I *almost* got kicked out of residency

Dr. Tea  0:01  
Owners of a direct care practice are more likely to experience higher job satisfaction than the insurance based practice. And it's no wonder why direct care is independent of insurance. Patients pay the doctor directly for their expertise. The doctor gets full autonomy in how they care for patients and how they get paid. We've chosen this path for the love of medicine. This is the direct care way. 

Dr. Tea  0:26  
By listening to this podcast, you may even start to believe you too can have a successful direct care practice. Come listen with an open mind. As I share my personal journey on how I pivoted from an insurance based practice to direct care right in the middle of a pandemic. And the valuable lessons along the way. This podcast may be the very thing you need to revitalize your medical practice. I'm your host owner of a direct care podiatry practice, Dr. Tea Nguyen.

Dr. Tea  0:55  
Hey there, welcome to episode 27. I had previously recorded this episode about the time I almost got kicked out of residency, only to find that after I published it, it was messy. Like I had to redo the whole thing, the story was the same. But here it is version number two, clean, edited and hopefully it works out. This is an important story because I know a lot of residents are going through some hardships, not just in the academics of residency, not just in the time demand that's required of us. But there's also another layer of systemic toxicity that I want to talk about, that parallels what we currently experience in the current state of healthcare, in medicine in the insurance based practices and incorporate medicine. And you'll see, first I do want to warn you, I'm going to swear because I couldn't find any other way to accurately describe some of the stuff I went to. So if you're listening to this, I'm going to give you a few moments to make a decision on whether or not to continue to listen to this episode, or save it for a time where maybe you have headphones on and there aren't people around that you might offend. All right, you ready? So back in 2011, I scrambled into a residency program. And it was some very hard times, you know, a lot of us go into medicine with a huge amount of debt. For me, it was six figures about $250,000, just to get through podiatry education. And we already enter into a practice where there is a sense of fear that if we don't complete what we intended on doing, if we don't get out of residency training, and go into work, then we have this looming debt over our heads. So in a way, people know that they can hold that over our heads, they can use fear of losing your position as a way to leverage you for their own good. And

Dr. Tea  3:13  
I don't know if you've already experienced this yourself, but there are some really toxic people that use your fear against you. And that's exactly what happened to me. So in my the end of my first year of residency program, you know, I went into the program, bright eyed, bushy tail, excited to learn, I love learning, and I love structure. So just having a general idea of what the day looks like, feels really good to me, because then I can anticipate that can plan for what's to come. And that's just how I enjoy learning. However, that was not the environment that I was in, I was in a relatively new program. And I don't know why there was a shift in energy where it went from educational to almost political, like I became a target for somebody up higher to pick on. And I'm not playing the victim card. But I am going to say it was a very toxic environment where it was intentionally made to make my life miserable, so that I would either get kicked out or I would choose to leave. It was made very clear to me that they did not want me there. And they were going to do whatever they could to ensure my life was a living hell. So it was about the end of my first year where I almost got kicked out. And this is what that looked like. Well, to be honest, I don't know what went down. 

Dr. Tea  4:46  
All I know is I got pulled out of my surgery cases that I was supposed to do with the attendings and I had to meet with the residency director. I had to meet with the Medical Director of the residency programs because cuz I went to a program that had DPS and DEOs. And then I got sent to a psychological evaluation where the gentleman said to me, I don't really know why you were here, you were just sent here. And I needed to write a report on us having this encounter. And that was it. That was it. That was a very strange experience for me, because he said, I'm just obligated to do what I'm told. And I'm told that I'm supposed to speak to you, and write a note about it. So clearly, there wasn't a legitimate reason why this was happening to me. 

Dr. Tea  5:33  
But it happened. And I got pulled out of these experiences without a clear reason why I also got pulled out and was told I had to do a random urine tox screening, again, with no clear reason why. So it was frustrating. But I wanted to be a compliant resident, I did not want to be the difficult resident. And I think the most difficult thing about me was that I didn't understand what was happening. So I had pushed back a lot, there was a lot of resistance, not in just my tone, but in my attitude, because it was very unclear to me what was happening and why it was happening. Then suddenly, in one of the meetings I had, with the residency director of the of all of the programs, he pulled me aside to our weekly harassment meetings, I call it because there was nothing educational or valuable with these meetings. But he just sat there sat me in his little room, berating me that I was not a good listener, that I was a bad resident, and that I am at risk at losing my position, if I didn't follow commands, if I wasn't quiet, kept my head down, and just stayed out of trouble. And I was like, I'm not creating trouble. 

