Residents are an essential part of the health care system, providing essential medical services while undergoing training to obtain medical licensure. However, a disturbing trend has emerged across the country where residency programs and hospitals are frequently violating the rights and protections residents have under their employment contracts, state labor laws, and accreditation standards. I have had to address these issues myself, despite having little knowledge of the legal aspects of health care.
Residents serve in a hybrid role of both employee and student. They are likely employees of the hospital or medical center where they work, but they are also students preparing for unsupervised practice after completing their training. As employees, residents enter into a contract with the program that outlines the rights and obligations of both parties. If the program violates this contract, the resident may sue the program. More than 40% of residents nationwide have experienced at least one labor rights violation, and when overworked residents make mistakes, their health and patient safety are at risk. Critics argue that enforcement is insufficient.
Residents are also entitled to labor protections regarding wages, discrimination, hostile work environment, and more. The Accreditation Council for Graduate Medical Education (ACGME) implemented a requirement that hospitals must have a formal policy that protects residents’ due process rights. This includes providing written notice if the program plans to suspend, not renew, not promote, or terminate a resident. Residents must have the opportunity to review the evidence cited and defend themselves prior to any such disciplinary action. Unfortunately, many residents are not fully aware of their 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 exercise their due process rights, the system is stacked against them. Dismissals do not require a formal hearing with legal representation, and programs routinely deny residents the right to have an attorney present when they contest disciplinary actions. Programs also do not provide legal assistance.
Further complicating this issue is that, from my personal experience, universities are often not actually obligated to follow their own rules and policies when it comes to protecting the rights of residents. Despite codified procedures and disciplinary procedures, universities continue to treat residents like disposable furniture. Administrators ignore residents’ perspectives and situations and blindly endorse disciplinary recommendations made against them.
Residents often forget that HR departments exist primarily to protect the interests of their employers, hospitals, and universities, not the residents’ employees. Similarly, the attending physician and members of the disciplinary hearing committee have obligations to the same employers who pay their salaries, creating an inherent conflict of interest for the residents. The role of this committee is expected to be to evaluate whether the disciplinary action imposed on the resident is appropriate. However, even if these committees render a judgment, they often have little actual influence over their recommendations. Often, the chief medical officer or other administrative leader has the authority to simply accept or reject the committee’s findings regarding resident discipline.
Recent experience suggests that even when a resident is granted a disciplinary hearing, the GME hearing committee tends to simply uphold the program’s original decision to dismiss or discipline the resident, regardless of any mitigating factors. Often, the final decision is one in which the dean simply signs off on the program’s recommendation without any deep consideration of potential misconduct. Disturbingly, the decision of just one person can temporarily destroy a resident’s career aspirations, regardless of academic performance or past good relationships, essentially equating to career suicide.
Defending rights through all possible organizations, filing complaints, and attracting media attention can help force programs to follow their own policies, but still does not guarantee a favorable outcome for residents. Residents can do everything right and still find their medical careers suddenly and unfairly interrupted. Moreover, when residents try to fight back by filing complaints and asserting their rights, they tend to feel overwhelmed by the process and make administrators very nervous. This often leads administrators to simply silence residents and forbid further discussion rather than addressing their grievances appropriately. The huge power imbalance dissuades most residents from pursuing justice.
For these reasons, residents who face disciplinary action should strongly consider hiring an attorney sooner rather than later. However, the majority of lawsuits and cases brought by residents against their colleges related to disciplinary issues tend to end in the residents losing. Because not all lawyers are familiar with the specific nuances of graduate medical education law, residents are best off seeking employment counsel familiar with medical labor issues. With knowledgeable legal guidance, residents can assert rights against exploitation, but the odds remain low. Protecting rights, ensuring strong enforcement, and changing a culture of abuse are critical to good medical training.
Val Bellman is an accomplished physician with expert training in psychiatry, psychotherapy, and public health. Dr. Bellman has a strong interest in pediatric psycho-oncology, immigrant health, interventional psychiatry, and digital therapeutics. He has made significant contributions to the field with over 50 publications and presentations. Dr. Bellman is currently exploring a non-clinical role to broaden his understanding of healthcare beyond direct patient care and gain valuable experience in healthcare management and the healthcare industry. With a diverse background and expertise, Dr. Bellman is a versatile and highly sought-after expert in the field of behavioral health care.
