Tackling Abuse in Med School, Residency, and Fellowship

This week on promising young surgeon, we have guest Dr. Lauren Umstattd

Dr. Frances Mei Hardin: This week on promising young surgeon, we have guest Dr. Lauren Umstattd with us in the studio. Dr. Umstattd is incredible at her craft as a facial plastic surgeon. She founded her own practice in Kansas City called Face Leewood, which she quite literally built from the ground up. The architecture and aesthetic of her practice is unrivaled, by the way. She is an elite athlete and division I college gymnast and proud wife and mom to two young boys, Harris and Jay. Dr. Umstattd is beyond disciplined and accomplished, and as someone who used to be her junior resident, I can confidently say that we all wanted to be like her when we grew know we’ve known each other for a long time. I used to be her junior resident, and I have some cool photos pulled from the memories from one our days at the VA together. Two, this awesome or photo shoot that we did with the girls way back in the day and makes photosy look fun, doesn’t? Yes, yes. It looks very fun and shiny in these photos. Like, don’t be fooled at all. Social media is a highlight reel. So, the third photo is from my wedding in New Orleans, and this is at the welcome party on Bourbon Street.

Dr. Lauren Umstattd: I have a picture of you in my office right there.

Dr. Frances Mei Hardin: Oh, my gosh. Perfect. Yeah, and that’s one of the ones that’s, like, a version of the one that we’ve shown you guys. So, like, enjoy. But again, do not believe it for a second. Social media is not real.

Dr. Umstattd talks about her own medical training and fellowship experience

Dr. Umstattd joins me today to discuss medical training, including her own residency and fellowship experience. And then more broadly, we have a discussion about how institutions have a vested interest in perpetuating their own cultures, even when they’re harmful or abusive. So, as a quick introduction to our residency, we did attend residency together. We were two years apart. And so, for instance, Dr. Umstattd was my senior resident on the busy head and neck service when she was a four, and I was a. You know what I love about you? To get personal, to get soft. You are always incredibly fair. And so I remember as your junior resident on head and neck, you were clear about your expectations. I got an email before my rotation even started with you, and it was like, here are the expectations. Very clear. Just personal to me only. I’m sure you said that to all of your juniors before they were about to come on to service with you, clear about the daily to do lists, and therefore, it honestly was, like, the easiest it ever was to not miss anything, to close the loop. It was just what I think a rotation should be. I describe your senior resident style as tough but fair, like, you’re a tough cookie. You hold yourself to an extraordinarily high standard. You hold other people who you work with to an extraordinarily high standard. But that’s awesome. That is such an excellent and appropriate quality for a surgeon, let alone like, a facial plastic surgeon.

Dr. Lauren Umstattd: Yeah. I think my team right now, my staff, at my office, they would agree with those descriptors.

Dr. Frances Mei Hardin: I love that. Yeah, I was going to say, play this for them. They’ll totally, like. I believe that. And I would really back you on that, because attention to detail is so important, and I don’t take that for granted. But as a junior resident, what was so effective about your leadership style is that I never felt like you would just fly off the handle unexpectedly. Inexplicably, that was something that I was just so afraid of happening, and it did happen, like, a fair bit from m people who didn’t have excellent control over their emotions or great emotional regulation skills. And so that just stands out. Like, I’m so happy to know you. I’m happy to have worked for you on a really otherwise awful and crazy service. So I’m just so excited to chat with you today.

Dr. Lauren Umstattd: Well, thank you for having me. And just a few things in terms of, being off the rails. I had just had our first child when I was running that service, and being postpartum, working 80 hours a week, having a newborn, breastfeeding, it was probably one of the most difficult times of my life. So thank you for remembering it in a positive way. I do think in looking back on our residency experience together and in reading some of the work that you’ve recently done, I do wish that I had been slightly more empathetic senior resident. I can remember one instance, actually, where you and me alone were rounding in the evening. It was really a long day, and we were seeing a patient doing some teaching before discharge. I was in there doing the teaching, and I remember you were sitting in the hallway, and I was not very nice to you. I think I remember that scenario very vividly, and I have some regret over the way that I spoke to you. I don’t know if you remember that day, but I said, get up on your feet. I don’t care if you’re tired. I’m in here working with this patient, and I expect you to as well. and I think that one reason I think that a lot of surgeons get hardened and become these bad personalities is that they learn it from other people. Right. And so that was one instance in my residency training that I felt like I was really not being fair to the team that I was working with. So I, would want to formally apologize for my behavior on that one day. I still very vividly remember that.

