dropping out of program

[Rony]

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Hey guys, I am desperately seeking some advice on getting out of my committment.

I am having a lot trouble coping with the adjustment I am having to make. Residency is not what I expected and I think I am at the lowest point of my life right now. I am literally loosing interest in food and sleep and cannot focus on anything at all. I have completely lost confidence and I feel so inadequate. I have easily put in 120 hours last week ...I am in a Gen Surg program on the East Coast as a categorical. I feel like I got deceived into believing the program is less malignant than it really is. I am motivated to do things because I fear being penalized, not because I want to do them.
Calls have been brutal.

I feel like I made a bad decision and I feel stuck. My dilemma is deciding whether it is the environment/atmosphere that I don't like or whether it is the field of General Surgery.

My question: What are my options? If I make a final decision to leave after my one year obligation, when and how do I tell my program? I'm more limited by time constraints this year since I can hardly interview with much freedom...is it better to try to get a position outside the match?


Thanks a lot.

 

[Dire Straits]

Hey guys, I am desperately seeking some advice on getting out of my committment.

I am having a lot trouble coping with the adjustment I am having to make. Residency is not what I expected and I think I am at the lowest point of my life right now. I am literally loosing interest in food and sleep and cannot focus on anything at all. I have completely lost confidence and I feel so inadequate. I have easily put in 120 hours last week ...I am in a Gen Surg program on the East Coast as a categorical. I feel like I got deceived into believing the program is less malignant than it really is. I am motivated to do things because I fear being penalized, not because I want to do them.
Calls have been brutal.

I feel like I made a bad decision and I feel stuck. My dilemma is deciding whether it is the environment/atmosphere that I don't like or whether it is the field of General Surgery.

My question: What are my options? If I make a final decision to leave after my one year obligation, when and how do I tell my program? I'm more limited by time constraints this year since I can hardly interview with much freedom...is it better to try to get a position outside the match?


Thanks a lot.

suck it up and FINISH THIS YEAR. if you drop out now you'll really screw your chances of ever getting back into a general surgery residency or any other kind of residency if you ever decide to come back to a career in medicine. finish the year and then see if you can get into the research lab next year at your program so you can have some time away from clinical medicine (and you'll still be making money) to reassess what you want to do with your life. do not make a rash decision now to drop out of PGY1. you need at least one year's postgrad training to get a license in most states any way, so if anything stay in so you can get your medical license. i'm not saying suck it up and finish all 5 years of general surgery residency, but do finish this (intern) year. even if after intern year you decide never to come back to medicine, having COMPLETED your intern year and gotten your license will open a lot more doors for you in other careers than just having graduated med school and dropping out of internship. at least completing intern year and getting your license will allow you to work at some acute care centers (doc in a box) if you ever need work. get professional help if you have to in order to get through the rest of the year.

 

[billydoc]

Hey guys, I am desperately seeking some advice on getting out of my committment.

I am having a lot trouble coping with the adjustment I am having to make. Residency is not what I expected and I think I am at the lowest point of my life right now. I am literally loosing interest in food and sleep and cannot focus on anything at all. I have completely lost confidence and I feel so inadequate. I have easily put in 120 hours last week ...I am in a Gen Surg program on the East Coast as a categorical. I feel like I got deceived into believing the program is less malignant than it really is. I am motivated to do things because I fear being penalized, not because I want to do them.
Calls have been brutal.

I feel like I made a bad decision and I feel stuck. My dilemma is deciding whether it is the environment/atmosphere that I don't like or whether it is the field of General Surgery.

My question: What are my options? If I make a final decision to leave after my one year obligation, when and how do I tell my program? I'm more limited by time constraints this year since I can hardly interview with much freedom...is it better to try to get a position outside the match?


Thanks a lot.

