poor diagnostic or therapeutic decisions.
7. Depression or other problems interfering with performance.

These things have a common outcome, danger to the patients. Faculty has a duty not to release a dangerous doctor out on the world.

Of the list above,
1. I handle the attitude problems (#1,2,3) by just saying quit it or I'll fire you. This works >95% of the time. Some adult children just need limits set.
2. I handle the thinking problems (#5 and #6) with an intensive individualized remediation program. Requires a lot of faculty time, but we're willing to do it.
3. For #4, I don't think there's a good solution. I've tried in the past and it has only occasionally gone well. Now I just try not to hire anybody with an addictive personality.
4. For #7, we try to make the program a supportive place. We recommend that residents use the employee assistance program confidentially if they need to.

Anyway, the point I'm making is don't worry about this. All you can do is be the best doctor that you can. That will be more than enough for most of you. For the rest, wait and see. Sufficient onto the day is the evil thereof. tomorrow will take care of itself.

BKN

 

[pgg]

For [substance or alcohol abuse], I don't think there's a good solution. I've tried in the past and it has only occasionally gone well. Now I just try not to hire anybody with an addictive personality.

Idly curious. How on earth do you detect an "addictive personality" via an application or interview? What are you looking for?

 

[3dtp]

Before you read this post, please understand, I don't know you and I have no opinion at all about whether your separation was appropriate on clinical ground. I'm just answering a question from the viewpoint of a PD who has been involved in a bunch of this, mostly on grievance appeal committees.

ACGME accredited residencies must have a nondiscriminatory grievance policy in place. This sets out the steps in firing a resident. Most require documentation and a period of probation prior to a firing. If the probation period goes badly, the PD can then fire the resident. The resident usually can appeal, it often goes to a committee that advises the Institutional Representative (usually called th dean for medical education or similar title). If the recommendation is for the ex-resident the fun begins. The PD and the resident can look forward to a very uncomfortable time. If it goes against the ex-resident, the firing is then final.

At that point, you can sue, but:
Medicine sets its own standards for entry to membership and qualifies it's practitioners. That's the privilege and duty of a profession under law. It's done that way because a profession is assumed to have special knowledge that the government takes note of. Government acts through the licensing boards at the other end of the training process, but even so the majority of the members are MDs and DOs.

For these reasons, the courts will usually only look at two things:
1. Did the institution follow it's own policy?
2. Is there evidence that the firing was discriminatory?
If the answer to the first is yes and the second is no, that's the end of it. The law assumes that the medical institutions should make the decisions about competence, not the courts. If you try to go to court without going through the grievance process, the judge will just send it back to the institution. Note that even if you win, the courts can't force the institution to take you back, they only direct financial damages.

As I understand your post, you made it easier for the PD by resigning, thus sidestepping the process. If he was sure of his ground, he may have felt he was doing you a favor by not giving you a firing for cause on your record. Or he may have failed to document his case and been unsure he could uphold it.

Obviously, he did you no favors. The reason is that no PD is going to hire a resident who has left another program without a thorough understanding of the circumstances. He'll have visions of stupidity, substance abuse or horrific interpersonal skills. Without exception he'll want a letter from the previous PD and it better say this is a great Doc who decided he didn't want to practice this specialty.

He also did society no favors. If he thought you incompetent, he should go through the process in order to make the reason for termination clear and to make it very hard for you practice. He should have to demonstrate the reasons for firing to the real jury of peers, which is the grievance committee.

We have enough bad/dangerous doctors out there.

Could you go back to the institution, claim that the resignation was coerced and go through the grievance process? Perhaps. Would it do any good?Perhaps. Only you know the circumstances well enough to make the decision. If you're considering this, a first step is to demand to review your file.

Anyway, good luck. PM me if you like.

p.s. You'll notice that mostly I agreed with Annette. The exception is that I don't think hiring a lawyer at this point is likely to help very much. They are by their training argumentative and unqualified to pass on medical competence. Plus, there is too much baggage between the professions. Medicine is deliberative and nonconfrontative. I have observed that they tend to annoy the grievance committee. Time enough if you decide to go to court.

