Can you be fired from medical residency?
The short answer is yes, you absolutely can. However, the one right that can protect you from an unfair program dismissal is your RIGHT TO APPEAL!
As you transition from medical school into an internship or residency, any training program will have a code of conduct along with policies and procedures that dictate how and when a program can remove a resident. Additionally, the med staff and hospital where you work will have similar policies that dictate how the program can remove a resident from training.
Thus, if you are being threatened with dismissal from a training program, you must obtain all the relevant documents that dictate your training program’s dismissal and appeal process. Those documents can include the following:
Removed from the Program for a Variety of Reasons
- GME Policies
- Training Contracts
- Program House Manuals
- ACGME Core Competencies
- Evaluations (Rotation, Performance, etc.)
What are the reasons a resident could be fired from a medical residency?
Just because you are a professional doesn’t mean you don’t have problems. And many times, when you are a professional, it can exacerbate problems, especially in medical residency, due to lack of sleep, heavy workloads, stress, and being overwhelmed with so much new information and responsibilities.
The five reasons most physicians are fired from medical residency programs include the following:
- Substance Abuse
- Clinical Problems
- Behavioral Concerns
- Professional Boundary Violations
Nearly all dismissals involve one or a combination of the issues listed above. So, let’s dive into each reason behind program dismissals.
Medical Residents with Impairment Issues
The stressors that residents may face can lead to substance abuse and addiction. The use of drugs, alcohol, or prescription medications can impair a resident’s ability to provide safe patient care. If a resident is struggling with addiction, it is crucial to seek help before it affects their ability to perform their duties. Most programs are willing to work with residents with impairment issues and may allow them to temporarily step aside from training to address their addiction.
It is essential to seek help and support if you are struggling with addiction to protect your career and your ability to provide safe patient care. The resident must enter residential treatment or an IOP (Intensive Outpatient Treatment Program) during the break.
Additionally, the resident would need to start attending a 12-step group, get their addiction under control, and undergo random drug testing. After substantially completing those requirements and, once sober, the program will allow them to return and finish training. The program would also likely require the resident to sign a Last Chance Agreement containing requirements the resident must continue during training.
Unfortunately, many residents are in denial when they have impairment issues and refuse to comply with the rehabilitative requirements imposed by their training program. In those cases, the program would permanently remove the resident from the training program.
The second way a resident could be fired from training would be through clinical problems. And this is a small percentage of the main reason the program would remove someone. But suppose someone is having difficulty grasping concepts and can’t seem to get them for whatever reason. In that case, usually, there’s something else beyond that not having the mental capacity to do it. Still, if there are continued clinical problems, usually, the program would put the resident in some corrective action plan or some coaching program, something like that, which would then assist them in getting up to speed.
And then, if the clinical problems continued after that remediation, that would be grounds for removing them from the program.
Medical Residents with Mental Health Issues
Mental health is another reason the program can remove someone. That usually leads to behavioral concerns or problems, like not getting along with other residents, attendings, some of the physicians in the hospital, or staff. Or you may have a terrible bedside manner due to some untreated mental health issue that also can lead to the removal from the program.
Dishonesty and Cheating
Dishonesty, so if you get caught cheating or something like that, it can be an easy way of getting removed from a program. It is also the most difficult one when dealing with a medical board. My firm represents physicians when they have issues with the medical board here in Arizona. And I can tell you that the dishonesty problems, whether with removal from training, are the absolute hardest to overcome when applying for full licensure down the road for several reasons.
If you have impairment concerns, you can remediate those. Go to treatment, drug testing, and AA, and get it under control. Same with mental health. Go to psychiatrists, get some psychotropics, and go to counseling. You can work on that. Clinical issues, just put in the work. Go through the extra steps needed to get your clinical problems under control and avoid getting fired from medical residency programs.
But if you are dishonest, there are not many things that you can do that satisfy a board’s concern about the character of that physician. Sure, you can do ethics training and maybe some other continuing education involving morals and ethics in the profession. However, I can tell you that dishonesty, cheating, and that type of things are very hard to defend as a defense attorney. And that is one thing that many boards are just not willing to get over.
I’ve seen people that have had problems in training or removed from programs, and they come back, finish out another program, and still have to think, all right, these are things you have to disclose to a medical board when you’re applying for licensure down the road.
And this is something that the residency could deny you licensure for.
Inappropriate Relationships and Professional Boundary Violations
So, impairment concerns, clinical issues, behavioral/mental health problems, and deception/dishonesty are the main reasons to remove someone from a program.
The last one would be inappropriate relationships and professional boundary violations. I remember having a client in mental health, and then they started a relationship with someone they had treated. That is a complete no-no, leading to the denial of their licensure because the program removed them.
I could lump that into boundary violations. There are some professional responsibilities that any healthcare provider must keep in mind, and one of those is inappropriate relationships with patients, and that’s just something you absolutely cannot do.
So, those are the ways a physician can get fired from medical residency.
What if you have one of these incidents happen? Generally, the program attempts to provide a path back for the resident, as I said before, through corrective action plans and some coaching programs. If the resident cannot fix the problem through a corrective action plan, the program will often make the resident sign what’s called the Last Chance Agreement.
The Last Chance Agreement lays out all the things the resident needs to do to stay in the program. Then, if they were to violate that last-chance agreement, that would be it. The medical residency removes them from the program. However, can a resident appeal a program dismissal? If there were a removal that would happen, there would be an appeal process. Sometimes it’s very short, like 48 to 72 hours, which could require the resident to appeal or lose those rights.
Appeal Process After You Are Terminated
Then, if you appeal, you will usually go in front of a committee that determines your fate.
