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[drumandmonkey]

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Hi

I am a PGY-2 in a top 10 IM program. I received a contract non-renewal this year.

I am thinking about switching specialties. I have already contacted some people in other specialties, just stating that I wanted to switch because IM was not a good fit and that I am interested in their field. As a med student I displayed interest in that field and have done research with small publications in that field.

My question is this: Would all future program directors contact my program director about me, no matter what I ultimately chose to go into, even in a field unrelated to IM? They just know that I left IM, but do not know of any non-renewal of contract.

I am concerned about this because I have actually tried to find IM programs to complete training in, and there were several interested programs, but after speaking to my program director, the interest vanished. My former program director had actually stated before that he was going to recommend me for other training programs, but this just did not happen. I never had any fights/unpleasantness with anyone in the office.

I did not do anything illegal, I was not unprofessional, and my academic performance never suffered. I was just burned out and had to undergo remediation, which burned me out more.

I suppose if I dropped the bar and went to very bad IM programs, then I may get more interest. But after thinking about this, I might as well just switch fields if I had to go to a bad IM program. Hence my question about other PDs from other fields contacting my PD. I would hate to have a poor shot at other fields just because of poor performance in IM, which is not well-suited to my personality in the first place (I was just trying to power through and get on with life, but that turned out badly since I burned out). It would be unfair for my PD to make any conjectures about my performance in other fields (unless I have some pervasive problem like antisocial personality, unprofessionalism, or lack of intelligence) since he is not in that field. I will not be going into any surgical field because that would also likely cause me to burn out. My step scores and in-training scores are all very much blameless.

Thanks.

 

[ThoracicGuy]

Hi

I am a PGY-2 in a top 10 IM program. I received a contract non-renewal this year.

I am thinking about switching specialties. I have already contacted some people in other specialties, just stating that I wanted to switch because IM was not a good fit and that I am interested in their field. As a med student I displayed interest in that field and have done research with small publications in that field.

My question is this: Would all future program directors contact my program director about me, no matter what I ultimately chose to go into, even in a field unrelated to IM? They just know that I left IM, but do not know of any non-renewal of contract.

I am concerned about this because I have actually tried to find IM programs to complete training in, and there were several interested programs, but after speaking to my program director, the interest vanished. My former program director had actually stated before that he was going to recommend me for other training programs, but this just did not happen. I never had any fights/unpleasantness with anyone in the office.

I did not do anything illegal, I was not unprofessional, and my academic performance never suffered. I was just burned out and had to undergo remediation, which burned me out more.

I suppose if I dropped the bar and went to very bad IM programs, then I may get more interest. But after thinking about this, I might as well just switch fields if I had to go to a bad IM program. Hence my question about other PDs from other fields contacting my PD. I would hate to have a poor shot at other fields just because of poor performance in IM, which is not well-suited to my personality in the first place (I was just trying to power through and get on with life, but that turned out badly since I burned out). It would be unfair for my PD to make any conjectures about my performance in other fields (unless I have some pervasive problem like antisocial personality, unprofessionalism, or lack of intelligence) since he is not in that field. I will not be going into any surgical field because that would also likely cause me to burn out. My step scores and in-training scores are all very much blameless.

Thanks.

Any program no matter the field will usually want to speak to your prior PD. You won't be able to escape that. Have you tried to sit down with your old PD to discuss his support for you in another field?

 

[Law2Doc]

Hi

I am a PGY-2 in a top 10 IM program. I received a contract non-renewal this year.

I am thinking about switching specialties. I have already contacted some people in other specialties, just stating that I wanted to switch because IM was not a good fit and that I am interested in their field. As a med student I displayed interest in that field and have done research with small publications in that field.

My question is this: Would all future program directors contact my program director about me, no matter what I ultimately chose to go into, even in a field unrelated to IM? They just know that I left IM, but do not know of any non-renewal of contract.

I am concerned about this because I have actually tried to find IM programs to complete training in, and there were several interested programs, but after speaking to my program director, the interest vanished. My former program director had actually stated before that he was going to recommend me for other training programs, but this just did not happen. I never had any fights/unpleasantness with anyone in the office.

I did not do anything illegal, I was not unprofessional, and my academic performance never suffered. I was just burned out and had to undergo remediation, which burned me out more.

