switching programs

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mumbai

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Hi everyone,
I never thought in my life that I will be dong postings like this in my life.
About myself i short.I am a FMG.I have score high 99 in both USMLE step 1 and 2 and was lucky to get in to Transitional year program in Midwest. I also have Green card. All thsse characteristic makes me a very good candidate.
I tried for Radiology and for highly reputed IM program in California.I focussed in California since my family was there. I was disappointed with the interview since getting residency in California for a FMG is difficult and hence when I came to know from Wife about a neurology pgy2 opening in a very malignant program in California in which she was already suffering.I applied there since I was confident about my abilities and since my wife was there and we wanted to stay in California I applied there and was unlucky that I got in it.
I have always been an excellent student and resident. I always knew that first couple of month in any residency are very crucial hence i started reading a lot and started asking question. Somehow Unknowingly I landed on wrong side of a VA attending. In VA we have very few pt and whole month of rotation I must have seen 5-6 pt's which includes consults.
The attending I do not know why failed me in rotation. I was extremely disappointed. I was not expecting a great evaluation but failing me was over kill.
In Neurology we do 2 month of intern month and then promoted to senior but since I failed rotation they made me repeat 4 month. Since I did not agree with the attending hence I appealed against that stating that there is not enough time and not enough pt to take such a drastic decision especially considering my excellent record in past.But I realized today that this was biggest blunder I did in whole residency.
I worked with a attending for 3 and half day when I started and other attending who happened to be chairman in weekly outpatient setting and must ave interacted with him 5 times.They became judge for appeal and guess what the moment I appealed against the decision both of them gave me bad evaluation.So the decision was already made even before the appeal process was started.I was appealing only against that particular attending but later realized that it was considered against program since the decision was made by program director. It backfired at me.
Well I did alright for next 2 month but I was extremely disappointed and started looking for position outside.
When my program Director came to know about it she got very upset and though I did good in 3 month she refused to promote to senior level and told me that they won't reniew my contract for next year .She told me that I will get PGY2 year completion and If i want to pursue Neurology I can join PGY3 anywhere. I was disappointed but since I was anyways planning not continue in program hence I was OK with decision.
I have applied for vacation during December long time back since I wanted to attend interview.
Later when she came to know that I am having position In PGY3 suddenly she changed her mind and called me on December 28th morning and shocked me by saying that she has decided to end my contract and today is my last day of work. The reason was that I took unauthorized vacation since she never signed my vacation request though I have submitted my request month before to program coordinator and due to lack of clinical judgment. She gave me 1 hour to decide if I want to quit or want to get fired.The advantage of being fired is that I will get 1 month of salary.She took my pager and ID. She gave me LOR which I asked her before which was 2 liner stating."He has finished successfully 5 month of neurology. She is concerned about my clinical Judgment." Can you imagine this LOR. Which PD is going to consider me for any position. And she made a big statement "she is disappointed at herself as program director".
This is so messed up.After couple of days i recovered back and appealed against the decision. This time it went forward as Judicial review. This was most anxiety and scariest moment of my life.
When I got the notice I was really really scared and did not want to face it but I motivated myself and went to Judicial review.
It went pretty good since my program Director has no concrete evidence.I also showed them my TY evaluation which stated that I am excellent resident.
I am still waiting for the decision. It is going to come on Monday. Well I am pretty positive that if they are fair it will be in my favor but knowing these people I know like everything it will also be unfair

I think everyday what went wrong. How can people be so evil that they want to destroy someone's career. Everyone is shocked with it but no 1 can do anything.When I talked to attending with whom I worked in VA later,he kept telling me that I am doing great and he was not sure why the other attending did not like me.But when I asked him to write it down he won't do it since he said that he has to work in department and he does not wish to go against his colleague since he will be retiring soon. Though it was his responsibility to give me evaluation.He never gave me evaluation till now. Can you guys imagine it.
Now I am going again for ERAS with new LOR from my TY attending and had some good interview and will match somewhere. But I lost 2 important year of my life. Imagine the hard work,money I have invested in my career.Getting 99 in both steps are not uncommon but it needs lots of hard work and being a good test take is not enough to achieve it twice. All my ambition in life and my confidence is shattered. And most important this blotch will remain in my career.
I will be writing outcome of the appeal and soon will add the transcript of appeal since I want everyone to know how unfair system can be.
I have read many posting about resident suffering and since till now everything was going smoothly for me hence I always use to jump to conclusion that it must be residents mistake but now i can really understand what they went through and it is not always that residents are on fault. Some attending do have malignant and sadist personality.

