Matched But Not Hired by Hospital??

[Quebec Queen]

I matched in 2009 for a residency program, thought I had an overall OK application, but wasn't hired by the hospital after I was asked to be interviewed after the match by a psychiatrist associated with hospital . . . wasn't really given a specific reason, just a form letter, . . .

If I apply again for a residency position, I don't know what I am supposed to say why I wasn't hired? Is this the kiss of death i.e. am I black balled forever?

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[synapse lapse]

I think everyone probably needs a little more information... I have never heard of something like this, why would you be asked to see a psychiatrist? What could you possibly say to the psychiatrist to stop yourself from being hired post match?

 

[WhoisJohnGalt]

I think everyone probably needs a little more information... I have never heard of something like this, why would you be asked to see a psychiatrist? What could you possibly say to the psychiatrist to stop yourself from being hired post match?

We all know there's more to the story, and if you want useful advice you're going to have to spill it.

 

[Blesbok]

We all know there's more to the story, and if you want useful advice you're going to have to spill it.

:werd:

The match is a contract and they are going to have a hell of a time getting out of it without a legit reason. They also don't exactly ask people to see shrinks on a regular basis after they have matched.

I am going to venture to guess that the OP has a chronic psych condition that they didn't feel was stable enough to allow them to treat patients at that hospital, but again I am just guessing.

The match isn't something taken lightly by programs as doing something like this without a damn good reason would get them a lot of unnecessary trouble in the future.

 

[NotAProgDirector]

The match is binding upon both parties. However, the match commitment is worded thus:

5.1 Match Commitment

The listing of an applicant by a program on its certified rank order list or of a program by an applicant on the applicant's certified rank order list establishes a binding commitment to offer or to accept an appointment if a match results and to begin training on the date specified in the appointment contract. The binding commitment may be released only through the waiver procedures set forth in Sections 2.5 and 3.4 of this Agreement. Each such appointment is subject to the official policies of the appointing institution in effect on the date the program submits its rank order list and is contingent upon the matching applicant meeting all eligibility requirements imposed by those policies. Those requirements must be communicated to applicants in writing prior to the rank order list certification deadline. It is recommended that each program obtain a signed acknowledgement of such communication from each applicant who interviews with such program.

So, it is quite possible (but rare) to match into a program where you do not meet their employment policies. An example of this would be failing a drug test -- if you're told that being employed by a program involves passing a drug test, you match there, and then fail the test, you do not get hired (and it's not a match violation for the program.

Almost everyone's employment policies include a statement like: "You must have all licenses/certifications, be physically present, and be medically fit to perform the job starting on xxx". So, failing the boards or not getting licensed would all be reasons to negate a match.

The "Medically fit" is the tough one. I assume that's what happened here -- they sent you a letter saying you were not medically fit. You can try to fight this -- either with internal reviews or in court -- if you think it is unfair.

Programs will certainly want to know the details, mainly looking to see if the issue is resolved (or was made into a bigger deal than it really is). You can simply state that "I was considered medically unfit to start work, but that issue has now resolved and will no longer be a problem" but I expect many PD's will not be interested, worried that you might not be telling the whole truth.

 

[madtown93]

The match is binding upon both parties. However, the match commitment is worded thus:



So, it is quite possible (but rare) to match into a program where you do not meet their employment policies. An example of this would be failing a drug test -- if you're told that being employed by a program involves passing a drug test, you match there, and then fail the test, you do not get hired (and it's not a match violation for the program.

Almost everyone's employment policies include a statement like: "You must have all licenses/certifications, be physically present, and be medically fit to perform the job starting on xxx". So, failing the boards or not getting licensed would all be reasons to negate a match.

The "Medically fit" is the tough one. I assume that's what happened here -- they sent you a letter saying you were not medically fit. You can try to fight this -- either with internal reviews or in court -- if you think it is unfair.

Programs will certainly want to know the details, mainly looking to see if the issue is resolved (or was made into a bigger deal than it really is). You can simply state that "I was considered medically unfit to start work, but that issue has now resolved and will no longer be a problem" but I expect many PD's will not be interested, worried that you might not be telling the whole truth.

