Be proud of yourself. You have arrived. You're a resident at last.
Your years as a resident can be among the most exciting and rewarding of your medical career. You've finally got your M.D., and you're actually practicing medicine. You're learning more than you ever thought your brain would hold. You're exploring your specialty in depth. Every day presents brand new challenges.
Of course, your residency can also be incredibly stressful. It's not easy to find a good work/study balance. You find yourself working 24, even 36-hour shifts and 80-hour work weeks. You've got no time to eat, you've got no time to sleep. Everything else in your life—hobbies, interests, family— comes second. Three years of that—or more, depending on your specialty—can wear anyone down. It isn't surprising that some people crack under this kind of pressure. What's surprising is that anyone survives it at all.
You need to know, though, that just because you crack a little doesn't mean you have to shatter into a million pieces. You'll make mistakes; everyone does. Some of those mistakes may even be serious. You'll get into an embarrassing screaming match on the floor with a nurse. One weekend, trying to blow off a little steam, you'll do something stupid like wreck your car or get a DUI. The goal is to make sure those kinds of mistakes don't derail your entire career.
That's where we come in. Below, we explore some of the most common problems you can face during your residency program. Some of these are professional, some are personal. We also go into your rights as a medical resident and how you can protect yourself if you should wind up in trouble for some reason.
The most important thing to remember, though? Whatever you're facing, Joseph D. Lento can help. Joseph D. Lento specializes in medical student and resident cases. He's dealt with hundreds of clients just like you. With Joseph D. Lento by your side, you can pick up the pieces and put them back together.
So, know what you're up against, and hang in for the wild ride of residency. But don't forget that there's someone you can call on who has your back when things get tough.
What Can Go Wrong?
If you're still early in your residency, a beginning intern perhaps, you're probably already feeling pretty overwhelmed. Let's face it, even if you're in your final year, you're probably feeling pretty overwhelmed. It may sometimes seem like you have thousands of things to remember and worry about.
What are the biggest risks you run, though? What are the mistakes that can threaten your future?
One way to get a handle on what's happening to you is to break your risks down into a few simple categories and deal with them one at a time:
- Competency issues
- Conduct issues
- Employee handbook guidelines
- Problems others create for you
One of the most obvious things to worry about is whether you're meeting expectations in your competencies. If your program decides you aren't up to basic standards, you could be looking at sanctions, anything from a verbal warning to complete termination from the program. What are these competencies, and what exactly are you held accountable for with regards to each one?
Competency categories are set by the Accreditation Council for Graduate Medical Education (ACGME), the accrediting organization for residency and fellowship programs in the U.S. There are six different categories:
- Patient care: involves learning to provide compassionate health care by listening to patients, clearly communicating with them, and allowing them to participate in making decisions about their own health.
- Medical knowledge: includes both knowledge of established and evolving medical science and also the ability to apply that knowledge effectively in clinical situations.
- Interpersonal and communication skills: means learning to communicate effectively with all medical stakeholders, including other physicians and health professionals, patients, and families.
- Professionalism: refers to carrying out responsibilities in an ethical manner—showing compassion to others, putting patient needs ahead of your own, respecting patient privacy, and maintaining sensitivity towards patient diversity.
- Practice-based learning and improvement: relates to your ability to understand medicine as an evolving field; means you know your own strengths and limitations; likewise, means you know how to go about finding answers.
- Systems-based practice: involves an understanding of the larger systems and contexts of medicine and how to access resources within these systems and contexts.
Each competency includes its own set of five milestones. During your time as a resident, you are expected to make satisfactory progress through these levels:
- Advanced beginner
Failing to progress is one of the quickest ways you can wind up in trouble in your program. Of course, “progress” can sometimes be subjective, and not all of your supervisors may agree you are moving forward or moving forward quickly enough. It is important to address any problems you may have in a timely manner since negative reviews can be hard to get changed once they've been written. However, if a supervisor's opinion is threatening to disrupt your career, it can be worth contacting an attorney to try and negotiate an equitable solution.
Of course, becoming a medical professional isn't just about demonstrating what you know and what skills you can apply to the job of making people healthier. Since the time of Hippocrates, the role of healer has been seen as all-encompassing, involving every aspect of a doctor's personality and behaviors. You need to be ethical to be a healer, and ethics isn't just something you can turn on and off in different areas of your life.
