Emergency situation-too late to defer or swap? please help

[lupinibeanie]

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If anyone could please help me in my situation with any advice, I would be truly grateful.

I got accepted into my top choice residency program (relatively noncompetitive field, primary care) to start this July 1st. I'm a US medical grad of this year.

Just as I moved to the new city for work, my parent was diagnosed with stage 4 cancer. I am basically the only source of support for my family, emotionally, mentally, and partially financially as well as of now (fully financially once the treatment begins). My parents have never had any sort of health problems like this before, and they are more than overwhelmed by not only the diagnosis, but also the long debilitating process that awaits in the future. They are not able to cope with this at all and are in complete shock.

I do not know what my options are with regards to residency deferral or swap at this point. I have already signed my contract with the program and I do not by any means want to cause any problems for the program that I hold in such high regard. However if being able to attend residency in the same city as my parents makes their life sustainable, I would like to pursue that option. The program in my family's city (my hometown) made it clear that they wanted me, and I respected and liked it very much, however I just ranked it lower than my top choice for other reasons. It's still a wonderful and very large program. I dont even know how to go about finding out if they are even in need of another PGY1.

I don't know if deferring is a possibility also. I am afraid to bring it up to the program director (although he is as sweet as any man you could imagine) because I don't know the ramifications of such a proposal. Also I don't know if my spot would be guaranteed for the coming year and I would feel awful about putting the program in a position where they are short one man. My family crisis though is the absolute priority at this point.

Any thoughts or tips on requesting to defer or swap?
I would be so genuinely grateful to anyone who can help me out.

Many many thanks

-feel free to PM me if that's easier for you

 

[UserNameNeeded]

That's really rough. I'm sorry I'm not able to offer any advice, but I think it's very noble that you're going to be looking after your parents. Too few people do that these days. I wish you and your parents all the best. And I hope the residency situation works itself out.

 

[lupinibeanie]

I appreciate you taking the time to write a response.

Thank you for your thoughts

 

[McGillGrad]

You cannot stop your life every time something tragically awful happens, especially when you're responsible for the health of others. Your decision to drop everything in your life and become responsible for something you have no power to change is going to shape who you will become in the future.

Spending time with your family is one thing, but to shoulder all of this responsibility is a life-changing decision. I would never allow someone to do that on my account and only you know if you feel it would be fair for someone else to do this for you.

 

[turquoiseblue]

sorry to hear about your situation. you may want to check out the website residentswap.org and find someone to swap with in your desired location. people do it all the time and your reasons are pretty compelling so it doesn't hurt to try. but first make sure you can do it and have everything set up to work, before you inform your pd unless you are definitely sure he/she is nice enough to comply and help you out anyways. some are ok with it and some pd's arent, so it is your call. whatever the case, just do it very carefully so it all works out.

good luck!!!


p.s. maybe you could even ask your PD to accept you later on another year. i dont know if he'll keep his promise but it doesn't hurt to ask. on the other hand, i was once accepted in a program but someone else took my spot because i was ill at the time i had to sign the contract part and not able to check mail, etc. and then he didn't give me another chance for the next year, and doesn't even respond to my emails, so it all depends on the PD.

p.s.s. please don't take this the wrong way, i hope everything works out for you, but if you're leaving altogether, please let me know, im looking for a pgy1 spot.

 

[docbill]

If anyone could please help me in my situation with any advice, I would be truly grateful.

I got accepted into my top choice residency program (relatively noncompetitive field, primary care) to start this July 1st. I'm a US medical grad of this year.

Just as I moved to the new city for work, my parent was diagnosed with stage 4 cancer. I am basically the only source of support for my family, emotionally, mentally, and partially financially as well as of now (fully financially once the treatment begins). My parents have never had any sort of health problems like this before, and they are more than overwhelmed by not only the diagnosis, but also the long debilitating process that awaits in the future. They are not able to cope with this at all and are in complete shock.

