HELP noncontract renewal notice in April

[nrddct1]

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I'm currently finishing a PGY1 in IM in good standing. Due to a incident in Dec I was put on academic probation. Since that time I've had no incidents and have worked hard to show improvement. My pd said I made improvements, but in his words, not to the extend that he would renew my contract. I was notified at the end of April!!! I've emailed a ton of IM vs FM programs since then and only have had a handful of responses. My feeling is things are pretty bleak given the short time period. I'm trying to prepare for the worst case scenario. What can I do to live, pay bills if nothing happens between now and July?

I have a masters in clinical research management degree prior to medical school. I have not taken comlex 3 yet.

 

[DocDanny]

A little bit more about your background would help.

Are you an MD or DO?
Are you a FMG or a US Grad?

And what happened in November?

 

[nrddct1]

I'm a DO, US grad. I basically pissed off a attending in a particular incident. No harm was done to the patient. It was basically a instance where I was caught in between two attendings orders. There was miss-communication and administration got word of this and I was deemed "unsafe" From then I was put under the microscope. I'll admit, I was a slow starter and did not defend myself initially after the incident. However the past 5 months have been benign and I tried my best to correct the deficiencies that were originally pointed out to me.

 

[DocDanny]

If that's all, then how can they say you didn't improve "enough"?

Were there any other, smaller incidents? Are they concerned about your academics?

To answer your question, it sucks they are letting you go now, and for this. Unless you aren't telling us something.

I would probably spend some time doing research. Then reapply maybe? Do you consider your PD to be on your side?

 

[nrddct1]

The "smaller" incidents were prior to december. I have to say, my evaluations from particular attendings have been mediocre and inaccurate. I hate going with a consipiracy theory, but I feel that is what happened to me. I dont see a difference between how I perform during rotations compared to my peers. I also performed above average on my inservice exam...to the surprise of my pd.

I think I have been pretty naive up to this point...regarding this whole situation. For one, thinking that if I worked hard, didnt get in trouble then I would be ok. Secondly, I believed my pd would give me ample notice if he decided not to renew my contract.

 

[nrddct1]

what kind of research does everyone talk about? I'm pretty desperate for anything

 

[cowme]

I'm a DO, US grad. I basically pissed off a attending in a particular incident. No harm was done to the patient. It was basically a instance where I was caught in between two attendings orders. There was miss-communication and administration got word of this and I was deemed "unsafe" From then I was put under the microscope. I'll admit, I was a slow starter and did not defend myself initially after the incident. However the past 5 months have been benign and I tried my best to correct the deficiencies that were originally pointed out to me.

what exactly did you do to piss off the attending so much? If you did anything inappropriate or rude, I don't know if you can ever get that black mark off your record, especially if it happens right off the bat

 

[nrddct1]

To the above poster, my main goal of starting this thread is finding out what my options are for survival ie having a roof over my head and paying my bills.

 

[NotAProgDirector]

Several thoughts:

1. I do agree that it's unfortunate to be told at the end of April that you won't be renewed. The ACGME requires 4 months notice if possible. A longer notice period is not necessarly a good thing, however, as sometimes it forces a PD to non-renew an intern who might otherwise improve if given more time.

2. Looking for a new spot is complicated, because what kind of spot are you looking for? Your program has declined to promote you, so you're probably going to need to look for a PGY-1 spot. But, you may not need a full 12 months of PGY-1 work. trying to find a 3-6 month PGY-1 spot at this time of year can be difficult.

3. I would like to point out that although you may feel that your performance is equivalent to your peers, it's possible that this is part of the problem (i.e. some lack of insight into your own performance). Needless to say, this is a circular argument, and its certainly possible that you've fallen into the Problem --> closer scrutiny --> increased appreciation of minor problems that everyone has but often go unnoticed --> trouble.

 

[nrddct1]

Ok well speaking with my pd, my current program has promoted me. I am on good terms with my pd...so he says. Honestly this whole process is so confusing, degrading, humiliating my head is spinning right not.

I agree that its possible that I have lack of insight into my own performance...so I have looked to others for feedback that have worked with me personally. My chief resident, some attendings have said I perform adequately have no reservations about my clinical judgement. I am quiet and reserved and I suspect that is not the culture where I am. Speaking with my chief resident about my situation, his words to me were that "I feel that we have failed you". Now how can I have so much contradictory feedback?
It seems to me that certain attendings dont like me and subsequently gave me poor/mediocre evaluations.

To make matters more confusing, in my 'letter of good standing' my pd says "it gives me great pleasure in writing this letter for...who is intelligent and professional."