BKN,
You are a bastion of integrity and nobility. And your institution may be also. I hope your program is highly sought after and those who are in it know how important it is to be in a program run by people of integrity and concern.

But, not all PDs and not all institutions are. Fortunately, the bad apples appear to be far and few between but they do exist. I surveyed around 20 PDs concerning abuse of disciplinary processes. More than half of them admitted that they knew a PD who abused the process or were involved in such an abuse as a resident.

There are highly financially motivated hospitals who have no business educating residents, PDs who do not find it hard to end the career of a resident who challenges them and delight in the exercise of raw, unchecked power. Institutions who hire these individuals desire the "hitman" qualities as it makes for a meek and compliant resident population. These people make the entire community look bad.

The ACGME does have institutional requirements for an appeals process, but it has no requirements for enforcing it or for an institution to follow it or for an RRC or IRC approval for changes. It merely must exist. There is no provision for the site visitor to review any procedings or minutes nor is there any provision for any minutes to exist. Hopefully this will change as the ACGME undergoes the next round of revisions, but even so, if an institution decides to cheat, documents can disappear, magically re-appear and new documents can mysteriously appear where none had been before.

For decades RRC work hours recommendations and the Bell Commission laws were brazenly ignored by hospitals. Not until Congress threatened oversight and MedED was graced with being the topic of the day on 60 Minutes did the medicine begin to clean house. Even in the face of legislation, Hopkins and others continued the abuses. Although it is anecdotal, please read Troy Madsen's diary on this web site. I doubt his experience is common, but certainly it is far from unique and he is one of the fortunate ones because he did indeed find a program that accepted him despite his experience with Hopkins. He is a braver soul than I.

For the rest of you, BKN is right. There is very little you can do, legally. If you do sue, even for the most brazen violations, your course is at best difficult. You will become a pariah, for a time, and the litigation will take the better part of a decade. Meanwhile, you are out of training, with skills decaying and even less hope.

To the PDs who might someday have a canned resident crossing their path asking for their help, please consider that despite a firing or resignation in lieu of termination, there may be a legitimate resident who spoke out at the wrong time, brought up a problem at a staff meeting that made an insecure PD look bad or demonstrated improper program or institutional behavior and was made an example. In such circumstances, a PD will write a letter using all the "insider" codes to say this is a horrible resident...don't hire him/her. The favorite term these days is "disruptive" or "unprofessional" without any specifics to support the claim.

Not all is what it appears to be.

g'night.

 

[OUsooner]

Not gonna lie here - all of this "firing the intern chat" is gettin me nervous too. I have never failed any board exam or course in med school but I also wasn't AOA material. I did well on clinicals - never had any problems other than the token surgery eval which said i "appeared to lack interest".

with all of the above taken into account, i am STILL nervous as hel!. that and i'm forgetting more **** everyday. by the time july roles around i might have no clue about ANYTHING medically related!!! should i be studying some???? HELP

the above is what happens when i don't drink.

 

[DrNick2006]

First of all the OP sounds fishy. Who is told by a PD they should resign or they will be fired and do it and not think they are deserving of it? If I was told to resign or be fired by my future PD without clear growns and fair treatment a war is gonna break out. This is my career and my livelihood we're talking about here, you better believe late night visits, crowbars and jumper cables would be brought in the mix before I was victimized.

THe point is the OP probably had it coming, it seems to me, unless they are that meek to just take it, and I don't see a person like that needing to be made an example of.

 

[Solideliquid]

I'm reviewing azotemia so I can discuss it at rounds.

Not gonna lie here - all of this "firing the intern chat" is gettin me nervous too. I have never failed any board exam or course in med school but I also wasn't AOA material. I did well on clinicals - never had any problems other than the token surgery eval which said i "appeared to lack interest".

with all of the above taken into account, i am STILL nervous as hel!. that and i'm forgetting more **** everyday. by the time july roles around i might have no clue about ANYTHING medically related!!! should i be studying some???? HELP

the above is what happens when i don't drink.

