Burned out of an MPH program

[NotAProgDirector]

Hey. Thanks for your advice/support in advance.

I recently finished my 3rd year of med school. I then took a leave of absence (gap year) and enrolled in the MPH program. Unfortunately, I crashed and burned with depression upon starting the MPH. I had to drop out very soon after starting. I dropped before the drop/add period ended, so there really are no incomplete grades or even a record of being there in the first place. Luckily, I'm doing a little better now and found a job at my hometown's university. I plan to go back to medical school as was originally planned and finish my MD in 2013. What am I obligated to tell my medical school and residencies to which I apply? May I simply say that I opted to work for 6 months, or do I need to explain the whole depression thing? Will this negatively effect my chances? Am I still competitive for ob/gyn? If I had to characterize my med school experience briefly, it's that I do well most of the time but occasionally do very poorly. I hate depression. It's not fair. I have stellar board scores and go to a top 5 school, and have decent clerkship reviews, but am in this position of worrying about not matching because of a few bad experiences due to depression. Please do share your thoughts, advice and encouragement. Thank you very much.

What are you obligated to tell your school? Since they probably approved a leave of absence for you to get an MPH, they will certainly be interested in why you don't have one. I think you will need to be 100% honest with them.

What are you obligated to report on your applications? That's a tougher question. First, you'll need to find out how your medical school will report this on your MSPE. They may insist on the full truth, and then you won't have any choice. They might say that you started an MPH but then stopped due to health reasons, and leave it at that. You are probably not obligated to report any more than that.

Simply saying that you decided to work for 6 months doesn't make much sense. First, doing so would usually require that you start paying back loans (assuming you have any). Second, it makes you look pretty wishy washy, unless you try to explain that you needed to do it for financial reasons -- but in that case you would have worked for 12 months, not 6, and in any case you NEVER want to lie.

Is it going to affect your application negatively? That's hard to say, but probably. Look at it from my standpoint -- you started an MPH and had to stop because of your depression. It would be a complete nightmare for my program were the same thing to happen when you started an internship, which (no insult to MPH's intended) is usually much tougher and more time consuming, and sleep interrupting, than an MPH. PD's will be nervous.

"Occassionally do very poorly" will not help in the application process. Since you didn't post any more details than this, it's hard to know what it means.

You wrote "...am in this position of worrying about not matching because of a few bad experiences due to depression." This is exactly what I would owrry about if looking at your application, from the other direction. Residency is hard, and I don't want residents having "a few bad experiences due to depression".

Your options? I expect your medical school will not be willing to simply sweep this under the rug. They will most likely document that you were approved for an LOA to pursue an MPH, but had to withdraw from the program for medical reasons. You will then have a difficult decision: you can either leave it at that and not discuss it any further, or you can talk about it in your application (in your PS, or elsewhere). If you don't mention it, it's illegal for anyone to ask about the details -- but you take the risk that by being vague, people get nervous (since they have no idea what the problem was), assume that since you didn't mention it there is something bad, and decide to pass on your application. On the other hand being honest and talking about it could yield the same result.

Critical in this would be improving your performance and trying to get your depression treated so you can move on. I realize that's easier said than done, but as mentioned above you need to be in as good health as possible if you want to complete a residency. Better to take time now to address this. If you burn out of a residency, you may never get another chance.

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[Janedoedoctor]

Perhaps I'm being completely naïve, but doesn't the OP have a right to confidentiality concerning his/her health?

What would be wrong with just saying that you had an (unspecified) medical issue that kept you from doing the MPH? Mention that it's resolved now and that relapse is extremely unlikely.
Being an MD, your PD should be very well placed to realise that they have no business asking for the details of your past medical issue. As long as you declare that it doesn't impede your capacity to do your work.

 

[NotAProgDirector]

Yes, you are absolutely correct. The OP is unlikely to be able to sweep this completely under the rug as if nothing happened. But they can say that they withdrew from their MPH for "medical reasons" and leave it at that. And if the OP does that, no one can legally ask for more details.