I'm sorry to hear that.hat really sounds like a serious stuff. I've never been in residency, and thus may be ignorant about it. But what if you just took LOA for medical reasons? Even docs get sick (but I realy hope that you stay well).
Good Luck to you. I hope it works out for you

 

[yaah]

Well, you are violating duty hours. So report it. Obviously it is detracting from your life, and you probably aren't the only one. This is why duty hours regulations exist. If they are allowed to get away with it, they will continue to do so. I realize it's tough to be the one who raises the red flag, but if no one else is going to...

If you just work the long hours and don't tell anyone about it, you are unlikely to get sympathy. How about your program director? That is their job, after all. Here, we can go to the Grad med ed director anonymously if we need to, and there is a hotline to report violations anonymously.

 

[toughlife]

Hey guys, I am desperately seeking some advice on getting out of my committment.

I am having a lot trouble coping with the adjustment I am having to make. Residency is not what I expected and I think I am at the lowest point of my life right now. I am literally loosing interest in food and sleep and cannot focus on anything at all. I have completely lost confidence and I feel so inadequate. I have easily put in 120 hours last week ...I am in a Gen Surg program on the East Coast as a categorical. I feel like I got deceived into believing the program is less malignant than it really is. I am motivated to do things because I fear being penalized, not because I want to do them.
Calls have been brutal.

I feel like I made a bad decision and I feel stuck. My dilemma is deciding whether it is the environment/atmosphere that I don't like or whether it is the field of General Surgery.

My question: What are my options? If I make a final decision to leave after my one year obligation, when and how do I tell my program? I'm more limited by time constraints this year since I can hardly interview with much freedom...is it better to try to get a position outside the match?


Thanks a lot.

Switch to anesthesiology

 

[f_w]

> I am literally loosing interest in food and sleep and cannot
> focus on anything at all. I have completely lost confidence and
> I feel so inadequate.

>My question: What are my options?

Get help ! Before you damage your health, yourself or one of your patients.

Your situation is not that atypical. For that reason, many larger residency institutions have a 'stressed resident' referral system. In a system like that, you can see a counselor familiar with these issues without your program actually knowing about it. The GME office picks up the tab for the service without ever knowing the names of the residents who used it.

And if after careful deliberation, you decide that GS is not for you, you might want to consider one of the surgical disciplines that don't eat their residents alive.

 

[beyond all hope]

One of my attendings said that you'll consider quitting a hundred times in your intern year. Everyone thinks that way at one time or another. You may not realize it but all of your fellow interns have felt that way or are feeling that way. We're just all too macho (esp in surgery) to admit it.

These feelings will hopefully pass. Don't quit. Life doesn't get much tougher than this, and it will get better.

You'll get to learn what you are doing until it becomes second nature. You'll learn the quirks of your fellow residents, attendings and nurses and how to work better with them. People will start to respect your judgements. You'll sleep a few minutes on call, and you'll learn to get by with it.

Give it a few months and see how you feel. If you want to opt out at that time, you have a lot of options. EM, anesthesia, radiology, optho, ortho or start another speciality from scratch.

 

[mosche]

Well, you are violating duty hours. So report it. Obviously it is detracting from your life, and you probably aren't the only one. This is why duty hours regulations exist. If they are allowed to get away with it, they will continue to do so. I realize it's tough to be the one who raises the red flag, but if no one else is going to...

If you just work the long hours and don't tell anyone about it, you are unlikely to get sympathy. How about your program director? That is their job, after all. Here, we can go to the Grad med ed director anonymously if we need to, and there is a hotline to report violations anonymously.

Listen to Yaah--he is wise beyond his years! True, many residents do hate residency; however if you are investing 120 hours/week, then you are in violation of the 80 hour rule, PERIOD. At our school many residents are of the opinion that 3 or 4 hours "ain't no big thing"; 40 hours, on the other hand, is the equivalent of an ENTIRE WORKWEEK in the non-medical world. Should an issue arise with a patient(i.e. lawsuit), the hospital will likely do everything in its power to divert blame(i.e. claim that it was your responsibility to inform the "powers that be" that you had -- unbeknownst to them -- worked soooo many extra hours). So, make certain that they ARE aware -- as well as the AAMC. If it makes it easier, pretend that you are doing them a favor by trying to avoid any legal issues that might arise from being overworked. If they don't care, make sure that you document your experience. Residency is the "big league"; so, cover your a**--I guarantee you that they'll cover theirs!

