Transcript
Speaker: Hello, and welcome back to Black Doctors Podcast. This is a special episode. This is a collaboration between our podcast and the SNMA, The Lounge Podcast. We are following up on a panel that was hosted at the Student National Medical Association Annual Medical Education Conference, dealing with the subject of early dismissal from residency.
Speaker: So before we get too far into it, let's hear from our guests and collaborators, the good folks at The Lounge Podcast. Hi, everyone. My name is Isabella. i am one of the co-hosts of SMA Presents the Lounge podcast. I'm also a first year emergency medicine resident.
Speaker: Yeah, so that's a little bit about me. Hi, my name is Dr. Dumebi Okocha. I'm an OBGYN resident, second year, and I am one of the co-hosts on SMA Presents the Lounge. Hello, everybody. How you doing? My name is aspiring student, Dr. Jared Jeffrey, one of the co-hosts of SMA Presents the Lounge.
Speaker: whether you're in the student's lounge, doctor's lounge, or lounging around at home, tune in for us and the hosts of the Black Doctors podcast, as we are going to kick it today, along with some other very special guests.
Speaker: Thanks so much for joining us for this episode. We also have two special guests, Mr. Greg Kerr and Mr. Michael Johnson, who are our resident lawyers. Mr. Kerr, would you mind introducing yourself?
Speaker: Hey everybody, Greg Kerr. I'm a partner at Brown Gold Sea and Levy in Baltimore, Maryland, and I've been working in graduate medical education issues for about the last 16, 17 years.
Speaker: And Mr. Johnson. ye Hi, I'm Michael Johnson, Michael Johnson Legal. My team helps physicians evaluate, negotiate, and then occasionally fight about physician contracts. And we help physicians across the country as they navigate these deals.
Speaker: Fantastic. Michael and I go way back when I was just getting started with the ByteDarkers podcast. We've been out since about June of 2020. So we've been working together for about um almost six years now.
Speaker: um Before we go any further, I do you want to give a disclaimer. This is not legal advice. Before we dive in, I do want to give a quick recap of a panel that we held at the Student National Medical Association Conference. So we're all starting from the same place.
Speaker: This panel was moderated by Dr. Love Anani, who is behind the scenes for this recording as well. It featured myself. I am an anesthesiologist and medical ethicist. It featured Dr. Josh Abamito, who is an emergency medicine resident.
Speaker: Dr. Tyler Smith, a fellowship program director and pediatrician and associate dean. And Mr. Greg Kerr, who is a lawyer practicing in D.C. and Maryland. The core focus of the panel was residency dismissal. We looked at the data and how it feels like from the inside and how you should protect yourself.
Speaker: ah Myself and Dr. Abomito shared our personal stories of issues that we dealt with during residency. Dr. Abomito actually had to switch programs in different different institutions where he finished his residency training.
Speaker: On the data side, the numbers are stark with black and minority residents making up about 5% of the residency workforce, but accounting for roughly 20% of dismissals in the data that we reviewed.
Speaker: Surgical dismissal rates for black residents ran as high as 12% compared to 2% for white residents. In a 2020 JAMA study found that 25% of residents reported discrimination based on race and ethnicity.
Speaker: Mr. Kerr walked us through the legal framework, what actually constitutes discrimination under Title VII and Title IX, and what protected characteristics are covered, and what that looks like in practice.
Speaker: He addressed hostile work environment claims and retaliation, and noted how discrimination cases today are often built on circumstantial rather than direct evidence. Practically speaking, the panel landed on several key takeaways, how you should document things during your training, follow up with emails, read your contract in your house staff manual.
Speaker: One thing we didn't really get into was the contract side, what residents and physicians should know before they sign and how legal counsel fits into that process from the very beginning. That is where this conversation picks up alongside our guest from the Lounge Podcast. We also have Mr. Kerr and Mr. Johnson, who is a contract lawyer.
Speaker: So excited that you're joining us. And we're goingnna jump into some questions that will further shed some light on this topic. So starting with Mr. Kerr, you've been doing this for 16 years.
Speaker: What is the most significant shift you've seen in how residency programs handle dismissal, legally, culturally, or procedurally? Yeah, so I had a really tough time trying to figure out which one significant shift I could talk about because there are definitely many. One thing I would say is,
Speaker: that there's definitely an increased incidence of dismissal since I started doing this. um And that's one thing that the data would show is interesting. I was looking at some of the ACGME data earlier today and in academic year, there were dismissals compared to the academic year when they were so that represents a fifty nine percent increase Anecdotally, i can tell you that culturally there's a shift in terms of the sort of amount of patients that residency programs are willing to devote to the remediation process.
Speaker: And I think part of that just has a little bit to do with kind of the supply and demand of, of you know, residents who are out there, potential residents for getting plugged into a program. Fortunately, that that does kind of lead a lot of programs to say, well, if it's not working out for this Trini, then, you know, maybe we can find somebody to plug in who could <unk> work out here. So that that those are two things. And I guess just as I've even seen happen within institutions, you've seen
Speaker: internal due process when there are disciplinary actions, those those processes become less fair, shorter timeframes for requesting due process, narrower scope in particular, sort of limiting the review from sort of all encompassing, is this the right thing? Is this the appropriate decision to make to just merely sort of a procedural issue You know, did you check the boxes? Did you do this and then this? Well, in that case, you know, we're, we're going to go ahead and approve that decision.
Speaker: So I realized that wasn't one thing, but, uh, those are, those are definitely some, some things I've seen change over the years. Yeah. And Mr. Johnson, so position contracts are your specialty.
Speaker: When does your work typically intersect with residency? Is it mostly at the attending level or are you seeing more residents seek contract guidance earlier? I think the smartest move here is for residents and fellows that are about 18 to nine months out from finishing training to start interfacing with a lawyer, start preparing for the interview process, start thinking about what practice setting they want to be in, what kind of setup they want. And that's usually when i connect with folks. It's a good idea on the front end to talk with a lawyer that navigates these regularly, talk through compensation data, make sure you understand what is normal for your specialty, your practice setting, your geographic region, and how volume plays into this.
Speaker: And none of that is trained in residency or fellowship. Like you really don't have a background on it. You really need to know that before you start interviewing. So you're prepared for questions about compensation, about, you know, work volume. You're just more prepared for that process. That's usually when me and my team come in. You know, if you can connect with someone like us that does this regularly on the front end, You know, around the time you start interviewing, that's really best. Not as much as you're going into residency, there's really not as much there, but that 18 to nine month period before you get out of training, that's a really good time to start preparing yourself for the next step in your career, the next ah the next piece of of this puzzle.
Speaker: We also interface a lot with attendings. okay A lot of my work now, seven, eight years out, is working with former clients that are three to five years out and looking to renegotiate compensation, looking to renegotiate aspects of their work obligations or... looking to exit ah execute a transition between jobs. And in that process, it's really good to have a lawyer that knows what they're doing on your side, very aware of physician contract issues to help you navigate those. There's plenty of ways where we can save you money and some heartache. Okay. So that's my advice.
Speaker: Love thank you guys for kind of shedding light on your perspectives as, you know, legal personnel. You know, as a resident, I know most residents receive a contract and sign it really without reading it carefully. I think we're just excited to have an actual job that like has an income and we're not just students anymore. So probably just skip over that part. But what would you guys say are two to three clauses that could come back to hurt us the most if we don't really understand what we're necessarily agreeing to?
Speaker: So I'll lead off with that. I would just say this is more sort of a practical thing, but know when you need to pass step three, you know, that it varies by institution.
Speaker: Some of them, you know, give you a little bit longer to do it, but ive I can't tell you how many times someone's come to me with an issue that says, you know, the The program, you know, says needed to pass step three by date and, you know, they didn't really give me protected time to study and, you know, so on and so forth. There's a variety of issues and and they're finding themselves dealing with, you know, a contract non-renewal or something like that because of that that deadline. So usually that's spelled out either in the contract or the house staff manual.
Speaker: um be Be familiar with that. ah Know what the evaluation process is supposed to be. that There's a set number of things that the ACGME says a residency contract has to can either spell out or contain a reference to. And in that I've seen contracts that are one page and I've seen, you know, 12, 13 page contracts. So they're going to vary from place to place. A lot of times the the the nuts and bolts are going to be in the house staff manual.
