Resident physicians are vital to the health care system, delivering essential medical services while training to become fully licensed doctors. However, a troubling trend has emerged nationwide, with residency programs and hospitals frequently violating the rights and protections resident physicians are entitled to under employment contracts, state labor laws, and accreditation standards. I personally was forced to deal with these issues, despite having virtually zero knowledge regarding the legal side of medicine.
Medical residents occupy a hybrid role as both employees and students. They are presumably employees of the hospital or medical center where they work, yet are also students being prepared for unsupervised practice after completing residency. As employees, residents have contractual agreements with their programs that establish rights and obligations for both parties. If programs breach these contracts, residents can potentially bring claims against them. Over 40% of residents nationwide have experienced at least one labor rights violation, jeopardizing their well-being and patient safety when overworked residents make mistakes. Critics argue enforcement has been inadequate.
Residents are also entitled to labor protections regarding wages, discrimination, hostile work environments, and more. The Accreditation Council for Graduate Medical Education (ACGME) has implemented requirements that hospitals must have formal policies safeguarding residents’ due process rights. This includes providing written notice if the program intends to suspend, not renew, not promote, or dismiss a resident. Residents must have an opportunity to review the evidence cited and advocate for themselves before such disciplinary actions. Unfortunately, many residents are unaware of their full rights as employees and trainees. Hospitals have been known to take advantage of this lack of knowledge by violating basic labor laws and educational regulations. Even when residents try to utilize their due process rights, the system disadvantages them – no formal hearing with legal representation is required for dismissal, and programs routinely deny residents the ability to have a lawyer present when appealing disciplinary actions. The programs also provide no legal assistance.
Compounding this issue, my personal experience suggests that universities are often not truly obligated to follow their own regulations and policies when it comes to protecting residents’ rights. Despite having codified procedures and disciplinary processes, institutions continue to treat residents as little more than disposable pieces of furniture. Administrators disrespect residents’ perspectives and circumstances, blindly endorsing whatever disciplinary recommendations are made against them.
Residents frequently forget that human resources departments fundamentally exist to protect the interests of the employer, hospital, or university, not the resident employees. Similarly, attending physicians and members of disciplinary hearing panels are beholden to the same employer paying their salaries, creating an inherent conflict of interest against the resident. The role of this panel is expected to be to evaluate whether the disciplinary action imposed on the resident is appropriate or not. However, even when these panels make a judgment, their recommendation often holds little real weight. Frequently, the chief medical officer or another administrative leader has the authority to simply accept or reject the panel’s findings regarding disciplining the resident.
Based on recent experiences, even when residents are granted disciplinary hearings, the GME hearing panels tend to simply uphold the program’s original decision to dismiss or discipline the resident, no matter what mitigating factors exist. Frequently, the ultimate decision comes down to the dean simply signing off on the program’s recommendation without deeply considering any potential injustice. Disturbingly, the decision of just one individual can momentarily destroy a resident’s career aspirations regardless of their academic record or past positive relationships – essentially amounting to career suicide.
While defending one’s rights through all possible entities, filing complaints, and involving media attention can help force programs to follow their own policies, it still does not guarantee a favorable outcome for the resident. Residents may do everything correctly but still face the abrupt and unjustified derailment of their medical careers. Furthermore, when residents do try to fight back by filing complaints and asserting their rights, the process tends to overwhelm them while making administrators extremely nervous. This often prompts administrators to simply shut the residents down and prohibit any further discussion rather than properly addressing the residents’ grievances. The immense power imbalance dissuades most residents from pursuing justice.
For these reasons, any resident facing disciplinary action should strongly consider retaining legal counsel sooner rather than later. However, the majority of cases or lawsuits brought by residents against universities related to disciplinary matters tend to be lost by the residents. Not all lawyers will have experience with the specific nuances of graduate medical education law, so residents are best served by seeking out an employment lawyer well-versed in health care labor matters. With knowledgeable legal guidance, residents can assert their rights against exploitation, though the odds remain difficult. Upholding rights, ensuring robust enforcement, and changing cultures of mistreatment is critical for outstanding medical training.
The author is an anonymous physician.