Dr. Frances Mei Hardin: Oh, my gosh. Well, no, I really do appreciate that, and honestly, I don’t remember it at all. So, why was I on the ground? Listeners can decide, was I a clown resident, and why was I out there? I honestly do not recall, and it may be because for other reasons, there are parts of residency I don’t remember. There are, like, whole weeks and months that I totally dissociated to survive. But I appreciate you saying that. And, again, that just doesn’t even rank. That doesn’t rank in my top 300 most traumatic residency moments. And I think that says a lot, though, because, like you mentioned, it was late, but you were doing the teaching. You were recently postpartum at the time. I do think that that story, even when I hear it back, I’m like, you’re a tough cookie. no one said you weren’t a tough cookie, but I think that’s fair. Like, we were on the same team, and so why was one clown out in the hallway?

Dr. Lauren Umstattd: Probably not my finest moment for the listener. She is not a clown. You were just simply sitting in the hallway because we had had a really long day, and you were on your phone or looking at the patient list or something. it’s not that you were doing something. You were just literally taking a physical break in the hallway.

Dr. Frances Mei Hardin: Yeah, but you weren’t. And so just like I said, because I really think that this is such an important point. Like, I like this debate because I want listeners to hear. It’s like most surgeons, most surgery residents have such a high tolerance for, like, I think that’s still a fair argument because we would have been physically equally exhausted, potentially, you more so, being postpartum. But, yes, you’re a division one athlete. I was a division one athlete for one year, but you were for more years. So, I mean, if you kind of go granular on it, you’re a tough cookie.

Dr. Lauren Umstattd: I don’t want to discount your background. When you look at your upbringing in terms of your childhood, all the activities that you were in, your academic achievement, you’re a very gritty person. I think, like you mentioned, surgeons have to be gritty people. Grit T-T-Y. Both of us have a lot of grit, and you had challenges, and I had also fairly significant challenges in dealing with the environmental milea that is surgical training.

And it’s interesting that you say that you forget a lot of your residency

And it’s interesting that you say that you forget a lot of your residency, because I honestly forget a lot of my fellowship. I think I feel like I’ve blocked it out in some way in my memory. I try to recall things, and I just have no memory.

Dr. Frances Mei Hardin: Totally. And that’s part of a known trauma response. I mean, even really resilient people and high functioning people will keep doing their job even when they’re in that state, of total nervous system dysregulation and dissociation. And so my heart just goes out to anyone who can relate to this at all, because you’re not imagining it. If it affects your memory, if it affects cognition, if it affects even some motor skills and things like that. So, anyway, I appreciate you saying that. And it also reminds me of just a, real quick one of my favorite quotes. And I will say that this past year, academy, which is one of the national ent meetings, was held here in Nashville, which I live outside of town. And so it was such an awesome opportunity to connect with several ents who I’m still in touch with, things like that. And I met up with one of your old co residents, and we had dinner. It was great. We stay in touch. He was another senior resident who was always pretty kind and fair towards the juniors. But there was this one day right before he graduated where I did call him to ask a question about a schedule, and he just blew up at me. It was like a Sunday morning, and it was terrible. Like, I had interrupted his biking, but, I was really scared about something. So I was just calling more as a colleague to be like, hey, I have this question about this. And he legitimately blew up at me. I was in tears for, like, 30 minutes, and the question didn’t get answered. And what’s so funny is a few months ago, because this is years later, and he asked me, he was like, I probably never exploded at you or scared you at work. And I was like, well, there was, one teeny time. Again, we’re still good. But there was that one teeny time. He had no recollection of it. He was like, that doesn’t even really sound like me. And you know what’s so funny is that it doesn’t sound like him, and that’s part of why we still maintain a good relationship. Like, it might have been a one off, but the quote is, the axe forgets, but the tree remembers. I’ve seen it just cited as, like, an african proverb, and I love that. And I find that to be true because I actually think a lot of the times where attendings or senior residents did psychologically traumatize me as a junior, they legitimately may not even remember those days.

Dr. Lauren Umstattd: Yeah, I think you’re spot on.

Dr. Frances Mei Hardin: So, in my experience as a resident, I feel like I both witnessed and experienced many instances of verbal abuse. That is really not okay, and it’s not any way to learn effectively. And it became so bad that by the time that I was a senior resident, I felt comfortable just openly stating. Like, even at departmental meetings, hey, look, I don’t learn that well in, a hostile environment. Like, I’m a person who’s mentating quite well. I’m generally with it. I learn pretty quickly, but I will learn much more quickly if someone would just calmly explain something to me one time.

