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 willing 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 easily 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. 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.
Know Your Appeal Rights
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.
Resident Program Dismissal Appeal
Can a resident appeal a program dismissal? In short, yes, they can.
But the resident needs to know the details of the program dismissal appeal process. If you are in a residency program and there have been negative training issues being dealt with by the program, there is a process to attempt to remediate whatever the issues are. And then, if those remediation efforts do not work in the eyes of the program, the program could potentially dismiss the resident.
The training program and hospital will have a code of conduct, policies, and procedures that deal with the removal of a resident from a residency program. It can be a short window to appeal, meaning sometimes these programs have a 48 to 72-hour window where if the resident physician fails to appeal the decision, they lose any appeal rights. Then the program dismisses them without the resident having the ability to fight the dismissal.
Appeal Process for a Medical Residency Program Dismissal
The training program is not just going to boot someone out without any attempt to remediate the behavior. I mean, assuming it’s not some heinous incident.
So, let’s say there is a corrective action plan in place, but it’s not working for the resident for whatever reason. The program may be at the point where they want to get rid of the resident. They will send a letter saying the program has voted to remove you from the program. If you want to appeal this decision or maybe even address the committee making the decision, you will likely have a concise window to appeal.
As I said, I’ve seen appeal windows as little as 48 hours for a residency program. If you fail to meet that appeal, that’s it. They will boot you out of the program without any way to get back in.
Once you appeal, they’ll usually say you must appeal via some written instrument. You most likely need to write a letter telling me you want to exercise my appeal rights. Then you would most likely be allowed to address the committee voting on whether to remove you from the program.
Sometimes programs will offer a last chance agreement, which is basically like, this is your last opportunity to make things right, remediate the problems. You are without any appeal rights if you violate the last chance agreement. Before you sign the last chance agreement, run it by an attorney in your state to review it. There are very few people that would specialize in that. But the last chance agreement can give the resident one last opportunity to stay in the program.
However, you don’t want to set yourself up for failure. Often, these last-chance agreements will be written in a way that almost makes it impossible for the resident to get through without some problem. You don’t have the same leverage that maybe someone licensed has.
And speaking specifically about where I am, in Arizona, when we represent people before the medical board, there are bright-line rules of what we have to follow. There’ll be an investigation, response, interviews, board meetings, and potential appeals and hearings. There are a lot of legal shields that we can use to defend doctors when their license is under investigation. However, those things are simply in place when you’re in a residency program. The deck is stacked against the resident. Maybe that’s the best way of saying it. So, it would be best to ensure you’re doing everything possible to save that.
Because as you can imagine, if you get kicked out of a residency program and want to continue and finish your training, it’s difficult to find another program that will let you in. Now, if a program has kicked you out, you need to take proactive measures to fix whatever the problem was. That’s difficult for clinical issues and dishonesty.
Saying I’m going to study harder sometimes isn’t enough. But if you have clinical problems, then you can take some ethics courses and things like that. If you’ve been dishonest, I can tell you it’s challenging to overcome convincing another program to let you in. And even if you do that, you still have to get licensed. And the medical board will know that the residency kicked you out of your training program for a reason.
Taking Proactive Steps to Resolve the Issues
And I have had people, or at least I know of people, who’ve been able to complete training. But once they apply to the medical board in the state they want to move to, that board has denied people for dishonesty issues during training. But with substance abuse, mental health, behavioral problems, and boundary violations, you can rehabilitate those things or be rehabilitated in many ways.
And if you do that before you try to get into a new training program, you can show them all the positive steps you’ve taken to remediate the problems. And I find that most residents have a much better chance of getting into a new program if they’ve taken proactive steps and fixed the problem.
If you don’t do anything, if you get removed from a program and then sit there for three months and start applying, they ask, all right, well, what have you done to fix these things? And you say nothing, well, you’re putting yourself in a challenging position.