Editor’s Note: This account highlights an unexpected turn of events during a well-planned career followed by the demonstration of tremendous resilience.
“My career was progressing exactly as I had envisioned it would.” I had been recruited to start a new orthopaedic subspecialty service at the center where I had trained. I admired my chairman, and he was pleased with my work. I was given research opportunities and resident teaching responsibilities. I built a “strong practice” meaning that I was productive, attracted patients from a distance, published scores of peer reviewed articles, was recognized as “teacher of the year” by a class of residents, and was involved with the resident competency committee. I was happy.
My parents instilled in me the principle that I must work hard to achieve my goals. I did and was rewarded for my efforts. It all felt right.
Then, my chair retired. In came someone new from the outside. No orthopaedic input was solicited by the search committee about the hire.
The new chair said to me personally: “I’m not here to steal your business, but you will need to use me as an expert who will guide your work.” This was said even though I had an established practice for over a decade. It felt patronizing.
This was implemented in subtle ways at first. My patient implant choices were scrutinized, especially those which needed to be custom-made. Each required formal approval by the chair. Also, all new decisions regarding the division were to run through the chair even though I was the division chief. In fact, the chair told me of seeking to hire a former “protégé” to take on my post as division chief. I was not asked, I was told. As it turned out, the protege declined the offer. I heard the outcome through my colleagues, not the chair.
Then, I was called into the chair’s office and told that a resident had complained about me. I was “hard on them in the OR.” The chair claimed that I was a “bully.” A letter of warning was issued, and it included other charges such as that my Press Ganey patient experience scores were not high enough. My scores, in fact, were noted to be above the department minimum. I asked to see the aggregate scores of my fellow faculty members since I doubted that mine were the lowest. I was told “no.”
Two patient complaints were also included in my list of offenses: in one, I had refused to perform surgery that I felt the patient did not need. The second involved me refusing to provide additional injections to a patient.
This collective list of “wrong doings” resulted in my resident interaction being minimized because I was “too hard and too mean.” This was declared despite having been recognized as “Resident Teacher of the Year” four years prior. Of note, I was told by a former resident that I was respected by those I taught for allowing them to operate and to “struggle with problems themselves” that arose during cases rather than just take the knife back.
A single additional patient complaint occurred and an “emergency meeting” was called to include a representative from Human Resources, the chair, and me. I was told in the meeting by the chair that “you are no better” and that a “performance improvement plan” (PIP) was being implemented. It would last one year. If all went well, I would be let off for “good behavior.” No specific goals were stated. The chair’s evaluation would determine the outcome. The residents were pulled from my service. Those who asked to return to me were told “no”. They could work with me on call but nothing more. This was coupled with “the residents don’t trust you anymore.” In short, I was “iced out of resident interaction.”
My chair also went to the OR to solicit comments about my behavior in that setting. He told me that “bad comments” had been made. By report, no one from the orthopaedics OR staff who worked with me said they had been spoken to.
In addition, the chair went to the clinic to ask about me. Interestingly, neither my medical assistant nor my clinic nurse was questioned.
After hearing all of this, it was hard to know what was true and what was not. I was told by some of the surgical and clinic staff that they were afraid of the chair after hearing the delivery of “multiple F-bombs” aimed the C-arm tech during surgery and hearing slamming and pounding on cabinet doors in a clinic room the chair was known to be occupying. The medical assist who reported this to me mentioned that she was scared to keep working in the area but was also afraid to say anything.
For eight months, I worked with my physician assistant only and no residents. I kept a low profile and tried to “hide myself.” I withdrew from non-patient care activities which saddened me. I had brought the “Perry Initiative” to our institution and served as an “Nth Dimensions” mentor. I did this work on my own time and in the initial years solicited industry support to fund it.
In month 11 of my one-year improvement plan, another patient complained that I had refused to do surgery which they felt they needed. This prompted another meeting with the chair and HR. I was told that I had been elevated to a higher level of probation for TWO more years and that no complaints would be tolerated. If they were, I would be terminated. This was done despite the chair acknowledging that there was nothing I could have done to make the patient happy and agreed that surgery was not the answer. Other colleagues in this same timeframe had patient complaints made about them. I was not the only one.
