contract non-renewal - need advice

[Iliad]

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Wow, this is a hard post to write. I'm a pgy 1 in a small fp program. So, far about 50% of my evals have come back as "he's doing fine, right where he should be" and about 50% as negative.

Some of this is feedback is fair and some of it isn't. I'm the first to say that I have alot to learn, but I'm not a danger and nothing I have done has been considered eggregious - just little things. I've been struggling with ADD my whole life and have been able to compensate for this. It took me another semester to finish med school, but I never failed a class - a solid straight B student. Both Steps are just over 200, although I had to take Step 2 twice. So it's been bumpy to say the least.

In January, I was put under evaluation - the secret type. Everything went fine except I screwed up a med order which meant the patient didn't get meds for one full day obviously, extending the hospital stay of a patient. Enter February, a remedial plan was written. Part of this included a psych consult. Psych was completely amazed that I'd been able to accompish what I have done without medication, but said times have changed and started me on meds. Too early to say if this has had an impact, but I think it is helping.

Nothing has gone extrodinarily well nor extrodinarily bad. I've been busting butt and know that I have benefited from the plan put in place. At this point, I don't know what the decision will be.

If my contract is not renewed, do I have other options to continue my career in medicine?

Grateful for the advice.

 

[f_w]

Do a search. It is an annual ritual on SDN to flog this one to death. For some reason, it is allways a 'small fp program' where this s%%% goes down. You should find a couple of threads on probation and nonrenewal that will give you many informed and uninformed opinions.

 

[Iliad]

Well, I've read the posts about contract non-renewal and definitely learned some things. I still have questions:

1) Is a contract non-renewal the same as being fired?

2) What are my options for moving ahead?
-- Can I repeat a pgy1 in the same speciality? If so, are there downsides to the decision later ie more explaining?
-- Should I be looking for a pgy2 spot?

3) Can I participate in the match again? Can it be for the same specialty or does it have to be a different specialty?

4) What are the best resources for learning about open spots?

5) Any way to get a copy of the scramble list from this year?

6) Any rec's on good medical lawyers that I can contact? The program has really done their work in terms of documenting (I don't think they've been fair - no surprise) I want to find someone who understands the longer term implications of this situation and can advise me as to what I NEED to do to protect my interests. I'm not talking lawsuit, but good informed advice.

Again, grateful for the advice.

ps - just read evals from my medical director - all scores are above average, with noted strengths and the weakness is being inefficient.

 

[f_w]

1) Is a contract non-renewal the same as being fired?

In effect yes. The only upside is that you can honestly answer 'no' to the question whether you where ever terminated from a residency program.

-- Can I repeat a pgy1 in the same speciality?

Yes.

If so, are there downsides to the decision later ie more explaining?

You have some explaining heading your way whatever you do.

-- Should I be looking for a pgy2 spot?

Yes.
That would be the preferred outcome. A program that lost some PGY-1s and is hurting for a warm body that can take PGY-2 call and doesn't mind your prior troubles.

3) Can I participate in the match again? Can it be for the same specialty or does it have to be a different specialty?

Don't think you are precluded from participating, it would mean a year idling.

4) What are the best resources for learning about open spots?

The index finger of your dominant hand which will have to do a lot of phone dialing in the months to come. You have a sales job heading your way, the product you are selling is 'you'.

5) Any way to get a copy of the scramble list from this year?

Officially, the only way to get the scramble list is by being a participant in the match. The unofficial way is to bribe a rotating medical student into sharing his password with you. Even under the threat of torture, you shouldn't give up this students name because the 'system' will retaliate mercilessly against him if they find out.

The program has really done their work in terms of documenting (I don't think they've been fair - no surprise) I want to find someone who understands the longer term implications of this situation and can advise me as to what I NEED to do to protect my interests. I'm not talking lawsuit, but good informed advice.

If they have done a good job in establishing a paper trail of repeated attempts to fix you, a lawyer won't be of great help. The only time you can attack decisions is if they didn't stick to their own rules.

ps - just read evals from my medical director - all scores are above average, with noted strengths and the weakness is being inefficient.

