Fired from residency program. What do I do now?

[Dakota45]

Hello, first time poster here just desperately looking for advice on how to handle the situation I am in. I have been more or less sitting at home for the last few days in a state of paralysis trying to come to terms as to what has happened to me. I am currently/was a third year general surgery resident and was abruptly fired from my program on Friday for showing up for a rotation intoxicated. I have had a problem with alcohol since I was an undergrad and my alcoholism has recently gotten to the point that I need to drink intermittently throughout the day to function at my optimum. While I was moonlighting late last week, I was called to the PD's office and told that my residency program has a zero tolerance policy for alcohol/drug intoxication while on call, and that it results in an automatic dismissal. I have absolutely no clue on how to handle this mess that I have got myself in. Becoming a surgeon has been all I ever wanted to do since I was in high school and now less than 2 years out I have no program to train at. I also don't have skills in any other field whatsoever. Is reapplying to another program an option? Do you think there is some way for me to appeal the decision of my PD (even though he said the dismissal was final)? I could really use some advise right now as this about the lowest I have ever felt in my life to this point.

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[BADMD]

This is a bad place to be. The road back is possible, but very difficult.

1) You need to self report to your state medical board. Your program will likely report you anyway. You will need to enter treatment and monitoring. Goal number one is to save your license eligibilty.

2) You can appeal your dismissal to GME, but it is unlikely that it will do much good. You might be able to appeal it while simultaneously negotiating a separation and be able to have a say in what exactly will be said to those who enquire. They may not play ball and you probably want an attorney involved. You probably should have/will get a copy of the hospital's dismissal policy and it will have your options in it.

3) After a period of sobriety and monitoring, and with the blessing of the Medical Board and monitoring program, you can try to reapply. You may want to start with your old program as they will hopefully have good thoughts about you. You likely will need to go to a different specialty. You want your PD to write you the best letter possible.

 

[AdmiralChz]

I am really, really sorry to hear this. You are in a tough place, for sure. But believe me, you are not alone in your struggles and people have overcome such issues before.

While the job and career implications of this are undoubtably severe, it's nothing compared to the threat to your health and wellbeing. If you haven't already, you need to seek immediate care for yourself in the way of a voluntary admission to some sort of a rigorous treatment program likely with an inpatient component given the degree of your alcohol use. I agree with BADMD, in fact many state medical boards won't even think about reinstating you before you can prove completion of such a program and enroll in a monitoring system. There may be one afforded (read: required by law) to you through your GME office that might be worth investigating, if not then you will need to do your own research. None of the advice we can offer you regarding a return to medicine is worth anything if you don't first have your sobriety for a significant amount of time. This may be harder than getting back into the clinical realm.

You might find that a lot of your issues stemmed from your clinical life/stress, and to be blunt it may require a career change. You need to be open and willing to explore your feelings and thoughts on that matter with a clear head, and honestly I would focus on getting sober first.

 

[Winged Scapula]

Agree with the others.

Getting back into residency is the least of your concerns at this point.

You need to get into treatment and save yourself, your life, your family and your career.

Its one thing to have been found to have a substance abuse problem but when it occurs on the job, most employers would do the same. Your PD may have no choice but to terminate you, even if you were otherwise a good resident. What you will want to have however, is some knowledge of how they will otherwise characterize your residency career up to this point. When the time comes, after you have successfully completed treatment, any new program is going to contact them.

 

[NotAProgDirector]

As others have mentioned, your primary attention has to be on getting your alcohol problem under control. If you re-read your post, you somewhat nonchalantly mention that you need to drink during the day to "function at your optimum". This is classic addictive thinking. I can guarantee you that you're not "optimum" when you're drinking. You need to get help, likely an inpatient rehab. It's possible to do it on your own, but most success is with supports and help.

I think it's impossible to avoid being fired over this. The only "escape route" I can see is to try to declare that you have a diagnosis covered by the ADA and need medical leave. That would have worked if you self reported your alcohol use, and hadn't used at work. If you can get put on medical leave instead of fired, your benefits would continue and they might be under more pressure to let you come back afterwards. But, I'm afraid that coming to work using alcohol probably voids your chances with this plan.

Once you're sober, then you can consider coming back to something. You'll need to have a significant length of sobriety to consider it -- you can't just go to rehab for 3 weeks, get out, and think someone's going to take you back. That wouldn't be good for you -- you need to rework your life to be alcohol free. That can be very difficult -- most of the recovered substance users I've managed need to disengage from all friends / family / social events / etc where their vice is present. So, if you have drinking buddies, you can't see them anymore. If friends are watching the "big game" and drinking, you can't go. You need to find new outlets -- new friends (or old friends who are willing to give up alcohol when you are around), new social events, etc. It's not easy, and I wish you the best of luck.

