Terminated during PGY7 - AMA

[Guest]

(02-03-2024, 07:17 PM)six_and_done Wrote: 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.

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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.

Why specifically did you offer to resign in your PGY2 year? Was there a significant incident that occured that prompted you to want to leave so abruptly?

[six_and_done]

During my PGY2 year I had accumulated concerning interactions with 2-3 of the senior residents that based on my perspective:
- suggested they thought I was performing in an unsatisfactory way
- assigned me extra 24hr call without a justifiable reason
- lacked any form of constructive criticism
- socially, it was apparent I became the laughing stock

I shared my concerns with the program director - particularly when extra 24 hr weekend calls clearly violated hours on paper - and the response made it clear that any chief resident was at liberty to do this.

It felt to me like the amount of negative interactions, complete lack of interest to address my concerns from the program director, and lack of clear opportunities to improve put me in a difficult situation.

I concluded I wasn't a good fit for the program and was willing to resign - this idea was presented to the program director. To my surprise, I was then presented with information that made resigning appear to be unusually high risk and would adversely affect my career.

[Guest]

What program were you unlawfully fired from? Did you consider litigation?

[six_and_done]

In order to reduce bias, I have purposely kept much information undisclosed.

I can't responsibly comment on matters of law or my opinion of litigation.

[Guest]

Unless the program was run by idiots, there was a lawyer involved on the program’s end before termination was brought up to the resident.

Of only there were a union the resident could have turned to…

[six_and_done]

The idea of union is interesting but would require adequate peer representation to adequately review issues brought to their attention.

For neurosurgery, it could be challenging to develop sufficient peer representation in matters of investigation for two reasons:
1) relatively low number of residents
2) unique characteristics of neurosurgery training programs vs other specialties

Without sufficient peer representation/review, a union may lack the information or guidance to fully investigate matters.

[Guest]

There are ample cases of resident unionization at this point. In none of those cases did the residents see it as a bad thing.

[six_and_done]

Good point. In theory and in practice, unions have shown to be favorable in many industries.
A spectrum in the quality of unions also exists and is dependent on certain nuances.

[Focus]

You all should unionize. Frankly physicians at university and hospital run practices should be unionized too but we like to pretend that we are management and not peons. I was too old to be part of that movement in residency, but if I had to start all over again I would absolutely work to develop it at where I trained.

[six_and_done]

I agree with your statement favoring unionizing.
Specialties will likely benefit from adequate representation in a union - specialties apart from each other if necessary.

Regarding the management structure of the hospital:
A developing C-Suite organization is increasingly the type of leadership in health care at the level of the hospital.
This would benefit from representatives from all over the hospital to best allocate resources.
At this time, in my experience, that C-suite leadership is lacking in members with the ability to make health-care related decisions in a hospital: active providers.

As resident unions evolve over time, they may become more effective. Unfortunately, residents do not have much financial leverage to compete with that of their employers.


Edit: Private practice isn't going away. It just developed into an institution that physicians were not trained to understand.