Inefficient as unable to get your assigned work done ?

 

[Winged Scapula]

Had this been posted earlier, you could have registered for the match today and gotten a copy of the scramble list yourself. The deadline was today at 9 pm EST.

 

[Oatcell]

GET OFF THOSE MEDS!!! You don't need them. People give meds to others in order to tolerate them better, it has no benefit to you. Only brings about your slow and agonizing demise!!! Document this as well. This is key for your legal council as far as you going so far on a limb as to jeopardize your internal organs to satisfy your programs request in order to remain in good-standing. DON'T SIGN ANYTHING. DON'T ACCEPT A PROBATION. Warnings and the such are not pertinent and don't have future ramifications/repercussions.

 

[Doowai]

WOw, this scares the crap out of me

 

[Shalom77]

GET OFF THOSE MEDS!!! You don't need them. People give meds to others in order to tolerate them better, it has no benefit to you. Only brings about your slow and agonizing demise!!! Document this as well. This is key for your legal council as far as you going so far on a limb as to jeopardize your internal organs to satisfy your programs request in order to remain in good-standing.

I have to strongly disagree with this. If ADD medication is helping you function better - and I realize you said it's too early to tell... then STAY on them. Unfortunately there is a lot of stigma surrounding taking medication for ADD... BUT it's MUCH better to be employed and functional and taking meds than to be unemployed. Don't let other's prejudice and the stigma prevent you from doing what is best for you. People with previously untreated ADD have really turned their life around with appropriate treatment which besides meds can include other types of non medication therapies/couching. Unfortunately I've seen people with ADD who've succumbed to the sneering/stigma of taking meds who then stopped taking them... and lost their jobs. Of course if the meds aren't helping... that's a different story. It's also wise to have a doctor helping you who is completely independant of the program even if you have to continue seeing their consultant.

Good luck!

 

[Top Gun]

I have to strongly disagree with this. If ADD medication is helping you function better - and I realize you said it's too early to tell... then STAY on them. Unfortunately there is a lot of stigma surrounding taking medication for ADD... BUT it's MUCH better to be employed and functional and taking meds than to be unemployed. Don't let other's prejudice and the stigma prevent you from doing what is best for you. People with previously untreated ADD have really turned their life around with appropriate treatment which besides meds can include other types of non medication therapies/couching. Unfortunately I've seen people with ADD who've succumbed to the sneering/stigma of taking meds who then stopped taking them... and lost their jobs. Of course if the meds aren't helping... that's a different story. It's also wise to have a doctor helping you who is completely independant of the program even if you have to continue seeing their consultant.

Good luck!

I agree as well. If the meds help you function better as a resident, stay on them. If they are helping you, then the program director will be able to see improvement in your performance and be more likely to offer you contract renewal.

 

[Faebinder]

👍

I have to strongly disagree with this. If ADD medication is helping you function better - and I realize you said it's too early to tell... then STAY on them. Unfortunately there is a lot of stigma surrounding taking medication for ADD... BUT it's MUCH better to be employed and functional and taking meds than to be unemployed. Don't let other's prejudice and the stigma prevent you from doing what is best for you. People with previously untreated ADD have really turned their life around with appropriate treatment which besides meds can include other types of non medication therapies/couching. Unfortunately I've seen people with ADD who've succumbed to the sneering/stigma of taking meds who then stopped taking them... and lost their jobs. Of course if the meds aren't helping... that's a different story. It's also wise to have a doctor helping you who is completely independant of the program even if you have to continue seeing their consultant.

Good luck!

I agree as well... take them if they are helping. There is no shame in it.

 

[Iliad]

Thanks for the feedback, this thread is a bit of a lifeline right now. I had an informative conversation with someone who is considered a bit of an expert in medical licensing. He gave me good advice for what I can do now to prepare for the potential of questions down the line. Basically, to add documentation from my perspective that is more balanced (basically, make sure the things I'm good at get documented too) and to gather LORs to have in my own file.