As mentioned, you'll need to involve your PHP (Physician Health Program). Each state has one, it may be called something different. Do this ASAP, your program will report this to them. Better to hear it from you, and what you're doing about it. Don't call them until you have a plan, and are actually doing something about it. EDIT: Not happy with this sentence. You should contact them immediately. They help devise a plan.

Take care of you first. Your career needs to be secondary for now.

 

[Gastrapathy]

https://floridarecoverycenter.ufhea...spitalization-program/impaired-professionals/

http://www.hazeldenbettyford.org/treatment/addiction-treatment-specialties/health-care-professionals

Lots of options (google rehab for physicians) but you have to go now.

 

[Dakota45]

As others have mentioned, your primary attention has to be on getting your alcohol problem under control. If you re-read your post, you somewhat nonchalantly mention that you need to drink during the day to "function at your optimum". This is classic addictive thinking. I can guarantee you that you're not "optimum" when you're drinking. You need to get help, likely an inpatient rehab. It's possible to do it on your own, but most success is with supports and help.

I think it's impossible to avoid being fired over this. The only "escape route" I can see is to try to declare that you have a diagnosis covered by the ADA and need medical leave. That would have worked if you self reported your alcohol use, and hadn't used at work. If you can get put on medical leave instead of fired, your benefits would continue and they might be under more pressure to let you come back afterwards. But, I'm afraid that coming to work using alcohol probably voids your chances with this plan.

Once you're sober, then you can consider coming back to something. You'll need to have a significant length of sobriety to consider it -- you can't just go to rehab for 3 weeks, get out, and think someone's going to take you back. That wouldn't be good for you -- you need to rework your life to be alcohol free. That can be very difficult -- most of the recovered substance users I've managed need to disengage from all friends / family / social events / etc where their vice is present. So, if you have drinking buddies, you can't see them anymore. If friends are watching the "big game" and drinking, you can't go. You need to find new outlets -- new friends (or old friends who are willing to give up alcohol when you are around), new social events, etc. It's not easy, and I wish you the best of luck.

As mentioned, you'll need to involve your PHP (Physician Health Program). Each state has one, it may be called something different. Do this ASAP, your program will report this to them. Better to hear it from you, and what you're doing about it. Don't call them until you have a plan, and are actually doing something about it.

Take care of you first. Your career needs to be secondary for now.

Thanks for your response. Getting sober has been something I have dreamed and aspired to achieve for much of the past decade. I have been a member of alcoholics anonymous since I started medical school and have twice admitted myself into rehab programs at the suggestion of family members/friends (and failed both time). I am way past the point of social drinking, and my addiction has now cost me my engagement, as well as my relationships with all of my friends and most of my family members. I will be looking into additional rehab programs to enter in the immediate future because I really have no other options at this point with no job and ~$350000 in debt. Though, I honestly don't know if there is any hope for me as I now (for the past two years) have a physical dependence on alcohol (the hand tremors are part of the reason why I would need to drink in order to work). Still, I will try to formulate some sort of plan on how to proceed forward. Once I do this, I will also call my PHP to see if anything can be done to salvage myself and my career in addition to what you have mentioned.

 

[IlDestriero]

Good luck Dakota. Inpatient rehabs and a significant period of sobriety is your best and only real hope to get back into medicine.
One anesthesiologist colleague quit and retrained in psychiatry as he felt that his addiction was dangerous to patients and easy access to drugs was a risk he wasn't willing to take. He's sober and clean for almost 20 years now. Don't give up.
Perhaps surgery isn't the best career for you moving forward, for multiple reasons.


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Il Destriero

 

[deleted480308]

You have to stop saying and thinking that you need to drink to work or the be "optimum". Drinking is why you are at home right now and not at work.

I wish you success at rehab...

 

[gutonc]

Lots of good information here and I hope you take it all to heart and follow through with it, and that you are able to succeed in the future.

I come from a family of alcoholics (some in recovery, some dead) and have a physician partner who has struggled with this as well so I'm more than passingly familiar with both the world of rehab/sobriety and that of physicians with substance abuse issues.

You need to find a rehab program that works for you, and the physician-specific ones @Gastrapathy mentioned may be a good option. Or they may not...but you need to find one nevertheless. You also need to remember/recognize/accept that sobriety is hard, and doesn't always stick. And relapse is common. And requires a lot of work. My dad has "fallen off the wagon" 3 or 4 times that I'm aware of since he got sober. The partner in my group just had his 2nd relapse in the 6 years since I joined the group. Both are currently sober. Both are working hard at it. Both will tell you that it sucks, but not as much as their drinking sucked for them.

Finally, don't screw around waiting to get into a program to register with your state's PHP. Do it yesterday.

