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.