To add a last twist to my story. Prior to my PGY1 year, I completed 9 months of a traditional internship year. I voluntarily resigned that program with the intention that I wanted to complete my training at a more established institution. This has become a issue now that I am searching for smaller programs where funding is limited. So I am trapped. I honestly see this as an end to my medical career...all of this for what?

 

[residencysearch]

sorry you're in a difficult situation, i hope it gets resolved. goodluck

 

[residencysearch]

.

 

[shopsteward]

You need to do as much as you can before your current year ends to get the best possible letters, recommendations and references. Once you are out of the institution you are unlikely to get anything more: out of sight is out of mind. So anything you can get now is going to be what you will have for the future. Also, if there are resources (databases, etc.) which you have access to now but won't once you have left, make the most of them.

Use anyone in your program you can to make contacts which will lead to another program or to a new job. At this stage, personal contacts are going to be your best bet for a worthwhile position. Talk to the PD about what options he can offer you. If you have completed your year, that means that he thinks you should be able to carry on in residency, just not at his institution, so he may be willing to help.

Is there any chance your first program would take you back? Again, a personal contact there would be your best first approach, rather than an anonymous email. Also, try your medical school for whatever help they can give you.

Good luck.

 

[DocDanny]

You voluntarily quit a program?!?!?

That would narrow your options going forward from here. I do not think that program would take you back.

But it seems you got promoted. Case closed?

 

[Buzz Me]

To add a last twist to my story. Prior to my PGY1 year, I completed 9 months of a traditional internship year. I voluntarily resigned that program with the intention that I wanted to complete my training at a more established institution. This has become a issue now that I am searching for smaller programs where funding is limited. So I am trapped. I honestly see this as an end to my medical career...all of this for what?

So you started but failed to finish your first internship because you resigned? And now they're not renewing your contract after your second internship? I definitely would have sought more constructive criticism throughout this internship (just flying under the radar and assuming that if you didn't cause trouble things would be OK is a risky move). It behooves you to shine as much as possible in general, but especially so if you've already left a residency program. Did anything else happen before your previous internship, or did you match straight out of med school?

Anyway, that's all water under the bridge now. Work on obtaining the strongest letters of recommendation possible at your current program, plan on taking COMLEX 3 soon, look for a backup plan for a "gap year" - e.g. research, moonlighting, etc. If your current PD supports you that will help tremendously in obtaining a new spot, though that may be at a PGY-1 level. And I'd inquire about your CMS funding status.

Best of luck to you.

 

[dragonfly99]

You have at least 2 problems:
1) you didn't finish your first internship, for reasons that are not immediately clear to me...it just seems like bad judgment to quit an internship 2/3 through the year. Why?
I don't think you are being totally honest. Something not so good must have been going on there, or you just can't stick to things? Or you had personality conflicts with people there?
2) You got nonrenewed for PGY2 at your 2nd internship. It looks like you at least are going to get credit for your year, which is good. So in theory you could go on to PGY2.

On the plus side, it sounds like you had/have a clinical research degree. Are there any large universities nearby, and/or research institutes where you could apply for a job? I would start emailing your CV/resume now, on your days off. And have a couple of references ready (at least their names/contact info in case someone wants to phone them). Have you ever worked in research before in a hospital or in someone's lab? If so, you might be able to get a job for a year or two while you regroup.

You need to be looking around internet sites where open spots are posted. Not sure if the "paid" sites are better than just sites like SDN that often have spots posted.

I'm also not sure how many DO spots there are around, overall...not as many as allopathic spots, for sure, but also probably not as many applicants for each spot.

You did pretty well on your inservice exam and you have said that your letter from your PD says something about you being intelligent. So your program must perceive the problem as either your interpersonal relationships with other hospital staff and/or attendings, or that you haven't applied your medical knowledge well to clinical situations. The last one is hard to prove or disprove - all interns and PGY2's to some degree have a lot of knowledge gaps in terms of what they have seen or not seen, and how to apply their "book learning". The interpersonal thing to some degree you can change that because you can always change your behavior even if it feels unnatural. Do they want you to smile more, disagree/argue less, be more obseqious (?sp)? You need to try and find someone in your program and try to get them to be brutally honest about what they think some of the problems are.

 

[nrddct1]

I think you guys are miss understanding. I resigned from my traditional year under my own decision. There was under no disciplinary cause.