 

[axiomofchoice]

I was under the impression that substance abuse protocols in medicine are similar to those in aviation. Approach your company/program/hospital with your problems and they will split the seas to get you treatment and salvage your career.

Show up to your job intoxicated - it becomes a criminal offense. In the case of pilots - they usually go to jail.

Surprised no one has mentioned this here....

 

[Donald Juan]

I was under the impression that substance abuse protocols in medicine are similar to those in aviation. Approach your company/program/hospital with your problems and they will split the seas to get you treatment and salvage your career.

Show up to your job intoxicated - it becomes a criminal offense. In the case of pilots - they usually go to jail.

Surprised no one has mentioned this here....

Why would you think substance abuse protocols would be similar to aviation when work/rest hours aren't either?

 

[npappasan]

You have to stop saying and thinking that you need to drink to work or the be "optimum". Drinking is why you are at home right now and not at work.

I wish you success at rehab...

This. The reality is that you have reached a point BELOW rock bottom. Drinking allowed you to physically climb back up to the point of rock bottom so you could function. Think about that. You have to drink in order to get back UP TO rock bottom. Please get help. States have very elaborate laws with regard to impaired physicians. The good news is that these laws are usually not set up to be permanently punitive but are geared to helping physicians recover and get back to work. You need to act quickly with regard to your problem. This life altering event you have just experienced is highly likely to push you over the edge with regard to your drinking. IMO, what your program did was very irresponsible with regard to your overall well-being because of this. I would have intervened in a matter designed to get you help. Please call someone. If you are in a state of crisis, call 911.

alcoholicsanonymous.com
800-840-0762

 

[gutonc]

I was under the impression that substance abuse protocols in medicine are similar to those in aviation. Approach your company/program/hospital with your problems and they will split the seas to get you treatment and salvage your career.

Show up to your job intoxicated - it becomes a criminal offense. In the case of pilots - they usually go to jail.

Surprised no one has mentioned this here....

No one has mentioned it because it's not true for physicians.

 

[IlDestriero]

Everywhere I've worked it's crystal clear there's a zero tolerance for substance abuse and if you're working/on call your alcohol level is expected to be 0.000. And they've gone out of their way to point out resources available to you. Anesthesia has also been a leader in work hour restrictions, time off after call, etc.
It is very black and white to them. If you're a "good" physician with a problem everyone wants you to succeed. They will work with you to get time off for rehab, etc.
If your coming to work intoxicated or diverting drugs, you're a "bad" physician that's a liability and putting patients at risk. Risk management and HR can't drop you fast enough.
Sadly the difference can be as little as if your chief resident gets to you before the PD when the word gets out. You go to him and you might be able to salvage your career, he comes to you and you're done.
I'm not clear from the OPs post if he had a chance to come clean to the PD or not.
If you have a problem, this is one time where the "easier to ask for forgiveness" is not the way to approach the situation.


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Il Destriero

 

[npappasan]

The problem is that people don't understand alcohol abuse disorders. He didn't show up to work intoxicated because he wanted to. He showed up to work intoxicated because he physically had to. He doesn't drink excessively because it makes him feel good. He drinks because it makes him feel less bad. He needs help, not derailing of his career and life. He's at extremely high risk for really hurting himself here in the near future.

 

[Raryn]

I was under the impression that substance abuse protocols in medicine are similar to those in aviation. Approach your company/program/hospital with your problems and they will split the seas to get you treatment and salvage your career.

Show up to your job intoxicated - it becomes a criminal offense. In the case of pilots - they usually go to jail.

Surprised no one has mentioned this here....

A fully trained physician is worth a ton to society, and the medical boards are willing to work with people who show a willingness to change and be salvaged. Even if they went to the point of showing up intoxicated to work, barring actual legal trouble (and often even then). If the OP had completed residency and was a practicing attending, he would have a reasonably clear, if difficult, path ahead of him to regain his right to practice.

It's going to be a bit more complicated for him, because he was only half trained when he hit rock bottom. If/when he is rehabilitated, he will have the big hurdle of either getting back into his program or finding another program to accept it. But the first step is still the same: get clean.

 

[axiomofchoice]

So what is it that one has to do to lose one's license to practice medicine?

Molest children? Repeatedly kill patients? Embezzel money?

on the one hand we want to be recognized for the overwhelming achievement and sacrifice that we've all made, on the other hand, how special of an achievement is it if we can totally screw the pooch in the middle of our training.

I know there is a lot of support for the OP in previous responses - and I agree with support, rehab and getting the OP back to practice. I'm just playing devil's advocate.

