Residency contract non-renewal. How should I move forward?

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I am a PGY1 (US grad at a US residency) who just received a non-renewal of contract letter from my residency program. I did reasonably well in med school (no reprimands, no grades below a B, >220 on step 1 and 2 first time, etc etc) and I feel like I have what it takes to do well in residency. I would like some advice on this matter and have already searched a number of threads like it.

I will spare the gory details because everything you say on the internet exists forever, but I basically had a big miscommunication incident early in my residency with an attending and it majorly pissed him off. Nobody got hurt but I definitely lost his trust. After that I was put on a remediation plan which actually was going fine. I jumped through all their hoops, proved that it was just a one-off incident. Things were actually looking better at that point, but I noticed that the usual friendly social interaction that my PD and others had previously shown was stunted. I felt shunned almost from the get-go.

Halfway through the year, I received poor evaluations from the attendings on an internal-medicine-type of rotation (despite asking for feedback, working hard, etc) afterward and was told that I wouldn’t be getting my contract renewed for next year. Some of the stuff in the medicine evals was true, some things were flat out lies. I attempted to explain this rationally and calmly to my PD but I was just perceived as being defensive. Yes, some of this is my fault, but every other intern I work with thinks that this response is way out of proportion to the actual problems. In fact, making matters worse, they pulled me off the medicine rotation – AND my future medicine rotations – for the rest of intern year because they don’t trust me. Guess what that means – matching into a PGY2 position somewhere else is going to be virtually impossible and I have to start over.

I could protest it formally but I probably don’t want to. I know that residents essentially have few rights, so making a stink about it is probably just going to piss-off the powers that be, and likely make any LORs worse in the future. I would rather finish the year, swallow my pride, go quietly and hope the LORs turn out ok. There are definitely some people in this program who will write on my behalf.

I am actually quite open to looking for an alternate career, such as working for an EMR tech company, or getting an MBA and doing something along those routes. My loan/debt load is far less than most residents and I would definitely be happy getting paid $70k/yr forever doing something non-medical. However, my primary goal right now is to finish my year and get into another residency program.

I was able to hustle and get all of my ERAS application stuff submitted to I can scramble/SOAP this year. My med school is aware of it and helped me out greatly, but all of my LORs, essay, etc etc are from MED SCHOOL not from this residency. It all happened too quickly and I didn’t have time to get new letters. To make matters worse, my essay and LORs from med school are all program-type-specific, limiting my authenticity to that type of program (it’s a very low-competition field thankfully). So, I feel like I could scramble/SOAP but I’m not sure how well it’s going to work out. I feel like it would be too rushed.

My second idea would be to wrap up this year, find a job in something for a year, get some good references from that and actually hit the interview trail again next year – with a new personal statement, LORs, etc. I feel like I might get better prospects if I “take some time and learn from my mistakes” etc. I could even take Step 3 and pass it during that time, to “prove” that I am an ok risk for a program to take. Granted, I can always scramble next year too.

What do you all think? I’m not trying to save my position here, I am trying to exit gracefully and find a program that appreciates my effort and dedication.

Sorry to hear that this happened to you. It's an awful thing to have happen.
You might want to try contacting the poster HIJay from this thread: http://forums.studentdoctor.net/showthread.php?t=856531 since he is one of the few people I've seen posting here who has been able to give detailed advice about what exactly the options are for non-clinical jobs.
It doesn't seem all that easy to find well paying non-clinical jobs unfortunately. For that reason, I do think that you should go ahead and try your best to get a new residency spot in SOAP.
If there is any way to get at least one or two new letters and rush them to ERAS then I think that would really help (I don't know for sure if that is possible under the new system, but I believe that under the old system you could add new letters for the scramble).

At this point do you think there is any chance that the PD would be willing to write a LOR that puts a "positive spin" on things or do you feel like that relationship has been too damaged?

Thanks for the link - it's good to know my alternate options. As for the relationship with the PD, who knows what that person is thinking. I have remained very positive and outgoing despite this situation, to the point where attendings have commented on "my spirit of determination."

