How Far Ahead To Let PD Know I Won't Be Back?

[Robbins]

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After some thinking, I've made the decision not to return for my third year of residency. Not on probation or in danger of getting fired or anything - but I'm at the point where going forward this is turning into negative training and I'll honestly be a better doc going forward if I bug out now than if I stick around for another year and try and memorize the whims of memorizers who don't always think far enough ahead.

So the $1,000,000 question: How far ahead of June should I let them know that I'm not going to be signing a contract?

I want it to be (1) far enough ahead to them to give them a chance to find another warm body outside the match but (2) not far enough ahead to where I could get screwed.

Already have multiple $200k+ clinical job offers.

(and no, I have no interest in seeking another residency and getting on the call, rounding, board certification hamster wheel).

 

[dmal]

If you already secured multiple job offers now then why are you worried about "getting screwed"? Is there a way your PD can influence those job offers? If not, I'd say just let the PD know ASAP if you already have a clear, definate direction of where you're going to go and what you're going to do come July.

 

[JackADeli]

...I've made the decision not to return for my third year of residency...

...How far ahead of June should I let them know that I'm not going to be signing a contract?

...Already have multiple $200k+ clinical job offers.

...I have no interest in seeking another residency...

I guess it isn't too complicated. I think first and foremost you should make sure you have a firm contract signed and completed with whereever you are going to work. As to your current place, you can arrange a meeting with PD to inform him/her at the time your re-newal contract is due. You do not need to give excessive advanced notice. You may or may not decide different as the renewal comes up. Still, you should assure you have a secure landing zone and give yourself enough time to assure significant evals have been completed before evaluators are biased by the news of your pending departure.

If you already secured multiple job offers now then why are you worried ....

I would caution you on putting too much faith in "offers". The offer means nothing, you have something when the actual contract is executed and your signing bonus is deposited. Even then, many places have a 90 day exit/contract cancel period.

 

[atsai3]

After some thinking, I've made the decision not to return for my third year of residency. Not on probation or in danger of getting fired or anything - but I'm at the point where going forward this is turning into negative training and I'll honestly be a better doc going forward if I bug out now than if I stick around for another year and try and memorize the whims of memorizers who don't always think far enough ahead.

So the $1,000,000 question: How far ahead of June should I let them know that I'm not going to be signing a contract?

I want it to be (1) far enough ahead to them to give them a chance to find another warm body outside the match but (2) not far enough ahead to where I could get screwed.

Already have multiple $200k+ clinical job offers.

(and no, I have no interest in seeking another residency and getting on the call, rounding, board certification hamster wheel).

Legally you are only obliged to tell your program director at that time you would otherwise be expected to sign your contract for next year. As I recall, typically they are just put in your mailbox around this time, and you are asked to sign it and give it back to the program coordinator.

Ethically, it would have been better to have told your program director back in October if you had known back then that you would not be back for training. October would have given your program director enough time to find a replacement of suitable quality (ie, take out advertisements, talk to other program directors, etc). And even if you didn't know 100% for sure that you would not be returning, then it would have been appropriate to at least give your program director a 'heads up' that you were thinking of not returning. Telling your program director now basically leaves your program director and your fellow residents in the lurch. Since October has come and gone, there's not really anything you can do about that now. Probably a good idea to tell your program director as soon as possible.

-AT.

 

[Coastie]

June 15th. Give em the good ole' 2 weeks.

After some thinking, I've made the decision not to return for my third year of residency. Not on probation or in danger of getting fired or anything - but I'm at the point where going forward this is turning into negative training and I'll honestly be a better doc going forward if I bug out now than if I stick around for another year and try and memorize the whims of memorizers who don't always think far enough ahead.

So the $1,000,000 question: How far ahead of June should I let them know that I'm not going to be signing a contract?

I want it to be (1) far enough ahead to them to give them a chance to find another warm body outside the match but (2) not far enough ahead to where I could get screwed.

Already have multiple $200k+ clinical job offers.

(and no, I have no interest in seeking another residency and getting on the call, rounding, board certification hamster wheel).

