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02-03-2024, 05:30 PM
(This post was last modified: 02-16-2024, 12:35 PM by six_and_done.)
Full disclosure: I will know this week if the final appeal went in my favor vs the recommendation of termination was found to be correct.
Based on the first stage of the appeal and hints I've been getting, I bet that the recommendation of termination will stand.
AMA
2/16 edit: appeal denied, termination confirmed.
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What did you do and what did they say you did.
I luckily made it through but almost was in your shoes, I feel for you. I transferred programs before badness happened and the new environment was the change I needed - night and day difference. I have witnessed this occur many times, and there needs to be legislation pushed to protect residents. How can one make it successful through college, med school, and years of residency and then randomly be told they are crap. Neurosurgery isn't complex, its usually interpersonal where problems occur and if not then I feel its up to the program to help. Many programs say they help "on paper", but never look at the root cause - resident mistreatment. Neurosurgery residents are motivated individuals, and you need to be in the right environment to succeed.
These cases always comes down to personality issues and labeled as "professionalism" in the majority of firings or non-renewals. Try to get in somewhere else or move on with your life. Your obvious bright enough to do anything you want if you matched into neurosurgery. Don't let others control your destiny.
I have seen someone who was a "crap resident" at one place turn into a solid resident at another. 3 times I've seen this personally in neurosurgery, multiple times in other fields. It is stupid and needs to stop. It destroys peoples lives in an ego filled specialty. Residents have no protection.
But attendings who have professionalism issues either leave or get fired and can pick up at another hospital or private practice. Also, I have seen multiple professionalism issues at attending and resident level, but people "pick and choose" who and what they want to enforce. Its a buddy-buddy system.
When trying to get hired at another place, it takes supportive people to get you in. There are two sides to any story, you just need to make sure the right story is told and understood. All about who you know. They will ask you "why did you leave", which unfortunately is a waste of time for you and the interviewer because it always presents a bad light. Your references will save you.
Good luck my friend and colleague!
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02-03-2024, 07:17 PM
(This post was last modified: 02-03-2024, 07:43 PM by six_and_done.)
What I did:
PGY1-4: I offered to resign PGY2 year, citing that I wasn't a good fit for the program. Unfortunately - I was met with an unexpected response by the chairman that made it difficult to resign. I was placed on remediation which I completed without issue. I suspect I lost trust and was resentful to some extent and this likely contributed to an unprofessional interaction with the chairman during a PGY4 six month review.
PGY5-6
PGY5 year was half research half clinical as punishment for my PGY4 incident if I recall correctly, accepted into spine fellowship July 2024
PGY6 year I was shocked to receive 6 month probation since PGY5 had excellent reviews. Nothing pointed to the additional items in the probation including my training being extended by 6 months (I had to cancel my Spine fellowship), being denied the position of chief resident.
I'm proud to say that I approached it with earnest respect, accountability. Only reason is because I think at the time I did love neurosurgery for sure.
In my opinion, documentation heavily points to completion of probation.
I was surprised to have my of probation extended and I responded by requesting it to be appealed, but the appeal was not available.
Partly because all the stress (I felt as if I was being forced to quit) etc, an intra-op argument with a co-resident was enough for the recommendation of termination.
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What they said I did:
I was unprofessional in the setting of probation and therefore failed to meet the terms of my probation.
My takeaway: I learned that in this situation, the details were not important because of the power/authority that a neurosurgery department has. I also believe that the interaction during my PGY4 year required a strong response (termination, LOA, offer to resign) - but officially, it resulted in a letter in my file and punitive modification to my PGY5 year. The threshold for tolerance of ANY type of problem for the remainder of my residency was very low. Maybe I didn't fully appreciate this and that was my mistake.
This was the perfect question to ask - thank you.
I'm happy to hear that things worked out more favorably in your case and thank you for the kind and encouraging message.
You make very important points:
On paper, is easy to demonstrate the infrastructure required to train a resident is present in any given department. In reality, I can say first hand it is not completely representative.
Departments and faculty can display some degree of impunity that may be detrimental to education of residents. Changing this would benefit from neurosurgery residents developing a reasonable argument to implement creative ways to address this.
I saw the "buddy-buddy" system you described - I wasn't able to fully integrate in this way, I think probably because of my personality - I wasn't an extrovert ever in my life and found it overwhelming to mix personal and professional life. However - I suspected this kind of system could lead to problems and saw some very detrimental effects in professional development and credibility in some people.
The ONLY thing that will get you back in is a good connection. Its peoples word against others. We know you can do the work, you did it for 6 years and took call, etc. If you were THAT incompetent and a risk to health, you would have been reported to the medical board and lost your license. Its a personality issue not a competence issue.
I have had friends try to get back in for years, some successful some not. Some get offered a "pre-residency fellowship" which actually is complete BS - because if they are "professional enough" to do the same exact work as a NSGY resident in a pre-residency fellowship - then they are good enough for a residency.
I think as a PGY-7 you will need to look for spots in other programs and have to do a few more years. I know people who had to start residency all over again. Its complete BS and hopefully someone will speak out one day to change this system.
What percent of neurosurgery residents get fired? Less than 10 percent?
Those look pretty much the same. You’re talking a difference of 0.5%, which doesn’t matter unless the SD is extremely low.
Residents get fired late for a lot of reasons, I hope you find your calling in life.
As someone making their rank list right now, what are the most important factors I think should of?
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Important factors that allow programs to be categorized.
There are endless variables, but for the purposes of ranking, the ones with most effect can be used.
Example:
Program size - large, medium, small
Location - favorable, tolerable, unfavorable
Focus - 2 years lab research vs not
More custom variables that can be identified can be used as well.
Add a points system based on preference.
If you are more interested in a small program, assign 3 points to programs of that size (and large would get 1 or 0 points)
This will provide a scoring system based on your preferences.
You can then compare between/within categories.
This serves as a way to increase confidence in the rank list to some extent.
