Advice on Moving Forward

[pgy?]

Kids, don't do drugs.

Exactly

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[hyperalgesia]

Easier said then done. Erase three years to "just go back and do it right. " I am suffocating in debt and my credit score is probably dropping another point as I type this message so spending another two to four years as a resident without a specialists take home pay doesnt really even seem like a possibility. Luckily, Ive been able to get in the door of PI.

Maybe you could take the high road and do a non-categorical community-based prelim surgery year. Excel based on your experience, complete general surgery residency and become a bad-ass transplant surgeon. I would just not be happy in a situation where I am the least trained among my peers. It would get to me over time. But you have to do what you have to do.

 

[Yo GabbaPentin]

Simply put, if you continue to pursue anesthesia (the field you found yourself in trouble) or pain (a field dealing with highly controlled/addictive medications), then your past problem will haunt you severely for the rest of your career. Even with MVA work, word of your situation will get around to the attorneys and it will dry up. If you ever have a complication of any kind, the malpractice attorney will mop the floors with you. And of course, everyone is expecting insurance to eventually tie board certification to reimbursement.

If you want to move past this completely then I recommend an entirely new field. Yes it's a ****ty situation but you need to come to accept the fact that your decision to even initially try the meds in your anesthesia drawer has lead to a lost 2.5 years. The longer you try to salvage that time, the more time you waste.

There was an SDN member a few years ago who was an all star chief resident in anesthesia. He developed an addiction and transitioned into ED. Do a search and contact him. He's a great guy and I think he can help you.

Best of luck.

 

[Arch Guillotti]

There was an SDN member a few years ago who was an all star chief resident in anesthesia. He developed an addiction and transitioned into ED. Do a search and contact him. He's a great guy and I think he can help you.

I am pretty sure I know which member you are referring to. I thought he did IM and pulm/cc though.

 

[Apollyon]

There was an SDN member a few years ago who was an all star chief resident in anesthesia. He developed an addiction and transitioned into ED. Do a search and contact him. He's a great guy and I think he can help you.

Best of luck.

I am pretty sure I know which member you are referring to. I thought he did IM and pulm/cc though.

Yes, it was IM/CC/Pulm - not EM.

 

[Yo GabbaPentin]

I am pretty sure I know which member you are referring to. I thought he did IM and pulm/cc though.

Yeah you are right. My mistake. He is a great example of picking up the pieces and making the best of his situation.

 

[Stim4me]

This is why I would do a residency again to avoid problems down the line. I completed 4 years of MD school, chose the long hours of anesthesia, did over 1500 cases in residency, hundreds of epidurals, a hundred nerve blocks of varing types, hundreds of a lines, probably a hundred central lines and fifty PA catheters. I was in the top half to top third of anesthesia residents in the country in my board and in training exams I havent been taking shortcuts to pain (shortcuts to happiness sure but not professionally whatsoever) but now I am definitely being told to take the scenic route after breaking my leg (and hobbling on one for awhile) in the last mile of the marathon. Im going to see where Im at financially and the opportunities available before jumping into implanting spinal cord stims however after entering the real world now as a licensed MD I see PAs and ARNPs doing nerve blocks and epidurals and I imagine my training is more advanced then theirs.

I believe there are now 20,000,000 more insured patients on the docket after Obamacare has been enacted. I dont think that insurers are going to increase their training requirements for providers the way ABMS boards have increased requirements and training then again I could be very wrong and that is the risk I would have to be willing to take. Like I said Im applying to redo residency in another field but is doing a crappy residency in a field Im not interested in to possibly match into a pain fellowship worth it? Would a hospital be more likely to credential me to perform interventional pain procedures as an FP? Its not a cut and dry decision to just say hey Im gonna go back and do residency all over again.

Consider an icu fellowship out of anesthesia, if you like that stuff. You will have less access to medications. Pain and general anesthesia is not the way to go with a substance abuse history... I have seen general anesthesia residence overdose on fentanyl at my residency. And there Are a ton of pain medicine doctors getting into trouble with their stories well documented I the PAin Medicine journal that comes out weekly... Everybody should get a second chance but anesthesia and pain medicine are high risk burnout and substance abusers fields.... Good luck

 

[Stim4me]

it's the TRT...got me heated.
I only respond angrily when someone first attacks me rudely and in a manner unbefitting of a gentleman. Ban all or none. Respect man authoritey!
I do like contributing though. I benefit from reading these threads. So I am here to help.

