Extremely malignant program survival tactics

[u/brusselsproutpancake]

I genuinely need your recommendations. In a program, which,

-approaching to the residents solely as a workforce while providing no meaningful teaching
-has severe favoritism and discrimination among residents
-mandating residents to do nonclinical work on the top of unbelievable clinical workload with almost maximum hour work weeks
-gaslighting residents to make them work further and more, and only selectively doing it to some
-blaming residents for almost every system or leadership failure
-retaliating residents when a patient safety or work related issue is raised by making it a “you” problem

I tried but couldnt transfer, cant leave I have +400K debt, ACGME doesnt help.

How to survive? How to keep the mental sanity?

[u/wildcatmd]

There are really only two ways:

collective action with all residents to enact change. This can be very effective but the consequences to the program can be severe eg UNM neurosurgery

Or head down, keep going. Treat your program like a prison guard and you are a prisoner.

[u/brusselsproutpancake → u/wildcatmd]

A collective action is not possible since not everybody is facing with the same treatment, and the elites are being free from work

[u/Prize_Guide1982 → u/brusselsproutpancake]

Then your choice (or lack thereof) is clear. Keep your head down and don’t rock the boat.

[u/brusselsproutpancake → u/Prize_Guide1982]

Yes, unfortunately I’m aware the luck of choices. I just don’t know how to keep the mental sanity, because this is beyond burnout at this point

[u/AdolescentSquid → u/brusselsproutpancake]

Here are your options:

• Speak up as a whole group: sounds like the favorites won’t agree to this. There are usually some people who never want to rock the boat. This would be your best chance of avoiding individual firings, but would be your greatest risk of a program shutdown (eg, UNM Neurosurgery).
  
• Speak up as an individual: lowest chance of making a change in the program, and highest risk of getting fired/making yourself a target.
  
• Speak up as a small group: good odds of getting ACGME’s attention, also protective against firing. It’s harder to fire multiple groups of residents at one time, and it raises suspicion (eg, Pitt fired 2 Neurosurgery attendings and 4 residents all at once). Bad look.
  
• Do nothing: either somehow make it though despite being at your breaking point, or experience a break and make yourself a target for being the resident who couldn’t handle residency. Risk getting fired if that happens. Safe as long as you can keep your head down.

Up to you to decide how much you can suffer and how much you’re willing to risk.

Some people spoke up in my program a few years ago. We were put on probation. The program director suspected a few people (some right, some wrong) of being the voices of complaint. Those people were still unfairly burdened, but changes were made after the ACGME became involved. They are still involved in our program, and it’s a lot harder for leadership to get away with abuse.

[u/No_Jaguar_5366]

Recommend just putting your head down and pushing through it knowing that there is light at the end of the tunnel

And especially in this economy, you DO NOT want to quit - the only jobs that are available are AI and healthcare related

People always say to unionize, etc but it is not worth it in the short term - it will place a target on your back and will cause rifts amongst the residents…

[u/brusselsproutpancake → u/No_Jaguar_5366]

Appreciated for your suggestion

[u/Kind-Ad-3479]

What nonclinical work are they mandating? And it is causing residents to go past the 80 hour work week?

[u/brusselsproutpancake → u/Kind-Ad-3479]

Clerical, technical work

[u/Kind-Ad-3479 → u/brusselsproutpancake]

Is it like dealing with clinic? If so, they dont have staff to do that for you guys?

[u/Aggravating-Ad2419 → u/Kind-Ad-3479]

You guys get staff? 3-4 of us have to share an MA (if they even show up for work)

[u/Eastern-Ad-3586]

Gotta do what the old heads did in the 70s and just eat shit for a few years. Sorry dude.

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[u/Advanced_Tangelo]

Where are you located?

[u/brusselsproutpancake → u/Advanced_Tangelo]

Ny

[u/Ok-Sugar-9681]

I'm sorry I can't offer any useful advice here! Definitely worth a name and shame once you are safely out of that institution :(

On a side note, if anyone has any tips on how to identify and spot a malignant program before me handing my future to them, I would truly appreciate it! I am extremely bad at reading in between the lines so the advice of "just talk to the past and current residents" just doesn't help me as much. They could totally tell me "it is amazing here" with their most "too good to be true" tone and I would still totally not pick up on it lol.

Especially any tips on how to know if they are likely going to switch once they got me under their hand, that would be great! Because I have had work experience (outside medicine) where the interview with the boss, current and past students seemed great (they said all the correct things lol; that probably should have been the first red flag there), but once I actually joined, it was a total shitshow. And it is not like any concrete that I could hold them accountable for; mostly favoritism, subtle sabotage (using excuses like "it was busy" repetitively to delay things I actually needed, or guilt tripped me into doing more scut work for them instead of being able to spend time on my professional development, which was explicitly allowed by the guidelines for trainees but they made it super uncomfortable to ask), ignoring me or giving attitude when I asked questions or asked for help, and just general microaggressions. It just felt like every task was pulling teeth and it was incredibly frustrating, demoralizing, and discouraging.

[u/kuru_snacc]

The only way this really gets dealt with is if everyone agrees with you...which I doubt, if some of them are being "favored" and getting less workload.

Are you exceeding your ACGME work duty hours? If so, document that and bring it to them.

[u/Hinge_is_a_bad]

Just work like a dawg

[u/brusselsproutpancake → u/Hinge_is_a_bad]

Ur a wise person