I would like to think that I will leave the program on good terms - that is basically my goal at this time, since I think I'm a decent enough resident and I'm not interested in fighting to stay in a department that doesn't want me. Part of me wants to protest but I'm also trying to be logical here, you know? I've already got two attendings who will write for me. I can get other attendings to write letters - but do you think that I could get some of the other interns to be job references if I pursue something nonclinical? I am very close with some of them and I think they could be excellent references.

As for getting some letters in post-non-match for the scramble/SOAP, that is a really good idea. I never had to scramble last time (ironically I matched at my #1 program), so I know little of the inner workings of not matching.

Sorry to hear about this. you will almost certainly need a letter from your PD at some point whether you reapply this year or in two years. People are bound to call him up at the very least. It is strange they pulled you off medicine months - this mgiht not be a problem in terms of transferring if you can do them as electives later on and thus possibly start as a PGY-2. There are some programs that have PGY-2 spots in the match that fail to fill (hopkins had one last year in your field for example), and others that have spots that are not in the match (e.g. emory, gwu) at the pgy-2 level.

I would have an honest discussion with your PD about whether they would support you applying somewhere else, happy to write a letter. It is difficult to know what happened, whether they were justified etc, but to some degree it doesn't mattter. What matters is whether they will support your quest of finding another residency now in the future.

I'm so sorry...

Originally Posted by splik

It is difficult to know what happened, whether they were justified etc, but to some degree it doesn't mattter. What matters is whether they will support your quest of finding another residency now in the future.

Precisely. That's what I need to find out.

Anyone care to comment on whether I would be better to scramble now into anything (and possibly be unhappy with it) versus waiting a year and building things back up? My guess would be the latter, but I don't know if there are special considerations (hypothetically: like how long step 2 scores are good for, etc).

You were probably blackballed by several faculty who were overly critical of your work because they were prejudiced by word of the first incident. You probably have many enemies you don't even know. Academics is an amazingly political place, and people newer forget.
You should probably plan to take a year or two off, do some research or something. Perhaps at your medical school. Reassess what you want to do and start over.
If they don't trust you enough to work on the wards anymore they're probably not going to support your continued interest in medicine anywhere. They've labeled you as dangerous and untrustworthy. If you think that there is a faculty member that you can trust there that you worked well with, ask them if they would be able to give you a positive LOR. Better to get that arranged now.

Originally Posted by splik

Sorry to hear about this. you will almost certainly need a letter from your PD at some point whether you reapply this year or in two years. People are bound to call him up at the very least....

I would have an honest discussion with your PD about whether they would support you applying somewhere else, happy to write a letter. It is difficult to know what happened, whether they were justified etc, but to some degree it doesn't mattter. What matters is whether they will support your quest of finding another residency now in the future.

This. If your PD is going to be a hurdle, I'm not sure how receptive any future residency is going to be to you. Nobody is going to hire you without talking to him, and his side of the story is going to be the one that gets believed. You might be able to land a prelim spot and try to prove yourself, but your current PD would have to be at least lukewarm for you to get to another shot. It's hard to know what is going on at your program, but the fact that you concede there was a "miscommunication" and that some of the issues in your post-remediation bad evaluations were true and that you feel the response was out of proportion (suggesting that there is some proportionate response that would be called for) makes me wonder if you are maybe downplaying things as much as your program is presumably up-playing them. There are a number of unforgivable things in residency, that some interns don't seem to appreciate as being deal breakers. These range from lying to attendings, to claiming you checked things you didn't etc,, and certainly can get you canned. We don't need to know what really happened, or get into the nitty gritty of whether your program acted reasonably or were absurdly draconian. We will assume for the sake of argument the latter. The question now is simply whether your program just wants you out of their program, or feels you represent such a danger that they will make it their business to keep you out of medicine altogether. If the latter, you are not going to be a resident. I would definitely finish out the year and sit for Step 3 regardless of what you do. At least if you get licensed, you have some GP options.

Originally Posted by IlDestriero

You were probably blackballed by several faculty who were overly critical of your work because they were prejudiced by word of the first incident.

