Medical Residency Issues

By the time individuals reach their medical residencies, they've most likely spent at least two decades in school already, and aside from the desire to practice medicine, many also carry an average debt of $215,900. Most won't reach their full earning potential for many years to come, and even this benchmark is often contingent on successfully completing a residency program.

It takes extremely hard work and determination to get through medical school, and once you graduate, the work isn't done. Even matching with a residency program is a stressful event that leaves many medical school graduates disappointed every year. So, if you're in your dream residency program, you need to do all that's within your power to protect your position there.

While your residency years can be some of your best, sometimes medical residents face performance issues or misconduct allegations during the course of their programs. Since these programs are uniquely situated between student life and employment roles, it can be confusing to navigate the professional and ethical standards that apply if you've been accused of violative behavior. An experienced attorney-advisor can help you understand your next best step when defending yourself against disciplinary action.

Are Medical Residents Employees or Students?

Before considering the type of disciplinary action you could face as a medical resident, it's important to consider the hybrid nature of medical residencies. Although residents are paid and have employee contracts along with descriptions of their jobs, medical residents are in their residencies for the purpose of training. In fact, this ambiguity has long been the subject of debate and ripe fodder for law school journal papers.

Academic hospitals with residency programs are affiliated with medical schools and often have complex partnerships. In general, medical residents are required to adhere to the misconduct and performance policies of both institutions.

Performance Problems in Medical Residency Programs

While medical residency programs are not graded, residents are expected to learn and demonstrate their ongoing accumulation of knowledge throughout the progression of their residency programs.

Residents are expected to display their knowledge through patient interaction, presentation of cases to their attending physicians, and demonstration of examination and treatment skills. In addition, issues like attendance and focus are key components to a resident's assessed performance. While it's expected that you will make mistakes during your residency, there are times when the mistakes are egregious in the eyes of the disciplinary board. Medical residents can sometimes face poor performance assessments through no fault of their own as hospital residency programs can be as political as any other work environment, and in some cases, they can even be discriminatory.

In fact, the AAMC discusses a 2018 National Academies of Sciences, Engineering, and Medicine (NASEM) report which found that female medical students are 220% more likely to suffer sexual harassment than women in other fields, and over 30% of postdoctoral students who've gone into academic medicine were victims of harassment. Further, women of color in this field experienced increased rates of harassment.

If you've been accused of academic misconduct within your residency program, you need to act quickly in building a defense. Even if you feel that the allegations are unfounded, politically motivated, or discriminatory, an experienced attorney-advisor will help you ensure your reputation and future career are protected.

A Medical Resident's Well-being

It is no secret that medical residencies can be grueling and although residency programs have worked to improve workloads contributing to the over-fatigue of medical residents, poor performance is often still attributed to exhaustion and burnout.

The AMA Journal of Ethics opines that “Residents and fellows are obligated, as are all physicians, to monitor their own health and level of alertness so that these factors do not compromise their ability to care for patients safely.” Accordingly, even if you're sleep-deprived, the obligation to take care of yourself is often placed on you despite having very few options to recover. It can feel like your options are to either let your attendance or your in-person performance suffer.

Lack of sleep can cause conditions even more severe than making mistakes here and there (which itself is of course a concern). It can lead to depression and social withdrawal, according to an article published by Nature Communications. Individuals suffering from these serious mental health conditions can also begin to suffer from addiction or other substance abuse disorders.

Medical Residency Misconduct

In addition to being penalized for performance issues, medical residents are also susceptible to claims of professional misconduct. These types of claims range from addiction to accusations of sexual assault or harassment. While some are more serious than others, any of them can affect your ability to receive your medical license and build your career.

Substance Abuse in Medical Residents

Addiction can creep up on you and threaten your future career before you've even realized that there is a problem. According to the American Addiction Centers, physicians suffer from substance abuse at about the same rate as the general public. Over one-tenth of doctors suffer from addiction, and even though you are only human, you may feel even more shame when you're a medical professional in active addiction—you may feel like you should know better.

Still, doctors are just as susceptible to addiction, and those practicing within specialty fields, like emergency medicine or even psychiatry, have the highest rate of addiction within the physician community. Substance abuse can be distinguished from addiction in that abuse may occur only once. If you took prescription medication recreationally, or to relieve stress when it wasn't prescribed to you, then this was likely an abuse. Addiction, however, is an ongoing dependency. Either can jeopardize your professional future if disciplinary action is initiated for the conduct violation.

Importantly, sometimes accusations of substance abuse are made even when there is no substantive evidence. Many of the symptoms associated with ongoing alcohol abuse could be misinterpreted.

Evidence of alcohol abuse could be any of the following:

  • Slurring words
  • Shaking
  • Bad hygiene
  • Poor memory
  • Irritability and mood swings
  • Marital problems
  • Leaving work early
  • Not showing up to work

Medical residents may be accused of substance abuse even when there are other factors at play that could make it look like an individual is experiencing active addiction. For example, if you're going through marital problems unrelated to your alcohol habits, then you're also likely to exhibit mood swings. Stress and exhaustion are also likely to lead to poor memory and even a slurring of words.

