Episode 88: It’s a kiss because it’s something nice that you can frame and hang on your wall. It’s death because you’ll never be able to work as a doctor.

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Today’s episode is all about the kiss of death when it comes to a residency training.  You never heard of this before.  I can guarantee it.  Let’s get started.  I just got out of a meeting called the Residency Training Committee Meeting, and I learned about a particular action that a residency program can take toward a resident that they feel Is not doing well that is essentially the kiss of death for their medical career.

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But let me set the stage first.  Residency training hearkens back to the days of like 1904 when Nathan Hale brought his ideas from Germany about the way medicine should be taught in America, and they were tough.  They never left the hospital. Burn out, and difficulty, depression and stress is a part of our medical training heritage here.  It was done that way by design.  It’s not an accident.  We go about 80 years in history until 1980, it was either ’84 or ’86 when Libby Zion died and her intern hadn’t slept very much.  Her resident was fatigued back in the good old days up in New York where they just ground residents into the ground.

Her husband was, I believe, a New York Times writer or something big, big writer and editor, and had a lot of connection and made a big media and legal case out of it and the upshot of all that is what you now recognize as the ACGME Duty Hour Restrictions on residents.  ACGME is the Accreditation Council for Graduate Medical Education. You’ve heard of OSHA probably, the Occupational Safety Health Administration?  That group is generally responsible for safety in the workplace, but when it comes to physician training they have stayed out of the argument so all of the typical OSHA requirements like having to get a lunch break and different stuff like that don’t apply to doctors at all.

The limited scope that the ACGME has is simply what they’ve made for themselves, in other words, duty hour restrictions, time off between call shifts, etc.. That’s it.  Residency programs can do anything they want to to residents besides violate those things on any kind of consistent basis or they face losing accreditation.

That’s kind of the backdrop is that it’s a difficult place.  In the old days, residency meant residency.  You actually lived there.  At the DeBakey Center in Houston, Texas, at Baylor, those residents never left the hospital.  They literally when they did a rotation with Dr. DeBakey did not leave the hospital for 30 days.  That’s what we have come from and you already know, I’m sure, about the duty hour restrictions.  That’s kind of where we are, but understand that at its root it’s a place where they’re supposed to train you and teach you.

That brings us to today’s topic because some of us don’t take the lessons very well.  We get too comfortable.  We get cocky.  I’ve mentioned that recently on a podcast.  It goes to our head.  We get some criticism.  It can sting, but what about when you are felt by a particular faculty member to not be cutting the mustard, not be measuring up to your restrictions, or to your requirements and they want to fire you?  Or they want to remediate you?

Let me give you a few definitions of some words.  What you have to correct folks is monthly evaluations.  That’s the simple stuff.  I generally say keep it clean unless your trying to stack up documentation to keep somebody fired.  Yes, you will be filling out evaluation forms on your peers, and they will be filling them out on you.  If there is a consistent pattern, which means two or more times you mess up doing the same thing, one possibility is to go to Level 1 Academic Remediation.  In Academic Remediation you can have a program or a plan to how you’re going to remediate and correct your deficiencies, is what it really means.  This can be written up as part of your permanent file and yes, it’s kind of a noose to hang you with if you don’t do what they say, but generally it’s felt that remediation is actually intended to help you and help you develop.

When it comes time to graduate from your residency program and you’ve graduated, you get your certificate.  You’re proud.  You hang it on your wall.  There’s a form that the residency program fills out on you, and if you’ve had Academic Remediation, it is possible for them to check one of two check boxes.  One would allow you to go on and get your board certification and be board eligible from that moment that you graduated even though you did Academic Remediation.  They could say don’t allow this person to become board eligible or board certified and that is the kiss of death.

Now, recall that after your intern year and taking your jurisprudence test and finishing Step 3 and all that in your USMLEs or COMLEX series if you’re a DO, that you could get your medical license and practice independently.  You can start moonlighting at that point.  You could even stop residency program all together, and never finish a residency and work what they call locums tenens and just get a job somewhere maybe in an urgent care clinic or in an ER making really good money more than you probably ever made and do that the rest of your life.  Many people do.  Quite a bit of people never get their board certification.  The only reason to continue the residency after the intern year is to, of course, really learn your craft and be a good clinician and be the specialist that you want to be, but ultimately the big carrot out in front of you academically is the board certification.

If a residency program says, “No, don’t allow this person to become board certified or board eligible,” not only can you never do that without totally repeating another residency and good luck finding one this day and age that would let you start all over.  It’s not going to happen.  Or you have to totally switch career fields.   It’s worse than just doing locum tenems and moonlighting.  You’re better off quitting your residency with your medical license if you feel like your program is going to burn you than continue in a place that’s continuing to document things because even if somehow you squeak through, if they put that on your record that you’re not going to be board eligible or certified, it almost invalidates your medical license because you can’t get insurance.  You can’t really work anywhere.  It’s almost impossible to work as a doctor.

I learned that today.  I thought I would share it with you.  The next level up from remediation is Academic Probation.  That’s a serious thing.  Probation is like a warning just like it sounds that you are in jeopardy of being fired if you don’t act on this.  It’s the next level up.  Academic Probation automatically will require you to explain the circumstances and for your entire professional file at your residency program to be made available to the medical board when you go to get your medical license.  Trust me.  It is a major ordeal.

If you want to hear more about my personal story and having survived that, if you are personally struggling with that issue or something like that, I want to hear from you.  Visit medical-mastermind-community.com. I do not want you to get the kiss of death, and you need to know the operational environment in which you find yourself.

That’s it from the Medical School Podcast today.  I’m your host, Dr. Dan.

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