Tip of the week: Don’t compromise on termination decisions

Residency Program Insider, May 25, 2010

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The process and decision to terminate a resident for academic reasons weighs heavily on most program directors’ minds.

“A lot of program directors wrestle with these decisions and feel guilty,” says Forrest G. Read IV, Esq., academic medicine and employment attorney at Tobin, O’Connor & Ewing in Washington, DC.
However, most program directors take their obligation to protect the public seriously. After giving the resident a chance to remediate and documenting his or her inability to perform at the required academic standards, program directors may decide to terminate residents who are performing below those standards.

Because directors feel badly about such a harsh consequence for the resident, they often resort to a “compromise” option. For example, program directors sometimes also opt to keep a resident on until June 30 to avoid disrupting call schedules or because one fewer resident will adversely affect patient coverage.

“This may be the less harsh and punitive way to go for the program director, but it may subject the institution to having to deal with a resentful resident and consequent lawsuit,” Read explains.
Not promoting residents to the next academic year but allowing them to finish the current one often backfires because it sends a confusing message. The residents think, “If I’m so bad, why am I not being terminated now?”

“It arouses some suspicion in the resident that there was something amiss in the program director’s decision,” Read says, adding that it can also cause the resident to feel bitter about the termination.
These two factors often make the resident more likely to initiate a lawsuit. The resident may conclude, for example, that the adverse decision is due to an unlawful, discriminatory reason.

Program directors should consult administrators in the GME office and legal counsel to discuss the terms of the termination, including the date the resident will be fired.

Every case is different, but it’s generally a better move to make the tough decision and not allow the resident to finish the year, Read says. The benefits of a swift, informed decision often outweigh the risks of a limbo period for the resident and the program.

This week’s tip is adapted from Residency Program Alert.

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