As you might expect, then, residency programs and state licensing boards aren't just interested in your medical competencies. In addition, they hold doctors to the highest ethical standards of both professional and personal conduct. That means that you can be sanctioned by your program for mistakes you make in your personal life as well as mistakes you make on the job. In the worst-case scenario, you can be terminated, or your state licensing board can refuse to grant you a license.
“Conduct,” though, can be a slippery term. What qualifies as misconduct?
Basically, conduct issues can fall into two categories.
First, there are those aspects of conduct that have to do with the medical field itself, problems of ethics and professionalism. Many of these are covered in one or more of the AGCME competency areas, such as “patient care” and “professionalism.” However, it can also be useful to think about them separate from your “competencies.” You are expected, for instance, to respect the sanctity of human life. As part of this respect, you must care about social justice and particularly the inequities that exist in terms of who has access to adequate health care. You are also supposed to respect the role patients' diverse backgrounds play in their overall health and well-being. In more concrete terms, you are expected to respect patient privacy, treat colleagues professionally, and maintain an appropriate demeanor.
In addition to these professional standards, though, most residency programs require that their residents conduct their personal lives in ethical ways as well. Conduct issues here can have just as much impact on a resident's progress and future in the field. Residents are supposed to maintain a healthy respect for the law, for instance. Even minor legal difficulties can become black marks on your record.
- Sexual misconduct: Our current culture takes sexual- and gender-based harassment and discrimination extremely seriously. Crimes such as sexual assault and stalking can land you in jail, leaving aside any impact they may have on your residency. In the digital age, even an accusation can follow you around for the rest of your life. But the definition of “misconduct” in a residency program isn't necessarily limited to physical or violent behavior. An inappropriate joke or unequal treatment of a colleague can be cause for sanction or dismissal, depending on your specific program. Know what your residency expects and how to avoid conflict.
- DUIs: If you work hard—and medical residents work harder than most—it's not surprising that you play hard as well. Maybe we mentioned this already, but a residency is hard. You occasionally need time and space to vent. The neighborhood bar has traditionally been one of the places residents go to do that. If you are a resident, though, a fistfight or an arrest for DUI can have repercussions in your professional as well as your personal life. Even if the trouble isn't strictly legal, wrecking your car or becoming known as the party resident can influence evaluations of your work.
- Drug abuse: Residents also sometimes fall prey to the lure of drug abuse. This makes a kind of sense. You're working long hours, and you need to be awake and alert. Just as likely, when you do have some downtime, you may find it difficult or impossible to get to sleep. Illicit drugs can offer tempting shortcuts to solving these problems. A drug charge, though, can be especially problematic for a doctor, someone whose job is to administer medicines properly and appropriately.
- Domestic abuse: The stress of residency programs can have an impact on your family just as much as you. When you spend long hours at work and can't always give your loved ones the attention they need, it can create household tensions. When these boil over, things can sometimes devolve into emotional or physical violence. Here too, the problems may be legal, but even if they aren't, they could affect your professional career.
Whatever your specific situation, if you find yourself in trouble over your conduct, it's important to deal with the problem early. Obviously, you want to do everything necessary to correct the behaviors. That may include, for example, seeking counseling or other social services.
Sometimes, though, things look worse than they actually are. It's even possible to wind up accused of doing something you didn't actually do. In other cases, the punishment may not fit the actual crime. So, while you must take responsibility for your actions, you may also need to obtain professional help from a qualified attorney, someone who understands the medical field and can work with you to safeguard your career.
Employee Handbook Guidelines
Beyond the professional, legal, and ethical standards that govern the entire medical discipline, your particular residency program will have its own set of standards. Indeed, you'll quickly find that individual attending physicians have unique expectations of you as well.
Residency programs provide all residents with an employee handbook, and it's a good idea to get to familiarize yourself with this resource early, so you are clear about the program's expectations. Those expectations can be large and small. What, for instance, is your hospital's policy on ID badges? Is there a particular etiquette you're expected to follow when writing professional emails? What are the rules about vacation time and personal leave?
Of course, your handbook will be full of other important information as well. You can find out what the staff discount is in the cafeteria and where you're supposed to park.
Most of this information will be of relatively minor importance. You're unlikely to be dismissed or disciplined for forgetting to wear your name tag. That said, you need to know if there are any significant rules particular to your program. And in any case, you don't want to develop a reputation for being the “problem” resident in your class. Problem residents tend to progress more slowly through the program. They tend to get less enthusiastic reviews. They may struggle when it comes time to get a license. Following even the minor rules can help you avoid that fate.
What if Someone Else is Doing the Harm?
Unfortunately, it can happen that the problems you face during your residency aren't of your own making, but rather someone else's doing.