Dr. Tea  6:51  
So long story short, anyway, in this meeting, he pulls out a piece of paper, and his back is facing the window. So the sun is shining over his shoulder, as he's reading this letter to me. And he says, To me, this is an anonymous letter by one of your peers, that says the following. That T is creating a hostile environment, and I don't feel safe, and I don't feel that I am learning with her there. And therefore something something something I don't remember the details, but essentially saying they wanted to kick me out what this man didn't know that I can see a letter and I can read backwards. I saw exactly who wrote the letter. I didn't pry, I said, I just sat there and I listened. And I said, Fine, people say what they have to say, again, I don't believe for a moment that I intentionally made somebody else's life a living hell, the way they're making it for me, no reason for this experience. 

Dr. Tea  7:46  
Then I went to the psychological evaluation as part of that remediation. In those conversation also fruitless, nothing came from it, other than I wasted some gas wasted my time and sank into a level of depression because it was like a vacuum. It was a vacuum of not understanding exactly why I had to even be there, I was losing out on opportunities to learn at a surgical residency, and no one gave me a clear answer other than a prescription for an antidepressant. So there you go, I was muzzled and medicated, that's exactly what my experience was like, in just my first and second year in my residency program. So I was infuriated, because I felt very perilous. And now that I think about it, that is the hardest time of my life, I never had dealt with such toxicity in a work environment. It was a really strange culture. I mean, we are supposed to give compassion in our patient care, but my entire training experience was anything but that they were so focused on trying to get me to either move out or get kicked out. They could not even generate reports that gave a reason why I had to do the psychological evaluation, why you had to do urine talk screening, all I had to sit in those harassment meeting with the director, just to be talked down to none of that. 

Dr. Tea  9:05  
But if I stepped out and didn't do the things they were asking me to do, then that would have been an obvious compliance issue, I would have been disobedient. So anyway, that's the story in a nutshell. And you might be wondering, maybe you're going through some hardships yourself with Our Clear understanding why you're going through it, but I wanted to share this with you. What kept me going was that I knew what was happening to me was very wrong. A lot of things were harsh, harsh. I even asked my co resident, why I was no longer on the surgery schedule. And all that was said to me was, I'm just doing my job. And any time somebody shuts down and says, I'm just doing my job, you know, there's a bigger reason behind that. But let me just tell you some of the things that I did learn from this experience. Maybe that might help you through your hardships. I learned in this experience that I was was that I got fed up. And I said well, if my program to run Actor is doing this to me, and the MediCal program director could give two shits less, then I would just have to keep going up to the chain of command. And then eventually I reached the CMO, I wrote him a very nice, professional letter, letting him know what I was experiencing as a resident. It was a hostile work environment, I don't appreciate what is happening. And I wanted to meet with him. 

Dr. Tea  10:24  
Yeah, I did that I wrote that letter sent it way upstairs, because I was not going to be left unheard. And I wasn't going to allow this to persist for future generations, I couldn't walk away and say, and keep my head down. And maybe that was my problem. Maybe that was my problem that they couldn't control me, they couldn't shut me down their philosophy of Medicaid and muzzle, I guess it just didn't work for me. So yeah, I became a pain in the ass after a period of time. But here's another lesson I learned. I'm not the only pain in the ass in the room. So sometimes you're put in a situation, and maybe you're medicated. But maybe you're inappropriately medicated, because there wasn't a real solution to the problem that you're in. And the reality might be that you are depressed, like I was because you're surrounded by a bunch of assholes, right? Think about your environment, did your environment create such a hostile living situation, that you feel powerless, that you've literally don't know what else to do? So you do the next logical thing, you take that prescription that was recommended. And you say, I think this will make my pain go away. And then guess what, your pain does not go away. You're just kind of numb at this point, the pain persists. You're still around households, I don't know how to say it. 

Dr. Tea  11:43  
And it makes me wonder how many people out there are being inappropriately medicated, because they're not looking at the environment. They're looking at you the individual as the problem or the source of the problem, because you got ganged up on. And did I get ganged up on? Yes, yes, I did. And here's the evidence, I spoke to the student who wrote a letter about how terrible a person I was. And they said to me, in these words, I didn't know they were trying to kick you out. I just wanted that position. So even students are being used as pawns to get a competitive position, because they were too afraid to not get a position, it was a lot at stake. So they were told the story. But if I got kicked out, or if they insisted in writing this letter, thus kicking me out, then they would get a position, it was a promise, Isn't that sad? We're in a state of affairs when we have to promise a threat to get what we want. But as you can see, the story didn't end there. I stayed, people in the leadership position did not stay, it was never my wish to see these people get fired. 