I do not know what my options are with regards to residency deferral or swap at this point. I have already signed my contract with the program and I do not by any means want to cause any problems for the program that I hold in such high regard. However if being able to attend residency in the same city as my parents makes their life sustainable, I would like to pursue that option. The program in my family's city (my hometown) made it clear that they wanted me, and I respected and liked it very much, however I just ranked it lower than my top choice for other reasons. It's still a wonderful and very large program. I dont even know how to go about finding out if they are even in need of another PGY1.

I don't know if deferring is a possibility also. I am afraid to bring it up to the program director (although he is as sweet as any man you could imagine) because I don't know the ramifications of such a proposal. Also I don't know if my spot would be guaranteed for the coming year and I would feel awful about putting the program in a position where they are short one man. My family crisis though is the absolute priority at this point.

Any thoughts or tips on requesting to defer or swap?
I would be so genuinely grateful to anyone who can help me out.

Many many thanks

-feel free to PM me if that's easier for you

Just talk to your program director. S/he will tell you what the options are. They are human too. I think it is fair to take some time off now, but you have to talk to the program director so s/he can place you on an elective or vacation for the first month. Also you won't be screwing over your team by leaving them hanging to cover the floor cause you waited too long to tell them.

Swaping or going to another program, I know nothing about.

 

[JPmamd09]

http://www.nrmp.org/res_match/policies/waivers.html

Check out this portion of the NRMP website. It talks about how waivers getting you out of the match contract can be granted. If you could be approved for one, in the event your program isn't amenable to any other agreement, at least you could re-enter the match next year without concern of being labeled a "match violator".

I would strongly suggest you let the PD know about your situation first. Maybe you could start off-cycle, or maybe they can work something else out for you.

I'm sorry to hear about your parent - thoughts and prayers to you and your family. And in my opinion, this is your family and you have to do what is right for you guys regardless of what anyone here says. Best to you.

 

[ShyRem]

I agree - talk to your PD ASAP. Also start poking around to see if there is a position near your parents you could get into. You have extenuating circumstances and a noble cause. What's the worst they can say? No. Then you look into a waiver of match contract because certainly you have reason. You should know you may only be able to get a transition year and then get into a PGY2 spot next year if one opens up.

 

[peppy]

Sorry to hear you are facing this situation. I experienced something very similar during med school so I have some idea of how gut-wrenching it is. In my situation I took a month off to come to terms with the news and try to help my loved one get their treatment set up. Even if you are not able to secure a residency spot at a program near your loved one, at the very least I think your residency program should be understanding enough to be willing to let you have a leave of absence to try to sort things out.
(I will always be grateful to the people at my school for being immediately understanding about my situation when I told them I needed time off!)

 

[gutonc]

You definitely need to talk to your PD. Getting a leave of absence may not be that difficult and is probably the best option. In spite of what you read on SDN, most PDs (esp in Primary Care fields) are decent human beings and will understand and try to accomodate you to the extent possible.

Even assuming that transferring programs is a possibility, I think that is a recipe for disaster. As a new intern, you need to have your head in the game 100%. If you somehow manage to move to the program in your parent's town, you'll be half-assing it at work the entire time - in a program you didn't want to be at in the first place - dealing with your family situation. This will likely mean poor evals by your seniors and attendings, the ire of your co-interns when you are constantly taking time off and could potentially put you at high-risk for being asked to leave a program or non-renewal of your contract at the end of the year. I don't think you'll be doing either yourself or your family any favors in this scenario.

I know this is a very tough situation and it probably seems like nobody else has ever had to deal with this before. But lots of people have. I have a couple of friends who ran in to similar situations over the past couple of years. One had a parent diagnosed with metastatic HCC toward the end of intern year. She took a 2 month leave to get stuff settled with her family, got back into internship and finished residency 1 month late (gave up some electives). Another co-fellow of mine had a similar situation earlier in the year. She took a month off (fortunately for her it was an elective month), moved back with her folks for that time and then came back. She will finish on-time.

 

[anon-y-mouse]

You cannot stop your life every time something tragically awful happens, especially when you're responsible for the health of others. Your decision to drop everything in your life and become responsible for something you have no power to change is going to shape who you will become in the future.

