Got no calls during SOAP for FM after pathology residency termination, PLEASE ADVISE!

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smve

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Dear readers:
I am an AMG who graduated from medical school in 2017. My step 1 is 215, step 2 is 216, all first attempts. I have one attempt on step 2 CS and passed the second time. Unfortunately, I was terminated at the end of first year of pathology residency due to performance issues in 2018. I was submitting either not enough sections required for diagnosis or too many sections, and my working pace was too slow.
After termination, I rushed to take step 3 despite my low practice test score in order to have the result back by September. Unfortunately, I failed step 3. I passed it the second time with a 208. After passing step 3, I was lucky to get a job as a full-time pathologist's assistant in a different hospital in May 2019. I improved significantly in grossing at my current job as a pathologist's assistant and got a group letter from 4 pathologists at the hospital I'm working at now. The 4 pathologists include the Chair of Pathology at my current hospital. I applied to 50 pathology programs in Sept. 2019 on the Northeastern coast and got only 2 interviews. Last Monday, I did not match. When tried to SOAP into FM and IM programs in NY, NJ, RI, and PA, I received no calls. For pathology LORs, I had one letter from Chair of Pathology from med school, one group letter from my current job, one letter from my research experience, and one letter from a pathology attending from Vermont.
Back in November, when I realized I only got 2 pathology interviews, I shadowed at a student-run clinic, which has a lot of immigrant patients. I got a letter from a FM attending from medical school and wrote a personal statement about switching specialty from pathology to FM. My additional FM LORs include the group letter from my current job and a letter from my research experience. Despite my efforts, I got 0 calls during SOAP this year as I just mentioned above.
During the past 2 years, I have reached out to my previous PD many times. She recently agreed to write me a letter to support me in switching into FM. Would any PDs, attendings, and senior residents please give me advice for how to return to residency? Thank you so much!
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My PD previously told me that in her letter, she will be honest about why I was terminated. In that case, it's possible the letter might not persuade anybody. I have read from other posts here that once terminated, chance of getting back into the same specialty is close to none. Would it be still worth a shot to reapply to both pathology and FM or just FM only? Please advise me.
 
It depends on why. If it says “so and so” couldn’t gross or process their slides at the level that was required“, a family med residency might not care as much as if it says “so and so was consistently late and had several instances of disagreements with faculty”.
 
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My PD told me clearly that I have no professional issues and have good work ethic. She said my grossing issues are due to problem with identifying pertinent clinical information and understanding the clinical question. As a result, I either did not submit sections required for diagnosis or submit more sections then necessary. How would this affect my chance with FM?
 
smve said:
My PD told me clearly that I have no professional issues and have good work ethic. She said my grossing issues are due to problem with identifying pertinent clinical information and understanding the clinical question. As a result, I either did not submit sections required for diagnosis or submit more sections then necessary. How would this affect my chance with FM?
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“problem with identifying pertinent clinical information” and “(not) understanding the clinical question” are not good for any specialty, to be honest...
 
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Unfortunately, I agree. I was hoping that the problem was that you were just too slow. In that case, your year+ of working as a pathology assistant would be hugely beneficial. Still, I think your best chance remains in pathology. The key is to show that your new skills will make you much faster, which will help with your other issues ("I was spending too much time on the mechanics of prepping specimens, with my experience as a pathology assistant I will now be able to focus on the clinical issues inherent in pathology" - something like that).

Applying only to NE is a problem. You need to apply much more widely, and include parts of the country that other people don't want to work in.
 
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At my current job, I have rectified those problems by looking up patient history and finding out clinician's question in order to make sure I submit sections to answer their questions. I also refer to a grossing manual in order to make sure I'm following the protocol. I have a group letter to support my current performance. Would this help?
 
Ok this makes a little more sense. I assume when you grossed a uterus for example, you may be grossing a routine hysterectomy specimen the same way as if the clinical question is uterine tumor, disregarding clinical information.

The relevance of clinical information in pathology is different than in fm in that regard. However, in fm it could be taken as an inability to synthesize all the clinical info to make a final decision. As a simple example, a clinician giving high dose po steroids for a rash without realizing the pt has diabetes and chf.

As others are alluding to, your best bet still may be path if you can reliably show programs you have rectified your issue with identifying and integrating clinical info at your current PA position.
 