So,I'm trying to get on with the next steps and have a few questions...

1) If I wanted to work on a IM spot (I'm FP, right now) - does my current year count and can I transfer into a IM PGY2 spot or am I looking for a PGY1 IM spot?

2) If I do have to go for a PGY1 IM spot, I'm essentially in the scramble (unoffically, because registration just closed)? I just realized that not being registered is likely a great thing for me, because I'm not limited to contacting programs on scramble day and after. I can start doing this now -this way I've got my app in there should the program have to scramble. Right?

3) Any suggestions about how I present this in the best way? Being dishonest isn't something I can do, so I need to figure out some way to position myself honestly, fairly and in the best possible light.

4) If I approach programs now, I have to do it without my current PD knowing. Any sense from you all about whether or not Programs generally honor the applicants need to be discreet? My experiencse from other professions is that this is honored generally. But the world of Medicine continues to surprise me.

Again, thanks for the advice.

 

[f_w]

1) If I wanted to work on a IM spot (I'm FP, right now) - does my current year count and can I transfer into a IM PGY2 spot or am I looking for a PGY1 IM spot?

You are looking for IM PGY-1. Maybe you can get your IM months credited which may allow you to do some extra electives later on.

2) If I do have to go for a PGY1 IM spot, I'm essentially in the scramble (unoffically, because registration just closed)?

Sort of. You are in the 'all others trying to get in the door' category.

I can start doing this now -this way I've got my app in there should the program have to scramble. Right?

And you should be dialing your fingers sore right now.

3) Any suggestions about how I present this in the best way? Being dishonest isn't something I can do, so I need to figure out some way to position myself honestly, fairly and in the best possible light.

As a previous poster mentioned, you might want to frame this as a 'now that I have seen IM, I have realized my calling' thing. If asked, you can blabber about FP being the 'jack of all trades master of none' and how it allowed you to 'see a spectrum of practice styles and being able to make your decision' etc.

4) If I approach programs now, I have to do it without my current PD knowing.

You won't be able to do that.
As he fired your a##, he probably couldn't care less. I mean, how much worse can it get, he knows you are going to be history pretty soon.

Any sense from you all about whether or not Programs generally honor the applicants need to be discreet?

They typically want an LOR from the PD at some point. You can require this LOR to be available to you. There is only so much the PD can write in there. At some point, you will have to be honest with your new PD (before you start) and prime him with all the dirt that the old PD will throw your way. And as your 'expert' told you, it is a good idea to have your own references, that way it is easier to diffuse the impact of your PDs low opinion of you (e.g. if your PD writes that they are letting you go because you consistently didn't manage to get your work done but then you have a rotation attending who can attest that in the right environment you where a very capable and efficient physician, it can help you to bring your side of the story accross).

But the world of Medicine continues to surprise me.

Don't think about this as a regular 'switching jobs' situation. This is more like transferring from one boarding school for troubled teens to another.

Oh: If a psychiatrist or properly credentialed clinical psychologist whom you trust recommends taking medication, I would suggest that you go with this advice rather some anonymous postings on 'the internets'. If you think that this providers recommendation is biased due to the fact that he is also working on behalf of the hospital, get an independent evaluation from a physician/psychologist whom you trust.

 

[Iliad]

"You won't be able to do that.
As he fired your a##, he probably couldn't care less. I mean, how much worse can it get, he knows you are going to be history pretty soon."


The situation stands that I am working under a remediation plan. I should know within the next couple of weeks, whether or not they will renew my contract. No decisions have been made, so I haven't wanted to jeopardize anything more.

I've been busting my a## to do the best job I can and am just now coming up for air asking what if things don't go my way.

I talked to the PD, he said he needed more time. "But if I wanted to move on, he would understand."

Now I'm trying to second guess what that means! Is he saying indirectly "please decide to not renew your contract".

Up until now, I've been thinking that I don't gain anything by not renewing. Would my LOR from him change? But, now I'm second guessing this.