 

[surg]

tell him/her when you are sure you don't need the spot. Meaning a signed contract with the new position or some sort of guarantee that the new position will hire you.

The minute you tell a program you are leaving, they will start looking for your replacement. Be nice to be able to hunt for them in the spring, but your first priority should be to make sure that *you* have a job next year no matter what.

 

[nitemagi]

June 15th. Give em the good ole' 2 weeks.

Ouch. That's definitely putting them into scramble mode.

I'd say sooner the better, to give them time to find replacements. Unless you have a grudge.😎

 

[JaggerPlate]

Already have multiple $200k+ clinical job offers.

Curious, if you wouldn't mind sharing ... what field?

 

[Winged Scapula]

I agree with surg and JAD (interestingly, the two attendings posting):

do nothing until you have a SIGNED contract.

Offers aren't worth the paper they <aren't> signed on.

In addition, if these are indeed clinical medicine jobs, please read the fine print in any contract you are offered. If you are leaving residency without doing what you need to become Board Certified, please know whether this is a requirement of the job, the hospital, the insurance companies etc. I can tell you that every hospital I have privileges at requires BC by time of renewal of privileges. You'd hate to sign on and then realize that you cannot fulfill that aspect of the contract and be out a job in a couple of years. If doing a specialty that may require admitting or treating patients in hospitals or other facilities, see what their requirements are for being on staff. You may find that finishing residency is one of them.

I would also check the contract you signed last spring and see how much notice you are required to give. To be sure, few if any PDs are going to come after you if you don't fulfill that notice, but "two weeks" (as suggested above) is only going to win you enemies in the very often small world of medicine.

Bottom line: once you have a signed contract for a job, then tell your PD.

 

[WorkaholicsAnon]

I agree with surg and JAD (interestingly, the two attendings posting):

do nothing until you have a SIGNED contract.

Offers aren't worth the paper they <aren't> signed on.

In addition, if these are indeed clinical medicine jobs, please read the fine print in any contract you are offered. If you are leaving residency without doing what you need to become Board Certified, please know whether this is a requirement of the job, the hospital, the insurance companies etc. I can tell you that every hospital I have privileges at requires BC by time of renewal of privileges. You'd hate to sign on and then realize that you cannot fulfill that aspect of the contract and be out a job in a couple of years. If doing a specialty that may require admitting or treating patients in hospitals or other facilities, see what their requirements are for being on staff. You may find that finishing residency is one of them.

I would also check the contract you signed last spring and see how much notice you are required to give. To be sure, few if any PDs are going to come after you if you don't fulfill that notice, but "two weeks" (as suggested above) is only going to win you enemies in the very often small world of medicine.

Bottom line: once you have a signed contract for a job, then tell your PD.

Or just freaking hunker down and finish the ONE year you have left. Finish what you started. Why add limitations to yourself down the line? You've already gotten through most of it. It's always better to be a fully board-certified physician (or at least board ELIGIBLE) if you can make it that far. And then you wont need to constantly worry about what Winged Scapula is talking about above. Believe me, the one (1, uno) year will FLY by.

Even if you have a signed contract for one of those cushy jobs (which I'm really curious what it is--a clinical job that doesn't require board eligibility? AND pays $200k?), you can get laid off, fired, etc. You'll need the credentials. I know you're feeling burnt out--believe me I did as well at your stage and through all of PGY3. But try to think long-term.

 

[Smurfette]

Keep in mind that they need to check your references and you'll need to get credentialled. Your program WILL know once they get the phone call (they will need to verify your residency training to get you privileges, you can't avoid it). And if your program is not supportive (i.e. if you blindside them, they could be a bad reference), it can hurt your ability to get credentialled....and if you can't be credentialled, you can't be employed (many contracts will state the contract is null and void if you cannot be credentialled). As soon as you sign the contract, you'll need to let your program know because 1. it's the professional thing to do, 2. you need to tell them before they find out from someone else, 3. you can gauge the fallout and who among your faculty is supportive from a reference standpoint and 4. they have adequate time to find a replacement or adjust rotations due to your departure. Also, as WS said, review the contract closely about the BC/BE factor or residency completion requirements....