I think abuse in many forms is common in residency training and fellowship training

So what do you feel like with the culture of teaching at academic hospitals and our experience in residency, specifically, how can we teach more effectively or accommodate a learner’s learning style if they say, look, I’m too scared to absorb new information like this?

Dr. Lauren Umstattd: that’s a complex issue with some complex thoughts, in terms of my opinions on how to, quote, unquote, fix or solve the problem, I think the first step in really solving any problem is getting more granular on what the problem actually is. I think abuse in many forms is common in residency training and fellowship training, in medical school training, in nursing training. It’s also not isolated to the world of healthcare. I think one of my good friends is a CPA, a certified public accountant, and she went through some abuse with her first job. And I think anytime there is a hierarchy of power, and the people at the top have control over the future, the reputation, the financial success of those under them, you are at high risk for abuse. That abuse can come in intimidation, quid pro quo, sexual, verbal, physical. And so, really, there needs to be a third party that is unbiased and, is looking out for those that are at risk for being abused. And with residency training, there’s the Acgme, which is kind of the big overseeing body of all residents in the United States. And for those that aren’t familiar with the acgMe, they serve as basically a third party that’s supposed to be, kind of the manager of getting into residency training and then graduating from residency. The problem is that the acgme really doesn’t check in that often or that in depth with residents. And then in a small department like we were, if all the residents actually speak the truth, or even in a big department, if all the residents speak the truth on these ACGMe surveys that we fill out there is retaliation felt, right? Because our bosses, our potential abusers, are the ones that get the results of that survey, and is the department that is bringing in the revenue from our work. It’s very similar to military training. In the military, abuse is rampant in multiple ways. the military is unique in that they don’t like third parties to come in and oversee anything. Right. they like to have everything in house. And so I very much see that kind of mirrored in the healthcare system. These giant hospitals, they want to keep everything in house. They don’t want the public to know that the surgeon that’s in charge of your surgery is a potential abuser and or that the helper surgeon or the resident surgeon just got yelled out in the hallway by the boss. Because if you knew that as a patient, you probably would not want that, surgical pair operating on you. And so it’s in the hospital’s interest to keep all of this very quiet, to not punitively harm the abuser, to not fire them, because then you avoid any lawsuit, and m then the residents are just stuck. I mean, even if you try to complain and report and all this stuff, you just get hush, hush, hush, hush, hush. And people say, just put your head down. Keep going. Get through it. And that’s the reason that the system hasn’t changed, in my opinion.

Dr. Frances Mei Hardin: Totally. And I do think that that last thing you said about as a resident, the hush.

Dr. Lauren Umstattd: Huh?

Dr. Frances Mei Hardin: Hush, hush. It’s also a revolving door. Like, this game is stacked way against the resident because the institution and the departmental figures will far outlast you. And so they really just need to wait you out, which in some cases, could be like three years, or in some cases, it’s five and so forth. But I love that. And it’s such a perfect introduction to institutions interests, which often won’t align with the resident or learner.

This story highlights deranged power dynamics in the hierarchy of medicine

And so I wanted to talk about how you once shared with me a really powerful story from when you were a fourth year medical institution at the institute where we trained. And I like that. It highlights deranged power dynamics in the hierarchy of medicine, like, what you’ve touched upon. And, again, that hierarchy extends from attendings through fellows, residents, all the way down to students and learners. this story really encapsulates the culture of this surgery department and program. And not only that, but as you listen, I would just urge you to think to yourself, how did this person think that they could behave this way and get away with it?

