Distaff Is Restless

A resident gets cut from Maricopa Medical Center's surgical training program. She says it's discrimination. It's just the latest problem facing the center's taxpayer-funded contractor, Medpro.

Also, Simon charged, his wife had never seen the evaluations on which she scored poorly, and that some of the evaluations were proof of the discrimination Magda suffered during her rotations.

The County Attorney's Office closed its investigation in July--in fact, just a day after the faculty at Maricopa voted not to renew Cynkutis-Simon's contract for 1998.

The investigation was unable to substantiate discrimination. "Our investigation revealed that MedPro . . . had legitimate non-discriminatory reasons for requiring you to get counseling," a deputy county attorney wrote to Cynkutis-Simon on July 22.

But even though that was the end of the county's inquiry into MedPro, Cynkutis-Simon says retaliation by MedPro continued.

As an example, she points to the promotion of residents to attending physicians. The attendings are responsible for teaching the residents in the surgery program. But MedPro has advanced four recent graduates into attending slots even though they've had problems, she says. One attending was on clinical concern for two and a half years, according to Cynkutis-Simon, while two others flunked their qualifying exams on the first try. Other residents have been suspended and rejected for rotations before, Cynkutis-Simon alleges. (One of the residents promoted to attending was a woman, however.)

Dr. White, the former resident now in private practice in Scottsdale, says there were instances where she was treated differently because of her gender. Once, a male resident made inappropriate advances toward her, and the incident was laughed off by Malone.

"I'm very tough to offend," she says. But "somebody pushing me down in the parking lot and putting their tongue down my throat" was too much, she says, so she complained and was told "no big deal."

"That comes to your word against theirs, and if that person is senior to you, which he was . . . it really is a no-win situation. They don't like complainers."

White's style of dress was even brought up in committee meetings, she recalls.

"You're not supposed to know what goes on in the governance committee, but you hear snippets," she says. "And once, someone defending me said, 'Look, she dresses very appropriately, nothing seductive, and if it's something in the way she walks, then, well, we have a problem here.'"

But White stresses that she doesn't think the program is biased against women--it's tough on everyone, men and women alike.

"Everyone had it hard, just in different ways," she says.
White adds that the pressure of the program is also hard on the people who run it; it's often difficult for them to sort out problems.

The most important thing, White emphasizes, is that she received a good medical education at MMC.

But the surgical-residency program faces problems on the educational front as well. During the past several years, the number of residents passing their certifying exams has dropped sharply, internal memos show.

The Accreditation Council for Graduate Medical Education--which is responsible for certifying residency programs nationwide--noted the decline in a letter to Malone dated July 23, 1996.

"It was reported that all four residents who completed the [surgery] program in 1995 failed the qualifying examination of the American Board of Surgery on the first attempt," Dr. John Boberg, head of the residency review committee, wrote. "Only three of the previous 19 residents had failed the examination on the first attempt."

That means MMC's first-time success rate on the qualifying exam was 68 percent for 1996. The national average for that same year was 77 percent. For the certifying examination--the next level up for the surgical residents--the 1996 success rate for those taking it for the first time was 73 percent, five percentage points below the national average. A residency program which falls below a 50 percent success rate risks losing accreditation.

Malone offered apologies and a solution in a letter back to the residency review committee on September 6, 1996.

"I believe it is only fair that I accept some of the blame for this disappointing and unacceptable performance," he wrote. "Maricopa Medical Center . . . has been in a major transition the last two years, as it moves toward becoming a private, not for profit, facility. As president and CEO of the Maricopa Faculty Association [MedPro], I have been, and continue to be, largely responsible for overseeing the facilitation of this sale."

Malone told the committee he was handing leadership of the teaching program over to Dr. Terry Simpson.

"He is an excellent teacher who is admired and respected by the student body," Malone wrote, noting awards Simpson won for his teaching abilities.

But four months later, Malone fired Simpson and took back control of the general surgery program. Malone, however, is not currently board-certified in surgery, as required by the ACGME standards.

The ACGME's Dr. John Boberg knows that Simpson left but says the council won't micromanage residency programs.

He concedes that Malone's lack of board certification is unusual, but that the committee sometimes waives that requirement for program heads who show academic accomplishment, such as publishing papers. Malone has a host of publications and inventions to his credit.

Boberg is concerned about the test scores. But until the program falls below the 50 percent standard, the council can't take any action, he says.

Boberg says there also are no plans to review MedPro's surgical-residency program before the next scheduled site visit in 1999.

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