Resident Program Dismissal Appeal (Is Your DEADLINE 48 Hours?)
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.
Common Reasons Why a Physician Would be Removed from a Medical Residency Program
So, let’s first talk about why a residency program would remove someone and the appeal process. In my mind, there are five common areas where a committee would remove a physician from a medical residency program. The 5 reasons most physicians are fired from medical residency programs include:
- Substance Abuse
- Clinical Problems
- Behavioral Concerns
- Professional Boundary Violations
My firm does licensing board defense for physicians. We defend their licenses before the med board or osteopath board. And almost every complaint comes out of the five areas listed above.
The first reason for removal from a residency program is impairment concerns. So, substance abuse issues, drugs or alcohol, prescription meds. If someone is abusing substances and it’s affecting their ability to provide safe patient care, that is a reason why the program could remove a resident. The program usually allows them to go to inpatient rehab, an intensive outpatient treatment program, AA and counseling. Sometimes they’ll be allowed to take a step back from the program for a period, and then they can restart and finish training after they have been rehabilitated.
But if the residency has given them those options for treatment and a resident is unwilling to accept that they have a problem or go through that, it can lead to dismissal from a program.
Clinical issues are the second reason the residency could remove someone from the program. If they can’t get the concepts or are having problems, depending upon the specialty, maybe safely doing some of the procedures, that can undoubtedly lead to removal from a program.
Most programs will always have some coaching program that can attempt to get the resident up to speed, but if someone can’t get the concepts or complete the residency safely, that certainly is one way to be removed from the program.
The third reason could be behavioral problems or mental health issues. Suppose they can’t get along with staff, other residents, attendings, or other physicians for whatever reason. In that case, if they are a disruptive problem, that certainly can lead to the removal from a program.
Dishonesty, so cheating or lying. I’ve had people who have faked their hours for whatever reason, which certainly can lead to the removal from a program.
And then the last reason would be boundary violations. If you are a provider, there are rules where you can’t have a romantic or emotional relationship with a patient you’re providing care to.
But there are times when sensitive topics are being discussed, especially in the mental health arena, and someone can prey upon those. And if a provider strikes up a romantic relationship with a patient, it can lead to dismissal from a program.
So, those are the five main reasons the residency could let someone go. Now, what’s the process for an appeal? As I said, if the program identifies an initial problem, they’ll almost always attempt to work on a solution with the resident.
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 who’s already 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.
Can you switch programs in residency?
A medical resident may change programs during their residency training. However, switching residency programs can be a difficult and drawn-out procedure, and depending on the particulars, it might not always be feasible. In general, residents who seek to change programs must get approval from both the director of their present program and the program they wish to move to.
They will need to make sure they are eligible for the new program and that the transfer won’t interfere with their academic progress. Before deciding to switch programs, residents must give it some serious thought and consult with their supervisors and peers.
What makes a residency program toxic?
There are several factors that can make a medical residency program toxic. One of the most common causes of toxicity in medical residency programs is the high level of stress and pressure that residents face on a daily basis. This can lead to burnout, which can affect a resident’s physical and mental health. Additionally, a lack of support from supervisors and colleagues, as well as inadequate resources and training, can contribute to a toxic environment in a medical residency program. Finally, poor working conditions, such as long hours and inadequate compensation, can also make a medical residency program toxic for residents.
What happens if a residency program loses accreditation?
If a medical residency program loses accreditation, the residents who are currently enrolled in the program will be affected in different ways depending on their individual circumstances. Some residents may be able to transfer to another accredited residency program, while others may need to repeat their training in order to meet the requirements for certification. In some cases, residents may be unable to complete their training and may need to pursue a different career altogether. It is important for residents to carefully consider their options and to seek support and guidance from their supervisors and colleagues if their program loses accreditation.