Forced To Resign Residency Before Termination - What Now?

Discussion in 'General Residency Issues' started by Craig 831, Dec 8, 2008.

  1. Craig 831

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    I am an MD Psych resident nearing the end of my PGY1 at a major medical university hospital.

    Just as I began my residency, I was diagnosed with a serious illness that required an aggressive Cytoxin and Prednisone treatment for the first 7 months of my residency.

    I performed poorly due to the extensive side effects of the treatment and pain medications. This was further compounded by my selection of a residency program that was fast-paced and highly demanding which may not have not been best-suited for me.

    Unfortunately, I was given an academic warning and later placed on probation.

    Even tho I am now in complete remission, the ACGME Committee is suggesting a "best case" option that I resign my residency after coming off the probation and then successfully completing the last 2 months of my PGY1 requirements. Otherwise, they will feel compelled to officially terminate me prior to that.

    My question is that if I indeed resign in the manner alluded to above, what can I possibly do to salvage my medical career from that point on?

    Has anyone here had enough experience to assess what my prospects are for obtaining another residency or possibly practicing medicine without a residency after successfully passing Step III?

    I would also really appreciate any advice, guidance, or referrals to web-based resources or individual advisers that can provide detailed information to help me best navigate this situation.

    Thanks in advance for any assistance you can provide.
     
    #1 Craig 831, Dec 8, 2008
    Last edited: Dec 8, 2008
  2. amanbano

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    I am very sorry to hear what happened, I understand a bit how you feel as I have been dismissed from my residency program, this was a combined program. Unfortunately now my situation is pretty bad right now. The only advise that I can give from my horrible experience is to try to get an observership or externship anywhere and try your best to keep good terms with your program director so that he writes you a good letter of reference or any other attending in the program. Infact I would like some advise from you if you have any. Also try to use all your contacts, although at some stage you dont feel like talking to other people. There are also organizations that help you with this sort of thing and if it is not too late they will help you negotiate with your program director to save your career. These people can be very helpful. Write back to me, god help us both

    ://
     
  3. Craig 831

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    Thank you for your reply. I am very sorry that you find yourself in a somewhat similar circumstance.

    Among your suggestions, you mentioned contacting "organizations" that may be of assistance in negotiating with my program director. Please be more specific about the names of these organizations.

    To others reading this thread, please contribute any insight or experience you may have that can allow me to best continue my medical career.

    Now that I have fully recovered from my illness, I believe I possess the skills to become an effective doctor in a slightly less hectically-paced institution.
     
    #3 Craig 831, Dec 9, 2008
    Last edited: Dec 9, 2008
  4. exPCM

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    I think you should not take everything your program says at face value.
    They say you must resign or they will terminate you! This sets off some red flags in my mind. Have you gotten a written guarantee that they will give you a certificate and credit for successfully completing the PGY-1 year if you resign? If they do not give you credit and a certificate for PGY-1 you will not qualify for licensure in the vast majority of states and you will not be able to transfer into another program as a PGY-2. If they are not going to grant you credit and a certificate I would definitely not resign and I would strongly consider getting a lawyer. If you do not get credit for the year then you will have burned up a year of your GME funding and have nothing to show for it.
     
  5. sirus_virus

    sirus_virus nonsense poster
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    Sorry to hear that. Please get a lawyer ASAP, and get one that is ready to make them pay you the entire value of your medical career if they don't handle this the fair and appropriate way.
     
  6. Craig 831

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    Thanks to the posters above for responding.

    For purposes of future discussion on this Forum, let's assume that I will be resigning my residency with my PGY-1 Certificate, but with a probation on my record.

    Therefore, I would still be most interested in any impressions or suggestions you may have that could help me after resigning.

    For example, how likely would another residency program want to grant me a PGY-2 residency ?? Would it be best to consider transferring my specialty to Family Medicine, for example? Also, have you ever heard of a PGY-1 passing Step III and practicing. What kind of careers would be available under this circumstance?

    Any guidance or suggestions about how to best manage my career after this unfortunate development would be greatly appreciated.

    Ironically, most of the concerns about my performance had to do with the speed and efficiency of my work. My dedication and ability to work well with patients was deemed very good.

    I have thus far been unable to locate any articles or resources available in the library or on the web to assist me. Let me know if you are familiar with any and provide links, phone numbers, or references if you are able. If you know of any professionals to contact with experience in these types of matters, please let me know as well.

    Thank you all very much.
     
  7. skypilot

    skypilot 2K Member
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    Pass step three and get your license. You will be able to practice somewhere. Urgent care, or with a more limited scope of practice. Plenty of people take a year off during residency. You will be one of them.

    Good luck. :)
     
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  8. dragonfly99

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    craig,
    I do think you should strongly consider getting an attorney...not to threaten your program necessarily (won't work too well) but to help you with knowing what your options are and making sure you understand any papers/agreements that you sign, and making sure that your interests are protected.

    It seems there are two different issues here, which are not totally separate but are likely overlapping. One is you became ill, and the 2nd is your residency wasn't happy with your performance. As far as being ill and needing chemo, it could be argued that they should have just offered you medical leave for a few months, probably with pay (depending on what the law and your contract says). Residency is stressful and demanding without having to deal with getting chemo. If you had cancer or something, I'm sure a lawyer would have a field day with your case, should you decide to take it to that level. I'm not saying you should, but I do think you need a lawyer. At this point you have little to lose, and I don't think you should be naive and think that the program is going to necessarily do things in your interest.

    As far as the 2nd issue goes, sometimes these supposed performance issues are just overblown, but sometimes the resident really does have a problem. You need to think about your role in all this, and where you are in terms of both knowledge level and ability to get things done in an efficient manner. Your friends and/or faculty that you felt were reasonable and fair toward you may be helpful to you in making a good assessment in this regard. You need to know where you are for purposes of self-improvement at this point in your career. For example, how have you done on the USMLE, in-service exams, etc. and what about the quality of your notes, medical decision making, etc.? Usually the truth is somewhere in between what the residency thinks/is saying and your own perception of what went wrong.

    I do think you should think about taking USMLE Step 3, as you're going to need to at some point anyway, and you need it to get a license in any state. Try to stay on OK terms with your residency program as much as possible, because they'll need to sign off on paperwork for you to get any license in any state.