Dr. Lauren Umstattd: Yeah. So, briefly, I was a fourth year med student. I was getting ready to apply for residency. Like the height of your med student career, you just want to keep quiet, keep your grades up, get your interviews done, and get a residency slot. That’s literally your goal. That’s the only reason you’re there every day. You want a job as a doctor. So I’m on rounds in an ICU. There’s a big team. There was the attending surgeon who’s in charge of the team. There are a couple of medical students, one of those being me, a few residents, a couple of nurses, a pharmacist and a dietitian, or a registered, nutritionist. I forget exactly their title. And I was presenting a patient. Whatever I said was seemingly not appropriate, which, okay, I’m a med student. I’m learning. Like, I’m going to make mistakes in terms of my assessment and plan for patients. And when I got done with my presentation, the boss attending said, come here. Come closer. And so I kind of lean in in this big group of people. He’s kind of making a show out of it. I thought he was going to whisper something to me. He reached up with his hand and slapped me in the face. And it wasn’t hard enough to actually physically hurt me. It was meant to be a humiliation tactic. And there were between five and ten people that witnessed it. I don’t know. I can’t remember exactly how many. And I just kind of stood there shocked, and I was like, what the hell just happened? He just hit me. I mean, this man is like, I don’t know, over 6ft tall, big guy, and I’m five foot four and weigh 100 pounds. And so I didn’t really say anything. We just kind of continued rounds, and not a single person came up to me afterwards and said, like, oh, my God, I can’t believe he hit you. That alone shows you how normalized this behavior is within this culture.

Dr. Frances Mei Hardin: Absolutely.

Dr. Lauren Umstattd: So that night, I, get in my car, and I’m driving home. I physically turn my car around because this is just me as a personality. I’m an enneagram eight. I’m not afraid of confrontation. I’m a challenger. I like to speak up. I turn my car around. I drive back to the hospital. I know where his office is. So I go to his office, and I knock on his door, and he’s there. And I said, hi, sir. I just wanted to let you know that today you crossed a line with me. I don’t ever want you to touch me again. And I thought that was going to be the end of it. He apologized, he pretended to be interested in my future career, what field I was going to go into with a ten minute discussion. And I thought, okay, this guy’s genuinely apologetic. Let’s move on. Next day, he publicly humiliates me in front of a big group. Again, he talks about my naked body, and kind of an analogy related to patient care, however you can imagine that playing out. So it was clear to me 24 hours later that this man was not apologetic and that his sexual comments towards me in front of a group was proving the point that he was still in charge and I was still the inferior. And so I recorded pretty detailed notes on my own about both of these interactions. And I finished out my rotation and I did not say one word to him. And I kept quiet for several months because I was applying for residency and I didn’t know who was friends with who. I didn’t want me reporting it to have any impact on my future, in terms of landing a job after residency interviews. So fast forward a few months, I go to the dean of my medical school and I tell her what happened. And she said, not hm. Really sure what to tell you. I guess you could go to hospital HR. She didn’t really seem that alarm. She didn’t push me to go report it. So I went to the HR department at the hospital, met with somebody, they took a report, and I really never heard anything after that. fast forward a few months. I ended up landing a residency spot at the hospital that I did medical school at. So I get a call from my program director. So my future boss, the boss that’s going to be in charge of my five year surgical training, and he said to me, I heard there was an incident. Congratulations on matching. We’re so excited to have you. I heard there was an incident, a physical altercation between you and one of the other surgeons at this hospital a few months ago. And I just wanted to ensure, as your future boss, that you are okay being around him. And I said, oh, yeah, no problem at all. Again, the inferior person here in the relationship. Oh, yeah, no, I’m happy to have a job. I just want to get paid. I don’t have any problem at all. So that tells you. Because I never told him anything. That tells you that there was a paper trail somewhere in the hospital about what this guy had done. It was physical and that my future boss had been alerted. Never heard anything else. Well, fast forward, what, seven years, eight years? Yeah. I make a TikTok explaining my experience because I have a lot of people that follow me who are either students in the healthcare industry or are, residents. And I just told them my story. And then guess who reached out to me, the hospital attorney, seven years later and wanted me to go through it all again to cover their butts. It’s just infuriating. and so that specific occurrence dictated what I would tolerate as a resident and as a fellow.

You received an apology from the hospital attending, but nothing came of it

I think our own experiences really inform us of where our line is in the sand. You mentioned I was an athlete. I think also I tolerated a fair amount of abuse as a gymnast. And so in my mind, my abuse meter was fully at the top. I was not going to allow any more abuse, beyond a certain point in my life. And so at this point in my life, I’m just done. I’m not going to tolerate it. And if you’re going to treat me like that, I don’t want to be around you, because there’s plenty of wonderful people in this world, and I’m not going to let these rotten eggs sour my day.

