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FirstMANdown

FirstMANdown

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Howdy all,

I am in a real predicament, I graduated as an AMG with mediocre credentials in 2005 on a 6 year road. I did reasonably well during my 3rd and 4th year clerck ships. I spent a year off studying and passing step 2 ck/cs :oops: and then was able to scramble into a middle of no where family program in the Midwest. However, things have not been working well for me. This program has a lot of politicking and although the benefits are nice the mentoring from the attending staff is very harsh and meticulous. every year 1 to 2 residents drop out of this program for official "personnel issues". But now it seems I am the whipping boy this year. out of 12 residents I am 1 of only 2 AMG's in the program and the odd thing is all the attending faculty are all AMG's too. The sad thing is that I have been working very hard in this program for the past 6 months now(since June 2006) and right from the beginning they failed me in my second month (1st month being orientation) then failed me in my 3rd month saying that there is "Academic" concerns although I have not failed any standardized tests as of yet and getting positive feedback from the third years and other attendings. my fourth and fifth month went find with good evals but the course director will not give me credit for any of the months I have worked there and on top of that is planning to shortly dismiss me by the end of January for having "Academic" concerns. My advisor told me in a bi-weekly meeting that there is something wrong with my "hard wiring" in that I am not appropriately processing information and recommended me to have a psych eval for some type of dyslexia or learning disability. Stating that I am at a level of a beginning third year medical student and not where I am suppose to be. ALL of the other residents seem to think I am getting the raw end of the deal and that I am being unfairly ascertained for some reason.
Although I have had some academic difficulties in medical school I have never heard any negative feed back like this during my 3rd and 4th year medical school rotations. I don't know what to do. I have considered ask for a resignation before I get fired. What really sucks is I am married with two daughters and we bought our very first house out here and my family is so settled in....I just hate disappointing them. I feel like a big time looser. Any body got any helpful advice for me whether good or bad just give it to me.

FirstMANdown:confused: :(
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Boy, I'm sorry. I really hope it works out for you. If I were you, I would do a couple of things. First you have to make sure it's all really worth it. If you really want to become a doctor, then fine--you're going to just have to suck it all up and study really hard so that you can achieve your dream. But if you'd be just as happy doing something else, then so be it.

Secondly, you've got to evaluate what exactly is keeping you from doing as well as you need to. Why exactly is your attending saying that you are at a med student level? Do you feel you are not taking care of your patients appropriately or do not have the adequate knowledge base? If so, can this be corrected by more studying or something else.

If medicine is something you really want to do, I would definitely try to talk to some more advisors at your school. Good luck! I really hope everything turns out OK.
 
Have they given you any tutoring to help you? Have they given you specifics (what you did wrong, what you should have done or considered)? It is very difficult to change what you don't know what is wrong. Have you seen your monthly reviews? Get copies of them. Ask to have more frequent reviews. Have an advisor go over clinical questions with you (IM has MKSAP, FM must have something similar). Get an eval for learning disablilities.

If you talk to a lawyer, for goodness sakes DON'T tell anyone! While the legal systems holds out hope they can help you, the system is not on your side. If you were a judge, who would you give more weight to? A resident who is under "academic concerns" or an attending/ program director. The review system in the medical education department won't be of much help either, as they have political reasons to back the program director.

Get an advisor outside of your system. Going through this can be extremely painful. You need someone whom you can rant, rave, and review things with who is outside of the ramifcations, and can stay objective- including if you need to consider a career outside of clinical medicine.

Good luck with getting through this. Don't let the bad guys keep you down.
 
Sounds like the OP has not managed the perceptions of attendings towards him or her. Or there is something about you that the attendings do not like. It's a vicious game and if you not play it correctly, you will get eaten.

My suggestion is to really take a hard look at yourself and try to imagine what it is that is causing the admin to behave so negatively toward you. Or are there budget constraints or other issues that make the program pyramidal, much like a surgery residency.

Getting a lawyer is good advice. Once you are on the path for career ruin, it is difficult to recover.
 
Hmm, just reading between the lines - 6 years to graduate, a year of "study" to pass step 2, and now "academic difficulty" at your residency program? It is hard sometimes to gauge the true details of situations like this online, but I'm not sure you have much of a case with your track record (sorry).

