A worried new recruit...

Started by HopefulIntern10
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HopefulIntern10

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Hello all. I was wondering if anyone has any experience with the following scenario. Suppose you were two weeks away from graduating medical school. Then suppose you had already been accepted to an accredited Residency training program in General Psychiatry. However, a stipulation of course, probably for ANY residency training program is that a pre-employment drug screen test must be passed to start. I am a newly recovering marijuana smoker and had previously been smoking since I started second year of medical school. I really cannot say why addiction chose to rear it's ugly head for me during my professional training...all I can say is that I had tried the stuff in high school, was not impressed, and then again in undergrad and again was not impressed. Well third times a charm. From what I know of the construction of my addiction to marijuana, in medical school, I made some of the best friends I will ever know and they were all marijuana smokers. They were not however all marijuana addicts. I AM and will forever have to be vigilant in making sure I continue to recover. It's ironic because my academic interest in addicitons is partly what drew me to this field. Anyways, I am on that path now. I have struggled with this for several years now and when they popped the pre-employment drug screening on me, I decided now was as good of time as any to put flame to my rear end. Now I fear I have hurt my possibilities of starting residency. I had been going through about an eighth (3.4 grams) of high-potency marijuana every 2-3 days for about the past 6 months and before that about the same amount every 4-5 days. I quit smoking and decided to get help about 11 days ago. I have not smoked in 11 days which is great because I had serious doubts as to whether I could even stop for 1 day, but now I feel I am not going to pass my drug test and I am at a loss about where to go from here. My test is not until May 27th, and at the very latest June 7th which is 15 days away. That would make all together 25 days sober before my urine test. Still I'm not sure I would pass. Would I be better off sitting down with the Residency Director soon and coming clean about these issues? Does anyone have any experience with similar situations? Is there a chance I could still pass and then I would bring up something that I have already begun to get help for? Sorry for all the questions but I am really freakin' here...I know I got myself into this situation and only I can face the consequences. So I am not asking anyone to do that...but it seems harsh that someone who will be graduating from medical school in the top 10 percent of their class, who has never showed up to rotations impaired, and has no criminal record could potentially lose their career before it even begins. I got into this line of work to help some of the most misunderstood and most judged of the afflicted, and now that seems in serious jeapordy. Again. I know I got myself here, but does anyone have any advice aside from...get sober 🙂 . I am already starting on that.
 
1) You don't mentions specifically what "getting help now" includes. If it is a formal Chem Dep program, then talk to your counselor there NOW.
2) Report yourself to the Health Professionals Service Program in the state you will be licensed in. Find it here. Since you already identify as having a problem, self-reporting as an impaired physician is FAR better than having the results of your urine test reported to the state board and then having them mandate that you report.
3) Armed with the above, contact your PD with the results of your test. You do have more than a little concern about still being positive--I've had clients with your history stay positive well out past 60 days.
4) Again, if you're serious about this being a problem, and about getting help-- DO contact your state PSP.

HopefulIntern10 said:
Hello all. I was wondering if anyone has any experience with the following scenario. Suppose you were two weeks away from graduating medical school. Then suppose you had already been accepted to an accredited Residency training program in General Psychiatry. However, a stipulation of course, probably for ANY residency training program is that a pre-employment drug screen test must be passed to start. .....That would make all together 25 days sober before my urine test. Still I'm not sure I would pass. Would I be better off sitting down with the Residency Director soon and coming clean about these issues? Does anyone have any experience with similar situations? Is there a chance I could still pass and then I would bring up something that I have already begun to get help for? Sorry for all the questions but I am really freakin' here...I know I got myself into this situation and only I can face the consequences. So I am not asking anyone to do that...but it seems harsh that someone who will be graduating from medical school in the top 10 percent of their class, who has never showed up to rotations impaired, and has no criminal record could potentially lose their career before it even begins. I got into this line of work to help some of the most misunderstood and most judged of the afflicted, and now that seems in serious jeapordy. Again. I know I got myself here, but does anyone have any advice aside from...get sober 🙂 . I am already starting on that.
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HopefulIntern10 said:
Hello all. I was wondering if anyone has any experience with the following scenario. Suppose you were two weeks away from graduating medical school. Then suppose you had already been accepted to an accredited Residency training program in General Psychiatry. However, a stipulation of course, probably for ANY residency training program is that a pre-employment drug screen test must be passed to start. I am a newly recovering marijuana smoker and had previously been smoking since I started second year of medical school. I really cannot say why addiction chose to rear it's ugly head for me during my professional training...all I can say is that I had tried the stuff in high school, was not impressed, and then again in undergrad and again was not impressed. Well third times a charm. From what I know of the construction of my addiction to marijuana, in medical school, I made some of the best friends I will ever know and they were all marijuana smokers. They were not however all marijuana addicts. I AM and will forever have to be vigilant in making sure I continue to recover. It's ironic because my academic interest in addicitons is partly what drew me to this field. Anyways, I am on that path now. I have struggled with this for several years now and when they popped the pre-employment drug screening on me, I decided now was as good of time as any to put flame to my rear end. Now I fear I have hurt my possibilities of starting residency. I had been going through about an eighth (3.4 grams) of high-potency marijuana every 2-3 days for about the past 6 months and before that about the same amount every 4-5 days. I quit smoking and decided to get help about 11 days ago. I have not smoked in 11 days which is great because I had serious doubts as to whether I could even stop for 1 day, but now I feel I am not going to pass my drug test and I am at a loss about where to go from here. My test is not until May 27th, and at the very latest June 7th which is 15 days away. That would make all together 25 days sober before my urine test. Still I'm not sure I would pass. Would I be better off sitting down with the Residency Director soon and coming clean about these issues? Does anyone have any experience with similar situations? Is there a chance I could still pass and then I would bring up something that I have already begun to get help for? Sorry for all the questions but I am really freakin' here...I know I got myself into this situation and only I can face the consequences. So I am not asking anyone to do that...but it seems harsh that someone who will be graduating from medical school in the top 10 percent of their class, who has never showed up to rotations impaired, and has no criminal record could potentially lose their career before it even begins. I got into this line of work to help some of the most misunderstood and most judged of the afflicted, and now that seems in serious jeapordy. Again. I know I got myself here, but does anyone have any advice aside from...get sober 🙂 . I am already starting on that.
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Find your state health professionals health program. There's one in every state. If you go yourself it is completely confidential. Talk to one of their counselors and see what they recommend.

