Despite the intensity of residency and fellowship training, the vast majority of physicians will satisfactorily complete their programs. And the under 1% per year who are dismissed from residency typically will get plenty of notice, performance feedback and guidance in advance of any action to remove them. Worries that residents may have about getting abruptly fired, therefore, are almost always unfounded.
“Dismissal, when it happens, is typically at the conclusion of a lengthy process. In the absence of some egregious behavior, dismissal doesn't just fall out of the sky,” said John Andrews, MD, the AMA’s vice president for medical education and professional development. “There are plenty of formal signs and formal processes that would lead to someone's dismissal for failure to progress in their residency.”
Dismissal during residency or fellowship training is rare. Data from the Accreditation Council for Graduate Medical Education (ACGME) for the 2023–2024 program year showed that 298 residents, or 0.2% of active residents that year, and 24 fellows—0.08% of active fellows—were dismissed from their training programs. Just six residents and four fellows came to the end of their time in their programs without completing the necessary requirements to graduate.
The physician specialties and subspecialties with the greatest number of residents and fellows dismissed that year were, in order:
- Family medicine.
- Internal medicine.
- Emergency medicine.
- Psychiatry.
- Surgery.
Research published in JAMA Surgery has shown that race and gender are correlated with a resident’s risk of being dismissed from their training program.
Not all residency dismissals are alike
There are two distinct types of dismissal in residency training. The first is related to disciplinary actions due to severe or egregious behavior. If, for example, a resident physician behaves abusively or illegally, they may be immediately dismissed from their program.
Dismissals can also be academic in nature. Performance-based dismissals are a process and typically come with multiple communications about the nature of the problems, performance-improvement plans and remediation measures. Though the exact process varies from residency program to residency program, performance issues will be something that struggling residents hear about long before dismissal.
“Milestone progression is reviewed semiannually,” Dr. Andrews noted. “It's mandated by the ACGME, so residents should have a clear view of how they’re progressing.”
In both types of dismissal, residency programs are required to provide residents with due process and outline a procedure for appeals. Additionally, all training institutions must comply with federal, state and local laws and regulations regarding employment and discrimination.
Read more about how residents can use their performance feedback to grow as physicians.
Communicate about personal issues
Every year, some resident physicians also transfer to another training program or voluntarily withdraw.
In the 2023–2024 program year, 705 residents and 233 fellows withdrew from their training programs. Such a decision can happen for a variety of reasons, often having nothing to do with performance issues. A physician may leave the area for personal reasons, need to take time off to care for a sick relative or have decided to pursue a career that did not require residency training.
Physicians who need time away from their residency training program for personal matters—which include treatment for substance-use or mental health disorders—often can prevent the necessity of program withdrawal.
With communication, physician residents and fellows often can organize leaves of absence, medical or family leave and return to complete their training at their institution without repercussions or damage to their reputation.
“Historically, admitting that there were issues like that was perceived to be a sign of weakness or lack of aptitude to train as a physician. So, people have been reluctant in the past to disclose that they have mental health or substance-use issues,” Dr. Andrews said. “I hope the culture's changed to a point where someone can walk into a program director's office and say: Look, I'm struggling in my work because I have to address these other issues and I may need some time to do that.”
Learn more with this AMA issue brief on the campaign to support medical student, resident and physician health and well-being (PDF).