Dr. Frances Mei Hardin: Totally. But, of course, as an announcement again to the institutions, if we don’t change the culture, then we lose brilliant people. Like, it’s kind of the brain drain then at the institution where that is the culture, because people like yourself, they won’t be willing to partake in it. Okay, well, eventually something’s got to give, so, like, the quality will go down. One thing I wanted to add is that what that attending said to you the next morning was just like, beyond. So let’s not actually totally gloss over what that attending said to you the next day. I remember hearing this story for the first time when you were a senior resident. Certainly not something we talked about, much in early years of even working together. But the night before you had turned around, you went and saw him. You received an apology. He seemed convincingly contrite. Like, I remember you being like, I honestly thought I was proud of how I handled it. I thought it was put to bed. I thought we were good. Like, I was willing to drop it. He had apologized. And I want to share what he said the next morning, because this still is just like, it really illustrates to people how much HR is not a piece of the equation here, because what happened was, I remember that you said that the patient’s abdomen was open. This was, like, a major, sick, you, patient, and a very large wound. And instead of saying, this patient has a very large wound, he said, you could take lauren here, strip her naked, drop her into red paint, and then hide her in the wound. Come on, grow up. That is what an attending with major power and influence at this hospital said to you in front of people, to double down on the power that he had over you after the previous day’s incidents. And that just grinds my gears. That gets me worked up also, maybe he actually does have a future in creative writing or something. Like, he should get an outlet, he should start a podcast, because that guy has a very vivid imagination and, like, very vivid insults or put down.

Dr. Lauren Umstattd: What’s interesting is that he’s married and he has children. I think that provides some context of, like, he’s not just this creepy dude that lives alone. He, he, has a woman and women in his life that he deeply loves and cares for. And how would he feel if someone talked about his wife like that? Give me a break.

Dr. Frances Mei Hardin: Yes, exactly. And like I said, just think about the fact that this man, seemingly nothing, came of the entire situation. He still remains a powerful and influential person at that hospital system today. They must have somebody at HR monitoring your TikToks now for anything that they have to just put out. but I really appreciate you chatting with us about that, because it’s such a good, representative story of a myriad of problems.

Dr. Lauren Umstattd: I think, if nothing else, me sharing the story tells everybody else out there that when things like this happen to them, they’re not alone, and you should go report them. And I’m glad I reported it. I wish I would have reported it earlier, and I wish I would have been more forceful with asking for feedback and what was the follow up. But I think if nothing else, it tells people that you are not alone. Because oftentimes when you’re experiencing abuse, really in any way, shape, or form, you almost feel like it’s your fault in some way. Like, what did I do to deserve this? Or what am I doing wrong? No one deserves to be treated in a horrible way. and so the only way we can change it is for people to speak up and continue reporting. I do think the reporting system, there are a lot of flaws, but doing something about it, even as simple as writing down detailed notes after the event happened, so that you can reference those in the future, because your memory is only as good as right after the event.

Dr. Frances Mei Hardin: Totally. And those are great tips for anyone who experiences something like that. And I definitely echo your sentiment that the problem is not you. There are definitely medical students out there who would experience this and be potentially too embarrassed or ashamed to even tell anybody, let alone report it. But they won’t even tell their friends. Why not? Because they might be like, are my presentation skills really terrible? Like, they’re so bad that somebody would lay hands on me. I should not be sharing that. I’m not a very good student. And it’s like, that is so far from the truth. Anyone who receives treatment like this, know that it’s not you. And know that even if you’re a medical student whose presenting skills need a little work, you don’t deserve that kind of treatment.

Dr. Lauren Umstattd: But I also think there’s this gray zone. I think most people that do anything to a very high degree. Let’s say you’re a musician and your coach, is very hard on you. There is this weird zone between a coach or teacher being really hard on you and pushing you to your fullest potential and then pushing you too much and doing it in the wrong way. And so I think sometimes things happen in that gray zone and it’s hard to make sense of it all in the moment. Sometimes it’s often years later that you look back and you think, wow, that was actually not okay.

Dr. Frances Mei Hardin: Absolutely.

I did a fellowship in facial plastic and reconstructive surgery

Well, to kind of shift gears a little bit, I’d love to talk about your fellowship experience in a non ACGME program and what happened, during your experience.