 

[deleted480308]

The problem is that people don't understand alcohol abuse disorders. He didn't show up to work intoxicated because he wanted to. He showed up to work intoxicated because he physically had to. He doesn't drink excessively because it makes him feel good. He drinks because it makes him feel less bad. He needs help, not derailing of his career and life. He's at extremely high risk for really hurting himself here in the near future.

showing up intoxicated isn't even remotely defensible. You may decide to drink to avoid DT, but you do that at home. You simply don't get to do it at work. They need help, but they did show up drunk because they wanted to do that more than they wanted to not show up drunk. Stay at home and be drunk was always an option but they chose to go in and deal with patients. They need to own that and statements implying that the alcohol helped don't get them moving in the right direction

 

[dorothyntoto]

My coresident was just fired, I found out today, for supposedly failing a rotation. She was in FM, and is an FMG from India. She was in her 2nd year, which should have been her 3rd year, but the program had held her back. She has had significant issues with the PD and and his wife who is also an attending. Does she have any recourse? I'm worried for her. It's an awful situation.

 

[ThoracicGuy]

My coresident was just fired, I found out today, for supposedly failing a rotation. She was in FM, and is an FMG from India. She was in her 2nd year, which should have been her 3rd year, but the program had held her back. She has had significant issues with the PD and and his wife who is also an attending. Does she have any recourse? I'm worried for her. It's an awful situation.

If she had already been held back, she was probably on probation. If she then fails another rotation at that time, she probably knew she'd be fired. She likely has little recourse except to try and find another spot somewhere... which will be very difficult to do.

 

[NotAProgDirector]

Let's not derail this thread. The OP needs support.

OP -- there is ALWAYS hope. I know you might not be able to see it now, but there is a way out of this. Rehab hasn't "worked" before, but maybe you just need something with a different approach. Or maybe you're more "ready" for it now. Or maybe something completely random and unpredictable will happen this time to make it work better for you. regardless, if you "fail" at rehab you get up, dust yourself off, and try again. Once you're sober, then you work on getting the rest of your life back on track. Things in your life that have been consumed by your alcohol use (engagement, residency, friends, etc) may be unrecoverable, but being sober will open all sorts of new opportunities for moving your life forward.

 

[SouthernSurgeon]

So what is it that one has to do to lose one's license to practice medicine?

Molest children? Repeatedly kill patients? Embezzel money?

on the one hand we want to be recognized for the overwhelming achievement and sacrifice that we've all made, on the other hand, how special of an achievement is it if we can totally screw the pooch in the middle of our training.

I know there is a lot of support for the OP in previous responses - and I agree with support, rehab and getting the OP back to practice. I'm just playing devil's advocate.

I'm really not sure what your argument is here.

He will lose his license or have it suspended. His program will report this to the state board and there is a well defined process in every state for this.

Several posters have alluded to it above - his only path to regaining a license is a formal recovery program, and there is no guarantee of success with that unless OP is able to demonstrate a long and sustained period of sobriety and behavior change

 

[Goro]

I suggest making a new thread for this instead of derailing this one.

My coresident was just fired, I found out today, for supposedly failing a rotation. She was in FM, and is an FMG from India. She was in her 2nd year, which should have been her 3rd year, but the program had held her back. She has had significant issues with the PD and and his wife who is also an attending. Does she have any recourse? I'm worried for her. It's an awful situation.

 

[Raryn]

So what is it that one has to do to lose one's license to practice medicine?

Molest children? Repeatedly kill patients? Embezzel money?

on the one hand we want to be recognized for the overwhelming achievement and sacrifice that we've all made, on the other hand, how special of an achievement is it if we can totally screw the pooch in the middle of our training.

I know there is a lot of support for the OP in previous responses - and I agree with support, rehab and getting the OP back to practice. I'm just playing devil's advocate.

I completely agree with @SouthernSurgeon, and the only other point I'd make is that one has to do a LOT to lose ones license to practice medicine permanently. That's a huge step. Obviously gross criminal activity (such as intentionally killing people or molesting children) will do it, but anything within the realm of possibly rehabable, physicians tend to lose their licenses temporarily and then can come back with restrictions if they show some humility and a willingness to work with the board.

Even physicians that have been found guilty of sexual misconduct (with adults) have been allowed back into practice eventually. The Atlanta Journal-Constitution had a great series where they looked into this and found that almost every state has mechanisms for it (whether you agree with it or you don't): http://doctors.ajc.com/doctors_sex_abuse/?ecmp=doctorssexabuse_microsite_nav

That said, almost all these mechanisms are much, much easier to take advantage of if you're already a fully trained physician. If you're a resident and you lose your license, even if you convince the board to give it back, finding somewhere to finish your training is a problem.

 

[Dakota45]

I completely agree with @SouthernSurgeon, and the only other point I'd make is that one has to do a LOT to lose ones license to practice medicine permanently. That's a huge step. Obviously gross criminal activity (such as intentionally killing people or molesting children) will do it, but anything within the realm of possibly rehabable, physicians tend to lose their licenses temporarily and then can come back with restrictions if they show some humility and a willingness to work with the board.