 

[njbmd]

Well, you are violating duty hours. So report it. Obviously it is detracting from your life, and you probably aren't the only one. This is why duty hours regulations exist. If they are allowed to get away with it, they will continue to do so. I realize it's tough to be the one who raises the red flag, but if no one else is going to...

If you just work the long hours and don't tell anyone about it, you are unlikely to get sympathy. How about your program director? That is their job, after all. Here, we can go to the Grad med ed director anonymously if we need to, and there is a hotline to report violations anonymously.

Hi there,
The above advice is correct. The 80-hour work rule exists for a reason and 120 hours is far above 80. This rule was set by the RRC and is a regulation for your program to be in compliance with. There have been plenty of programs that were put on probation for hours violations so maybe your program needs a wake-up call. This being said, see below.

If you are totally unhappy, talk it over with your program director. If you are in a quality program, your PD will not want you to continue if you are miserable. Sure, it is a couple of months into the year and you have some adjustments to make but keep good lines of communication open. You are going to need a letter from your PD to change programs. Do your best and make sure that your PD is aware of the hours violations.

You want to be the consumate professional as you negotiate through the rest of this year. This means getting your work done and cutting your losses. Many people have discovered that getting through a General Surgery residency is just not for them. Better to make the change now than try to recoup during your PGY-4 year. Just do a good job and realize that you have options.

Good luck and I hope everything works out for you. No one should be miserable in their job especially after working so hard in medical school.

njbmd 🙂

 

[surg]

I'm sorry to hear that you are having such a difficult time. It is the rare intern or resident that does not ask themselves what they have gotten themselves in to and whether they shouldn't just quit at least a few times a year. This is especially true in a high stress environment like surgery. The first month is also hardest because you add the stress of being in a new place, away from your typical support system and starting a new job where they do just about EVERYTHING different from the last place that you are. The feelings that you have are normal, but losing interest in food and sleep and be a sign of depression as well that is exacerbating the problem.

A few thoughts:
1) consider whether your next rotations are going to be any better. Often each hospital/program has a few really miserable ones, did you just do one of them? hopefully the next one will be better.

2) try to find some support amongst your fellow residents. They are feeling the same things do, they are just coping with it in different ways. You will often find that if you reach out to others, they will also share their stories with you and help you realize that you are not the first or last to feel this way. They may also be able to share some tips/tricks that help you get through the day faster and less stressfully.

3) failing that, is there a faculty mentor you can talk to? They caxn also be of surprising help and have seen it all before as well.

4) Stop worrying about whether you made a bad decision, and focus on the future and what you want to do with it. Surgery may still be your calling (or not). Being a intern, while necessary to becoming a surgeon, is just about the worst of it at most programs. It should get better year by year.

5) If you feel that you must leave your program either for another surgery program or another specialty, let your program director know as soon as you are absolutely sure. Talk with a faculty mentor before then if you can as well. Most program directors do not want unhappy residents in their program and will do their best to help you find a program that fits your needs better. They are more likely to be helpful if they are not surprised and find out that they are going to have a hole in their program with no notice. They will want to recruit someone to fill your spot if you vacate it (perhaps one of your hardworking prelim friends won't have to go look for a job!).

Bottomline: it is stressful to be an intern. it is stressful to be in a new place. it is stressful to be away from your friends. These are all the realities. These things will pass if you can bear with them for now. They pass easier as you resolve the issues (no longer being an intern, the place being less nes, and making new friends). Don't give up on yourself and your dreams. If you need to go elsewhere to make it happen, give others the chance to help you get there!

Good luck.

 

[MAC10]

Hey guys, I am desperately seeking some advice on getting out of my committment.

