HELP !!! bad record, kicked out of residency... what to do next ???

[stuckinowhere]

OK normally I post under a different user name but I have a sensitive issue that I need help with, and sorry for lack of specifics cause again I have to protect my privacy ! Anyway to proceed with my story I am an AMG who did not have a good record during med school. I graduated near the bottom of the class, passed Step 1 second attempt, and to top it off had more than 1 negative citation on my transcript for professionalism. I applied to a moderately competitive specialty during M4 year and did not match (big surprise) so I ended up doing a research gap year while applying to a much easier specialty.

I eventually ended up matching to an uncompetitive specialty near the bottom of my rank list (basically a backup's backup). I honestly thought there was no way I would end up where I did, the program was in a bad location and I did not think I would fit in with the other residents. I was one of the only US MD's and everyone else had a different ethnic background. But I took things seriously and tried my best because I knew how much it sucked to not match at all. My initial rotation evaluations were not bad but when I got to one particular rotation with one particular attending everything changed. Again I'm not 100% comfortable giving exact details but I felt that this person went out of his way to pick on me for no reason at all, for very small things, and made my life there miserable. I could not perform well under those circumstances and ended up with a bad evaluation. When I met with my PD I complained of unfair treatment, but I think that made my situation worse because that particular attending is very close to the PD. I was made to repeat the rotation elsewhere, and was placed under increased scrutiny and supervision.

Unfortunately I did not do much better when I repeated the rotation, and while I was not required to repeat it yet again I was told that any further problems, no matter how minor, for the rest of the year may result in dismissal. This could not have come at a worse time because several very bad things happened to me in quick succession: 1)we had our inservice exams to take, and with recent events fresh on my mind as well as a personal emergency, I ended up doing terribly. 2) I got into a dispute with another resident over a really dumb issue that she started, but the PD heard about it and was not pleased with me and 3) a patient that I had recently cared for CALLED the hospital and made a totally BS complaint against me. That was the last straw for the program and I was dismissed.

I feel that my treatment was completely unjustified and I am currently considering legal action, but in the meantime I need to get myself another residency somewhere. Off cycle positions are almost impossible to get into so I am considering applying for PGY-1 from scratch. Given my prior dismissal and my rather poor record from medical school I have to be realistic, but I am willing to take ANY residency program in ANY specialty in ANY location. 1 bed hospital in the northern tip of Alaska? No problem, I'm there. My question at this point is: what are my chances of getting in somewhere, anywhere, given my history? What do I have to do to increase those chances? It seems to me that you can make up for a bad Step 1 score with a high Step 2 score (which is what I did), and you can make up for poor basic science grades with high clinical grades, but how the heck do you make up for a prior dismissal and all these other issues???

I would appreciate any advice. Thanks.


EDIT: I would prefer IM but again I'd take anything including even psych and FP. Actually I would prefer ER or gas but I'm pretty sure those are closed off given my record.

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[Doctor Bob]

My question at this point is: what are my chances of getting in somewhere, anywhere, given my history?

Slim to zero. You have multiple strikes against you.
1) failures on the step exams
2) negative professionalism evaluations in med school
3) failure to match
4) dismissal from a program
5) antagonistic relationship with your PD (who will be contacted by any program you apply to)

Programs want people who are easy to get along with, won't cause patient/staff complaints, and are teachable. To someone who doesn't know you (which will be everyone you come in contact with throughout the interview process, you are not easy to get along with (strike #5), you will cause patient/staff complaints (strike #2, strike #4), and you are not easily teachable (strike #1, and poor inservice score).

What do I have to do to increase those chances? It seems to me that you can make up for a bad Step 1 score with a high Step 2 score (which is what I did), and you can make up for poor basic science grades with high clinical grades, but how the heck do you make up for a prior dismissal and all these other issues???

Nobody likes to hear excuses. I'm not going to take a stance on the rightness or wrongness of your situation because I'm only hearing one side of it... but... even hearing only one side what I hear is "there were multiple reasons I was dismissed all of which were someone else's fault".

People do like to hear about self-reflection and self-improvement. You would be better received on the interview trail with a story about how you had faults, you recognize them, and you have taken steps to fix them. You will be less well received with a story of how the system has conspired against you.

Actually I would prefer ER or gas but I'm pretty sure those are closed off given my record.

You are correct. These are closed to you.

 

[stuckinowhere]

One more question: am I able to apply as a beginning PGY 1 to the SAME specialty that I was dismissed from? I have a couple of months under my belt, and occasionally I hear about mid year openings via word of mouth, but those are extremely rare. There are way more fresh PGY 1 spots starting July 1, and I don't really mind having to repeating a few months. That's frankly the least of my concerns, but really, I would like to do the same specialty.

Doctor Bob, thanks for your honest input. No I don't plan on whining and complaining about my situation on a re-application the same way that I rant on a message board, that's for sure. I'll try to emphasize my positives (yes there are some believe it or not!!) and while I won't attempt to hide or sweep anything under that carpet I'm focus on how negative events caused me to grow and improve. I'll try to be as upfront and honest as possible and hope that someone takes my story seriously to at least grant me an interview.

 

[gutonc]

One more question: am I able to apply as a beginning PGY 1 to the same specialty that I was dismissed from? I have a couple of months under my belt, and occasionally I hear about mid year openings via word of mouth, but those are extremely rare. There are way more fresh PGY 1 spots starting July 1, and I don't really mind having to repeating a few months. That's frankly the least of my concerns, but really, I would like to do the same specialty.

Yes. You're even less likely to get a spot in a specialty you were kicked out of than you are another one. But there's no reason you can't apply.

