I had successfully completed my General Surgery residency and started my Vascular Surgery Fellowship in June 2013. I was told by the program director that I was doing very well, my first six month review as mandated by the ACGME was due in December of 2013, he put this off. The program director, for the first time in April of 2014 (10 months into 24 month fellowship) was upset about me taking my boards, he told me that although all my evaluations are positive, I am not the worst fellow but close to it. He put me on call every other day and had me working 120 hour weeks up to my boards (which I took vacation time for). In April 2014 he told me that I was not the best fellow they ever had but close to it. I was unsuccessful on the general surgery oral boards, as I did not have time to prepare. Since that time he had cussed me out, and created an adversarial relationship. In April when he initially told me I had issues, I told him that I was suspected of having ADHD. I told him I was evaluated by a psychiatrist who did not think I had ADHD, this occurred in the past and I should have not disclosed this information to him. He wanted me to be on Adderall, my family physician refused to prescribe it stating that if I had ADHD I would have not made it through medical school and general surgery training. When telling him this, in August of 2014 the program director handed me a letter and had me sign that I need to be on Adderall. He wanted me to see a Psychiatrist of his choosing, instead I switched my primary care physician and explained to her that I am in a fellowship and my program director had me sign a document stating if I do not take Adderall, despite not having a diagnosis of ADHD that I would be terminated, the new primary doctor understood the situation and wrote me the prescription, and gave me a diagnosis of ADHD without testing me for it.
The program director considered me not taking Adderall without having a prescription for it, non-compliance with a medical condition that could impact patient care. I have never had an adverse event with a patient. At subsequent reviews he focused on "deficiencies of ADHD, attention, organization, time management"
He would not speak with me regarding my performance, would berate and belittle me, and in December 2014 I was due for my 6 month review and I could not get him to do it. He had previously told me not to go to the Graduate Medical Education (GME) office, but out of concerns regarding my relationship with him I went on December 19, 2014. On January 7, 2014 I had a meeting scheduled with the director of the GME and the program director, I thought it was a meeting to address my concerns, but instead I was placed on probation, with the reason now being I could not do vascular surgical cases independently. Although the whole time until I was placed on probation I was doing theses cases. The American Board of Surgery has performance forms for General Surgery, I modified this for vascular surgery and got several filled out after doing the case by the other faculty that I am at the expected level and can do the case. He got wind of this and told me the GME director mandated I stop. I called the GME director, as this was the GME director's idea, and he said that conversation never took place. At the time I was placed on probation, I started tape recording. I have both these conversations and several others where the program director was lying on tape. I have tape recordings of attending's telling me I am able to do these cases and then the program director telling me that's not what those attending's told me [program director] and then the same attending's telling me they never had any conversation with the program director.
My probation stated I could get feedback whenever I wanted, he met with me twice, and the second time was 2 weeks into probation. He told me that I am "hard wired against being a surgeon and nothing I do can get me off probation"
After that, he refused to meet with me. When I scheduled appointments he would not show up and say he did not see them on his calendar. 2 weeks into the probation I retained my attorney.
I went to all the staff, none knew I was placed on probation.
A meeting was set up on March 16, 2015 and my mentor was included, the day before my mentor told me I can do these cases, I have done well, he has a good feeling that I will be taken off or at worst asked to do another year. At the meeting I was asked to resign and the program director told me if I resigned it would not be reportable to the medical board. This is untrue, as resignation from fellowship is reportable when I checked the medical board rules. Additionally on the advice of my attorney, I did not resign as I would have forfeited the right to appeal. The reason for termination was stated as failure to improve during probation (which I have ta recordings of facility stating I can operate and am at my appropriate level)
Additionally most faculty were unaware I was terminated, and I was getting telephone call asking why I was not at work the next day. My mentor who was at the meeting terminating me, said he was not informed of the decision to terminate me until 5 minutes before the meeting. My mentor offered to take over the role of being my program director and sign my certificate, and the GME director declined.
We have 9 faculty. I did not approach the program director, one of the other faculty told me I will not win against the system, that I can do these cases an to just go and do these cases as a General surgeon. The chairman does not really work with the fellows much and told me he did not work with me. The remainder of the six out of nine faculty supported my reinstatement and I had very strong letters of support saying I can complete my training. The comments in their letters ranged from "I never saw any deficiencies that warranted the termination" to detailed descriptions of operations I did independently. One support letter mentioned a case and commented on the very high difficulty level and my abilities being at if not above the level required. All support letters were written after my termination.
All my negative evaluations came after I was placed on probation. Evaluations are in aggregate form and the negative comments came from the program director, as he said these comments to me personally. I could not get the program to give me evaluations in a non-aggregate form. Additionally I was not allowed to see these negative evaluations until after I was terminated.
I lost my appeals. The attorney had not disclosed my recordings, he said in the past when residents or fellows disclose they tape recorded the conversations with faculty, it created a situation of distrust. The program director had put examples of cases where he lied about events during the probationary period. Again I did not see this in my file until after termination, for example he wrote that I mismanaged a patient by wanting to take the patient off Xarelto and I have a tape recording that would prove that is false. He would not let me transfuse a patient with a massive arm hematoma, and stated in one of his examples that I mismanaged the patient, yet if I had not been cut off from the EMR due to termination I could easily show that the patient had complications from not having a transfusion and ultimately needed one, approved by another attending. There was another case he cited where I could not get a wire up on an endovascular case for a suspected May Turner syndrome, I have a tape recording of him, as he was unable to get the wire up himself and the patient had a totally occluded infrarenal IVC, again his report of my "problem" in this case could be shown untrue with the medical records.
In summary, I have worked very hard in this fellowship and was terminated for not taking Adderall when I had no diagnosis and no doctor willing to write me Adderall, even though I switched primary care doctors and took the medication after he threatened to terminate me if I didn't. Also there was never a question of me not being able to operate and independently do vascular cases, until probation. The program director stopped me from collecting performance forms after my cases, yet I have letters of support and the undisclosed recordings saying that I can in fact do these operations.