I actually know for a fact that this happened. At least one attending on a new rotation was notified in advance that I had some difficulty earlier. I don't know if they gave specifics, but I'm sure it didn't help. I'm not sure how much of a hurdle the PD letter will be to obtain. I was always a very enthusiastic intern and I am still hopeful that if I finish out the year in decent enough standing that I can get at least a neutral letter. Then again, this disaster wasn't something I expected, so anything is possible. This is why I'm thinking it might be wise to take a year or two and get into a decent job situation. That way if clinical medicine never works out for me again, I've got an alternative area in which to climb the ladder.

Originally Posted by sella turcica

... Then again, this disaster wasn't something I expected, so anything is possible. This is why I'm thinking it might be wise to take a year or two and get into a decent job situation. That way if clinical medicine never works out for me again, I've got an alternative area in which to climb the ladder.

Leaving medicine will always be the fallback option. I think you need to explore whether you can stay in it first, and if that doesn't pan out, then look into other careers.

Does your program have any history of firing or non-renewing its residents?

This is terrible, and I am so sorry to hear it. Can you possibly reconcile with your PD? As one of the earlier post states, letters and recommendations from your PD follows you forever. What if you actually discuss with him how to recover from this? This may be the one time you have to totally let go of all your pride and just tell him that all of what happened was a big mistake on your part, (even if you don't feel like it was) and that you would like to recover from this somehow and continue with medicine. We had a resident who was kicked out of the program after years of battling with attendings but I heard he somehow made a peace with my PD and was able to get a letter that can carry him forward. If you already have a backup plan anyway, what is there to lose but a few min of pride, in case he rejects to your peace offering?

Originally Posted by Law2Doc

It's hard to know what is going on at your program, but the fact that you concede there was a "miscommunication" and that some of the issues in your post-remediation bad evaluations were true and that you feel the response was out of proportion (suggesting that there is some proportionate response that would be called for) makes me wonder if you are maybe downplaying things as much as your program is presumably up-playing them.

Nonsense. This shows that he has taken some personal accountability and is giving us a balanced perspective rather than the typical "it's all the program's fault" that we're used to seeing on here.

First, it is important to ensure that you really know what the problem is, and how serious it is. It is possible that this is all due to a single bad event which "labelled" you as a problem. It's also possible that you have a bigger problem than you think. Either way, it's critical that you find out. Perhaps your PD can help. Perhaps someone in the GME office. If you try to explore this, you need to go in being clear that you're not trying to fight this, but trying to understand it. The IM PD might be a great person to ask -- they would likely tell you the honest truth, as they have nothing to hide from you,

Being a US grad will help you tremendously in SOAP. If you can get faculty to write letters for you now, you can send them to your Dean's office and they can upload them immediately. They will then be ready for SOAP.

As far as "taking a year or two off to recover" vs "getting right back into the game", I cannot stress how important it is to try to get right back in the game. If you spend 2 years doing research, it's not going to make you a stronger candidate for a clinical residency -- in fact I worry it would do the opposite. PD's would see you as someone who failed out of a non competitive field, and then did non clinical work, perhaps weakening your skills further.

On the other hand, you should definitely not do something you don't like. That's a presciption for disaster. Residency is hard work with long hours. If you find the material / conditions / situation miserable, you are unlikely to be able to perform your best, and it will show.

So:

1. You should decide whether you want to continue in your current field, or change. From your old posts, it appears you applied to psych. You need to decide whether you want to continue in this field, or switch to something else. Ideally, you should figure this out before SOAP starts.

2. You need to talk to the IM PD about your performance, and get some honest feedback.

3. You also need to talk to your PD. You will ABSOLUTELY need a letter from your current PD to participate effectively in SOAP. You need to figure out what your PD will support you for.

4. You then participate in SOAP. If successful, then that's the plan. If not, then you'll apply to the 2013 match. You'll then need to figure out what you'll be doing for 7/2012-6/2013. You'd also have a chance to apply for off cycle spots, etc. You could do a year of research. Or, depending upon what state you're in, you might be able to work (most states require at least 12 months of clinical training, unclear if your program will certify that you completed 12 months satisfactorily. Also, unclear if practicing medicine unsupervised is a good idea for you in any case.

5. Pursuing another degree (MS, MPH, M Ed) is usually NOT a good idea, unless you're giving up on a clinical career and want to open other avenues.