 

[Astrocyte]

Listen to BKN. Don't think about what you can lose; think about what you will gain (e.g. clinical experience/knowledge, etc.) Treat your patients like family. Believe it or not, you have been groomed for success.

For those who have not matched yet, be honest with yourself and interviewers, because misrepresentation might lead you to places you don't want to be.

 

[Poety]

Not gonna lie here - all of this "firing the intern chat" is gettin me nervous too. I have never failed any board exam or course in med school but I also wasn't AOA material. I did well on clinicals - never had any problems other than the token surgery eval which said i "appeared to lack interest".

with all of the above taken into account, i am STILL nervous as hel!. that and i'm forgetting more **** everyday. by the time july roles around i might have no clue about ANYTHING medically related!!! should i be studying some???? HELP

the above is what happens when i don't drink.

I feel the same way.. but BKN calmed me down, I'm going back to gardening now, with my illegal friends. JUST KIDDING gawd, get a sense of humor folks sheesh!

 

[APACHE3]

Because I finished my school early, I haven't touched a patient (nor a book)in 3 months. I've been spending time with the kids since I wont see them in intern year!! I guess I better crack the books again...now I'll really be shi%$ing bricks while getting pimped on rounds. My program did let an intern go last year, but at least they allowed him/her to transfer to Psyche. But that means the precedent is there...I hope BKN is right! To the OP...please give more detail..what was your FIRST dicsussion with PD about..knowledge, ethics, attitude??? There has to be something you are not telling us.

 

[DrNick2006]

First of all the OP sounds fishy. Who is told by a PD they should resign or they will be fired and do it and not think they are deserving of it? If I was told to resign or be fired by my future PD without clear growns and fair treatment a war is gonna break out. This is my career and my livelihood we're talking about here, you better believe late night visits, crowbars and jumper cables would be brought in the mix before I was victimized.

THe point is the OP probably had it coming, it seems to me, unless they are that meek to just take it, and I don't see a person like that needing to be made an example of.

Hehe, 3 am spelling. wonder what I will do to patients at 3 am.

 

[Von Hohenheim]

In such circumstances, a PD will write a letter using all the "insider" codes to say this is a horrible resident...don't hire him/her. The favorite term these days is "disruptive" or "unprofessional" without any specifics to support the claim.

Hey, don't forget about "inappropriate".

 

[dinosaurcrumpet]

Sufficient onto the day is the evil thereof.

This statement was a little vague to me. I had to look it up. Apparantly it's mat 6:34

"Therefore I say to you, Be not anxious for your life, what ye shall eat or what ye shall drink; nor yet for your body what ye shall I put on. Is not the life more than the food, and the body than the raiment? Behold the birds of the heaven, that they sow not, neither do they reap, nor gather into barns;'and You r heavenly Father feeds them. Are not ye of more value than they? And which, of you by being anxious can add one cubit onto the measure of his life? And why are ye anxious concerning raiment? Consider the lilies of the field, how they grow; they toil not, neither do they spin: yet I say unto you, that even Solomon in all his glory was not arrayed like one of these. But If God doth so clothe the grass of the field, which today is, and tomorrow is cast Into the oven, shall he not much more clothe you, 0 ye of little faith? Be not therefore anxious, saying, What shall we eat ? or What shall we drink? or With what shall we be clothed? For after all these things do the Gentiles seek; for your heavenly Father knoweth that ye have need of all these things. But seek ye first his kingdom, and his righteousness; and all these things will be added unto you. Be not therefore anxious about tomorrow; for tomorrow will be anxious for itself. Sufficient unto the day is the evil thereof."

The online parallel bible translates the last line as - "Each day's own evil is sufficient."

