Negotiating Medical Residency Withdrawal

By the time a medical graduate enters medical residency, the graduate has invested an enormous amount of time, effort, and money toward entering the medical profession. Medical residency is not the time, indeed, it's the worst time to fall off the career track. A post-graduate medical residency in the graduate's chosen specialty field should be a crowning achievement, not the undoing of the graduate's career. Yet suffering dismissal from a residency program can threaten everything for which the medical graduate has worked. Fortunately, options may exist to avoid a residency dismissal. Withdrawing from the residency instead of suffering dismissal can be by far the better course. Yet negotiating an effective withdrawal often takes special sensitivity to the graduate's interests and the school's concerns. If you face dismissal from your medical residency, retain national academic administrative attorney advisor Joseph D. Lento of the Lento Law Firm to help you negotiate an effective withdrawal. Preserve your opportunity to gain another residency and license in your chosen professional field.

Medical Residency's Role in Licensure

Medical school graduates typically enter post-graduate residency programs expecting to qualify for medical board licensure in the residency field. But medical graduates must also have state licensure to practice medicine at all, never mind their hoped-for specialty licensure and field. Medical graduates could qualify immediately for state licensure, having completed the necessary step exams. But the American Medical Association explains in a recent transition-to-practice article that medical residents instead typically practice under a training certificate. Medical residents are, after all, providing direct medical care to live patients. Residents should have some form of licensure reflecting their qualification to treat patients. But that licensure is usually only temporary, preliminary to the resident's longer-term choice of state in which to license and practice. Many residents do not seek to qualify for a full state license beyond the temporary training certificate until nearing completion of residency when they discern their practice state and field. Thus, the resident's performance can affect not just national board certification for the specialty field but also state licensure to practice medicine.

Licensing Impact of Residency Dismissal

Dismissal from a residency program can adversely affect state licensure to practice medicine. State licensure to practice medicine requires more than just passing exams and earning a medical degree. It also requires completing a detailed application revealing positive and negative history. Licensing boards can and do consider negative professional history, including highly relevant residency dismissal. After all, residencies show how the candidate for licensure actually practices medicine. Under court decisions like Kraft v William Alanson White Psychiatric Foundation, residency supervisors have a legal privilege to publish negative evaluations of supervised residents, evaluations that can and do reach licensing bodies. And don't expect to conceal negative information when applying for state licensure. An American Medical Association career planning resource has this to say about disclosing derogatory information:

A physician should never try to hide derogatory information from a licensing board. It is much better to come forward with the information, assist the board in obtaining records and other necessary data, and provide any justifications that may prevent the denial of a license. Full disclosure of all information requested is by far the best approach to successful licensure. A physician should remember that, in most states, making a false statement on an application for licensure is grounds for denial or future restriction.

Other Impacts of Residency Dismissal

Dismissal from a residency program can have other adverse impacts on a medical graduate's career beyond making state licensure medicine more difficult, time-consuming, and uncertain. Residency dismissal means loss of employment, employment benefits, and wage income. Residencies are, obviously, programs that provide compensation and benefits to the resident. Residency is also a critical step in the medical graduate's transition from school to full-time, career-long medical practice. Residency dismissal cannot just interrupt but derail plans for state licensure and permanent or long-term medical practice employment. Residency dismissal also directly affects national board certification in the resident's specialty field. Dismissal from one residency may prevent the medical graduate from gaining another residency or from gaining a residency match that the resident prefers. Even if the candidate goes on to complete another residency in the same field, the national board may consider the dismissal when determining whether to grant board certification. In short, residency dismissal can greatly complicate, if not entirely derail, a medical graduate's career.

Residency Dismissal Risks

Dismissal from a residency program is a real, not just an imagined, risk. One recent article in the Journal of Graduate Medical Education indicates that well over one thousand medical residents each year leave or fail to successfully complete their residency. Many of those terminations involve dismissal for violation of residency program standards. Residency programs maintain strict professional care and professionalism standards with which residents must comply. Violation of those standards can lead to dismissal. For example, the Morehouse School of Medicine's internal residency program policies and procedures list abundant professional care and professionalism standards with which residents must comply to maintain their residency in good standing. The professionalism standards alone address patient respect, patient autonomy, respect for patient concerns, respect for care-improvement systems, respect for peers and other workers, respect for diversity, appropriate professional dress, appropriate professional hygiene, and appropriate use of social media. You may face residency dismissal involving false, exaggerated, or unsupported allegations of any of these kinds of violations. And you may prefer to withdraw from your residency program than dispute those charges. Retain national academic administrative attorney advisor Joseph D. Lento to help you make and successfully implement that decision.

Remediation Before Dismissal

The above Journal of Graduate Medical Education article alludes to both informal and formal remediation programs that residencies deploy to prevent failure and dismissal. Residency programs may offer corrective training or place the resident on probation before dismissal. Residency programs may also modify schedules, reassign the resident to different supervisors, restructure the resident's role, and even offer counseling, training, or a leave of absence. But not every residency program is so supportive of and resourceful with residents. Resident dismissals happen, nonetheless. If you face residency dismissal, retain national academic administrative attorney advisor Joseph D. Lento to help you prevent dismissal, investigate and advocate for remediation options, and negotiate withdrawal on favorable terms if remediation options are unavailable or unattractive. Sometimes, perseverance in the residency program makes the most sense. Other times, withdrawal makes more sense. Let attorney Lento help you evaluate options.

