How to go back and finish IM residency ?

[midwest123]

I'll try to be as succinct as possible here. Its a bit of a complicated situation.

I finished med school with mediocre scores. Got into a US IM residency in the midwest. Again, I did mediocre. I passed all my steps just barely on the first try. I think i was just waiting for residency to be over as i was already feeling burnt out with the hours halfway through year 2. I started mismanaging my time, staying up late, doing chartwork late at home, and waking up late on a few occasions... like hours late one time for an ICU rotator which is terrible (i felt bad for the other resident who had to cover and took over their shifts early to make up for it). In my 3rd year I didn't do well on the in-service exam, wasn't waking up in time to meet the quota for morning conferences. I ended up putting my name down for a morning conference i didn't attend and was terminated midway through year 3. I was honest about it and admitted it rather than lawyer up. I was also not controlling my t1dm, a1c was like 11 (not an excuse, i'm responsible for my own health).

PD was understanding but it felt like her hands were tied. She said she'll do whatever she can to help me find another spot... but i couldn't complete my 3rd year there. I'd have to complete it somewhere else. They did help me get my license though. wrote a good letter.

I ended up getting a job doing primary care in a fairly nice FQHC a few months later by a stroke of luck. Became medical director after a year. We opened a brand new facility after a year too. Commercial insurances accept me save for one. I work 35 hours a week and see 8-14 patients a day. Some mornings i don't see anyone to be honest. Have 2 FNPs working under me. Everyone i work with is nice. I make good money for what it is i guess, a bit more than some FM docs in a larger nearby city. I do like the laid back and flexible nature of the work. I like conversing with my patients and seeing how they've been. I do MAT work too and find it rewarding. I've been here 5 years with a good track record and no issues. I've made good money in business ventures and the market to supplement my income. At 34 and living pretty comfortable. i'm debt free now and just paid off a modest house.

I tried emailing around right after residency to different programs and felt dejected after not getting anywhere. I gave up on reapplying for the last couple years because it felt like reliving that nightmare all over. its depressing thinking about your failures. But after 5 years i realize i'm not getting younger and my chances go down progressively. I don't think i'd change my career path even after completing a residency. But it would be nice to get BE/BC and open up more opportunity for places i could work. I'd also like to keep patients when they switch to a better insurance. It sucks hearing "i really like you doc, i want to keep you, but how come you don't take my insurance?"

i emailed my PD again today. waiting on a response. Any pointers from the community on steps i can take to get my foot in the door or find program with an open spot ?

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[DrMetal]

I ended up getting a job doing primary care in a fairly nice FQHC a few months later by a stroke of luck. Became medical director after a year.

I'm just curious: they didn't care that you hadn't completed a residency?

 

[midwest123]

I'm just curious: they didn't care that you hadn't completed a residency?

not really. I was completely up front with them during the interview about what had happened. it raised some eyebrows. PD sent them a letter. they hired me. I was up front with the medical licensing board as well and didn't get pushback there. I was surprised too. But i guess they really needed me.

 

[xffan624]

I'll try to be as succinct as possible here. Its a bit of a complicated situation.

I finished med school with mediocre scores. Got into a US IM residency in the midwest. Again, I did mediocre. I passed all my steps just barely on the first try. I think i was just waiting for residency to be over as i was already feeling burnt out with the hours halfway through year 2. I started mismanaging my time, staying up late, doing chartwork late at home, and waking up late on a few occasions... like hours late one time for an ICU rotator which is terrible (i felt bad for the other resident who had to cover and took over their shifts early to make up for it). In my 3rd year I didn't do well on the in-service exam, wasn't waking up in time to meet the quota for morning conferences. I ended up putting my name down for a morning conference i didn't attend and was terminated midway through year 3. I was honest about it and admitted it rather than lawyer up. I was also not controlling my t1dm, a1c was like 11 (not an excuse, i'm responsible for my own health).

PD was understanding but it felt like her hands were tied. She said she'll do whatever she can to help me find another spot... but i couldn't complete my 3rd year there. I'd have to complete it somewhere else. They did help me get my license though. wrote a good letter.

I ended up getting a job doing primary care in a fairly nice FQHC a few months later by a stroke of luck. Became medical director after a year. We opened a brand new facility after a year too. Commercial insurances accept me save for one. I work 35 hours a week and see 8-14 patients a day. Some mornings i don't see anyone to be honest. Have 2 FNPs working under me. Everyone i work with is nice. I make good money for what it is i guess, a bit more than some FM docs in a larger nearby city. I do like the laid back and flexible nature of the work. I like conversing with my patients and seeing how they've been. I do MAT work too and find it rewarding. I've been here 5 years with a good track record and no issues. I've made good money in business ventures and the market to supplement my income. At 34 and living pretty comfortable. i'm debt free now and just paid off a modest house.