 

[FACS]

This statement was a little vague to me. I had to look it up. Apparantly it's mat 6:34

"Therefore I say to you, Be not anxious for your life, what ye shall eat or what ye shall drink; nor yet for your body what ye shall I put on. Is not the life more than the food, and the body than the raiment? Behold the birds of the heaven, that they sow not, neither do they reap, nor gather into barns;'and You r heavenly Father feeds them. Are not ye of more value than they? And which, of you by being anxious can add one cubit onto the measure of his life? And why are ye anxious concerning raiment? Consider the lilies of the field, how they grow; they toil not, neither do they spin: yet I say unto you, that even Solomon in all his glory was not arrayed like one of these. But If God doth so clothe the grass of the field, which today is, and tomorrow is cast Into the oven, shall he not much more clothe you, 0 ye of little faith? Be not therefore anxious, saying, What shall we eat ? or What shall we drink? or With what shall we be clothed? For after all these things do the Gentiles seek; for your heavenly Father knoweth that ye have need of all these things. But seek ye first his kingdom, and his righteousness; and all these things will be added unto you. Be not therefore anxious about tomorrow; for tomorrow will be anxious for itself. Sufficient unto the day is the evil thereof."

The online parallel bible translates the last line as - "Each day's own evil is sufficient."

Ah, the God-like power of the PD. Better get on you knees, bitches, and pray for mercy or he shall zap you with his almighty cattle prod.

 

[dinosaurcrumpet]

Plus, there is too much baggage between the professions. Medicine is deliberative and nonconfrontative. I have observed that they tend to annoy the grievance committee. Time enough if you decide to go to court.

Translation: Medicine is a passive-aggressive bastards club that's hierarchical to the Nth degree. You can never win by answering back, no matter how "right" you might be.

Just work hard, fit in, work hard again and do some more fitting in. Amending rather than defending, a happy intern makes.

 

[Poety]

Because I finished my school early, I haven't touched a patient (nor a book)in 3 months. I've been spending time with the kids since I wont see them in intern year!! I guess I better crack the books again...now I'll really be shi%$ing bricks while getting pimped on rounds. My program did let an intern go last year, but at least they allowed him/her to transfer to Psyche. But that means the precedent is there...I hope BKN is right! To the OP...please give more detail..what was your FIRST dicsussion with PD about..knowledge, ethics, attitude??? There has to be something you are not telling us.

HOW COME PSYCH GETS THE HAND ME DOWNS DAMMIT!

 

[APACHE3]

HOW COME PSYCH GETS THE HAND ME DOWNS DAMMIT!

Not really..maybe the intern just did not like IM and wanted to go psyche..I heard this 2nd hand and did not (will not) ask the PD what happened, so when I start I'll never know who it was anyway.

Anyway, I do like the term Infopenia. Thats great. Can someone please bolus me with a liter of Harrisons and 250cc of Pharmacopia and a suppository of Sanford to correct my acute infopenia!!!

 

[Poety]

HOW COME PSYCH GETS THE HAND ME DOWNS DAMMIT!

Not really..maybe the intern just did not like IM and wanted to go psyche..I heard this 2nd hand and did not (will not) ask the PD what happened, so when I start I'll never know who it was anyway.

Anyway, I do like the term Infopenia. Thats great. Can someone please bolus me with a liter of Harrisons and 250cc of Pharmacopia and a suppository of Sanford to correct my acute infopenia!!!

I'm not too enthused when I see people getting booted from one specialty and transferred to psych, it like that other thread .... where sometimes psych attracts the people with "issues" or slackers or something

 

[ORBITAL BEBOP]

I'm not too enthused when I see people getting booted from one specialty and transferred to psych, it like that other thread .... where sometimes psych attracts the people with "issues" or slackers or something

Did you ever think that maybe some of those switchers made a mistake choosing their first residency? I would hope the people who go into Psych are interested in it and believe in it, b/c I dont know why anyone would switch to psych if didnt want to instead of IM or FP. Maybe having 'issues' helps them empathize with patients.

I loved psych in med school but didnt apply for a variety of reasons. I took anesthesia mainly for the monetary gain, but I couldnt stand it. I am glad to be going into Psych and I gave another field a chance, but it didnt work out. It doesnt mean i have issues or am a slacker. If anything, I have done years of extra residency.

sheesh

 

[Orange Julius]

I know of at least four psych docs at my school's program who "left" other specialties due to "impairment". Psychiatry just doesn't necessarily see that as a disadvantage. That's all. It makes sense, I guess. People with problems tend to understand people with problems. What's more, by the very nature of the specialty, they spend their careers being supervised by psychiatrists, so whatever issues they have aren't likely to get out of hand.