Your response was appropriate... You were antagonized for no reason... This forum is composed of a small group of passive aggressive tools...

 

[pgy?]

more exposure and opportunity to divert drugs in an ICU than in an interventional pain clinic.

 

[hyperalgesia]

If I had a SA disorder in remission, I think my primary objective in life would be to prevent relapse. I would try to get something that doesn't require a DEA.

 

[Tenesma]

I find it hard that another anesthesia residency won't take u and just let u finish ur pgy4 year? I know 2 impaired docs who made the turn around and one of them is now successful doing 100% interventional.... so find a desperate residency director.somewhere in this country to finish that residency.

 

[Arch Guillotti]

Wayyy more exposure and opportunity to divert drugs in an ICU than in an interventional pain clinic.

How come?

 

[pgy?]

I find it hard that another anesthesia residency won't take u and just let u finish ur pgy4 year? I know 2 impaired docs who made the turn around and one of them is now successful doing 100% interventional.... so find a desperate residency director.somewhere in this country to finish that residency.

Would be the ideal but Im trying to be realistic. It just doesnt seem that way right now.

 

[pgy?]

How come?

Drips and Syringes left around. Sharps boxes. Not that I ever did that just saying its there more prevalently than a clinic.

 

[hyperalgesia]

I find it hard that another anesthesia residency won't take u and just let u finish ur pgy4 year? I know 2 impaired docs who made the turn around and one of them is now successful doing 100% interventional.... so find a desperate residency director.somewhere in this country to finish that residency.

I was thinking about this... I also know 2 guys with similar history. Both are attendings now, one in academics doing non-interventional, the other did accredited fellowship and is interventional. Neither was dismissed from residency but both came very close. I guess it depends on your program director.

 

[Stim4me]

How come?

I agree. Based on my year experience in the icu, I never hung a versed or fentanyl drip on an intubated patient. Nursing does that. Also majority of icu work is pulmonary, cards, neuro, post surgical care... Very stimulating and satisfying in my opinion.... In any case just a suggestion...

 

[ampaphb]

Have a good friend who runs the critical care program @ Jackson Memorial in Miami, if that would be helpful to u

 

[Yo GabbaPentin]

I was thinking about this... I also know 2 guys with similar history. Both are attendings now, one in academics doing non-interventional, the other did accredited fellowship and is interventional. Neither was dismissed from residency but both came very close. I guess it depends on your program director.

That's the key. Almost dismissed is a lot different than dismissed. Once you've been booted, it's close to impossible to ever get back in. I remember interviewing amazing candidates who were booted from other highly competitive specialties for utter nonsense reasons and our PD wanted nothing to do with them. I can imagine that from a PD's prospective in this case, the risk of relapse and potentially harm to the resident may not be worth the risk.

If you could actually get in to another program, I say go for it. The problem is that the chances are slim to none. Either way, just finish training in something.

 

[ampaphb]

That's the key. Almost dismissed is a lot different than dismissed. Once you've been booted, it's close to impossible to ever get back in. I remember interviewing amazing candidates who were booted from other highly competitive specialties for utter nonsense reasons and our PD wanted nothing to do with them. I can imagine that from a PD's prospective in this case, the risk of relapse and potentially harm to the resident may not be worth the risk.

If you could actually get in to another program, I say go for it. The problem is that the chances are slim to none. Either way, just finish training in something.

Couldn't agree more. Residents are terrified of program directors and chairmen blackballing them. As a result, they quietly accept their 'fate'. PD'S count on this passivity.

Wanna know what scares the crap out of PD's, chairmen, and university directors of GME? Lawyers. Never ever ever passively accept dismissal from a program without first consulting an attorney.

As Yo GabbaPentin said, once you have been dismissed, you have no leverage. PD's almost never dot all the i's and cross all the t's of required institutional rules. They assume if you did something wrong, you will just shrink meekly away, and wont put up a fight. Surprise them.