I'm in a similar situation as Quebec Queen. I matched this year into a program with good scores and a resume, but was then withdrawn from the the program recently because I did not pass the pre-employment health screening. At this point, they stated that they will send a waiver to the NRMP describing the circumstances, which at that point the NRMP will go through an "investigation" and ask for details from me and the program. I was reading the NRMP policies and from what I understood, if it is found that the applicant has violated the match policy, it is possible to either have no ban, 1-3 year ban, or a permanent ban from participating in NRMP match system. I'm really freaking out about this and I'm not quite sure how the NRMP will "punish" me or if this situation is even punishable. Please, any feedback would be wonderful as I'm in a desperate situation. Everything else looks good on paper, it's just this one particular situation.

 

[rokshana]

I'm in a similar situation as Quebec Queen. I matched this year into a program with good scores and a resume, but was then withdrawn from the the program recently because I did not pass the pre-employment health screening. At this point, they stated that they will send a waiver to the NRMP describing the circumstances, which at that point the NRMP will go through an "investigation" and ask for details from me and the program. I was reading the NRMP policies and from what I understood, if it is found that the applicant has violated the match policy, it is possible to either have no ban, 1-3 year ban, or a permanent ban from participating in NRMP match system. I'm really freaking out about this and I'm not quite sure how the NRMP will "punish" me or if this situation is even punishable. Please, any feedback would be wonderful as I'm in a desperate situation. Everything else looks good on paper, it's just this one particular situation.

and that would be?

 

[madtown93]

and that would be?

Well I don't want to go into details but whatever happened the program has a zero tolerance policy for it. I'm an IMG, Step 1 235, Step 2 229, Step 2CS Pass, passed everything on first time.

 

[dozitgetchahi]

Uh, so drugs I'm assuming?

I don't understand why people come on here and ask for advice while giving out little tidbits of information and expecting everyone to guess. Nobody is going to be able to dispense useful info without at least a bare minimum amount of details.

 

[calvnandhobbs68]

I guess the main point would be, sorry you're so dumb that you couldn't figure out not to smoke the gangja or do a line of coke before your pre-employment screening.

 

[Doctor Bob]

I don't understand why people come on here and ask for advice while giving out little tidbits of information and expecting everyone to guess. Nobody is going to be able to dispense useful info without at least a bare minimum amount of details.

It's better this way. Then we can make up whatever backstory we want.

We can't give any useful information, but we can imagine a much more interesting story...

 

[madtown93]

It was a hair test, which can go back months.

 

[rokshana]

Well I don't want to go into details but whatever happened the program has a zero tolerance policy for it. I'm an IMG, Step 1 235, Step 2 229, Step 2CS Pass, passed everything on first time.

and was smokin' a little weed worth throwing all of that hard work down the toilet?

next time, get a hair cut before the test....

sorry, but you are not going to get much sympathy here about that...maybe you can talk to them and see if they will allow you to go to rehab to prove that you aren't doing drugs anymore, but programs usually are not so forgiving if you aren't part of the program...if you were already a resident, then they would look to rehabilitate you.

 

[Raryn]

It was a hair test, which can go back months.

I recommend shaving your entire body next time, even your eyebrows. Pluck the eyelashes out.

Either that, or you know, avoid doing drugs. Even in Colorado, where it is ostensibly legal, marijuana is enough for the licensing board to pull a physicians license.

 

[NotAProgDirector]

I am amazed that programs are doing hair tests. They are not terribly accurate, and theoretically can sense use months ago, which won't have any clinical significance.

In any case, what's done is done. The "good" news here is that you won't get a ban. The NRMP will simply waive your match. You can search of an out-of-match position to start sometime this year (if you can find one), or you'll apply again next year. Either way, programs will want to know what happened to cause the problem this year, and the best advice is to be honest.

 

[IlDestriero]

 

[deleted480308]

I am amazed that programs are doing hair tests. They are not terribly accurate, and theoretically can sense use months ago, which won't have any clinical significance.

In any case, what's done is done. The "good" news here is that you won't get a ban. The NRMP will simply waive your match. You can search of an out-of-match position to start sometime this year (if you can find one), or you'll apply again next year. Either way, programs will want to know what happened to cause the problem this year, and the best advice is to be honest.