I suppose if I dropped the bar and went to very bad IM programs, then I may get more interest. But after thinking about this, I might as well just switch fields if I had to go to a bad IM program. Hence my question about other PDs from other fields contacting my PD. I would hate to have a poor shot at other fields just because of poor performance in IM, which is not well-suited to my personality in the first place (I was just trying to power through and get on with life, but that turned out badly since I burned out). It would be unfair for my PD to make any conjectures about my performance in other fields (unless I have some pervasive problem like antisocial personality, unprofessionalism, or lack of intelligence) since he is not in that field. I will not be going into any surgical field because that would also likely cause me to burn out. My step scores and in-training scores are all very much blameless.

Thanks.

I agree with the above -- every program will want to talk to your PD.

More troubling to me is your emphasis on having been in a "top 10" program and now contemplating "dropping the bar" and considering "very bad programs". Dude, you aren't lowering the bar -- you didnt stay on the bar they started you at. They pushed you off as not top ten material (ignoring the circumstances, which aren't really important to this point). You should be begging someplace, anyplace, to let you finish someplace and get boarded. Beggars don't really get to be so picky. Whatever place lets you finish ought to be regarded by you as the best place in the world. You can't lower a bar from an imaginary point you never really mastered.

 

[drumandmonkey]

So let's just say that (hypothetically, not true in my case) a resident finishes PGY-2 but resigns to pursue a different field, even though a contract was offered him? Would all future program directors of all new specialties still call up his program director to check on his standing at the previous program? Thanks.

 

[Law2Doc]

So let's just say that (hypothetically, not true in my case) a resident finishes PGY-2 but resigns to pursue a different field, even though a contract was offered him? Would all future program directors of all new specialties still call up his program director to check on his standing at the previous program? Thanks.

Yep.

 

[colbgw02]

I received a contract non-renewal this year.

I did not do anything illegal, I was not unprofessional, and my academic performance never suffered.

Unless you are alleging something nefarious, then I do not see how both of these sentences can be true.

 

[IlDestriero]

So let's just say that (hypothetically, not true in my case) a resident finishes PGY-2 but resigns to pursue a different field, even though a contract was offered him? Would all future program directors of all new specialties still call up his program director to check on his standing at the previous program? Thanks.

Yes.
They want to know what the program thinks about you. Were you a hard worker, academically solid, a team player? If not why not, and why would they want you? And of course, why you left/are leaving.
There's a world of difference between quitting a program and getting kicked out.
The specifics of the situation are also very important. We terminated a resident because he was a horrible fit for anesthesia. He wasn't stupid, he wasn't lazy, he was a whiner but he did the job. The problem was that in a crisis he was worthless. You can't consistently panic in a crisis as an anesthesiologist. He would have had a miserable career and probably would have hurt people. It simply was not the career for him and it was painfully obvious during his second year. He was endorsed 100% by the PD for a residency in PM&R, got into a decent program, and according to my pal Google is doing just fine. When it was done, he acknowledged his faults, the poor fit, and that he should have quit on his own many months earlier. He was actually happy to move on to a different career.
How you go out and why make all the difference in the world.

 

[IlDestriero]

Unless you are alleging something nefarious, then I do not see how both of these sentences can be true.

People that get terminated often lack insight.

 

[smq123]

I did not do anything illegal, I was not unprofessional, and my academic performance never suffered. I was just burned out and had to undergo remediation, which burned me out more.

As an FYI, if you had to undergo remediation, that generally means that your academic performance suffered. If not your academic performance, then there was a severe lapse in clinical or ethical judgment, which is just as bad.

Anyway, yes, any program that you are looking to switch into, even if it is in a different field, will still want to speak to your PD. Your PD may not be able to assess your "fit" for another specialty, but he will be able to assess your work ethic, your communication skills, and your personality as a physician in general.

 

[colbgw02]

People that get terminated often lack insight.

Yeah, well, I wasn't going to be the one to say it.

 

[drumandmonkey]

My main problem is that I tend to panic in crises, which causes me to not make very good decisions shooting from my hips. I did not have any lapses in ethical judgment. My academics were blameless as my ITE scores were well above average for nation and for the program. I do not think that I was not a team player, or that I had poor communication skills, or had poor work ethic, etc. He told me that he would endorse me for internal medicine, but when it came down to it, I have not received any offers yet, despite temporary interest from several programs. Thus I feel like I am better off switching specialties.

