Your Residency Permanent Record!!!

[Doctor Bagel]

I'm ignorant about this one. I know we have some sort of record, but how much does it matter? And I'm not talking about things like training exam scores, etc.. More the soft stuff.

For example, I know someone who apparently had a complaint filed against her by a notoriously malignant ED attending. The attending in question is pretty much ridiculous, and everyone in my program (and the university as a whole) has had a bad run in with him. I don't know the exact details of the incident, but she was told this complaint was filed, and I guess it's in her record. Does this matter? If so, my program is being kinda crappy for not standing up for her. If it doesn't matter, then I guess it just doesn't matter. Curious because I ran into something against this same guy who luckily was taking most of his ire out against my attending. But he could have filed something about me (luckily he didn't) just because he's a jerk. BTW, I think the context of both my run in with him and this other residents run in regarded an inappropriate admission to our unit. Is that really something residents should have to worry about?

I feel like I'm in high school and hearing threats about my permanent record. Residency is so ridiculous, I guess.

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[Samoa]

It's only relevant if your PD wants to fire you. And possibly LORs for fellowship.

 

[Winged Scapula]

Well, I've always wondered if it goes beyond that.

When you apply for privileges at a hospital, they will require credentialing information from your program. Now if the same PD is there, he probably doesn't have to whip out your file to check and see if you met the criteria and answer any questions.

But if there is a new PD, someone who isn't knowlegeable of you, how much do they read through (and yes, I have one of those letters too - written by a senior resident when I was an intern. I was allowed to write a rebuttal [my PD liked me and did not care for that senior resident])?

Not that it matters - I cannot imagine that some random letter amongst all the other good ones/evals would hurt someone. But my POV is that such things can follow you beyond residency and fellowship to hospital credentialing and potential practice hires.

 

[dragonfly99]

I would think that it matters a lot how much your program director wants to screw you over. He can choose to mention it (or not) when he's asked for info from a state medical board or to write an evaluation for a job or fellowship. Even if he can't take it out/remove it from your file, it would seem that the "spin" he puts on it would matter a lot.

As an aside, it's almost always better to take the path of least resistance with nurses and attendings, and anyone senior to you, unless direct patient harm will result from not doing so. They can always hurt you more, and it's almost invariably not worth it to tangle with people about not taking one more bogus admission, etc.

 

[Doctor Bagel]

I would think that it matters a lot how much your program director wants to screw you over. He can choose to mention it (or not) when he's asked for info from a state medical board or to write an evaluation for a job or fellowship. Even if he can't take it out/remove it from your file, it would seem that the "spin" he puts on it would matter a lot.

As an aside, it's almost always better to take the path of least resistance with nurses and attendings, and anyone senior to you, unless direct patient harm will result from not doing so. They can always hurt you more, and it's almost invariably not worth it to tangle with people about not taking one more bogus admission, etc.

Yeah, you're probably right. Unfortunately, though, we get put in positions as interns (well, changing next year) where you either piss off the ED attending or you piss off the charge nurse in the unit, so you could be written up either way.

Other than being written up, what other type of stuff would be in there. I've honestly been annoyed at my program about a lot of things, and I've probably stupidly been a little too vocal about that. I got a comment in my last eval about seeming "anxious" about all the changes in my program. Initially, I was thinking that was fair, but then I got a little bugged because it seemed like it was putting it all on me, when our program just flat out sucks at communication with us about stuff and shut us down when we tried to ask questions. So yes, me being "anxious" is in there somewhere, but I also didn't have great reasons to have absolute faith in my program and not be "anxious" about stuff. I mentioned this to another resident, and she made some comments, like "oh, there must be something in your file, too," which now has been feeling just a tad bit paranoid.

And I thought I was coming to a touchy feeling everyone's happy type of program, so this whole year has been a little weird for me. Of course, these false beliefs about my program led to a huge chunk of my disillusionment this year, too.

BTW, the 3 exclamation points in the subject headline where my lame attempt to be funny in some "dun, dun, dun" type of way about your PERMANENT RECORD!

 

[mcl]

Generally, the credentialing paperwork I've filled out for former residents asks specifically about disciplinary actions, not specific negative evaluations that might crop up. Having several negative evaluations or formal complaints might indicate a pattern which the PD might reflect by scoring the resident "good" rather than "excellent" in a category continuum, but I doubt that has any impact on the former resident's career. Often programs end up shredding the individual evaluative documents and just keeping the semi-annual letters in the permanent file as a resource for completing credentialing paperwork.

 

[Law2Doc]

It's only relevant if your PD wants to fire you. ...

Agreed. I would say this is the main thing. In most cases, if you have predominantly acceptable evaluations, with one aberration or two over the course of the entire residency, it probably won't ever come back to bite you. Many residents rub someone the wrong way someone along the road; it's the nature of the long hours, poor diet and high stress levels. But if the PD decides to get rid of you, thanks to this system he has the evidence he needs so that he can legally do so for cause. You cannot say -- I was the perfect employee and never heard of anyone having anything bad to say about me -- as it is all there in the file -- nurse X complained about you, and then the PD mentioned it in the last annual review, and you signed a document showing that they discussed your evaluations, etc. Essentially, this is very effective papering of the file, so that if the PD needs to pull the trigger on someone he considers questionable, he can do so.