 

[QofQuimica]

Unfortunately I did not do much better when I repeated the rotation, and while I was not required to repeat it yet again I was told that any further problems, no matter how minor, for the rest of the year may result in dismissal. This could not have come at a worse time because several very bad things happened to me in quick succession: 1)we had our inservice exams to take, and with recent events fresh on my mind as well as a personal emergency, I ended up doing terribly. 2) I got into a dispute with another resident over a really dumb issue that she started, but the PD heard about it and was not pleased with me and 3) a patient that I had recently cared for CALLED the hospital and made a totally BS complaint against me. That was the last straw for the program and I was dismissed.

I'm not a PD, but if I were, the biggest issue I would have with hiring you as a resident is your complete lack of insight about *your* role in creating and perpetuating the problems you're having. Take a look at the paragraph I quoted and try to imagine how it comes off to a stranger: it's all about how other people are doing this or that, but you don't take any responsibility or even acknowledge your own role in creating and maintaining conflicts with other people. Ok, we all have a few attendings and/or co-residents whom we just don't gel with, but you haven't had one bad experience with one person. You're consistently having antagonistic relationships with multiple people everywhere you go: trouble with professionalism in med school, trouble with professionalism in residency, conflicts with attendings, conflicts with other residents, even patients taking the time and trouble to call the hospital to complain about you. You're also underperforming academically, and this is a pattern that started in med school and has continued on through to your intern in-service exam. Ultimately, the one single thing all of these bad interactions and academic problems you've described have in common....is you.

Before you do anything else, even think of doing anything else, you really need to introspect a ton about why and how your interpersonal interactions have all gone so wrong. Because until you figure out why you're having these issues, and what *you* can change about how you interact with other people, you're just going to continue having more and more of the same problems.

 

[stuckinowhere]

Before you do anything else, even think of doing anything else, you really need to introspect a ton about why and how your interpersonal interactions have all gone so wrong. Because until you figure out why you're having these issues, and what *you* can change about how you interact with other people, you're just going to continue having more and more of the same problems.

This happened a couple of months ago so yes I was able to sit down and think about my next move. I did some other non-clinical work in the meantime but still, given what has happened over the last year I decided I still want to return to residency somewhere, ANYWHERE. As far as blame goes yes I of course have my part to play. I won't make any excuses for my med school performance (it was ME taking MY exams after all), but I definitely had an upward trend and my LOR's reflected that. For residency I was basically not prepared to go to the program that I ended up matching to (it was very very low on my list, I expected much higher), so I did not have a good attitude starting from day 1. I kept thinking how did I end up matching here, I deserve better, the weather sucks, etc. And it is not a surprise that I ended up in trouble after carrying that sort of negativity. I can't do anything about the past but I can say 100% that my attitude has changed. Seriously I say this over and over again, but I'll take any position I can get. I know its easy for you guys to look at my history and say oh his record stinks he'll never make it, the chances are 0-1%, etc. I already know that most doors are closed. I wanted to do ER or gas but I know that is totally out of the question. But hey, even FP is fine to me right now, and I would be HAPPY to match there instead of sulking and complaining like I did in the past. All I want to know from you guys is, how can I make amends and improve my situation as it is??

 

[rokshana]

This happened a couple of months ago so yes I was able to sit down and think about my next move. I did some other non-clinical work in the meantime but still, given what has happened over the last year I decided I still want to return to residency somewhere, ANYWHERE. As far as blame goes yes I of course have my part to play. I won't make any excuses for my med school performance (it was ME taking MY exams after all), but I definitely had an upward trend and my LOR's reflected that. For residency I was basically not prepared to go to the program that I ended up matching to (it was very very low on my list, I expected much higher), so I did not have a good attitude starting from day 1. I kept thinking how did I end up matching here, I deserve better, the weather sucks, etc. And it is not a surprise that I ended up in trouble after carrying that sort of negativity. I can't do anything about the past but I can say 100% that my attitude has changed. Seriously I say this over and over again, but I'll take any position I can get. I know its easy for you guys to look at my history and say oh his record stinks he'll never make it, the chances are 0-1%, etc. I already know that most doors are closed. I wanted to do ER or gas but I know that is totally out of the question. But hey, even FP is fine to me right now, and I would be HAPPY to match there instead of sulking and complaining like I did in the past. All I want to know from you guys is, how can I make amends and improve my situation as it is??

just your comments of "even fm" and "i deserve better" are big red flags that your attitude hasn't really changed much...

maybe you should look into doing research...esp at a place that has residencies...a few years building up your CV and getting to know people in the different residency programs may help...or you may find you find a place in research.

but don't think you are going to just step into a place right away...you will need the time away for people to feel that you have made changes to you the issues you have (and you do have issues...you need to figure out how to learn from them and fix them) and do thing to SHOW people how you have made those changes...programs, even the lowest ranked, malignant, middle of nowhere, places are will leave a spot unfilled rather than fill it with someone who is difficult and not a team player...their desperation to fill a spot is not going to necessarily give you a job.

 

[NotAProgDirector]

You had multiple professionalism issues in medical school.

Then you had multiple professionalism issues in residency.

How exactly do you plan to explain that you've addrssed these issues and that they won't happen again?

 

[Perrotfish]

This happened a couple of months ago so yes I was able to sit down and think about my next move. I did some other non-clinical work in the meantime but still, given what has happened over the last year I decided I still want to return to residency somewhere, ANYWHERE. As far as blame goes yes I of course have my part to play. I won't make any excuses for my med school performance (it was ME taking MY exams after all), but I definitely had an upward trend and my LOR's reflected that. For residency I was basically not prepared to go to the program that I ended up matching to (it was very very low on my list, I expected much higher), so I did not have a good attitude starting from day 1. I kept thinking how did I end up matching here, I deserve better, the weather sucks, etc. And it is not a surprise that I ended up in trouble after carrying that sort of negativity. I can't do anything about the past but I can say 100% that my attitude has changed. Seriously I say this over and over again, but I'll take any position I can get. I know its easy for you guys to look at my history and say oh his record stinks he'll never make it, the chances are 0-1%, etc. I already know that most doors are closed. I wanted to do ER or gas but I know that is totally out of the question. But hey, even FP is fine to me right now, and I would be HAPPY to match there instead of sulking and complaining like I did in the past. All I want to know from you guys is, how can I make amends and improve my situation as it is??