Well, be honest and stop doing drugs and get a hair cut

 

[madtown93]

I am amazed that programs are doing hair tests. They are not terribly accurate, and theoretically can sense use months ago, which won't have any clinical significance.

In any case, what's done is done. The "good" news here is that you won't get a ban. The NRMP will simply waive your match. You can search of an out-of-match position to start sometime this year (if you can find one), or you'll apply again next year. Either way, programs will want to know what happened to cause the problem this year, and the best advice is to be honest.

Thank you aProgDirector for being honest and not scolding/criticizing me about the situation. Yes I do understand that I shouldn't have made certain mistakes and should've used my better judgement to foresee the potential consequences, but yes what's done is done and I will definitely not make that mistake twice.

But my question is, what guarantee is it that the NRMP will simply grant the waiver? I mean, technically by me not joining the program isn't that still a match violation because of the fact that it's considered legally binding? Basically, I know the NRMP evaluates waivers on a case by case basis, so is my particular situation grounds enough to just grant the waiver instead of banning me for 1-3 years? I really hope so...

Thanks again for replying, this was really stressful situation and has caused a lot of pain for a lot of people I know. I'm an idiot, but what happened is not a reflection of who I am as a person or will be as a physician.

 

[gutonc]

But my question is, what guarantee is it that the NRMP will simply grant the waiver? I mean, technically by me not joining the program isn't that still a match violation because of the fact that it's considered legally binding? Basically, I know the NRMP evaluates waivers on a case by case basis, so is my particular situation grounds enough to just grant the waiver instead of banning me for 1-3 years? I really hope so...

They will grant the waiver (which is automatic in this case) to the program, not you, because the fine print of the Match agreement says the program can get a waiver if you don't meet it's employment requirements. You will not see any Match waiver/violation consequences from this. Which is good, because you have enough consequences to deal with unfortunately.

 

[madtown93]

Okay that being said, what are the best steps going forward in regards to this? Academically, I have all the right scores (although I'm an IMG), and Im applying to IM, passed everything on my first try, had 13 interviews this year, and I'm a US citizen.

 

[madtown93]

Step 1 : 235
Step 2ck: 229
Step 2CS: Passed on first attempt

 

[NotAProgDirector]

You can try to find a position this year. Your spot is open now, so perhaps there are others. There's no central list, so it involves lots of work on your part to find any open positions.

If not, then start getting ready for the upcoming match. New letters, etc.

This all assumes you've made the one clear choice that needs to be made: That MJ no longer has any role in your life.

 

[madtown93]

You can try to find a position this year. Your spot is open now, so perhaps there are others. There's no central list, so it involves lots of work on your part to find any open positions.

If not, then start getting ready for the upcoming match. New letters, etc.

This all assumes you've made the one clear choice that needs to be made: That MJ no longer has any role in your life.

So far I've been e-mailing a lot of programs to see if they have any vacancies. I'm not really counting on this to work but I know it won't hurt to try. I'm mainly banking on applying to next year's cycle as the worst case scenario. I have a question though for my year between now and next June/July. There are two options, I can either:

1. Find research (paid or unpaid) and get my name published on a couple of papers (and possibly take Step 3 sometime before June/July)?

2. Work for a EMR company as a clinical project manager (clinical implementation) for a pretty well known company, for the next year?

The one difference between these two is that one involves exposure to clinical research even though I won't be interacting with patients and the other involves working with physicians and hospital administration to improve EMR platforms. I have an interview coming up for option #2. What would impress programs more during my year off? I feel like everyone does research and it's not very unique but at the same time option #2 doesn't necessarily keep me exposed to raw medicine everyday (and plus I don't think I'll have time to even study or Step 3 with this option). Thanks for all your help so far.

 

[gutonc]

So far I've been e-mailing a lot of programs to see if they have any vacancies. I'm not really counting on this to work but I know it won't hurt to try. I'm mainly banking on applying to next year's cycle as the worst case scenario. I have a question though for my year between now and next June/July. There are two options, I can either:

1. Find research (paid or unpaid) and get my name published on a couple of papers (and possibly take Step 3 sometime before June/July)?

