Getting back into medicine

[dvd5627]

I have perhaps a unique situation and was hoping people here could make some suggestions. I graduated medical school in 2003 then completed a transitional internal medicine year (pgy1) and then 2008-2010 completed 2 years (pgy1 and pgy2) in psychiatry. I got a license to practice and worked for 1 year as a psychiatrist 2012-2013. I have not touched a patient since 2013. I have recently reconsidered getting back into medicine (I have been employed in various insurance-related positions since 2014). The main reason for the interruptions/gaps in my training is that I am a recovering alcoholic/drug addict. I have been clean/sober since 2013 but before then used/drank since high school.

I had accepted that I would never go back into medicine. Secondary to a new volunteer position (the 12 step group I am an active member of calls this "service work"), as I mentioned above, I am reconsidering getting back into medicine. This position involves chairing group meetings of "dual diagnosed" patients (substance/alcohol use disorder plus dsm axis 1 and/or 2 psychiatric diagnoses). I see how much help I can offer these people in a non-clinical capacity (listening to what they say, helping them open up about things they're going through, helping them be a part of group discussions), and can't help wondering how much more I could do for these people if I was a practicing physician.

Would a psychiatric residency program consider taking me as a pgy 3 resident with such a long gap in my training?

Am I allowed to apply as a pgy2 in a psychiatry residency training program after having already successfully completed a pgy2 year in psychiatry?

Would it be better to start over in a different specialty (like family medicine then behavioral health fellowship then addiction medicine fellowship - ASAM)?

Are there other suggestions anyone has?

Thanks for reading.

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[NotAProgDirector]

First, no matter the career outcome, addressing your substance issues and getting your life back on track is the most important thing. It's not easy and something to be proud of.

Now on to your question. There are some details missing from your post. I assume that you (likely) had problems in residency due to your substance use / medical issues and hence only the two years of training. I mention this because it means that any letter/summary from your prior program may have some negative assessments in it.

The second issue is your medical license. Have you maintained it during the last 9 years, or let it lapse? I'm going to guess the latter. Your pathway would be easier if you still have it, and if you've been engaged with your state's PHP (or whatever they call it) this entire time.

Let's start with the easy answer: There is less than a zero chance that anyone will take you as a PGY-3 in psych. Your skills have atrophied greatly, and medical care has changed in the last 10 years. Honestly, you should not be even considering a PGY-3 spot -- if some program were foolish enough to give you one, you would likely find yourself in over your head quickly and in some remediation plan, which is not a good place for you.

You can look for a PGY-2 psych position. Nothing stops a program from taking you as a PGY-2. These spots are not in the match, you'll need to reach out to programs to try to find a spot. You should assume that all programs will want to hear from your prior program, even if it is from 10+ years ago. They should have records of your performance, and whomever is running the program now should be able to generate some sort of a summary. If you plan any clinical work going forward, you're likely to need this so you might as well ask for it. The one issue with repeating your PGY-2 year is the residecny funding problem -- but this is usually a relatively minor issue and won't stop most programs from considering you. You can read more about GME funding rules here: Medicare’ Payments for Graduate Medical Education: What Every Medical Student, Resident, and Advisor Needs to Know (Click on the Download report button). Long story short, your institution will get less funding for your last year, often isn't a problem for lots of complex reasons (there are multiple threads on SDN about this)

You can also apply to a new field. No matter what, many / all may be concerned about the gap in your clinical experience. But they may also be interested in helping you work in the field of addiction medicine. Similar funding issues as above.

You could try to get your license back and just practice without additional clinical training. If you still have your license, this is a real possibility. If you've let it lapse, many states won't consider licensing you with such a long gap. And you'd need to start the PHP process, which can be very onerous depending on the state.

You could apply to addiction medicine 1 year programs. This might be your best option. They may be happy with your prior clinical training, it would give you a second chance. You'd get a training license, and build a new history of clinical practice. You would likely not be board eligible, but that may not matter. After a 1 year Addiction Med fellowship, you might be able to use that experience to reapply for a Pgych PGY-2 or an FM PGY-1. I don't know if Addiction Med programs absoutely require completion of a core residency first -- and even if they say they do, if they have an open spot they might be willing to consider you anyway given your story. This will depend on whether funding the fellowship is partially dependent on having a full license and having some independent clinical activity.