Any thoughts?

 

[Shalom77]

My understanding is that the contract non-renewal has not happened yet and is at this point just a possibility.

Have you talked to your PD directly about this and asked whether this is a possibility? I don't know how good your relationship with your PD is but I don't think talking to him/her hurts. It might be worth discussing your chances and whether s/he thinks a more "focused" field might be more appropriate for you. If you don't think your PD is a good person to talk to is there some other attending in your program you could discuss this with for advice?

I would assume that programs would contact your PD regardless of your request. That is likely to hurt you even more at your program especially if they've been working with you with the intent of keeping you in the program - if they think you are going to leave anyway then they may no longer bother.

I would try to get a better sense from your pd about where you stand in terms of the possibility and when the decision would be made. I realize you can't trust anyone in medicine but the only other thing I would be concerned about is that applying can be very time consuming and can distract you enough such that you perform worse in your current program. Regardless of whether you end up staying at your program or leaving you need your clinical performance to be strong.

Edit: was writing when you posted...

 

[razorback58]

It is my understanding that ADD/ADHD is protected under the American Disability Act.

Any thoughts? Sounds like once you got diagnosed with ADD then you have recourse with EEOC and ADA. Where I got my info.

http://www.allbusiness.com/legal/legal-services-litigation/5523001-1.html

 

[razorback58]

Do a search. It is an annual ritual on SDN to flog this one to death. For some reason, it is allways a 'small fp program' where this s%%% goes down. You should find a couple of threads on probation and nonrenewal that will give you many informed and uninformed opinions.

Interesting thread
http://forums.studentdoctor.net/showthread.php?t=246161&highlight=nonrenewal

 

[Faebinder]

Do a search. It is an annual ritual on SDN to flog this one to death. For some reason, it is allways a 'small fp program' where this s%%% goes down. You should find a couple of threads on probation and nonrenewal that will give you many informed and uninformed opinions.

That's cause when a PGY IV surgery resident is fired or contract not renewed... everything is hush hush and the person usually easily finds another residency spot that will take a resident who has 4 or 3 years of experience.

 

[f_w]

The situation stands that I am working under a remediation plan. I should know within the next couple of weeks, whether or not they will renew my contract. No decisions have been made, so I haven't wanted to jeopardize anything more.

Good idea to lay low then. Still, get your CV together and start calling. Emphasize that at this point your PD doesn't know.

I've been busting my a## to do the best job I can

And that is your best bet.

I talked to the PD, he said he needed more time. "But if I wanted to move on, he would understand."

Now I'm trying to second guess what that means! Is he saying indirectly "please decide to not renew your contract".

It would certainly relieve the headache you seem to be causing him. If you where to find another program and he can promote you away without any major hubub, his problem would be solved. If he doesn't renew your contract he might have to explain his decision. And if physicians hate one thing, it is being second-guessed and having to justify executive decisions.

Up until now, I've been thinking that I don't gain anything by not renewing. Would my LOR from him change? But, now I'm second guessing this.

They send you a contract, you sign it. If something better comes along, you can still give them notice that you won't be there for PGY-2.

 

[nattygann01]

GET OFF THOSE MEDS!!! You don't need them. People give meds to others in order to tolerate them better, it has no benefit to you. Only brings about your slow and agonizing demise!!! Document this as well. This is key for your legal council as far as you going so far on a limb as to jeopardize your internal organs to satisfy your programs request in order to remain in good-standing. DON'T SIGN ANYTHING. DON'T ACCEPT A PROBATION. Warnings and the such are not pertinent and don't have future ramifications/repercussions.

.

I'm just a 4th year, but I'm pretty shocked that any physician who has NOT fully worked up a person can advise them to STOP taking medications!?! I'm not saying he should or should not be on meds, but I just don't think anyone on SDN has enough information right now to advise him on this...

 

[secretwave101]

Fascinating and terrifying thread. I'm constantly chewing my nails about getting renewed. Made it through internship though, and no red flags (I know about).