If your program wants you out, you will be out (and it sounds like they are adding to your already questionable paper trail). Find out what you want to do and do whatever it takes to do it. Be humble, respectful, and proactive in your desire to learn. Turn the tables during your weekly meetings and ask your program for commitment about how they are going to help you (this is why we are in residency). Politely take notes during these meetings and start your own file. Make it clear to them that seeing a psychiatrist is something you will consider, but will be confidential and in no way substitute for the program's obligation to rectify your clinical practice ability. Call the ACGME and ask for a confidential advisor to become acquainted with what is going on - they may be able to prevent the program from firing you if they have not, in good faith, attempted to teach you. Take notes for every meeting and ask for feedback about your performance from every attending you work with. Become the most proactive resident in their eyes.

Good luck - you may need to find a new job pretty soon...
 
NinerNiner999 said:
Hmm, just reading between the lines - 6 years to graduate, a year of "study" to pass step 2, and now "academic difficulty" at your residency program? It is hard sometimes to gauge the true details of situations like this online, but I'm not sure you have much of a case with your track record (sorry).

If your program wants you out, you will be out (and it sounds like they are adding to your already questionable paper trail). Find out what you want to do and do whatever it takes to do it. Be humble, respectful, and proactive in your desire to learn. Turn the tables during your weekly meetings and ask your program for commitment about how they are going to help you (this is why we are in residency). Politely take notes during these meetings and start your own file. Make it clear to them that seeing a psychiatrist is something you will consider, but will be confidential and in no way substitute for the program's obligation to rectify your clinical practice ability. Call the ACGME and ask for a confidential advisor to become acquainted with what is going on - they may be able to prevent the program from firing you if they have not, in good faith, attempted to teach you. Take notes for every meeting and ask for feedback about your performance from every attending you work with. Become the most proactive resident in their eyes.

Good luck - you may need to find a new job pretty soon...
Click to expand...


This is the best advice you will get in here. It is very real.

I gather you are a PGY1. So, my sugestions will be directed to that.

It could be possbile the the scope of Family Medicine is not for you. It may be too broad. You may want to consider a specialty that more focused.

With that said, you will still need to learn the basics. You mentioned that you did well on the inservice exams, right? If so, you may simply not be in the right program.

In order for you to be able to get into another residency, you will need to have a good relationship with the program director. You will need a letter from them.

Do not mention lawyer to them. But do get one just in case.
Ask for specific details of poor performance. Do this in a way to demonstrate that you want to learn from the mistakes, but take notes. Use this information for two reasons: 1. to learn 2. if it goes to court and lawyers, they will have to prove that you did not do well. That means specific cases.

Remember that all you have to do is finish PGY1 and if you never want to do another residency or finish this residency you really don't have to.

You can find a job in some urgent care or somewhere with low level of complicated care and do fine.

As far as your family and the new house, well, you are in medicine and relocation for residency and jobs is part of the game.

Good luck.
 
You seem to have papered over your med school record in this post. What is a "6 year road"? I take it this does not involve also getting a JD or MBA/MPH? If it involves failing multiple years and board exams at your school, and then involves not matching into a family practice program, I would hesitate to describe it as mediocre. It's sounds downright poor. (Edit: I see from a previous post that you failed step 1 three times and step 2CK three times.)

You need to own up to the fact that you already had some academic problems before you started at this program. They have nothing to gain by flunking you out; that is just more work for everyone else. Are you being honest in your self-assessment? Are you sure you don't actually have serious academic problems similar to those you have had in the past? I'm also not sure why you think you are above the IMG residents at your program; they are probably the cream of the crop from their home country and are likely working their asses off at your program.

Niner's advice is about as good as you're going to get. You are at the mercy of the program here, and you need to get on the PD's good side as soon as possible.
 
I'm just a third year, so I don't have any advice. I just wanted to say that I am so sorry that you are going through this. You have come so far, getting through four years of med school and two board exams. Maybe FP isn't for you as others have mentioned, but maybe it's just that this particular residency program isn't for you. I hope this works out for you. Good luck to you!
 
futuredo32 said:
I'm just a third year, so I don't have any advice. I just wanted to say that I am so sorry that you are going through this.
Click to expand...

OH GOD! that small group **** is really working on you...RUN! RUN AWAY!
 
futuredo32 said:
I'm just a third year, so I don't have any advice. I just wanted to say that I am so sorry that you are going through this. You have come so far, getting through four years of med school and two board exams. Maybe FP isn't for you as others have mentioned, but maybe it's just that this particular residency program isn't for you. I hope this works out for you. Good luck to you!
Click to expand...

