How to approach application to Occupational Medicine residency after non-renewal

[IonClaws]

Hi everyone -

I've posted for some time on these forums on my struggles throughout Neurology residency and recently anticipated firing of some kind soon. Well, unfortunately, that suspicion was well founded and I was informed by my PD that my contract will not be renewed after my PGY-3 year. I have not been pulled from the wards and will be allowed to finish this year, so I am grateful for that, and my full medical license is also currently in process.

I have found my weaknesses tend to fall in the hospital where a ton of emergencies can happen. Unfortunately, this is where the majority of residency training in nearly all fields, Neurology included, tends to happen. The clinic seems to be more of my forte, I can sit and chat with patients and for the most part, don't need to worry about sending them to the ER.

On discussing my non-renewal, my PD did seem unhappy that I was being let go and that "he couldn't tell me how upset he was that it's come to this." I discussed Occupational Medicine with him and asked if he'd be willing to write a supportive LOR, he said he would, but that he didn't know much about the field. Not that surprising as it's a very niche field, but one that I think would be a good fit for my working style and personality. I plan on applying this coming June through ERAS and working various medical jobs to keep my family afloat in the interim, to begin July 2022.

My main question is - how do I approach this? I am avoiding re-applying to IM or Neurology because my superiors have told me directly that I would continue to have the same if not worse problems with those fields, so I doubt they'd support me applying to those. I don't want to come across to OEM residencies like "I can't cut it in anything else and your field is non-competitive and I want a good salary so here I am." I also would like advice on how to present my journey in residency in a positive light despite the obviously negative ending of non-renewal.

Thanks so much guys.

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[NotAProgDirector]

I think you'll find them very receptive to "I discovered that my strengths are in the outpatient clinic, and that the inpatient service with acute emergencies was a challenge for my skills and style".

If your current institution has Occ Med, residency or not, I'd recommend getting experience and an LOR. Your PD should let you do electives in Occ Med.

Don't discount the possibility of getting a spot in July. You have a PGY-1 done. If there's an open spot, there won't be many applicants.

If you have a preferred location, consider asking your PD to reach out to the Occ Med PD. It's all about the story. If your story is "Great in clinic, doesn't do well in emergencies", Occ Med will be happy to take you. If your story is "narcissistic nightmare", perhaps less so. But that's not you.

 

[rokshana]

Hi everyone -

I've posted for some time on these forums on my struggles throughout Neurology residency and recently anticipated firing of some kind soon. Well, unfortunately, that suspicion was well founded and I was informed by my PD that my contract will not be renewed after my PGY-3 year. I have not been pulled from the wards and will be allowed to finish this year, so I am grateful for that, and my full medical license is also currently in process.

I have found my weaknesses tend to fall in the hospital where a ton of emergencies can happen. Unfortunately, this is where the majority of residency training in nearly all fields, Neurology included, tends to happen. The clinic seems to be more of my forte, I can sit and chat with patients and for the most part, don't need to worry about sending them to the ER.

On discussing my non-renewal, my PD did seem unhappy that I was being let go and that "he couldn't tell me how upset he was that it's come to this." I discussed Occupational Medicine with him and asked if he'd be willing to write a supportive LOR, he said he would, but that he didn't know much about the field. Not that surprising as it's a very niche field, but one that I think would be a good fit for my working style and personality. I plan on applying this coming June through ERAS and working various medical jobs to keep my family afloat in the interim, to begin July 2022.

My main question is - how do I approach this? I am avoiding re-applying to IM or Neurology because my superiors have told me directly that I would continue to have the same if not worse problems with those fields, so I doubt they'd support me applying to those. I don't want to come across to OEM residencies like "I can't cut it in anything else and your field is non-competitive and I want a good salary so here I am." I also would like advice on how to present my journey in residency in a positive light despite the obviously negative ending of non-renewal.

Thanks so much guys.

So sorry to hear this!
Agree with nAPD... the approach that outpt is where your interest and strengths are will go a lo g way.

have you thought about a primary care IM or FM residency...outpt interest and strength, esp with support would help you.

 

[the argus]

So sorry to hear this!
Agree with nAPD... the approach that outpt is where your interest and strengths are will go a lo g way.

have you thought about a primary care IM or FM residency...outpt interest and strength, esp with support would help you.

Primary care IM programs have the same requirements as "traditional" IM programs in regards to inpatient and ICU service time during training. There is no distinction from the ACGME/ABIM between primary care and traditional programs, the distinction comes solely from the program itself and how it manages elective time.

