The process and decision to terminate a resident for academic reasons weighs heavily on most residency 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.
Despite this guilt, 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 have no other choice but to terminate residents who are performing below those standards.
However, the directors' guilt can still lead to decisions that can land the hospital in legal trouble. Because directors feel badly about such a harsh consequence for the resident, they often resort to a "compromise" option. They dismiss the resident but allow him or her to finish and get credit for the current academic year, Read says.
Program directors sometimes also opt to keep a resident on until June 30, the end of the academic year, 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 because of an unlawful, discriminatory reason.
"We've had cases where residents have done just that," Read says. "This is a very real and practical situation we advise program directors on all the time."
Additionally, giving residents the opportunity to finish the year can hurt patient care and the functionality of the program. Residents in limbo often lose their motivation and stop performing activities, such as:
- Responding to calls
- Completing charts and other paperwork in a timely manner
- Working congenially with colleagues
- Following department or institution policies and procedures
Program directors should consult administrators in the graduation medical education office and hospital 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.
Julie McCoy is the associate editor for the residency department at HCPro.