http://www.fsphp.org/

And even though we tend to associate these programs only with addiction issues, they are there to serve our health in all aspects including medical, psychological, and social issues. I know several people who have used their services for non-addiction issues.
 
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I don't want to hijack the thread, so I hope the community can deal with two scenarios at once. I am in a slightly different situation that concerns me. I'm considering Psych as a career. Currently I'm MS3. My grades (esp clinical grades and evals) and step 1 are solid to stellar.

Situation: I have Bipolar type 1 that has been very well-controlled since diagnosis two years ago as an MS1. Before then my at-the-time undiagnosed condition wasn't a big deal, and I functioned okay. That is until I had my first and only full blown manic episode, which required a weekend hospitalization (I actually had enough insight to walk myself straight into the ER and ask for emergent tx). The diagnosis obviously is written all over my insurance records as I have and still receive(d) treatment. However, my diagnosis is not in my academic record because I've never taken a leave of absence, never had academic/professionalism issues. In other words, my school is for the most part in the dark regarding my mental health issues.

So what administrative or bureaucratic obstacles might I run into in residency/licensing given my health history and need for continued treatment, and how can I wisely address these? Same way as you're advising the OP? Will I need to let my PD know immediately?

By the way, my choice to go into psychiatry will be based on far more than my own mental health experiences. Regardless, how do you feel about people like me and OP going into psychiatry? Perhaps I should start a second thread for that.
 
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seamadi said:
Regardless, how do you feel about people like me and OP going into psychiatry?
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Ever read "An Unquiet Mind" ? I have not but I have heard good things and it's on my reading list.

FROM WIKI: Kay Redfield Jamison (born October 14, 1946) is an American clinical psychologist and writer who is one of the foremost experts on bipolar disorder as well as suffering from the disorder since her early adulthood. She is Professor of Psychiatry at the Johns Hopkins University School of Medicine and is an Honorary Professor of English at the University of St Andrews.

No worries about "hijacking" the thread 🙂 I can't really say what you should do, but it's good to hear from someone who has similar issues. Even though my issue is Chemical Dependency and yours is a separate Axis I issue, I see very similar circumstances. We both have schools who are in the dark due to no prior related issues, which may or may not work in our favor. So thanks for posting. Makes me feel less isolated. In terms of your question, I think those suffering from mental illness who are f@$ked up enough to know what's going on with their patients but not so f@$ked up they can't help their patients are in a unique position of perspective that many who come to this field simply don't possess. Unfortunately many come to Psychiatry because it's the only thing they can match to because of grades or other circumstances. Not that they don't become good psychiatrists in the end but it's all a matter of what experiences you can bring to the table for your patients. You having experienced a full blown manic episode will likely be invaluable experience to those going through the same thing. Especially when you can sit across from them and say "I know what you are going through." I hope everything works out for us both.

Also thanks to everyone who responded. I think I plan on talking with an attending of mine here at the program to get further direction as he has gone through the same issues with Cocaine after he had already started Residency. I.E. I think I WILL take the route of "self-reporting" but I need to get with him to clarify the process. I also want to talk to my therapist to get her input.
 
seamadi said:
I don't want to hijack the thread, so I hope the community can deal with two scenarios at once. I am in a slightly different situation that concerns me. I'm considering Psych as a career. Currently I'm MS3. My grades (esp clinical grades and evals) and step 1 are solid to stellar.