REASON I HAD TO RESIGN WAS BECAUSE I STARTED THAT INTERNSHIP IN OCTOBER SO I AS OFF CYCLE. I HAD THE FULL SUPPORT OF MY PD AT THAT TIME. THEY DID NOT WANT ME TO LEAVE. I FELT I WANTED TO TRAIN AT A MORE ESTABLISHED TRAINING PROGRAM. IN FACT MY PD AT THAT TIME GAVE ME GREAT REVIEWS WHICH INABLED ME TO BE ACCEPTED AT MY CURRENT PROGRAM

I am still under good terms with my traditional year pd. I contacted them and due to funding, they are not able to accommodate me.

 

[ForbiddenComma]

Several thoughts:

1. I do agree that it's unfortunate to be told at the end of April that you won't be renewed. The ACGME requires 4 months notice if possible. A longer notice period is not necessarly a good thing, however, as sometimes it forces a PD to non-renew an intern who might otherwise improve if given more time.

The ACGME is a powerless organization and may be dismissed as such. To the OP, any appeal against this decision would be a waste of time. Marshal what LORs you can from friendly attendings and look for spots online. Be careful -- I was in a similar situation once, and I had an attending attempt to give me a "trojan horse" LOR at the behest of my malignant ex-PD (i.e., she wrote a letter that was very positive so that it would be used, but she was planning to destroy me on the phone to any programs that called. I am not making this up. Yes, some people are really like that.) Make sure you can trust your LOR writers. It would be best if they do not have a close relationship with the PD.

2. Looking for a new spot is complicated, because what kind of spot are you looking for? Your program has declined to promote you, so you're probably going to need to look for a PGY-1 spot. But, you may not need a full 12 months of PGY-1 work. trying to find a 3-6 month PGY-1 spot at this time of year can be difficult.

I would call it near-impossible. The number 1, 2 and 3 things any PD looks for are what are called "red flags." Countless articles and monographs in PD and GME publications pound the point home that there is nothing worse than "red flags," and it is very unlikely a PD in your original specialty would ever feel comfortable hiring you when you have the big, huge, massive red flag of a non-renewal letter. Scores, grades, research, etc are pretty much irrelevant in the face of this red flag. In addition, it sounds likely that your PD would tell a future PD not to hire you -- and in the insular world of PDs, where the word of a fellow PD outweighs anything else, this is a near-impossible obstacle to surmount. I would suggest seeking out a different specialty, and explain away this as you not having a "good fit" in IM and your PD being upset at your looking at different specialties. That is your only long shot.

 

[nrddct1]

That really just boggles my mind that someone can be two faced like that. I'm always one that takes others for their word...still naive I guess.

Any other pieces of advice on planning for worst case scenarios?

 

[Sol Rosenberg]

The ACGME is a powerless organization and may be dismissed as such. To the OP, any appeal against this decision would be a waste of time. Marshal what LORs you can from friendly attendings and look for spots online. Be careful -- I was in a similar situation once, and I had an attending attempt to give me a "trojan horse" LOR at the behest of my malignant ex-PD (i.e., she wrote a letter that was very positive so that it would be used, but she was planning to destroy me on the phone to any programs that called. I am not making this up. Yes, some people are really like that.) Make sure you can trust your LOR writers. It would be best if they do not have a close relationship with the PD.

Wow. Just wow. I used to tell people looking for a job to always ask a person for a reference in person, because I thought most people were basically good and that they would rather make up some lame excuse not to write the LOR/give the reference or say yes and then just "not get around to it," then to expend the extra effort to say yes and then give a bad reference. What you describe above is likely illegal (if you could prove it,) but, more importantly, just plain evil.

 

[ForbiddenComma]

Wow. Just wow. I used to tell people looking for a job to always ask a person for a reference in person, because I thought most people were basically good and that they would rather make up some lame excuse not to write the LOR/give the reference or say yes and then just "not get around to it," then to expend the extra effort to say yes and then give a bad reference. What you describe above is likely illegal (if you could prove it,) but, more importantly, just plain evil.

My experiences with this program in Las Vegas was the first time in my life that I really had to acknowledge the fact that some people just plain like to hurt other people. Yeah sure, you see it in the news and such and yeah sure, we have all been bullied and/or have been bullies on the playground but, that is far different than experiencing it first-hand from a well-respected pediatrician program director with 50+ years experience and his trusted assistant program director who went well out of her way to falsely portray herself as my friend... with apparently nothing but malice as a motive.

I still find it completely boggling.

Anyway, being able to read your LORs is good but as I have learned, is sometimes not enough. To the OP and anyone in a similar position, make sure the person writing you a positive LOR will not betray you on the phone to people who call. I was very lucky to find out beforehand the asst PD's true intentions... otherwise I'd still be unemployed to this day. It is sad and pathetic that that is how some physicians (!!!) operate but, that is the world we live in.

 

[404958]

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