A sad story – Need advice

[FTD234]

My daughter was just fired from her residence program.
My daughter was diagnosed depression when she was a college student. She applied to a medical school and honestly told the interviewer of the school about her depression. The interviewer thought my daughter could do it and admitted her into the medical school. Under continuously treatment of depression, she went through MD, passed Steps 1, 2, 3 Exams, and finished first year internship. She is now in PGY2 residence program offered by the same medical school she graduated. She told us she loved the program and was happy to work there.
Due to taking the high dose of depression medicine, she slept so deep that she couldn’t hear the phone calls from the hospital and miss calls. A nurse complained about this and one of the two attending physicians thought her performance was poor. The director of the program thought my daughter is not suitable to be a doctor and fired her. This blow made her so sad that she had to be hospitalized for the depression treatment.
We parents would like to pay off her Stafford student loans with our retirement savings to relieve her pressure and take her home for one or more years break till her depression is improved. Our questions are
(1) Is it possible to appeal this case? Is it useful to appeal? Is it possible to go back to continue PGY3 after a year break for depression treatment?
(2) After one or a few years break, if she would like to continue pursuing medical career, how difficult to apply for the same program or other residence programs as PGY2?
(3) If it is impossible to continue a residence program, what kinds of career are for an MD without completing residence program?
Your advice is greatly appreciated. Thanks!

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[Shikima]

Contact the RRC and ask what the appeals process is.

 

[FTD234]

Would you tell me what is RRC? I am not in Medical field. Thanks!

 

[Raryn]

Would you tell me what is RRC? I am not in Medical field. Thanks!

The RRC would be the residency review committee for her specialty. It's a national body and would NOT be the one to contact for an appeal.

On the other hand, every institution is required to have a GME office (GME being graduate medical education). You can probably find the one for her medical school/residency program by googling "Schoolname GME". The GME office would be the ones to discuss possible appeals with (though she may want to start by talking with her former program director first). Depending on the circumstances of dismissal, appeal might be possible, but it may also not be possible. In many circumstances, the best you can try to ask for would be a neutral letter from the program that wouldn't preclude you getting a spot elsewhere, whether as a PGY1 or PGY2. Even in the best of circumstances, she wouldn't go back as a PGY3 when she was dismissed mid-PGY2.

That said, I think it would be bad idea for her parents to be taking point on contacting these offices. It would likely be more effective coming from her.

 

[amine2086]

The RRC would be the residency review committee for her specialty. It's a national body and would NOT be the one to contact for an appeal.

On the other hand, every institution is required to have a GME office (GME being graduate medical education). You can probably find the one for her medical school/residency program by googling "Schoolname GME". The GME office would be the ones to discuss possible appeals with (though she may want to start by talking with her former program director first). Depending on the circumstances of dismissal, appeal might be possible, but it may also not be possible. In many circumstances, the best you can try to ask for would be a neutral letter from the program that wouldn't preclude you getting a spot elsewhere, whether as a PGY1 or PGY2. Even in the best of circumstances, she wouldn't go back as a PGY3 when she was dismissed mid-PGY2.

That said, I think it would be bad idea for her parents to be taking point on contacting these offices. It would likely be more effective coming from her.

My thought is there are two separate but related issues that need to be addressed:
1. Your daughter's medical condition. This should be first and most important focus. From what you described your daughter's depression has progressed significantly where she is having difficulty functioning as a resident physician (it's a very demanding job and those without any medical problems often have difficulty). It's unfortunate that her program has decided to fire her as a better option would be to give her a leave of absence which would allow her to take care of herself and perhaps restart when she is I'm better state of health). But it is what it is. She needs to get help and being around a loving family would be helpful.

2. Your daughter's future: there may be option to appeal, find an open position at different residency, explore other career option(s). As others suggested, start with the GME office.

 

[NotAProgDirector]

This is a difficult situation for you.

The most important thing you can do is support / help your daughter recover. You can help her move ahead with her career, but as others have mentioned getting involved yourself is likely to make things more complicated / worse.

First, remember that you are hearing only 1/2 of the story. Your daughter's program may have a different version of events. It's possible that problems like this have been happening for some time, and recently gotten worse. It;s possible that her performance has been marginal in the past. It's also possible that her performance was totally fine until recently. It's impossible to tell.

From your description, she was fired not because she was depressed, but because she was not responding to pages. Yes, perhaps the reason she was unable to respond was because of her medications -- but this put patients at risk. As a PGY-2+ she was responsible for supervising PGY-1 residents. If she is not responding to her pages, that means that she may not have been available to help them. Regardless of the cause, not repsonding to pages is very concerning behavior. If this had been going on for some time, she should have found a way to work around it or requested a leave of absence.

Regardless, the question is what to do next:

1. I would not liquidate your retirement to pay her loans off without reviewing that option with a financial advisor. In general, liquidating your retirement to pay for anything is a bad idea.

2. If she is ready, she needs to contact her program. As stated above, there should be an internal mechanism for asking for a review of her situation. This is sometimes called an "appeal" process, or a "grievance". Either way, there is a time limit to request it and hence she should request it ASAP. There isn't much to lose by appealing the decision. You hope to have her reinstated, perhaps in a remediation program.

3. She needs to be better before returning to work. As mentioned above, sleeping through pages is not acceptable.

4. How difficult it would be to find a new program depends on how competitive an applicant she was in the first place -- US grad vs DO vs International grad, how well she did in school, USMLE scores, and the field she is in. Perhaps this is the wrong field for her and she should look into something else? Perhaps this is exactly what she wants to do and she should look for a new program. It's impossible to say what her chances are.

Bottom line: My heart goes out to you. I would be devastated if something like this happened to my child. Your first focus is on getting her healthy, and requesting an appeal (to ensure you don't miss a deadline). Once she's healthy, she will likely know what to do. Don't make calls for her or try to fix this yourself -- although you may have the best of intentions, it will not go well. No employer wants to be called by their employee's parents. Ensure you get advice before making any financial decisions, or you could make matters worse.

 

[dragonfly99]

I agree with the people above, who said that you should not call the GME office on your daughter's behalf, but if she's at all well enough, you should consider having her call there and ask for an appeal to see if she can be given a medical leave for 2-3 months to deal with this, with some possibility to return to residency later. She probably would need to repeat months and/or the 2nd year of residency, if they agree to take her back. But she has to be able to be awake/respond to pages and questions appropriately, else she can't do that specialty that she has picked - it sounds like it's something that is directly patient care , not something like pathology, etc. It might be hard, but not definitely impossible , for her to return to residency.
As far as the student loans go, you should not clean out your retirement savings to pay that off. You could consider asking for a deferment (the interest would build up, though), or you could just take up the payments, or at least the interest, for her for a few months while you all decide what she's going to do. It certainly can add to stress having big student loans to pay off but you should not clean out your entire bank account to get rid of them all at once. reassure her it's not necessary to pay it all off at once - I've been out of med school since 2004 and I still have student loans and it's really Ok - as long as you are paying the payments regularly nobody is going to come after her/you. Besides which if you are a middle class person, you can actually get a tax deduction while paying them off - I only recently started to make enough that I don't get to deduct the interest from my taxes any more, but as a resident or other middle class type of job the next year, she could get a tax deduction while paying off her loans and/or interest...