I tried emailing around right after residency to different programs and felt dejected after not getting anywhere. I gave up on reapplying for the last couple years because it felt like reliving that nightmare all over. its depressing thinking about your failures. But after 5 years i realize i'm not getting younger and my chances go down progressively. I don't think i'd change my career path even after completing a residency. But it would be nice to get BE/BC and open up more opportunity for places i could work. I'd also like to keep patients when they switch to a better insurance. It sucks hearing "i really like you doc, i want to keep you, but how come you don't take my insurance?"

i emailed my PD again today. waiting on a response. Any pointers from the community on steps i can take to get my foot in the door or find program with an open spot ?

What about doing a PM/Occ med residency to get board certification? You can actually get it through a shorter pathway as it would fall under the complementary pathway.

"The complementary pathway is designed to accommodate physicians who wish to make a mid-career shift into the practice of the specialty. In order to qualify through this pathway, physicians must complete two or more years of training in a clinical residency program. They must also complete one year with an ACGME-accredited residency program in which certification is being sought."

 

[hallowmann]

If you like your work and plan to stay in it, other than board certification, I'm not sure what else you'd be getting from completion of residency after doing 2.5 yrs of GME already and working all this time.

That said, even if you're on the fence, it doesn't hurt to apply for advanced positions/open spots and see what you can get. I'm not sure I would try super hard trying to "pad" your resume as it's already probably as solid as it can be. The only thing I might do is try to network with academic faculty in training programs around the area. Best case scenario is you get back into your previous residency, but you're already working on that.

I'd also second the Prev Med/Occ Med option.

 

[midwest123]

If you like your work and plan to stay in it, other than board certification, I'm not sure what else you'd be getting from completion of residency after doing 2.5 yrs of GME already and working all this time.

That said, even if you're on the fence, it doesn't hurt to apply for advanced positions/open spots and see what you can get. I'm not sure I would try super hard trying to "pad" your resume as it's already probably as solid as it can be. The only thing I might do is try to network with academic faculty in training programs around the area. Best case scenario is you get back into your previous residency, but you're already working on that.

I'd also second the Prev Med/Occ Med option.

in terms of what i'd be getting i guess i'd just want the flexibility having options. For primary care doubt any really nice hospital / clinic would hire a PCP who is not BE or didn't finish residency. But I could be wrong. I know the laws on this very state to state. Part of it is ego too... i still view my residency as a failure and i want to correct it and make it right.

I would like to get back to my previous residency but when i left they said i couldn't complete it there, i'd have to go somewhere else. But people can change their mind.

The PM/OM route seems very interesting. I've never heard of it. From what i understand with the complementary pathway I would need to submit documents, then take an exam ? Seems i've already missed the exam deadline this year though.

 

[wholeheartedly]

in terms of what i'd be getting i guess i'd just want the flexibility having options. For primary care doubt any really nice hospital / clinic would hire a PCP who is not BE or didn't finish residency. But I could be wrong. I know the laws on this very state to state. Part of it is ego too... i still view my residency as a failure and i want to correct it and make it right.

I would like to get back to my previous residency but when i left they said i couldn't complete it there, i'd have to go somewhere else. But people can change their mind.

The PM/OM route seems very interesting. I've never heard of it. From what i understand with the complementary pathway I would need to submit documents, then take an exam ? Seems i've already missed the exam deadline this year though.

Through your current practice have you established relationships with any physicians in your area that are affiliated with residency programs?


Are you confident that your issues from before won’t creep up again?

How many years do you have to do in the same residency program to finish? is there a requirement for IM that you have to complete x years in the same program?

 

[midwest123]

Through your current practice have you established relationships with any physicians in your area that are affiliated with residency programs?


Are you confident that your issues from before won’t creep up again?

How many years do you have to do in the same residency program to finish? is there a requirement for IM that you have to complete x years in the same program?

There aren't many other physicians in my area. Definitely none currently affiliated with academia or residency programs.
I'm confident it won't be an issue again. I realize my mistakes and have rectified them.

I just have to do 1 year. I still have my 2 years of credit i can transfer over. And it can be done anywhere. I just need to find a place to give me a spot.

Two of my friends during residency continue to work at that same hospital. both are CC attendings now. not sure if its worth reaching out to see if they have any pull. i hate putting people in that sort of position.

 

[NotAProgDirector]

Getting a new training spot in IM is going to be very difficult. Some tough love coming here, in case you need a trigger warning.