    If you still like psych, might be able to stay as a psych resident (somewhere else). A lot depends on what kind of letters of recommendation you can get, perhaps where you went to school, your USMLE scores, whether you are IMG/FMG vs. not, most likely. Right now you need to do damage control. I would be careful about formally resigning without the input of an attorney, and you better make sure you get credit for your 1 year if there is any way you can.

    As far as practice options with only 1 year of training (particularly if most of it is in psych) I think they are dismal long term. That is my honest assessment. In my experience it's hard to get even a moonlighting job without at least a couple years training, and often the urgent care places, etc. really want only someone who has finished a residency, and often only want only "board certified" NP's, PA's, internal med, family practice, peds and ER docs. I am not sure about moonlighting in psych facilities.
     
  9. Craig 831

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    dragonfly:

    Thank you for taking the time to craft such a thoughtful reply.

    I will abide by your advice to consult an attorney, not as a way to necessarily dispute the Committee's determinations but to assure that my rights are protected and any paperwork is done properly.

    That being said, are you suggesting that any competent civil attorney would suffice or would you recommend a lawyer specializing in these matters? If it is the latter, how do you locate such an individual?

    Based upon your honest assessment, it appears that obtaining another residency for PGY-2 would benefit me more than trying to simply complete Step III and attempt to practice. This had been my opinion as well.

    With that in mind, can you offer any suggestions about whether I would more likely obtain a PGY-2 residency under my circumstance if I abandoned Psych and instead applied for one of the more available FM residencies? Would acceptance be more likely? What would you do?

    Finally, I accept your observation that the assessment of my performance was a combination of both my medical condition as well as the fact that the fast-paced and extremely demanding nature of this particular residency was not best-suited for me.

    I will pay particular attention to this variable when evaluating any future residency opportunity that may hopefully present itself in the future.

    Other than obtaining as many independent recommendations from co-workers and insuring that my rights are protected by enlisting competent counsel, if you happen to think of anything else that I can do to improve my future prospects please let me know.

    Thank you so much for your time and concern.
     
  10. skypilot

    skypilot 2K Member
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    Definitely it is important to complete a residency. I just think you can take a year off and work somewhere in medicine or in research and return to the grind refreshed. Getting a license is always a good idea. It is also a huge accomplishment you can be proud of.
     
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  11. mig26x

    mig26x Senior Member
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    I vote for getting a lawyer!!! Let the lawyer do the dirty work on why they are treating you like this and let him put some pressure on this people. You were sick, you took some pretty heavy meds and now they treat you like this?? And I thought residency programs were here to teach us medicine.

    I cant believe this!!!
    Please get a lawyer.
     
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  12. Taurus

    Taurus Paul Revere of Medicine
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    Agreed. Consult a lawyer to make sure your rights aren't being trampled, but keep it to yourself. Show your hand only when you plan to publicly let it be know you're fighting your dismissial.

    You shouldn't take what you're told by the program at face value. Here's a recent case of dismissed dental student fighting back against University of Michigan and winning.

    Expelled dental student awarded $1.7 million in lawsuit against 'U'
     
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  13. Craig 831

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    Thank you all for your responses.

    Only today did I find out about my institution's House Officers Association. I made an appointment and will be seeing someone there on Friday 12/12/08.

    Most of you will likely find it hard to believe that I hadn't really considered or contacted the HOA before. In our phone conversation, the HOA representative certainly expressed that she would have preferred to hear of my situation much sooner than now.

    The previous advice in this Thread to obtain the services of an attorney have also been duly noted. I am in the process of looking for one locally to assist in discussing the available options and to assure that any "separation" paperwork or agreements are in proper order.

    I am also in the process of identifying all of the co-workers and Attendings that were supportive of me during my residency to see if I can accumulate written recommendations from them.

    Many of my colleagues have only recently expressed to me that it seems unfair that the situation has come to this point given the medical issues I confronted early on. Although not a 100% excuse, there's no doubt that my medical condition was a mitigating factor in my performance.

    Just to be fair, I also am honest enough to admit that this particular residency program does not best suit me compared to several others I could have selected that are far less intense and demanding.

    That being said, if any of you have any additional thoughts, suggestions, or recommendations to offer based on anything discussed in this Thread so far, I would be extremely appreciative.

    It is very sobering to realize that many years of schooling and intense dedication can almost instantly be blown away after only 8 months of a residency, especially under these circumstances.

    Thanks to all of you again for your help.
     
    #13 Craig 831, Dec 10, 2008
    Last edited: Dec 10, 2008
  14. dragonfly99

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    Sorry to hear about your troubles.

    I would try and get a lawyer experienced in employment and/or contract law. Unfortunately I don't have good ideas/input into how to find one like that. It would be nice if the AMA and/or CIR or one of those resident organizations would make up a list or how-to guide on finding these types of attorneys.

    My only other advice is that sometimes it is easier to switch fields (vs. say getting into another psych program). That way you can use the rationale of "I don't think psych was that well suited to me, but I feel like I would do much better in [insert other field like pathology, internal med, etc.] because of x, y and z reasons". That said, if you have psych attendings that will write you a LOR saying you'd make a good psychiatrist, you might just be able to start over at another program. Realize that wherever you go, you might lose credit for some of the months you did. The new residency may want you to start all over as an intern. That would suck but I do think it would be doable, and worth it if you could get in somewhere that you would like and that would train you well.
     
  15. marsupial

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    I am so sorry you had to be on Cytoxan. Ick.

    1) Find a lawyer--One way to do this is to contact the best law school in your town, find the prof who teaches employment law, and ask for his best student who is out in practice in your town.

    2) File a complaint with the Equal Employment Opportunity Commission.

    3) DO NOT RESIGN. If you resign, you are 'admitting fault' in a sense, and you can't collect unemployment insurance. Your program doesn't care about you having money to pay your loans and put food on the table! appalling.

    4)Get good letters of rec from anyone you can. Faculty. Patients. Other residents. Nurses. Medical students. Seriously, I'm not kidding.

    5) Document every conversation you have with officials. Keep every written notice. Keep a record of your doctor visits and when you first notified the program about your illness. Print emails that involve you asking for time off or accommodations for your illness.

    6) When you finish the year, absolutely get a letter saying you finished your PGY1 so you can get a license.

