Dismissed from residency, what to do next?

[JMKP]

I am a CA-1 in a major university hospital anesthesia residency program. My PD dismissed me from the residency program based on some attending's complaint. I made a mistake that does not impact pt care, however, at wrong time with a wrong person. He thinks that I am not a good fit for anesthesia despite my academic performance and hardwork. He agrees to support me for my future career endeavor. I graduated from a US medical school with competitive USMLE scores. I am thinking about applying for radiology or family medicine residency. It is too late for me to register for NRMP to participate in SOAP this year. I wonder where I can find residency vacancies outside the match. I tried residency swap, there are not many opening spots... Meanwhile, what kind of jobs I can find as a licensed MD without residency? I am desperate for advice. Thank you for your help.

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[Chicago2012]

Pretty sure its too late to SOAP since ROL are already finalized

 

[Brigade4Radiant]

I am a CA-1 in a major university hospital anesthesia residency program. My PD dismissed me from the residency program based on some attending's complaint. I made a mistake that does not impact pt care, however, at wrong time with a wrong person. He thinks that I am not a good fit for anesthesia despite my academic performance and hardwork. He agrees to support me for my future career endeavor. I graduated from a US medical school, scored 237 on Step 1, 244 on step 2, and 222 on step 3. I am thinking about applying for radiology or family medicine residency. It is too late for me to register for NRMP to participate in SOAP this year. I wonder where I can find residency vacancies outside the match. I tried residency swap, there are not many opening spots... Meanwhile, what kind of jobs I can find as a licensed MD without residency? I am desperate for advice. Thank you for your help.

What was the mistake? Did they warn you? You can try to see if you can find a place outside the match?

 

[asdad]

I was able to make the switch into radiology after re-applying through ERAS. My step scores are similar to yours, and I got about 15 interviews. You should be competitive for a radiology residency.

Since you have completed all 3 steps and up to 2 PGY years, you will be eligible for a full physician license in many states. Check your state licensing requirements. Having a full license will increase your employment opportunities for the gap year. You can moonlight in urgent care or do insurance H&Ps, which while tedious, pay fairly well. Research in your new chosen field is also worthwhile to do during the gap year.

New positions also become available throughout the year. You may be able to find such a position through a website such as residencyswap.com.

 

[Mass Effect]

I'm not sure anyone is competitive for radiology with a termination on their record.

OP, I would look for a slot outside the match and if all else fails, re-apply next year with your former PD's backing.

 

[JMKP]

I was able to make the switch into radiology after re-applying through ERAS. My step scores are similar to yours, and I got about 15 interviews. You should be competitive for a radiology residency.

Since you have completed all 3 steps and up to 2 PGY years, you will be eligible for a full physician license in many states. Check your state licensing requirements. Having a full license will increase your employment opportunities for the gap year. You can moonlight in urgent care or do insurance H&Ps, which while tedious, pay fairly well. Research in your new chosen field is also worthwhile to do during the gap year.

New positions also become available throughout the year. You may be able to find such a position through a website such as residencyswap.com.

This is very helpful advice. Thank you!

I'm not sure anyone is competitive for radiology with a termination on their record.

I am worried about this too. Technically, I resigned for next year's contract. There's no probation or anything on record. I don't know how the new residency PD will perceive this.

 

[ThoracicGuy]

This is very helpful advice. Thank you!



I am worried about this too. Technically, I resigned for next year's contract. There's no probation or anything on record. I don't know how the new residency PD will perceive this.

They will want to speak to your past PD. Make sure you are both on the same page.

 

[JMKP]

I spoke to my PD. He said he will write me a good letter and support my application. Any more suggestions on what type of job I can get in my gap year?

 

[ThoracicGuy]

I spoke to my PD. He said he will write me a good letter and support my application. Any more suggestions on what type of job I can get in my gap year?

You need to be on the same page about the reasons for your dismissal so that when people ask you, what you say will be the same as what your PD says. You said you were dismissed based on one attending's comments. That would be unusual, particularly without being allowed a period of probation prior to dismissal. That makes me think there is more to it than what is said here. You don't have to go into detail about it if you want, but like I said, just make sure what you say and what they say are the same thing.

 

[JMKP]

You need to be on the same page about the reasons for your dismissal so that when people ask you, what you say will be the same as what your PD says. You said you were dismissed based on one attending's comments. That would be unusual, particularly without being allowed a period of probation prior to dismissal. That makes me think there is more to it than what is said here. You don't have to go into detail about it if you want, but like I said, just make sure what you say and what they say are the same thing.