 

[Poety]

Did you ever think that maybe some of those switchers made a mistake choosing their first residency? I would hope the people who go into Psych are interested in it and believe in it, b/c I dont know why anyone would switch to psych if didnt want to instead of IM or FP. Maybe having 'issues' helps them empathize with patients.

I loved psych in med school but didnt apply for a variety of reasons. I took anesthesia mainly for the monetary gain, but I couldnt stand it. I am glad to be going into Psych and I gave another field a chance, but it didnt work out. It doesnt mean i have issues or am a slacker. If anything, I have done years of extra residency.

sheesh

Oh chill out, you're so sensitive - and I am going into psych, and yeah, I don't particularly like certain types that go into the field - I also don't hang out with them, I stick with the more driven, intellectually challenging colleagues I have that tend to have less issues.

EVERYONE has "issues" but theres some issues that don't bode well for being a good physician. And last I checked, I wasn't talking about people switching because they picked the wrong specialty READ THE THREAD TITLE AND THE ORIGINAL OP.

Also, when you switch, go ahead and survey the people around you, there were some places I interviewed at that I didn't rank at all because of the odd balls I met in the residency program.

And if you want to know, the original specialty I was going into was surgery.

 

[Poety]

I know of at least four psych docs at my school's program who "left" other specialties due to "impairment". Psychiatry just doesn't necessarily see that as a disadvantage. That's all. It makes sense, I guess. People with problems tend to understand people with problems. What's more, by the very nature of the specialty, they spend their careers being supervised by psychiatrists, so whatever issues they have aren't likely to get out of hand.

See? Ugg, what kind of impairment?

Having to be supervised by colleagues is just not a good way to have to practice medicine if you ask me. And I hate to spill the beans here, but some psychiatrists are harder on someone with mental illnesses than other specialties, especially since they have first hand experience on how debilitating it can be.

 

[Orange Julius]

Oh chill out, you're so sensitive - and I am going into psych, and yeah, I don't particularly like certain types that go into the field - I also don't hang out with them, I stick with the more driven, intellectually challenging colleagues I have that tend to have less issues.

Who are you kidding, poety? We all know you're as nutty as a fruitcake.

 

[Poety]

Who are you kidding, poety? We all know you're as nutty as a fruitcake.

DAMMIT! SHHHHH its a secret not a well kept one I see!

 

[Orange Julius]

Having to be supervised by colleagues is just not a good way to have to practice medicine if you ask me.

Not by colleagues. They're supervised by their supervisors, who happen to be psychiatrists.

And I hate to spill the beans here, but some psychiatrists are harder on someone with mental illnesses than other specialties.

Perhaps. But most aren't.

 

[Orange Julius]

DAMMIT! SHHHHH its a secret not a well kept one I see!

See?

 

[Taurus]

For these reasons, the courts will usually only look at two things:
1. Did the institution follow it's own policy?

What if the program doesn't follow its own policy? I know of a situation where the PD thought the policy was one way but it was actually presented and explained in a different way. The PD was completely ignorant of how the policy was really presented. There was documentation and eye witness evidence to back up what the person was saying. I would think that the program would be considered liable at that point and stand to lose substantial damages. The program initially screwed the person royally but as soon as that person got a lawyer they backed down fast. Things are quite uncomfortable now.

Lesson is do a good job, get along with everyone, and don't break any rules. AND always ask for clarification and get everything in WRITING. Otherwise, it is just he says, she says scenario.