    7) E-mail your CV and story to EVERY PROGRAM DIRECTOR that's running a program you'd be OK with transferring to. Do it now!! Tell them that you expect to finish the year, but you need a PGY-2. That way if a spot opens up you are in. I disagree with restarting--internship sucks, and psych is one of the friendliest fields to residents--someone will take you in and help you graduate without losing a year.

    If you do get terminated, these programs will have heard about you ahead of time,and they still might take you in and help you finish the PGY-1 year.
     
  16. dragonfly99

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    Wow, marsupial's advice is really good.
    I didn't realize that if he resigns he can't collect unemployment.
    I agree 100% with getting a lot of LOR's right now. The only time to really do this (or at least best time) is while you are still working there.

    I agree that psych tends to be a less competitive field, but I was wondering how much of a chance he'd have to restart if he was fired or had to resign residency. Won't the PD blackball him with other program directors?

    The most troubling thing here to me is how the program is firing the resident even though he was apparently sick and on chemo. It seems like this is a lawsuit waiting to happen, though I don't know what he was sick with, or how sick he was. It seems like under the circumstances he could maybe negotiate to be let go @the end of the year, and/or leave by mutual agreement (one of my friends did this) rather than to resign or be fired. In exchange for that he promises not to say anything bad about the program, and they promise not to hinder his future training (i.e. give him documentation of all his training, and not go around saying bad stuff about him as a trainee).
     
  17. aProgDirector

    aProgDirector Pastafarians Unite!
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    A couple of thoughts:

    1. First, I'm not sure we have the whole story. When a resident gets sick (especially with a chronic illness), the question arises whether they should continue training while being treated or take an LOA. Sometimes its obvious -- if you have major surgery, you need an LOA. But sometimes, like this case, it's not. The OP required cyclophosphamide and prednisone -- so likely they had vasculitis of some sort, or a glomerulonephropathy. Doesn't matter -- the point is that in this case I would discuss with the OP whether they wanted a long LOA (since treatment is 6+ months) vs to continue training. IMHO, most residents want to continue -- there's already quite a bit of delayed gratification in medicine training, and delaying more is not very enticing. I point out that the resident gets held to the SAME STANDARD if they continue. Either they can do the work or they can't, perhaps with some reasonable accomodation if the illness creates a disability (but just "feeling bad" is not a disability). So, it's possible that the OP was offered an LOA, declined, persisted in training even though their performance started to suffer, and now is left with the consequences.

    If a resident does take an LOA, it might be without pay (i.e. FMLA) depending on the program's policies.

    2. Even given the above, one thing seems clear to me: If the OP's performance now that they are in remission was fully back to baseline and they were doing well, the program would not be talking about terminating them. It's possible that the performance problems predated the illness and are related but separate.

    3. Unemployment is small beans compared with the pain of having to answer the question "Were you ever terminated" on every license, credentialing application in the future. Resign, or continue, but do not base your decision on unemplyment benefits unless you are financially destitute and have no other choice.

    4. Using internal resources (i.e. your HOA) in concert with your PD is a great idea. Getting your lawyer to contact your PD is a really bad idea. Your lawyer is for independent advice for you. I would try to never mention that you have a lawyer to your PD. Once you do, it will become an adversarial relationship and there's no going back.

    5. Transfering into a PGY-2 in another psych program is a BAD idea. Here's why: according to your current PD (and your own admission), your efficiency / speed of your work is the problem. If you go to a new program and start as a PGY-2, you'll be overseeing PGY-1's in a new environment -- that's really hard and will magnify any efficiency problems you may have.

    Here's an idea: You want to find a program with an open pgy-2 spot for next year, but you want to start with 3 PGY-1 rotations to "get the hang" of the new program. This will allow you a smoother transition. The LAST thing you want is to show up in a new PGY-2 spot and start to struggle in the first few blocks.

    6. If you switch to FM, you will certainly have to repeat at least 3-6 months of your PGY-1, maybe more, of your PGY-1. Perhaps the whole thing. Psych and FM are very different, depending on how much IM time was in your PGY-1. Also, FM covers peds and OB, which you likely didn't have at all.
     
  18. 3dtp

    3dtp Senior Member
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    Much of this is excellent advice. I do agree with the others that you need an attorney. This attorney must, repeat must be skilled in medical credentialing laws in your state, not just employment law. As apd said, nearly every state license app I have seen or filled out asks some variation on the "did you ever resign/were you ever disciplined/resign under threat of termination" question.

    This lawyer is for your own protection and knowledge, not to scare the program. They don't scare easily.

    Do not mention the fact that you are seeking legal council to anyone, not even your mother!

    If word gets back to the program it can sink you. But, you do need an attorney skilled in this area of specialty practice so you know the rules, what can and cannot be done and what your options are. As you are aware, this is a deadly serious business. What role you, your illness, your performance or lack thereof and the reasons do not mitigate your need for good council. Call your state bar or state medical society and ask them for the names of lawyers with skill in this area. The programs know the rules, and the playing field, so should you.

    As apd surmised, there is something curious in that you appear to be six months out of cycle here, nearing the completion of your pgy-1 year in December, which is six months out of cycle. I hope things work out.

    Skypilot, I beg to differ. Without the completion of a residency today, unless you are willing to go bare and work for cash alone, it is very, very difficult to get into practice. Insurance panels will not credential you, making it much more difficult to make a living, unless you plan a cash only practice. Most EDs will not hire someone not BC/BE in emergency medicine/internal medicine or family practice. Even formerly safe havens are now insisting on BC/BE physicians.

    I did an economic analysis somewhere else on this forum a few years ago, and it is theoretically possible to make a reasonable living as a GP these days, but many states require two, not one year of residency and a few require three. Someday, I'd like someone to do a study and demonstrate how all this specialty training has improved our medical care delivery system, but then I digress.
     