Even physicians that have been found guilty of sexual misconduct (with adults) have been allowed back into practice eventually. The Atlanta Journal-Constitution had a great series where they looked into this and found that almost every state has mechanisms for it (whether you agree with it or you don't): http://doctors.ajc.com/doctors_sex_abuse/?ecmp=doctorssexabuse_microsite_nav

That said, almost all these mechanisms are much, much easier to take advantage of if you're already a fully trained physician. If you're a resident and you lose your license, even if you convince the board to give it back, finding somewhere to finish your training is a problem.

I called my state PHP earlier today and was told that I am ineligible for nearly all of their services because I have already been fired and will be losing my license in the immediate future. (The lady also proceeded to tell me that I am a "disgusting human being" and am lucky to not be in prison right now after performing surgery under the influence). Aside from that, she mentioned that if I were somehow able to become sober, there is no medical residency program on Earth that would take someone who has "as little self-discipline" as I do. To be honest, I don't even see the point in entering a recovery program now, being that I will likely never be able to practice medicine again anyway. Even if I could find the power in me to break this curse on my life, without medicine, I will undoubtably revert back to my old habits and drink myself to death. I know you are all trying to be supportive and optimistic (and I truly appreciate that) but I don't think there is any way out of this mess for me.

 

[rokshana]

I called my state PHP earlier today and was told that I am ineligible for nearly all of their services because I have already been fired and will be losing my license in the immediate future. (The lady also proceeded to tell me that I am a "disgusting human being" and am lucky to not be in prison right now after performing surgery under the influence). Aside from that, she mentioned that if I were somehow able to become sober, there is no medical residency program on Earth that would take someone who has "as little self-discipline" as I do. To be honest, I don't even see the point in entering a recovery program now, being that I will likely never be able to practice medicine again anyway. Even if I could find the power in me to break this curse on my life, without medicine, I will undoubtably revert back to my old habits and drink myself to death. I know you are all trying to be supportive and optimistic (and I truly appreciate that) but I don't think there is any way out of this mess for me.

please don't allow that petty judgmental person keep you from getting help...i know that the idea of not being able to practice surgery or even medicine seems like the end of the world, but its not...see if you can talk to your PD and see if there is anything they can do to get you help.

 

[ThoracicGuy]

I called my state PHP earlier today and was told that I am ineligible for nearly all of their services because I have already been fired and will be losing my license in the immediate future. (The lady also proceeded to tell me that I am a "disgusting human being" and am lucky to not be in prison right now after performing surgery under the influence). Aside from that, she mentioned that if I were somehow able to become sober, there is no medical residency program on Earth that would take someone who has "as little self-discipline" as I do. To be honest, I don't even see the point in entering a recovery program now, being that I will likely never be able to practice medicine again anyway. Even if I could find the power in me to break this curse on my life, without medicine, I will undoubtably revert back to my old habits and drink myself to death. I know you are all trying to be supportive and optimistic (and I truly appreciate that) but I don't think there is any way out of this mess for me.

Even if medicine isn't in your future, you still need to get help. Your chances for a return aren't zero. I would be very surprised if your state board doesn't have anything you'd be able to participate in. It would be worth further investigation.

But even if none of this works, get help.

 

[IlDestriero]

One small minded low level career bureaucrat might want you to fail, but she's not the ultimate decision maker. Research your state board's regulations and programs yourself, I'm sure they're available online or by request and quite detailed. Once you know the real score you can see what you qualify for or not. No matter what, you know that the road back begins with an inpatient rehab program somewhere, hopefully one designed for professionals.
You could just give up and drink yourself to death, but one doesn't get as far as you've gotten by giving up quickly and taking the easy path. There's no reason to start now.
Even if surgery, or medicine isn't in your future, there's plenty of great work to be done and often all that is needed to get the ball rolling is a champion to take the lead and make it happen. The history books are full of heroes that rose above their tarnished pasts like a Phoenix out of the ashes.
This is just another hurdle to overcome in your journey. Some things are unforgivable and completely unrecoverable, fortunately you've dodged that bullet and have a chance at a new start. But you've got a lot of work to do first.
Good luck.


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Il Destriero

 

[Apollyon]

To be honest, I don't even see the point in entering a recovery program now, being that I will likely never be able to practice medicine again anyway. Even if I could find the power in me to break this curse on my life, without medicine, I will undoubtably revert back to my old habits and drink myself to death. I know you are all trying to be supportive and optimistic (and I truly appreciate that) but I don't think there is any way out of this mess for me.