It really seems like you're doing all you can. Of course, we're getting the story only from you and in all fairness there could be some other stuff there that would change the look of your situation. In general, however, I know that small FP programs value adherence to "culture" as much as to medical care. In other words, you can end up in almost as much hot water for using personal days on Christmas - even if you're technically allowed to - as for making a glaring medical error (depending on the error, of course). Humility, penitence, and constantly-open lines of communication to your PD and adviser go a LOOoooong way to clearing the air. Never forget that at the heart of family medicine is communication. In these situations, I think it's immensely important to both regularly update anyone who might be doubting you about all that you are doing to make things right, and to just to keep in touch with them.

Initiative and humility cover a multitude of sins.

 

[medicinesux]

it is situations like these which turn my stomach in ways that make me believe I will be reincarnated in a future life to become a union boss.

 

[ahmad1]

I know a guy who was fired, last year toward the end of his intern year, because of a couple of bad evaluation. He took a year off and now is applying to a different residency. I haven't kept in touch with him, but I heard that he had a very good interview season. I think the secret to his success was that he took a year off and shadowed a bunch of physicians/residency programs and showed them that he was committed.
So hang in there. If your contract is not renewed then you can certainly apply to IM, but you have to start as PGY1. If I were you I would also look at Psychiatry, Occupational Medicine etc., and you can start as PGY2 in those specialties.
Have you thaught about taking a year off and shadow physician in different specialties that way you can show them that you are really hard working.

 

[DrDawg]

Schedule regular meetings with your PD until you have a contract in hand. Maybe every other week if possible. Talk with Graduate Medical Education to determine when they expect to sending new contracts to your programs office, and when they needed them returned (so you know if your department is giving you the run around). Ask for documentation of any remedial plan with clear goals, and an evaluation process on how you are progressing with these goals. Does the ACGME have any info?

Good luck

 

[LeemerDO]

Here's an additional scenario that maybe you guys can help me with.

I applied to a hospital that had both ER and FP with the primary intention of pursuing ER. For the most part, the ER program essentially gave me the run around and did not inform me either way of where I stood in terms of my chances there. In the end, I had to hear from a confidential source that both myself and another intern were not selected for next year. They still have not let me know either way. In the interim I had also applied to their FP program, you know, kind of like a back up. Their FP program from the start was in dire need of residents since it was essentially operating at half capacity. They were hell bent on increasing the FP program to the extent that they had axed a position for next year's PGY2 ER slots. Today I just received word that they rejected me. What baffles me is that they did not match a single PGY1 spot this year, their current potential PGY2s are itching to leave this program, therefore leaving only two PGY3s next year. Any input as to why a program would intentionally shoot themselves in the foot, especially since their main impetus is to get their FP program to grow? I'm at a loss for explanation.

I'm not really pissed either. The fact that they at least said something declarative was relief enough since they were keeping us guessing in the wind. In fact I already signed a contract with someone else long before they had a chance to reject me. I'm just disappointed at the fact that I won't have the chance to formally reject them on my terms, or at least keep them guessing for a long time as well. That's all.

 

[Faebinder]

Here's an additional scenario that maybe you guys can help me with.

I applied to a hospital that had both ER and FP with the primary intention of pursuing ER. For the most part, the ER program essentially gave me the run around and did not inform me either way of where I stood in terms of my chances there. In the end, I had to hear from a confidential source that both myself and another intern were not selected for next year. They still have not let me know either way. In the interim I had also applied to their FP program, you know, kind of like a back up. Their FP program from the start was in dire need of residents since it was essentially operating at half capacity. They were hell bent on increasing the FP program to the extent that they had axed a position for next year's PGY2 ER slots. Today I just received word that they rejected me. What baffles me is that they did not match a single PGY1 spot this year, their current potential PGY2s are itching to leave this program, therefore leaving only two PGY3s next year. Any input as to why a program would intentionally shoot themselves in the foot, especially since their main impetus is to get their FP program to grow? I'm at a loss for explanation.