 

[BKN]

This statement was a little vague to me. I had to look it up. Apparantly it's mat 6:34

"Therefore I say to you, Be not anxious for your life, what ye shall eat or what ye shall drink; nor yet for your body what ye shall I put on. Is not the life more than the food, and the body than the raiment? Behold the birds of the heaven, that they sow not, neither do they reap, nor gather into barns;'and You r heavenly Father feeds them. Are not ye of more value than they? And which, of you by being anxious can add one cubit onto the measure of his life? And why are ye anxious concerning raiment? Consider the lilies of the field, how they grow; they toil not, neither do they spin: yet I say unto you, that even Solomon in all his glory was not arrayed like one of these. But If God doth so clothe the grass of the field, which today is, and tomorrow is cast Into the oven, shall he not much more clothe you, 0 ye of little faith? Be not therefore anxious, saying, What shall we eat ? or What shall we drink? or With what shall we be clothed? For after all these things do the Gentiles seek; for your heavenly Father knoweth that ye have need of all these things. But seek ye first his kingdom, and his righteousness; and all these things will be added unto you. Be not therefore anxious about tomorrow; for tomorrow will be anxious for itself. Sufficient unto the day is the evil thereof."

The online parallel bible translates the last line as - "Each day's own evil is sufficient."

That passage should be required reading for SDNers IMneverHO

 

[BKN]

What if the program doesn't follow its own policy? I know of a situation where the PD thought the policy was one way but it was actually presented and explained in a different way. The PD was completely ignorant of how the policy was really presented. There was documentation and eye witness evidence to back up what the person was saying. I would think that the program would be considered liable at that point and stand to lose substantial damages. The program initially screwed the person royally but as soon as that person got a lawyer they backed down fast. Things are quite uncomfortable now.

Lesson is do a good job, get along with everyone, and don't break any rules. AND always ask for clarification and get everything in WRITING. Otherwise, it is just he says, she says scenario.

Well, you answered your own question. The program can reverse it's position or fight and it and probably lose (money).

p.s. got back the in-training scores today. Everybody did great, no infopenia and no grievance committee this year, thank you very much.

 

[BKN]

Anyway, I do like the term Infopenia. Thats great. Can someone please bolus me with a liter of Harrisons and 250cc of Pharmacopia and a suppository of Sanford to correct my acute infopenia!!!

Infopenia is always chronic (with occasional critical exacerbations). Treatment takes a year. But our cure rate approaches 95%.

 

[BKN]

Idly curious. How on earth do you detect an "addictive personality" via an application or interview? What are you looking for?

You can't always of course. But there is often something in the records, particularly dean's letters or transcripts. There may be times between jobs and out of school, "leaves of absence for personal reasons", DUIs etc.

Candiates on interview always try to be on their very best behavior. People who are excessively hyper or distractable are concerning but the interview process by itself can be a very stressful experience, so I'm hesitant to make a decision on one bad interview alone. But if more than one interviewer has a problem, we'll take a pass.

 

[OldPsychDoc]

Infopenia[/B]. Thats great. Can someone please bolus me with a liter of Harrisons and 250cc of Pharmacopia and a suppository of Sanford to correct my acute infopenia!!!

The suppository of Sanford sounds do-able....

 

[3dtp]

Not gonna lie here - all of this "firing the intern chat" is gettin me nervous too.

You should be. All residents should be aware that this does go on, so that if you do end up in one of these places you don't innocently or accidentally hand them the knife to disconnect your carotids.

That being said, there are outstanding programs and institutions who are honorable and have high integrity. You can't tar every one with the same brush or you become as bad as the evil programs. The good programs are horrified or incredulus when they find out about the shenanigans of those who are malignant.

Forewarned is forearmed.

 

[Taurus]

I have heard about some ob/gyn residents who were dismissed for infopenia. They were given chances to remediate but I guess didn't. If a resident was dismissed for knowledge deficiency reasons, what does that person do to find a new residency? How difficult would it be? Do they have to go the match again? Are you somehow blacklisted by PD's now? If the affected residency specialty was competitive, would that person ever be able to match in that field again, e.g., ortho? Or is psych, fm, or im their likely future?

 

[APACHE3]

Can you be dismissed for infopenia in your first month? I guess I understand if its your 10 month, but I hope PD's will give us at least a couple of months to show our stuff!!