As a lawyer, I really couldn't suggest a better system for an employer. Not only are they collecting complaints on every employee, but having you sign off that you have been informed about them and that a discussion with your boss has occurred. Makes it very hard to sue if you get fired for cause.

 

[Doctor Bagel]

Generally, the credentialing paperwork I've filled out for former residents asks specifically about disciplinary actions, not specific negative evaluations that might crop up. Having several negative evaluations or formal complaints might indicate a pattern which the PD might reflect by scoring the resident "good" rather than "excellent" in a category continuum, but I doubt that has any impact on the former resident's career. Often programs end up shredding the individual evaluative documents and just keeping the semi-annual letters in the permanent file as a resource for completing credentialing paperwork.

That seems pretty reasonable.

I know any negative stuff can be used to fire you, but do programs generally want to fire people without good reason? It's an ongoing SDN idea, but I'm still doubtful that it's real for most programs. I have learned we're pretty disposable, though. At a program where we've lost 2 people in my intern class and have had no trouble replacing them with good applicants.

Reading through this thread has reminded me that I am neurotic. So yeah, still processing this "anxiety" about my program thing.

 

[Law2Doc]

That seems pretty reasonable.

I know any negative stuff can be used to fire you, but do programs generally want to fire people without good reason? ...

Good reason is in the eye of the beholder. The point is that if they decide they have a reason, this ongoing papering of the file often allows it to be legally sufficient.

 

[kayenn]

I completed my internship at a different hospital and recently found out that my then program director had mentioned a clash that I had with a senior resident, in my annual evalutaion.
It turned out that if your program director wants to make your life hell , he/she can make a mountain out of a mole hill. funny thing is , I m still remembered in good words from the rest of the faculty of that program and they provide very good letters of recommendation I got superb monthly evaluations from every rotation , but it is the Program Directors letter that all residency programs and fellowship programs require. and with that kind of a comment written in my file on record, Im really wored about the impact it will have in future. That Program director has stepped down, but the new one doesnot know me,a nd will only have that comment in my file,to refer to for any future recommendations I request. How will I undo the damage that she did before leaving?

 

[Socrates25]

I would think that it matters a lot how much your program director wants to screw you over. He can choose to mention it (or not) when he's asked for info from a state medical board or to write an evaluation for a job or fellowship.

I'm not so sure about this. While PDs always have a choice, I think most medical boards have rules in place forcing PDs to make any potentially negative disclosure to the medical board, even if its total BS. I've heard of medical boards filing disciplinary actions against program directors for failing to disclose potentially negative information, even if its stupid trivial stuff that people in practice wouldnt care about. The Texas Medical Board, for example, has specific statements in their policies that they will come after PDs who fail to disclose and that only the medical board, not the PD himself, can decide if its "worth reporting" or not.

 

[dpmd]

I know of some "secret probation" strategies that can be used where you get a letter of probation but if you keep from doing anything else bad they PD will throw it away. I would guess the same thing could happen with a letter from a notorious jackass attending about something that was blown out of proportion. Of course this is assuming you are generally a decent resident that the PD likes (or at least doesn't dislike)

 

[Doctor Bagel]

Wow, necrobump. I had forgotten about this situation, but thinking about it again makes me angry. Jeez. Actually thinking about the one ED attending in question makes me angry. We get endless lectures about professionalism, but apparently those same standards don't apply to people in charge.

Anyway, I submitted an application to the state board for my full license, and as I recall, the question form for your program PD was pretty open-ended about disciplinary issues, so it seemed like PDs have a decent amount of discretion assuming you're not officially placed on probation. While I love what I do and the almost 100% employment rate with good salaries in our field, the practice of medicine involves lots of fear, I guess.

 

[Osteoimperfecta]

Obviously it depends on the complaint. If every write up = career problems, then a good chunk of physicians will be out of work right now.

 

[Psych2014]

While I love what I do and the almost 100% employment rate with good salaries in our field, the practice of medicine involves lots of fear, I guess.[/QUOTE]

I like this thread because it speaks to the fears (large or small) that most of have in the back of your mind, after reading our personal file at residency, and having had a couple of reviews, where you find negative comments, with no name attached, and nobody ever aproached you about it. It feels like little stealth bombs.

I think the key issue is in the above quote, if we expect to get through this MD life without fear and trepidation and some scratches and bruises, I'm fairly sure we'll be dissapointed.

 

[dragonfly99]

Perceptive comment (just above here...).
You psych docs are paid to be perceptive, I guess...
Anyway, I think attendings have some of these same fears, though not to the same degree. Even attendings can be written up for yelling at residents, nurses, etc. Or patients can write them up for something stupid. I just signed a contract as an attending, and part of my pay (granted, a small part) is based on how patients and clinic staff review me. It's just part of what we have to live with, and we have to live with some uncertainly as to how others will react to us and perceive us...and have to understand that we can control some aspects of this but not others.

Dr. Bagel, I don't think you have a lot to fear in your specific situation that you described, unless something further happened. However, when people are telling you that you act too strident or anxious, they are telling you something...at best, that you over-react to stuff and maybe they are right (and had/have your best interests at heart)...at worse, they are warning you off to keep your mouth shut that they don't want to hear your input/complaints...or you could end up in actual "trouble" with an actual letter in your file.