Originally Posted by Substance

Does your program have any history of firing or non-renewing its residents?

Not many, but yes.

Originally Posted by aProgDirector

First, it is important to ensure that you really know what the problem is, and how serious it is. It is possible that this is all due to a single bad event which "labelled" you as a problem. It's also possible that you have a bigger problem than you think. Either way, it's critical that you find out. Perhaps your PD can help. Perhaps someone in the GME office. If you try to explore this, you need to go in being clear that you're not trying to fight this, but trying to understand it. The IM PD might be a great person to ask -- they would likely tell you the honest truth, as they have nothing to hide from you,

Being a US grad will help you tremendously in SOAP. If you can get faculty to write letters for you now, you can send them to your Dean's office and they can upload them immediately. They will then be ready for SOAP.

As far as "taking a year or two off to recover" vs "getting right back into the game", I cannot stress how important it is to try to get right back in the game. If you spend 2 years doing research, it's not going to make you a stronger candidate for a clinical residency -- in fact I worry it would do the opposite. PD's would see you as someone who failed out of a non competitive field, and then did non clinical work, perhaps weakening your skills further.

On the other hand, you should definitely not do something you don't like. That's a presciption for disaster. Residency is hard work with long hours. If you find the material / conditions / situation miserable, you are unlikely to be able to perform your best, and it will show.

So:

1. You should decide whether you want to continue in your current field, or change. From your old posts, it appears you applied to psych. You need to decide whether you want to continue in this field, or switch to something else. Ideally, you should figure this out before SOAP starts.

2. You need to talk to the IM PD about your performance, and get some honest feedback.

3. You also need to talk to your PD. You will ABSOLUTELY need a letter from your current PD to participate effectively in SOAP. You need to figure out what your PD will support you for.

4. You then participate in SOAP. If successful, then that's the plan. If not, then you'll apply to the 2013 match. You'll then need to figure out what you'll be doing for 7/2012-6/2013. You'd also have a chance to apply for off cycle spots, etc. You could do a year of research. Or, depending upon what state you're in, you might be able to work (most states require at least 12 months of clinical training, unclear if your program will certify that you completed 12 months satisfactorily. Also, unclear if practicing medicine unsupervised is a good idea for you in any case.

5. Pursuing another degree (MS, MPH, M Ed) is usually NOT a good idea, unless you're giving up on a clinical career and want to open other avenues.

Excellent advice. I was hoping you would add something to this unfortunate thread. Good research, I did match in Psych, in fact at my top program. Irony can be so ironic. I will meet with the PD again soon, the last time we talked a LOR was on the table dependent on my finishing the year. Finishing the year is important to me for a variety of reasons, so when the alarm goes off I will continue to roll out of bed.

these types of threads always scare the crap out of me...it seems too easy to piss off the wrong people who can then turn around and completely derail your career.

You said this about your program having a history of firing or non-renewing residents:

Originally Posted by sella turcica

Not many, but yes.

This is why applicants should 100% avoid programs that have ANY history of firing or non-renewing a resident (even if the firing was justified).

If firings were justified, you can infer its because the program has lower standards and will not accept that fact and better their subsequent selection standards or help the bad residents improve. Such programs care nothing of their own reputations.

If firings were not justified, its because the place is "malignant": bad personalities that carve vendettas out against residents; resident interpersonal conflict ; too many IMGs with no second options etc.

Either way, the lesson is if any program has any history of firing any residents for any reason, avoid them or rank them low.

Anecdotally, I have heard that most of the firings are done by a disproprotionately few programs.

This forum is really unique for these types of thread. Thanks to everyone above who has added extremely useful feedback. For a person who's about to begin residency in July, it is critical to be very well aware of such possibilities lest I be involved in a similar situation.

Originally Posted by TheMan21

these types of threads always scare the crap out of me...it seems too easy to piss off the wrong people who can then turn around and completely derail your career.

Same type of thing almost happened to me during intern year. The PD and I got into a misunderstanding over something that didn't involve me at all. Fortunately, I was able to prove myself but could only imagine how my life could have changed drastically. We eventually settled our differences, but the entire year sucked being on eggshells and giving no excuse to be terminated unjustly.