Spending time with your family is one thing, but to shoulder all of this responsibility is a life-changing decision. I would never allow someone to do that on my account and only you know if you feel it would be fair for someone else to do this for you.

Glad there is a caveat at this user's signature for this crap advice. Family comes first. Fortunately as a US grad, you will have the ability to re-enter this non-competitive speciality any time you desire in your life. This is your last opportunity to be with your parents, so you should do that. Try to take Step 3 if possible, since you don't want to deal with the 7 year limit (i.e. step 3 within 7 years of step 1).

 

[IMdocT]

my friend is in a healthcare field and her mom was diagnosed with cancer, but her family kept telling her that the mom was doing OK. my friend did not ask her boss about options to take leave and thought waiting until her regular vacation time would be good enough for her to go home and see her mom. but her mom's health was not as good as anyone let on and she passed away before my friend could go home.

you only have 1 true family in this lifetime. to me, work is work (can be important work), but family is top priority. however, being the start of internship, i understand how that complicates things. but i'm starting residency too and i don't know much about deferment/swaps etc. but if i were in your position, i would ask the PD for options as other posters have said. if your PD is a good person, he would understand why you're in a dilemma and do his best to help you out. even if you left, i'm guessing they would be fine with 1 less intern. i imagine they just need to reorganize the schedule so 1 less resident is on elective rotations and will be on the wards in any 1 month. i heard programs can easily find replacements too. however, i do find the risk of no guarantee of a saved spot pretty scary. just my personal opinion, but i think you have to do what you think is right.

 

[lupinibeanie]

Thank you all for your responses, they mean the world.

I am trying to make this huge decision and take all factors into account. Unfortunately there are more struggles other than the disease itself to deal with (I will spare you all the long list), and so I am weighing up my every move as best I can. Every decision I make will have ramifications that I know I must face in the future.

But like many of you stated, I only have one set of parents. That in itself is crystal clear.

I will contact my PD and then take it from there. That seems to be the overall census and I too agree with it.

Thank you very much for your help in this matter. It means so much during this difficult time. It proves there are still plenty of kind people in the world 🙂

Please feel free to keep posting should anyone else have any thoughts or advice/knowledge about the process. I was unaware of some of the details you all mentioned and every bit helps me get one step further in the right direction.

My sincerest and biggest thanks again

 

[marsupial]

You'll be scrutinized in residency, and you'll be compared to people who are perky, happy, and chipper with healthy parents and lovesick, doting significant others who make them dinner and buy them massages and pay their expenses. You won't be able to perform like these people and put on the "act" needed for internship; your evaluations will not look good if you are not Mary Sunshine. End of story.

Take time off. Get a waiter job (you already know how to wait on people from 3rd year of med school). Travel with your parent if possible. Then start only when you can. You'll get back in. easily with that story.

 

[JackADeli]

...I am basically the only source of support for my family, emotionally, mentally, and partially financially as well as of now (fully financially once the treatment begins). ...

I encourage you to support your family the best you can. I would also encourage you to figure out what your ability to financially support them while in residency or if you defer and are not in residency. Residency may be the best financial opportunity for you and them, especially in the current economy. Also, depending on how long you family lives with cancer, your ability to finish residency in 3yrs can markedly improve the amount of support you can provide.

You may also want to check into how you can get your parents as your "dependents" and thus enrolled into your residency healthcare plan.

 

[DrJosephKim]

Have an open and candid discussion with your program director. Hopefully he/she will be an understanding individual who can guide you through this difficult situation.

 

[Mr FancyPants]

I totally agree with the consensus of the replies - the health of your loved ones reigns supreme and trumps all. Its hard to believe that some here suggest you think otherwise.

What will you remember later in your life? The extra time you spent with and helping your parent in need, or delaying internship for a year?

I was in a very similar situation. One of my parents became very ill 3 months into internship. I spoke with my PD, told him I was leaving at the end of the year and he completely understood. I went through the match again in a different specialty and lost a year. Never regretted it for a nanosecond...

Best of luck and sorry that you have to deal with this after happily matching, but it will all work out!
FancyPants.