    #18 3dtp, Dec 14, 2008
    Last edited: Dec 14, 2008
  19. aucdiver

    aucdiver Medical Director, Occupational Medicine
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    I was an (IMG) FP PGY2 resident in a similar situation. I was placed on probation after performance issues on night-float and required to repeat the month. I had to get a Psych eval, show performance improvement, and do well in my next month's rotation. In the end, Despite successfully completing the required tasks I was not offered a 3rd year contract, went through the appeals process and lost. I was 6 months off-cycle from my fellow residents, and was being compared to them (There's a lot more to it than that, but essentially, with all the evidence presented by the faculty my lawyer and all of the residents in my program think I should have been allowed to complete my residency and I should sue). I'm not the sue-type, but the case posted earlier about the Michigan Dental student intrigued me. I WAS able to pass step3 on first attempt prior to the end of my 2nd year, but PD stated "cannot transfer that knowledge to the bedside". Luckily I have preceptor LORs. I spent 3 months in the ACGME appeals process, 3 months completing FCVS, and 3 months getting aWisconsin license. Now, 9 months after completing PGY2, I am still jobless and having to begin payback to SallieMae (wont defer for unemployment or economic hardship without exhorbant fees). I'm job hunting, but when I say I'm not BE/BC, they say no thanks, but good luck! Try to finish residency!

    I recommend that you seek your advisor and ask for help out of this situation (mine didn't help at all, because his head is so far up the PD's...) Tell him you will come in early, take extra training, repeat a particular month, anything. Let him know that you are committed to becoming the best resident you can be. Once you get out of one program you ARE black-balled. I can't even get into the military because of this, and local VA clinics won't take me. (I'm trying prisons and immigration detention facilities now). I've even signed up for the match, and would be eager to redo PGY1 at this point, but I haven't received any interviews. (All of my LORs aren't submitted, yet, though). I will try to scramble, but I tried that last year through findaresident, and was unsuccessful.

    I had a classmate that didn't complete PGY3 in my program b/c he failed step3 too many times. He finally passed, called up one Urgent care center (after getting licensed) and after an unpaid week of working, was able to get signed off by another doc to get malpractice and is making $65/hr. He's a fifth pathway grad.

    I guess the only other possibility is doing an observorship at another residency. I don't even know if that is possible. As a med student, you are under the control of the med school. now that you've finished med school, I don't even know if a residency will let you rotate. It's a bad deal, believe me. This sucks worse than anything.
     
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  20. Craig 831

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    I have carefully read all the recent postings here and am in the process of following much of the advice that has been given. I will be meeting once again with my HOA (House Officers Association) representative to discuss my situation. My HOA representative has forwarded all my information to their Board as well as their attorney. I expect to hear back from them by the end of the week.

    The delay in seeking their input has hurt me. It's funny to have to admit ignorance, but it was only recently that I even became aware of HOA's potential advocacy role in situations such as these.

    Given the very sobering prospects posted here of potentially practicing without a residency after passing Step III or even obtaining another residency, my options in this matter are obviously limited more than even I cared to admit to myself.

    The path to satisfactorily resolving my situation "internally" may also be reduced given the lateness of the game. My HOA rep has also alluded to this possibility, especially if all the "paperwork" and "procedures" were followed according to my contract.

    For purposes of posting in a public forum, I understand where that would leave me and the options available.

    Please allow me a few days to clarify what will be the immediate course of action. I will post again at that time.

    In the meantime, thanks to all of you for your advice. Ironically, I honestly have not had anyone objectively speak to me with such insight and even compassion since this started.
     
    #20 Craig 831, Dec 17, 2008
    Last edited: Dec 17, 2008
  21. dragonfly99

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    aucdiver,
    I actually ran up against some of the problems you alluded to in getting moonlighting jobs postresidency (but prefellowship) while doing bench research. Some places want you to be board certified, not have just completed your residency, even to moonlight. The VA will take you with a completed fp or IM residency. It is sad that a PA or NP is judged qualified to work in a VA outpatient facility, while a doc with 2 years of residency is not. Same with urgent care centers, etc. You may be able to get a job in a prison or detention facility, as you mentioned. I'm glad you passed Step 3 and have a license.

    aucdiver, would think you could keep trying a while longer with nrmp's Findaresident service. Are there any faculty @your old program who might be willing to help you find a new spot? Perhaps you'd have to repeat a year, but hopefully not your intern year.

    I'm wondering if you could pursue a nonclinical job if all else fails? FDA and other government entities hire physicians - I know that you need a license, but you might also need a completed residency (I think for FDA you do). With your 2 years of fp residency, would think you'd be a good candidate for something like a preventative medicine residency (? 2 or 3 years). If your previous PD had questions about your clinical abilities in certain situations, maybe you could negotiate with him/her to see whether he'd not oppose you (i.e. not say anything bad about you) if you applied for something like that. I also think you could try switching to some other specialty (? psych maybe). You could make the argument that it takes different clinical skills. Shoot, you could probably go be a pharmaceutical rep., and make a lot more money than a resident.
     
  22. dragonfly99

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    craig,
    Agree that you should try and salvage your current residency if you can. Perhaps they would agree to your repeating 6 months, then moving on from there. I honestly think restarting somewhere else would be equally as difficult as doing that, so maybe not much to lose in asking whether your program would let you do that. I know it must suck to be somewhere you feel under pressure, etc. but restarting would be hard also.

    I think you need to start looking for other programs now too...at least keep your eyes peeled and sign up for a site like Findaresident.
     
  23. 3dtp

    3dtp Senior Member
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    Craig/auc,

    Getting a second residency is difficult. It is not impossible. You may have to repeat/restart somewhere fresh. It may take a long time, but it has been done. Craig, once whatever transpires happens, you will either be back in or outside the box, as auc is now.

    Once outside the tidy little box the med-ed establishment have constructed, the NRMP/match traditional ways of finding a residency are now usually won't work. Occasionally they do. With the uptick in med student applicants for residency it will, in the not too distant future become even more difficult to land a residency position, in my thinking.

    This does not mean it is impossible. But to get into a position to finish residency training you must be prepared to work outside the box and around the outside of the system. You will have to know where the "chinks" in the system are, and be able to exploit them. This means being in the right spot when an opportunity arises, being prepared to act on an opportunity and a great deal of legwork, and likely expense in getting to know a number of program directors who will work with you. Be prepared for dramatic disappointments along the way. But persistence eventually usually pans out and many do land a second residency position. Some even land a third after developing problems at their second. Do not let this happen to you, as a third residency is even harder to get than a second.

    There are some bad programs/directors out there. But, there are also many many more that are good programs. I will repeat what one PD told me many years ago: "These guys make us all look bad." The good PDs know the nature of the beast, they know that there are bad program directors. APD commented once on the inappropriateness of disciplinary psychiatry which I know for a fact goes on at certain programs.