If the acute care issues were so dramatic that the OP couldn't complete a neurology residency, I doubt they would sufficiently manage the higher acuity seen during an IM residency. Lots of neurologists work outpatient only, so the OP's program obviously thought they were too much of a liability to even let finish residency as a bridge to an outpatient only neurology practice.

Occupational medicine sounds like a great option for the OP. Will still get to do a significant amount of neurology related patient care. NaPD's advice is spot on in terms of how to frame the application.

 

[Dral]

Have you looked into preventive medicine residency also? I think it's less clinical exposure for the most part so if you want a lot of patient interaction, occ med would likely be a better choice.

I get where you are. I thought about neuro early in med school. I realized quickly that I was not the acute care type of person...confirmed on ICU rotation intern year which I just did not like at all...worst month ever.

I think either of those would be great (preventive or occ med). I am happy with what I do, but I always have this thought in the back of my head how I would have liked to also do preventive medicine.

You might also bridge neuro and occ med together on your app. With at least some background in neurology, I think you could spin that as a positive asset that could help you in a career in occ med.

For example:

Occupational neurology.

The nervous system is vulnerable to the effects of certain chemicals and physical conditions found in the work environment. The activities of an occupational neurologist focus on the evaluation of patients with neurological disorders caused by occupational ...

www.ncbi.nlm.nih.gov

 

[xffan624]

Hi everyone -

I've posted for some time on these forums on my struggles throughout Neurology residency and recently anticipated firing of some kind soon. Well, unfortunately, that suspicion was well founded and I was informed by my PD that my contract will not be renewed after my PGY-3 year. I have not been pulled from the wards and will be allowed to finish this year, so I am grateful for that, and my full medical license is also currently in process.

I have found my weaknesses tend to fall in the hospital where a ton of emergencies can happen. Unfortunately, this is where the majority of residency training in nearly all fields, Neurology included, tends to happen. The clinic seems to be more of my forte, I can sit and chat with patients and for the most part, don't need to worry about sending them to the ER.

On discussing my non-renewal, my PD did seem unhappy that I was being let go and that "he couldn't tell me how upset he was that it's come to this." I discussed Occupational Medicine with him and asked if he'd be willing to write a supportive LOR, he said he would, but that he didn't know much about the field. Not that surprising as it's a very niche field, but one that I think would be a good fit for my working style and personality. I plan on applying this coming June through ERAS and working various medical jobs to keep my family afloat in the interim, to begin July 2022.

My main question is - how do I approach this? I am avoiding re-applying to IM or Neurology because my superiors have told me directly that I would continue to have the same if not worse problems with those fields, so I doubt they'd support me applying to those. I don't want to come across to OEM residencies like "I can't cut it in anything else and your field is non-competitive and I want a good salary so here I am." I also would like advice on how to present my journey in residency in a positive light despite the obviously negative ending of non-renewal.

Thanks so much guys.

I'm sorry this happened. I went through something similar and transitioned to PM. I was lucky to get a spot at a PM program at the same hospital I was already doing Peds. I am 50 times happier in my current program. I would second Dral's suggestion to consider PM. My clinical experience was pretty much outpatient only. PM still has clinical options, but less so than Occ Med so depending on what you want to pursue. Right now I'm finishing up the PM residency and starting the job search.

Re: applying. Definitely follow the line that was mentioned before re: "strengths and interests". Remember many of the residents and other people interviewing you likely went through similar changes of heart so don't feel defensive about it or characterize it as a failure. You're pivoting to something that will fit you better. To stand out from other residents who may have similar stories (as PM resident I interviewed multiple residents for my program who had similar stories), you need to somehow craft an application that makes it clear that it's not just a fallback, but something you are passionate about. Rotate at Occ med in your current residency if you can and/or other public health type rotations. If you're not able to land a spot in July, then focus on doing activities that lean towards Occ Med or public health even if they just are volunteer activities such as contact tracing. Even if you not able to do too much during the months after your residency ends, you should familiarize yourself with the field and really be able to talk about the current issues. When I interviewed residents, the residents that stood out were the ones who clearly had knowledge and passion for the topics in the field.

 

[Splenda88]

Primary care IM programs have the same requirements as "traditional" IM programs in regards to inpatient and ICU service time during training. There is no distinction from the ACGME/ABIM between primary care and traditional programs, the distinction comes solely from the program itself and how it manages elective time.

If the acute care issues were so dramatic that the OP couldn't complete a neurology residency, I doubt they would sufficiently manage the higher acuity seen during an IM residency. Lots of neurologists work outpatient only, so the OP's program obviously thought they were too much of a liability to even let finish residency as a bridge to an outpatient only neurology practice.