My advice, just pass and stay out of any kind of spotlight. Some people are just a-holes!

-R

Originally Posted by Law2Doc

. The question now is simply whether your program just wants you out of their program, or feels you represent such a danger that they will make it their business to keep you out of medicine altogether. If the latter, you are not going to be a resident. I would definitely finish out the year and sit for Step 3 regardless of what you do. At least if you get licensed, you have some GP options.

.

Can you please explain how this dangerous doctor be GP and treat people. Somebody need to protect the public, Its either the residency program or the state medical board is making nasty mistake.

Originally Posted by TheMan21

these types of threads always scare the crap out of me...it seems too easy to piss off the wrong people who can then turn around and completely derail your career.

You know why because they are sick in their head and you can do nothing about it

This happened to a few sresidents in my program. On guy was openly gay which didn't mesh with the high "Christian" values of the PD. Not very Christian in my view but what can you do? He was able to transfer directly into a PGY2 slot into a program in Michigan.

There was a second resident as well who was asked to leave. He got poor reviews because he would essentially "freak out" at the sight of blood or major trauma in the ER. I know the ER doc got him blackballed. He always did well in clinic. He ended up going to a PGY-2 slot in Michgan as well.

Bottom line - there are other residencies out there. THey may not be where you want to be or the best or what you envisioned. But, you should be able to find somewhere that will let you finish (as long as you have never killed anyone) and put this behind you. You should not have to go through the match again. Many programs you just need to call to see if they have a PGY2 slot that needs filling, ask them to fax you the paperwork and see if they will take you.

Originally Posted by MD forever

.

Can you please explain how this dangerous doctor be GP and treat people. Somebody need to protect the public, Its either the residency program or the state medical board is making nasty mistake.

I was assuming for the sake of argument that the OP was being hosed, not that he was a real danger. We don't have facts from either side from which to really draw a conclusion.

Originally Posted by cabinbuilder

...

Bottom line - there are other residencies out there. THey may not be where you want to be or the best or what you envisioned. But, you should be able to find somewhere that will let you finish (as long as you have never killed anyone) and put this behind you. You should not have to go through the match again. Many programs you just need to call to see if they have a PGY2 slot that needs filling, ask them to fax you the paperwork and see if they will take you.

This assumes the PD is at least lukewarm. If he wants to be an impediment to the OP getting another residency, I don't see many places hiring him despite that.

Originally Posted by Law2Doc

This assumes the PD is at least lukewarm. If he wants to be an impediment to the OP getting another residency, I don't see many places hiring him despite that.

It makes things more difficult, but this is not a complete show stopper. Particularly if the program/program director has a reputation for being problematic. Honest PDs running good programs will take a good look at what they are told on both sides. This is particularly true if you can get good references from attendings, chiefs and even fellow residents from within the program.

To my certain knowledge, there have been a number of residents in this situation who have landed new residencies and gone on to complete them successfully, and are now in practice, one who is now a PD in her own right.

A resident in this position has to be creative and politely persistent. Sometimes a personal visit to nearby programs of interest may be very helpful, as a personal contact is always more informative than a telephone call than an email than a letter in an envelop.

Outside the NRMP is definitely better if you can land a position that has come open in mid-year. I do agree with OP that smiling, working, watching backs can be essential to completing the year. If the PD is honest (no way to judge this from here), and a letter can be had, do not sign away your right to see it. If the PD will not be honest to your face, can you trust them to be honest behind your back? Sometimes a sprinkle of sunshine will keep the cockroaches hidden.

Originally Posted by 3dtp

It makes things more difficult, but this is not a complete show stopper. Particularly if the program/program director has a reputation for being problematic. Honest PDs running good programs will take a good look at what they are told on both sides. This is particularly true if you can get good references from attendings, chiefs and even fellow residents from within the program.

To my certain knowledge, there have been a number of residents in this situation who have landed new residencies and gone on to complete them successfully, and are now in practice, one who is now a PD in her own right.

A resident in this position has to be creative and politely persistent. Sometimes a personal visit to nearby programs of interest may be very helpful, as a personal contact is always more informative than a telephone call than an email than a letter in an envelop.