 

[IlDestriero]

If they're throwing you out of your internal medicine program because they think that you are a poor fit for internal medicine, you shouldn't expect an endorsement to continue training in IM.
What are they going to say? "We fired him because he was bad in a crisis and made poor decisions, but I'm sure he will do fine in your second rate program."
Switch to PM&R or rads, Path, etc. Use your weakness as a selling point for why you were not successful in IM and would be a good fit for a low stress field like those above. The spin is that it's not that you didn't know what to do as evidenced by your scores, but were very uncomfortable under stress in these situations and not suitable in that career. If that is really the only problem, your PD should support your switch to a different low speed high drag specialty where you would rarely encounter the things that made him terminate you.

 

[bashwell]

By the way, how does IM have so much emphasis on crisis management? Unless you pick a particular elective, isnt it mainly just ICU term that's crisis intensive? Maybe some crises interspersed in cards, etc. but otherwise I would've thought IM should be pretty slow paced. Is there any way to get your PD to change his mind, maybe tell him you're really interested in a slower paced subspecialty like endocrinology? If you have research you could spin in that direction, then all the better I would think?

 

[drumandmonkey]

Well sometimes floor patients have to be transferred to the ICU, and someone has to manage that, right? There are lots of unexpected problems that come up that needs you to tend to immediately. That's where my problems come in. I was interested in general outpatient IM, which is not that acute, but I still have to get through heavy inpatient wards at my institution, and I was really intent on just powering through.

I still cannot get around the fact that the PD can't just tell me that I was a poor fit for internal medicine.

 

[drumandmonkey]

I was generally fine until someone develops sepsis and is tachypneic and tachycardic and hypotensive. Or someone develops severe bradycardia due to medication side effect. Then my mind just races. But if presented with questions about hypothetical patients having a crisis, I would be able to answer those questions correctly. I agree that I mismanaged some cases, and I certainly don't want to go into pulm/crit care or cards because I know I would be miserable. And while I do think that what you get out of residency is somewhat dependent on what you put out (for instance, if you work proactively and naturally acquire information easily, you will learn more), but still would anyone here disagree that where you train does not matter? Hence my predicament. And thoughts about switching fields.

 

[Siggy]

By the way, how does IM have so much emphasis on crisis management? Unless you pick a particular elective, isnt it mainly just ICU term that's crisis intensive? Maybe some crises interspersed in cards, etc. but otherwise I would've thought IM should be pretty slow paced. Is there any way to get your PD to change his mind, maybe tell him you're really interested in a slower paced subspecialty like endocrinology? If you have research you could spin in that direction, then all the better I would think?

At my hospital (400+ bed county hospital), the IM call team is the default responders for all codes and rapid response calls. While every other IM team and admitting service is checking their list to see if it's their patient, the IM senior is already starting to run the show. Additionally, the IM senior covers the ICU overnight. So an IM resident who can't handle a crisis is going to be having problems every call shift with handling crises.

 

[ThoracicGuy]

I was generally fine until someone develops sepsis and is tachypneic and tachycardic and hypotensive. Or someone develops severe bradycardia due to medication side effect. Then my mind just races. But if presented with questions about hypothetical patients having a crisis, I would be able to answer those questions correctly. I agree that I mismanaged some cases, and I certainly don't want to go into pulm/crit care or cards because I know I would be miserable. And while I do think that what you get out of residency is somewhat dependent on what you put out (for instance, if you work proactively and naturally acquire information easily, you will learn more), but still would anyone here disagree that where you train does not matter? Hence my predicament. And thoughts about switching fields.

You are at a point where being picky about where you train isn't really an option. Even if you switch fields, you are unlikely to get a top program in that field somewhere. You're likely to end up in a lower end location due to the non-renewal. I think you need to be a bit more realistic about your future options here. If you can't find a spot somewhere, you're going to end up in a place where you don't have any good job options and lots of debt to pay back...

 

[drumandmonkey]

Is having a contract non-renewal better or worse than a voluntary resignation?

 

[bashwell]

Is having a contract non-renewal better or worse than a voluntary resignation?

Unfortunately, I'd think worse. 🙁 It's basically them firing you, or you quitting. All things equal, it sounds better if you quit than if you were fired. At least that's what I'd think.

 

[smq123]

Is having a contract non-renewal better or worse than a voluntary resignation?

I agree, I think it is worse to have a contract non-renewal than a voluntary resignation. Making the decision to lose one of your senior residents, a year before he/she would have graduated and thus completely messing up the call pool/rotations schedule, is a pretty significant decision that basically translates to, "It is worth a major administrative headache to not have this person in our program."