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Yeah, 50 programs on NE was the main problem here. You need to apply basically to every program in undesirable places.

I think what you outlined in your last post is a good story. You need the PD letter to attest to your performance in your old program, then your letters as a pathologist assistant can show that you've improved, and your personal statement can explain the specific steps that you've taken to rectify your former problems. Your multiple step failures and old YOG may still be big red flags, but I think that's your best bet rather than a specialty that you don't really have any credible experience in.

The question is, is your old PD's letter contingent on you switching to FM, or could you get her to write a neutral letter for a path application? If she won't give you a letter for a path application, I think that's a major problem with that plan. In that case you might be stuck trying for FM, in which case you need to do everything you can in the coming months to get more FM exposure. I think you can still spin your story in a way where you're showing how you recognized your deficiencies, improved since your termination, and are now able to recognize important clinical information through the changes you've made.
 
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Back in September, my PD already wrote me a letter for pathology which she was willing to send to any program that asked for it. She mentioned that in the letter, she was going to be honest about why I was terminated. I did not ask her to upload the letter on ERAS for fear that the comments would hurt my application. I only sent the letter to programs that asked me for it. The 2 programs that interviewed me did not ask me for the letter. There was a 3rd program that asked for the letter after I emailed them first to express interested. After reviewing the letter, they decided to interview me but were out of spots at the time. They waited for a cancellation which never came. At the end, they were never able to schedule me for an interview. If I ask my PD to upload this letter on ERAS for the next cycle, would that hurt me more since the content might not be neutral?
 
smve said:
Back in September, my PD already wrote me a letter for pathology which she was willing to send to any program that asked for it. She mentioned that in the letter, she was going to be honest about why I was terminated. I did not ask her to upload the letter on ERAS for fear that the comments would hurt my application. I only sent the letter to programs that asked me for it. The 2 programs that interviewed me did not ask me for the letter. There was a 3rd program that asked for the letter after I emailed them first to express interested. After reviewing the letter, they decided to interview me but were out of spots at the time. They waited for a cancellation which never came. At the end, they were never able to schedule me for an interview. If I ask my PD to upload this letter on ERAS for the next cycle, would that hurt me more since the content might not be neutral?
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I think one of the problems is not submitting PD letter. Most people would want to see what previous PD said and would want to make their own judgment, even if they didn’t ask to submit. You should have it up there for transparency reasons. Also, apply very broadly, I think your best bet is getting back in a path residency. Your work since termination is all towards becoming a better pathology resident. Being an AMG and a native speaker, you should be able to get a spot.
 
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smve said:
Back in September, my PD already wrote me a letter for pathology which she was willing to send to any program that asked for it. She mentioned that in the letter, she was going to be honest about why I was terminated. I did not ask her to upload the letter on ERAS for fear that the comments would hurt my application. I only sent the letter to programs that asked me for it. The 2 programs that interviewed me did not ask me for the letter. There was a 3rd program that asked for the letter after I emailed them first to express interested. After reviewing the letter, they decided to interview me but were out of spots at the time. They waited for a cancellation which never came. At the end, they were never able to schedule me for an interview. If I ask my PD to upload this letter on ERAS for the next cycle, would that hurt me more since the content might not be neutral?
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without a PD letter most places are not going to continue looking through your app
 
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Thank you so much for everyone's insights and advice. Your comments gave me a lot of hope and lifted up my spirits. Thank you again! For less desirable places, would funding be an issue since I used up one year of funding already and have only 3 more years of funding left for pathology?
 
Does anybody know where to look for unexpexted PGY1 pathology openings? I have been looking on resident swap and Freida. Thanks!
 
Why not shadow/volunteer under your previous programs PD, APD, Faculty and demonstrate your improvement and try getting back into the same program, or at the least, she can mention in the LoR that you improved.
 
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I agree that not including that PD letter likely hurt you, as did your region of choice. Can you move out of that region? You need to apply broadly next time.

Also, if you don't match next year, can you move to MO? They will allow you to work as an assistant physician under the supervision of a licensed attending. This will help you to transition to another specialty if need be.
 
Anybody know how to find assistant physician jobs in MO? When I search on indeed, I only find one once in a while.
 