It’s undoubtedly difficult if you get removed from a training program because you don’t want to give up on becoming a practicing physician. And so, trying to find a new program that’s going to let you in can be difficult. But as I said before, just because you’re a professional doesn’t mean you don’t have everyday problems like everybody else.
Well, that’s a little primer on whether the medical residency can fire you from the program.
Kicked Out of Residency
(How HARD is it?)
How hard is it to get kicked out of residency? So, this can be an issue if a resident has several problems, and you can be terminated from your program, dismissed, fired, or whatever you want to call it. But let’s talk about what can lead to a program dismissal and then some things you can do to avoid that.
First, many people who aren’t going to make it through residency are weeded out in their internship year.
Most Common Way Someone Can Be Removed from Residency
The program often weeds people out if they can’t make it due to whatever the problem is. They won’t match in residency for whatever reason, or maybe they’re even kicked out during their intern year. And that’s the first thing. Many people who the residency would’ve kicked out; the committee just weeded them out early. Let’s talk about some items or some of the most common ways the committee can remove someone from residency.
First, substance abuse is probably the number one thing—prescription drugs, alcohol, or other hard drugs. But if you are impaired when you come into work to provide care, that is a problem. It’s just a reality. But just because you’re a physician doesn’t mean you don’t have other issues in your life. And substance abuse is just simply one of those that can arise based on genetics.
Some people have difficulty coping with stress and do that by using drugs or alcohol. Residency is a stressful time. Lack of sleep and having many things thrown at you can exacerbate problems with people inclined to have substance abuse issues. And if you are consistently late or not showing up, the program will take an interest in that. What will happen is many times, if someone has a substance abuse problem, the program will allow them to place the residency on hold.
They can get either residential intensive outpatient treatment or whatever they need. And then, after they’ve completed those programs and demonstrated a period of sobriety, the program can let them back in. They’ll likely have to be in some monitoring, meaning random drug tests, may be mandatory participation in a group like a 12-step group, or something like that. But if you have substance abuse issues and are willing to admit that you have a problem, then do the things needed to remediate those problems. Most of the time, residency programs are eager to work with a physician.
The second would be clinical issues. Suppose you can’t cut it clinically. In that case, you’re just having a hard time understanding concepts. If you’re in any procedure-based specialty and can’t perform the procedure safely, this is an easy and familiar way to be removed from a residency program.
Most places will provide extra training and extra support. Still, if someone is incapable of understanding concepts or providing safe patient care, the program will remove them. It is the toughest one to fix. If you have substance abuse problems or behavioral concerns, you can remedy them.
Although, you will demonstrate some intellectual capacity if you go through undergrad, med school, and internship. But for whatever reason, some people just can’t cut it in residency. And then that’s one way of getting kicked out.
Professional Boundary Violations and Dishonesty
The following way would be boundary violations. Starting relationships with patients is an obvious no-no. And every medical board in the country has rules against improper relationships between physicians and patients.
I have had clients that have struck up relationships with patients during residency, which led to their removal from the program. It’s just a terrible idea, and you should avoid it. So, learn the rules in your state.
Dishonesty is another way of being removed from a program. You may ask, what types of things can be dishonest? Saying that you have done shifts that you haven’t done, timing out. Or saying that you worked a certain number of hours, but you’re either leaving early or coming late.
Any cheating will be a problem for any resident. Dishonesty is another one that’s tough to rehabilitate. I had had clients I’d represented before, either the medical board or the board of osteopathic examiners, who had dishonesty in their background. The board was unwilling to issue the license because of that.
Anything that could be considered a violation of the code of conduct. Or anything that leads to character issues can be used to justify the removal from the program. And how hard is it to get kicked out? It isn’t easy. The program is going to provide resources to fix whatever your problem is. They’re not just going to kick you out immediately unless it’s an enormous lapse of judgment. I mean, take all the things I just said. So, substance abuse, dishonesty, behavioral concerns, and professional boundary violations.
And if you have a substantial clinical error, that could lead to the program dismissal. If you show up to work high and start providing patient care, that could lead to your program dismissal if you are, as I said before, just ultimately making up for the fact that you will work when you’re not.
Know Your Appeal Rights
There is a threshold where the residency can tell, no, you’re out of here. But most of the time, they will provide a corrective action plan, verbal coaching, and counseling. Something that will allow the resident to continue in the program.
What happens if you get fired during residency?
A resident will likely first be disciplined, placed on probation, or suspended before they are fired from the program. The resident will have appeal rights if terminated from the program.
Can you fail out of residency?
Yes; however, each program understands that a resident will make mistakes in training. Unresolved problems could cause a resident to fail out of the program.
What percentage of people drop out from residency?
The percentage is very low. For instance, in Emergency Medicine only 0.8% of all residents drop out of their residency program.
They’ll start there. And then, if there are still problems, usually they’ll ask a resident to sign the last chance agreement, which dictates the terms. It would be best if you did these things satisfactorily, or the committee will remove you from the program. But be careful in signing a last-chance agreement. Many of these, in my opinion, contain terms or requirements that are nearly impossible for the resident to meet. Before you sign that agreement, I certainly would have somebody look that over.
Now, you do have some appeal rights. If the program dismisses you, you can’t appeal the decision and usually address the committee or submit a written response to the reason behind the program’s removal. But to be honest, you don’t have a ton of leverage or rights in fighting a program dismissal.
So, can you get kicked out of residency? Absolutely. Is it hard? I wouldn’t consider it hard if someone is willing to work on their problems. Some people aren’t, so removing someone from a residency program is very easy.