HELP!

[futuredo32]

I graduated residency in 2015 . I switched to what I thought was a better program after massive changes were made to my initial program . I knew my first year of psych residency I would prefer FP but listened stupidly to others who said to stay and get a second residency in FP after, I tried and failed but had planned to try next year. I failed the board exam last year and was sick this year but they are letting me take it tomorrow. I had been studying from Clive and Spiegel- last years and honestly hadn't looked at DSM 5. It has big changes and I am a slow studier so I can take the exam tomorrow knowing I will fail or not. I feel like another failure will lessen my already low chances of a second residency. I have a small private practice and it's not paying the bills. I currently take 4 insurances I just have so few patients. I will be BE until next year and if I don't pass the boards I am done for and will have nothing. I currently have a part time locums job. ALL the jobs want BC or some BC/BE. Do I take the exam tomorrow knowing I have zero chance of passing? I wanted to pass this year to show FP programs I can pass their board exam too. But I am beyond burned out, learned my hashimotos converted and that's why I have been feeling so ill, my TSH was 0.04 (seeing an endocrinologist next week). I don't know whether or not to take the board tomorrow or not. I wont pass I am positive of that. My DSM 4 psych was strong my neuro not good. My DSM 5 psych is non existent. I should have read it anyway not just for the board, I realize that............ I am burned out and a slow studier, no trying to hustle and cram today.
So a few questions
1. My comlex scores were all low passed first time. Will failing the psych board exam twice lessen my chances of matching into fp when I apply next year?

2. How do I pass the board exam next year? I did Clive and Spiegel about 7x but its not updated for DSM 5. I got BTB I didn't like it. I will go to any course. I have almost a year to study. I am a very anxious test taker.

3.If I don't get BC next year and I have a strong feelling I am stuck in psych - no offense, I liked it in med school, how am I going to work? Everyone wants BC/BE. I have no clue how many have a cash practice. I have a practice and take insurance and see 6-12 patients a week I am really fearful for my future like seeing me being homeless and jobless. I know this sounds like catastrophic thinking but it could likely happen if I don't pass next year.
Please help.

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[splik]

There was an updated Kenny and spiegel for DSM5 and I still advised people to get the old one. It is completely irrelevabt whether you know DSM-IV vs 5 you don't need to know any diagnostic criteria really and there weren't any substantial differences. There is a document that summarizes the key changes you could learn in 15mins. I don't know the DSM criteria and don't use it in my work. Unless you get your money back just take the damn exam. You don't have to tell anyone you passed or failed or took it etc.

 

[futuredo32]

I am guessing there is a spot on the FP application asking about board certification and how many times. If not it would be an interview question. I don't feel prepared

 

[TexasPhysician]

I believe a fellowship extends BE. At worst, do a 1 year fellowship in sleep, addictions, or pain. All could lead to a more rewarding career path.

If you are struggling in psych pp, FM pp is going to be much harder to achieve success.

 

[futuredo32]

I cant land a fellowship. My first PD knows I want out of psych, she would be my letter of recommendation , she wont do it for a fellowship. My PD at my second residency hated me after I reported witnessed sexual harassment that was severe, the PD was BFF with the sexually harassing attending. The sexual harasser had a history of doing this and no one ever said anything. It was severe and another resident said either I report it or she would. So, I did and he was so mean after that, threw my diploma at me and said I would never pass the board exam, Thank you but that isn't feasible

 

[dl2dp2]

You are not thinking entirely clearly right now. Not passing the boards in and of itself is actually not a huge deal. In the long run it's probably harder to get a job or start a practice in FM than psych, if similar things happened in your new residency program. Many FM programs are just as malignant if not more so than psych programs.

If you made a decision about FM, you should aim again for FM residency and figure it out with the sexual harassment stuff. If you are still questioning if you should just be a psychiatrist, that needs to be figured out first through some other means (i.e. therapy, talking to family etc).

You need to figure out what exactly happened in the last two years, with the sexual harassment, mental health related stuff, and all that stuff. From what your posting it sounds like you are obsessing over details instead of big picture career development and it's doing a number on your mental health. Since you graduated from a residency it's highly unlikely that you'll be homeless and jobless, even if you don't become BC for a period of time, and further more you have a job doing locum, and I'm assuming the performance is reasonable...this makes the mere fact of BC even less relevant. You can always chalk it up to "family reasons" for not taking the exam.

 

[futuredo32]

I don't need my own pp for FP, I will work for someone else. The locums is 8 hours a week and ends in Dec. I know I want FP its my PD who be my letter writer pressing me to take and pass the board, she knows I have performance anxiety. I am being treated by a psychiatrist who does therapy, I have issues, I am working on them. I have a great therapeutic alliance with him.
I don't think matching in FP is likely, I tried. Low scores on Comlex all of them.
I realize my thoughts are so anxiety driven and that is why I am asking for advice. I am totally panicked.
Will ABPN even let me test if I don't take it tomorrow after they extended my test date?