On an encouraging note: there are 1 year ED fellowships off of FM residencies. If you do well in FM and garner some strong letters of rec you might end up working in the ED after all.

 

[stuckinowhere]

aProgDirector: I sent you a PM

On an encouraging note: there are 1 year ED fellowships off of FM residencies. If you do well in FM and garner some strong letters of rec you might end up working in the ED after all.

Great ! I didn't know that. Thank you for that info.

 

[dragonfly99]

I agree with the others who said you need to take a few months to figure out *why* you're having these conflicts with people. The academic issues you can "fix" by studying harder for in-service exams, etc. potentially. But the other stuff you have to figure out why it is happening, and you should have tried to before now...or tried harder. I've had conflicts from time to time too during residency, but the number you have suggests some problem with either your general attitude or at least how you come across to other people, or that you get anxious and then act it out on other people. It could be a lot of things. I would suggest to talk with a clinical psychologist or something, and see if he/she can help you figure it out or give you some sort of personality survey and/or books to read, exercises to do to figure out what is the root of all these conflicts. People get very stressed in med school and/or residency and from time to time people will do things that will get under your skin, but you have to have ways to be able to bite your tongue, or redirect other people's aggression so that you don't come back at them in an aggressive manner - nobody is perfect but this happened to you too many times. Also, sometimes patients have unrealistic expectations but you have to find ways to manage that as well- it's not necessarily fair, but patients want our best, or at least something approximating that, and they don't care if we are tired, hungry, sleep-deprived, it's crappy weather outside, etc. They are scared and sick and they want you to care about them or at least put on your best face and make sure they get the right treatment. So that patient complaint episode would be something you need to think hard about and think how it could have potentially been avoided.

 

[Law2Doc]

I'm not a PD, but if I were, the biggest issue I would have with hiring you as a resident is your complete lack of insight about *your* role in creating and perpetuating the problems you're having. Take a look at the paragraph I quoted and try to imagine how it comes off to a stranger: it's all about how other people are doing this or that, but you don't take any responsibility or even acknowledge your own role in creating and maintaining conflicts with other people. Ok, we all have a few attendings and/or co-residents whom we just don't gel with, but you haven't had one bad experience with one person. You're consistently having antagonistic relationships with multiple people everywhere you go: trouble with professionalism in med school, trouble with professionalism in residency, conflicts with attendings, conflicts with other residents, even patients taking the time and trouble to call the hospital to complain about you. You're also underperforming academically, and this is a pattern that started in med school and has continued on through to your intern in-service exam. Ultimately, the one single thing all of these bad interactions and academic problems you've described have in common....is you.

Before you do anything else, even think of doing anything else, you really need to introspect a ton about why and how your interpersonal interactions have all gone so wrong. Because until you figure out why you're having these issues, and what *you* can change about how you interact with other people, you're just going to continue having more and more of the same problems.

Strongly agree with this. You aren't going anywhere with the attitude that an attending hated you and a patient made a bogus claim, etc, etc. You are better off figuring out that you were a screw up, taking full responsibility, and figuring out how you are going to fix things. Nobody is going to buy your "the world is stacked against me" routine, but MAYBE we might buy that you were a royal screw up, and now own it, if you can prove to us why that won't continue to be the case.

 

[Arcan57]

If you wake up and go outside and meet a jerk then you've met a jerk. If you go through the day and all you meet are jerks, then you're the jerk.

 

[mcl]

Strongly agree with this. You aren't going anywhere with the attitude that an attending hated you and a patient made a bogus claim, etc, etc. You are better off figuring out that you were a screw up, taking full responsibility, and figuring out how you are going to fix things. Nobody is going to buy your "the world is stacked against me" routine, but MAYBE we might buy that you were a royal screw up, and now own it, if you can prove to us why that won't continue to be the case.

So it seems that we are all in agreement that the possibilities of matching to another residency are remote at best, but what would give the OP the best shot at proving to programs that he/she could now succeed in residency training? My primary idea would be health-related volunteer work, either at a hospital or community clinic. That would potentially develop contacts who could vouch for professionalism and communication skills in dealing with patients and staff. Secondarily, I would suggest some form of regular continuing medical education, possibly attending Grand Rounds or joining a local medical society. Is there any agreement that those actions might help? Are there other proactive solutions?

 

[michaelrack]

xz

 

[QofQuimica]

So it seems that we are all in agreement that the possibilities of matching to another residency are remote at best, but what would give the OP the best shot at proving to programs that he/she could now succeed in residency training? My primary idea would be health-related volunteer work, either at a hospital or community clinic. That would potentially develop contacts who could vouch for professionalism and communication skills in dealing with patients and staff. Secondarily, I would suggest some form of regular continuing medical education, possibly attending Grand Rounds or joining a local medical society. Is there any agreement that those actions might help? Are there other proactive solutions?

I think if it were me, I'd start by talking to a trusted faculty at my old program for ideas, see if they'd be willing to write me a LOR when the time came, maybe even put in a good word for me if they knew a PD, etc. Because without someone the potential new PD knows and trusts vouching for the OP's reformation, why would any sane PD agree to the risk of taking on an intern with a consistent 5 year history of academic difficulties and professionalism problems?