Dr. Tea  12:46  
That was not at all what I desired, I wanted my pain to go away. I wanted to graduate, I wanted to move on. I wanted to never look back. But here I am looking back and understanding the politics instilled in the system of medicine, you know, I could have kept my head down, I could have stayed medicated, I might have even gotten a divorce. Because I was so miserable. I didn't know what else to do. Or there's no more there's always a choice. Or I could have said something. And I did. I wrote a letter I met with the CMO and the higher ups and they solved the problem from the systemic side. They didn't try to solve the problem by continuing to medicate me, which was really nice. It gave me a little bit of faith in the system just a little bit. So people ever wonder why I have such a problem with authority. That's why because I can't trust them. They're trying to medicate me. Those are, that is my truth that I don't love authority, because this is what they've done to me. What does this have to do with direct care? Right?

Dr. Tea  13:47  
 I mean, you're here for a reason. You're here listening to me spill my guts about a painful experience I had, but I want to share something with you and how it relates to direct care. This experience helped me move really or it prepared me to move cautiously into a world where people confuse their position or title for leadership. Leaders create leaders. They do not muzzle they do not medicate. And they certainly don't push you down to their level. I hit a sense of powerlessness that I never wanted to feel again. And I see this happening in the insurance space model of the muzzle and Medicaid model is what it is. It's pervasive. There are hundreds of stories where a doctor spoke out about various ethical issues, safety issues, like not having enough PPE, like not having the autonomy to offer patients life saving medications and so on and even talking about work culture. These hospital systems shut these doctors down either blatantly through a Twitter blast, forcing doctors to resign or firing Then the toxicity in medicine is really systemic. And we are taught very early on, we have a lot more at stake, we have a lot of debt to pay off. So if we lose our job, we have huge sacrifices, right. 

Dr. Tea  15:12  
But if we don't speak out, what we are saying is that this is okay to treat doctors in this way. Silence is a form of endorsement. And that is why I could not keep silent as much as I wanted to as much as the people who loved me wanted to also there's a perceived safety net in getting a paycheck from working at institutions, I get it, but is it really safe? What exactly are we trading for, for that safety, and it's become quite obvious that we lose autonomy in ourselves and in our patients care, we accept conformity, we accept suppression, and it didn't just reveal itself in my residency experience, but it is on a much greater scale, a huge problem of why doctors are afraid to leave the perceived safety net of conformity and not go out on their own and not go out in direct care. So that's the parallel that I see, I have so much more to share. But I don't want to dwell on the past. 

Dr. Tea  16:13  
And I don't want you to dwell on that either. So if you find yourself experiencing this type of toxic work environment, this level of harassment, just know that you're not alone. And you're actually more empowered than you think you just have to know who to speak to. So I certainly hope that you reach out to somebody that you trust that can help you, you don't have to do this alone. So I'm glad you're here, it means that you already have an awareness of options, what exists and what's even possible for you. So the next best thing that you can do with the information that I've shared with you here is to share it with a friend, because you never really know if somebody is suffering in silence, whether it be in their residency program, or in their practice. By sharing this, they might be one podcast episode away from a totally different life. I wish I had some kind of resource like this, when I was going through my drama, I'm going to share with you an analogy that I find really fascinating and relevant. If you lived your life, the way a pilot flies a plane, you would know that just one degree of difference can change your destination significantly. 

Dr. Tea  17:20  
So this seemingly small thing that you do today, and doing it consistently is the very thing that's going to change the projection of your future. So if every single day you're doing something to improve your yourself, maybe it's an interpersonal skill, maybe it's a business skill that you're acquiring, maybe it's just being in a better environment, a better supportive environment that helps you thrive, those small actions, those individual choices that you make, it can lead to a totally different future. So if you would, please share this with all of your medical friends, so that they to know that they have options outside of traditional models, but also that a toxic work environment should not be tolerated and a toxic insurance based environment should also not be tolerated. I hope you enjoyed this episode. Please give it a rating so that others can be empowered to know this information as well. And wishing you all the best in your journey in some of the hardships. There are some important lessons. So pay attention to those, but also know that you're not alone. If you need help in reaching out, my contact information is below. I would love to connect. And I would love to see where I can help you in your next journey. Take care. 

Dr. Tea  18:35  
Thank you so much for being here with me today. If you enjoyed this episode and want to hear more, please like, share and subscribe so more people like you can have access to another way of practicing medicine, that direct care way. Let's connect by my info in the show notes and send me your questions. It might be the topic for future episodes. 

Dr. Tea  18:55  
And lastly, if you remember nothing else, remember this. You are in control of your life. See you next time.