Dr. Lauren Umstattd: So I did a fellowship in facial plastic and reconstructive surgery. So in the United States, some fellowship programs are within the ACGME purview and then some are not. As it currently stands today in 2024, facial Plastics fellowships are kind of the wild west. There is this kind of loose third party that oversees them in terms of accrediting them. But there’s really no oversight in terms of protecting, learners. There’s also no standardized pay, which is interesting, just as a reference, they can kind of take advantage of you as a fellow. The residency pay scale is pretty, straightforward when you get paid as a resident. I took two, thirds of a pay cut from my pgy five year to my pgy six year. Just shows you how much, that person valued me as a provider in his office. Every day I would drive home past the domino’s pizza place and there was a little sign out that they were hiring a manager. And the starting salary for the manager was quite a bit higher than what I was being paid right then as a fellow, which was a little, disappointing. Now, I knew that going into the fellowship, but, for those who don’t have a clear understanding of the medical system, you interview at all these places and then you just match somewhere. There’s not, as much control in going somewhere. It’s not like you hit yes or no when they offer you a job. You go on all these interviews, they rank all the applicants and then you get basically an email that tells you where you’re going to go for the next year. So my fellowship was supposed, to be twelve months. I left after ten and there were a number of things that I just didn’t want to put up with anymore. And at that point I was confident enough in my own surgical skills that I said, you know what? I’m just not going tolerate this behavior anymore. I don’t want to be here. I’m not learning anything and I’m, being abused by this person and their team. And so for that reason, I’m going to leave my fellowship early and it’s something that is rarely talked about. I don’t know anybody. So before I made that decision, I knew nobody that had a really challenging fellowship. I knew nobody who left their fellowship. But since I have done that, I have had numerous people reach out to me who are either currently in a fellowship and having a really hard time or who have left their fellowship in various fields and specialties. And so again, I think it’s hard when you’re in the moment because it feels like you’re alone and you’re the only one to ever do this, to make this big decision. I think objectively, if we talk about what I felt like I didn’t get in my fellowship was I didn’t get an open and honest person in terms of teaching me the surgical things that I wanted to learn. I was, quote, supposed to just learn by observation. Don’t ask me questions, end quote. That’s not, the right environment for a surgeon to learn. For those that have not been in an operating room for a long case, when you’ve scrubbed in with a person, you are within 2ft of them, right? You’re standing right next to each other for hours. And so it’s a great opportunity for you to quiz your mentors, your co residents, whoever you’re operating with, like, hey, why do you use this sutra for that? Or how has your technique evolved over the years? it’s a great environment to just discuss things and there was no opportunity for that in my fellowship. I was strictly told not to, which was odd to me. There were also some hostile workplace things that would happen. the staff were told that they weren’t supposed to talk with me or eat with me. I was only going to be there for a year. They shouldn’t be friends with me. We would get reprimanded if we would chat in the hallways in between patients. mind you, this was in 2020. We all felt some degree of social isolation. We had moved to another state. I had uprooted my husband and my child. And so going to work and chatting with your coworkers, just about. How’s life? How was your morning? What did you bring for lunch? I mean, very benign things. not being able to talk to another human that you’re in the office with is kind of bizarre, right?

Dr. Frances Mei Hardin: Yes, very much a toxic work environment that was created.

Dr. Lauren Umstattd: And so, it was pretty evident early on in the fellowship that they were water and I was oil, and we really weren’t going to mix. And so I tried to stick it out. We had several meetings very early on where they and I sat down and it was mostly a yelling, session where I wasn’t allowed to talk and they would yell at me. I was specifically told during those instances that I had to take my phone and put it on a different floor of the building so that I couldn’t record anything. They would physically want to see my phone on another floor of the building. So specifically, I couldn’t record those conversations. and I said, wow, there is something wrong here. I didn’t really know who to reach out to. I reached out to three separate individuals in that specialty and I said, something is happening here that’s not good. I’m not meant to be here. This is not a good match. And none of them really provided me any solid advice. They said, well, stick it out or quit and do a different fellowship. the other thing that, that showed me is that everyone’s busy in their own world, right? No one has time or really any interest in getting involved in helping you. And so I kept trying to stick it out, stick it out, stick it out. And towards the end, I had some paperwork that I was going to have my fellowship director fill out, for my Kansas license because I was applying for my Kansas medical license and he essentially refused to sign it. And so that told me, hm, he’s not going to do anything for me long term. I don’t even think he’s going to sign my fellowship paperwork if I stay here the full twelve months. So we packed all our stuff up in my apartment and we drove to Kansas City the next day. all that to say that I didn’t anticipate any of that going into the fellowship. I thought our interview went pretty well. I landed third on my rank list out of 14 programs. I was very excited for my fellowship, and I really think you just don’t get a sense of who people really are until you’re with them every day. Ah, it’s hard for me to go into any more detail. And fear of litigation on, their end, essentially.

Dr. Frances Mei Hardin: Totally.

