The Hidden Costs of Failing to Fail Residents

Abstract

In 2000, after a decades-long multicontinent medical murder spree, Michael Swango was caught and charged with fraud and murder. He pleaded guilty and will serve the rest of his life in a federal prison. Nine years later, Nidal Hasan was charged with the shooting deaths of 9 soldiers at Fort Hood. Although the beginning of Swango’s problematic behaviors in the late 1970s and Hasan’s 2009 arrest are separated by almost 30 years, they share a history. Both individualswere physicians. Bothwere identified as potentially dangerous at multiple junctures by multiple individuals throughout their medical school and residency curriculum. Both were allowed to continue in their training despite serious concerns on the part of peers, faculty, and others. We recognize that a program must balance many issues, including legal and due process issues, when considering whether to dismiss a resident with performance problems. Other scholars have addressed these questions.4–6 The purpose of this article is to urge program directors and faculty to consider both the apparent costs of dismissing a disruptive resident and the hidden costs of not doing so.We hope that by fully considering these hidden costs, program directors will be better able to continue the important work of developing physicians who serve the public and their profession.