    If there are solvable problems, then get to work solving them and be prepared to demonstrate/document the steps you've taken to solve them. If the situation is political then be prepared to show that too, and have excellent references to help document that.

    The good program directors are the ones most likely to be sympathetic to your cause and most willing to take a chance on you, provided they know the whole story. Unvarnished. To be able to tell this story will take a lot of introspection and candor. It is best to enlist a trusted friend to help flush out and develop a candid and completely truthful accounting, warts and all. Your former program will not be your friend and your best defense is to know this in advance, know that they are willing to say and covering that in a rational and honest manner.

    Then its a matter of "pressing the flesh." It is a political game, and you will need to make contacts with pd's/chairs who are in a position to help you. This can be done by calling them and talking to them, email, letter, or face to face. I prefer face to face because it is not easy to hide body language and honesty (or conversely the lack thereof) will be easier to spot than in a telephone call. It is also a tad harder to just shrug off a person sitting in front of you in your office than a voice on the telly.

    Good luck, guys. OH, and be wary of choosing a specialty because it's easy or there are lots of openings. Psychiatry has been suggested. Specialty program directors are not going to bring you into a program because you are desperate for any slot. They will bring you in because you are excited about their field and you will learn better medicine for it.
     
  24. NinerNiner999

    NinerNiner999 Senior Member
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    Remember that you are also employed by the university/hospital. Aside from your professional "career," you still have a "job" and cannot be terminated without cause. Illness should not be "cause" - especially since you worked while ill. TALK TO YOUR HUMAN RESOURCES COORDINATOR. Get the hospital on your side while the HOA works on the academic side of things...
     
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  25. dragonfly99

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    niner,
    do you really think that will be helpful?
    Residency programs can do pretty much what they want to do with residents and fellows. They call us "trainees" and not "employees" and we don't really get the same benefits as other employees. I mean, if you are an RN they have to have cause to terminate you, but if you are a resident the PD and dept. chair can pretty much decide whatever they want to do with you, right? All they have to do is produce 1 or 2 bad things (or more, if there are more) some attending said about you in an evaluation. Bang.
    Cause. I don't see how the hospital can help the resident, or why the hospital would want to. They can just hire another resident...what is their motivation to help the resident?
     
  26. eforest

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    I worked a job where I was basically hired "at will" which meant I could quit at any time (with two weeks notice of course) and that the job could fire me at any time, for any reason (ie no reason at all).

    I worked another job where I was NOT hired "at will" and where this was NOT the case. At the latter job, my supervisor wanted me gone, and did not have a good reason to fire me so she started by writing me up-

    1. Lab errors (made a mistake with a buffer 1x- realized the mistake and dumped it out before anyone used it)
    2. Taking unauthorized time off (took off one day to see a sick relative out of state- had already cleared it unofficially and was told I could take time off, but officially was not allowed to take time off as it was early in my employment)
    There were a number of other things

    Anyway, my boss and I spoke, and she said that she felt that things were not working out and that she was required to come up with specific greivances in order to officially write me up and start the 'firing process.' I told her I would be willing to just leave and we actually came to an agreement-- she would get me set up at another lab at the same institution or would write me a recommendation for a job at another institution. We actually parted on good terms, but that's not the point here.

    The point is that if someone wants you gone- they can make it happen. All they have to do is start writing you up. I was thinking on the wards- on any given rotation, someone could give me a horrible evaluation, and it could all be true! Unprofessional attire (I actually had chocolate stains on my scrubs- realized it at the end of the day!), unprofessional demeanor (cried outside the OR once), poor knowledge base (did not answer pimp questions correctly) --


    Life isn't fair and you have to make sure you watch your back and get things in writing. I only had that one really unfair situation at that one job once, but I learned a lot from that. There is no employer- employee loyalty. I'm not saying be paranoid all the time, but also don't get a false sense of security.
     
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  27. 3dtp

    3dtp Senior Member
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    Others are on target. The university/hospital has rules and "standard policies." These policies are written to protect the hospital and not you. The HR coordinator is the hitman who does the bidding of the hospital/chair/pd, is paid by the hospital and is there to see that when the execution takes place, the death warrant is properly signed and recorded.

    dragonfly and eforrest are 100% correct. These people are not your friends and they are not on their side.
     
  28. maceo

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    depends on how desperate they are. If you were an anesthesia resident in 1997 there woul dbe every ivy league knocking on your door. You WILL be able to find something, even if it is in preventive medicine or something. and yes you can do something if you have alicense. dont worry. You ask excellent questions. best of luck to you my friend
     
  29. aucdiver

    aucdiver Medical Director, Occupational Medicine
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    I also agree. My PD Required me to get a Psych eval and required "unfettered access" to speak to the Psychiatrist. This is an ethics violation, but when I presented this to my HR director, I was pacified and sent away. I learned too late that I was supposed to file a complaint with the ethics committee. HR is NOT your friend.
     
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  30. dragonfly99

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    I also know someone who was required to see a psychiatrist and had to have reports sent from the psychiatrist to our program director. He had to do this as a condition of perhaps being able to return to residency, which he was allowed to do after a few weeks.
     
  31. Destressed

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    Similar to Craig and some of the others that have posted info, I am a PGY3, though lost 6 months due to illness, etc. I am in a highly competitive and small field in a very competitive and unforgiving residency program.

    I successful passed by PGY-1 Internship.

    My PGY-2 year started off sick w/ complications requring me to be evaluated by all my docs to determine that I was "medically & psychiatrically stable to return to work". Told that I would need to make up the 6 months during elective time, but also will not be treated any different that my colleagues who did not miss time.

    The program has been tough - harder than I thought it was. In hindsight, probably not the right one as the stress is a significant factor in preventing me from excelling.

    But, no matter what I do/did, there was always fault found. Yes, I'm not perfect, but not the worst resident every - despite being quoted as that in one of my evals. I never did any harm to a patient, despite someone else in the program doing that and not having any repercussions. Most evals were average, with some unsatisfactories - which I think were true deficiencies in some cases, but in others, biased. Some things said are inaccurate. And, even the deficiencies, I believe, are a bit over-exaggerated. And, I was never informed that I was doing so bad - even during the rotations.