 

[pgy?]

That's the key. Almost dismissed is a lot different than dismissed. Once you've been booted, it's close to impossible to ever get back in. I remember interviewing amazing candidates who were booted from other highly competitive specialties for utter nonsense reasons and our PD wanted nothing to do with them. I can imagine that from a PD's prospective in this case, the risk of relapse and potentially harm to the resident may not be worth the risk.

If you could actually get in to another program, I say go for it. The problem is that the chances are slim to none. Either way, just finish training in something.

This is what Ive been told by the higher ups of other departments. Its still only been a year so maybe after two the environment would be less hostile towards me but Im not holding my breath.

Honestly the lawyers couldnt care less about certification. A lawyer is the one who introduced me to PI anyways. That being said I still give an honest, professional opinion of my exam findings and imaging findings and offer treatments I think appropriate. Which have solely been non narcotic med management up to this point. I see FPs are doing facets and epidurals...Im not saying its right Im just saying its what Ive seen in the real world.

PM me with info ampha por favor. Thanks.

 

[Aether2000]

Very difficult situation- in any case from the forum- best wishes for restarting your career.

 

[Ducttape]

im going to take the hard line. you need to go back and do a full residency, but not in anesthesiology and not in pain.
Pain is not in the workings for you. it doesnt matter how many epidurals or injections that you have done. it doesnt matter how many cases you have done. the stuff you did, is what the average anesthesiology resident does. no big whoop.
you have a problem, you should not ever expose yourself to the temptation or possibility of relapsing.
from your posts, you are feeling bad about what "they" did to you. you may be taking some of the responsibility for your past transgressions, clearly not the majority, and what you did is essentially the worst thing a resident could possibly do. they dont fire residents for just taking drugs or malpractice, for example...
from a statistical standpoint, your chances of not relapsing or dying in anesthesiology residency are dismally poor. some astronomical number of "clean" residents die before completing their residency.
go back and do a different residency. i would recommend psychiatry and addiction medicine. or maybe int medicine. your past work counts for nothing. you have to have a completely fresh start.

(and fyi, it doesnt matter how many more patients are on the docket - the restrictions on physician practice will only get tighter, especially as noctors take over the world)

 

[Aether2000]

Agree with Ducttape....I have had several residents in training programs that had recurrences of substance abuse in both anesthesia and pain programs....they were ultimately canned from the programs and never finished. They did residencies in other areas such as pathology.

 

[pgy?]

im going to take the hard line. you need to go back and do a full residency, but not in anesthesiology and not in pain.
Pain is not in the workings for you. it doesnt matter how many epidurals or injections that you have done. it doesnt matter how many cases you have done. the stuff you did, is what the average anesthesiology resident does. no big whoop.
you have a problem, you should not ever expose yourself to the temptation or possibility of relapsing.
from your posts, you are feeling bad about what "they" did to you. you may be taking some of the responsibility for your past transgressions, clearly not the majority, and what you did is essentially the worst thing a resident could possibly do. they dont fire residents for just taking drugs or malpractice, for example...
from a statistical standpoint, your chances of not relapsing or dying in anesthesiology residency are dismally poor. some astronomical number of "clean" residents die before completing their residency.
go back and do a different residency. i would recommend psychiatry and addiction medicine. or maybe int medicine. your past work counts for nothing. you have to have a completely fresh start.

(and fyi, it doesnt matter how many more patients are on the docket - the restrictions on physician practice will only get tighter, especially as noctors take over the world)

Ill address this commonly perpetuated anecdote. There have been SOME deaths amongst residents which I imagine is why most if not all residency programs would not allow me to finish. The monitoring program I am in which includes random hair testing and blood alcohol testing (can detect alcohol in blood up to a months use away) has nearly a 90% success rate of preventing relapse. This is a fact not a subjective anecdotal based statement.

I take responsibility for what I did and frankly its a little insulting to say that I havent because I still want to pursue a career in pain where the likelihood of handling narcotics is low. I am paying the price for my misdeeds and I accept that. I brought all the consequences of my actions upon myself.

