Fellow Leaving C&A Fellowship Early

[Mad Jack]

So someone asked me a question I get with some frequency from residents that want to try child fellowship but are worried about the consequences of leaving after 1 year when they're board-eligible. This particular fellow is in a C&A fellowship that they have found to be toxic, and with a program director that they find to be punitive. Fellow would like to leave after a year, but noted in her contract that it would be considered breach of contract and that per tye contract would be reported to future employers as such.

While many, and probably most, employers likely wouldn't care, my greater concern comes for things like licensure in states that require a PD letter and how having an antagonistic relationship with one's former PD might affect that. Given the individual's description of the current situation, it does not seem as if that relationship will improve, but they might at least get a neutral letter from the PD if they finish, albeit at the cost of their sanity.

What advice would you offer someone in such a situation? They really want to leave, but basically are just concerned with the consequences.

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[comp1]

Tough it out? If the PD is already described as "punitive," I could see this going south just as you described. Hopefully they are already in their own therapy to work on coping with negative influences in their lives. It's more than just leaving early and licensure, it's about their whole career. I mean do they still want to treat kids? I see a lot about a single program (which is very temporary) and not much info about the actual practice of child psychiatry which might be going on for the rest of their working lives. I guess at the start of your career your time in training seems like forever, but wow does not it not as you get further along.

 

[Sushirolls]

Get letters now to get licenses in those states that would even require a PD letter.
Some states are moving to a "compact" and have slightly less paperwork for new license once you have an established license in one of those states.
Leave after you get your license in those state(s).

The biggest issue is making sure you have the credit in eyes of ACGME / ABPN or whoever it is, that you completed 4 years of residency to still be BE for General Psychiatry. If you have that concretely locked down, then leaving is fine with likely little to no consequences.

Fellowship is basically a job... once you are out of residency and in working in real world no one cares if you baled on a fellowship. Some might have questions on license or insurance, about non-completed fellowship. But that's easy... "didn't want to practice CAP"

This is also why, for students and residents, when picking a CAP fellowship... don't pick one with call. Pick one with happy residents - there is no reason in the world of Psychiatry to voluntarily enter into a malignant CAP fellowship. Things just aren't that competitive. And if you really want to do some CAP - you can with general psychiatry. Heck, ARNPs or doing a whole lot of CAP out there and its just plain scary.

 

[Celexa]

I would want a lot more information about how the PD has behaved in the past and also if there are any disciplinary actions against the resident, even minor ones.

To withhold the basic requirements for licensure from a resident in good standing... Would be I suppose technically possible, but likely legally indefensible. For a resident with a clean record and any degree of supportive safety net in the form of money, family support, professional contacts, I doubt a PD would go that far. But I would be prepared to lawyer up if it came to that. My understanding is the PD letter for licensing is a statement of good standing/completion, not a letter of reference. Letters of reference are at the discretion of the writer. Letters confirming completion of requirements are not.

Far more likely to be in the PDs power might be to poison the residents reputation and ability to work in certain places locally. Particularly at an academic center and specifically in their own subfield. But if the OP is planning to move somewhere else, that wouldn't be much of a worry, and could be countered if they have people to speak for them. How much this type of retribution could matter would very much depend on the where the trainee wants to work in the future.

 

[Atreides]

Agree with @Celexa. PD's have fairly little actual power once you're gone. And if they tried to say you did not complete fellowship/were in poor standing when you actually weren't, that's a straightforward legal matter to deal with.

Yes they can poison your reputation and ability to work locally but even that is quite limited. I had such a PD and while he blocked me from getting a position at our institution, that's about all he could do. I literally get private practice referrals from my former APD and other attendings I worked with in training. Even in a niche subfield, it's had minimal impact on my career. Your reputation is built upon many interactions with multiple people. There's only so much "poisoning" of reputation one person can do.

 

[Mad Jack]

I just advised the fellow that it might make her life more difficult, and while it wouldn't be the end of the world to leave early, toughing it out would reduce variables. They decided to stick things through. I don't want to provide many clear examples of what has happened between the resident and PD, as CAP is a small world and it may make things easily identifiable. But based on the read it sounds like a very poor fit of fellow and program, as well as the program being a bit of a workhorse program that focuses on dollars over education.