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You have to find a collaborating physician in order to get the license. He/She has to sign on the application.

smve said:
Anybody know how to find assistant physician jobs in MO? When I search on indeed, I only find one once in a while.
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Is it really that easy to get dismissed for "performance" issue? I mean yeah if your performance was beyond salvageable....but man I didn't know it was this easy to get dismissed...starting FM residency this July and I'm getting pretty nervous
 
iwillnevergiveup said:
Is it really that easy to get dismissed for "performance" issue? I mean yeah if your performance was beyond salvageable....but man I didn't know it was this easy to get dismissed...starting FM residency this July and I'm getting pretty nervous
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Most people do fine, and the OP's problem was one that was specific to the field of pathology. Chances are you won't be at the bottom of your class, but even if you do find yourself in that position, showing up early, soliciting feedback, and showing that you give a crap and are trying to improve goes a long way.
 
I just got a new letter from my PD. The letter only documents the rotations I completed at my previous program. Besides mentioning that I remediated 2 of my rotations, it says nothing about my performance. Mostly importantly, it says I "left" the program instead of I was "terminated". Would this be the "neutral letter" that I can use to apply to programs?
 
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iwillnevergiveup said:
Is it really that easy to get dismissed for "performance" issue? I mean yeah if your performance was beyond salvageable....but man I didn't know it was this easy to get dismissed...starting FM residency this July and I'm getting pretty nervous
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It is logistically difficult to get someone removed from residency. Maybe non-renewal of contract is easier, but you have to really demonstrate that they were not meeting expectations and continued to not meet expectations despite remediation efforts. Unless, of course, you do something egregious that violates your contract outright.

Most residents do fine. Some need a little help, but still get through residency without any issue. Some need a lot of help and still make it through residency. Some need a lot of help and don't improve and are better suited in another a specialty.
 
smve said:
I just got a new letter from my PD. The letter only documents the rotations I completed at my previous program. Besides mentioning that I remediated 2 of my rotations, it says nothing about my performance. Mostly importantly, it says I "left" the program instead of I was "terminated". Would this be the "neutral letter" that I can use to apply to programs?
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It's about as neutral as you can get. Yes, you should use it and see if you can get a spot.
 
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Did you ask the 2 pathology programs where you got interviews this year why they didn't rank you high enough to match?
 
Are you sure it would be appropriate to ask them that question?




abc2019 said:
Did you ask the 2 pathology programs where you got interviews this year why they didn't rank you high enough to match?
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In my application, do I have to specify whether I was terminated or "left?" Is it okay to say in my application that I "left" the program which is what my PD letter says?




NotAProgDirector said:
It's about as neutral as you can get. Yes, you should use it and see if you can get a spot.
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I will say I left due to performance issues and then mention my improvements. Would that be a good way to put it?
 
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ThoracicGuy said:
I think you need to figure out a more nuanced way of saying that.
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What would be a more nuanced way of saying it?

Reason: Work environment and (personal/medical) issues impeded resident development?

Most of the blame goes to the resident I understand....but is there a better way of "yes I screwed up....but the arranged marriage did not work in general?"
 
Swampurt said:
What would be a more nuanced way of saying it?

Reason: Work environment and (personal/medical) issues impeded resident development?

Most of the blame goes to the resident I understand....but is there a better way of "yes I screwed up....but the arranged marriage did not work in general?"
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Maybe something more that there was some difficulty when you started the training program and you were behind. Eventually you left the program. You took a year as a pathology assistant and now feel that the problems with speed and technique have been fixed and that the issues wouldn't be a problem. Not necessarily those words exactly, but just saying 'performance issues' and leaving it at that is likely to raise a few eyebrows.

As well, blaming work environment or medical issues isn't likely to fly as that looks like just trying to blame other things instead of taking personal responsibility for what happened.
 
Swampurt said:
What would be a more nuanced way of saying it?

Reason: Work environment and (personal/medical) issues impeded resident development?

Most of the blame goes to the resident I understand....but is there a better way of "yes I screwed up....but the arranged marriage did not work in general?"
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Maybe try reframing it by saying you did not like pathology and were unmotivated? Considering you are going for FM, maybe say that you realized you missed interacting with patients?
 
Thank you so much for all these great advice and suggestions. If I apply for pathology, Family med, and preventive med in September, how many programs should I apply to for each specialty?
 
There are some commercial services that claim to help residents re-enter residency. Has anyone used these before? Are they reliable?
 