 

[BKN]

Can you be dismissed for infopenia in your first month? I guess I understand if its your 10 month, but I hope PD's will give us at least a couple of months to show our stuff!!

I suppose so, but I've never seen it. Usually at least a year, often two.

It takes a while to become familiar with the new residents. Months at the small places. Much longer at the big places.

If a resident was dismissed for knowledge deficiency reasons, what does that person do to find a new residency?

First, there is very little of this. Happily, the med schools are more responsible about this than they used to be. Best not to admit those who can't do the work. If admitted, better to filter at MS1 or 2.

Second, since the schools do a better job of screening for lack of ability, infopenia at the resident level usually has another etiology (drugs, depression, family stress or illness, personality disorder, etc). What I've found is, almost anybody who can get into residency can get out. Sometimes they need a little more time, sometimes they need a litte more motivation.

So firings are rarely solely for lack of information. Often there is inability to put the info to use (synthesis) or other personality issues.

Now to get to your question. It would be hard but is usually possible. Usually a different specialty with a different style of practice that fits the resident's strengths better. As has been noted before, a fired resident needs to keep a good relationship with his previous PD. Any sensible PD who is thinking aobut giving a retread a second chance is going to talk to the previous faculty.

 

[Firebird]

Sufficient onto the day is the evil thereof. tomorrow will take care of itself.

BKN

I love the fact that you quoted that.

 

[8744]

...What's "not performing as expected?" Examples off the top of my head (not exhaustive).

....
2. Not answering pages
....


BKN

No joke. I was reprimanded by my program for not answering some of their pages. Two when I was at home asleep after night float. I was told that I had to roll my pager over to somebody if I was going to be asleep and twice when I was up in Detroit interviewing and I wasn't carrying the stupid thing.

On all occasions my program knew where I was (presumably they have my schedule) and as far as being asleep could have called me at home if it was that important fer' chrissakes. (Which is wasn't)

But it is important to answer pages, kids. One thing you need to be able to count on is that you can reach the person who is listed as being on call or covering. It's just one of those things.

 

[ORBITAL BEBOP]

Oh chill out, you're so sensitive - and I am going into psych, and yeah, I don't particularly like certain types that go into the field - I also don't hang out with them, I stick with the more driven, intellectually challenging colleagues I have that tend to have less issues.

EVERYONE has "issues" but theres some issues that don't bode well for being a good physician. And last I checked, I wasn't talking about people switching because they picked the wrong specialty READ THE THREAD TITLE AND THE ORIGINAL OP.

Also, when you switch, go ahead and survey the people around you, there were some places I interviewed at that I didn't rank at all because of the odd balls I met in the residency program.

And if you want to know, the original specialty I was going into was surgery.

I read the quote by the OP but I was answering to what you posted, esp about Psych getting the hand me downs. You are allowed to do that, right?

I think there are residents you wont like in any field. Its not psych dependent. And I met odd balls in residency programs in IM and anesthesia as well.

And you went into surgery and what happened?

What issues dont bode well for being a good physician, esp psych specific traits?

And anyone, please answer what the definition of 'impaired' is when it comes to physicians.

And I am "chilled out". I obviously choose what threads are impt to me.

 

[Doc Samson]

HOW COME PSYCH GETS THE HAND ME DOWNS DAMMIT!

A large part of our professional philosophy has to be that behavioral problems can be treated. While a medicine program might fire a resident, we might tend to look for ways to remediate the problem. We're also much more familiar with addiction issues, and know that effective treatment is possible. BTW, the MOST impaired resident I ever worked with wasn't a psychiatrist, and the impairment was an eating DO.

 

[lsres]

Thank you for your posts. It seems my difficulties started after I publicly discussed working hours with another resident in our program in the cafeteria about problems we were having with working hours during our first month (she was putting in about 100 hours a week in another rotation in the hospital and I figured I my hours were about 95). Shortly after this things went downhill. I admit I made mistakes but it seemed that the program was focusing on every small thing I did while not saying as much when other residents had similar problems. For example I got into trouble because I did not answer two call pages (the other person is on the line waiting for me to call the extension) while driving from the clinic to the hospital. When I called back as soon as I got to the hospital the callers were not there. I was subsequently accused of infopenia. I did have some weak areas and was working hard to correct any deficiencies in my knowledge but did not get a chance to take any exams. It was also becoming apparent to me from my positive experiences elsewhere and from my experience there that this was not the right program and probably not the right specialty for me.

