Residency

Handling resident contract nonrenewals

Residency Program Insider, February 12, 2008

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Nonrenewal of a resident's contract can have a significant impact on the resident's future career. However, when done properly, it can help the resident make appropriate planning decisions and assist him or her in moving forward to a more suitable position.

 

Resident contracts are renewable training appointments, one year in length, corresponding to the length of a program year. Each year, the program director renews a resident's contract upon successful completion of the requirements and progression through the program. If the resident does not fulfill these requirements, the program director can choose not to renew the resident's contract. The program director may base nonrenewal decisions on things like poor evaluations, failed remediation attempts, and an inability to perform required procedures. At times, a program director may not renew a contract when it is evident that a resident does not "fit" into the culture of the institution or if it is evident that the field of medicine is not for resident.

 

For the purpose of this article, we will use the term notifying party to refer to the individual responsible for notifying the resident of the nonrenewal. Here are some tips to ensure that the notifying party handles the situation in the most appropriate and least stressful way to the resident and the program director:

 

  • Decide who will act as the notifying party. The notifying party must have authority over the program and knowledge of the situation. Typically, the program director or department chair gives the notice. No matter who holds this responsibility, the program director should also be present, as well as at least one other person who should take notes.
  • Follow the procedures exactly. Refer to your institution's resident dismissal policy for the proper procedure and protocol for contract nonrenewal.   
  • Give the resident plenty of notice. ACGME requires the notifying party to give the resident at least four months notice and the notification must be in writing. If situations prohibit a four month notice, then give notice as soon as possible. At best, you want the resident to have the opportunity to find another program.
  • Notify the designated institutional official (DIO) of your intent. Use your DIO's expertise to help formulate the notification and to give advice on how to present the non-renewal. Often, the DIO can serve as an invaluable resource in reviewing the documentation and ensuring that the written notification meets the ACGME and due process requirements. Prior to notifying the resident, it is a good idea for the DIO, program director, and hospital legal counsel to meet to verify they are following the appropriate processes.
  • Have supporting documentation. You must have reasonable evidence to warrant your decision. A resident's file frequently has conflicting evaluations, so remember it is the weight of the evidence that supports the program director's decision. There should be a track record of evaluations of resident's performance, outcomes from remediation attempts and direct input from various faculty and the program director.  Many programs rely on the input and support from the departmental education committee in making non-renewal decisions.
  • Inform the resident of his/her right to appeal under your institutions due process policy. Give the resident a copy of the policy and make sure that he/she understands it and is aware of any deadlines for appeal.
  • Obtain signatures of all involved on the notification letter. This shows that there is a clear understanding of the evidence presented and the decision rendered.

 

Best,

Christine Redovan, MBA

Director, GME & International Affairs

MetroHealth Medical Center

Cleveland, Ohio



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