You quit your fellowship because it got to a point where it was unreasonable

Well, thank you for sharing that. And, you know, because obviously, we talk, and you know that I applaud you for leaving the situation when it got to. I mean, again, you’re a person of remarkable grit and resilience. So, obviously, you know that it had gotten to a point where it was just kind of outrageous. It was beyond unreasonable. And I think that what’s so awesome about you sharing your story is, obviously, this is not the first time it’s happened, but I definitely believe that other people do not feel confident enough in their skills and in their acumen as surgeons or physicians to speak out about it. But I’m not surprised that you have the knowledge base, the confidence, the technical skills, and you have your beautiful practice that’s thriving. And so why not call a spade a spade and also be offering, like, an olive branch and maybe a roadmap to other people who come behind you and are, in a similar situation?

Dr. Lauren Umstattd: And I will say residents are not afforded that same flexibility. When I shared the story recently on social media, a lot of people were like, well, how do you do what you do if you quit your fellowship? Some of it is state dependent and position dependent. So I’m in the state of Kansas, and I own my own practice, which means I’m my own credentialing know. I am board certified as a doctor through my residency program. So I already had that box checked, so I can already be a real doctor in the United States and take care of patients in a very safe and helpful way. The fellowship was essentially a bonus for me. I don’t need it. I did learn some in it, and I’m grateful for some of the surgical things that I learned. but residents can’t just leave. They can’t leave like I did with my fellowship, because they have to be fully trained in order to get hired by a group or hired on at a hospital. And so there was a lot more flexibility with me as a fellow as, compared to most trainees that are in residency. You have to graduate that program or switch to a different program, which is incredibly challenging, to be able to practice independently one day.

When residents started to honestly report on AcGMe surveys, retaliation ensued

Dr. Frances Mei Hardin: Right. And you touched on earlier, especially in small programs like ours. But I’m sure possible in any residency program is the issue of retaliation because when we started to honestly report on the AcGMe surveys, then what happened was an AcGme site visit. And the AcGMe site visit was like this very scary, nebulous thing. Like, residents didn’t know what to expect. We received very little information on it. We kind of hoped that help was coming, which was not the case. But what was so wild was that many residents had answered truthfully on the surveys that led to a site visit that led to a lot of attendings. Overtly, I mean, to my face. Many attendees, said directly to my face, you’ve messed up now, except with more expletives in it. And they would just literally be like, you messed it up for everyone, and now they’re going to close the program down. All of you will be employed. All of you will be totally unhirable. It’s going to ruin your life. And I’d be like, sitting in clinic, like, oh, should I go see the next patient? Or do you want to keep threatening me? Or what’s, up? What are the vibes here? Do I get out of seeing patients if I just sit here and take your threats? Like, okay, maybe we can work out a deal or something like that. But, I mean, that’s me making light of a situation that went on for months, and at the end of it, nothing came of the AcGme site visit. What’s so funny, and I think that it’s relevant here, is that one of our mutual senior residents back in the day made, us take the surveys in the resident office with him standing behind us. And I remember him changing my answers. It was like, have you ever witnessed discrimination based on gender or race? I was like, yes. And he’s like, that is going to create a mountain of paperwork. You’re not allowed to say anything other than it’s amazing here, and we’re very happy society. That’s why it was so funny, because when he graduated, suddenly all the survey numbers dropped drastically. And there were questions that were like, you guys are the happiest department in the hospital. You’ve had perfect scores for all these years. So what’s going on? And they could not make sense of the numbers. So that’s a little bit funny.

Dr. Lauren Umstattd: Yeah. Shows the realities of how reliable survey answers are, even if they’re quote unquote anonymous.

Dr. Frances Mei Hardin: Well, to kind of wrap things up in terms of our conversation broadly, I think that we have, well, illustrated the vested interest problem. Like, it’s really hard to find a neutral third party when you’re in medical training or as a physician, because, of course, the hospital has a vested interest in protecting the attending. The acgme has a vested interest in protecting the system as it is. And the fellowship overseeing bodies want to protect their programs and continue to support them.

Larry Nasser sexually assaulted hundreds of gymnasts, according to documentary

So I know that you mentioned that a lot of this reminded you of the athlete, a documentary which came out in 2020, which hits close to home, given your extensive career as a gymnast.