I am having a lot trouble coping with the adjustment I am having to make. Residency is not what I expected and I think I am at the lowest point of my life right now. I am literally loosing interest in food and sleep and cannot focus on anything at all. I have completely lost confidence and I feel so inadequate. I have easily put in 120 hours last week ...I am in a Gen Surg program on the East Coast as a categorical. I feel like I got deceived into believing the program is less malignant than it really is. I am motivated to do things because I fear being penalized, not because I want to do them.
Calls have been brutal.

I feel like I made a bad decision and I feel stuck. My dilemma is deciding whether it is the environment/atmosphere that I don't like or whether it is the field of General Surgery.

My question: What are my options? If I make a final decision to leave after my one year obligation, when and how do I tell my program? I'm more limited by time constraints this year since I can hardly interview with much freedom...is it better to try to get a position outside the match?


Thanks a lot.

Swith fields now before its too late.

 

[GenSurg]

There are a lot of other fields in medicine. It is true that intership sucks, but it really doesn't improve for you anytime soon. Second and third years will stress you out in the ICU. I think you peak during your 4th and 5th years of training. You mostly operate and make management decisions. When you start practicing after residency, there is no 80 hour work week, and you will have to do scut like d/c summaries and admit notes/orders.

I'd recommend talking to PDs in other fields you may be interested in. A lot of GS residents turn to anesthesia, radiology, pathology.

You really should stick out the year and see how it goes. Over the next couple of months, you may work with some great people and do some better rotations.

That being said, by talking to other PDs, you are keeping your options open for next year. If you decide to go through the match again, you'll need to let your PD know and get a LOR. Think about keeping things quiet until you need to let someone know though. Other staff and residents can be hard on residents who decide to leave the field.

Good luck.

http://ipods.freepay.com/?r=20049323

 

[Laryngospasm]

I think that for most residencies the intern year is the worst, and general surgery is known for having one of the hardest intern years around. Consider switching programs after this year, as it will be almost impossible to change in the middle of the year, and you will also place yourself in the position of prolonging your residency training which is something that you definitely dont want to do..none of us do.

You should also seriously consider getting on some antidepressant medication. I do recall some very depressing times during my intern year, call Q3 for months on end, freezing temps, no sunlight, and if there was then it didnt matter because your stuck inside with those damn fluorescent lights. The number of times that I thought about taking my car and the remaining money in my bank account and fleeing to mexico are diffucult to remember.

You should know that anyone who goes through a difficult residency has these thoughts, and you are not alone. Commisserate with your classmates and talk to friends and family..it will help more than you can imagine. There was a running joke at the neurosurgery program at my school where on of the upper levels would ask the intern if he/she was on an SSRI and the intern would say "No" then the upper level would say "you will be."

 

[Lemont]

All very good advice so far. However, I would be careful with how you approach professional psychiatric care and anti-depressant medications. Although they may prove helpful, your residency program can use it against you if they really want to. I know people say it is all 'confidential' and it is for your own benefit, but realistically nothing is really confidential if they want to get at it. I only bring it up because I have seen it happen before. And also, you will have to disclose any psychiatric care you received as well as any psychiatric meds you've taken when applying for an unrestricted medical license and also for some hospital priveleges when you are an attending. So it may complicate those processes too.

 

[beary]

And also, you will have to disclose any psychiatric care you received as well as any psychiatric meds you've taken when applying for an unrestricted medical license and also for some hospital priveleges when you are an attending. So it may complicate those processes too.

Is this true? How could the licensing board or hospitals possibly found out about psychiatric care you had received?

 

[pillowhead]

And also, you will have to disclose any psychiatric care you received as well as any psychiatric meds you've taken when applying for an unrestricted medical license and also for some hospital priveleges when you are an attending. So it may complicate those processes too.