I also think I may have a problem with sleep apnea. I was scheduled to have a sleep study which I had to cancel when I lost my insurance after leaving the program. The advice given by the sleep specialist about sleeping positions has helped some. As one of the weaker residents in the program I should have tried to keep a lower profile. The lesson is to keep your mouth shut and do your best not to create any waves. Also do your homework. I found out too late this has happened before with other residents in the program. Also don’t be afraid to admit it if you made a mistake in choosing a specialty or program.

I have worked hard to get where I am and have taken and passed step 3 of the USMLE after leaving the program. Helping patients as a doctor is what I want to do. I am going to move on and do the best I can but when I start thinking about what happened…I am trying to hold onto the belief if you have faith and do what is right things will eventually work out.

 

[Poety]

A large part of our professional philosophy has to be that behavioral problems can be treated. While a medicine program might fire a resident, we might tend to look for ways to remediate the problem. We're also much more familiar with addiction issues, and know that effective treatment is possible. BTW, the MOST impaired resident I ever worked with wasn't a psychiatrist, and the impairment was an eating DO.

ok.

 

[lsres]

Was "not performing as expected" the only reason they gave you, with no further explination? That sounds awefully weak. Have you looked at your file? Did you ask for further explanation?

Apparently, legal action doesn't produce much of a result against residencies. However, I think it would depend on what kind of documentation of your "poor performance" and how they tried to remediate it. Your resignation won't look good. Lawyers are often worth the money even if you don't take legal action. Check with a lawyer that specializes in employment practices, and is NOT affiliated with the hospital in anyway.

If you were sucessful in getting your program to let you back in, would you want to be there? Retaliation is a real thing, and the program director usually has the final say in all things regarding the residents.

The way things were there I would prefer not to go back there if I was given the opportunity.

 

[KluverBucy]

Not gonna lie here - all of this "firing the intern chat" is gettin me nervous too. I have never failed any board exam or course in med school but I also wasn't AOA material. I did well on clinicals - never had any problems other than the token surgery eval which said i "appeared to lack interest".

with all of the above taken into account, i am STILL nervous as hel!. that and i'm forgetting more **** everyday. by the time july roles around i might have no clue about ANYTHING medically related!!! should i be studying some???? HELP

the above is what happens when i don't drink.

fuk. someone get this guy some Ativan STAT. it's my experience that these types of people are depleted of their Thiamine and thus could be hovering on the cusp of Wernicke's encephalopathy. who knows, maybe due to his apparent long term history of EtOH he has already developed a form of Korsakoff's. good luck with the bottle buddy...

 

[mysophobe]

Eponyms...hurting...brain....

 

[Annette]

The way things were there I would prefer not to go back there if I was given the opportunity.

Despite what BKN advised, I would look for a lawyer. Not to sue, but to help see what your options are. Just don't tell anyone that you have hired a lawyer. You have invested way too much time and money to this career to quit without putting up some kind of fight.

Would the program director help you look for a different residency? You say that you don't think you picked the right specialty. Maybe you program director would agree, and be willing to help you get into another residency. Were there other faculty who were supportive of you? Will they help you look for a different residency? You could also talk to the medical education department (that oversees all the residency programs).

Don't be defensive, though. The natural instincts of people in medicine are to help (usually). If you start blaming the program director for anything, you will lose any goodwill you may have developed.

As for insurance/sleep study, see if you can't be put under cobra. I think you have so many days after you leave to enroll. It may be somewhat expensive, but you can get the sleep study done to help support your case.

Good luck with all this. I know you are probably feeling like crap right now, but you have to pick yourself up. No one else will do it, and the longer you delay, the harder it will be.