 

[Perrotfish]

I think if it were me, I'd start by talking to a trusted faculty at my old program for ideas, see if they'd be willing to write me a LOR when the time came, maybe even put in a good word for me if they knew a PD, etc. Because without someone the potential new PD knows and trusts vouching for the OP's reformation, why would any sane PD agree to the risk of taking on an intern with a consistent 5 year history of academic difficulties and professionalism problems?

Are medical student rotations an option for Interns who have failed the year? Is spending the year 'auditioning' a practical or good idea?

 

[Doctor Bob]

Are medical student rotations an option for Interns who have failed the year? Is spending the year 'auditioning' a practical or good idea?

No.

When you're a medical school you're protected by the medical school's liability shield (all medstudents have liability insurance in some amount whether they know it or not). It's why a lot of foreign students can only do observerships; because their school doesn't provide this coverage.

So in the OPs situation they would have to provide their own insurance to be able to have patient contact (and convince the hospital that they should be allowed to do this- this is normally a non-issue because the school has an arrangement with the hospital, but the hospital doesn't have it with individuals), or they can do an observership. Observerships are 1) hard to come by and 2) pretty useless for proving to a program that you aren't going to be a problem for them... because you don't have any meaningful patient contact and can't prove how you would be as a resident.

 

[urgentcase]

OK normally I post under a different user name but I have a sensitive issue that I need help with, and sorry for lack of specifics cause again I have to I eventually ended up matching to an uncompetitive specialty near the bottom of my rank list (basically a backup's backup). I honestly thought there was no way I would end up where I did, the program was in a bad location and I did not think I would fit in with the other residents. I

I would appreciate any advice. Thanks.


EDIT: I would prefer IM but again I'd take anything including even psych and FP. Actually I would prefer ER or gas but I'm pretty sure those are closed off given my record.

Unfortunately residency training is about someone else's perception of how you are and what you know. I agree with you that there is very little objectivity there, and the system is more suitable for a talent show or a beauty pageant than a serious field such as medicine. However, there is nothing you or anyone else can do to change it. You can thank Dr. Osler for creating this demonic system 100 years a go. Thus comes the question, what to do in your situation? Is there anything you can do? The answer is no. You have way too many red flags on your application to be in any shape for re-application at this point. What can you do? You need to take a step back. Go for nursing, or occupational therapy, or physical therapy, or podiatry. You have to start over. You could also go for a post-doc, although I would not recommend it unless you feel passionate about some field. Have you considered law school? Being an MD/JD gives you a unique advantage in that field even if you are not boarded in medicine ( and it would only take 3-4 years).


The more important question though is why did things happen to you. There is a very simple explanation here. You don't think like a salesman/woman.. and that's how ACGME wants you to think. A couple of years a go there has been a move for more compassionate doctors and issues that were unheard of in medical education such as professionalism/communication skills/personal interactions came into prominence and became part of the "competencies". Thus, in our day and age, these skills are as highly stressed as the actual doctoring- or what we all went to med school & residency to learn. When a patient comes to your clinic, the first thing on your mind should be customer service. Also, you have to treat everyone around you as if they are your boss, and make sure they are satisfied. There is a saying out there "bring a treat for every dog, so that no dog will bark you down". Its much simpler than you think. Just be nice, don't argue with anyone and think how you can help others rather than how you can help yourself. Your thinking process definitely affects your actions whether consciously or sub-conscioulsy. Don't be angry at the world. Don't think that others have wronged you in any way. Just a positive and helpful, non belligerent attitude will go a long way. This may be against your nature. You may not be that kind of a person. I don't think you can change, or necessarily need to change your personality, but you need to develop a professional attitude and carry it into any professional interaction that you may have. Have some time for punching the wall or a bag (your preference) at the end of the day to feel better about yourself, but leave the fists, the teeth, and the punching bag at home when you step into the professional sphere. Let this be a life lesson for you. You are still young. People have started from scratch at a much older age than you and have achieved much. The good news is that you live in the US. Here, if you are friendly, and helpful, people will respond positively to you. Most importantly, take everything people say here with a grain of salt. People are just people. Even aProgDirector is wrong sometimes, and has been wrong about a number of issues over the years that I've been on this site. Your fate is not sealed. You are the master of your destiny to a certain extent, and keep trucking towards your goals!

 

[HomeSkool]

Nobody likes to hear excuses. I'm not going to take a stance on the rightness or wrongness of your situation because I'm only hearing one side of it... but... even hearing only one side what I hear is "there were multiple reasons I was dismissed all of which were someone else's fault".

Exactly my thoughts as I read the OP's opening statement. It read something like, "bad things happened during med school, but they weren't my fault, and then bad things happened during residency, and they also weren't my fault, and then I got fired." OP, you need to be a lot more insightful about your own culpability in this affair. If you had problems crop up in med school, residency, and an outside facility where you were made to repeat a rotation, then the problem is you.

For residency I was basically not prepared to go to the program that I ended up matching to (it was very very low on my list, I expected much higher), so I did not have a good attitude starting from day 1. I kept thinking how did I end up matching here, I deserve better, the weather sucks, etc. And it is not a surprise that I ended up in trouble after carrying that sort of negativity.

No, it's not a surprise at all. I'm not sure why you "expected much higher" or "deserve[d] better" when, by your own admission, you had a major red flags in your academic background. I can assure you, though, that your negative attitude and sense of entitlement were major factors in the interpersonal problems that led to your dismissal.

But hey, even FP is fine to me right now, and I would be HAPPY to match there instead of sulking and complaining like I did in the past.

This statement reeks of entitlement. "Even FP is fine"?! Most of the FPs I worked with in med school and internship chose that specialty because they loved the type of work and the front-line-of-care role that the job afforded them. Just because you find a given specialty distasteful doesn't mean that everybody else does. You can be sure that PDs will pick up on your elitism and toss your application in the trash if they feel you're disrepectful of their field.