Outside the NRMP is definitely better if you can land a position that has come open in mid-year. I do agree with OP that smiling, working, watching backs can be essential to completing the year. If the PD is honest (no way to judge this from here), and a letter can be had, do not sign away your right to see it. If the PD will not be honest to your face, can you trust them to be honest behind your back? Sometimes a sprinkle of sunshine will keep the cockroaches hidden.

Like I said above, if the PD is lukewarm, the OP will have a chance. If he's going to tell other PDs that the OP is a danger to patients and forced them to pull him off all medicine rotations, it's simply not going to happen. No residency is desperate enough to snatch up other programs headaches. So OP needs to feel out his PD.

For the poster, I really feel for you. I know it must be a terrible feeling to have worked so hard to get through medical school and then be told your not good enough for whatever reason, however there is always hope. Just because one program doesn't want you does not mean there is not another program for you.

Matching into a program is like marriage, first there's dating which is like the interview stage. Everybody has their best foot forward.
Once you match and began working then you might see and notice things you wish you had before you proposed. I would just say that your program was a poor fit for you.

Some things to do now to focus on the future. Work your butt off for the remaining 4-5 months you have left. Keep reading, keep asking questions. Your learning and taking excellent care of patients should be your top priority. This can only help you in the future. Attendings that you will work with in the future may hear rumors that you are this or that, but if they are smart and educated people they will know that always take someone's opinion with a grain of salt. Mike Tyson may be a bad man in some people eyes, but he may a great guy to others. It's just perspective and your experiences. Sorry, kinda having diarrhea of the mouth now.

2nd. Print out all your intern year evalutations and get a list from your program coordinator about the procedures that you have completed. This will prove helpful when you reapply for residency either as an intern or possibly find an open 2nd year spot.

3rd. In the end of the year you should have an exit interview where the program will discuss your performance. Did you meet all the ACGME core competencies and such. You will be asked to sign a form saying that you were present at this meeting and understood what was discussed. Get a copy of that form. It will prove invaluable to you if you try to get a 2nd year spot.

4th. I don't know if this is possible, but try try to show your PD that you are not incompetent and can work hard. Your PD's reccomendation carries it's weight in gold.

Good luck to you. Be positive and keep your head up. It may seem hopeless, but after great adversity there is always a time of ease. SDN provides some valuable advice and support so use them PRN.

Originally Posted by newdude2009

...Mike Tyson may be a bad man in some people eyes, but he may a great guy to others. It's just perspective and your experiences. Sorry, kinda having diarrhea of the mouth now...

Mike Tyson went to prison, and it's only recently, years later, that he has been reaccepted. A jury of his peers at the time found him to be a bad man. Guys like Kobe Bryant or Ben Rothlesberger, who were accused but never convicted are probably better examples. But this is assuming we even want to compare the OP with alleged rapists.

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.

However, you still have options.

1) Find an employer that does not care about board-eligibility. Urgent cares work for this. Also apply for PA positions.
2) Kiss up to your PD. Hey, you never know. Maybe he will magnanimously relent.
3) Wait for your PD to retire. Maybe the next guy will have more mercy.
4) Look at the non-clinical options.

I left my program because my PD told me point-blank that he would be searching for reasons to fire me the whole time I was there, simply because he didn't like me. I found a job at an urgent care in a much better city and couldn't be happier. If I had remained, I would have been the most miserable SOB on the planet. Good luck on your search.

Originally Posted by ForbiddenComma

However, you still have options.

1) Find an employer that does not care about board-eligibility. Urgent cares work for this. Also apply for PA positions.
2) Kiss up to your PD. Hey, you never know. Maybe he will magnanimously relent.
3) Wait for your PD to retire. Maybe the next guy will have more mercy.
4) Look at the non-clinical options.

I left my program because my PD told me point-blank that he would be searching for reasons to fire me the whole time I was there, simply because he didn't like me. I found a job at an urgent care in a much better city and couldn't be happier. If I had remained, I would have been the most miserable SOB on the planet. Good luck on your search.