 

[Law2Doc]

Is having a contract non-renewal better or worse than a voluntary resignation?

Doesn't really matter much -- either way your prospective PD is going to want to talk to your prior PD. If you don't finish out the year your PD might be more of pain to deal with when needing forms filled out for future credentialing paperwork, since you left him shorthanded. But I agree that this whole worrying about where you train has to stop. You are going to be jackpot lucky when any residency in any field is willing to take a Chance on you, so stop focusing on you being top ten caliber etc. If you get anything consider it the best place in the world.

 

[Law2Doc]

...
Switch to PM&R or rads, Path, etc. Use your weakness as a selling point for why you were not successful in IM and would be a good fit for a low stress field like those above...

I'm not sure these are necessarily low stress, just different stress. There's a reason some of these fields get sued a lot more than IM. From what I'm reading between the lines, he's actually probably better off in a field requiring less, not more, attention to detail.

 

[rokshana]

how is this something different? contract not renewed is a polite way to say you were fired...
and obviously your PD is not so supportive since you had interest and once they spoke with your PD you had no interest...you probably should make an appointment wit your PD to find out what he is saying and how you can get him to be, at best, more neutral.

and maybe you should think outpt family medicine...

 

[blebb]

If they're throwing you out of your internal medicine program because they think that you are a poor fit for internal medicine, you shouldn't expect an endorsement to continue training in IM.
What are they going to say? "We fired him because he was bad in a crisis and made poor decisions, but I'm sure he will do fine in your second rate program."
Switch to PM&R or rads, Path, etc. Use your weakness as a selling point for why you were not successful in IM and would be a good fit for a low stress field like those above. The spin is that it's not that you didn't know what to do as evidenced by your scores, but were very uncomfortable under stress in these situations and not suitable in that career. If that is really the only problem, your PD should support your switch to a different low speed high drag specialty where you would rarely encounter the things that made him terminate you.

Lol @ rads being low stress

 

[NRAI2001]

Well sometimes floor patients have to be transferred to the ICU, and someone has to manage that, right? There are lots of unexpected problems that come up that needs you to tend to immediately. That's where my problems come in. I was interested in general outpatient IM, which is not that acute, but I still have to get through heavy inpatient wards at my institution, and I was really intent on just powering through.

I still cannot get around the fact that the PD can't just tell me that I was a poor fit for internal medicine.

OP has so many inconsistencies... I m guessing like with so many other people that were dismissed or suffered major problems during residency we aren't hearing the full story here..

Like others have said that your comment about dropping the bar and going to a non top 10 program being an option you didn't feel comfortable with.. That already shows a big problem.. If anything the fact that you are coming from a top IM program and have no interviews shows there is more to the story than you let on..

If you are interested in general outpatient medicine why does it matter if you went to or continue in a "top" program?? Why does it even matter if you continue IM? Why not FM? Is it below you? If anything FM is very well suited to do general outpatient medicine..

 

[Cellpathology]

If they're throwing you out of your internal medicine program because they think that you are a poor fit for internal medicine, you shouldn't expect an endorsement to continue training in IM.
What are they going to say? "We fired him because he was bad in a crisis and made poor decisions, but I'm sure he will do fine in your second rate program."
Switch to PM&R or rads, Path, etc. Use your weakness as a selling point for why you were not successful in IM and would be a good fit for a low stress field like those above. The spin is that it's not that you didn't know what to do as evidenced by your scores, but were very uncomfortable under stress in these situations and not suitable in that career. If that is really the only problem, your PD should support your switch to a different low speed high drag specialty where you would rarely encounter the things that made him terminate you.

LOL and who told you that pathology was a low-stress field? What makes you think we would want someone who couldn't hack it in internal medicine?

 

[Cellpathology]

Lol @ rads being low stress

Yeah what the hell are they talking about? I can't count on five hands the number of times per day I make some life altering decision in pathology

 

[jazzman84]

People conflate the lack of direct patient contact in rads or path with lower stress, but that's not reality. Instead of having a set patient census, you are in some way responsible for every patient that comes across your screen (a hell of a lot more people than you would have to look after in the ICU or on wards). Try telling a transplant surgeon that the single HCC has grown to over 5cm and violates Milan criteria.