All I want to know from you guys is, how can I make amends and improve my situation as it is??

Insight, insight, and insight. You need to do some serious soul-searching to understand why you've had these repeated difficulties in your professional interpersonal relationships. And then you need to convince potential PDs that you've successfully taken appropriate steps to correct these difficulties. Any program you apply to is going to contact your former PD, who is not going to have nice things to say about you. Normally, I'd recommend that you contact your med school dean or a close mentor who's willing to run interference for you; that way, they could contact those programs and speak favorably on your behalf. With problems extending all the way back to med school, though, it sounds like that may be a problem. At this point, I'm not sure what you can do except begin looking for other types of work, as suggested by urgentcase.

Your fate is not sealed.

Your fate is not sealed, but many roads are closed to you at this point. Accept this fact and seek out the roads that are still open. Correct the problems that put you in this position if you want those roads remain open.

 

[Law2Doc]

Unfortunately residency training is about someone else's perception of how you are and what you know. I agree with you that there is very little objectivity there, and the system is more suitable for a talent show or a beauty pageant than a serious field such as medicine. However, there is nothing you or anyone else can do to change it. You can thank Dr. Osler for creating this demonic system 100 years a go. Thus comes the question, what to do in your situation? Is there anything you can do? The answer is no. You have way too many red flags on your application to be in any shape for re-application at this point. What can you do? You need to take a step back. Go for nursing, or occupational therapy, or physical therapy, or podiatry. You have to start over. You could also go for a post-doc, although I would not recommend it unless you feel passionate about some field. Have you considered law school? Being an MD/JD gives you a unique advantage in that field even if you are not boarded in medicine ( and it would only take 3-4 years).


The more important question though is why did things happen to you. There is a very simple explanation here. You don't think like a salesman/woman.. and that's how ACGME wants you to think. A couple of years a go there has been a move for more compassionate doctors and issues that were unheard of in medical education such as professionalism/communication skills/personal interactions came into prominence and became part of the "competencies". Thus, in our day and age, these skills are as highly stressed as the actual doctoring- or what we all went to med school & residency to learn. When a patient comes to your clinic, the first thing on your mind should be customer service. Also, you have to treat everyone around you as if they are your boss, and make sure they are satisfied. There is a saying out there "bring a treat for every dog, so that no dog will bark you down". Its much simpler than you think. Just be nice, don't argue with anyone and think how you can help others rather than how you can help yourself. Your thinking process definitely affects your actions whether consciously or sub-conscioulsy. Don't be angry at the world. Don't think that others have wronged you in any way. Just a positive and helpful, non belligerent attitude will go a long way. This may be against your nature. You may not be that kind of a person. I don't think you can change, or necessarily need to change your personality, but you need to develop a professional attitude and carry it into any professional interaction that you may have. Have some time for punching the wall or a bag (your preference) at the end of the day to feel better about yourself, but leave the fists, the teeth, and the punching bag at home when you step into the professional sphere. Let this be a life lesson for you. You are still young. People have started from scratch at a much older age than you and have achieved much. The good news is that you live in the US. Here, if you are friendly, and helpful, people will respond positively to you. Most importantly, take everything people say here with a grain of salt. People are just people. Even aProgDirector is wrong sometimes, and has been wrong about a number of issues over the years that I've been on this site. Your fate is not sealed. You are the master of your destiny to a certain extent, and keep trucking towards your goals!

I'm not exactly sure how you think getting a JD will help this guy. The law market is supersaturated and law firms are going to be as skittish about taking a residency washout as other residencies. Its also a field that focuses in on professionalism, and your progression in a firm is very much based on subjective evaluations from the partners and feedback from clients, so really the same hurdles. If you are mainly suggesting he make a career change I get that, but I'm not sure law is really the right progression given his issues.

 

[Dejavu]

I'm not exactly sure how you think getting a JD will help this guy. The law market is supersaturated and law firms are going to be as skittish about taking a residency washout as other residencies. Its also a field that focuses in on professionalism, and your progression in a firm is very much based on subjective evaluations from the partners and feedback from clients, so really the same hurdles. If you are mainly suggesting he make a career change I get that, but I'm not sure law is really the right progression given his issues.

I guess I could see how a guy could sell himself as "I never intended to practice medicine; but I used med school as background knowledge so that when I finish law school I can practice in a medico-legal arena".

It might work, but I am reminded of the story of the snake convincing a girl to pick it up and carry it and then later biting her. When she expressed surprise, he said "you knew I was a snake when you picked me up."

Kinda like saying that PDs (med school or law school) should be wary of "picking up" this kind of applicant.

 

[gasthrowaway]

EDIT: I would prefer IM but again I'd take anything including even psych and FP. Actually I would prefer ER or gas but I'm pretty sure those are closed off given my record.

lol, classic. the fact that you even took the time to type er or gas shows how absolutely delusional you are.

this whole thing reeks of elitism. you screwed up big time in med school, got pissed when you matched with a bunch of IMGs at a low-tier program, and then entered with a crap attitude. You thought, "But I'm an AMG!!! That makes me so much better than these peons!!!" When, in reality, these IMGs probably had step scores 20-30 points higher than yours, much better LORs, no red flags, and were all-around better applicants. The ONLY thing you had going for you was your AMG status. You then proceeded to piss of attendings.... fellow residents.... and even patients..... and all along the way, took no RESPONSIBILITY for your own actions.

The first thing you need to do is step back and take a look at yourself. Take some damn responsibility, and figure out how to improve your attitude.