    But, the PD decided after completing my PGY-2 year to place me on probation. Se has informed my supervisors in advance of my deficiencies and the requirements that I need in order to get off probation. I think that the requirements are humanly impossible. And, since the Attendings are all aware of my situation, they seem to be more demeaning, harder on me, and find every fault - even if it is small. Of course, all the good is never mentioned. So the evals are not getting any better, of course.

    I applied to another program for a PGY-2 or PGY-3 slot, who was initially very interested in me. But, after getting my evals and talking to my PD, decided I was too risky.

    I sense that my PD and the other Attendings have set me up to fail. They will be deciding whether to terminate me, or whatever this week. An advisor on staff was assigned to me at the last minute, but he seems to report to my program director and I question if I really can trust my advisor. My program director - she's definitely playing the PC route.

    So - what happens? There seems to be no support in this program. Though I want to leave and transfer, my evals and comments from my PD will not help me.

    Please advise as my career may be over. And, I would like to be a doctor in this truly competitive but interesting field which requires a lot of compassion - something that almost all patients have said I have.

    I should also mention my Step I-II scores are 95%, Step III is a little lower, but still - passed
     
  32. dragonfly99

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    Destressed, you may end up having to switch fields if you can't finish @your current program. If you get booted from your current one, it might be very hard to get into another program in the same field, esp. if it's a competitive field. I would try to do everything you can to stay in your current program...grovel, etc. This is particularly true if you still like your specialty and want to do it...perhaps the being out 6 months really hurt you more than you realize, and that you'll "catch up" with your peers, learning-wise, given a few more months. It doesn't seem like there is much you can do except try to convince the powers that be that you are committed to working hard. If they don't want to let you finish, you can't really force them to keep you. Perhaps they would agree to extend your residency by 3-6 months, if they feel you need remediation?

    You don't say how many years your residency would be...I'm assuming 4-5 and that it's something like derm or rads.

    If you don't have a state medical license, I'd work on getting that ASAP. It might be hard if you aren't in the good graces of your program, though...

    If your current residency ends up not working out, you'll be able to do a different specialty very likely. I'm assuming you did pretty well in med school if you were able to get this residency, and your USMLE scores are good. Tons of IM or fp programs would take you, as would some other specialties I'm sure. Did you do an IM or transitional year as your intern year? IM would make it easier to get a PGY2 spot in various specialties, so I was just curious.
     
  33. Destressed

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    Thanks for the advice. I've read a lot of the other unfortunate and unfair stories happening to other residents.

    I think at this time, my fate has been determined. I've even called the Attending on a bad eval - questioning him for his rationale. He didn't respond thru email, but was nicer to me that day. Not that it means anything, but at least it's documented. I know that this small department has made a decision unanimously and is just following protocol - so no lawsuit can be filed.

    Although I read other stories, the only possible difference is that I am an MD, PhD; and in a competitive field. I did very well in Med School - AOA, etc. Yes, my program is 4 years, and I have completed a separate transitional year. By going into other fields - which I really don't want to do - may be easier - but it's NOT what I want to settle for.

    But I had some medical issues before graduating - requiring surgery - and since then, my memory is not as sharp (relative to prior- though still highly functioning, even per recent neuropsych eval). But, I'm not impaired in any way. Stress however, is probably a bigger cause of my less optimal performance and when combined w/ the medical issues - it's just too much. But, I've been told by doctors that this should not preclude me from being a doc in the field.

    I kind of want "out" of the program. I know it's best to finish - but these are people who are unforgiving - and I don't forsee any grovelling, or anything will help. I've asked to extend the residency - but they never wanted to do that. This program is way too stressful and I've been told by a friend in the department that I'm just not the same personality type. I don't play by the cast system rules, I don't like to be yelled at for no reason just because the Attendings are having a bad day. I'm a nice person and I don't want to be "like them".

    I would like to stay in the field - just need a fresh start somewhere else. I applied somewhere - they were VERY interested until they saw my evaluations. How can you not provide your evals when a program asks for them? Isn't that suggesting you're hiding something?

    I want to avoid lawyers as much as possible. I've spoken to an administrator friend at another university and they have told me that lawyers going after University lawyers can get messy. I'd rather find a new place to go.

    How can I find other positions while keeping my prior evals sealed?

    What about research at another university, with the suggestion that if things work out - take me for a residency?

    Oh, and another thing - assuming that the program is kind enough to let me know that I'm being dismissed, is it best to resign before?
     
  34. dragonfly99

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    How can I find other positions while keeping my prior evals sealed?

    [/quote]

    Herein lies the problem. The only way out I see for you is if you can find an attending or two to talk with the PD @another program, to basically tell them that you are O.K. clinically, and to ignore the bad evals.

    I don't see where getting a research spot @ another place will help you, as I doubt your intelligence and research skills are seen as the problem here.

    You will be able to get an IM spot if you try, but if you're in some area like derm or rads you might be hosed for that specialty.
     
  35. LADoc00

    LADoc00 Gen X, the last great generation
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    Isnt it ironic or even quite sad that often an institution like medicine which is supposed to have empathy for its patients doesnt have the same level of empathy for its own members?

    What is that saying about "Reap the Whirlwind"....
     
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  36. dragonfly99

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    LADoc,
    I agree, but also remember we are only getting 1 side of the story on here.
     
  37. dragonfly99

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    I disagree about the call. At least at all the decent residencies I have seen, everybody has the same call schedule. Every resident in my IM program had the same number of call months over the 3 years, with maybe the exception of a 1 or 2 week difference...usually none.

    I agree that prejudice of all kinds still exists. This includes race prejudice, sexism, and also prejudice according to national origin. This isn't limited to medicine and medicine isn't immune from these problems. More of the prejudice I have seen is from patients not wanting a "foreign doctor" and this is usually because of the patients with lower educational levels having trouble understanding the docs when they talk...also sometimes it is just prejudice according to race or national origin.

    It sounds like the last poster just had a bad experience at his/her residency. Unfortunately a lot of FMG and IMG's get stuck in the crappy places for residency, and this may lead to problems by itself. They also get stuck in surgical prelim years more often, where they might get overworked with little chance of ever having an upper level surgery position ("bait and switch" at work).
     