Speaker: That's where you're going to see a lot of the discussion about how often you expect to get evaluated. I see, you know, clients tell me, you know, I never got semi-annual valuations in, you know, December, January or at the end of the year. and And it's crazy to me. I mean, that's such a foundational aspect to all of this.
Speaker: And know what the remediation and due process procedures are. You know, if trouble does kind of pop up, you shouldn't be finding out for the first time what that process looks like when you're in the middle of it. So so those are things I would definitely recommend being aware of.
Speaker: If you have any intention at some point of wanting to maybe move on from your program, sometimes the contracts will say, this is how much notice you need to give in order to resign. um So that's definitely something to kind of factor in. You you don't want to say, well, I'm going to i'm go to leave next week and find out you got to give three months notice.
Speaker: Now, that's a big one that i've I've seen very recently with folks just not understanding the timelines if they want to transition between programs. One more other thing. Some programs will allow you to moonlight during training and pick up some additional work, some additional comp. I know everyone is kind of struggling on comp while they're... in training. So this can be something to look into. probably should not be your first question during the match process, you know, whether you can work outside, but it might be super valuable. You know, my my wife's a physician, a psychiatrist, and she benefited from this quite a bit during like the last 12 to 18 months, being able to pick up a little bit of outside work, kind of ease some of the financial pressures.
Speaker: It's not really a negotiable point. I wouldn't typically recommend trying to negotiate that on the front end. Okay. But understanding whether that is an option or not in a particular program could theoretically impact like which program you rank at what level. So that's something to consider.
Speaker: Well, and and one thing I'll just add that that's a really good point about sort of not being able to negotiate things early on. That's actually an NRMP rule. Like, so if you got your position through the match, they're going to prohibit you from trying to negotiate the terms of your your contract with your match program.
Speaker: You know, those may be things that, and often are, dealt with if you sort of, for example, become organized through one of the unions like CIR, you know, they'll have a number of different provisions in a collective bargaining agreement that can cover all kinds of things like the amount of time you have away, your pay, things like that. But but yeah, so just just not to give yourself a match violation, would i would recommend against trying to you and negotiate terms of contract during those interviews.
Speaker: And I think you guys also kind of already touched on this a little bit in terms of like the difference with dismissal and like just not renewing it, like a non-renewal of a contract. Can you kind of talk a little bit more about like those differences?
Speaker: Absolutely. I mean, it both of them obviously have the same end result as, and then you're not going to be training there anymore. Um, but obviously a non-renewal least presents the opportunity for, for completing the training year.
Speaker: You may get, in fact, be able to get credit for that year. And especially if you're talking about an intern year, um that may make all the difference in the world between you being able to go out and apply for an unrestricted license.
Speaker: ah versus not being able to. Most jurisdictions have at least a one year of of successfully completed graduate medical education to get a license. Some require two, but but that's a that's a big difference. There's also a difference in terms of what that means to other programs who are looking at you.
Speaker: you know Obviously, dismissal is sort of the biggest red flag. Not renewal is not great, but I mean, at least that might be portrayed in a better light than than a straight up dismissal would. So I think those are those are two slightly different statuses for important reasons, but both of them carry with them, at least in an ACGME accredited program, the right to due process if they're imposed on you.
Speaker: Okay. Okay. That makes a lot of sense. Mr. Johnson, i I know you touched on this already, but I just wanted to double back. Is there anything in the residency contract that can be negotiated or is it like just best practice to just take it and leave it?
Speaker: I wish these were negotiable, but unfortunately that is just prevented by the rules. We could have a whole other podcast about why that is and why that should not be the case. Okay. Greg and I talked about that off offline, but no, it's possible that in some fellowship process,
Speaker: programs that are not through the match, there could theoretically be some room, but that's going to be a very, very, very small subset of folks. But your typical, you know, you you apply to the match and you match with someplace. and No, that's not going to be a negotiable contract. You have to take it. Yeah.
Speaker: So Mr. Kerr, at what point in a resident's experience, should alarm bells go off that this could become perhaps a legal matter? Or what are some early signs that people may tend to ignore or miss?
Speaker: So definitely a lot of things could trigger that um sort of awareness that that that you might need to sort of take some actions. Obviously, you know, you get a negative end of rotation evaluation.
Speaker: you know, the program director calls you into his or her office and says, you know, we need to talk about some concerns that we've got. Obviously escalating from there, early remediation, you know, putting on a performance of improvement plan or notice of concern. There are called many different things at different institutions, but, but the, the basic elements of, it are the same is that there's something deficient about your performance and we need to address it before it gets to the more severe adverse actions.
Speaker: Obviously, another sort of red flag is if you get the sense that you're being treated differently than your peers who were in a otherwise, you know, sort of similarly situated to you, you know, they're coming down on you for turning in your notes late or, you know, what have you. And, you know, you're looking at the person next to you and saying they they do the same thing.
Speaker: um what's What's the difference? why Why is this sort of a focus for me? and You know, that that's where maybe sometimes the relationships that you have with your co-residents and kind of talking through some of these things can be helpful because a lot of times I talk to folks when they're much further down the road and they're saying,
Speaker: You know, sort of, I think that I'm kind of being treated differently, but I don't know. You know, it's good to be able to have the relationships with your co-residents where you can check in and see, you know, am I imagining this or is this real?
Speaker: Because those can certainly be things that hopefully you would nip in the bud early on. But if not, at least in sort of maybe the due process context, you can say, you know, there's a differential in how expectations are being applied.
Speaker: That may or may not be due to an illicit reason, like discrimination based on any number of different protected characteristics. It could also be something as simple as, you know, there's ah an attending out there who's just really hard on you because they don't like you.
Speaker: And that's getting more airtime and more attention than the positive stuff. So those are all sort of some of the basic, like, I'm going to need to sort of start to pay attention to this and maybe start to take some action.
Speaker: And then when you do notice kind of signs of mistreatment or different treatment from your attendings, what are things that we should do? Should we keeping a paper trail on things? How should we be documenting what's going on in order to, I guess, build a case?
Speaker: Yeah, that's that's definitely sort of the name of the game. I mean, you basically want to take a a page out of the playbook of of the programs and really any employer, you know, when they're looking to discipline an employee, they're going to build a paper trail. They're going to sort of start to catalog all the ways in which You know, you're not meeting expectations and the things that they've done in order to try to bring you along and meet expectations in order to say, see, you know, we've been pointing these things out. It hasn't been working out. So this is why we're, you know, taking this action.
Speaker: we've We've tried everything and it's not enough. And so similar principle for for residents is... you know, create that paper trail and it's going to require a little bit of diligence. I mean, residency is already a lot of work, a lot of long hours, but when you consider what the alternative is, if you're not sort of keeping up on those things, it's definitely worth it because you want to come prepared for those kinds of situations. So what do I mean?
Speaker: You know a lot of times, especially in, you know, busy academic medical centers or maybe even more so in some of the private equity owned institutions out there that have residency programs, the faculty are going to highly invested their time into their practice, their WRVUs and all those kinds of things that are important to them professionally. And a lot of times the evaluations and mentoring and everything as supportive residents kind of falls to the bottom of the list, unfortunately.
Speaker: So sometimes you're not even going to get the evaluations that you're supposed to get when you complete a rotation. Maybe if you do get them, they're going to be late or they're not going to include all of the, you know, sort of great details that you were getting verbal feedback on. I mean, ah countless times I have heard I got the written evaluation that they're sort of looking at for taking this action.
Speaker: And it's totally different from what I was being told day in and day out, you know, whether it's in the OR, or whether it's in the clinic or the the floor or whatever. and um And part of that breakdown is because, yeah know, you got a four-week block, maybe more depending on your specialty,
Speaker: That attending iss not going to remember every single encounter that they had with you. A lot of times it's going to be, you know, their gestalt about what happened or sort of whatever was most recent.