 

[Shikima]

I'm not exactly sure how you think getting a JD will help this guy. The law market is supersaturated and law firms are going to be as skittish about taking a residency washout as other residencies. Its also a field that focuses in on professionalism, and your progression in a firm is very much based on subjective evaluations from the partners and feedback from clients, so really the same hurdles. If you are mainly suggesting he make a career change I get that, but I'm not sure law is really the right progression given his issues.

Well, to give the guy a chance --- he could always be a lawyer fighting for VA claims?

 

[michaelrack]

x

 

[cbass1350]

Do you think someone with your interpersonal skills would be fit to become an FP?

Do you look down on certain other specialties, in comparison to your former, as inferior? and if so why?

Why do you hate Alaska?

 

[Makati2008]

I think this guy is done and rightfully so. I think his previous post indicates that his change is a farce.

 

[Law2Doc]

Well, to give the guy a chance --- he could always be a lawyer fighting for VA claims?

Only if he gets such a job. I'm saying law isn't necessarily going to be a more fruitful avenue. Even the low end law jobs. If he does do a career change, the guy really needs to find a path where professionalism isn't evaluated. Which is not an issue in most jobs, just the organized professions.

 

[asdad]

Do you think someone with your interpersonal skills would be fit to become an FP?

Do you look down on certain other specialties, in comparison to your former, as inferior? and if so why?

Why do you hate Alaska?

By "even FP", he was probably referring to its uncompetitiveness and not looking down on it. Same thing for Alaska.

 

[rokshana]

By "even FP", he was probably referring to its uncompetitiveness and not looking down on it. Same thing for Alaska.

right...because he seems to have so much respect ...dude looked down on the program that was willing to rank him and he thought he "deserves" better...

 

[DocBlin]

Here is a reason to bring back "frontal lobotomy" for the OP!!!

 

[Shikima]

Only if he gets such a job. I'm saying law isn't necessarily going to be a more fruitful avenue. Even the low end law jobs. If he does do a career change, the guy really needs to find a path where professionalism isn't evaluated. Which is not an issue in most jobs, just the organized professions.

So.... being a day trader?

 

[stuckinowhere]

wow..... I leave town for a week and this thread bursts alive. I appreciate the constructive comments here, but it seems like most of you don't think I can return to residency anywhere. So I've decided to hold off on applying this year and return to my old job for now. In the meantime, is there anything clinical I can do with my degree ? I have around 9 months of internship and I passed step 3. Can I moonlight somewhere or work in a urgent care ? Heck I'll even work at a seedy strip mall writing scripts for pain meds (plz don't slag me I need to pay the bills somehow and my day job doesn't pay much). Thanks.

 

[Law2Doc]

wow..... I leave town for a week and this thread bursts alive. I appreciate the constructive comments here, but it seems like most of you don't think I can return to residency anywhere. So I've decided to hold off on applying this year and return to my old job for now. In the meantime, is there anything clinical I can do with my degree ? I have around 9 months of internship and I passed step 3. Can I moonlight somewhere or work in a urgent care ? Heck I'll even work at a seedy strip mall writing scripts for pain meds (plz don't slag me I need to pay the bills somehow and my day job doesn't pay much). Thanks.

I think you are going to need to finish internship to be eligible for a license before you can write scripts or otherwise moonlight.

 

[Winged Scapula]

wow..... I leave town for a week and this thread bursts alive. I appreciate the constructive comments here, but it seems like most of you don't think I can return to residency anywhere. So I've decided to hold off on applying this year and return to my old job for now. In the meantime, is there anything clinical I can do with my degree ? I have around 9 months of internship and I passed step 3. Can I moonlight somewhere or work in a urgent care ? Heck I'll even work at a seedy strip mall writing scripts for pain meds (plz don't slag me I need to pay the bills somehow and my day job doesn't pay much). Thanks.

Here are the requirements by state for initial licensure.

 

[gutonc]

Here are the requirements by state for initial licensure.

Of note...there is not a single state that will license you without completing at least 1 year of residency. Looks like the USVI might take you if you take the SPEX exam first.

But honestly, a massive attitude adjustment, some serious introspection (preferably with the help of a psychoanalyst) and another shot at the Match is your only real shot at salvaging a career in medicine.

 

[Gasworks]

I'm going to go against the grain here and suggest that you do have a good chance at finding another spot but you are going to be right where you started, at a bottom of the barrel program in a horrible location where you will likely be the only AMG in the entire program. I did my prelim year in such a program and the fact of the matter is that some PD's place such value on having a US grad in the program that they will overlook ANY problems you may have with your brain.

As to everyone piling on the "jerk" bandwagon, I don't know what medicine looks like where you practice but around here 90% of the docs I work with are jerks. They screw with your reputation at meetings, they screw with your department with administration, they screw with your livelihood badmouthing you to your referring physicians and all the while shaking your hand and smiling in your face. Sounds to me like being a jerk would actually be an asset in this environment.

So please ignore all the people who tell you to go flip burgers for a living, take some time and research community programs in crap hospitals with high % IMG's and write, email or even call the PD directly and state your case. People are graduating from off shore diploma mill schools that are banned in many states and still getting residency.. unless you are a total psychopath or have face tattoos you should be able to find a spot.

 

[Law2Doc]

I'm going to go against the grain here and suggest that you do have a good chance at finding another spot but you are going to be right where you started, at a bottom of the barrel program in a horrible location where you will likely be the only AMG in the entire program. I did my prelim year in such a program and the fact of the matter is that some PD's place such value on having a US grad in the program that they will overlook ANY problems you may have with your brain.

As to everyone piling on the "jerk" bandwagon, I don't know what medicine looks like where you practice but around here 90% of the docs I work with are jerks. They screw with your reputation at meetings, they screw with your department with administration, they screw with your livelihood badmouthing you to your referring physicians and all the while shaking your hand and smiling in your face. Sounds to me like being a jerk would actually be an asset in this environment.