2. Work for a EMR company as a clinical project manager (clinical implementation) for a pretty well known company, for the next year?

The one difference between these two is that one involves exposure to clinical research even though I won't be interacting with patients and the other involves working with physicians and hospital administration to improve EMR platforms. I have an interview coming up for option #2. What would impress programs more during my year off? I feel like everyone does research and it's not very unique but at the same time option #2 doesn't necessarily keep me exposed to raw medicine everyday (and plus I don't think I'll have time to even study or Step 3 with this option). Thanks for all your help so far.

Option 1 would be nice if you had a guarantee of publications. Which you don't. I'd take Option 2 in a hot second.

And you need about 45 minutes to study for Step 3.

 

[IlDestriero]

It's 2 months, 2 weeks, #2 pencil. And with the computer testing, you don't even need the pencil.

 

[NotAProgDirector]

If you do the EMR gig, then make sure you do something else that gives you some patient contact. Volunteer somewhere, or shadow a doc. or see if you can shadow clinical work where you're doing your EMR work.

 

[madtown93]

If you do the EMR gig, then make sure you do something else that gives you some patient contact. Volunteer somewhere, or shadow a doc. or see if you can shadow clinical work where you're doing your EMR work.

Okay that sounds good. The one issue is that if I take this EMR position, I will be in the hospital working with administration, but I don't think I won't be exposed to raw medicine, but I think the fact that medicine is moving more towards a business these days, so understanding the operational efficiencies of a hospital will only help me in the future. Any thoughts?

 

[madtown93]

**will be exposed to raw medicine

 

[madtown93]

Also, given my situation, how do I answer this ERAS question:

Is there anything in your past history that would limit your ability to be licensed or would limit your ability to receive hospital privileges? *

 

[madtown93]

Also, a few additional question in regards to the NRMP waiver:

Since I'll be applying for the next cycle, what exactly will the NRMP disclose to programs that I rank? Will they just state that a waiver was issued but not state the reason? Or will they state whatever the reason that was written on the waiver? I'm assuming the program can contact the NRMP and ask what the reason was for the waiver?

 

[NotAProgDirector]

Also, given my situation, how do I answer this ERAS question:

Is there anything in your past history that would limit your ability to be licensed or would limit your ability to receive hospital privileges? *

I think the answer to this is "no". You failed a drug test as part of a pre-employment screen. Thus you were simply not hired. Your next employer won't be privy to these results, and you'll get a clean slate. Same for medical licensing, this isn't reportable since you were not terminated.

Also, a few additional question in regards to the NRMP waiver:

Since I'll be applying for the next cycle, what exactly will the NRMP disclose to programs that I rank? Will they just state that a waiver was issued but not state the reason? Or will they state whatever the reason that was written on the waiver? I'm assuming the program can contact the NRMP and ask what the reason was for the waiver?

All that is reported is that you were granted a waiver. And the NRMP won't tell us anything -- we would need to look up in the NRMP system your history, which some PD's will do.

 

[madtown93]

I think the answer to this is "no". You failed a drug test as part of a pre-employment screen. Thus you were simply not hired. Your next employer won't be privy to these results, and you'll get a clean slate. Same for medical licensing, this isn't reportable since you were not terminated.

All that is reported is that you were granted a waiver. And the NRMP won't tell us anything -- we would need to look up in the NRMP system your history, which some PD's will do.

Okay, so I spoke with the NRMP and yes all that a program will see is that I was granted a waiver, but the specifics of why the waiver was granted will not be shown. Since I matched in 2015, it's possible that PD's can contact the program I matched into and find out more details, correct?

Do PD's bother to do this? I guess it may depend on what kind of program it is and how many applications they receive. The reason why I'm asking is because I'd rather get an interview first and explain myself in person rather than not getting an interview because the PD contacted my previous program, but I guess that's something I can't really avoid. Any thoughts/advice on this?

 

[NotAProgDirector]

You can completely avoid the problem, by talking about it in your application.

There's no perfect strategy here. If you put it in your application, every one knows about it. Some may decline to interview you over it. If you don't, some people may not check your NRMP match history, and if you don't mention it they may never notice.

Which scenario would you rather live with?

 

[madtown93]

You can completely avoid the problem, by talking about it in your application.