 

[hallowmann]

...
You could apply to addiction medicine 1 year programs. This might be your best option. They may be happy with your prior clinical training, it would give you a second chance. You'd get a training license, and build a new history of clinical practice. You would likely not be board eligible, but that may not matter. After a 1 year Addiction Med fellowship, you might be able to use that experience to reapply for a Pgych PGY-2 or an FM PGY-1. I don't know if Addiction Med programs absoutely require completion of a core residency first -- and even if they say they do, if they have an open spot they might be willing to consider you anyway given your story. This will depend on whether funding the fellowship is partially dependent on having a full license and having some independent clinical activity.

The vast majority of addiction medicine programs require completion of a primary specialty residency, but some programs might still accept someone without it. The ABPM also requires a primary specialty board certification in order to obtain addiction medicine certification.

 

[xffan624]

The vast majority of addiction medicine programs require completion of a primary specialty residency, but some programs might still accept someone without it. The ABPM also requires a primary specialty board certification in order to obtain addiction medicine certification.

A preventive medicine residency could be an option for obtaining this. OP just needs one year of residency (and Step 3) to qualify.

 

[dvd5627]

thank you, no a programdirect!

First, no matter the career outcome, addressing your substance issues and getting your life back on track is the most important thing. It's not easy and something to be proud of.

Now on to your question. There are some details missing from your post. I assume that you (likely) had problems in residency due to your substance use / medical issues and hence only the two years of training. I mention this because it means that any letter/summary from your prior program may have some negative assessments in it.

The second issue is your medical license. Have you maintained it during the last 9 years, or let it lapse? I'm going to guess the latter. Your pathway would be easier if you still have it, and if you've been engaged with your state's PHP (or whatever they call it) this entire time.

Let's start with the easy answer: There is less than a zero chance that anyone will take you as a PGY-3 in psych. Your skills have atrophied greatly, and medical care has changed in the last 10 years. Honestly, you should not be even considering a PGY-3 spot -- if some program were foolish enough to give you one, you would likely find yourself in over your head quickly and in some remediation plan, which is not a good place for you.

You can look for a PGY-2 psych position. Nothing stops a program from taking you as a PGY-2. These spots are not in the match, you'll need to reach out to programs to try to find a spot. You should assume that all programs will want to hear from your prior program, even if it is from 10+ years ago. They should have records of your performance, and whomever is running the program now should be able to generate some sort of a summary. If you plan any clinical work going forward, you're likely to need this so you might as well ask for it. The one issue with repeating your PGY-2 year is the residecny funding problem -- but this is usually a relatively minor issue and won't stop most programs from considering you. You can read more about GME funding rules here: Medicare’ Payments for Graduate Medical Education: What Every Medical Student, Resident, and Advisor Needs to Know (Click on the Download report button). Long story short, your institution will get less funding for your last year, often isn't a problem for lots of complex reasons (there are multiple threads on SDN about this)

You can also apply to a new field. No matter what, many / all may be concerned about the gap in your clinical experience. But they may also be interested in helping you work in the field of addiction medicine. Similar funding issues as above.

You could try to get your license back and just practice without additional clinical training. If you still have your license, this is a real possibility. If you've let it lapse, many states won't consider licensing you with such a long gap. And you'd need to start the PHP process, which can be very onerous depending on the state.

You could apply to addiction medicine 1 year programs. This might be your best option. They may be happy with your prior clinical training, it would give you a second chance. You'd get a training license, and build a new history of clinical practice. You would likely not be board eligible, but that may not matter. After a 1 year Addiction Med fellowship, you might be able to use that experience to reapply for a Pgych PGY-2 or an FM PGY-1. I don't know if Addiction Med programs absoutely require completion of a core residency first -- and even if they say they do, if they have an open spot they might be willing to consider you anyway given your story. This will depend on whether funding the fellowship is partially dependent on having a full license and having some independent clinical activity.

thank you!

 

[dvd5627]

A preventive medicine residency could be an option for obtaining this. OP just needs one year of residency (and Step 3) to qualify.

let me also look into this. thank you!

 

[NontradICUdoc]

Cross posted in the Pre-DO thread, I answered you there