So please ignore all the people who tell you to go flip burgers for a living, take some time and research community programs in crap hospitals with high % IMG's and write, email or even call the PD directly and state your case. People are graduating from off shore diploma mill schools that are banned in many states and still getting residency.. unless you are a total psychopath or have face tattoos you should be able to find a spot.

A lot of times the only "jerk" out there is the guy who tells you to throw bad money after good and double down on a position you can't possibly win. Did you read OPs post? He's had concerns raised in med school and continuing into residency. He has used language suggesting that the one residency that took a gamble on him was someplace he considered beneath him, calling it a "back ups back up". And most importantly somehow none of the many issues he had were his fault -- there were always excuses. I think a lot of us weren't trying to be jerks, but save the guy an exercise in futility. If he can find a spot, bully for him. But I think a lot of us look at his history to date as the on paper equivalent of a "face tattoo".

 

[Raryn]

I'm going to go against the grain here and suggest that you do have a good chance at finding another spot but you are going to be right where you started, at a bottom of the barrel program in a horrible location where you will likely be the only AMG in the entire program. I did my prelim year in such a program and the fact of the matter is that some PD's place such value on having a US grad in the program that they will overlook ANY problems you may have with your brain.

As to everyone piling on the "jerk" bandwagon, I don't know what medicine looks like where you practice but around here 90% of the docs I work with are jerks. They screw with your reputation at meetings, they screw with your department with administration, they screw with your livelihood badmouthing you to your referring physicians and all the while shaking your hand and smiling in your face. Sounds to me like being a jerk would actually be an asset in this environment.

So please ignore all the people who tell you to go flip burgers for a living, take some time and research community programs in crap hospitals with high % IMG's and write, email or even call the PD directly and state your case. People are graduating from off shore diploma mill schools that are banned in many states and still getting residency.. unless you are a total psychopath or have face tattoos you should be able to find a spot.

The only programs left that crappy are probably the IMG mills in NY that are outside of the match. And even then, they probably wouldn't take the OP.

 

[dragonfly99]

I think if he still wants to be a doctor he doesn't have THAT much to lose by reapplying, but he needs to be able to find a couple of people to write him recommendation letters, which might be hard. Probably would be Ok to use 1 or 2 from 4th year of med school, if he can re-approach the ppl who originally wrote him a letter.
I do think that he needs to address some of the concerns of his previous program in his personal statement, because the programs are going to see that he has been an intern before.

He will not be able to get a license to practice without at least 1 year of residency.
It might be legal for him to moonlight at an urgent care place ONLY if he is under the supervision of a licensed doctor, but without personal connections (a colleague, family member, etc.) it will probably be impossible to find that type of job.

I think he needs to talk with a clinical pysch doc, counselor or psychiatrist to try to figure out why some of the interpersonal conflicts happened. He passed the board exams, etc., so he would be able to absorb the scientific stuff/knowledge base to be a doctor but there is some problem(s) between him and other ppl, in terms of how he is interacting, that he doesn't have insight into.

The post above saying that 90% of docs are jerks and saying what they do to each other, though hyperbolic, is not completely incorrect. I think it's a much lower %age than 90% but there is definitely backstabbing that goes on, both in academics and in private practice. In private practice, people do that b/c they want more referrals and probably subconsciously they want to feel they are the "best" specialist in their area. At the end of the day there are only so many referrals and so people's perception of me, and the other docs I practice with, is very important. I would not personally try to "steal" patients from other doctors or say bad things about them unless I had a good reason because I think it is unethical.

 

[MadHopsMD]

I think if he still wants to be a doctor he doesn't have THAT much to lose by reapplying, but he needs to be able to find a couple of people to write him recommendation letters, which might be hard. Probably would be Ok to use 1 or 2 from 4th year of med school, if he can re-approach the ppl who originally wrote him a letter.

If you are reapplying after leaving from a program. It is very important to get a letter from the previous program director. I have left a program also even though it was mutual in my case. Actually my previous program director volunteered to give me one.

But before that my medical school dean told me straight up -- you need a letter from a previous program director or else you are in trouble

Better you ask your program director in person to write you a favorable one (or at least non-damaging one). I think its almost a prerequisite to get it in order to match/get interviews.

 

[umean2tellme]

Overall it sounds like you screwed yourself from the very beginning. Your best bet is to make amends with your PD at the old program and pray that he shows some mercy and writes you a favorable letter. If he/she isn't on your side then you're in trouble no matter what you do because every potential program you go to will want his/her opinion of you.

 

[inep]

I think this thread has touched on something very important but hasn't really addressed it.

Most people make it through training of some sort and have a career and can support themselves. But what happens to the very small fraction who actually wash out (not most of the people who start these posts and end up finding something somewhere and moving on) but rather the statistically 1 in 300 or so who fails multiple years of medical school, fails step exams, has to keep petitioning for advancement, can't interact with patients, gets busted cheating/committing crimes and actually gets barred from completing residency? Obviously these people were either never very interested in the medical field to begin with, they can't cut it intellectually/professionally, or they have a personality that is incompatible with medicine. Maybe they are just too young and immature and could succeed at this profession in 10 years or so.

But regardless, it is "game over" and some point. There are numerous one line comments in this thread about "you are done" "it's over" etc. Well, then what? Does this person work at Wal-mart forever? Is it time to do the double-barrel inhaler? The sense of finality of these comments is concerning. What exactly are you all implying? I have known people who actually fabricated research as a resident and went through some really bad times for 5-10 years but 20 years down the road they got back on track, got licensed and became an associate professor. What actually happens to these people who screwed up so bad that nothing is possible? Surely somebody knows somebody that this has happened to. I am sure we are all curious -- where did they land?