I also dont see how the rise of arnps who will always have a degree considered by most to be inferior to that of an md will INCREASE requirements. I understand the point of needing more training to do interventions because I do but my training in anesthesiology does allow me to offer SOME tools in regards to interventional pain management.

I cant do the SIS as of now since Im not board certified it looks like but any other thoughts on further training would be appreciated.

And Ill reiterate I am still looking into redoing residency as its the most likely path for me.

 

[Aether2000]

Sounds like you have made up your own mind. I have no advice that would forward your cause.

 

[Jcm800]

Good luck. Remember the "biggest and most life altering" decisions, 15-20 or more years down the line may not seem that big. Not saying this decision isn't huge, it is. But think long haul. Now that you truly are in the first day of the rest of your life, think about the rest of your life.

My only advice is, you gotta work hard on finishing SOME residency. If not this year, maybe next, or the year after. You could end up setting yourself up to be stuck as PA like person if it all goes bad, and it seems like it will (healthcare)

There was a guy like this where I did anesthesia. His situation was very different, but bottom line, never finished residency, he basically was full-time break and lunch giver in the OR, and propfol giver if pain attending was present during procedures that needed sedation. All sedation where I was at was room air generals for these crazy pain patients...but I digress

 

[pgy?]

I have definitely not made up my mind about not finishing residency.

Most likey will if I get an opportunity.

I have made my mind up about pain.

 

[Ducttape]

• Abstract

Send to:


JAMA. 2013 Dec 4;310(21):2289-96. doi: 10.1001/jama.2013.281954.
Substance use disorder among anesthesiology residents, 1975-2009.
Warner DO1, Berge K, Sun H, Harman A, Hanson A, Schroeder DR.
Author information
Abstract
IMPORTANCE:
Substance use disorder (SUD) among anesthesiologists and other physicians poses serious risks to both physicians and patients. Formulation of policy and individual treatment plans is hampered by lack of data regarding the epidemiology and outcomes of physician SUD.

OBJECTIVE:
To describe the incidence and outcomes of SUD among anesthesiology residents.

DESIGN, SETTING, AND PARTICIPANTS:
Retrospective cohort study of physicians who began training in United States anesthesiology residency programs from July 1, 1975, to July 1, 2009, including 44,612 residents contributing 177,848 resident-years to analysis. Follow-up for incidence and relapse was to the end of training and December 31, 2010, respectively.

MAIN OUTCOMES AND MEASURES:
Cases of SUD (including initial SUD episode and any relapse, vital status and cause of death, and professional consequences of SUD) ascertained through training records of the American Board of Anesthesiology, including information from the Disciplinary Action Notification Service of the Federation of State Medical Boards and cause of death information from the National Death Index.

RESULTS:
Of the residents, 384 had evidence of SUD during training, with an overall incidence of 2.16 (95% CI, 1.95-2.39) per 1000 resident-years (2.68 [95% CI, 2.41-2.98] men and 0.65 [95% CI, 0.44-0.93] women per 1000 resident-years). During the study period, an initial rate increase was followed by a period of lower rates in 1996-2002, but the highest incidence has occurred since 2003 (2.87 [95% CI, 2.42-3.39] per 1000 resident-years). The most common substance category was intravenous opioids, followed by alcohol, marijuana or cocaine, anesthetics/hypnotics, and oral opioids. Twenty-eight individuals (7.3%; 95% CI, 4.9%-10.4%) died during the training period; all deaths were related to SUD. The Kaplan-Meier estimate of the cumulative proportion of survivors experiencing at least 1 relapse by 30 years after the initial episode (based on a median follow-up of 8.9 years [interquartile range, 5.0-18.8 years]) was 43% (95% CI, 34%-51%). Rates of relapse and death did not depend on the category of substance used. Relapse rates did not change over the study period.

CONCLUSIONS AND RELEVANCE:
Among anesthesiology residents entering primary training from 1975 to 2009, 0.86% had evidence of SUD during training. Risk of relapse over the follow-up period was high, indicating persistence of risk after training.