  38. DarthNeurology

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    Realize that no matter how well you do in your PGY-3 year, that the deck is stacked against and could be sort of forced out in that your experience most likely is not that you are being "stressed out", but that attendings are acting inappropriately towards you to make you quit. What does it mean that you don't have the "personality" for the specialty? If you are being yelled at for no reason frequently by attendings this is inappropriate and will bring down your work performance no doubt. Nobody has skin so thick that it wouldn't affect their performance in perhaps trivial but obvious ways, like being curt with fellow residents maybe?

    The only way out is to sit down with your PD and tell him/her, how you want to do a better job and be a better resident but some of the feedback is conflicting and you don't honestly understand what you need to do to improve, and that you want to meet with the faculty every month or every two weeks. This is proactive and looks good, and will make you seem more "human" to these attendings who are probably doing you a diservice. You can't actually sit down everybody and say, "Take it easy, stop harrassing me and help me do my job better."

    If your PD doesn't come up with a list of what to do or offer real advice then I would resign and go someplace where your real talents and obvious knowledge and skill, based on AOA, can be appreciated as you ARE being underutilized and harassed by attendings currently. In the end, the program probably doesn't deserve to have a resident like you (don't give nice residents to mean programs as they invariably break them) and you would be happy elsewhere.
     
  39. DEBIB

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    Hello Destressed,

    I know this is from a while ago but I wondered if you are still going strong in that program. I looked into becoming a physician years ago but thought long and hard and decided not to go for it and I'm okay with that. Not that that is what you should do but I was just hoping you are doing better and found another program. It's like anything else, the people you work with on a persistant basis is important and I don't buy the 'not the right personality' thing either.

    Thanks,
    Debib



     
  40. satakay

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    These Residency Mafia are real mobs..they are bastards...They destroyed my life no matter what..once they plan to destroy some body, they will do it..no matter how good you do or how bad the other fellows were....
    SUE them guys , we must get united and do something about this organized mobsters...

    BY THE WAY NEVER TRUST THE PD..NEVER EVER NOT EVEN A SINGLE WORD..SOBs
     
  41. Taurus

    Taurus Paul Revere of Medicine
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    One of the categorical medicine residents was fired last week from the program where I am doing a transitional year at. The person didn't anything wrong more than the mistakes that the typical intern makes. Don't be fooled by residency; it is a very political process. Once you're on the sh*tlist, it's very hard to get off of it. Be careful of what you say and do. Know which butts to kiss.
     
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  42. DrJosephKim

    DrJosephKim Advisor
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    Depending on your medical history and your risk for developing a chronic disability, you may wish to pursue some non-clinical options that may be more conducive to a lifestyle that allows you to work part-time, work from home, or work with minimal ambulation.
     
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  43. PharmaTope

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    ugh that is awful. ya politics are everywhere and it truly sucks.

    i agree with taurus, if you are on the ****list you cannot get off it. people ususally get an opinion of you and it never changes.

    im not in residency but call me paranoid, i always fear of losing my job. you never ever know how things will turn out. it is true if someone wants you gone, they will make it happen. the writing up process isnt always required especially in a "work at will" state. some states protect employers from needing tons of write-ups.

    always remember that you are an employee and granted we want a good work relationships with coworkers you need to get in, do your job, and get out. im 100% not like the guy i am in the workplace. i hope it works out for you guys here. i hate hearing stories like these but realize they are a reality.
     
  44. DrJosephKim

    DrJosephKim Advisor
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    Sorry to hear about your troubles. I think if you approach this wisely, you can find a second chance at residency. It may need to be at a different institution, but I would urge you to start by approaching your state's physician health program (you can find a directory on the Federation of Physician Health Programs: fsphp.org)
     
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  45. Roofie

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    This is an old post but for the love of god, if you have a medical condition especially one requiring chemotherapy, do not resign. You relinquish all legal rights; unless against tough odds, you can prove constructive discharge. If you are out of a program without a legitimate reason, everyone will assume you got canned. There is really no difference in obtaining a residency position after resigning or getting officially canned. Lying about the situation will not really help you, because invariably PD's talk to each other. Also you will still have to answer yes to those licensing questions.

    After reading this thread I see some possible legal remedies. One is a violation of the ADA. A program must make reasonable accomodations for a resident suffering from a physical disability.

    The program could have also committed a tort by engaging in disciplinary psychiatry. The facts need to be fleshed out some more, but I smell enough stink to suspect that a tort may have been committed here.

    Another possibility is disparate treatment whether due to race or a hostile work environment. We could possibly allege violations of Title VII. We need to know if you are a protected class. If you are a man, were you evaluated predominately by women? Or vice versa. Are you an ethnic minority in your workplace? This could apply whether you are a white resident working at a predominately black residency or a Jewish resident in a predominately Christian residency program. Or vice versa.

    There could also be traditional torts being committed here like interference with an economic contract, slander, or libel. These torts are more difficult to get past summary judgment. You will need to allege specific incidents which may be difficult because you do not have access to the evidence in possession by the alleged tortfeasors.

    That's why its important to allege discrimination if you belong to a protected class to invoke statutory violations that have a lower burden of pleading to get past summary judgment and into discovery where you can start to "fish" for evidence of violation of those traditional torts. Of course the fishing must be done under an otherwise legitimate reason.

    I know it may seem like a low blow but the programs are doing the same thing. They may be alleging academic incompetence for traditionally non-academic shortfallings like personal appearance, pride, arrogance, or some other derogatory terms that boil down to personality conflicts.

    Ultimately, you will have to consult an employment attorney on the plaintiff's bar. Do not trust anyone else including resident union attorneys, who are not really experienced in challenging an adverse peer/program review. They are good at getting you off of a DUI, providing licensing guidance, or other general practice problem. BUT they will not be able to get you out of this mess.

    You may want to get in touch with members of the American College of Legal Medicine. A large part of their membership consists of physician-lawyers who suffered adverse peer review problems and may be able to offer cogent advice. They may be able to lead you to attorneys who enjoy banging heads with the leaders of institutions.
     
    #45 Roofie, May 24, 2010
    Last edited: May 25, 2010
  46. DarthNeurology

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    Ironically, there is a bias very much against med students/residents who have a history of medical, or especially mental, illness. I think it is because doctors see a lot of sick patients each day, and you separate the illness and pathology in such a way that lets you deal with it. Thinking about your own mortality then this would be disturbing to some doctors. So hearing about a colleague, or trainee, with an illness is disturbing on some level. When it comes to evals, any little thing can set off an attending, be it your race or if you talk a lot about your medical problems and maybe they think you think you will get special treatment.

