Consequences of Quitting Fellowship as 1st year Fellow

[Krogershopper]

I started a 2 year IM fellowship this past July and am having serious thoughts about quitting. After going through med school and a fairly rigorous IM residency, I don't think I am a quitter. But this program can not be described as anything other than malignant. I feel much less respected as a person and doctor than I was in residency and have been getting increasingly depressed over the past 3 months. There have been many times when I can't imagine any way I could finish this year off, though 2nd year is admittedly much less call.

I've read numerous threads about people wanting to quit fellowship, but am still left with the following questions that I'd be extremely grateful to have answered:

1) What are the real consequences of quitting fellowship on future career prospects in hospitalist medicine or IM primary care?

2) For instance, would quitting this fellowship 3 months in have any harmful effects on obtaining future state medical licenses or hospital credentialing for jobs in fields other than the fellowship (ie, IM or psychiatry, which I may pursue in the future)? The below 2 threads give conflicting info:

- jdh71 (who seems knowledgeable/experienced) gives a resounding and frightening yes in the very last post from this thread: Want to Quit Fellowship
- BUT gutonc, TopGun, and aProgDirector (who also seem knowledgeable/experienced) seem to give a resounding NO here: Need Fellowship Advice/Help!!

3) Is there any way at all to resign amicably from the fellowship?
- The thing is, I'm not sure how the program will make things work if I resign, since I cover a VERY busy inpatient consult service for 6 months in the 1st year. So, by quitting, they may just resent me either way. I just wonder if there is a way to avoid a situation where the program would intentionally try to screw me (ie, like what jdh71 describes by telling state licensing boards negative things behind closed doors). Currently, I can only think of telling the PDs the truth...that I am very depressed, and I just need to focus on my mental well-being and my family. Truthfully, with the way the program treats its fellows, I just wouldn't feel that bad for the program/attendings. I'd feel bad for the other fellows who may have to cover, but I feel somewhat deceived by the senior fellows not giving me some kind of warning during the interview (though I guess they may have been afraid too). I just don't get why the program wouldn't try to ensure incoming fellows have realistic expectations of the program...

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[AdmiralChz]

I am sorry you are not enjoying your fellowship, but as you know it is optional additional training - you can break off and become an internist really at any time since you’ve completed a residency. But to answer your questions...

1) I don’t see leaving a fellowship hurting you much for outpatient jobs, unless it’s in the same medical center or extremely close by. Even then it’s a bit of a stretch. It is easy to explain leaving the fellowship - just emphasize it was a poor fit, you are more passionate about primary care, whatevs...

2) I’m a little confused by your question. I don’t think this will be an issue with state boards, but you’ll need to explain the interruption in training on each application. As long as you have been in good standing and not placed on disciplinary leave or something, I don’t see it being a problem (just use the same reasoning as above.
- You mention a worry about closed door communication with the state board by your fellowship program - unless you’ve broken the law or had some major issue, this sounds illegal and frankly, unlikely.
- A different field (psych) is brought up, doing a different fellowship or even a second residency might be harder to obtain now. You’ll have a history of leaving a fellowship already so you’ll need to convince a future program you won’t leave them as well.

3) Probably not, parting is such sweet sorrow and all that. Carefully consider your options here, because once you leave you will likely close that subspecialty off for good. Be professional and evaluate the decision closely - will things get better next year as a “senior” fellow? Have you tried discussion your concerns with someone you trust in the program?
- Bottom line, if you must leave them give your program plenty of notice so they can plan coverage appropriately. It is nice that you are worried about their coverage, but to be selfish that is their problem and perhaps the staff may have to take a more active role with less trainees around.

Definitely focus on your mental health and get well, that is the most important thing here. If you believe leaving would be the best course going forward for yourself, go for it. Good luck and let us know how it all goes for you.

 

[Bobblehead]

Currently, I can only think of telling the PDs the truth...that I am very depressed, and I just need to focus on my mental well-being and my family.

Consider addressing this separately from your proposed solution of leaving the fellowship. Perhaps a leave of absence to address (mental) health and family issues would be a better answer than walking away at this time.

 

[Krogershopper]

Consider addressing this separately from your proposed solution of leaving the fellowship. Perhaps a leave of absence to address (mental) health and family issues would be a better answer than walking away at this time.

That doesn't seem to address the actual problem. The reason I feel depressed is 100% from the fellowship itself....

 

[Gastrapathy]

Do you want to practice this sub?

If not, it's no big deal to walk.

 

[Pathbusiness]

I would walk. Remember you are the most important person in your life.

 

[michaelrack]

If you mention depression or even any health related issues as a reason for leaving, it will follow you around forever (on licensing applications, etc).

 

[NotAProgDirector]

As long as you leave in a professional manner, all will be fine. Give a reasonable amount of notice. Your contract may specify. If not, 60 days is very reasonable, no one (reasonable) would argue. 30 days is probably fine for a fellow. Walking in and quitting, is not.

 

[Krogershopper]

Thanks very much everyone for the advice. To answer AdmiralChz's question, the reason why I'm so concerned with the consequence of quitting fellowship on future credentialing/licensing is because of all the posts on SDN that warn of this. It seems that training gaps or incomplete training can lead to delays or even prevent one from getting credentialed/licensed. Below are some example quotes of what I've read:

- Multiple posts on this thread (Resignation process/advice):

"..every single state license and hospital privileging application you ever submit in the future will be delayed while the board scrutinizes your application more closely due to the gap"

"Unfortunately medicine is an unforgiving field where if you have a red flag, or a gap, people see it as a big negative and a future risk--no one really gives you a chance afterwards unless you have the support of a your PD."