Speaker: It could be something that somebody told them that day about you. And even though they had nothing to to do with that experience, they're going to write it down. So take a ah couple of minutes every time that you get, you know, positive feedback from that attending and say, you know, just a very simple, not over the top email that night, the next morning, you know, dear Dr. So-and-so, appreciate and working with you today.
Speaker: I really appreciated you sharing that I was good at XYZ, whatever it is, and and send that off. If that attending doesn't write back and say, to oh, whoa whoa wait a minute, I didn't say that. I actually told you you were the worst resident I ever had, you know so on and so forth.
Speaker: They're not going to do that. They're too busy. Then you get to sort of build that up, keep that for yourself, have a little file set aside, accumulate as many of those as possible so that you have some ammunition When the program director comes to you and says, you know, you're deficient in X, Y, and Z, you can say, you know, I respectfully, you know, I'm having some difficulties or squaring now with the feedback I have been getting, you know, this is, this is what I'm seeing.
Speaker: And so you can sort of supply that that paper record ah maybe to head things off before they get worse or to use them as part of an an internal due process. So do that, you know, sort of, you know, religiously download your evaluations religiously. Don't just let them sit on MedHub or New Innovations and never look at them. Make sure you have that in your file as well.
Speaker: If you have verbal meetings with an attending or your program director, or maybe even the program coordinator about something that's significant, um you want to do a ah recap via email about that meeting. Because again, if it is a he said, she said situation, nine times out of 10, the people hearing about that are going to credit whatever the attending has to say versus what your recollection is months later.
Speaker: So... Get in the habit of doing those kinds of things. and it And it can be done in a professional and polite way without being confrontational adversarial.
Speaker: Those are those are some sort of tips in terms of trying to you know get the record on your side or at least have it accurately reflect what was going on. Yeah, if I could just add two things to that. One is from the perspective of the academic attending, they're being pushed more and more and more to create more and more volume as part of their practice. ok Historically, they really weren't pushed as hard on volume. They could spend a little bit more time on the academic component, the GME component of their job description. ok
Speaker: I'm getting a lot more academic attending contracts that say and ah attending is 100% clinical, 0% academic, yet are required to provide feedback, to provide guidance, to provide written reports on residents and fellows, and there's no carved out time for this. And, you know they're feeling that pressure. so just...
Speaker: Doesn't excuse them not doing what needs to be done for you, but that is just a a reality that is happening in academic medicine is starting to look more and more like a volume requirement for other practice settings.
Speaker: And then second piece here is that I'll tell you from a lawyer side when two folks talk to each other they don't always hear the same thing. And it is very difficult to document, to understand what was actually said. If there's no contemporaneous meeting evidence, there's nothing that really reflects what, you know, went on in that conversation. So doing that in a thoughtful, professional, not over-the-top way, okay, be tactful with this.
Speaker: But if you do it thoughtfully, then when that attending may be... doesn't remember everything, but maybe checks their emails and remembers what was discussed through that summary that could be helpful to you down the line.
Speaker: I really like the way that you guys frame those things. If if I can you know kind of just try to summarize, it seems like you're saying that it's best to try to get ahead of the situation before there's a situation, right? Keeping some kind of paper trail via just normal conversation, normal emails, things of that nature puts you in an advantageous position for that if there ever is some kind of adverse reaction or any kind of adverse ah action taken against you, you at least have something that you can at least arm yourself with. Do I have that right?
Speaker: Absolutely. Yeah. Very nice. Very nice. So we're going to pivot the conversation just a little bit. And I want to actually see what the residents on the call have to say about their residency training and um what you guys think about contracts. So like.
Speaker: Just, you know, from your own personal perspective. What did you guys know about your contracts before you signed? Or like, you know, having been in residency for some time now, are there things that you may have learned later down the line that you weren't taught going into contract signing? I think just like many people have mentioned, I didn't really know if I had a...
Speaker: a choice about the contract. So I kind of read it and I was like, ok this is how much I'm getting paid. These are the benefits that I'm going to get. And then I mean, I've matched here. It's a binding contract. It is kind of what it is. I think maybe something that I should have looked more at when I was like interviewing for residency is the benefits that come in the contract before ranking. Not saying that my benefits are you know bad or anything. Is this something I've never thought about, you know, like 401k and then like Roth IRA, like those types of things I never really thought about until comparing with other programs like, oh, they get a Roth. We don't really get a Roth. And then also i never looked too much into like the disciplinary action like or like the um remediation part of my contracts, is you know, you think like, oh, that'll
Speaker: never happened to me or whatever, you know what i mean? But, you know, everyone kind of has like a stumble in the road. You get a learning plan, you get this, you get that. And you want to know how i can, i guess, recover from a deficit.
Speaker: And I think, I mean, that may not be on a contract, but I think that's something that should be asked while you're inter interviewing for residency. Like, OK, if I have a deficit, What can I do to correct that deficit? And, you know, how long do I have?
Speaker: um I think, you know, we're all very high achievers. So a lot of times it's hard to think about struggling in something. But um I think just being frank and honest, like really asking a program, you know, how will you support me through that process? It's super important. So. Mm hmm.
Speaker: Definitely. Yeah. I was going to like piggyback off what you maybe said. I feel like the benefits portion is sometimes like not really emphasized as emphasizes the salary. I feel like the salary is what like pops up, you know, as the most visible thing when you're signing and then benefits because i don't know how much we knew about benefits.
Speaker: prior to matching residency for us to really know what exactly is good benefits versus like not so great benefits. But I think the other thing too, I don't know if this necessarily like ties into contracts would be more so like what it even takes to be, have your contract renewed. Like I remember I went to,
Speaker: like my sent my semi-annual ah meeting with leadership for my program. And, you know, like there's, they basically just kind of talk about things that you're doing like well in, maybe things that you want to kind of like keep an eye out for, um like as you're kind of like continuing in the program.
Speaker: And then like ah there's like the documentation piece in terms of like there's things I had to fill out. There's things that like my my assistant program director had to fill out. And then there's like a portion where they actually say whether or not like they're promoting you or they recommend you to continue on or not, which like I was like, oh, I didn't know. Like this was like a year by year thing. I thought I was just, you know, staying law on. this So that part kind of tripped me up. I thought when I signed my contract, that was the end of that. So I was like, that's what I thought. So I'm not going to lie. I was like, oh, OK. Like, I'm glad you guys promoted me. But like, I just didn't know this was a question. Right. So I think that's like something that a lot of
Speaker: like any who otherwise haven't started residency or haven't gotten far in it, like know that it's like this is not just a you just stick by because you signed the contract. Like they can decide for whatever reasons, like, you know, whether they think that you should be promoted to the next year or not. And so like I think that does kind of add an extra layer of like maybe some nervousness or um like ah let's say if you have things that are really pending kind of like needing to be either remediated or just things that they see to be like significant stuff you have to work on like I can only imagine how someone could feel in their program and not feel secure because that might be what causes them to not be promoted um so I think those things are just like
Speaker: stuff that we have to kind of keep in mind, like make sure that you're very aware of like, what are the things that your program is saying you need to kind of have ready and like set every year? And what are the things that they've told you? Like, this is what we're hoping that you continue to improve on. So that way you're actively working towards that and showing that you're working towards us So that way you don't get blindsided, God forbid, if you're not getting promoted, you know? So I just think like, just those are kind of the silent things about residency that I i just otherwise they didn't know prior to matching.
Speaker: Well, it it's interesting you mentioned that the the part about like expecting that the contract's just going to roll to the next year. mean, even for a categorical position, every contract that I've ever seen with respect to residency and fellowship as well, said they have that you know sort of protective language for themselves that says, you know this is a one-year contract. you know There's no guarantee of another year, even again for a categorical position. I think that's why folks like yourself are you know kind of thrown by that. you know
Speaker: What do mean? Of course I was going to get another contract because that's what categorical residency is all about. So that those are one of the read the ways that these institutions kind of like preserve for themselves a little bit of extra wiggle room in terms of their commitment. But of course, they expect you to be fully committed.
Speaker: One rule that used to exist in the ACGM we had number of years ago was that if there was going to be a non-renewal, the resident was supposed to be notified of that.
Speaker: four months before that contract term was to expire. For reasons i don't understand, that's no longer the case. A lot of institutions still do have that as sort of a artifact of that, you know old ACGME requirement.