FP is rough. Perhaps something a little less competitive like . . . hmm.

. . . .

. . . . crap, I've got nothing.
 
Tired said:
FP is rough. Perhaps something a little less competitive like . . . hmm.

. . . .

. . . . crap, I've got nothing.
Click to expand...

How about psych? Now that I have mentioned it.... sounds perfect for him.
 
Tired said:
FP is rough. Perhaps something a little less competitive like . . . hmm.

. . . .

. . . . crap, I've got nothing.
Click to expand...

I just spit diet Coke out of my nose. And your Uncle panda is so jaded that this doesn't happen very often.
 
The OP is toast. He should try to leverage his way into being allowed to complete intern year and then call it quits. I believe in fighting city hall but it sounds like, just from what the OP said, that they have him dead to rights with an impeccable paper trail and the full weight of their bureaucratic broadside waiting to unload on his drifting, rudderless, mastless, hull.
 
However, when I was at a large (or small) East Coast (or West Coast) Medical Center (or community hospital) that we will call "Earl" to avoid the usual howls of protest in the same (or different) specialty the program was highly malignant and known to single out a few residents who wouldn't toe the line for harrasement. They lost nine residents in two years out of a total of 18. (Or 30).

This specialty is not supposed to be malignant but that was not my experience (or it was).

Sincerely (or not),

Panda Bear, MD (or Grizzly Bear, DO)
Resident in Some Other Specialty
Incognito
 
I cracked a few comments on this thread, but let me be serious for a moment.

The tragic thing about this situation is that, regardless of whether or not the OP is being wronged by his program, he unfortunately has placed himself in the position of having few options or leverage. If you read through his previous posts, he simply didn't position himself with adequate board scores, recs, grades, etc to do much of anything except go along with whatever decision his program makes.

If he had a stronger record as a student, he could tell his PD, "Shove it up your a$$" and move on to another program. Unfortunately, this option is not really open to him, and so he is at their mercy. I'm sure they are very aware of this fact, which probably makes it much easier for them to do what they are doing.

This is exactly why, regardless of what specialty you want to do, we should all work to have the most impressive record possible. You never know when you're going to stumble into a situation where you get screwed, and high USMLE scores and good grades are as good as cash if you need to find another spot somewhere.
 
I am so sorry abt your situation. Unfortunately, you cannot change your med school grades or USMLE Scores. Therefore, you must focus on the future. Re-evaluate your professional goals. Do you want to continue in Fam Medicine or change fields(psych, peds, IM). If you resign from your program and switch fields (reapply next year), I do not think you need a letter from your previous PD. (This is what I was told- pls confirm). I would suggest calling your previous dean of student affairs for guidance. I think it may look better if you resign, rather than being terminated.

I hope one of the PD that frequent this site is able to give you advice.

:( :(
 
Tired said:
I cracked a few comments on this thread, but let me be serious for a moment.

The tragic thing about this situation is that, regardless of whether or not the OP is being wronged by his program, he unfortunately has placed himself in the position of having few options or leverage. If you read through his previous posts, he simply didn't position himself with adequate board scores, recs, grades, etc to do much of anything except go along with whatever decision his program makes.

If he had a stronger record as a student, he could tell his PD, "Shove it up your a$$" and move on to another program. Unfortunately, this option is not really open to him, and so he is at their mercy. I'm sure they are very aware of this fact, which probably makes it much easier for them to do what they are doing.

This is exactly why, regardless of what specialty you want to do, we should all work to have the most impressive record possible. You never know when you're going to stumble into a situation where you get screwed, and high USMLE scores and good grades are as good as cash if you need to find another spot somewhere.
Click to expand...

Most FM programs are not rough. but the vast amount of knowledge can be demanding. Peds, IM, OBgyn etc.

He could try a less demanding specialty like:

Well I'll let you make the list.

And there is a list.
 
1bloodyred said:
Most FM programs are not rough. but the vast amount of knowledge can be demanding. Peds, IM, OBgyn etc.

He could try a less demanding specialty like:

Well I'll let you make the list.

And there is a list.
Click to expand...

Let me rise in defense of Family Medicine. You ideally have to know and retain a lot of medical knowledge. You get the worst aspects of primary care without the glory. And if you think FM doesn't work hard you have never done FM. Those mother-****ers really know how to move the meat and that's no lie, all while trying to retain the traditional social skills of the country doctor.