It is not unknown for residents to be put in awkward, even unethical, situations by their superiors. Some of these situations can be particularly serious. How should you react, for instance, if you're asked to participate in committing fraud on government or insurance programs? Other's scenarios can be more minor: perhaps you realize a colleague or even an attending physician is incompetent and putting patients at risk. Situations like these don't just make things awkward for you as a professional; they can ultimately get you accused of serious misconduct. You could find yourself on probation or even removed from the program. Precisely because they carry such risk, it can be especially useful to retain the services of a qualified attorney in these cases, someone who knows how to navigate the difficult political and legal waters of a health facility.
Of course, you could also face other kinds of abuse as a resident. Just because you are a doctor now doesn't mean you can't suffer the impact of harassment and discrimination. Whether these come about as a result of your sex, your race, a disability, or some other reason, as an employee, you are entitled to be treated fairly by your residency program. If you aren't, you need to speak up, even if you fear reprisals. An attorney can make sure you are treated with respect while shielding you from any kind of retaliation.
Finally, what can happen to you if one of these things goes wrong during your residency? That probably depends on your specific program. You can be certain, though, that you are subject to sanctions for your behaviors and that termination is always on the table.
The St. Mary Medical Program in Long Beach, CA, for example, lists these possible sanctions for violations of “professional behavior”:
- Mandated counseling
- Official warnings
- Dismissal from the program
Emory, in Atlanta, uses slightly different wording, but the list is essentially the same:
- Administrative notice
- Verbal warnings
- Written warnings
While obviously, these penalties become more severe as the lists go on, it's important to remember that any sanction, even a light one, can affect your future success, both as a resident and in your career as a doctor. Your record will follow you and can be a determining factor in licensing and hiring decisions. If there are problems are mistakes in your record, a qualified attorney can help you fix them.
Your Rights as an Intern
Now that you know what kinds of issues can come up for you as a resident and what penalties you might face, you also need to know your rights.
To begin with, just because you've made a mistake—even a big mistake—does not necessarily mean your career is over. There are a number of protections in place designed to help you get through your residency un-scarred. These include ACGME guidelines, rules about learners, laws about employees, and laws about how public employees can be treated. If you've encountered a serious problem in your program, if you're facing disciplinary action for something you didn't do, or if you think the penalty you've been given is just harsher than you deserve, know that you do have options for defending yourself.
Your Rights Under the Law
As it happens, the Supreme Court is one important source of resident rights. The court has dealt with residency programs directly in both Missouri v. Horowitz and Michigan v. Ewing. In each of these cases, the court noted that medical residency programs are ultimately educational in nature. That means residents cannot be treated arbitrarily. Specifically, the court wrote in Michigan v. Ewing that “disciplinary actions must be the result of a careful, deliberate, reasonable decision-making process.”
The court went further, however. First, it made clear that residents have a right to know the state of their progress and if they are in any danger of being dismissed. Specifically, the program must provide residents with “notice of deficiencies.” Second, and just as important, residents must have the “opportunity to cure” or correct those deficiencies before they are dismissed. These rulings suggest that residents can be dismissed only under extraordinary circumstances. If you're facing dismissal, this could work in your favor.
Rights as a Learner, Rights as an Employee
As a resident, you are both a learner and an employee. That is, you are a paid staff member at the hospital where you work. However, you aren't yet considered a fully licensed physician. You are still in training. You derive important rights from both of these roles.
As a learner, you are protected by rules created by the ACGME, the most important authority in the U.S. when it comes to medical school residencies. This organization has the power to withhold accreditation from any program it feels isn't meeting its high standards. As a result, the protections it offers residents carry significant weight.
Perhaps the most important of these is its insistence that all fellowships and residency programs establish and maintain certain due process rights.
Drawing inspiration directly from the Supreme Court decisions above, the organization specifies exactly how this process should occur:
“A panel made up of impartial members of the medical community must be assembled so that the resident can testify to what they believe are the facts in the case. After hearing from both sides, the panel then makes a recommendation on what actions should be taken. The Chief Medical Officer (CMO) can then accept or reject the recommendation.”
As in those decisions, the implications here are clear. You are entitled to defend yourself against accusations about both your professional progress and any personal misconduct.
At the same time, you are also an employee, and this entitles you to certain rights and protections as well. First, because you have supervisors, you cannot be held responsible for your actions if those actions arise out of decisions they made. Of course, you have an obligation to report misconduct to a higher authority if you're aware of it, but mistakes that grow out of doing what you are told—especially if you don't know any different—cannot be held against you.