Speaker: But even then, they still have the wiggle room that used to exist in the ACGME policy, which was if something happened, And that four months before the contract was up, they could go ahead and not renew you. So that those are those are some things that I hear a lot of people say, wait a minute, weren't they supposed to give me notice? Yes, but.
Speaker: um And then we have an unhappy conversation about the the last part of that. Very interesting. Very interesting. These things have so much nuance. It's really a situation that you have to tiptoe through as a recent medical graduate.
Speaker: That's not just getting into a job, but you're getting a job that's also training. That's a commitment to this institution that has requirements. That's also, there's a lot of different things to navigate. It's interesting.
Speaker: I want to go back to the medical students. Earlier in the the episode, it was mentioned that 5% of residents are Black and 20% of residency dismissals are to Black residents.
Speaker: As two Black residents on the call, could you guys just tell us what this statistic means to you, what it what it might tell you about what residency is or the culture around residency at the moment?
Speaker: Yeah, i actually really love that question. it it's It honestly is what it sounds like, right? Like we're not really represented, I would say. But at the same time, I can imagine that there's probably a lot more of people who look like us that are being dismissed for maybe reasons that who knows what it could be linked to, whether it's it's linked to things that could be rooted in racism, it can be rooted in just bias or or just like kind of having a higher threshold to not want to work with a specific kind of resident because of, you know, their background or the way they look. I mean, there's probably so many things that go into it, but I will say that like, you know, as somebody currently in residency and like one of the few, i would say like Black people in my within my specific program, I do think that sometimes it feels like you kind of have to
Speaker: you you really can't slip up. You know, like you you really have to kind of be on your P's and Q's because you already stand out. And then you also then have this like larger responsibility of showing that in a way that you're just kind of in a way deserving of your position, even though we shouldn't feel that way. It it does feel that way because it's like you're only one of the few people in the space. And so it's almost like to kind of represent yourself in a positive way. and so i do I do think it kind of lends to a little bit of like pressure.
Speaker: Like, can you... kind of be comfortable making mistakes because you're going to make mistakes as a resident. That's the point of the process is like for you to learn and kind of grow. and so to expect perfection is a little bit unrealistic. However, I do think that there's a higher burden on us to probably have that mindset a little bit more than our non-Black counterparts just because they're more in the room and we're just not as represented. And so I do think there's like It just the numbers kind of reflect, I would I would say, the representation and also kind of reflect maybe the support we may feel on a day to day basis. I will say, like, despite that, I do feel supported in my program. Like, I think the people there are very kind and supportive.
Speaker: But, you know, it's it's different when you know that someone like looks at you and just doesn't assume that you're the physician versus your counterparts who are non-Black, who they they kind of just get that benefit of the doubt, like, oh, that has to be the physician.
Speaker: And so I do think, you know, it it lends you to kind of. once again, present yourself in a way that might be a lot a lot more tight than your peers may feel like they have to do just because they don't feel that pressure. So that's probably how I would say that statistic means what it means to me, at least.
Speaker: Yeah. And I also want to give Aldrin a chance to introduce himself and come on. he's come He's sliding in a little late, but I feel he has a lot of great tidbits to add. Hey, how's everybody doing?
Speaker: Very good. Very good. Welcome, Dr. Aldrin. My name is ah Dr. Alden Samari. I'm a second-year psychiatry resident at UC Davis School of Medicine in Sacramento, California. Welcome, Dr. Alden. We were just talking about the statistic that Black residents make up 5% of the workforce, but 20% of dismissals.
Speaker: Do you have any thoughts on that? i Yeah, yeah, good question. So my thoughts on that is quite common. Every week I get... DMs, messages from residents that are going through struggles in their residency program.
Speaker: And I'm just dismayed at the fact that it's targeted behavior. Even myself, I've experienced as of recent some targeted behavior toward me due to my presence on social media, which is interesting. But shout out to it.
Speaker: Seth's kiss to my residency program on everything. They supported me. They know what type of time I've been on. You know what I mean? And it's these small in in inflictions of lack of support, lack of identity, like lack of of appropriate recognition for black residents that I think that is oftentimes undermined in residency programs. You don't feel like you got a voice.
Speaker: Oftentimes with isolators, sometimes you're like the only resident. When I was in neurology residency, I was the only black resident out of the whole four years. And during that process, I didn't feel like I could talk to anybody. I still remember one of my homies in a family medicine program residency program. He was one of the only black dudes that I ever saw in my four or five months while I was there.
Speaker: i still remember biking to work, about to hit the ICU with respectfully, Dr. Bradley and Sabella. yeah I don't rock with the ICU too much, but I remember crying to him. He was like, bro, I'm so proud of you.
Speaker: You're doing your thing. And that meant everything to me before going into the ICU. And then after that, just feeling like I was, again, isolated. And so I feel oftentimes a lot of residents of color They don't have that that that that ability to channel the their feelings, their emotions, the challenges that they're facing. You know, you're taught to internalize that medicine, but in specific, as a black resident, that could be used to target you, which is unfortunate, as opposed to being a strength, right? They say being able to communicate your challenges in medicine is important, but what if you never have that space to do so? And so I think that plays a significant role. And I think another part of it is that we got to enter into academia, you know what I mean?
Speaker: Things like less than 2%. of physicians in academic space of color. You know what mean? So we got to get back. We got to be in the spaces of program directors, deans, chairs of residency program, chairs of departments as well.
Speaker: And that's the way that we could, you know, dismantle a lot of the biases that's there, you know? And so, yeah, those are like, kind of like the two general thoughts i have to think about right now in terms of that topic.
Speaker: Yeah, I think it was really nice for us to kind of just talk about, like, generally our experiences um in terms of being residents. I do want to circle back, I think, to some of the questions you were talking about with our two lawyers. You know, we talked about, like, just the processes of potentially either being having a renewal of your contract, not having a renewal, dismissal. i would say, as you guys kind of have already stated, um when it comes to What leads to that is usually whether or not a person has been given feedback, whether it's some level of criticism or not, and how they apply that, it sounds like.
Speaker: So I want to kind of see from our lawyers' perspectives, like when it comes to how we should handle, let's say, a verbal reprimand or criticism that doesn't actually make it into writing, like if it's just kind of like said on the fly, especially when we suspect it's laying the groundwork for something more formal, how should we really handle handle that?
Speaker: Yeah, so this is kind of probably one of the soft skills that requires, a you know, a little bit of practice before you do it, because I think there are obviously a lot of You know, sort of emotions wrapped up in it. You know, it was it was said earlier, you know, about how basically everyone is in residency is a very high-performing individual. This may be the first time somebody has said, you know, you're not quite cutting it.
Speaker: and um And there can be a lot of shock. There can be a lot of disbelief. There can sometimes be some defensiveness about it. And all of those are natural feelings, I think. And um one one thing you have to kind of keep in mind is that oftentimes the the folks who are running these programs, whether it's a PD or APD or just a faculty member who's been there for a really long time, and this is... I hate to generalize, but there are definitely some specialties out there where the ah the egos are a little bit bigger than in others. But, um you know, these are folks who are not really expecting to hear a a lot of disagreement from their residents and to be challenged and for these conversations to be adversarial.
Speaker: You know, that you may be totally justified in, you know, sort of say, where in the world is this coming from? What are you talking about? But that's often a counterproductive way of approaching the situation given the personalities involved and and things like that. so Oftentimes when I have the opportunity to talk to somebody who's at that stage of things, which is where I prefer to have an opportunity to kind of intervene is, you know, I want to find out from them sort of what their perspective on the situation is.
Speaker: And one of the most common things I hear is, you know, they're telling me that I'm, you know, my, they'll just sort of pick a competency. One of the the six core competencies say, you know, you're deficient in that.
Speaker: but not get any specifics or any kind of details about what those issues are. And it's just ah ah just a it as vague as you could possibly make it. And um so as a classic example of how to try to you know, message it and keep the tone the right way is you know, basically come at this, the conversation with whoever it is on faculty you're talking to, whether it's leadership or just core faculty or whoever is, um, you know, obviously, you know, ah I want to try and be as successful as possible in this program. I want to be an asset to the service or, you know, this department, whatever it is, you know, obviously disappointed that there, there are some concerns. I want to I want to you know, try and address those.
