Quoted: Unfair termination

[Doodledog]

An SDN member asks:

Hello,
I have been unfairly placed on a performance plan and am worried I may be terminated. I feel I am being harassed and charges have been cooked up aginst me.
1. Lied to attending
2. Have bossy attitude etc.

What are my options:
1. Should i take legal help.
2. Should I resign.
Please let me know.
Thanks

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[NotAProgDirector]

Unfortunately, this is a common question in the Residency Forum here on SDN. You might want to read the following threads:

• options after being terminated?
• This sucks! Six month extension...
• What are the implications of academic probation during residency?
• Urgent Help! Drowning Intern
• Wrongful termination of PGY1 contract
• When should you take legal action or just suck it up and move on?
• Probation, now what?

Program directors are charged with deciding whether residents are promoted or graduated. No matter how selective the admissions process is, some people fail at each step (i.e. some people fail out of medical school, some out of residency, some out of fellowship, etc). As there is no uniform test / assessment of competency, all probation / termination assessments are subjective, and subject to interpretation and abuse.

If you have been terminated unfairly, what can you do?

Follow the grievance process as defined by your program / GME office. Each program must have a grievance process, although what it is and how it is structured is completely up to the program. Often it includes an "independent" review, but this usually involves other PD's, people in GME, etc and there is concern about how independent it truly is.

Hire a lawyer. Most of the threads linked above suggest getting a lawyer. Although it's your perogative, it usually doesn't help. Programs are held to "Academic Due Process" which is a very different concept than Employment Due Process. Programs are legally held to following their own written policies -- as long as they do that, there is not supposed to be cause for legal action. You usually do not have the right to have a lawyer present at a grievance process.

Contact the ACGME. This is guaranteed to be a dead end. The ACGME and RRC do not get involved in individual resident / program issues. You can report your program to the ACGME if you think they have violations, especially around duty hours, but this will not fix your probation nor get you your spot back.

Contact the NRMP. This is not a match issue at all, and they have no standing in this issue.

Doesn't my contract promise me a spot for a year? No, it doesn't. Most contracts include a clause saying that they have to give you XX months notice if they will "not renew" your contract -- i.e. if you will not be given a PGY X+1 contract next year. However, you can be terminated for poor performance at any time and with minimal notice, as long as the rules as stated in your contract / housestaff manual are followed.

Sadly, your choices seem limited:
1. Activate the grievence process and see what happens.
2. Find a faculty mentor / advocate at your program.
3. Hire a lawyer. Expensive, and may not work, but it's something you can do that's under your control.
4. Try to convince your PD to help you find a new program.

Regardless of the outcomes of #1-3, your long term prospects in this program seem dim. You don't trust them anymore, and even if you force them to continue your training, it's going to be difficult. In the end, convincing your current PD (or other faculty at your institution) to help you find a new program is probably in your best interest.

I would love to hear other people's input into this type of situation.

 

[Shalom77]

One thing I might consider that hasn't been mentioned is that if your program is associated with a medical school, contacting the ombudsperson (which I think many (?most) have.) Usually, this is completely confidential but I would check what the parameters are in your institution. They may have insight into the personalities at your institution, have helped other people in your situation and can guide you towards the correct channels and even accompany you to meetings if you think it would be helpful. (It can be helpful to have a non threatening (at least compared to a lawyer) but theoretically "objective" third party present.) ​

I don't know much about grievance processes, so I'll have to defer to others. Again getting advice from someone in your institution would be helpful. ​

I do think it is worth putting your perspective of the "misunderstanding" between you and the attending in writing and the other charges so that there is a written record of how you perceive things/your response to the

charges. Be as respectful and professional as possible in this letter. ​

I agree with discussing this with a faculty member with whom you have a good rapport, preferably a senior faculty member. They can also help you judge the situation and your ability to stay in the program (and also help with switching programs.) Someone who won't advocate for you within your program for political reasons, may still be quite supportive of you to another program if they otherwise think highly of you.​

I'd think about the purported reasons and the "real" reasons behind your programs actions. ​

• What happened between you and the faculty member who accuses you of "lying" to them?​
• What behaviors are they attributing as "bossy" and with whom? (nurses, fellow residents, med students, etc.) Ask someone you trust (a nurse, fellow resident) to provide feedback about how you come across or what you might consider changing in your interaction style.
• Is there some other reason they can't officially use - but is really the reason why they are initiating this.

The better you understand what is really going on (and you might never completely) the better you can figure out whether it's a correctable problem.

The big question is do you have a future in this program or not. That's hard to answer not knowing the specifics - which is why I think talking to someone local to give you more insight into this question would be helpful​

Before resigning, I would look into the possibilities of switching programs. My sense is that it's better to try to switch while in a program than after resigning. Ideal would be if you can get the support of your PD for a switch or if not that, at least the support of other faculty/with a neutral PD. I do think it helps if there is some other legitimate/convincing reason you can cite as to why you might be switching (ie the program you are looking to switch to is closer to your family, etc.) ​

What's absolutely essential - is to be at your best clinically and academically and to work on correcting any weaknesses (including how you come across to others.) High quality performance may not save your position at this residency, but is key if you want to be able to finish a residency. It's easy to let your performance slide under the stress and uncertainty of your position - but while you may never change the minds of the attending acusing you of lying and his/her buddies - excellent performance can win you other supporters who might help you switch residencies. Although it can be hard to beat a reputation in residency, some people do judge others based on their own observations/interactions and not on hearsay. Keep your focus on your end goal.​

Consulting a lawyer obviously could be helpful at least to understand your options. I do agree that the likelihood of a lawsuit being successful is low and even if you "win" you lose - because working for a program that doesn't want you is bound to be a bad experience. A lawsuit is expensive, adversarial, and time consuming. Mostly it keeps you looking backward instead of helping you reach your goal which is to finish residency. Therefore, I think it's better to focus on correcting any issues in your program if possible or switching. "Success is the best revenge" is a better motto than trying to prove you are right because in residency, "the resident is always wrong" and programs have a lot more power and resources to make this story stick than you will ever have to prove your case.​

 

[Poety2]

Trust me on this one - get your PD's SUPPORT AND MOVE ON, good luck, this is not uncommon, and it may be widdled down to you and the program just not clicking (my case) which is OK - its all in the way you handle it that is going to make or break you.

If you seem reactive, overly emotional and defensive, then you may not fair well (despite if you are right or not), but keeping your cool and staying level headed may actually work in your benefit to another program to see that you can deal with a great load of stress in a professional manner.

Good luck!

Poety