I am asking everyone's opinion for following question.
1. I have couple of offers for PGY2 since I have done TY but everyone is letter asking from current PD. What should I do??
2. I am sure after this experience i will not be in this condition ever but I was wondering if this part of my career will come in my way of getting fellowship??
3. Is there any way by which we can report this program so that what happened with me does not happen to anyone else??
 
Unfortunately, it's going to be difficult to find an open PGY-2 position without a letter from your current Program Director. Is there any way you could approach your PD, explain your situation, and see if they'll at least write you an objective, fair letter? Your career depends on it, after all!

Are there other attendings with whom you've developed a good rapport, and would feel comfortable writing you a strong letter? This would be very helpful (and would likely be needed anyway when interviewing for other positions).

If you were fired from your residency program midway through a year, then yes, that will come up in subsequent interviews for residency and fellowship positions. So be prepared to discuss it openly and honestly.

Best of luck.
 
I think you revealed your answer in your decription. You saw 5-6 pts in a whole month? Perhaps you indeed need to make up for the month then. What did you do during the rest of the time? I mean, I could understand a MS4 surgeon-wannbe slacked off in his primary care clinic but, as a resident, how can you only see one patient a week and feel Ok about it. If things were indeed this slow, you could have asked to do something else, like writing case reports, taking some calls, etc.

It looks like you kinda "settled" for neurology and were probably not too motivated to ask for the learning opportunities. Make sure the next speciality you choose is what you really want.
 
5-6 pt that was the workload in VA.It is very light rotation. And is my point.
 
Program directors are given wide latitude to evaluate, promote, and terminate residents. This is somewhat inherent in the process -- it is our responsibility to measure competence, and there is no single, objective measure. I have seen medical residents with 99's on their USMLE's who are frankly, IMHO, incompetent physicians. Measuring competence is an inherently subjective experience, and hence open to interpretation.

It is also open to abuse. I have plenty of residents who have a run-in with a faculty member and get a sub-par evaluation. I could theoretically try to fire them for it. I don't -- I only terminate residents when there is a pattern of poor performance without improvement with remediation, and then I help them arrange the next stage of their training.

Reading your story is very distressing. Here's my thoughts:

First, I have to acknowledge that there is some chance that your PD is correct. It's possible that your performance is really poor and that you have poor insight into it. Just because your TY year evaluation is good, or your USMLEs are 99's, doesn't mean that you're going to be a good neurologist. Discussion boards like this are difficult in this way -- it's impossible to know where the truth lies. Still, I'll assume for the rest of this discussion that you are being treated unfairly (which is my gut instict, BTW)

Facts:
1. Your training there is finished. You're never going to get a fair assessment now. The best you can get out of this situation is a clean break and a fair LOR. Arguing for (or getting) your old position back is a bad outcome.

2. Legally, GME programs are held to their own internal, published rules. Your program should have a "program manual" or something similar. You should review this to see what the rules in this situation are. If your program broke their own rules, you can definitely make them fix this (although it could take years and lots of $$ to do so through the legal process).

3. It seems crazy that they gave you 24 hours to quit or be fired. Your contract probably has a clause about this in it. Usually, they would need to give you several weeks notice unless there was an "egregious event" -- i.e. you did something that was SO bad that they had to fire you immediately (i.e. stabbing your program director). "Egregious" is a vague term, and they could try to come up with some clinical decision you made, but this is something you could probably argue.

4. Luckily, although you may not see it this way, the LOR from your program director isn't as bad as it could be. Look at it this way: the letter is completely ridiculous. How could a PD write a letter like that? The letter is actually evidence that your evaluations are unfair.

Here's what you do:
1. You're done with this program. Sounds like you understand that, but I'm just making it 100% clear. If the review reinstates you, you could then ask the PD to trade you a reasonable LOR for your resignation. Or, you could try to finish out the year but I doubt that will go well given this story.

2. The outcome you want from the Judicial review is a new LOR, written by someone else. Alternatively, you could get a written statement from the Judicial review that your evaluations / termination were unfair and punitive -- that attached to your PD's LOR would be very helpful.

3. Get an LOR from the faculty who likes you at the VA. Promise that you will NOT use it internally -- i.e. you will not use it to fight your termination or any internal issue, and only use it to apply to new programs. If they are uncomfortable with that, ask them if they would be willing to do so verbally, off the record, with programs.

4. reapply for a new PGY-2. If you were offered a PGY-3 spot somewhwre, maybe they have room for a PGY-2 starting now? Might as well ask.

Good luck!
 
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