Mass Effect said:
I agree that not including that PD letter likely hurt you, as did your region of choice. Can you move out of that region? You need to apply broadly next time.

Also, if you don't match next year, can you move to MO? They will allow you to work as an assistant physician under the supervision of a licensed attending. This will help you to transition to another specialty if need be.
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Why should OP move to MO? OP can get a full or unrestricted medical license in ~33 states if his/her program would give credit for PGY1... Then he/she can do whatever the heck he/she wants with his/her license (i.e work as a GP in urgent care, prison, IHS etc...)
 
smve said:
Thank you so much for all these great advice and suggestions. If I apply for pathology, Family med, and preventive med in September, how many programs should I apply to for each specialty?
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Preventive med usually requires a full medical intern year prior to applying unless it is a combined PM/IM or PM/FM residency. Pathology intern years will not fulfill the minimum patient contact months required by these advanced standing programs
 
Splenda88 said:
Why should OP move to MO? OP can get a full or unrestricted medical license in ~33 states if his/her program would give credit for PGY1... Then he/she can do whatever the heck he/she wants with his/her license (i.e work as a GP in urgent care, prison, IHS etc...)
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The OP wants to be a pathologist and while he/she can get an unrestricted license in 33 states, he/she won't be able to work as a pathologist. Not only that, but the OP likely needs some supervision and someone to speak to his/her abilities in pathology in order to successfully match. I'd say this is the case even if he/she decides to match in FM. Once you fail out of residency, you need people to speak up on your behalf and your skills. Working in a prison on a license obtained after one unsatisfactory year of residency is not going to accomplish this, even if the prison decided it was desperate enough to hire him/her.
 
Mass Effect said:
The OP wants to be a pathologist and while he/she can get an unrestricted license in 33 states, he/she won't be able to work as a pathologist. Not only that, but the OP likely needs some supervision and someone to speak to his/her abilities in pathology in order to successfully match. I'd say this is the case even if he/she decides to match in FM. Once you fail out of residency, you need people to speak up on your behalf and your skills. Working in a prison on a license obtained after one unsatisfactory year of residency is not going to accomplish this, even if the prison decided it was desperate enough to hire him/her.
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I see... But OP should understand that not all is lost... He still can practice medicine as a doc if he/she never gets a path spot.
 
Splenda88 said:
I see... But OP should understand that not all is lost... He still can practice medicine as a doc if he/she never gets a path spot.
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Can you explain how this would work? A pathology intern year has no clinical exposure whatsoever. How and what kind of job in medicine can you do with just a pathology intern year and a medical license? I’m legit wondering since I’m in the opposite position of OP... I’m stuck in a pathology intern year and looking for a way out.
 
Here is my update. I left my job as a Pathologist's assistant after one year of full-time employment. I moved to another state where my med school is and started volunteering at a free clinic where one of the FM attendings at a FM residency affiliated with my med school works. After 2 months, the attendings is impressed by my presentations and notes and is willing to write me a letter to apply to FM residency programs.

I previously thought about applying to both pathology and FM this year in order to maximize my chances of matching. However, there's an ERAS application question that asks " Was your medical training interrupted?" Next to the question is a text box for further explanation. Because the answer I put will be seen by all programs I apply to and will be different for pathology vs. FM, that means I can only apply to either pathology or FM now and not both. Does anyone have any strategies for how to answer this question in a way so that the answer would make sense for both pathology and FM?
 
smve said:
Here is my update. I left my job as a Pathologist's assistant after one year of full-time employment. I moved to another state where my med school is and started volunteering at a free clinic where one of the FM attendings at a FM residency affiliated with my med school works. After 2 months, the attendings is impressed by my presentations and notes and is willing to write me a letter to apply to FM residency programs.

I previously thought about applying to both pathology and FM this year in order to maximize my chances of matching. However, there's an ERAS application question that asks " Was your medical training interrupted?" Next to the question is a text box for further explanation. Because the answer I put will be seen by all programs I apply to and will be different for pathology vs. FM, that means I can only apply to either pathology or FM now and not both. Does anyone have any strategies for how to answer this question in a way so that the answer would make sense for both pathology and FM?
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That does not mean you can only apply to one specialty, just don’t be specialty specific in your answer
 
Would you give an example about how to word the answer to make it not specialty specific?
 
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