Some (most?) places will check your references before offering a final contract...best to ask them what their plan is.

 

[Apollyon]

I can tell you that every hospital I have privileges at requires BC by time of renewal of privileges.

Wow...that is tight. The hospital system with which I was associated in South Carolina was a bear with credentials, and they gave 5 years of board eligibility to get board certified (with privilege renewal annually).

 

[shopsteward]

OP, you've had a long-term plan for the last six or seven years at least, and now you've hit a tough spot in the road. It's a bad idea to make a practical decision (giving up your residency) which will have significant long-term consequences and limit your future options, based on short-term problems and emotional reasoning. (Any problem in residency is by the nature of residency a short-term one, relatively speaking.)

About the offer you have had: it's a good idea to follow the advice above about checking the contract and only giving up your residency after it is signed. But even then, please remember that the person who offered this contract is doing it for their own reasons, not to help you. And unless there are lots of similar offers around, as soon as you leave your residency you have lost the bargaining value you currently have. What will stop the offerer from trying to renegotiate the contract, or just paying you off, at some point in the future? What will you be able to do if they do that?

In the end, a good way to make a difficult decision is to do what you think you will regret the least.

 

[Winged Scapula]

Wow...that is tight. The hospital system with which I was associated in South Carolina was a bear with credentials, and they gave 5 years of board eligibility to get board certified (with privilege renewal annually).

Dues are annual but I think privilege renewing here is every two-three years, as I recall (been here 3 years, have gone through it just once). But yeah, I was suprised too...really means that non BC are going to have a hard time getting privileges here.

A friend of mine is a surgeon who never got BC and is no longer BE; she works as a surgical assist (her choice to leave practice so she could spend time with her children). A couple of hospitals will not credential her even as a surgical assist because she is no longer BE/BC.

 

[NotAProgDirector]

It used to be relatively common practice for people to complete an internship and then go get a job. Many of those who did so now are now finding it difficult to get any job at all, as everyone wants board certification. Dropping out is likely a permanent decision -- your chances of getting back into a program will not be good. It's a risky move.

 

[Robbins]

Or just freaking hunker down and finish the ONE year you have left. Finish what you started.

Appreciate the advice regarding staying; but a great many things have changed here in the past few years. Most of them for the worse, particularly in the realm of office politics, and two good years sounds better (at least on paper) than two good years and a really bad half year.

"A danger foreseen is half avoided.”

 

[turquoiseblue]

i agree with aPD that these jobs for licensed MD's are hard to come by anymore. being BE/BC should be your goal in addition to being licensed. finishing residency can't hurt anything. i am sure you'll regret not finishing the rest. after you finish then you can go for the easy jobs of a licensed physician if you want, and then if you don't like it you can always find a better one. let's say you want to do call and everything, well then you'd be stuck because it will be very difficult to find another residency program to take you back after you leave.

 

[JackADeli]

Appreciate the advice regarding staying; but a great many things have changed here in the past few years. Most of them for the worse, particularly in the realm of office politics, and two good years sounds better (at least on paper) than two good years and a really bad half year.

"A danger foreseen is half avoided."

Are you a medical student as your status lists?

It is more difficult every year for individuals to practice without BC (even if they completed residency and just didn't sit for the exam). The healthcare industry is increasing restrictions making it progressively harder as you run down the ranks from experienced BC, unexperienced BC, fresh grad BE, incomplete residency but licensed, etc... Insurance companies and organizations, especially payers are setting strict minimum standards for who they will pay (i.e. purchase a product from) and what they will pay for said product.

You should do what you want but understand you are making a CHOICE that has potential consequences many of which are reasonably forseeable. You may have a job at a place tomorrow without completing residency. But, I doubt very much it is a guaranteed 20 year contract. Healthcare admins change regularly. Business models are adjusted and evolve. You may find yourself in the next 5 years looking for a new job; only to find you are ineligible/fail to meet the professional standards of training to be employed at a new shop. At that time, you will also be deemed no longer a candidate by other residencies to complete your traing and get the missing certifications. By quitting your training early, you are surrendering much of your future choices and limiting opportunities (which shrink more each year).