Still, if you're accused of substance abuse, and there is truth to the allegation, you need to understand you have options and deserve an opportunity to move forward in your profession. An experienced attorney-advocate understands how to communicate mitigating circumstances to disciplinary boards, which may be willing to work with you if you agree to attend a treatment program or submit to drug testing.

Sexual Misconduct Allegations Against Medical Residents

Medical residents must adhere to codes of conduct, and these codes will undoubtedly contain provisions prohibiting sexual harassment or assault. Additionally, due to the academic nature of residency programs, there is recent case law to suggest Title IX can apply to residency programs at academic hospitals. Title IX is a federal civil rights law enacted in the 1970s to protect individuals from being excluded from participation on the basis of sex. In addition to sex-based discrimination, sexual harassment and sexual violence are also prohibited under Title IX.

Sometimes allegations of sexual misconduct are unsupported or result from a misunderstanding between two people. In the fast-paced and hectic world of residency programs, miscommunications between individuals are likely to occur. You may not even realize you're crossing a boundary until someone reports you for misconduct.

The AMA Journal of Ethics released an article noting the importance of clear policies regarding sexual misconduct in academic hospitals, adding that there should be increased training to prevent violation of boundaries between residents or residents and attending physicians. The article further notes that currently, policies are often too vague.

Sexual misconduct claims often come with the most serious consequences for the accused. While professionalism and substance abuse violations can be remediated through treatment programs or lifestyle changes, sexual harassment or violence is usually an automatic bar to your medical license and termination of your contract with your residency program. Importantly, those terminated from a medical residency program have the right to appeal the decision.

If you've been accused of sexual misconduct in your medical residency program, the first thing you should do is contact an attorney-advocate who understands how important your professional future is to you.

Disciplinary Board Actions

In addition to hospital policies, medical residents are also expected to adhere to their affiliated medical school's rules and may be subject to the school's disciplinary actions if they're accused of wrongdoing that violates the policies of either institution.

Common disciplinary actions often include the following:

  • Administrative notice
  • Verbal warnings
  • Written reprimand
  • Probation
  • Suspension
  • Termination

An administrative notice is minor and could even happen when a resident simply fails to remit the appropriate credentialing paperwork to program directors. While administrative notices aren't considered a “censure,” the department chair may have the discretion of including them in your permanent academic file.

When a resident commits a slight policy infraction, they could receive a verbal warning. Verbal warnings are intended to inform the resident of wrongdoing and should clearly communicate such. Verbal warnings are more likely to be kept on record and become part of your permanent academic file.

Written warnings are more serious than verbal warnings and are generally utilized when a verbal warning hasn't proved sufficient in curbing the violate behavior. Written warnings should be accompanied by a description of how to correct your behavior, and you are usually required to sign them in acknowledgment. Again, this will go in your file.

Probation is serious and can occur if your performance is considered inadequate or if you demonstrate an ongoing inability to comply with your program's requirements. You may also be placed on probation if you commit other acts of misconduct pursuant to the institution's policies. Not only will a record of probationary discipline go into your file, but it may be disclosed in any subsequent letters of recommendation you request.

Suspension is a punishment that you could face for repeated offenses, such as the violation of rules and laws, misconduct, or continued performance issues. It's important to note that even though a verbal warning may seem fairly inconsequential, a continuation of the same behavior can escalate to a suspension if you aren't careful.

Finally, termination is the ultimate consequence and is reserved for the most egregious offenses like sexual violence or the theft of pharmaceuticals. If you're terminated from your medical residency program, you have a right to appeal the decision pursuant to your institution's policies. It is imperative that you consult with an advocate who will work tirelessly to protect your professional future.

How Do Disciplinary Actions Affect Getting Your Medical License?

When you ultimately apply for your state's medical license, the application is likely to require that you disclose whether or not disciplinary actions have ever been leveled against you. You'll also be required to disclose whether you've ever been terminated or asked to leave a hospital. Notably, answering yes to these licensure application questions may not automatically prevent you from receiving your license in some states, but in some cases, it may.

The outcome of disciplinary actions against you in your medical residency program can have far-reaching impacts that jeopardize not only the time and money you've put into your medical education but also your ability to earn money going forward. If you're a medical resident facing accusations of misconduct that could result in disciplinary action, you need to discuss your case with an experienced attorney-advisor who understands how high the stakes are.

Medical Residency Misconduct Defense

Medical residency programs are a continuation of an emerging physician's career. These programs are a combination of academia and the professional world, and as such, medical residents must navigate policies on both fronts.

Joseph D. Lento and the Lento Law Firm know that when your medical residency position is in jeopardy because of threatened disciplinary action for accusations of academic misconduct, professional misconduct, substance abuse, or sexual misconduct, it's not just your reputation that's at stake. It's also your career. To learn more, call 888-535-3686 today.

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If you, or your student, are facing any kind of disciplinary action, or other negative academic sanction, and are having feelings of uncertainty and anxiety for what the future may hold, contact the Lento Law Firm today, and let us help secure your academic career.

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