You're human before you are a doctor. You need to get sober. A recovery program isn't to get you back into residency - it is to keep you alive. Don't even consider medicine until you heal you as a person, not a doctor. That's what you have to get, and get into your head. What is the old saw of AA - "drinking will take you to 1 of three places - jail, the grave, and the nut house"? You are at or lower than rock bottom. Well, lost your engagement, and your job? Not arrested yet, at least. However, if SO and job are your life, then, maybe you're there. But, if you don't want to change, or help, then help won't help you. And help is there for you.

 

[NotAProgDirector]

It's really inexcusable that she said these terrible things. She is also mostly wrong.

The only correct bit is that you probably don't qualify for PHP. The problem is that you're on a training license, and that license is contingent upon you being enrolled in a residency program. So, when you get fired from your program, your license also disappears (regardless of the circumstances, your license would also end if you simply quit, etc). If you had a full license, then they wouldn't take it away, instead we'd be going down the PHP pathway.

But that's the end of her input that is useful. This is not a self discipline issue. She clearly has some preconceived notions about your situation, possibly generated by a similar illness in her social circles. Ignore her. There absolutely is a way forward.

Also, if you don't hear anything else I say, listen to this: You are currently unable to make good decisions. This is part of your illness. You are not thinking clearly. You need to find someone to help you, and you need to trust them. The hive mind here on SDN can try to help, but a real person is better.

Step 1 is getting sober. Without that, there is no path forward. You need inpatient rehab. It hasn't "worked" in the past is meaningless -- each attempt is new, different, and can be successful.

Once you're sober, you absolutely can get back to medicine:

1. You could apply to residency programs again. Her comment that no one will consider you is wrong. We are interviewing a candidate who went to rehab in medical school. If you're a good candidate, someone very well might see your story and consider you.

2. You have 2 PGY years completed. If you're a US grad, in most (if not all) states you can get a medical license. This would allow you to work as a physician, either as a career without further training, or to gain clinical experience to apply to residency again. If you get sober, you will get a license from most states -- perhaps with ongoing monitoring, but that's fine.

Having worked with patients with addiciton who get sober, there's only one thing that's certain: You will be a different person when sober. Perhaps you'll decide that you no longer want to be a physician, and you'll direct your intellect elsewhere. Perhaps you'll want to be a physician but do something other than surgery -- for example, you could even work in addiction medicine. This may seem impossible now, but you can't see outside of the box you're in. And perhaps you'll still want to be a surgeon -- that will be a difficult process, but certainly not closed off forever.

 

[npappasan]

I'm starting to get a vibe that the OP is yanking our chains. The thread is getting more unbelievable as it unfolds. I cannot imagine that things have gone down this way. I was somewhat skeptical about the initial termination. If he has a substance abuse problem, I can't imagine that his program wouldn't have taken steps to get him help. OP really lost me with the above post of how the PHP responded. No way a PHP would respond like this. That's like a suicide hotline telling you to off yourself. We're being goofed on guys.

 

[npappasan]

showing up intoxicated isn't even remotely defensible. You may decide to drink to avoid DT, but you do that at home. You simply don't get to do it at work. They need help, but they did show up drunk because they wanted to do that more than they wanted to not show up drunk. Stay at home and be drunk was always an option but they chose to go in and deal with patients. They need to own that and statements implying that the alcohol helped don't get them moving in the right direction

Again, lack of understanding as to how addiction works.

 

[Arcan57]

I'm starting to get a vibe that the OP is yanking our chains. The thread is getting more unbelievable as it unfolds. I cannot imagine that things have gone down this way. I was somewhat skeptical about the initial termination. If he has a substance abuse problem, I can't imagine that his program wouldn't have taken steps to get him help. OP really lost me with the above post of how the PHP responded. No way a PHP would respond like this. That's like a suicide hotline telling you to off yourself. We're being goofed on guys.

It may that the program thought he really liked drinking but the PD didn't think he was alcohol dependent. Warning someone about a zero tolerance policy would make sense in that context. Showing up intoxicated to a clinical rotation (especially if patients or nursing/ancillary staff notice) gets HR involved and if the policy is zero tolerance than that person is gone. While PDs seem like the ultimate power to the residents because of the PDs power in terms of advancement/remediation decisions, HR trumps PD when hospital policies are violated.

I agree that the PHP interaction sounds off, but I don't get the sense that the OP is lying about their situation in total.

 

[Mad Jack]

The problem is that people don't understand alcohol abuse disorders. He didn't show up to work intoxicated because he wanted to. He showed up to work intoxicated because he physically had to. He doesn't drink excessively because it makes him feel good. He drinks because it makes him feel less bad. He needs help, not derailing of his career and life. He's at extremely high risk for really hurting himself here in the near future.