Speaker: can Can you give me some specifics about that? Was there one patient? Was there one shift? Was there, you know, whatever? Because that contextualization can make a big difference.
Speaker: There's at least two possibilities. One is there's a factual error, you know, that that's been made. Somebody thought it was you, but it was somebody else. You weren't even on call that day. And, and you know, sort of there's a there's a misunderstanding about that. Or maybe it was something that somebody thought was um incorrect about what you did or didn't do.
Speaker: And there was maybe a good reason why you didn't do that. Maybe the last time you had that kind of patient, the other attending who you used to rotate with always said, well, we do Y. And instead you did x So there's potentially some context that you can give them that may affect how they decide to handle that situation.
Speaker: There's also a third possibility, which is you did screw up. And that happens because this is residency and, you know, you're learning. And so then you can say, okay well, if I can apply that lesson to the next time, that wouldn't happen again. And that's exactly what that program leadership wants to hear, is that that's not going to be repeated and you are...
Speaker: going to operationalize that feedback. um In fact, that's from one of the core competencies with practice-based learning and improvement. So um they're going to be happy to hear that.
Speaker: ah So ask for the specifics, get the rationale in a non-confrontational way, if at all possible. And then when you have that information, if you do think that there is a misunderstanding or an explanation that is necessary, it's my advice that most of the time, it's a good idea to provide sort of a polite and professional response to that, whether it's a verbal reprimand or whether it's something in writing to sort of make a record clear. We've talked a lot about making the record um already today. I think that's exactly applicable in this situation as well.
Speaker: You know, because when, when you have that reprimand somewhere in the record that you don't respond to, people are going to assume that you have, you have capitulated to that. Did you agree with that?
Speaker: So, so I would sort of recommend sort of being on top of that as well in terms of response. and ah And again, in a, in a professional way that does not provoke sort of that defensive reaction from the program, that's going to feel like they're, they're in opposition with you as opposed to working with you.
Speaker: Once again, with those very, very clutch gems, these tips that you're given are some of the kind that seem very intuitive after you think about them.
Speaker: But once you're not in that space, once you're not having troubles or situations, these are things that are so easy to overlook. Very, very important. I want to direct one more question to the residents that are on the call.
Speaker: And, you know, feel free to answer if you choose. Do you believe that there's a culture of silence around dismissal from residency programs? And if so, why do you think that the culture is one of silence and that it wouldn't be talked about more openly?
Speaker: I do think there's a culture of silence. And I think from a program perspective, I've never ran a program, obviously, but I think it's almost somewhat, in my opinion, embarrassing for a program to lose a resident that they interviewed, went through the whole process of matching, got them through a certain time in their career, and then now they're being dismissed. I think there is a certain level of not shame, but it is like a strike against a program to lose a resident, like even though it may not always feel that way, like it looks bad on the residency. Like imagine as an applicant, you're looking at potential residencies and you see six in one class, but seven in another. class That means something's off. So from a program's perspective, I think it just looks weird.
Speaker: um And I think also there is shame in like just in medicine in general of just making mistakes and needing remediation. or i think In my opinion, there's also an unsaid, I think it's very aware that certain demographics are more likely to be remediated or dismissed.
Speaker: And it's not the best to acknowledge that sometimes because it's been this acknowledging almost like the racist history of residency. so Any other residents have thoughts?
Speaker: I feel like Aldwin would have a good response to this, I feel like. he's had so um I would say there's definitely a feeling culture of guilt surrounding it.
Speaker: I could speak a little bit on my experience. mean, I wasn't dismissed, but I resigned from my residency program in neurology. And it was such, it it felt like I had failed my community. It felt like I failed my hood. Like I felt my, I failed myself, you know?
Speaker: And I kept it, like, even when the SMA conference came around, like, a couple months later, Hartford, Connecticut, where I have started my neurology residency, I was shocked because people were asking me, like, well, how's residency going? And it's like, how do you answer that question? I'm not in residency, right? Like...
Speaker: And I had to like the word the conversation away from that because other people have perceptions about you going through that process. You know what And not everyone that you tell that information, disclose it have your best interest. A lot of people, my personal opinion, want to see you fail. They don't want to see you be successful, especially being a person of color is already a target on. you know?
Speaker: And so for me, it was very challenging, like navigating those circumstances. But, you know, I attribute being part of SNMA and Black Psychiatrist of America for helping me getting back to where I needed to be.
Speaker: But again, I encounter these circumstances oftentimes a lot where, you know, people go through the situations and, you know, they disappear off the map, you know, they lose a sense of themselves, their identity, because,
Speaker: I feel going going to the game, our identity is attached to medicine. And when you lose medicine, you lose your identity. And I was lucky enough to to think that, like to change that thought process by evaluating, like, where do I go from here?
Speaker: Who do I seek help from? And I started to communicate. I started to tap into my resources, started to tap into conferences, tapping into other organizations that led me to my purpose. And I think that we have to communicate that more freely and adequately to people are going through this process. Like you are not alone. Yes, there's challenges that going to face in medicine, but that that challenge does not define who you are. Medicine is not you. Medicine is a part of you, but there's also the greater good and the greater goals that you can accomplish for those patients that are waiting for you despite those challenges. It makes such a remarkable story the end of the day.
Speaker: yeah Yeah, I think those are all great responses. I i definitely think there's a huge just culture of silence, period, and suffering and residency is how I would describe it. I think like we know it's hard. Like we we hear people say that it's hard, but then like when you're in it, like you're not supposed to be basically...
Speaker: saying it, if that makes any sense. Like you kind of just have to kind of keep it to yourself, put your head down, and do the work. Because once again, if you sometimes I feel like if you show evidence or signs of like weakness or like not being able to keep up, those are holes that people could, you know, maybe it could be leadership or it could be someone who even knows within your program.
Speaker: that will find a way to kind of knock you down as a square. And so like everyone knows me, like I'm very private, like my class knows I'm very, I keep a very private like life from my residency program. and I do that purposefully because- more mo Smart move, smart move.
Speaker: Yeah, like, I just feel like I see it as work. Like, they're wonderful people, great people. And I have relations, you know, I have close relationships with some people in my residency program than others. But I also, like, understand that, like, I really can't blur those lines because that's why you find yourself in situations because you were too trusting because you, you know, I heard all sorts of crazy horror stories from people who kind of just assumed that everybody in their program was going to just have their back and they could just kind of be free.
Speaker: But what they say and what they do, And they didn't really have those boundaries set. And so now they had a window that they allowed for someone to basically, once again, kind of knock them down a peg.
Speaker: And so I knew from, you know, from early on that I was going to continue to like maintain a level of privacy in my personal life, aside from residency. And I think that's what allows me to kind of like not really associate myself with any shame or like any kind of like silence because like I'm being intentional about what I'm being silent about and I'm not necessarily like allowing it to kind of like make that decision for me, I guess, if that makes any sense. So yeah, I will say that I think it's a weird time, but I don't think that like, I don't think it means that you need to like always 100% have your guard up all the time and you can't like confide or trust in anybody. But just think you have to be wise about it and just realize that it's not everybody that is going to be your bestie.
Speaker: And you have to kind of like be able to have that discernment on like who actually can you confide in when it comes to certain things. So yeah, yeah. It's crazy you said that. One more thing. It's crazy you said that because that brings me back. You can't.
Speaker: I'm sorry. from New York. Like, I don't trust anybody, you know, in general. But there was a scenario when I was in the Razi residency. I told a senior resident that I was depressed. Do you know this man went and put it on my evaluation?
Speaker: And you know, those kind of things can ruin you when you're going up for board certification and all these kind of things. And this is the dude that we was talking about the Warriors, like two, three days ago, we were talking about the Golden State Warriors winning the championship. You know i mean And then he goes and do that. So like, I perfectly agree with your sentiment. You can't trust any and everybody in your residency program. And I still move that like that to this day. Yeah, I'm going to be cool with you. We could kick it.