Causes for Residency Dismissal

The causes for residency dismissal often center on the resident's clinical performance or lack thereof. Substandard care, or general incompetence, is a real concern for residency programs, which must guard patients against malpractice risks. Indeed, as one National Library of Medicine article on professional liability for residents' documents, hospitals, and other residency sites must dismiss residents who don't exhibit the necessary knowledge and skills for standard practice or risk malpractice liability for the resident's substandard care. Other causes for residency termination, though, can be many and various. The resident may be perfectly qualified and skilled to administer standard medical care but may exhibit other professionalism concerns. Patient neglect, including failing to show up for assigned rounds and failing to follow through on promised care, can be one serious concern. Medical practice under the influence of drugs and alcohol can be another serious concern. And in the worst cases, patient coercion or abuse, breaches of patient confidentiality, and inappropriate relationships with or harassment of patients, colleagues, and subordinates can be other concerns. All these concerns also become concerns for medical licensure. If you face residency dismissal involving any of these serious issues, or other issues, retain national academic administrative attorney advisor Joseph D. Lento to help you prevent dismissal, to keep your record clean and straight, and to negotiate withdrawal from an unduly challenging and unfair residency. Get the professional help you need to preserve your career.

Fighting for Residency Withdrawal

In some cases, the residency just doesn't work out. The problem may be in the residency site, supervisor, supervision, assignments, support, or schedule. The problem may be with unreasonable or deluded patients, or their family members, making false allegations. Or the resident may just face personal circumstances like illness, injury, or the death of a family member or close friend, interfering with the residency's performance. In those circumstances, withdrawal from the residency may be in everyone's best interest. But withdrawal from a residency program isn't always available. Residency program supervisors or administrators may instead, for a good reason, bad reason, or no reason, pursue dismissal of the resident and termination of the residency. In that case, the medical student will require skilled and experienced academic administrative attorney advisor representation to negotiate an effective withdrawal. Even if your residency program has already terminated your residency, retain national academic administrative attorney advisor Joseph D. Lento to represent you in withdrawal negotiations.

Medical Residency Withdrawals

Medical residents do withdraw from residency programs with significant frequency. One study summarized in a National Library of Medicine article indicates that about 2,500 medical residents withdraw from residencies every year while another 1,000 medical residents take an extended leave of absence. You are not by any means alone if you pursue withdrawal from your medical residency. Many residency programs and sites have experience, and sometimes substantial and frequent experience, with resident withdrawals. A significant majority of withdrawals occur because of specialty or program changes. Medical graduates can, with residency experience, think better of their initial choice. Maternity and paternity leave make up another third or so of leaves or withdrawals. Performance issues, research sabbaticals, and physical disabilities each make up around ten percent of leaves and withdrawals. No matter what your residency site or program tells you, residency withdrawals do happen for a variety of reasons. Withdrawal may be your best route.

Medical Residency Withdrawal Policies

Medical residency programs generally assume wide latitude to supervise, evaluate, correct, counsel, and dismiss residents without substantial formal policies and procedures for withdrawal or other relief. One physician's article, The Fundamentals of Resident Dismissal, published in The American Surgeon, advocates that residency programs exercise that professional liberty and judgment without substantial concern for the limited legal requirements. Yet residency programs do generally maintain residency policies, some of which may offer leave options, if not outright withdrawal options. The residency policy at the University of California Irvine School of Medicine's residency program in internal medicine provides an example. The policy gives a Clinical Competency Committee broad discretion to determine the adequacy of the resident's performance and to recommend dismissal of residents not performing to standards, with deficiency notice but not a formal hearing. The policy does, however, permit residents to apply for family leave, medical leave, military leave, and other leaves without specifying rights to outright withdraw. The leave policy at UCLA's David Geffen School of Medicine is similar, granting options for various forms of leave but not offering a specific withdrawal option. If you face residency dismissal but prefer residency withdrawal, retain national academic administrative attorney advisor Joseph D. Lento to determine your program's withdrawal options. If your program does not publish or disclose withdrawal options, let attorney Lento determine what informal withdrawal options may exist. Don't give up. Representation and negotiation may lead to productive options.

Due Process in Medical Residency Terminations

Notwithstanding the discretion that residency programs have to determine a resident's qualifications and fitness, substantial authority exists suggesting that a medical residency program must at least provide basic due process to a resident before terminating the residency. The U.S. Supreme Court case of Regents of the University of Michigan v Ewing held that while programs of medical education have wide latitude in determining the sufficiency of performance, they must follow a careful, deliberate, and reasoned decision-making process. The programs must also, at a minimum, notify the participant of deficiencies warranting termination while giving the participant an opportunity to correct those deficiencies. These minimum procedures give residents the opportunity they need to consult a skilled and experienced academic administrative attorney advisor who can advocate for residency program withdrawal or other appropriate relief on the resident's best terms. Without due process, a resident might not learn of alleged deficiencies or have the chance to prove the allegations incorrect. With due process, the resident's attorney advisor can set the record straight. Retain national academic administrative attorney advisor Joseph D. Lento to ensure that your residency program gives you that fighting chance. Due process can make all the difference to your future if you retain a skilled and experienced attorney-advisor who knows what to do for you.

