Do not need PD letter
[QUOTE=ForbiddenComma;12197103]To the original poster,
It can get better.
Not having your PD's approval means that you cannot get into another residency program, full-stop, end of discussion. Really, it does not matter how bad of a reputation his program has... once someone has entered the hallowed priesthood of "Program Directors," the other PDs will treat his word as the Word of God. There is no getting around that fact. All the LORs in the world from other attendings -- even those that supposedly outrank him, such as the chair or the dean -- will not make up for the lack of a positive letter from your PD. I will not sugar-coat it. Without a letter from your former PD, scrambling would be a waste of time and money.
I would not give up hope of matching to another residency just because you don't have a PD letter. I know several people fired or who have left their programs without a PD letter. They still got interviews and matched. Some open-minded programs don't ask for a letter. It may take more searching for programs (i.e. larger geographic area) and you may need a bit of luck to find those programs. Also, you should come up with a positive explaination of why you left your previous program. However, please do not give up hope. Good luck!!!