I'm glad to hear that you found a successful way to cope with a terrible situation. Since questions about this type of situation show up on here fairly often and often the advice they get on here is pretty vague, I am curious to know more about how it was for you.
Was it hard for you to find places that were open to taking someone who had not finished residency? My impression from when this question has come up before has been that even urgent cares often want BC/BE people.
I also thought that docs were not allowed to work as PAs (even though I personally think that it would be justified for someone who didn't finish residency to be able to work under another doc's supervision as a PA). When you applied to PA positions, did the places give any indication of how it might work if they hired you instead of someone who had done PA school?

Originally Posted by peppy

Was it hard for you to find places that were open to taking someone who had not finished residency? My impression from when this question has come up before has been that even urgent cares often want BC/BE people.
I also thought that docs were not allowed to work as PAs (even though I personally think that it would be justified for someone who didn't finish residency to be able to work under another doc's supervision as a PA). When you applied to PA positions, did the places give any indication of how it might work if they hired you instead of someone who had done PA school?

Yes, not being BC/BE hurts as that is the first question asked. However, clinics and ERs hire moonlighting residents all the time, and they certainly have not passed their boards either.

Docs do not technically work as PAs, but working for PA salaries can be a good place to start. An MD with one-two years of residency has far more training and qualifications than a PA fresh out of school, after all... and the MD's charts do not have to be co-signed. Sure, many clinics will be like "OMG NOT BOARD CERTED??? " and you won't have a shot... but if you can get them to think about it logically, having an MD at PA prices saves them a hell of a lot of money. A board-certified ER doc is far, far more expensive than I am. Then, later on, you can ask for raises after you've proven yourself.

Finally, there is one very important class of people who could not care less about board eligibility: The patients. Not once has a patient asked me about board certification. They ask about my med school, sure... but not BC/BE.

[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.

QUOTE]

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!!!

Got my PD and ass't PD, as well as an attending to write letters for me. Granted, I have no idea what the contents of the letters will be! I still hope that they are on my side and essentially were forced by others to give me the boot. Scramble/SOAP is in a few days, fingers crossed. I am hopeful that I can get this career back on track. Maybe I'll even become enthusiastic about it again.

Originally Posted by sella turcica

Got my PD and ass't PD, as well as an attending to write letters for me. Granted, I have no idea what the contents of the letters will be! I still hope that they are on my side and essentially were forced by others to give me the boot. Scramble/SOAP is in a few days, fingers crossed. I am hopeful that I can get this career back on track. Maybe I'll even become enthusiastic about it again.

Good luck!

In the future, when I ask someone for a LOR I word it like, "Would you be comfortable
writing a positive letter of reference?"

Any hesitation on their part with an answer then move on to the next person.

The worst feeling in the word is not knowing if someone is writing a good or bad letter.
Less anxiety for you in this game is always better.

well, I scrambled for PGY1 positions but didn't match. I only applied to a few though, most of the programs were in really undesirable locations or had a bad rep. I would rather take a year off, take step 3 and just reapply the normal way. Thank god for IBR.

Please send me law firm who is good at taking care of such issues(familiar with residency contract and malignant programs). Thanks

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Originally Posted by jakstat

I'm in the same situation as the OP...except I was not informed of non renewal until a week and a half ago! Yeah way to screw me out of reapplying and scrambling.

My question should one approach the question when asked...Why did you leave your current program?

If you pick a different specialty or geographic region (or both) it's probably easier to say you simply realized you weren't on the path that would be most fulfilling, were too far away from family SO etc. If you stay in the same specialty, it's a hard question to answer because if you say something vague like personality conflicts or that a different program would be a better fit, they are going to probe deeper.

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Originally Posted by TheMan21

these types of threads always scare the crap out of me...it seems too easy to piss off the wrong people who can then turn around and completely derail your career.

Agreed. I cringe in horror at these threads.

Originally Posted by jakstat

I'm in the same situation as the OP...except I was not informed of non renewal until a week and a half ago! Yeah way to screw me out of reapplying and scrambling.

My question should one approach the question when asked...Why did you leave your current program?

What is your relationship like with the PD at this point? Any chance you can ask them if they would support you in saying that this specialty wasn't a good fit and that you might do better in a different specialty?
I'm definitely sorry that this happened to you. What a rotten thing to have to deal with. Hope things get better for you soon

Originally Posted by mercaptovizadeh

Agreed. I cringe in horror at these threads.