Residency Dismissal Appeals

Appeals from residency dismissal may be available under your residency program's procedures. Whether you prefer to stand and fight your residency dismissal or seek withdrawal to improve your circumstances before re-entering residency, an appeal may help improve your situation. Emory University School of Medicine, for example, maintains a hearing and appeal procedure for residency terminations. If the residency program determines to terminate the resident's employment, the resident may appeal to the School of Medicine's dean, who either decides the appeal or appoints another official or panel to do so. Where a residency program offers an appeal, the right to appeal can give a resident a chance to contest the initial charge through any preliminary hearing or other determination before seeking another option such as withdrawal. An appeal can buy your retained academic administrative attorney advisor time and open lines of communication to negotiate withdrawal on the best possible terms. Appeals, in short, can play a useful role in getting a troubled resident out of one residency program and into another. But appeals and withdrawal negotiations require skilled and experienced academic administrative attorney advisor representation to be effective. Retain national academic administrative attorney advisor Joseph D. Lento to help you make appeals and other procedures work for you in obtaining withdrawal.

Alternative Available Relief

Do not give up if you have exhausted all published administrative procedures and appeals and still face dismissal from your residency program. With attorney advisor Lento's skilled representation, you may have other alternative available relief for withdrawal rather than dismissal, through oversight channels. Medical schools and medical employers generally maintain corporate counsel offices or other oversight offices and officials to ensure that the program complies with legal requirements and treats each resident fairly and equitably. Attorney Lento has helped hundreds of college and university students nationwide obtain alternative relief through those oversight offices and the outside attorneys those offices often retain. Attorney Lento has a nationwide network of contacts and relationships, and a national reputation, that facilitates his negotiation for alternative relief outside of published procedures. Let attorney Lento investigate your other options for residency program withdrawal before you give up your good fight for your future in the medical profession.

What to Do When Facing Residency Dismissal

If you face dismissal from your medical residency program, don't ignore the matter. Instead, address the challenge with the same resolve and determination you have used to get as far as you have in your medical education program. If, as may well be wise, withdrawal is your short-term goal toward the longer-term goal of preserving your residency options, you may need to take each of the following steps in this approximate order to forestall or reverse residency dismissal:

  • Promptly retain skilled and experienced academic administrative attorney advice and representation by hiring attorney Joseph Lento of the Lento Law Firm
  • Help your retained academic administrative attorney advisor obtain your program's notice of alleged deficiencies and other records and information
  • Let your retained academic administrative attorney advisor determine and invoke your residency program's hearing and appeal procedures
  • Gather, organize, and convey to your retained academic administrative attorney advisor all documentation relating to the threatened dismissal
  • Maintain your professional conduct, respecting residency administrators, supervisors, and colleagues, rather than making matters worse
  • Maintain and complete your residency duties, including all patient rounds, patient follow-ups, and recordkeeping
  • Avoid signing any corrective action plan, last-chance agreement, separation agreement, and release of claims until your retained attorney advisor reviews those documents and advises you

Scrutinizing Re-Entering Residents

When facing dismissal or withdrawal from a residency program, the resident should be thinking about how the resident's actions and record will look when the resident re-enters a residency. The resident's record matters to the new residency site. One physician consultant writing in a residency program alert warns residency sites to inspect re-entering resident applications with special scrutiny. The alert recognizes that termination of the resident's prior program may well indicate an unqualified or unfit residency candidate. The alert cautions residency administrators to investigate the record of candidates who left their prior residency site without completing the program. The alert also cautions administrators to compare the resident's application with the results of the administrator's investigation to see if the applicant is honest in disclosures. Expect scrutiny of your re-entry application if you are facing dismissal from your present residency site. Indeed, whether you suffer dismissal or voluntarily withdraw, you should be making your best case for re-entry now while you still have that chance. Retain national academic administrative attorney advisor Joseph D. Lento to negotiate the best terms and document the most favorable record for your residency re-entry.

Hire a National Academic Administrative Attorney Advisor

When you look for qualified attorney advisor help, be sure that you retain the right attorney-advisor with the right experience and skills. Local criminal defense attorneys, civil litigators, and attorneys with transactional practices generally lack skill and experience with these sophisticated academic administrative matters. You don't want a novice representing you when you have so much at stake. Your medical education and career are worth having the most qualified academic administrative attorney advisor available to you. National academic administrative attorney advisor Joseph D. Lento of the Lento Law Firm has helped hundreds of college and university students nationwide preserve and complete their education, including their medical education. Attorney Lento is available to help you negotiate a medical residency withdrawal rather than face dismissal. Call 888.535.3686 or go online now.

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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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