applying for PGY2 after resignation, Program Director?

[swedegirl17]

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I would appreciate any advice anyone can offer. I'm hoping a PD can look at this, but I'm new to this and not sure how to go about doing that. I'm sure this issue has been explored previously, but I've searched through the forums and I can't find a definite answer, maybe I didn't look enough. It's a long story so please bear with me.

I completed my first year of a AOA FP residency, then took a LOA secondary to a death in the family and medical issues. We weren't really sure what was going on. I just didn't feel well, fatigue, nausea, malaise, headache, weight loss, hypoglycemia, hypotension, some strange lab abnormalities. At the time, with the added stress of the death, we chalked it up to stress, depression and my drs were concerned of possible relapse of an eating disorder which I have a hx of. I improved quite a bit during the six months I took off. Was tx'd for anemia, some minor thyroid stuff, ate better, rested etc. returned to work. I really thought I was ready to go back. Within a little more than a month my symptoms returned, but much worse. I was hospitalized, mostly in the ICU approx 8 times within 3 mos, obviously using all my sick and vac time and depleting any reserves I had left. About six wks into these admits, I was dx'd with Addison's disease,why it took so long I have no idea. However, it took a couple more admits at a tertiary care center to stablize adrenal crisis, determine appropriate amounts, types of steroids etc. and did have a couple more adrenal crisis in the process. I did eventually stabilize somewhat and continued to work as much as I could throughout this.

I just reached a point, for obvious reasons, I didn't think I was healthy enough to continue to care for patients and I wasn't being fair to my colleagues who kept having to pick up the slack, and I just couldn't do it anymore and I resigned as my hospital admin couldn't grant me another leave secondary to the lengthy first leave.

I have applied to many "open" PGY2 FP positions off cycle via residentswap, find a resident etc with no luck. They seem to fill almost overnight and I'm sure right now I'm considered a liability. I made the decision to go through ERAS for the july season. I'm applying for FP/EM as well just because I enjoy that, but more FP positions as well.

When I apply for FP, are they going to offer PGY1, PGY2 spots, how do I know? Should I ask for only PGY2?, but how do I even do that. I don't see that option on ERAS. What are my chances? I got tons of interviews the first time around, but am terrified of not getting any now. All interviews but with the residency I picked the first time around were ACGME so I think I was a decent candidate. I would be willing to repeat year one. I would hate it, but I would do it. I think I still am a fairly strong candidate. I have COMLEX scores of 86 and 90, mostly good evals and am taking step 3 at the end of oct.

Realistically, what are my chances. I left on good terms with my PD, my LOR are very good. I feel that I explained my LOA as briefly, but as well as I could. Basically just saying I took a LOA due to symptoms with an unclear etiology and death in the family. Received tx for obvious stuff, felt better, but never but never got a comprehensive dx. It was finally dx'd after returning, but by that point I was pretty sick. I'm hoping they recognize Addison's is easy to miss, but also very manageable and I do emphasize I am well controlled and I have no factors hindering me etc. In one of my LOR the attending helps explain that the first leave was likely due to undiagnosed Addison's and I've spoken to him several times and he's willing to state I'm capable of performing all responsibilities, duties etc.

Any advice, what else should I be doing? Basically I'm in panic mode right now. This last year has been hell and all I want to do is get back to my life and get on with being a dr.

If you've made it this far, thanks for listening.

 

[gutonc]

Any advice, what else should I be doing?

You should be talking to your old PD and asking if you can re-join the program now that you're in better shape. Ask him/her if s/he can recommend other programs you should talk to or call other PDs for you. Apply to programs through ERAS for PGY1 spots and when you get the interview, tell them you'd be interested in a PGY2 spot but would happily start as an intern again to prove yourself. It's not uncommon for programs (at least in IM) to take a resident as a conditional PGY2, i.e. they function as an intern for 3 or so months and if they prove themselves capable, they move up to PGY2 status. I've seen people do this successfully and also seen people flail (and it becomes obvious why they left the prior program).

Whatever you do, "PGY2 or bust" is a really bad idea.

 

[turquoiseblue]

definitely try to get back into your past program if you can and say you were ill and finally recovered.

meanwhile, also try to apply via eras/nrmp for a pgy1 spot. you may have to restart, because quite frankly it is tough to get anything in the scramble for pgy1 or pgy2, because if you think about it, there are very limited number of spots and im sure there are at least hundreds if not thousands of applicants trying to get the same spot as you.

i was ill for my last 2 months, and wasn't welcome to return, but got a good LOR from the PD, stating i had no problems. you may need to get yourself a good PD letter so you can even apply to PGY2. i personally can't qualify for pgy2 in most cases but you probably can.

if you're amg or have really good scores i see you can at least restart as a pgy1 if you match. definitely state your illness in your aplication and how you recovered, so they know why you left your program. that is a good reason or 'excuse' to leave i would guess or you could state you had family problems if you don't want to get into that and potentially appear as a physically weak candidate. as for a pgy2 your chances are much more slim for reasons i stated above.

i don't know if this is true but some or maybe one specialty (ies) will allow you in with a PGY1 in FP such as radiation oncology, but that is very difficult to get anyways. but maybe it is worth a try if you want a PGY2.

good luck

p.s. isn't it just awful how they hang you out to dry if you have to leave for some reason? it's not going to be easy but i've seen other people able to get back into the system, so it is possible.

 

[NotAProgDirector]

The advice you've received so far is very reasonable.

You should absolutely contact your prior PD. Perhaps they can get you back in the program. if not, perhaps they could help contact other programs looking for open, off cycle spots.

I'm assuming by "AOA" program you mean an osteopathic program. If you're applying to ACGME programs, you'll absolutely need to start as a PGY-1 as you won't get any credit for your AOA training.

The NRMP match for IM is PGY-1 only. PGY-2 positions need to be found outside the match. I think the DO match is the same, but could be wrong.

Good luck. You have a compelling story. The only problem with your story is that Addison's, although treatable, is not curable. Will you be able to handle 24 hour call without decompensating? What happens when you get a cold? PD's may worry about this, and it might affect your chances of getting a spot.