Residency Termination?  Residency Probation?

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Basic Advice 

1) You are not a failure, and you are not alone.  There are literally dozens of physicians just like you at any given point in time, out there looking for a path out of the darkness, looking for some help figuring it all out.  I hope this site can answer some of your questions.

2) Never forget that your residency director holds a great deal of power over you.  And that includes exactly how you leave residency if it comes down to that.  Be humble, minimize confrontations, and ask for help to get to your next destination.  I would also advise against disclosing your legal counsel until it is absolutely necessary.  In recent years I have started to realize that the most terrible part of the residency system is that your program director (and the staff being directed or coerced by him/her) has the ability to literally manufacture 'evidence' of your incompetence whenever he/she would like.  Written evaluations are considered evidence in the Graduate Medical Education Committee hearings as well as in a court of law.  Nobody, and I mean absolutely NOBODY stops to ask the question of whether or not the contents of the written evaluations are true or fair.  It is like being put on trial for a crime where the local police department has the freedom to write witness reports that state whatever they please.  This is an extremely difficult battle to win for the individual.  Only residency reform in the shape of lawsuits and legislation will reduce the residency director's capacity for unlimited power and absolute destruction of whomever he/she pleases. 

3) Get legal counsel early.  Consider getting legal counsel even if you're just being placed on probation so that they can review the probation document.  It may become exhibit A if and when you are terminated.

4) Never Resign!  Even if your residency program director says that he/she will help you if you do.  Probation is a reportable event, and termination is a reportable event.  Resigning at the end of a probationary period or in lieu of termination will not do much to improve your record.  But it will make it much more difficult to seek legal action if it comes down to that.

After a few years of speaking with folks on the phone, over email, and reviewing legal cases I realize that it's not this simple.  If you think that you will end up filing a lawsuit, then don't resign.  If they have actually made an honest effort at rehabilitating you, and they are giving you the opportunity to resign, consider taking it.  When you reject their offer to let you resign, you are basically declaring all out war.  They will try to destroy you, defame you, whatever it takes to get you terminated.  And they will tell anyone who asks about you that you are the worst thing they've ever seen.  If you resign, there's a chance that they will be kind and help you get to your next residency.  But there are plenty of instances of them shutting residents out as soon as they resign.  Resignation makes their life very easy, and once they have a resident out, they often want nothing else to do with them.

Make this decision very carefully.   

5) Another exception to point #3 would be if you can see the direction that things are heading in, and you have not yet been placed on probation.  If executed early enough, a resignation could allow you to quietly excuse yourself from a hostile environment before career and reputation damaging documentation has been generated.  

6) Never Give up on what you really want to do.  I ran into one of the staff surgeons from a different department more than a year and a half after my first GME committee hearing (In the military, you may find yourself lingering around the same hospital for quite a while after you've been terminated).  I worked with this doc for a month when I rotated through his department as an intern, and we have always had a very cordial relationship.  He asked me what I was going to do and I told him that I still want to complete the residency that I started.  He then proceeded to tell me that he had been derailed not once, but twice in his journey to becoming a staff surgeon.  Terminated from one residency, and one fellowship.  He said that he never gave up because he knew that he had what it takes, and he would be the one to determine what he does for the rest of his life and he was glad to see that I felt the same way. 

7) Revenge in the form of a lawsuit, settlement, or simply exposing the malice of your oppressors seems like an attractive idea.  But put your focus on getting to that next residency.  There will be time for legal action later if you have ample evidence and a good case.  Most lawsuits take between 5 and 10 years to conclude anyway, so you can't rely on them to fix your immediate problems most of the time.  Get back to training as quickly as possible!    

8) Just to emphasize the points made in bullet 7...   Through this website, I've made contact with a former Orthopedic Surgery resident who I most definitely regard as a friend at this point.  Since 2013, when he was dismissed, we have spoken about once a year on the phone just to update one another on our progress.  His dismissal was so much more unjust than my own, and it has helped give me perspective on just how easy abuse is in this GME system.  He was a PGY-5 in good standing, who had already been accepted to a spine fellowship.  A series of minor events that angered his program director and generated friction between him and another senior resident led to his separation.  There was no misconduct, no evidence of incompetence.  Just a grudge and the willingness to abuse power.   Well, unlike 99.9% of residents and former residents who fall into this sort of trap, my friend had time. He had the time and the money to fight these people and force the truth to be spoken in depositions and in court.  It has been 6 years now, and he has expended at least $4 million in legal fees.   He's not finished yet either.  Could be another few years, and I expect that it will be at least another million dollars.  

I admire him for fighting, and if I had his resources, and was certain that victory was possible I would have pursued similar courses of action.  But most of you will agree, that returning to the profession in some capacity has to be the most important goal.  I believe that he will return.  He may even return to the program that cast him out (the University is going to end up firing some people most likely).   And most of you don't have several million dollars to expend in order to pursue a court victory that may not come for 6-8 years.  

So again, focus on the next residency position, and try to save the emotional trauma, the rage, the lust for revenge for your therapy sessions.