I am a critic but I don't believe I ever said it was easy.
 
Panda Bear said:
Let me rise in defense of Family Medicine. You ideally have to know and retain a lot of medical knowledge. You get the worst aspects of primary care without the glory. And if you think FM doesn't work hard you have never done FM. Those mother-****ers really know how to move the meat and that's no lie, all while trying to retain the traditional social skills of the country doctor.

I am a critic but I don't believe I ever said it was easy.
Click to expand...

The arguments I have heard about why FP is an "easy" residency usually revolve around one of two themes:

1) FP is essentially clinic work, with relatively little inpatient. Because of this, the hours are pretty easy.

2) FP does OB, peds, and IM topics in 3 years. Because it's so short, and trying to cover such a breadth of material, FP residents don't really learn everything about all the fields they are supposed to be covering.

Personally, I discount #2, just based on my own personal experience. The vast majority of FP residents and Staff I have worked under were really bright, and I would happily send any of my family members to them for primary care.

I wonder about #1 though. Is this actually true? On my MS3 FP rotation, the inpatient experiences were pretty limited, and on most blocks the residents seemed to get out of the hospital by 5p.
 
Tired said:
FP is essentially clinic work, with relatively little inpatient. Because of this, the hours are pretty easy.
Click to expand...

A significant amount of family medicine residency training takes place in the hospital, particulary during internship. As for the hours, when I was a resident (1998-2001, before the 80-hour workweek limit), we rarely worked more than 80 hours/week...but during internship, it was usually pretty close to that. Overall, however, I felt that the hours were reasonable. That's not a bad thing.

FP does OB, peds, and IM topics in 3 years. Because it's so short, and trying to cover such a breadth of material, FP residents don't really learn everything about all the fields they are supposed to be covering.
Click to expand...

Since most family physicians are well-trained, this argument is self-defeating. It isn't necessary to know "everything" about a subject in order to manage patients within your scope of practice. As Panda Bear said, you do have to be able to integrate a lot of information, and you rarely have the luxury of being able to say, "Sorry, that's not my area." Some people naturally find this quite intimidating, but for anyone with a generalist mindset, that's what makes it fun.

As I've said before, anyone who thinks family medicine is easy isn't doing it right. ;)
 
I'm so sorry about what you're going through, FirstMANdown. :( :( I agree with the prior posts about how you should try to get on the program director's good side. You may need letters of recs from the other faculty and the program director when applying to other residency programs. Residency is different from medical school and I've heard of several stories in which residents have been asked to leave after their first year (in peds, family medicine, and internal medicine). I've also worked with one fp resident in the past who had been asked to leave and she was a great teacher in my opinion, but only took more time in completing the tasks.

My suggestions:
  • Do what the program director and faculty ask you to do and try to get on their good side, since you will most likely need letters of recs from them. If they have remediation they want you to do, do that. If they want you to go to psychiatry for evaluation, go ahead and do that too. Seeing a psychiatrist may be very helpful in dealing with the stress of the entire situation and in dealing with depression. If you have depressive symptoms, this may keep you from learning and doing the best that you can do.
  • Be prepared to look for another residency programs. Match day is coming up in about 2 months and there are many fp programs that will be unfilled and will need residents. Try to finish up your intern year. You will have one year under your belt and, if you need to do PGY-1 year over again, it may not be as bad the second time around since you already have experience that other people might not have. Many of the FMG's that I know have been out of practice for 5 years or more before starting fp residency. Doing PGY-1 year again isn't as bad if in the end you can graduate from residency.

Take care and look for the silver lining in that black cloud. I'm so sorry for the pain that you have to go through. :(
 
Panda Bear said:
However, when I was at a large (or small) East Coast (or West Coast) Medical Center (or community hospital) that we will call "Earl" to avoid the usual howls of protest in the same (or different) specialty the program was highly malignant and known to single out a few residents who wouldn't toe the line for harrasement. They lost nine residents in two years out of a total of 18. (Or 30).

This specialty is not supposed to be malignant but that was not my experience (or it was).

Sincerely (or not),

Panda Bear, MD (or Grizzly Bear, DO)
Resident in Some Other Specialty
Incognito
Click to expand...


You crack me up when you get on your rants (or your not amusing at all). :laugh: (or :( )
 
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