"...leaving on bad terms will impact him especially in smaller fields and when his former PD is asked to answer that licensing/credentialing question(s): "would you hire this individual again?", "is this individual eligible to be hired again?" It says a lot for maturity and professionalism as well as having the foresight to mitigate potential problems down the road if he were to stay."

"some licensing boards want references from every place you've trained. Better safe than sorry in terms of burning bridges."

- From last post on this thread (Want to Quit Fellowship):

"the one thing to remember is that when filling out applications for BOTH state medical license AND hospital credentialing you will be asked about all of your training time. You will be asked if you finished your training. You will be asked to tell people why you didn't finish your training. AND lastly you will have to provide documentation from ALL your past training programs that you were there, this documentation will be sent by your training program directly to the state medical board and employers, you will NEVER see what is said unless it is shown to you, or you have a lawyer rip open the confidentiality process of these things. Lots of "interesting" things can be said about you - none of it incorrect or a lie or "illegal" but state boards and hospitals can read between the lines. So. It's in your best interests to make sure you leave your current fellowship as friendly as is possible. You can do what you want but just remember at some point you will have to ask your current PD to tell other people you were his fellow."

 

[VA Hopeful Dr]

All true, which is why you don't want to burn any Bridges unnecessarily. That being said, I cannot imagine a program director wants to keep a fellow who doesn't want to be in that field.

Like aPD said, just give plenty of notice and do a good job while you're working out your notice and everything should be fine.

 

[jdh71]

Do your best to end things amicably and you'll ultimately be fine. Give notice now. Talk to your PD. Work out an agreeable end date (if you can). If if can't be done very nicely, give a notice that is appropriate per the language of your contract and then leave.

Yes. You'll have to explain it on every license and privileging application but you have a reasonable explanation and you will give it. None of this will ultimately be a huge deal.

 

[ThoracicGuy]

I am planning to leave a program too. I am half way through my first yr. its not a malignant program but its a program without structure. It used to be on probation for 4 yrs due to poor education...
The fellowship is for the 3 yrs and i have signed a first yr contract. Is Feb a good time to give notice for end of july leave. I already know someone who can easily take my spot in july...

If other employers ask me who i left the fellowship ill say” the program had been on probation, was on a financial freeze and education was poor...”

How does that sound?

Thanks

If it's been on probation for four years, why'd you go there?

 

[Gastrapathy]

Again, are you wanting to repeat the fellowship or just move on? If the former, take responsibility for your own education and stay

 

[Pinkyblack]

I had no clue it had been on probation in the past. They dont stay these stuff when interviewing. It’s not public info...

I love cardiology but under these circumstances i would be happier leaving the fellowship and moving back home...

 

[ThoracicGuy]

I had no clue it had been on probation in the past. They dont stay these stuff when interviewing. It’s not public info...

I love cardiology but under these circumstances i would be happier leaving the fellowship and moving back home...

Do you want to be a cardiologist?

 

[AdmiralChz]

It used to be on probation for 4 yrs due to poor education...

"Poor education" isn't a criterion for probation, it almost always is much more specific than that. Did they not address the deficiencies that led to the probation?

Anyways, if you honestly don't have an interest in continuing in Cardiology (which it actually sounds like you do) then all you need to say to future employers is that you had a change of heart and no longer have an interest in the subspecialty. I wouldn't go into your perceived deficiencies of the specific program, it could come across as crass or vindictive.

 

[anonperson]

I do not know the criteria they followed to but it was on probation 2007-2011

I am not enjoying the program. In addition, living in a small rural area of ohio as a single woman is rough.

It was on probation nearly 7 years ago.
Program may not be perfect but you need to decide if you want to be a cardiologist.

If you leave this fellowship, you've burned that bridge and will probably not be able to get into any other fellowships for cards. If you're fine practicing as an internist, just leave with the appropriate notice.

You're already committed to staying until July per your post. So basically 2 years left of fellowship which will determine the next 30 years of your career. Think very carefully about this and your future (earning potential, lifestyle etc)

 

[deleted480308]

7 years ago is irrelevant

And I would be careful here, there can only be so many unhappy residents of your gender in that very specific geographical region in your small subspecialty.....programs have the internet too

 

[Raryn]

I hope some of the above details are obfuscated, because how many people of your age, gender, state, rural location, specialty, and PGY year could there be?

 

[rokshana]

Thanks for your feedback

Earning potential like you said will be fine

Lifestyle, i am not sure.

I turned 40 this yr. i would like to have a family. Living here in this rural area there is absolutely no social life compared to where i used to live and practice as an internist.

As a general cardiologist will i have a lifestyle good enough to have a family? I thought about this before applying and i thought it would be ok but now that I see how private practice works i doubt it.

Working as an internist and doing ER shifts in my home city where family and friends are gives much more flexibility and understandbly less income. That’s what i am thinking...

While they may have not said anything about having been on probation 7 years ago ) though not sure how that has a role now), you obviously had to know the location of this program so why was it even on your rank list?

As others have said, you can work as an internist but don't expect to be able to work in an ED in any place other than in some small town or rural area...big city hospitals have plenty of EM train doctors to do that work.

If you are ok with never becoming a cardiologist, then simply turn in your notice, otherwise it's 2 more years and just get it done.

 

[Perrotfish]

Anyways, if you honestly don't have an interest in continuing in Cardiology ... then all you need to say to future employers is that you had a change of heart .

Ba dum bum