 

[IlDestriero]

Yeah what the hell are they talking about? I can't count on five hands the number of times per day I make some life altering decision in pathology

Do you really find pathology stressful?
I never said it was easy, just a better fit for someone who is a poor fit in a high patient contact/ long term follow up field.
The OP never actually said why he/she was a poor fit, other than that it wasn't related to intelligence, so there is necessary speculation.
When was the last time you coded a patient?
How about responded to a significant level 1 trauma?
Called it when a patient was non resuscitatable in the ER with the parents there crying in the corner?
Did a challenging surgery knowing that in spite of your best efforts, they will likely die anyway?
Told a patient or a family member that their loved one was going to die?
Those are things I would find quite stressful.
When you make your dozens of life altering pathology evaluations a day, does that usually cause you significant stress? Do you tell mom and dad that Jr's leukemia is back? That would be stressful.

 

[NotAProgDirector]

All fields of medicine involve sources of stress. The stresses in Pathology are different than the stresses in other fields. Telling a patient they have a fatal illness is stressful. Processing a frozen specimen to tell a surgeon whether they have clean margins is stressful. Reading 100 CXR's and making sure you didn't miss a nodule is stressful. It's impossible to agree which stress is "worse", as that's up to each person's opinion.

 

[Cellpathology]

Do you really find pathology stressful?
I never said it was easy, just a better fit for someone who is a poor fit in a high patient contact/ long term follow up field.
The OP never actually said why he/she was a poor fit, other than that it wasn't related to intelligence, so there is necessary speculation.
When was the last time you coded a patient?
How about responded to a significant level 1 trauma?
Called it when a patient was non resuscitatable in the ER with the parents there crying in the corner?
Did a challenging surgery knowing that in spite of your best efforts, they will likely die anyway?
Told a patient or a family member that their loved one was going to die?
Those are things I would find quite stressful.
When you make your dozens of life altering pathology evaluations a day, does that usually cause you significant stress? Do you tell mom and dad that Jr's leukemia is back? That would be stressful.

I 100% disagree with your assertion that making the decision that someone's cancer is back is less stressful than informing someone that their cancer is back (100% based on what the pathologist said) ..Do you actually think it is black and white more than 50% of the time? If so, you are dead wrong. I often find myself wishing that I was the oncologist on the other end who simply waits for the results and then initiates treatments based on very standardized protocols. The nuances in pathology are infinite and mentally you are on detail overload every single day....... I never said that the other jobs you are describing were not stressful, so if you are trying to convince me that they are, you are wasting your time.....And I definitely did not say pathology was more stressful, but i will not agree that it is less stressful...I simply pointed out the fact that you think pathology is not stressful when you obviously have a very limited understanding about what it is that we do on a daily basis. I, on the other hand, completed my clinical rotations, so I have an idea of what these other physician roles entail. I do not deny the stress that goes along with them. I think it is you who are suffering from a lack of perspective. Also you mentioned rads as not being stressful too. Who are you kidding? Do you actually think its easy to make dozens (sometimes 100s in the case of rads) of decisions on a daily basis when the impacts of those decisions are very significant and the price for being wrong can mean the end of your career or the end of someone's life? Pathology and rads are no different from other fields in terms of stress.

 

[j4pac]

If they're throwing you out of your internal medicine program because they think that you are a poor fit for internal medicine, you shouldn't expect an endorsement to continue training in IM.
What are they going to say? "We fired him because he was bad in a crisis and made poor decisions, but I'm sure he will do fine in your second rate program."
Switch to PM&R or rads, Path, etc. Use your weakness as a selling point for why you were not successful in IM and would be a good fit for a low stress field like those above. The spin is that it's not that you didn't know what to do as evidenced by your scores, but were very uncomfortable under stress in these situations and not suitable in that career. If that is really the only problem, your PD should support your switch to a different low speed high drag specialty where you would rarely encounter the things that made him terminate you.

PM&R manages sick patients on its inpatient wards. Patients who recently had strokes, TBIs, and spinal cord injuries with all their associated comorbities do crump once in a while. Path, Rads, and Derm are the three specialties that come to my mind as specialities that handle less acute patients. Derm is highly likely off the table considering level of competitiveness but I would imagine that Path and may Rads could be in play.

 

[j4pac]

All fields of medicine involve sources of stress. The stresses in Pathology are different than the stresses in other fields. Telling a patient they have a fatal illness is stressful. Processing a frozen specimen to tell a surgeon whether they have clean margins is stressful. Reading 100 CXR's and making sure you didn't miss a nodule is stressful. It's impossible to agree which stress is "worse", as that's up to each person's opinion.