There's no perfect strategy here. If you put it in your application, every one knows about it. Some may decline to interview you over it. If you don't, some people may not check your NRMP match history, and if you don't mention it they may never notice.

Which scenario would you rather live with?

This is on eras:

"Please add an entry for any current or prior D.O. Internship, D.O. Residency, D.O. Fellowship, M.D. Residency or M.D. Fellowship in which you have trained, regardless of the length of time spent in the training. After completing the required fields, click Save. Additional entries may be added as needed."

But the fact is I never even started the residency even though I matched. I didn't even start the orientation, so there was never even a start or end date to mention. Therefore I shouldn't have to even mention it right? Besides, they'll see on my applicant match history that I received a waiver

 

[gutonc]

This is on eras:

"Please add an entry for any current or prior D.O. Internship, D.O. Residency, D.O. Fellowship, M.D. Residency or M.D. Fellowship in which you have trained, regardless of the length of time spent in the training. After completing the required fields, click Save. Additional entries may be added as needed."

But the fact is I never even started the residency even though I matched. I didn't even start the orientation, so there was never even a start or end date to mention. Therefore I shouldn't have to even mention it right? Besides, they'll see on my applicant match history that I received a waiver

You are really wound up about this and need to chill out a little bit. I get that this situation sucks, but you're not making it any easier on yourself.

No, you have never done any PG training so you can safely answer this question "no".

 

[madtown93]

In your experience, what is the typical match success rate of a reapplicant? (I feel like my situation is slightly different since I already matched, or does that not even matter?)

 

[gutonc]

I think we should stop answering your questions, because every time we do, you come up with some other crazy, or essentially unanswerable question.

 

[madtown93]

okay fair enough, Thanks for your help so far.

 

[NotAProgDirector]

n=1 but I had this exact thing happen to one of my matched interns a few years ago. Matched with us, failed her drug test. Waived the match. She matched just fine the next year. YMMV.

 

[IlDestriero]

In your experience, what is the typical match success rate of a reapplicant? (I feel like my situation is slightly different since I already matched, or does that not even matter?)

This will likely come up at all the interviews and may keep you from matching so if this happened to me, I would do one of the following.
Go see a professional that you can reference that as proof of wanting to change your lifestyle. Maybe volunteer for the year with anti drug groups, free clinic, DARE, etc.
Fabricate an elaborate trip to Amsterdam, etc. and hope they look the other way after assuring them it was a situational thing. "I was in the red light district and one of the two prostitutes said that pot made her horny, so I said what the hell and bought a few buds. It was quite a party." Maybe not...
If it was anything other than marijuana, I wouldn't admit to that. Hard drugs and prescription drug abuse are much harder to forgive. Failing a brethalyzer, etc at pre screening would need something like rehab and AA, in my opinion.
They won't have access to your records and I would never release them either.

 

[madtown93]

aProgDirector and IlDestriero, thanks for the feedback. I know I may be asking some ridiculous questions but I definitely appreciate you guys giving me advice about this.

When you say to go see a "professional" that can vouch for me, what kind of professional are you referring to? Like a drug/addiction counselor or something?

Also, this is slightly related and more directed at aProgDirector: During this year off, I decided I'm going to take Step 3 and the goal is to not just simply pass but to do really well. How much weight does that have with program directors that I finished Step 3? Does it really matter at all?

 

[Doctor Bob]

During this year off, I decided I'm going to take Step 3 and the goal is to not just simply pass but to do really well. How much weight does that have with program directors that I finished Step 3? Does it really matter at all?

I'm sure it's program dependent, but the programs I've been with have viewed step 3 as "passed" or "didn't pass". The actual score has been irrelevant.

 

[NotAProgDirector]

I agree that "scoring well" on Step 3 won't have much of an impact. But it might be worth getting it out of the way. And scoring well can't hurt. Not scoring well can hurt, though.

 

[madtown93]

Question: If I'm thinking about applying to FM as a backup and I have no FM LORs but I have 3 IM LORs (1 of them is a sub-I LOR), how would FM programs respond to this? I keep hearing that it just depends on the program, some require atleast 1 FM LOR whereas other FM programs don't even look at who wrote the LOR.