If your residency is with a government employer, state or federal, you are considered a public employee. This guarantees you certain additional rights. For instance, you are allowed to express your political views under the first amendment, and you are protected, during investigations, against self-incrimination. Most important of all, you cannot be fired without cause. Your residency program must have a clear, demonstrable reason if it decides not to renew your contract.
Finally, it bears repeating, as an employee and as a learner, you are protected from racial, sexual, physical, and many other kinds of discrimination and harassment. This applies whether the harassment originates with your supervisors or your colleagues. Such discrimination can interfere with your ability to do your job and make progress in your program. When it does, you have every right to address it.
The Grievance Process
The ACGME also outlines a set of expectations for how residency programs must respect residents' due process rights. Specifically, residents must have an opportunity to defend themselves and appeal any sanctions. In addition, they must be heard by a panel of medical professionals. That is, no single individual can entirely control your fate. Finally, as a last protection, a panel's decision must be ratified by the Chief Medical Officer before it becomes final.
As with most things, though, every program has its own approach to dealing with resident grievances about academic and disciplinary matters, as long as that approach ultimately falls within this broad framework.
For example, the University of North Carolina Hospitals Graduate Medical Education Program outlines three separate steps in appealing any disciplinary decision.
- Residents must first attempt to resolve their problems with their department chairs.
- If residents remain unsatisfied, they can then bring their concerns to the hospital's Chief Operating Officer.
- If the problem remains unsolved, residents then have the right to request their case be heard by an ad hoc appeals committee made up of five members of hospital staff. This committee must include at least one resident.
The grievance process for residents at UCLA's David Geffen School of Medicine is similar. However, as part of the public University of California medical system, residents may be represented by a union, the Committee of Interns and Residents/ Service Employee International Union (CIR/SEIU). This representation extends to both informal meetings and formal arbitration hearings. Of course, residents are entitled to hire legal representation as well.
It is also worth noting that when the appeals process at your residency fails, you still have options open to you for resolving your dispute. Specifically, you can file a civil suit against your residency program. While doing so should be a last resort, it can be a way to recover your reputation and your career in extreme situations.
What to Do When Problems Arise
You know what can happen in a residency program. You know your rights. In concrete terms, though, what do you do if you find yourself facing an academic or conduct violation in your residency program.
First, don't panic. While your residency is a crucial step on your way to becoming a doctor, you do have options, ways to defend yourself, and help you can call on.
- Once you've gotten a handle on the situation itself, you want to make sure you deal with the problem immediately. Be proactive about expressing your concerns with your direct supervisors and, if necessary, your department chair. It is difficult to go back and reconcile a problem from months or years before.
- Document everything. When you meet with anyone about your concerns, make sure you document who you talked to, where and when the discussion took place, and what was said. When possible, ask for written documentation of decisions, even if that documentation is only in an email.
- Don't discuss your situation with your colleagues. The quickest way to make a bad situation worse is to draw other people into it. Complaining to others or refusing to perform your responsibilities adequately can become separate grounds for discipline.
- Last but not least, find legal representation. Every situation is different, and it isn't easy to say just how an attorney may be able to help you. At a minimum, however, a qualified lawyer can offer you important advice on how to approach your superiors and how to explain your situation. Of course, attorneys can also serve as negotiators, working out an equitable settlement, so your career doesn't suffer. They can represent you in formal hearings. They can even file lawsuits on your behalf if that becomes necessary.
How Does Attorney Joseph D. Lento Help Medical Residents?
It isn't enough to simply find a local attorney to handle your case or pick one out of the phone book. Your residency is vital to your career as a doctor. You can't move forward without it. If you're in the unfortunate position where your residency is in jeopardy, you can't just trust anyone to help. You need someone who understands both the law and the medical field.
Attorney Joseph D. Lento built his career on medical student and medical resident cases. He's helped hundreds of clients across the United States, just like you, keep their dreams on track. Joseph D. Lento understands the law, particularly as it applies to medicine. However, he's also experienced at dealing with health administrators, navigating hospital bureaucracy, and negotiating with government officials. Joseph D. Lento believes you work hard, that what you do is valuable, and he'll do whatever it takes to make sure you succeed.
Whether you've been accused of misconduct or you're trying to get a supervisor to change their evaluation, Attorney Lento and the Lento Law Firm can help. Don't wait. Contact the Lento Law Firm today at 888-555-3686 or use our automated online form.