He has failed rehab twice, casually drank his way through nearly a decade of alcoholics anonymous, is at the point of alcohol dependence, has lost everyone he cares about to his alcoholism, and was drinking on the job. Even now, the way he types, he does not seem like a person committed to getting clean. That, to me, says that this is the sort of guy who needs his future derailed if he's ever going to be sober, and even then it may not be enough. The rehab failures, in particular, are an issue as they demonstrate he has already failed both conservative and aggressive treatment, and the things he has already lost but kept drinking regardless show me that potential loss is not enough to get him on the right track.

OP, you need a physician sobriety program, as others have mentioned. Normal rehabilitation programs will not provide the level of security a residency will want before taking you on. They function differently depending on the state, but often involve drug and alcohol screening at random intervals, going to meetings, and zero tolerance for even a single failure. You need medical detox first, given your physical dependence, but after that you need a physician program for life if you ever want to practice medicine again. Good luck, and I'm sorry all of this happened to you.

...And then I read the OP's last post, that's just astounding and unbelievable. PHPs are staffed with people that understand addiction and are generally independently run by physicians. The majority of people referred to them have had impairment issues on the job. This just doesn't sound real. If it is, you need to find out who her supervisor is and get her fired.

 

[Mad Jack]

It's really inexcusable that she said these terrible things. She is also mostly wrong.

The only correct bit is that you probably don't qualify for PHP. The problem is that you're on a training license, and that license is contingent upon you being enrolled in a residency program. So, when you get fired from your program, your license also disappears (regardless of the circumstances, your license would also end if you simply quit, etc). If you had a full license, then they wouldn't take it away, instead we'd be going down the PHP pathway.

But that's the end of her input that is useful. This is not a self discipline issue. She clearly has some preconceived notions about your situation, possibly generated by a similar illness in her social circles. Ignore her. There absolutely is a way forward.

Also, if you don't hear anything else I say, listen to this: You are currently unable to make good decisions. This is part of your illness. You are not thinking clearly. You need to find someone to help you, and you need to trust them. The hive mind here on SDN can try to help, but a real person is better.

Step 1 is getting sober. Without that, there is no path forward. You need inpatient rehab. It hasn't "worked" in the past is meaningless -- each attempt is new, different, and can be successful.

Once you're sober, you absolutely can get back to medicine:

1. You could apply to residency programs again. Her comment that no one will consider you is wrong. We are interviewing a candidate who went to rehab in medical school. If you're a good candidate, someone very well might see your story and consider you.

2. You have 2 PGY years completed. If you're a US grad, in most (if not all) states you can get a medical license. This would allow you to work as a physician, either as a career without further training, or to gain clinical experience to apply to residency again. If you get sober, you will get a license from most states -- perhaps with ongoing monitoring, but that's fine.

Having worked with patients with addiciton who get sober, there's only one thing that's certain: You will be a different person when sober. Perhaps you'll decide that you no longer want to be a physician, and you'll direct your intellect elsewhere. Perhaps you'll want to be a physician but do something other than surgery -- for example, you could even work in addiction medicine. This may seem impossible now, but you can't see outside of the box you're in. And perhaps you'll still want to be a surgeon -- that will be a difficult process, but certainly not closed off forever.

I thought OP was three years into residency, and thus would have an actual medical license in many states? Just curious about the technicalities for curiosity's sake.

 

[axiomofchoice]

You are correct that after 3 years of residency you qualify for an unrestricted license in every state (the rules are slightly different for foreign grads). However, you need to actively apply for an unrestricted license - it doesn't just happen after x years of residency.

Finally - theres always a way back. A close friend failed out of college, was addicted to alcohol, porn, and meth. He spent the better part of 1 year living on the streets engaging in prostitution etc. That was 15 years ago - he is not nearing the end of a well respected GS residency. When he applied to medical school he detailed his journey through hell in his personal statement - something I discouraged him from doing. A good number of programs loved it - and eagerly gave him a shot.
For 10 years he got his act together - Obviously it started with sobriety. After time he became a sponsor in both NA and AA. He put his experience to work.

The moral of the story is this. Like the people above said, sobriety is step number one. When you achieve this - it will be YEARS before you are ready to return to medicine. But it is certainly possible.

 

[npappasan]

Sham post

 

[npappasan]

A close friend failed out of college, was addicted to alcohol, porn, and meth.

Wow

 

[Mad Jack]

You are correct that after 3 years of residency you qualify for an unrestricted license in every state (the rules are slightly different for foreign grads). However, you need to actively apply for an unrestricted license - it doesn't just happen after x years of residency.

Finally - theres always a way back. A close friend failed out of college, was addicted to alcohol, porn, and meth. He spent the better part of 1 year living on the streets engaging in prostitution etc. That was 15 years ago - he is not nearing the end of a well respected GS residency. When he applied to medical school he detailed his journey through hell in his personal statement - something I discouraged him from doing. A good number of programs loved it - and eagerly gave him a shot.
For 10 years he got his act together - Obviously it started with sobriety. After time he became a sponsor in both NA and AA. He put his experience to work.