    I think it is telling that APD printed in Caps that you will be held to the same "SAME STANDARD", as I think that if you have a mental/medical illness you have to prove that you are far better than average to erase any concerns the PD/attendings may have.

    Sad day that a resident with vasculitis gets the boot while docs with alcohol and drug addiction programs get all sorts of second chances. I know addiction is a "disease", but a lot of these docs should know better or care that they were intoxicated when they cared for their patients.

    Current medical care doesn't encourage a lot of emotional care for the patients, patients are known by the name of their disease and room number, same thing if you are in training and develop a serious condition, all your colleagues will see is the disease.
     
  47. drash

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    I am sorry to hear about your situation. I am in a similar situation, well not exactly similar. If anyone has any advice, I would appreciate it. I am PGY 1 resident in IM and I am in the last month of my internship. in my case, my program is extending my internship for another 6 months because of deficiency on one of the six ACGME competencies - interpersonal and professional skills. it all started with my behavior towards nursing staff and colleagues, way back in september 2009. I was under a lot of pressure - I had a back surgery in june 2009 and my back was still causing problems, my personal life was a mess (details are not important) and the fact that my better half was the chief resident at the same program, made it worse for me. anyways, once I got frustrated and answered rudely (no slang used) to a nurse. she complained to someone and it reached the program. thsi coupled with another complaint by a co-intern (about my inappropriate response to his joke) put me under strict observation. after that, there were a couple of complains about me not being cordial to colleagues (all true) which kept me under observation. a few months later, things improved on my part when my physical and mental health improved. I did not have any issues, whatsoever, with anyone, since last 5 months. but the associate PD who was monitoring me all this time, was not happy with my progress "saying its insufficient or below expected" and took the matter to RPPC - resident promotion committee - where I was called to put forth my point, which I did but they were not convinced and decided to extend my internship for 6 months. of note, there is no problem with my medical knowledge or patient care. I have received good evaluations from the attendings I have worked with but this associate PD (who is also the chair of RPPC) conveniently forgot to include those evaluations during the meeting.

    after this, I spoke with the PD once who suggested I shd. take this as a learning opportunity and also suggested that if I want, i can try for a pgy2 position at other programs. but the RPPC committee decided that they will only give me 6 months' credit, if I chose to go to another program. While I know it all started with my mistakes, i corrected them before it went too far, but they are not satisfied. the associate PD is hell-bent on ruining my career and she is constantly searching to find faults with me. she has asked every other residents if they have anything negative to say about me (positives are carefully excluded). now, I am not 100 % perfect and there were minor issues (believe me, "minor issues") in last few months but the program is making a big issue out of everything. I am very close to getting a second yr spot, but with this, I will loose that spot because they will definitely ask why only 6 months credit and that will be the end of it. I am thinking of getting advice from a lawyer but if anyone has any suggestions I would deeply appreciate. from this description, it may look like its all my fault, but believe me, its not. Thanks everyone...
     
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  48. glade

    Removed

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    If you can go to another program and your program will help you do it (or at least not backstab you), do it. Because your current program sucks ass. Any program where some complaint about a response to a joke leads to probation needs to be dropped down a well. And all signs are that they're planning to axe you anyways, with the continued monitoring and the ominous "you're not doing well according to us." So I'd bite the bullet, transfer, lose the six months, and start fresh. Then, after you graduate, send the associate PD of your current program a picture of you carefully evacuating your bowels on a photo of her.
     
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  49. hopeless 1

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    Can someone please let us know about key phrases one can mention in their personal statements/applications to let other PD's know that they are not as horrible as their doctored evals or PD letters may state. I also had a medical condition that interfered with my residency, but that was no longer an issue after i received treatment. Even after attendings verbalizing how much better/improved I was, they almost always failed to document anything positive I did, or would document a few positives that would easily be underscored by hugely negative, distorted, and often made up information. A few even documented the COMPLETE opposite of what they told me during our meetings prior to evals coming out. During the long list of posts, someone mentioned that some PD's realize that there are bad PD's out there that are willing to ruin other's careers due to minor disagreements of character/opinion/etc. How can we "softly" suggest this in our applications. Due to excessive pressure of falsified records, and an extremely hostile environment, I resigned my position. I am having a difficult time explaining why I left my program, without trying to place any blame on them. (Because in the end, no matter how true the blame may be, its all just seen as whining, right?) What is the best way to go about doing this?
     
  50. epson

    7+ Year Member

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    Craig sorry to hear about your situation it is really tough. I went through something similar suffering from depression. Here is my 2 cents, from what I saw personally your PD has total control over your future now and in the years to come. Even if you do get a second chance they will HAVE to speak to your PD, it is only fair. You give your side of the story but they have to speak to your PD to get his side and endure patient safety. Nothing personal but how do they ensure that what you say is totally true and you did mention you had some performance issues. Ignore the side effects of the drug treatmetns, harsh but true, most places are scared to death of patient safety.

    I know that this is hard, if you think that you will have to leave then talk to your PD and see if you can get a fair or even neutral letter. Have him write a letter stating your time and credits. If you can get a sit down with your PD, see if he is willing to point out what you can improve and is willing to take calls from other PDs in other programs to even just talk about your time in his program.

    My advice is to start with the end goal in mind. What do you want to acomplish? Legal stuff I know nothing about, I did have a lawyer and what they told me is that if the program really wants you gone, you will be gone, they will nckel and dime you to death.

    As for getting into another program, timing is everything. Here is what I did, get a list of every single program and prepare a cover letter and send out to every PD in an email along with your other credentials, if you can get a PD letter send it. IF you apply for PGY2 you will have a smaller base of competition.

    I am doing this after 3 years away from the program. I was terminated after 3 years in a 4 year program. Tough, I was totally devastated and it took me 2 years to get over my fear and anger and really think about what I did wrong and what I could do. I was so afraid but swallowed my pride and emailed my PD and asked if he would send a letter to other programs, he agreed, I cannot see the letter but I have no choice. I heard back from several programs who will contact my PD, I am waiting to see what happens and praying, it is in gods hands now. I have done everything I can do but I am looking at PGY4 open slots.

    Good luck and remember keep focused on what you want to accomplish
     

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