• Abstract

Send to:


J Clin Anesth. 2009 Nov;21(7):508-13. doi: 10.1016/j.jclinane.2008.12.026.
Should anesthesia residents with a history of substance abuse be allowed to continue training in clinical anesthesia? The results of a survey of anesthesia residency program directors.
Bryson EO1.
Author information
Abstract
STUDY OBJECTIVE:
To determine the experience, attitudes, and opinions of program directors regarding the reintroduction of residents in recovery from substance abuse into the clinical practice of anesthesiology.

DESIGN:
Survey instrument.

SETTING:
Anesthesia residency training programs in the United States.

MEASUREMENTS:
After obtaining institutional review board approval, a list of current academic anesthesia residency programs in the United States was compiled. A survey was mailed to 131 program directors along with a self-addressed stamped return envelope to ensure anonymity. Returned surveys were reviewed and data compiled by hand, with categorical variables described as frequency and percentages.

MAIN RESULTS:
A total of 91 (69%) surveys were returned, representing experience with 11,293 residents over the ten-year period from July of 1997 through June of 2007. Fifty-six (62%) program directors reported experience with at least one resident requiring treatment for substance abuse. For residents allowed to continue with anesthesia residency training after treatment, the relapse rate was 29%. For those residents, death was the initial presentation of relapse in 10% of the reported cases. 43% of the program directors surveyed believe residents in recovery from addiction should be allowed to attempt re-entry while 30% believe that residents in recovery from addiction should not.

CONCLUSIONS:
The practice of allowing residents who have undergone treatment for substance abuse to return to their training program in clinical anesthesia remains highly controversial. They are often lost to follow-up, making it difficult, if not impossible to determine if re-training in a different medical specialty decreases their risk for relapse. A comprehensive assessment of the outcomes associated with alternatives to re-entry into clinical anesthesia training programs is needed.

there are no studies in pubmed to suggest that random testing, hair testing, etc reduces the risk of recidivism. and death being the initial presentation in 10% is considerable.

at least, 43% of program directors think addicted residents should be allowed re-entry.

your posts continuously point out that you are not ready. if i were a residency director, reading your posts, i can almost taste that you blame the system, and are not accepting your own responsibility for your own actions, and have not and are not going to be able to move on. addicted residents can finish an anesthesiology program and be successful attendings, but the ones that i personally know have a much different mindset than you are exhibiting.

i can only pray that you do not harm any patients on your way to an overdose.


fyi i handle narcotic prescriptions every day, typically 2-3 times a day. and i believe i am a low opioid prescriber. also, addicts find a way. pill counts: "oh ma'am, you are short a couple, but its okay". procedural sedation: "IV fentanyl for sedation for the procedure, lets use a multidose vial"; "ill push the versed"; "just throw that waste in the big sharps bucket. where did i put that clamp?" pill mill: "ill write for extra pills if you give me a few". shared 'decision-making': "midlevel, its your turn to write our script" (true story, one PCP and his NP were co-prescribing and didnt think they would get caught).

its not hard. and im not an addict...

 

[pgy?]

"from a statistical standpoint, your chances of not relapsing or dying in anesthesiology residency are dismally poor. some astronomical number of "clean" residents die before completing theirresidency."

Appreciate the study as it shows a survey of PDs demonstrating relapse amongst residents allowed to return. I shouldnt have said theres no chance of me relapsing because the risk is always there and 10% do relapse in the program I am in. I would like to see what substance they relapsed on, what kind of monitoring program they were on, what was their drug of choice, and more specific data to see where I would fit.

Aside from your ad hominems and logical fallacies I appreciate the study. Ill take the high road with your insults.

 

[Silent Cool]

I was wondering if I could get some advice. I am currently a PGY4 anesthesiology resident however I am being asked to resign due to issues with substance abuse. I plan(ned) on a career in pain and was considering applying for non accredited pain fellowships. Do you believe this would be an issue in regards to practice, credentialing, and reimbursements? I have always planned on pain and am considering all options at this point. I was originally interested in pain through PMR and have an interest in PMR. Is FP an option to go into pain? Any advice would be greatly appreciated.
.

What substance are we talking about?

 

[lobelsteve]

What substance are we talking about?.

Is it important? Its the patient, not the drug.