The moral of the story is this. Like the people above said, sobriety is step number one. When you achieve this - it will be YEARS before you are ready to return to medicine. But it is certainly possible.

So if he were able to get a license, he would qualify for physician addiction programs in his state. Around here licenses can actually be conditionally granted based on addiction program participation if you have a history of substance abuse, which would be perfect for a guy like OP. Difficulty- here physicians have to pay for all of the services that the addiction program provides, which isn't cheap, and is not going to be easy to afford without a job.

 

[dexter1990]

Very sorry to hear about your troubles. As others have mentioned, you need to make getting sober your priority if you ever wish to reclaim your career. If you are willing to do this, it might not hurt to consult/hire a lawyer that specializes in this type of thing.

Wishing you well.

 

[Light at end of tunnel]

It sounds like you are taking responsibility for your issues, and that is a huge plus.

Wishing you well.

 

[IM2GI]

It's really inexcusable that she said these terrible things. She is also mostly wrong.

The only correct bit is that you probably don't qualify for PHP. The problem is that you're on a training license, and that license is contingent upon you being enrolled in a residency program. So, when you get fired from your program, your license also disappears (regardless of the circumstances, your license would also end if you simply quit, etc). If you had a full license, then they wouldn't take it away, instead we'd be going down the PHP pathway.
.

This is a very sad thread and I feel for the OP. Hopefully he is taking one breath at a time and doesn't let himself get overwhelmed and make a poor decision.

I would say though, he mentioned that he was moonlighting, and that he was a third year resident. Isn't it possible that he already took his step 3 and got his own independent medical license to moonlight? Would that improve his options through the state board?

 

[Raryn]

This is a very sad thread and I feel for the OP. Hopefully he is taking one breath at a time and doesn't let himself get overwhelmed and make a poor decision.

I would say though, he mentioned that he was moonlighting, and that he was a third year resident. Isn't it possible that he already took his step 3 and got his own independent medical license to moonlight? Would that improve his options through the state board?

Yes. A full license would leave him more options to rehabilitate.

 

[eosinophilic]

I am an addict and have been in recovery for a little over 2 years now. I was given the opportunity to resign rather than be fired. I figure I can offer some experience, strength, and hope. Call the PHP again and simply tell them you are a physician in need of treatment. You do not need a license to be in the program in my state as I had my training license prior to resigning and did not receive a full license until months after I completed treatment. You need help, you need to be monitored and you need all of this to get any part of your life back that is now lost. My scorecard read zero multiple times before I was finally forced to confront my demons. Recovery is not easy. Most doors are closed to you now that you are outed as an addict but it doesnt mean that new ones wont open. I have found my way to having a content, successful life so far even as I have been turned down by hundreds of programs in regards to training. Ive built a practice, made good money and also spend a couple days per week working with fellow addicts. The point is dont give up but you have to have to have to get in a program or youre just spitting in the wind. Feel free to contact me.

 

[chicagochildpsych]

It's shocking to me how this board is so supportive of addicts who practice medicine and call "Phoenix's that rise from the ashes", but every IMG is doomed to failure. This is from an IMG who treats addicts (including impaired physicians).


Sent from my iPhone using SDN mobile app

 

[IlDestriero]

IMGs aren't doomed to failure, but they have their own significant hurdles to overcome. Though many are dreamers, are preyed upon by a for profit system, and are doomed to failure. Unfortunately these dreamers also lack the insight to realistically assess their likelihood of success.
Former addicts can practice medicine after successful treatment and a maintenance program, but there are some careers that they won't find forgiving at all and mine is one of them.


--
Il Destriero

 

[bannie22]

Is he definitely fired? Is there no avenue for appeal?
I was always under the impression that alcoholism is something one can declare and be sent for rehab and placed on leave during rehab because it is a medical condition.

 

[IM2GI]

Is he definitely fired? Is there no avenue for appeal?
I was always under the impression that alcoholism is something one can declare and be sent for rehab and placed on leave during rehab because it is a medical condition.

Self-reporting is different than being caught.

 

[NotAProgDirector]

Is he definitely fired? Is there no avenue for appeal?
I was always under the impression that alcoholism is something one can declare and be sent for rehab and placed on leave during rehab because it is a medical condition.

As mentioned above, if he had an alcohol problem at home and came in for treatment, then he would go out on medical leave and would be ADA protected. Unfortunately, coming to work drunk changes the situation significantly, and usually leads to termination. An argument can be made that his alcohol use was not under his full voluntary control. Another argument is that he clearly states that he made the choice to drink to decrease hand tremors -- and that's unacceptable and clearly a voluntary decision.