If licensing boards were to restrict the practice of physicians who have ever taken SSRIs or other psych meds in the past, we would have a very serious, profound physician shortage on our hands. Restricting the practice of a poorly controlled schizoaffective or bipolar physician is one thing--restricting the practice of all poor med students/residents who just couldn't cope for a bad rotation or semester is another thing entirely. I'd be shocked to see a licensing board giving a damn about someone taking prozac or seeing a therapist for a couple of months during a difficult intern year.

 

[f_w]

Actually, they routinely ask you whether have or ever had 'any medical or mental condition that could potentially affect your fitness to practice'. Sure, you can deny that, it could just backfire down the line if you hurt a patient in a drug induced haze and someone digs up your 'unstable past'...

 

[Lemont]

What I am saying is that issues that come up during residency can go beyond the residency itself. Remember, you can graduate medical school, complete a residency and still not be allowed to legally practice medicine because you are denied a permanent medical license.

State licensing boards can be fickle and I have heard of them denying doctors licenses for things that we might think are not such a big deal. Likewise, I have seen them grant licenses to doctors who had done so many wrong things that you wonder why in the world they still have a license. When you apply for a permanent license they thoroughly check your academic and training history, usually starting from the time you entered medical school. As well as do a criminal background check from even before then. So any ammo you give them can potentially be used against you.

That is why it is important to know exactly what is in your file at your residency program. Because when you apply for a license you will be required to sign a waiver that gives the licensing board access to your records at your residency program(s) and your medical school. This waiver absolves your residency program and med school from illegally disclosing information about you to the licensing board since you signed a waiver giving them permission to do it. Thus, if your residency program knows that you sought psychiatric care and made any notes in your file about the severity (even if they exagerrated to protect their own butt down the line) it could potentially affect your licensing. That also goes with anything else they may have put in your file about you during residency that you may not know about.

 

[ORBITAL BEBOP]

For students/residents who are already on psychotropic meds, when should they let their pd know? During their application process (ie essay), at their interview, after the match?

Thanks.

 

[Lemont]

For students/residents who are already on psychotropic meds, when should they let their pd know? During their application process (ie essay), at their interview, after the match?

Thanks.

How about never. Unless you ever have to legally.

 

[f_w]

If your psych issues impair your ability to do your job safely, you would have to divulge this to your program. Unless specifically asked, I would not volunteer that kind of personal health information.

 

[surg4me]

Here's are several important questions that I have...can anyone answer any of them?

1. what happens if I applied to another field this year and do not match?

Do I lose my spot as a PGY2 for general surgery next year?

2. Another question is...if I apply in ERAS this year, do I automatically forfeit advancement to PGY2 of a categorical position that I currently have for the following year in general surgery?

3. Or can I continue on to PGY 2 level as general surgery and try again next year to switch?

4. if I decide to switch into anesthesia or something that require a prelim year, will finishing a categorical GS this year make up for a prelim year or do I have to reapply for a prelim year for 2006?

 

[Smurfette]

1. Then you can either pursue something non-medical or scramble into something. You do not automatically lose your PGY2 spot, although it is really shady of you to apply to other programs without telling your program of your intentions to allow them to look for your replacement. Plus, How will you get time off to interview unless you tell your program?

2. If you submit a ROL for the match, then you are committed to doing whatever program you match into...so legally you would be in a sticky situation. Just applying on ERAS does not forfeit your PGY2 spot unless you register and go through the NRMP. I would talk to a lawyer or someone involved in contract law to find out your current program's contractual obligations and those of the NRMP match to see if they do or don't conflict before getting yourself in trouble. However, you are allowed to drop out of the match at any time, and I believe the NRMP contract is only enforceable once you submit the ROL.

3. You can continue on as a PGY2 and decide next year if you want to re-do the match, or find a spot outside the match.

4. An intern surgery year counts as a prelim year or transitional year for most programs that would require one. However, some specialties may prefer a medicine prelim year (like neurology or rad-onc). I've never heard of an anesthesia program that wouldn't count a surgery year as a prelim year, but I am sure there may be a couple programs out there that are exceptions to the rule.