Speaker: But I'm not going to dispose every and anything about You what mean? Like I'm going to keep, I'm going to stay guarded. Sorry, but not sorry at all. I agree with the answers that have been said, and it's nice that we all kind of like have our own a perception of what I guess we define as silence within residency culture. i think we we we kind of were already talking a little bit about the steps that kind of go into the dismissal process and like once again, the non-renewal process of a contract, um as we discussed with the lawyers and just kind of going back to that a little bit. i think there's also like this other aspect of it where now maybe let's say we're assuming that everything was documented and everything was kind of like accounted for.
Speaker: Then there's this plan that's made because I do think from what I remember with my my semi-annual meeting, you typically kind of have like a plan that you're going to say that you're going to kind of take into consideration as you're moving on either to the next other half of the year or the next stage.
Speaker: And so they call it basically a performance improvement plan. So I think that's kind of specific, though, to those who like or have been said that they have something that they truly need to work on and they actually have like a written out plan as to how they're going to do that.
Speaker: I don't think I got to that stage. by God's grace, but i know that it's like an actual specific thing for residents who have like had these situations happen within their program and have and actually have a written out plan step by step. So I would say for maybe for those who are listening, who are residents who who are in that stage where they're like actually on a performance improvement plan, like what would you kind of say from your perspective or like the first two to three things that they should do to kind of navigate i'm how to, you know, work towards that or I guess achieving whatever is on that specific plan?
Speaker: Yeah, and I think you're intro to the topic is kind of important because there is a distinction between what the ACGME calls an ILP or in intobu individualized learning plan that every resident is supposed to have compared to remediation plan, a performance improvement plan, whatever sort of, you know, sort of nomenclature they want to put on it. It does vary from place to place.
Speaker: But those are two different things. And the latter is one where they're identifying that there's there's a performance deficiency that they want to address. And the one thing I want to say just off the top about that is it is not the end of the world when that happens.
Speaker: There are plenty of literature out there that records that anywhere between 6% and 28% of residents at one point or another get put on remediation during their training.
Speaker: and successfully complete. So if it happens, it doesn't mean that you're you know irrevocably on the road to dismissal, especially at programs where they really do want to invest in the remediation process. And there are certainly plenty of them out there.
Speaker: But when that happens, in addition to not panicking because of what I just said, the the second step is take a thoughtful approach to it and be self-reflective because there may actually be some things that you do need to improve on in your performance. And it's not just all, you know, there they got it wrong.
Speaker: And I think that opens a lot of people up to the possibility of there are some things that I might need help with. And, know, listen, I've never gone through residency, but I've dealt with enough residents where I can kind of see the patterns. And One thing that's clear to me is that things get progressively more difficult as time goes on.
Speaker: you know, medical school, that's tough. Residency, that's another step up or a couple steps up from there. Things that worked for you earlier in your academic career may not be enough when you're in the demands of residency.
Speaker: And for folks out there, for example, who, you know, may have ADHD, had coping strategies that they were able to apply when the stakes were, you know, a little bit lower, the workload was a little bit lower, that may not be enough anymore.
Speaker: And so that's the time where you need to have sort of the self-awareness and the ability to advocate for yourself to say, these are things that I need now that I'm in residency. And this is a, it's a touchy subject because it's a very individual, you know, sort of issue for everybody.
Speaker: Do I disclose to my program or my institution that I have a disability? Because there's justified concern about the stigma that goes with that and maybe some judgments that get made based on that.
Speaker: and And I can't dictate to any one individual person how they resolve that that conflict. But what I would say is that if you have to choose between stepping up and talking to the disability services office or HR or whoever about something that you need um versus letting things continue to kind of take a downward spiral because no one's accommodating you in a way that that they could be done, i think I'd rather kind of speak up and advocate for myself.
Speaker: Even if it's not a disability accommodation, when you get that plan, look at it and say, is this going to support me? Or is this just a bunch of, you know, sort of targets that I need to hit? I can't tell you how many remediation plans I've seen that say, get better. You know, you need to have a certain milestone score in this particular sub-competency by the time that, you know, we wrap this thing up in a couple months. That is not a good plan.
Speaker: In fact, there's there's a lot of literature supporting the SMART remediation plan. So specific, measurable, attainable, relevant, and time-bound characteristics to how you're gonna remediate something.
Speaker: Make it as objective as possible, make it measurable. And again, things that you need for support, whether it's because of a disability or not, now's the time to ask. And don't please, please do not keep that as a verbal ask only.
Speaker: Put that in an email to the to the folks who are working with you on this. Because one of the things that we look at when we're doing the due process stage of things down the road is three components to academic due process are notice of deficiency, opportunity to cure the deficiency, and a careful and deliberate decision-making process. Notice and opportunity to cure go hand in hand.
Speaker: Just telling a resident you're not good at X does not necessarily afford an opportunity. So if part of the opportunity is the support structure, like having a mentor, having feedback meetings every week so that somebody can tell you and keep you in the loop on whether you're meeting expectations or not, these are fundamental aspects of any kind of academic medicine.
Speaker: So making sure that if those things are not included in your plan to include them and do it in writing so that they don't happen, you can say, wait a minute, you know, I asked for the plan to include all of these things that were going to be easily done.
Speaker: and make a real significant difference in me being able to progress, if they didn't happen, you know, it's not through a fault of my own. The process was flawed. And I'll tell you that in all of the, don't know, hundreds at this point of these academic ah due process proceedings I've done,
Speaker: the The arguments that get the most traction and make the most difference are the ones that are process related. Because if you go in there and try and explain how you're attending, doesn't know what he's talking about, and you're a better doctor at this specialty than they think you are, you're going to lose. 99 times out of 100.
Speaker: But if you can point out a way that the process was flawed, was not followed, you didn't get an opportunity for very good reasons, then you have a much better chance of success. So at that early stage, when this is all being constructed, you need to be putting it out there about what you need, why it's important.
Speaker: Be familiar with the processes on remediation, know how this process is supposed to go, that they skip a step, you know, now's your time to bring that up. Be aware of what you're signing.
Speaker: You know, so a lot of times the program just slides the paper across to you at a desk and says, we want you to sign this. If it doesn't say that, you know, your signing is just to acknowledge receipt only,
Speaker: It could be misconstrued as when you sign that, you're agreeing to all the things that are, you know, said in there about your disagreement with, you know, your alleged deficiencies. So be careful about that.
Speaker: and And this is the stage where I wish people would come to me, you know, get get that yeah competent, trustworthy advice. from somebody, it doesn't have to be a lawyer. I love it when people come to me versus, hey, I just got dismissed and they're telling me about this thing and it happened three months ago and we could have done some of this to intervene.
Speaker: But like, even if it's ah a mentor, like there's a faculty member who is sympathetic to the situation. I've heard lots of stories, including Summit, the AMAC, you know, have conversations with those people and and have them push you in the right direction. that That's invaluable.
Speaker: I want to jump in real quick and and ask a follow-up question about, and kind of in the perspective of the medical student that is experiencing fear in this situation.
Speaker: They are sitting at the table, that letter just got passed to them, and they're concerned about the trajectory of their career at this point. They don't want to be blacklisted. They don't want to be labeled as difficult to work with.
Speaker: They don't want to be out of their residency program. In that moment, what is the tangible steps that ah that a medical, so that a resident rather, sorry, that a resident should pursue?
Speaker: what What should be their first thing that they do following that meeting? Yeah, i mean, I think it's it's some of the things we talked about, and I think it's reflecting on you know, what the feedback is. Once you have those specifics about what somebody is saying is is wrong about, you know, how you're going about things, get them to teach you the right thing. I mean, if this is a training program. These are people with a wealth of experience and knowledge.
Speaker: Um, sometimes they may even be flattered by the fact that you asked them, you know, like this is how, okay. So this is how I've approached this situation in the past. You know, you, you've got a lot of experience. would, I would ah really be grateful if you can teach me like what you think the best approach is.
Speaker: And right there, you can kind of get an indication of what's the mentality of this program. If they're going to respond with, you need to figure out on your own, that's going to be a tougher road for you to travel.
Speaker: But if you get a person across that other side of the table who says, okay, let me let me talk you through this. This is what I would do. That's a positive sign. That's somebody who's going to work with you.