My chair told me: “you need a coach, and I have one for you.” I did get a coach but not the one that was suggested. Mine was a former surgical chair from the institution who was certified by the hospital system as a physician coach. She proved to be very valuable to me. Yet, I was later accused of not following directions and had used the wrong coach. The chair ignored me every time I stated that I had secured a coach. In a dismissive manner, I was accused of not following directions. After six months of this, my coach recommended that I disclose her identity. At that point the chair claimed not to know I had a coach but then offered to pay her. I declined.
My junior partner was given a pay raise higher than mine even though I had exceeded his RVU’s by a significant amount. When I questioned the difference in salary adjustments, the chair made demeaning remarks and said that since I had maximized my time off, I should expect to have lower RVU production. I had to respond with the facts. My email response demonstrated that despite taking time off, I had increased my productivity that year by at least 50 additional surgeries. There were many more episodes of false accusatory statements made to me by the chair without factual evidence throughout my PIP. It became clear that I was “walking around with a target on my back.”
During this period, I began looking for faculty positions at other institutions. I eventually accepted one. After signing my offer acceptance, the following day I submitted my resignation.
Two other incidents occurred thereafter: The chair attempted to take my name off two ongoing funded randomized controlled studies that had been IRB approved. The effort was unsuccessful. Also, my request that “administrative” rather than “vacation” time be used for a prestigious traveling fellowship I had been selected for was denied. I was told to use my own time. In stark contrast, one of my colleagues was granted administrative leave for her traveling fellowship responsibilities.
These events resulted in the recurrence of “imposter syndrome.” I had “achieved” my way out of it early on in my career but now I was back there again mentally. Those who understood what was going on, including my coach, advised me to contact an attorney and fight back. For a variety reasons, I decided against it.
To put this into context, two other highly productive surgeons also left the department after working for some time under the new chair. No exit interviews were performed by Human Resources or the department so their reasons for leaving went undocumented. One week prior to my departure date, I was invited via text to an exit interview. I declined to do one with the chair but agreed to one with the vice chair. Why one was offered to me and not the others is unclear. During the exit interview itself, it appeared that the person conducting it had never done one before and my words about why I was leaving were not going to be helpful to future surgeons who experience similar situations.
While doing the interview, I was suddenly reminded of another incident several years before during the chair’s first year. A “difficult” resident was being discussed and the chair said, “We can’t fire her, but we can definitely pave the way and open the door. This will show her the way out so she can walk out on her own.” This told me that the chair was “very polished and knew how to work the system.”
At my going away party, one of my colleagues said, “your situation is just like what the chair did to __________,” meaning the previously mentioned female resident. This tells me the chair has a “playbook.”
Now for some positives:
My junior partner credits me as his mentor and advocate. He has relayed these words to many people. I was given multiple going-away parties, including by the OR staff, Clinic personnel and my department colleagues. These were given by those involved, not the department. I have been told that patients have asked how they can schedule continuing care with me at my new venue. When I ran into my original chair at a meeting, he told me how upset he was about the faculty departures which included me. As previously stated, he had been very supportive and helped me launch my career. My journey continues.
Here is what I have learned from these experiences:
- In some circumstances, even hard work and many achievements will not guarantee success and job security. I won’t worry about that as much anymore. I have proven myself and can be who I am and stay true to my values. Those traits will get me noticed and opportunities will continue to come my way.
- Despite years of trying to call out targeting and discrimination, it is still very alive, just more creatively hidden. I feel like we are fighting a losing battle.
- How I treat people leaves a lasting impression.
- People who have vocalized their positive thoughts and well wishes have reminded me that “I am not a bad person.”
- There is a difference between a leader and a boss. My chair wants to be a “boss.” I want to be a “leader.”
- The head of the department creates the atmosphere for everyone in their orbit. Seek to inspire, not intimidate.