I used to think it was all about not hearing both sides of the story and that the resident was fairly warned and offered a chance to improve. The majority of the time I think that's the case, but I've learned that there really are people who get into trouble merely due to personality issues or a single error or a poor test score or any number of things that just get a resident targetted...and the resident may not know there's a problem until it's too late. It's sad.

My current PD is willing to support my effort to find another program in the same specialty. and yet he is the same one that thinks Im not a good fit in his program. Contradictory? I think admnistration and my PD handled my situation poorly. Even my chief resident thinks he failed me.

well today I found out I performed above average on the in service exam. hopefully that will help somewhat in my search.

Originally Posted by jakstat

My current PD is willing to support my effort to find another program in the same specialty. and yet he is the same one that thinks Im not a good fit in his program. Contradictory? I think admnistration and my PD handled my situation poorly. Even my chief resident thinks he failed me.

well today I found out I performed above average on the in service exam. hopefully that will help somewhat in my search.

Did they tell you why they refused to renew your contract? If your in-service scores were above average, clearly its not a knowledge deficit.

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Originally Posted by jakstat

my pd said he was "pleasantly surprised" I dont know how to take that...but the more I think about it, the more demeaning it sounds. I'm so tired of the medical field at this point...its pretty much wrecked my life

At least you have this exam, which will make it harder for the PD to lie in his letter and say you lacked knowledge (somehow all these fired residents are portrayed as dangers to themselves and others, who should never step into a hospital again - except perhaps its mental ward).

He'll have to fabricate something else, or just write some lukewarm "he was solid" letter, which shouldn't damn you from switching.

I think for most people who get fired, it would probably be easier to get a spot in a different specialty...perhaps hard for other program directors to swallow that you might do well at THEIR program if you got booted from a program in their particular specialty. For the psych resident who got booted due to bad internal medicine evaluations, it might help to make sure you know exactly why the IM people decided they didn't like you. Was it that they didn't think you had a good attitude, didn't think you were organized enough, didn't think you liked interacting with the patients? Did they think you didn't work hard enough? You have to know what the problem was before you can address it in future interviews (and endeavors).

Originally Posted by mercaptovizadeh

At least you have this exam, which will make it harder for the PD to lie in his letter and say you lacked knowledge (somehow all these fired residents are portrayed as dangers to themselves and others, who should never step into a hospital again - except perhaps its mental ward).

He'll have to fabricate something else, or just write some lukewarm "he was solid" letter, which shouldn't damn you from switching.

Actually quite a lot of residents who don't work out do fine on tests. I doubt this changes much.

Originally Posted by jakstat

my pd said he was "pleasantly surprised" I dont know how to take that...but the more I think about it, the more demeaning it sounds. I'm so tired of the medical field at this point...its pretty much wrecked my life

I find it demeaning as well. The scores work in your favor especially if you plan on working in the same field. I would say not to give up looking. Even if you did not find a spot in the scramble, search for off-cycle spots. Study for Step 3. Limit the amount of time your away from the clinical environment. Good luck.

I thought as the OP I would update this thread and ask a couple of questions.

I ended up listing just a couple of programs in the scramble and (big surprise) didn't scramble anywhere. I had personal reasons for this choice, and at the time it seemed very "rushed". Why make a bad decision on top of an already huge mess, right?

I also did not secure a PGY2 position for next year, but again that came down to a lot of factors - some of which were out of my control and some of which were under my control. I don't want to divulge any specifics about this on the internet because it wouldn't achieve anything and could only come back to haunt me.

I am currently planning to take Step 3, and I reside in a lenient state (ie: I can take Step three "whenever" in the process). So, I'm going to study for this, take it and beef up my credentials a bit. My medical school and some affiliated PDs are aware of my situation and I am making inroads there, in anticipation of reapplying for the June 2013 cycle. Yep, two years wasted. But what can you do...

Any thoughts on Step 3? I can't find any specific dates (such as the MCAT back in my day, which was given 2x per year) so I'm guessing that you can sign up for Step 3 at any time? Also, if you had tons of free time, how much would you spend studying for Step 3? I spent 4-5 weeks on step 1 and 2, made >220 on both.