Dr. Lauren Umstattd: Yeah. So athlete a was a documentary made about Larry Nasser, who was a physician with USA gymnastics and some, other gyms, like Michigan. He was employed there for a long time, and he sexually assaulted hundreds of gymnasts, sometimes with their parent in the room with them, the treatment room. And a lot of these, when I talk about how sometimes you don’t know you’re being abused until years later, a lot of these athletes didn’t realize that they were being sexually assaulted, despite the fact that he penetrated them, until years later, as an adult. When they think back to this, he had the ticket to the Olympics, right? He worked very closely with Marta and Bella Corolli, who were in charge of picking the girls that went and made the Olympic team. And so there were some gymnasts very early on that voiced some concerns about his abuse, and they were silenced. And so they went rung, up. They went to USAG, the United States gymnastics, and said, hey, this abuse is happening. USAG essentially did the same thing that the Boy scouts of America did for years, where they just bury evidence because they want to protect their reputation. Right. USA gymnastics wants to be looked at as this great sport that most of us enjoy every four years at the Olympics. But that is a highly profitable organization, and they are highly susceptible to abuse. Right. A bunch of little girls and leotards. Again, essentially the same as the Boy scouts of America. Profitable organization, high risk of abuse, given that it’s a bunch of young boys where adults have, unlimited access.

Dr. Frances Mei Hardin: Yeah, totally.

Dr. Lauren Umstattd: And so, I think that what came out in the athlete, a documentary, is that, yes, there are bad eggs, and we cannot prevent bad eggs from getting into the system. Right. Whether it’s a surgeon that’s training you or, a teacher that’s teaching your child, there are bad eggs out there. They’re one in a million. Right. But unfortunately, we come into contact with millions of people during our life, and so the responsibility lies in the reporting system, because that’s the person and the group and the organization that’s going to keep these people safe. And so for residents, there has to be someone to go report to. That’s going to go to bat for you because you can’t go to bat for yourself. You’ll just get fired or you’ll get yelled at every day, or you won’t get access to the good cases. I mean, you’ll just be black sheeped for your entire residency. Same with the know, they couldn’t go to USAG. They needed a third party who could come in and support them in a way that would help them get away from their abuser while not prohibiting them from advancing in their career.

Dr. Frances Mei Hardin: Right? Totally. Well, I think it’s a lot to chew on, and I really appreciate the conversation to give these illustrative points, which remain a good jumping off point for this conversation and the discussions about what neutral third parties, if any, can be available for medical training and early career physician support.

Do you believe in karma? Dr. Umstattd: I don’t know

I want to wrap up really quick with my segment, which is, do you believe in karma?

Dr. Lauren Umstattd: I don’t know. I feel like my gut tells me it’s not real, but my brain tells me I want it to be real because I, still want it to be real. I think, like kindergarten teachers, preschool teachers, nurses, they should have all the good karma in the world because they are what makes our world go round. They educate our children, they have the hardest jobs. So for them, I want them to have all the great karma in their future life. And for those one in a million bad eggs, I hope that karma is real, and I hope they’reborn as an earthworm one day and just eat all day.

Dr. Frances Mei Hardin: Oh, yeah, that lifts the spirits to think about, for sure. yeah, I agree. I think that part of the problem with karma is that maybe it doesn’t happen on a timeline that is useful or satisfying. But like I said, for morale related reasons, I just have to be like, oh, man, for the surgeons who have yelled at me every time a surgeon yells at me, I’m like, I got to believe in karma. And maybe I go mess with my voodoo dolls a little bit, and then you have to just basically let go or be dragged. I really like that mantra.

Dr. Lauren Umstattd: Totally agree.

Dr. Frances Mei Hardin: Thank you so much, Dr. Umstattd. Really appreciate you, and it’s always just such a joy to chat with you.

Next week, we will have Dr. Ellie Dejong discuss navigating mental health sabbatical

Next week, we will have Dr. Ellie Dejong on the podcast to discuss navigating a mental health sabbatical during residency training. She is a brilliant anesthesiologist who completed not only one, but two residencies. After excelling in her pediatric residency, she realized that she had a dedicated interest in PeD’s anesthesia and went on to Stanford for an anesthesia residency. And while her story is highly personal, any resident who’s struggling may be able to take a roadmap from her experience to their own program director. For instance, to come up with an effective path forward, follow me on Instagram at at Francesmay, Md. And at rethinkingresidency visit my website, rethinkingresidency.com, to learn more about resident physician stories and ways that residents can most effectively navigate the game of residency. I cannot wait to connect with you on the next episode of promising young Surgeon.