 

[Aether2000]

The only case I can think of where a controlled substance being abused or inappropriately taken and maybe have less impact later on with residency would be marijuana in states where the laws are evolving.

 

[pgy?]

Treatment taught us that it really doesnt matter what the substance (or even behavior is). The problem is not the drug, its us. "Alcohol is but a symptom..." There were alcoholics at the treatment center I was at who were in the same program but relapsed on alcohol. There was a pothead at the treatment center I was at who relapsed on alcohol and mj. Personally Im more of an alcoholic than anything else (not trying to rationalize its just whats always been there and what I actually miss using). If the substance has made your life unmanageable then thats the problem. We all have similar basic personality traits...egomaniacs with an inferiority complex...so I think if a substance causes a problem for you (me) then it needs to be taken out of the equation before recovery can occur.

And even though theopinions of me that people on this board have of me arereally none of my business I do want to make it clear I do accept the consequemces of my actions and know that the decisions made on my fate were a dorect result of my actions and what they thought would be best. It sucks losing nearly everything and having to start from the bottom up but thats the way it was meant to be.

 

[Doctodd]

Your response was appropriate... You were antagonized for no reason... This forum is composed of a small group of passive aggressive tools...

I agree too.....but the TRT levels need to be checked.

 

[Jcm800]

Treatment taught us that it really doesnt matter what the substance (or even behavior is). The problem is not the drug, its us. "Alcohol is but a symptom..." There were alcoholics at the treatment center I was at who were in the same program but relapsed on alcohol. There was a pothead at the treatment center I was at who relapsed on alcohol and mj. Personally Im more of an alcoholic than anything else (not trying to rationalize its just whats always been there and what I actually miss using). If the substance has made your life unmanageable then thats the problem. We all have similar basic personality traits...egomaniacs with an inferiority complex...so I think if a substance causes a problem for you (me) then it needs to be taken out of the equation before recovery can occur.

And even though theopinions of me that people on this board have of me arereally none of my business I do want to make it clear I do accept the consequemces of my actions and know that the decisions made on my fate were a dorect result of my actions and what they thought would be best. It sucks losing nearly everything and having to start from the bottom up but thats the way it was meant to be.

i dont think anyone means to be hating on you. we are not in your shows. and i think anyone who takes the time to post a response on this thread genuinely hopes you make it and it works out for you. internet lacks tact, and things often come off sounding different than intended. so take away the positives and dont sweat the perceived negatives. everyone is pulling for you.

 

[emd123]

Treatment taught us that it really doesnt matter what the substance (or even behavior is). The problem is not the drug, its us. "Alcohol is but a symptom..." There were alcoholics at the treatment center I was at who were in the same program but relapsed on alcohol. There was a pothead at the treatment center I was at who relapsed on alcohol and mj. Personally Im more of an alcoholic than anything else (not trying to rationalize its just whats always been there and what I actually miss using). If the substance has made your life unmanageable then thats the problem. We all have similar basic personality traits...egomaniacs with an inferiority complex...so I think if a substance causes a problem for you (me) then it needs to be taken out of the equation before recovery can occur.

And even though theopinions of me that people on this board have of me arereally none of my business I do want to make it clear I do accept the consequemces of my actions and know that the decisions made on my fate were a dorect result of my actions and what they thought would be best. It sucks losing nearly everything and having to start from the bottom up but thats the way it was meant to be.

Stay sober and the test will take care of itself.

 

[ferning]

Do occupational medicine, it should just be 1-2 years and u can get a head start by taking mph credits that transfer

Job market is the hottest right now and will be good for awhile. Lots of extra work too reviewing disability claims. The va can pay u FT for this and u just need a medical license in 1 state

Enter a physician monitoring program asap, which i belive is confidential and internal program of state licensing boards, u get one chance in these programs and can still practice without a blemished record after. Only 1 chance though

Change jobs, move and go inpatient even if u dont need it to show ur committment and put peoples minds at ease afterwards

But u are clearly not thinking clearly if u think pain medicine is still something for u to pursue. Opiates are not something the mind can unsee, the substance absolutely matters. Quitting alcohol is somethig many people do without formal interventions or help, narcotic addiction not so much. Relapse rate has to be worse than any other drugs, ur anecdotal evidence aside

 

[pgy?]