Occupational medicine sounds like a great option for the OP. Will still get to do a significant amount of neurology related patient care. NaPD's advice is spot on in terms of how to frame the application.

I don't know too much about primary care IM, but I think FM might be a good fit for OP given that many programs don't put too much emphasis on inpatient medicine.

 

[shaggybill]

I don't know too much about primary care IM, but I think FM might be a good fit for OP given that many programs don't put too much emphasis on inpatient medicine.

This is probably true, but also a crapshoot if you are going through the match. My FM program was VERY inpatient heavy and we were unopposed so we were very busy too. If he/she happens to match at a program like mine, that would be quite unfortunate.

 

[Mass Effect]

Sorry stupid question alert -- what is preventative medicine? Like what is the day-to-day role? I know what Occ Med is, but I thought PM was part of Occ Med training and wasn't as much clinical.

OP, I commend you for your attitude. I think your insight into your skills will really play well and I agree with pushing your skills in the clinic. I might consider a PGY 2 FM program as well, but only at programs that are very outpatient heavy.

 

[Dral]

Sorry stupid question alert -- what is preventative medicine? Like what is the day-to-day role? I know what Occ Med is, but I thought PM was part of Occ Med training and wasn't as much clinical.

OP, I commend you for your attitude. I think your insight into your skills will really play well and I agree with pushing your skills in the clinic. I might consider a PGY 2 FM program as well, but only at programs that are very outpatient heavy.

What is Preventive Medicine?

The goal of Preventive Medicine is to protect, promote, and maintain health and well-being and to prevent disease, disability, and death. Learn more here.

www.acpm.org

A lot of it overlaps with public health, and as seen there, occ and aerospace med.

Day to day can vary from field work (epi type stuff for example) to desk work, to clinical work (such as the following)

I found this in a search...looks sweet on the surface:

Physician - Preventive Medicine - Executive Healthcare - New York, NY - Indeed.com

MEDPATH

www.indeed.com

Physician, Aerospace Medicine (NASA, Moscow)- Preventive Medicine & Community Health - Galveston, TX 77555 - Indeed.com

Univ. of Texas Medical Branch

www.indeed.com

Johns Hopkins Bloomberg School of Public Health

Protecting Health, Saving Lives—Millions at a Time.

www.jhsph.edu

Being in preventive medicine with focus on aerospace would be so cool with where we are now (that space hotel announced not long ago).

 

[Dave1980]

What is Preventive Medicine?

The goal of Preventive Medicine is to protect, promote, and maintain health and well-being and to prevent disease, disability, and death. Learn more here.

www.acpm.org

A lot of it overlaps with public health, and as seen there, occ and aerospace med.

Day to day can vary from field work (epi type stuff for example) to desk work, to clinical work (such as the following)

I found this in a search...looks sweet on the surface:

Physician - Preventive Medicine - Executive Healthcare - New York, NY - Indeed.com

MEDPATH

www.indeed.com

Physician, Aerospace Medicine (NASA, Moscow)- Preventive Medicine & Community Health - Galveston, TX 77555 - Indeed.com

Univ. of Texas Medical Branch

www.indeed.com

Johns Hopkins Bloomberg School of Public Health

Protecting Health, Saving Lives—Millions at a Time.

www.jhsph.edu

Being in preventive medicine with focus on aerospace would be so cool with where we are now (that space hotel announced not long ago).

What's the job market like?

 

[HemeOncHopeful19]

What's the job market like?

I can’t imagine the space hotel physician job market is too hot (Sorry I couldn’t resist).

OP I hate to see this update and hope you can figure out something that works for you.

 

[Dral]

I’m not sure of the job market. One of my med school friends did a previntive med residency and got a job right away. However, I’m not sure. Maybe someone more in the know can chime in.

 

[medready]

Not sure about job market for PM but there is a very high demand for board certified occ med docs (as long as the applicant isn't dead set of location of practice).

 

[ThoracicGuy]

Paging @fantasty

 

[Cherbourg]

OP, consider reaching out to a few Occ Med programs right now to ask about vacancies this July. Tell them you are very interested in their program and will be applying this fall, but were wondering if there are any openings for the incoming class.

If you don't secure a position for this July, there is a good chance that you can work in Occ Med this year while applying. If you can finish your PGY2 year, you should be able to get a full license and DEA number in most states. While you do that, contact some of the big Occ Med clinics wherever you're willing to live and they may be willing to hire you full time or per-diem. This would serve to give you a feel for the field and also will be something you can point to on your applications as evidence of your commitment to the specialty.

Good luck!