Speaker: You know, when when folks are contacting me and telling me about these situations, you know, a lot of times I'm i'm trying to ferret out, you know, in talking with them where the problem lies. And oftentimes it's somewhere in between.
Speaker: You know, it's not the program totally being wrong. It's not the resident totally being wrong. There's usually some aspect of performance that could be improved. That's natural. Again, this is residency that's going to happen.
Speaker: Sometimes I might get a sense that there's some form of discrimination that might be playing a role. And in that case, there's a highly factually specific analysis that needs to get done to to try and determine whether that's happening and if so,
Speaker: Is it going to be strategically advantageous to bring it up now? Or do we let them kind of pay out some rope and kind of you know let them let them hang themselves with you know making further kinds of statements and treating somebody differently?
Speaker: So when when folks are trying to you know sort of work through what do I do next, It's highly individual. There's no one size fits all approach. A lot of times too, it's like, you know, I'm, I'm not a therapist, but, but I do a lot of listening and letting people vent and sort of like just getting unburdening yourself a little bit from the stress of the situation can be helpful and get them back into a mindset of like, let's be successful. Let's be constructive about this. Because as as I said earlier on, i can't emphasize it enough.
Speaker: The egos involved at the leadership level do not want to have somebody on the other side who they feel like is an opponent. And sometimes they may set up a situation where there's no helping that, but if you can avoid it, that's always going to you know help things go a little bit smoother.
Speaker: Those are all really great, you know, tips and advice. And I hope the people listening on will, you know, apply that to whatever sitting scenario they're in or if their friend is in it or, you know, just apply simple trips and tricks so that you're not like stuck in these type of situations.
Speaker: um One of the questions I had was, um so if you are getting a dismissal or a non-renewal, how does that impact your career in the long run? So I'll chime in. I think Michael's probably got stuff to add to this too. I mean, obviously those are those are things that are forever going to be reported on verification of training forms that are going to be relevant to licensure, relevant to credentialing.
Speaker: You know, so it's again, not necessarily death knell for getting licensure, getting credentialing, but it's at least going to make the the process a little bit more complicated. You're going to have to explain what that was about.
Speaker: and it varies to depending on jurisdiction and sort of what they'll make that. But those are, so those are things that that training program, anytime you go out to apply for a license is always going to send out that form that indicates that there was discipline or there were concerns or whatever.
Speaker: You know, the they often hear a lot about, you know, what about the data bank, the National national Practitioner Data Bank? I guess the good news there is that for basically all intents and purposes, things that happen in residency don't really echo into the the data bank.
Speaker: um There's actually sort of What the data bank sort of deals with is collecting incidents of adverse clinical privileges actions is a very specific term.
Speaker: And from the data bank's perspective and in their regulations, because residents and interns generally aren't even subject to those things because they're not granted clinical privileges in the context of their training,
Speaker: it doesn't even show up on their radar. So there's, I mean, maybe some exceptions for fellowship where there might be clinical privileges involved. You don't really have to worry about the data bank, but Michael, you probably see some more like further down the road practitioners. You might have some thoughts about that.
Speaker: Yeah, very good. i think big picture, if you face this, but you finish your residency or fellowship, either internally or in a new program,
Speaker: The odds of this having a massive impact on your ability to get a job afterwards is very, very small. okay I talk with folks constantly that bring up issues that they had in residency or fellowship, and it is not really impacting their next step in their career. A couple caveats there.
Speaker: the if you're going to more of like a hospital employee kind of a larger group setting especially outside of maybe the most attractive metro areas most competitive markets it's going to have essentially no impact okay if you can get privileges if you can get credentialed you know that's that's really not going to be an issue It's certainly possible that there might be some unique instances in academic medicine where this might impact your ability to to be as competitive for those types of roles.
Speaker: But I really see that very few and far between. ok So if you are facing this now and you're thinking ah or maybe having some negative thoughts about how this is potentially going to carry forward with you, I'll tell you from my side, I really don't see that happening. on a day-to-day basis. I have plenty of clients that I've worked with that had concerns, that got into jobs, that have been successful. I've made plenty of money.
Speaker: taylor let's talk about money. You have money coming in. There is financial success ah that's available to you at the end of this. i would not feel like all is lost or or lose hope on that on that side.
Speaker: As we start to close, we've been talking for quite a while. There's there's two questions to kind of wrap up with. For a third or fourth year medical student listening to this show right now, what is the single most important thing that you would want them to do before they start residency?
Speaker: And then for those in residency right now, what's the one or two things that they should think about doing to protect themselves? So ah I'll offer my thought that I'm actually really interested to hear what the current medical residents would have to say about this, because I think a lot of my exposure to this area is on the worst case scenarios where things have just gone wrong for a variety of reasons. And, um, and it's sort of easy for me to sort of see the negative side of things, because that's what I confront every day,
Speaker: but i to the extent that I sort of have an uplifting note about that is that I think in terms of your, your mental outlook on the process, and I usually say this in connection with, with folks who I'm helping who've just been put on remediation is, you know, you kind of have to sort of try and manifest, you know, success. You got to sort of think about this in those positive terms, because, you know, you can create a self-fulfilling prophecy if you sort of go into the, the whole process thinking negative things.
Speaker: So I guess for folks who are starting out fresh, mentally prepared to succeed, you know, to, to do well, and you've been very successful in, in all your pursuits up to this point, you know, sort of p apply all that same energy and that skill and that knowledge to the, the new challenge of residency.
Speaker: Don't assume the worst. But if some know that if something does happen, that you have some, you know, awareness now about how to, how to tackle those issues, you know, be, be looking at these processes, the things we've been talking about in this conversation, um to know before it's actually upon you so that, you know, it's, it's not a struggle to kind of acclimate to, to that new reality.
Speaker: Yeah. I think that's, but I'm interested with the residents think about that. That was ah certainly great points there. I think my thought on this is that when we started residency to find a mentor, someone that's willing to support you, establish rapport early on.
Speaker: Like when I transferred into my current residency in psychiatry, one of the first things I did was I started to meet my program director like monthly. I did that for like five, six months in a row.
Speaker: I met with my the chair of my department. So intentionally trying to ah build a network of support and learn what do I need to do? How do I get better? How do I thr thrive residency?
Speaker: And also ask the questions, the challenging questions. And what I do love about my program is that they're very transparent with me too. And that gives me the opportunity to also be transparent if I'm going through challenges.
Speaker: Hey, Aldrin. We see that you're having challenges with interviewing skills or whatever the case may be. i Okay, well, need to do, right? And we established a plan on how to tackle those issues. And I think that's very important.
Speaker: Starting off, not just assuming everything is perfect because no one is telling you anything, but rather assuming that you should be in touch with your program director and any leadership in your program as much as you can, honestly.
Speaker: if it If it has to be once a week, even if it's a text or email, like, Do it, go for because then you establish that correspondence. This, you know, ah the importance of communicating through a texting, email, having, you know, a list of ways in which your program can tap in with you and support you hopefully and facilitate, you know, a a foundation against your weaknesses and also supporting your strengths at the same time too. So that's something that I think about often.
Speaker: Yeah, I think what I would say, um even though I kind of already alluded to this, was like I would just just don't get too comfortable. don't know if there's like a better way to phrase that, but I think what happens, at least what I've noticed, is that people get comfortable And they engage maybe in conversations or say things that maybe is written in reference to somebody else at the program or or in reference to a situation.
Speaker: ah you don't know how that's going to follow you. And I've seen how like people have just kind of gotten comfortable and just think that. you know, what they say doesn't have impact, but you really have to kind of be mindful about like the kind of space you take up in this in in this setting and how your words can be twisted or used against you. Thankfully, it has not happened to me. But once again, I've seen situations, I've heard situations that where that has happened to people. And I'm someone who I learned from other people's experiences. So that way, if I can avoid going through it myself, I am.
Speaker: um So I would just say, I think like kind of just having once again, firm boundaries, Being, of course, kind and pleasant to everybody, being being someone that people want to work with, but at the same time, also like understand where you're at, the environment that you're in that this is still a professional space, and just being kind of mindful of like what what you say and kind of the conversations that you're allowing yourself to be a part of.