...A danger foreseen is half avoided...

Interesting... I have also heard things such as "play now pay later" or "you may be failing to see the forest for the trees" or "2/3 of residency may be more the 1/2 but in the end you are still not fully trained and board certified".

Best of luck.

 

[dragonfly99]

You had better be careful, OP. If you're in a 3 year residency it is probably fp, peds or internal medicine. You won't be board eligible if you don't finish residency, and as others have already pointed out, that can really hurt you with insurance companies in the future, and a lot of hospitals would probably not credential you. A few places don't require board certification, but it seems short-sighted to limit your future options in this way. What if you end up hating this first job, and then you end up having to quit and find a new one? Many people don't stay in their first jobs postresidency (I think 40% or so are gone within a couple of years or something like that).

Perhaps the OP is saying that he/she cannot tolerate the current situation and the office politics for another year. OP may be afraid he'll be put on probation, etc. and thinks it is better to bail out before that happens. I just wonder if doing so will really allow him to dodge the problem(s). He will still need references from the program, I would think. At minimum, I wouldn't tell your program director or anyone else that you are leaving until you get a signed contract in your hand. However, I can't believe you can get a signed contract in your hand without someone checking your references at your current program.

Everyone gets irritated by residency at times. It feels like so much criticism and that people are micromanaging you. If you get on to someone's bad side, particularly the PD, that can make it even more painful. If it's truly that bad, maybe the answer is to switch programs. Otherwise, try to just suck it up and fly below the radar for the 3rd year...shouldn't be too many call months, anyway. I think quitting now could be penny wise and pound foolish.

 

[JackADeli]

...Perhaps the OP is saying that he/she cannot tolerate the current situation and the office politics for another year. OP may be afraid he'll be put on probation, etc. and thinks it is better to bail out before that happens. I just wonder if doing so will really allow him to dodge the problem(s). He will still need references from the program, I would think. At minimum, I wouldn't tell your program director or anyone else that you are leaving until you get a signed contract in your hand. However, I can't believe you can get a signed contract in your hand without someone checking your references at your current program...

I too am reading this possibility between the lines. However, I would argue, getting placed on probation but still graduation still has far more upside then down when compared to quitting residency prior to completion.

 

[Poety2]

Appreciate the advice regarding staying; but a great many things have changed here in the past few years. Most of them for the worse, particularly in the realm of office politics, and two good years sounds better (at least on paper) than two good years and a really bad half year.

"A danger foreseen is half avoided.”

This is interesting, I'm of the mindset, and forgive me for being so naive but, things DO work out as they should. So lets say for instance you're having some difficulty with the politics (I ALWAYS have difficulty with politics) what I've learned in my 3 years of medicine (+ 2 of psych!) is that if I keep my head down, be humble and fly under the radar, I have a much easier time.

You only have one year left. Your last year is NOTHING compared to the other two. If you've surpassed those, you are now on the downhill slope to BOARD ELIGIBILITY! Lets say, you feel it doesn't matter. What if, they no longer pay physicians that didn't complete residency? IE Insurance companies no longer reimburse for non-board certified/eligible care? Then you will be stuck and without any potential to earn the money you'll need to pay back loans, etc.

We're facing a lot of changes in medicine, so please just think about this before you give up. I'm a single mom of one that has completed a residency, plus a half of residency! So if I can do it, I'm sure you can to... 🙂

 

[Poety2]

I too am reading this possibility between the lines. However, I would argue, getting placed on probation but still graduation still has far more upside then down when compared to quitting residency prior to completion.

Definitely agree!

 

[BADMD]

"The days when you could just hang a shingle and start billing the government are over," Secretary Sebelius said in a briefing.

Ignoring all the other stuff you have said that I disagree with, this should give you pause. CMS is looking for reasons/ways not to pay claims. It would be a very simple requirement to require BC/BE status for Medicare/Medicaid claims and do so in the name of quality. While this would create huge issues, there would be very little political pressure to prevent such a rule change. There is a distinct possibility that such a decision could severely limit your ability to earn in the future.