Touché. But there is probably a difference between managing a coding patient and being vigilant enough not to miss a nodule. Stressful? Yes...but likely not to the extent that you're tachycardic about to break down into a corner. Only the patient understands his limitations. After all, if the OP got into a top 10 IM program, he/she likely handled the stress of medical school pretty well.

 

[gutonc]

You're all pretty.

 

[IlDestriero]

Touché. But there is probably a difference between managing a coding patient and being vigilant enough not to miss a nodule. Stressful? Yes...but likely not to the extent that you're tachycardic about to break down into a corner. Only the patient understands his limitations. After all, if the OP got into a top 10 IM program, he/she likely handled the stress of medical school pretty well.

I guess we all find different things stressful. Hopefully we select careers that are a good fit with our personality and can appropriately manage that stress. Having said that, the two radiologists that are close family members of mine who I see quite often have never used the word stress to describe problems with their jobs or the field in general, so radiology was a good choice for them apparently. That is not the case with my surgical and icu colleagues. Quite the opposite in fact, where the topic of new grey hairs and needing to go home and decompress is a daily conversation. When one of our extremely ill newborn patients died recently in the nicu after a risky surgery, the attending neonatologist looked like she was hit by a truck still the next day even though her management was fantastic and the child had little chance of survival.
To get the thread back on track, it would be nice if the op came back and explained a little better what problems he had that caused the burn out and poor fit with im. A bright IM resident can specialize their way out of a lot of a lot of headaches, though that may create new and worse headaches.

 

[rokshana]

I 100% disagree with your assertion that making the decision that someone's cancer is back is less stressful than informing someone that their cancer is back (100% based on what the pathologist said) ..Do you actually think it is black and white more than 50% of the time? If so, you are dead wrong. I often find myself wishing that I was the oncologist on the other end who simply waits for the results and then initiates treatments based on very standardized protocols. The nuances in pathology are infinite and mentally you are on detail overload every single day....... I never said that the other jobs you are describing were not stressful, so if you are trying to convince me that they are, you are wasting your time.....And I definitely did not say pathology was more stressful, but i will not agree that it is less stressful...I simply pointed out the fact that you think pathology is not stressful when you obviously have a very limited understanding about what it is that we do on a daily basis. I, on the other hand, completed my clinical rotations, so I have an idea of what these other physician roles entail. I do not deny the stress that goes along with them. I think it is you who are suffering from a lack of perspective. Also you mentioned rads as not being stressful too. Who are you kidding? Do you actually think its easy to make dozens (sometimes 100s in the case of rads) of decisions on a daily basis when the impacts of those decisions are very significant and the price for being wrong can mean the end of your career or the end of someone's life? Pathology and rads are no different from other fields in terms of stress.

sorry, but doing 3rd year clinical rotations as a med student does not give you any true idea about what the other specialties are like...
not saying there isn't stress in non clinical specialities, but it is not the same as dealing with patients and their families...

 

[Cellpathology]

sorry, but doing 3rd year clinical rotations as a med student does not give you any true idea about what the other specialties are like...
not saying there isn't stress in non clinical specialities, but it is not the same as dealing with patients and their families...

like i said...... i didnt say the other fields were less stressful, i said pathology is not less stressful......

 

[Promethean]

*HUG*

I'm in love with a former AOA officer, 245+ Step scorer who didn't finish her intern IM year. She is going back to school now, to pick up a trade, as she is not eligible for a medical license (and truly, given the reasons she didn't finish, that is what is best for everyone.)

Sounds like OP isn't in quite the same boat. With at least 1 PGY down, OP is able to get a full license. So, working as a rural GP or wage slaving it at a medexpress are always options.

If you can get back into any training program... any training program at all, any specialty, and finish it successfully, you should count yourself incredibly fortunate. Medicine is not forgiving of those who step (or are pushed) off the narrow path.

You will never find a program that doesn't want to talk to your old PD. If you want to have any hope of getting a seat anywhere, you need to arrange that sit down ASAP. Politely inquire about your deficiencies, and ask for advice regarding next steps. Mention that the programs you were interested in weren't interested in you after talking with the PD, and ask if they are aware of anything that they might have felt necessary to disclose that could be hurting you. Ask, most humbly, how you might be able to correct any such problems.

You don't realize it, but you are in a position of grasping at straws. If you should happen to catch one, you should cling to it, love it, cherish any opportunity that you may be so fortunate as to be entrusted with. You aren't remotely without hope, but you do need a lot of humility to get anywhere you'd want to go.