The problem is simply that if they do this, you're assuming that PD's will simply say "OK fine, no problem, no big deal". That's not necessarily the case. PD's might "guess" that the health problem was alcoholism, or severe depression, or schizophrenia, or a brain tumor. All of those could go badly as a resident, and have some chance of recurrence. PD's might decide that such a candidate is a bad risk, and move on. Then again, they might not.

In the OP's situation, that's exactly what I would do -- leave it vague and don't explain further. Depression is a complex issue, often worsened by sleep deprivation, and can cause long LOA's. I expect that many of my colleagues would seriously consider that a potential problem worth avoiding. So, best to leave it vague.

If the OP had withdrawn from an MPH due to an MVA and trauma and was now all better, I would explain that in short detail. That's a one time event, and should (hopefully) have no lasting effects.

 

[collosalmockery]

Yes, you are absolutely correct. The OP is unlikely to be able to sweep this completely under the rug as if nothing happened. But they can say that they withdrew from their MPH for "medical reasons" and leave it at that. And if the OP does that, no one can legally ask for more details.

The problem is simply that if they do this, you're assuming that PD's will simply say "OK fine, no problem, no big deal". That's not necessarily the case. PD's might "guess" that the health problem was alcoholism, or severe depression, or schizophrenia, or a brain tumor. All of those could go badly as a resident, and have some chance of recurrence. PD's might decide that such a candidate is a bad risk, and move on. Then again, they might not.

In the OP's situation, that's exactly what I would do -- leave it vague and don't explain further. Depression is a complex issue, often worsened by sleep deprivation, and can cause long LOA's. I expect that many of my colleagues would seriously consider that a potential problem worth avoiding. So, best to leave it vague.

If the OP had withdrawn from an MPH due to an MVA and trauma and was now all better, I would explain that in short detail. That's a one time event, and should (hopefully) have no lasting effects.

So your colleagues would consider past depression of a medical student as a problem and move on to the next candidate who was lucky enough to not get depressed? Wow. Initially life is not fair for many people when they are born with genetic diseases or genetic tendency to have diseases and then the fellow members of human species determine who will success and who will nto based on the phenotypic expressions of ones ugly genes. Yes, patient health is most important but as long as the candidate is not currently depressed and has stellar evaluations, he/she must be put on equal footing with the candidates who were "lucky" to not get depressed. But hey, I am not the PD of your program, just saying.

So I guess the best thing is to never get diagnosed with depression as a medical student, even if you are depressed and are having suicidal thoughts, cuz well, it can affect your choice of residency.

 

[NotAProgDirector]

I understand your frustration.

Legally, a medical leave of absence from training should have no bearing on your future employment. I agree that in a perfect world, I would completely ignore this and assess a candidate based upon their current performance.

But, we don't live in a perfect world. I have done just this several times before -- take people who had a major problem like this. Some of the time things go fine. Some of the time, they have a recurrence during training -- not terribly surprising since sleep deprivation, long hours, irregular schedules, emotional situations at work, etc, all will tend to worsen psychiatric issues. When a resident does go out on a long leave, it creates a catastrophe for the rest of the program. Although most residents would like to think that they would chip in to help their comerades, it's a much harder issue when it's your elective that get's usurped to cover someone else's ICU. And there's no way to "pay it back" given the way the schedules work.

If this happens, it's hard for me to not think about it and consider it. It's an interesting ethical question -- should I take an intern who has a high risk of relapse of their depression / substance abuse / etc because it's only "fair" to that intern to assess them based upon their current performance, or is that "unfair" to the other interns who might have their schedules affected in a major way due to an absence? This isn't limited to psychiatric issues, can be seen with any medical condition that tends to flare, be chronic, and impact one's ability to work -- MS comes to mind.

I'm not saying what the right answer is. Despite my experiences in the past, I still do take residents who have a history of a leave during medical school, even those for depression. But I expect that some PD's may not -- although they may miss out on some good residents, they also certainly avoid some extended leaves and the problems they create.