I'm not really pissed either. The fact that they at least said something declarative was relief enough since they were keeping us guessing in the wind. In fact I already signed a contract with someone else long before they had a chance to reject me. I'm just disappointed at the fact that I won't have the chance to formally reject them on my terms, or at least keep them guessing for a long time as well. That's all.

I hate to say it but it seems to be a relatively common problem with the bad FM programs. They seem to use residents as a form of scut and hardly do any serious teaching (procedures or electives that give practice privilages). I hope the program is shut down and the PGY funding is passed on to another program that deserves the money.

 

[Hoo\/er]

Enter February, a remedial plan was written. Part of this included a psych consult.

Disciplinary psychiatry? Check out this article.

Medical Education's Dirtiest Secret - Use of Medical Residents

 

[Top Gun]

Disciplinary psychiatry? Check out this article.

Medical Education's Dirtiest Secret - Use of Medical Residents

Damn! That article really drove home the point that residency programs have residents by the gonads! I'm hoping I'll end up matching into a benign program. All of the programs seemed really nice when I interviewed, but I guess I'll never know until I start working at one of them.

 

[Oatcell]

its sad that when a system find a person not like 'them' they automatically prescribe a psychotropic med to make them blend. become sheep. sad really🙁

 

[f_w]

GET OFF THOSE MEDS!!! You don't need them. People give meds to others in order to tolerate them better, it has no benefit to you. Only brings about your slow and agonizing demise!!! Document this as well. This is key for your legal council as far as you going so far on a limb as to jeopardize your internal organs to satisfy your programs request in order to remain in good-standing.

Sorry if you don't like to be quoted. But in your initial post, you dispensed medical advice to someone who is not your patient. I didn't get on your case because I figured that one of the mods will.

Yes, there is a conflict of interest for an EAP type physician to recommend psychotropic medications to an employee. But YOU are certainly not in a position to advise the OP to disregard the treatment recommendations of a properly credentialed provider (who has a doctor-patient relationship with 'iliad', albeit one tainted by the fact that he is also an agent of the hospital).

We only know the OPs side of the story. I have seen residents who developed serious psychiatric issues during their residency and it was felt that their impairment put patients at risk. As a program director or attending supervising residents, it is your duty to address such issues before someone looses and eye. Anytime you apply for licenses or credentials, you will be asked whether you have any mental illness that impairs your ability to do your job. That question is being asked for a reason.

Oh btw. mr/ms street-paralegal: When you sign your employment contract, the content of the 'housestaff handbook' is considered part of the contract. Typically, the housestaff handbook will specify when someone can be referred for medical or psychiatric evaluation. It works that way for pilots or the guy pushing the levers at the nuclear plant or anyone else who needs to be on the top of their game for each and every thing they do.

 

[Oatcell]

there was no dispensing of meds. i was simply stating the fact that just because a person does not 'fit' in or like everyone else does not make them crazy or psychotic. we live in this kind of society. its really a shame. well. i would still recommend that you seek help only if you think you do and perhaps if your loved ones, who know you best may say you do too. your pd and faculty and such should not decide this matter for you. good luck in this matter👍

 

[secretwave101]

I agree there is some prevalence to the "you need a psych eval" ultimatum, but I don't think it's 'rampant'. The truth is that residents are, especially in small FP programs, extremely integral parts of a system. To lose one is a big deal.

The psych eval really seems to be more of a hazing thing than an actual dismissal thing. Again, I speak from FM where times are lean anyway. Surgery is probably very different. The guy I saw evaluated was totally normal, MLE in the 250's, but so exhausted that he was forgetting H/H's on rounds in the AM. And, you guessed it...surgery intern. Psych eval? Just give the poor bastard a few days off!

 

[persia]

I think Oatcell has some good points. The psych evals are more common than we realize in medicine. AMSA has a strong statement against forced psychological evaluations and sees it as the first step towards dismissal.

It is my understanding that this also happens at the resident level. People have discussed this on the board before.