Somebody with an MD must surely have better prospects than people who dropped out of high school. Could this person enlist in the military and be placed in a PA role, or even get a commission and due a GMO tour (from what I understand GMOs are non-internship trained). Thoughts?

 

[inep]

A lot of times the only "jerk" out there is the guy who tells you to throw bad money after good and double down on a position you can't possibly win. Did you read OPs post? He's had concerns raised in med school and continuing into residency. He has used language suggesting that the one residency that took a gamble on him was someplace he considered beneath him, calling it a "back ups back up". And most importantly somehow none of the many issues he had were his fault -- there were always excuses. I think a lot of us weren't trying to be jerks, but save the guy an exercise in futility. If he can find a spot, bully for him. But I think a lot of us look at his history to date as the on paper equivalent of a "face tattoo".

This is what I am talking about. He is now a "face tattoo"? Ok, what would be your suggestion for him now? Give up immediately and look for a minimum wage job? Go back to college and study for a totally different profession? The guy probably has huge debts and needs some direction. He also has a lot of medical knowledge regardless if he is subpar compared to his peers. Would be a shame to throw all that away and start selling cars.

 

[Law2Doc]

This is what I am talking about. He is now a "face tattoo"? Ok, what would be your suggestion for him now? Give up immediately and look for a minimum wage job? Go back to college and study for a totally different profession? The guy probably has huge debts and needs some direction. He also has a lot of medical knowledge regardless if he is subpar compared to his peers. Would be a shame to throw all that away and start selling cars.

There are literally thousands of possible job paths (just not this one). Some are better than others. Some are minimum wage and some can earn considerably more. Some require additional schooling. I don't know that a thread full of premeds/med students/residents and attendings advising someone on paths outside of medicine will be of great value -- this is more into the province of a college guidance counselor.

FWIW I don't think that he'd be throwing anything away selling cars or any other similar job where you can earn a middle class income. Taking a stab at medicine and coming up short means you found a door that's closed -- it doesn't mean you've generated something that would be "a shame to throw away". The real shame would be to thumb down a job you could do because you've invested so much toward a job you can't.

 

[Iamnotme]

I think this thread has touched on something very important but hasn't really addressed it.

Most people make it through training of some sort and have a career and can support themselves. But what happens to the very small fraction who actually wash out (not most of the people who start these posts and end up finding something somewhere and moving on) but rather the statistically 1 in 300 or so who fails multiple years of medical school, fails step exams, has to keep petitioning for advancement, can't interact with patients, gets busted cheating/committing crimes and actually gets barred from completing residency? Obviously these people were either never very interested in the medical field to begin with, they can't cut it intellectually/professionally, or they have a personality that is incompatible with medicine. Maybe they are just too young and immature and could succeed at this profession in 10 years or so.

But regardless, it is "game over" and some point. There are numerous one line comments in this thread about "you are done" "it's over" etc. Well, then what? Does this person work at Wal-mart forever? Is it time to do the double-barrel inhaler? The sense of finality of these comments is concerning. What exactly are you all implying? I have known people who actually fabricated research as a resident and went through some really bad times for 5-10 years but 20 years down the road they got back on track, got licensed and became an associate professor. What actually happens to these people who screwed up so bad that nothing is possible? Surely somebody knows somebody that this has happened to. I am sure we are all curious -- where did they land?

Somebody with an MD must surely have better prospects than people who dropped out of high school. Could this person enlist in the military and be placed in a PA role, or even get a commission and due a GMO tour (from what I understand GMOs are non-internship trained). Thoughts?

I have not read the whole thread admittedly, but I am a softie and while I certainly think that with a bad record most specialties are closed off, I think there is usually a likelihood that someone even with a poor profile can match. I think that if someone applied to something like FM/peds/psych even with a poor profile the likelihood is that they would match - certainly not at a good program, but I think it's unlikely they would not. Call me crazy, but as you are saying, I think it's kind of harsh to say hey you came all this way but no no you've had issues so now you can't practice.

Worse case scenario though, I would consider being a PA - yes you do need more training, but frequently I believe you can get some credit and it's far easier to be a PA than an MD, not to mention that the demand is high.

 

[Doctor Bob]

Could this person enlist in the military and be placed in a PA role, or even get a commission and due a GMO tour (from what I understand GMOs are non-internship trained). Thoughts?

Not feasible. For one, GMOs have all done at least an internship year; you have to be independently licensed. In order to be used as a PA in the military you have to have completed a PA training program.

 

[Shikima]

PA may not be a route to consider either due to his past "indiscretions". You have the same transparency issues in reporting - to the school, the professional society and the board of medicine.

 

[21p]

I think this fella would be a tough fit anywhere. Medicine is a 'people' business, whether you're a radiologist, surgeon, or pediatrician. You have to be able to communicate with at least your peers/patients, usually both, in order to do well in a team environment. Nearly anyone with a backbone loses face in a feud or two...

however, the word 'antisocial' comes to mind when reading the post. You may benefit from seeing a therapist, bc your post sounds like it was typed by:

 

[ruralsurg4now]

Jesus Christ, there is some bad advice being ddispensed on this thread. My personal belief is that if you do not try you will fail. Is he a tough sell with slim chances? Yeah. But since everyone gang piled on, you convinced him to not even try. Good job, SDN.

Here's the reality. If he sits out any time at all, his chances fall dramatically. You either get back in now ...or never. I mean unless he does something crazy like win a Nobel Prize.

How about apply for a prelim spot and prove you can cut it? And instead of busting on the guy, how about understanding that a program such as he described is a tough program? It's clearly a crap program that is like training in a foreign country that makes an AMG the "cultural outsider." And such programs are generally heavily dependent on high in-service scores to look at all acceptable. So anyone who scores low would get the axe.

If you're still around, OP, PM me and we'll discuss strategies. Good luck.