One year later...been sober 2 plus years now. Applied to over 300 residencies in neurology, pmr and fm ended up getting two interviews. Advice from PD was to do research and try to get an academic to vouch for me. Loans were too much of a burden for me to do this

Seeing patients at a couple of drug addiction treatment centers. Opened my own practice. Prescribe narcs about 1/10 patients. Never more than a few Percocets. Super successful practice so far. Taken a few injection courses and shadowed PMR pain guy. Got new letters of rec still little success in getting interviews. Basically unemployable due to what Ive done in the past but life goes on and is pretty damn good.

 

[drusso]

One year later...been sober 2 plus years now. Applied to over 300 residencies in neurology, pmr and fm ended up getting two interviews. Advice from PD was to do research and try to get an academic to vouch for me. Loans were too much of a burden for me to do this

Seeing patients at a couple of drug addiction treatment centers. Opened my own practice. Prescribe narcs about 1/10 patients. Never more than a few Percocets. Super successful practice so far. Taken a few injection courses and shadowed PMR pain guy. Got new letters of rec still little success in getting interviews. Basically unemployable due to what Ive done in the past but life goes on and is pretty damn good.

Congratulations on your continued recovery!

 

[Stim4me]

Good work on recovery. Can you practice/prescribe without a residency??
Why not try for pathology, IM, or occ Med residency first, then stage a come back ?!

 

[willabeast]

the person in my anesthesiology residency who arguably got the best job immediately after residency while i was there almost killed himself with self injected anesthetic medications during his residency. part of his rehab was volunteer work at a really good hospital - where he was hired when he left residency . but...the residency attending staff really really liked this guy. not sure how this helps the discussion, but i love life's ironic moments. you might check this article out.
https://umms-pac.org/pdf/Reasons_to_hire_recovered physicians.pdf

 

[pgy?]

Good work on recovery. Can you practice/prescribe without a residency??
Why not try for pathology, IM, or occ Med residency first, then stage a come back ?!

Yes can practice and prescribe with 3 years of residency. No dice with IM or occ med either...very frustrating getting rejections daily from programs that wouldve taken me four years ago so I just focus on the positive and the succes Im having practicing my own way!

 

[melancholy]

Good work on recovery. Can you practice/prescribe without a residency??
Why not try for pathology, IM, or occ Med residency first, then stage a come back ?!

I thought you could practice as a GP in a private practice after one year of internship? It is likely not relevant in your case, but coming from a DO background, I had some colleagues who specialized strictly in OMT practices and would open up shop after internship. Of course, in their case they were able to find sufficient demand for the service and people willing to pay cash or willing to try and get partial reimbursement from their insurance companies for it. Any interests in some sort of integrative medicine practice?

Here's the article I randomly pulled up about the practicing after internship question.

http://thedo.osteopathic.org/2014/02/practicing-after-one-year-of-gme-is-it-feasible-should-it-be/

 

[DrCommonSense]

I'd like to see you talk that way to my face. You little internet troll piece of trash. My comments to him were meant to be caring and sweet because that's what he needs. I said literally that he could come back after taking a year off and get into medicine...even pain. Let alone five years as you stated. Dumb ass.

Huge risk of relapse without taking some serious introspection first. Even with it, the risk is high but I wouldn't deny him his dream on some silly post of mine. My advice is fairly impartial..I'm not taking a huge stance..

Damn son, Papa Lou don't play!

 

[DrCommonSense]

That's the key. Almost dismissed is a lot different than dismissed. Once you've been booted, it's close to impossible to ever get back in. I remember interviewing amazing candidates who were booted from other highly competitive specialties for utter nonsense reasons and our PD wanted nothing to do with them. I can imagine that from a PD's prospective in this case, the risk of relapse and potentially harm to the resident may not be worth the risk.

If you could actually get in to another program, I say go for it. The problem is that the chances are slim to none. Either way, just finish training in something.

Wow that shows you how screwed up medicine is in general that good residents from highly competitive specialties can be booted for trivial reasons and are unable to obtain other residency positions.