Unfortunately this is a senior faculty. My pd has low tolerance for faculty's complaint. I guess I could appeal for a period of probation. However, this program is somewhat unforgiving. once you are on the blacklist, it doesn't matter how hard you try, you never get off. Rather than continue the misery for the next 2 yrs, I'm prob better off to resign and search for a new niche to thrive.

 

[ThoracicGuy]

Unfortunately this is a senior faculty. My pd has low tolerance for faculty's complaint. I guess I could appeal for a period of probation. However, this program is somewhat unforgiving. once you are on the blacklist, it doesn't matter how hard you try, you never get off. Rather than continue the misery for the next 2 yrs, I'm prob better off to resign and search for a new niche to thrive.

Appealing will likely remove any positivity seen on communication from your PD to future residency PDs. I don't think fighting it is probably the best idea if the PD is currently willing to help you. The main point is just making sure you are on the same page now and in the future. This question will come up on state licensing, hospital licensing, etc in the future.

 

[BDUS]

What about wording an appeal in an apologetic/give me a second chance-type of way? I was in similar situation to you. I appealed and won the appeal on the basis that I was told without any previous remediation/probation/written warning that I would be dismissed and I was told about the dismissal for the first time around this time in March a few years ago. According to the program policy apparently I should have been warned in writing by earlier march so the medical director approved my appeal. I ended up staying at my program and graduated from residency. If you get your appeal approved maybe the dismissal won't be in your file. In addition, nothing stopping you from looking at other programs for next year.

 

[saywhaaaaa]

Sorry, but I'm having a really hard time buying it that you were straight up dismissed from residency for one (singular) mistake that "did not impact patient care" unless you dropped a serious racial/bigoted slur or said/did something otherwise absolutely horrendous. I guess it's not really important either way if the end game is the same (i.e., dismissal from residency), but it's tough to give advice without the whole picture.

Edit: I'm well aware that my advice as a third year med student holds little weight, but I'm also a non-trad student with years of experience in the professional world.

 

[DermatoFIGHT]

That is really odd. I am going out on a limb here but............... which attending's gf/wife/nurse interest did you sleep with?

 

[BDUS]

That is really odd. I am going out on a limb here but............... which attending's gf/wife/nurse interest did you sleep with?

It can't be so hard to believe that life isn't fair. We hear about minorities, woman, people with certain religious beliefs, animals, children being mistreated. It doesn't mean they were at fault or deserved what they got. Sometimes if you or a friend weren't in their shoes it's hard to believe such things occur. Whenever, someone on this forum makes a thread like this some people tend to point the finger right back at the person asking for help.
In residency, there was a resident who had been written up for her clinical work and also complaints from co-residents for her laziness. She would study or sleep during her calls and leave her intern alone but she didn't have any problems getting by. There is favoritism, racism, ___isms in residency too. I don't know what the op's situation is but let's not be so quick to judge.

 

[DermatoFIGHT]

I agree, there are lots of messed up things in residency that have nothing to do with performance. This is work life unfortunately.

 

[CptNemo]

Yeah, I could totally see how a resident crossing certain powerful attendings could cause a world of pain for that resident. The corollary of that is that a resident should be ultra careful and not do anything to anger/cross those types of people... but as has been pointed out, that's the reality of work life, which is often hard for people to transition into after having been in academic environments their whole lives.

In a case like this, I would do whatever is possible to stay with my original program if there was any glimmer of hope of that happening. Otherwise, you then have to explain to not only other residency programs, but also to medical boards and credentialing committees the circumstances under which you were dismissed from a program. I would think that all University based programs have a formal appeal process in which a disinterested party analyzes the facts and comes to a decision. I have known residents who have either won or lost such appeals.

Saying "My PD dismissed me from the residency program based on some attending's complaint," even if 100% true, will not cut it. It will go over much better with people if you show that you can analyze your role in the situation, what you have learned from it, and what you have changed in your life or approach to medicine to prevent something like this from happening again. Also, having your program director on your side in circumstances like this is crucial to any future careeer prospects. Even then, I would think that getting any sort of competitive residency would be an uphill struggle, because ppl would view it as a huge red flag. I would also look for open spots in your current institution, perhaps your PD could help you more directly then.

 

[IlDestriero]

That is really odd. I am going out on a limb here but............... which attending's gf/wife/nurse interest did you sleep with?