 

[futuredo32]

So to simplify, test tomorrow or no? I can't see me passing. Hearing it was impossible for many if they curve it big, maybe. I am weak in neuro, I had stopped studying for about 2 weeks until I learned they would let me test this year and with me I forget. I don't feel prepared. If I had known from the day I opted not to take the test MAYBE I could have passed but for me and my limited short term memory I felt like I started all over 12 days later. I studied so so hard. I have ADHD inattentive type and can normally compensate by studying harder . I have been on a prescribed psychostimulant over the summer and it has just caused anxiety. I feel like a 2nd fail on the boards would be lessening my chances for a FP residency. But at the same time it will irk my former PD who will be my letter writer. I feel like in applying for FP, one failure, meh, ok, but two? So for now I will abbreviate my question to should I or should I not take the board exam tomorrow?

 

[dl2dp2]

I don't need my own pp for FP, I will work for someone else. The locums is 8 hours a week and ends in Dec. I know I want FP its my PD who be my letter writer pressing me to take and pass the board, she knows I have performance anxiety. I am being treated by a psychiatrist who does therapy, I have issues, I am working on them. I have a great therapeutic alliance with him.
I don't think matching in FP is likely, I tried. Low scores on Comlex all of them.
I realize my thoughts are so anxiety driven and that is why I am asking for advice. I am totally panicked.
Will ABPN even let me test if I don't take it tomorrow after they extended my test date?

Okay great. Don't panic. Call ABPN and say your severity anxiety is still interfering with your test taking ability and you can get your psychiatrist to issue a letter on your behalf. No need to take the test when you are not ready. This is similar to any other medical issue that might interfere with the exam.

If you can't match in FP, then take a deep breath and look for a new locum gig, nationwide if need be. You'll find one.

Worst case scenario you can start/ramp up your own practice. This is not that easy but definitely not hard if you take insurance. I would call insurance companies to see if you are eligible to be on their lists. In that case nobody cares if you are board certified.

 

[futuredo32]

I tried to match in fp before and got the Ohio program and I applied to 30 programs. IF I am not going to get a FP residency it makes no difference if I take it and fail again. It's the impact of making it less likely to match in FP that makes me worry to
I have a slight chance of passing if I take it and it will be practice if I take it. I am just worried about how it will look to FP residencies. I haven't tried to build my pp. Havent tried to get on more insurance panels. The only thing making me question about taking it tomorrow or not is how it will impact my already low chances of getting into FP during next years cycle.

 

[TexasPhysician]

It won’t affect your FM application much. Your biggest hurdle is that applicants like yourself do not have full funding. Many institutions concerned about $ (vast majority) would take a FMG over you with no USA training. It’s a $ thing.

Passing the psych boards is mainly for your future psych career.

I also fail to see how a past PD would glowingly support a new residency vs a psych fellowship. A FM program will want to hear from your psych PD.

 

[futuredo32]

She knew year one of residency I wanted to leave psych for FP. She knows now I still want that. She would not support anything psych related but has offered to write a letter for FP. I get the money thing. I was hoping that maybe a second year spot would open, I did a TRI and a full psych residency (MD). I would gladly start as a PGY1 though. I just want a job I like.

 

[Roxas]

She knew year one of residency I wanted to leave psych for FP. She knows now I still want that. She would not support anything psych related but has offered to write a letter for FP. I get the money thing. I was hoping that maybe a second year spot would open, I did a TRI and a full psych residency (MD). I would gladly start as a PGY1 though. I just want a job I like.

I'm just curious, as a future psych applicant, what do you not like about the field?

 

[futuredo32]

I find it boring. Not enough diversity. I don't mind therapy to a degree, I like the dr patient relationship but it is not diverse enough. I am struggling with my private practice, I don't have many patients, so that doesn't help. But I miss the whole rest of medicine. I loved it during med school but I think on any rotation, the attending and residents influence your interest in a field and I had a great attending. But I had a patient suicide in residency which is so different from another death, I blame myself daily for her death and honestly to me (and no offense to the amazing psychiatrists here, I just find it boring and monotonous. Wash, rinse, repeat. So few diagnoses and meds. And I am the type of person who takes my work home with me. I just want the variety of FP and you still get to keep a Dr Patient relationship although not as close. I would prefer a clinic that allowed me to do therapy and meds but no clinic I have found will. I like the therapy the most and I definitely have issues and on one hand I think it makes me a better psychiatrist because I can relate to the patients but on the other hand, I have my own issues and taking on those of others is too much. But overall to summarize, I need more diversity of diseases, I get bored and lonely sitting in my office. I want to work in a FP clinic where I can do procedures see different types of diseases, work with medical assistants and just be more social. And, since the test is paid for, I am taking it. I will feel bad either way but just worse when I get the email saying I failed. I need new resources to study from for next year. But I am going for the Hail Mary. Thanks for all of your responses. And my psychiatrist is a psychoanalyst and I thank God for him. Psychiatrists are needed but it's not for me.