Situation: I have Bipolar type 1 that has been very well-controlled since diagnosis two years ago as an MS1. Before then my at-the-time undiagnosed condition wasn't a big deal, and I functioned okay. That is until I had my first and only full blown manic episode, which required a weekend hospitalization (I actually had enough insight to walk myself straight into the ER and ask for emergent tx). The diagnosis obviously is written all over my insurance records as I have and still receive(d) treatment. However, my diagnosis is not in my academic record because I've never taken a leave of absence, never had academic/professionalism issues. In other words, my school is for the most part in the dark regarding my mental health issues.

So what administrative or bureaucratic obstacles might I run into in residency/licensing given my health history and need for continued treatment, and how can I wisely address these? Same way as you're advising the OP? Will I need to let my PD know immediately?

By the way, my choice to go into psychiatry will be based on far more than my own mental health experiences. Regardless, how do you feel about people like me and OP going into psychiatry? Perhaps I should start a second thread for that.
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You will need to read very carefully the questions that need to be answered for getting your state medical license. In most states there is some question about having an illness that could/has impaired your ability to care for patients. I would encourage you to be truthful. Don't forget that if you are found to have knowingly lied on an application, then that act will likely have far greater negative consequences for your career because you would have exhibited evidence for poor professionalism/character.

Also as others have mentioned most states have a physician's impairment program. Going to them will help things greatly.

If you are doing well, having an illness should have minimal impact on your career. The state will want to keep a watch over you in order to make sure that patients are not harmed. Since you will be in a training program and supervised, I doubt that there will be a major problem in getting a temporary license. The board will likely require some type of statement from your treating MD or might ask you to show up and answer questions.

Letting your PD know about your illness, is your option. In general all I need to know is when a resident envisions an illness causing problems that I will need to solve (e.g. being pregnant, missing work, etc.).
 
psychattending said:
You will need to read very carefully the questions that need to be answered for getting your state medical license. In most states there is some question about having an illness that could/has impaired your ability to care for patients. I would encourage you to be truthful. Don't forget that if you are found to have knowingly lied on an application, then that act will likely have far greater negative consequences for your career because you would have exhibited evidence for poor professionalism/character.

Also as others have mentioned most states have a physician's impairment program. Going to them will help things greatly.

If you are doing well, having an illness should have minimal impact on your career. The state will want to keep a watch over you in order to make sure that patients are not harmed. Since you will be in a training program and supervised, I doubt that there will be a major problem in getting a temporary license. The board will likely require some type of statement from your treating MD or might ask you to show up and answer questions.

Letting your PD know about your illness, is your option. In general all I need to know is when a resident envisions an illness causing problems that I will need to solve (e.g. being pregnant, missing work, etc.).
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There is also a tremendous difference legally between self-referral to a state PHP versus being referred by the state board, your training program, or your hospital. If you self-refer there are a number of legal benefits. One of them being that there is a 'safe haven' law that applies to self-referrers.

For instance, if you have Bipolar and self-refer to your state PHP and say 'I have bipolar, I want to make sure it does not hurt my ability to provide professional and competent care', and then you follow through with their requirements, you are legally and ethically allowed to answer 'no' to the question about medical, psychiatric, or substance use disorder.

You will still be monitored, but it will be by the state PHP, and not the medical board. And as long as you are compliant, the confidentiality laws are such that no one else will know that you are being monitored. No red flags. Which is a tremendous boon.

If you are referred by the state board or your institution, you don't get that benefit.
 
masterofmonkeys said:
There is also a tremendous difference legally between self-referral to a state PHP versus being referred by the state board, your training program, or your hospital. If you self-refer there are a number of legal benefits. One of them being that there is a 'safe haven' law that applies to self-referrers.

For instance, if you have Bipolar and self-refer to your state PHP and say 'I have bipolar, I want to make sure it does not hurt my ability to provide professional and competent care', and then you follow through with their requirements, you are legally and ethically allowed to answer 'no' to the question about medical, psychiatric, or substance use disorder.

You will still be monitored, but it will be by the state PHP, and not the medical board. And as long as you are compliant, the confidentiality laws are such that no one else will know that you are being monitored. No red flags. Which is a tremendous boon.

If you are referred by the state board or your institution, you don't get that benefit.
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I'm not sure that what you say is completely correct. I suspect things might vary by state as to the specific wording of the question. In MO the questions is not whether you have an illness but whether you have an illness that has impaired your functioning (usually defined as having been admitted or having to take a LOA). As far as I know in my state, if you are admitted for a psychiatric illness while working as a MD or as a medical student then you have to declare on your form that you do have a psychiatric illness that has impaired your ability to treat patients. There is no safe haven. All that said, if the person checked themselves in or sought treatment then the board takes the evidence of insight as a positive sign.
 
What happens to medical students, residents, etc who are mistakenly diagnosed and told they have bipolar when actually it's something else? Is this a determination that is stamped on a person's record for all time and deemed mandatory for reporting purposes? Medical records aren't like legal records though. They're private and they change all the time. Does the patient have any say in the matter? How would the patient even know--lots of people "think" they have bipolar and other things who probably don't.
 
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