It's actually surprisingly easy to manipulate the mob. I've done it myself to make sure we made offers to the people I wanted and effectively blackballed a couple faculty candidates as well that had good academic potential, but have bad partner written all over them. Some faculty are clueless, they're out of the OR 1/2 of the time and when they are there, they're not engaged. They will vote with you if you influence them correctly. Then once the scales start to tip, it's all over unless someone feels strongly enough to put up a fight. Faculty meetings can be quite entertaining.
Lying about a critical fact would be the short track to months of probation for professionalism concerns. Once on probation, it would be easy to get pushed over the edge. We are fortunate to not have to deal with those kinds of issues very often.

 

[JMKP]

Thanks everyone for the advice. I was extremely lucky to get a radiology residency position in an academic institution in a desirable location outside the match. I am very happy to leave my current anesthesia program. On retrospection, I have regretted my decision going into anesthesia since the first month of CA1 year. However, I was willing to work with it and hoping things would become better. Honestly, I have never considered myself as a bad anesthesia resident. I worked hard. I cared about my patients. I was good with procedures. I scored over 90 percentile on the IT exam in CA1 year. Professionalism was never an issue. I think things may have turned out differently if I were in a different anesthesia program... Anyway, here is my 2 cents from my experience for those who have similar circumstance. In a situation like this, I can either follow the PD's lead or fight against it. I chose to follow his lead, even knowing my old PD is the eccentric and not trustworthy type who is very good at manipulating the mobs. My thought process was that If I alienate him in a bad way, even I manage to stay, I probably won't get a good letter when I apply for jobs or fellowship later, which what ultimately matters. If I appeal for remediation or probation, a program like this can make it extremely difficult no matter how hard you try, and it will be on my record. It was a gamble, but I think I made the right choice in retrospection. It's important to get support from other faculties. I was able to get good letters from 4 other faculties at the associate professor level or above. I tried to reach out to the DIO and PDs in other specialties. They were surprisingly helpful. Meanwhile, I tried to seek for short term employment options in the potential gap year. There are a few opportunites for licensed MD without completion of residency. Fortunately for me, I didn't need it in the end. The most important and difficult thing in a situation like this is to remain calm and confident. It is easy said than being done. At times, I thought my career was over and all I worked for in the past decade was in vain. Thanks to support from family and friends, I was able to turn things around. Although a very stressful experience, there is much to learn from it.

 

[Winged Scapula]

I'm glad it worked out well for you. Thank you for providing more details about your experience which may help others in the future.

 

[medumacation]

I don't care what you did to get dismissed from your anesthesia program, the fact you came back here to update makes you awesome in my book.

 

[mercaptovizadeh]

Thanks everyone for the advice. I was extremely lucky to get a radiology residency position in an academic institution in a desirable location outside the match. I am very happy to leave my current anesthesia program. On retrospection, I have regretted my decision going into anesthesia since the first month of CA1 year. However, I was willing to work with it and hoping things would become better. Honestly, I have never considered myself as a bad anesthesia resident. I worked hard. I cared about my patients. I was good with procedures. I scored over 90 percentile on the IT exam in CA1 year. Professionalism was never an issue. I think things may have turned out differently if I were in a different anesthesia program... Anyway, here is my 2 cents from my experience for those who have similar circumstance. In a situation like this, I can either follow the PD's lead or fight against it. I chose to follow his lead, even knowing my old PD is the eccentric and not trustworthy type who is very good at manipulating the mobs. My thought process was that If I alienate him in a bad way, even I manage to stay, I probably won't get a good letter when I apply for jobs or fellowship later, which what ultimately matters. If I appeal for remediation or probation, a program like this can make it extremely difficult no matter how hard you try, and it will be on my record. It was a gamble, but I think I made the right choice in retrospection. It's important to get support from other faculties. I was able to get good letters from 4 other faculties at the associate professor level or above. I tried to reach out to the DIO and PDs in other specialties. They were surprisingly helpful. Meanwhile, I tried to seek for short term employment options in the potential gap year. There are a few opportunites for licensed MD without completion of residency. Fortunately for me, I didn't need it in the end. The most important and difficult thing in a situation like this is to remain calm and confident. It is easy said than being done. At times, I thought my career was over and all I worked for in the past decade was in vain. Thanks to support from family and friends, I was able to turn things around. Although a very stressful experience, there is much to learn from it.

Congratulations on surviving that gauntlet! Your career in medicine stood on the knife's edge and you made it. Good for you.