Speaker: Yeah, I agree with you guys 3,000%. I think I have a couple of points. And like Isabella said, like, you know, like be friendly with everyone, but, you know, have boundaries. Because like residency feels like your life, right? Because you're there more than you're at your own house.
Speaker: But at the end of the day, like, it's a job. You know what i mean? Like, it's a job. It's, you clock in, you clock out. And not everyone needs to know every part of your business. But I do feel you know,
Speaker: People tend to want to teach people that they can relate to almost like things are almost more forgivable when you are almost like friends in a way. So I wouldn't necessarily like isolate yourself and then me against them cause that never works either.
Speaker: You know, find commonality with people, even if you're from different walks of life, be that person that's very approachable, you know. So even though you're not spilling all your business, you know, i think, you know, Isolating yourself is also never the answer either, because if they don't hear from you, then they don't know you. So like what Aldwyn was saying, like meeting with your program director so that they get to know you.
Speaker: So that is something, you know, out of left field comes like, oh yada, yada said this about you. Your program director can say, that's something that I'm really familiar with. You understand? So think that's one point. I think the second point is understanding like feedback from just what's the word?
Speaker: You know, attacking your skill versus like attacking your personality. There's this big thing about, you know, calling people quiet or calling people, you know, uninterested versus you're just more type B or more laid back.
Speaker: I, you know, nip those, you know, in the bud, you know, like if people are pegging you as something that's not true, i think sometimes small comments snowball into big comments. Like I'll be personal. I got one comment beginning of intern year or the end of intern year that that I need to work on my communication because I'm just so blunt.
Speaker: But i think I'm just very direct at work. I'm not mean in any way. i just say I'm blunt. And I nipped it in the butt. i say I'm not blunt. I just say what I mean. And I mean what i say. Next thing you know my next comment is, oh, maybe, you know, she has a strong personality and she's very clear with her work. You know, so You know, they you know, they take something that someone says and then they amplify and I'm like, this is just my intern year. You know, i have to nip that in the butt. Like I'm not, you know, this brash, harsh person. I'm just very blunt at work, which I feel like you should be like it's not a game, you know.
Speaker: So I think also just nipping things in the bud that are not true about you. And then three, taking every bit of feedback. One with a grain of salt, but two just like, we're gonna see someone says to me that I need to C-sections. Like yeah I don't have enough C-sections.
Speaker: That's something you need to work on. I wouldn't just like put it under the rug. You need to be actively aggressive with your learning because no one's going to care more about your learning than you. So if you have low numbers in a certain procedure, um i'm an OBGYN resident, by the way, then you actively need to get that. No one's going to care about your C-section numbers except you. You know what i mean? So if that means, for instance, like, oh, asking the second year if you can double scrub with them in a C-section so that you get your numbers. Be more aggressive with your learning because then when everything's said and done,
Speaker: There's not like there's only you to blame, but it's like if they told you this your first year, in your third year, and you still haven't worked on something, then then it's kind of on you for not being aggressive if you're learning. so Thank you guys for all of those very, very powerful answers.
Speaker: As we wrap up, please, i would want to give each and every one of you the opportunity to say where people can find you and what's the best way to reach out if they have questions or they find themselves in a difficult situation.
Speaker: Our friends in law can start. Yeah, so um this is Greg Kerr Brown Gold C. Levy. You can s certainly reach out to me directly gpc.browngold.com and certainly info at browngold.com is our intake team that's actually trained on how to ask the right questions when it comes to residency matters so that I get the most pertinent information.
Speaker: and certainly our website, www.browngold.com, where I have information Pretty much on a monthly basis, at least blog posts that are residency related, employment law in general related as well.
Speaker: So those are just a number of resources that are out there. I'm Michael Johnson. And the best way to stay in touch is through Instagram, at physician contracts. I think I might have the nerdiest Instagram profile in all of Instagram land. Okay, we go chirp about physician contract issues, things that you might...
Speaker: face as you try to understand physician employment agreements, negotiate them, try to enforce them later. That's a good way to stay in touch and use those videos, those ah reels and posts to start educating yourself about the typical issues that you might face.
Speaker: And through that, you'll see um our website, the law firm website, michaeljohnsonlegal.com. But i I highly recommend, doesn't have to be us, okay?
Speaker: Highly recommend that you get help as you're interviewing, maybe before you start interviewing. And also start that process 18 to nine months out, okay?
Speaker: That gives you enough time to understand the core issues around physician contracts, understand how comp works, understand how exiting these things works, prepare yourself for the interview process, okay?
Speaker: and then have your team in place on the front end before you get that offer letter, before you get that contract, so you are ready to go. Sometimes you'll face some pretty tight deadlines, maybe even tighter in Greg Kerr's world, okay?
Speaker: But you'll face some tight turnaround times. Once you're in the interview process, you get offer letters, contracts, okay? You want your team in place, and I recommend that you get legal help from a lawyer that really understands physician contracts and does that regularly.
Speaker: um But that's what we do at Michael Johnson Legal. Very nice. Thank you, gentlemen. And our resident physicians, please um use your full titles to to exit this time.
Speaker: All right. Well, it was good chatting with the lawyers on the call and my physician colleagues. I had a great time. This is Dr. Isabella Ntibu, a first year resident in emergency medicine signing off. I will say if you want to connect with me, I have everything is private. So you probably will not be able to connect with me, but like will say that you can connect with the podcast.
Speaker: at snma official on instagram and if you go to the link tree you can find our link to um our podcast episodes we also have our own website um snma.org slash page slash the lounge if you want to kind of learn a little bit more about us and what we talk about um i'm one of the co-hosts of the podcast i've been a part of the podcast since it started back in 2020 the summer of the pandemic and uh you can also just Email us as well if you have any questions or you want to come on to the podcast, you have any topic ideas. Our email is podcast at snma.org.
Speaker: So, yeah, just connect with us, stay in touch. And these are the kind of conversations we love to have on the podcast because it's really about helping underrepresented people in medicine kind of understand like what their options are, understand what the opportunities are like and what affects us on a day to day basis. So I think this is a really cool episode be a part of.
Speaker: Ed, proof that lawyers and doctors can get along. This is Dr. Alden Samari, second year psychiatry resident at UC Davis. Just want to give a shout out to Dr. Bradley, allowing us to be on a podcast, the Black Doctors podcast. So big up to you for giving us this space to discuss a very critical and important issue, especially as pertains to residents and medical students of color.
Speaker: Unlike Isabella, my Instagram page is public and open. DMs is open. The IG is open. I'm trying to hit 10K followers by the end of ah the summer. So, you know, flood the follower list. You know what mean? My IG is thehoodpsychdoc.
Speaker: And then ah my TikTok is whitecopapi. Yatul Sabin. So tap in with me if you have any questions or concerns. I'll be available. Thank you very much. All right. And last but certainly not least, I'm Dr. Demabia Kocha, second year OBGYN resident.
Speaker: If you guys want to reach me, my TikTok is still very active. Well, I'm not active, but it's not private. At D-S-O-K-O-C-H-A. I'll start posting again when I'm a senior resident. Thank you.
Speaker: And I am neither a lawyer nor a resident physician, but it's your boy, Jared Jeffrey, aspiring student doctor. If you want to reach out to me, you can just like Isabella, find me at s at podcast at snma.org for email. My Instagram is public DJ underscore absolute.
Speaker: I also want to give a shout out to Dr. Bradley. Thank you for bringing us all together. Thank you for welcoming us onto your platform. This has been an amazing conversation. Perfect. I'm Stephen Bradley, host of the Black Diders Podcast. Thank you for collaborating, for really carrying this episode as I struggled with technical difficulties.
Speaker: To our lawyer colleagues, thank you so much for joining us on this collaboration between the SNMA, the Lounge Podcast, and the Black Diders Podcast. I'm an anesthesiologist, critical care medicine physician, available on social media at Stephen Bradley, MD, or the Diders Podcast. You can find a lot of my stuff on on social media as well.
Speaker: Thank you all. Hopefully this was helpful and excited to collaborate and share across platforms with information for our community.