First, you're absolutely not going to get a PGY-3 spot. I realize that according to the ABIM you only need 6 more months of training, but as far as programs are considered they are not going to hire you into a PGY-3 position without being certain you're ready to supervise PGY-1 and 2 residents and they are not going to graduate you and qualify you for board certification unless they are certain that you're qualified to do so. At best, you might be able to get a PGY-2 position. But even that is questionable -- you were a marginal candidate to start, then had a marginal performance, and failed out of a training program in your PGY-3 for professionalism issues. And your current job doesn't sound all that rigorous. Are you really ready to jump back into caring for hospitalized patients? Over the weekend I admitted a patient with a pelvic abscess (after a hemi-pelvectomy for a rhabdosarcoma), a blood sugar of 600, creatinine of 3.7, Na of 154, and a WBC of 35. As a PGY-2, I'd expect you to be able to come up with an initial plan for this patient - maybe you are, but I expect after multiple years away from inpatient medicine that might be a bit daunting. People who don't know you aren't going to be excited about taking a risk on you.

So, realistically, you're probably looking at starting at the PGY-1 level again. Maybe not for a whole 12 months, so you'd need to find a program that was willing to be flexible. And you'd need to be willing to invest several years into retraining, and not end up in the same situation as prior.

As mentioned, another option is Occ Med or Preventive med. These are different residencies than IM. Both need an intern year -- which you already have. Preventive med has the complementary pathway -- you'd complete 1 year of a Preventive Med residency and then be board certified in Preventive Med. You would not be BE/BC in Internal Medicine, but it would likely open more practice options for you. Occ Med may or may not have something similar -- but even at worst it's a 2 year residency.

 

[Sushirolls]

You already have a gift that some people long for.
You are free from the BS that comes with board certification and MOC scat.
You have yourself squared away financially. You have a job that is tolerable and not scat.
You have a medical license, you have experience, you are fully capable of simply going and opening your own private practice now. DPC/concierge/cash, etc.

Healthcare any year now can go crash from government over reach. Why do you want to throw away 2 or even 3 years on residency to lower your earning potential?

These really is one of those moments, see the shiny positives of what you got. Residency is scat, why do you want to add more scat to your life?

 

[midwest123]

Getting a new training spot in IM is going to be very difficult. Some tough love coming here, in case you need a trigger warning.

I agree with you. its pretty unlikely i get the spot... but you miss 100% of the shots you don't take. I appreciate the honest feedback though. Going back to PGY-3 on the ICU shift does seem a bit daunting. I would be ok with starting as a PGY-2. I would most likely try to shadow with floor and icu teams free for 3-6 months or so at the program with a pgy-2 or 3 to get back into the swing of things. As per your example assuming the patient is stable hemodynamically i see that he is in renal failure, hypernatremic, raging infection, very dehydrated, diabetic. He needs fluids and a line, but not NS due to the sodium, which corrected is 166.. probably 1/2ns, i'd want to check a K and bhob before starting insulin drip, lactic acid, abg wouldn't hurt if he is acidodic, blood cultures, vanc/zosyn broad spectrum . q4hr labs as i dont want to send his sodium down tooo quick. surgical consult for the abscess. i'd check if he's a CHF guy to make sure i dont flood his lungs before dumping fluids. i'm sure with a few months of floors to refresh myself i could do better but thats my quick take.

You already have a gift that some people long for.
You are free from the BS that comes with board certification and MOC scat.
You have yourself squared away financially. You have a job that is tolerable and not scat.
You have a medical license, you have experience, you are fully capable of simply going and opening your own private practice now. DPC/concierge/cash, etc.

Healthcare any year now can go crash from government over reach. Why do you want to throw away 2 or even 3 years on residency to lower your earning potential?

These really is one of those moments, see the shiny positives of what you got. Residency is scat, why do you want to add more scat to your life?

good point. its better to look at the glass half full sometimes. i'm pretty lucky to be in the position i'm in despite not completing a residency. if this residency thing doesn't pan out maybe in a couple years i'll think about starting a private practice.. but that carries its own risks, headaches, and stressors when starting up.

 

[Sushirolls]

Your glass is like 90% full

 

[NotAProgDirector]

I agree with you. its pretty unlikely i get the spot... but you miss 100% of the shots you don't take. I appreciate the honest feedback though. Going back to PGY-3 on the ICU shift does seem a bit daunting. I would be ok with starting as a PGY-2. I would most likely try to shadow with floor and icu teams free for 3-6 months or so at the program with a pgy-2 or 3 to get back into the swing of things. As per your example assuming the patient is stable hemodynamically i see that he is in renal failure, hypernatremic, raging infection, very dehydrated, diabetic. He needs fluids and a line, but not NS due to the sodium, which corrected is 166.. probably 1/2ns, i'd want to check a K and bhob before starting insulin drip, lactic acid, abg wouldn't hurt if he is acidodic, blood cultures, vanc/zosyn broad spectrum . q4hr labs as i dont want to send his sodium down tooo quick. surgical consult for the abscess. i'd check if he's a CHF guy to make sure i dont flood his lungs before dumping fluids. i'm sure with a few months of floors to refresh myself i could do better but thats my quick take.

To be fair, that's a decent start of a plan. Many institutions wont let you shadow due to COVID, but you can try. If you can get a place to allow you to shadow, that might be a way to get a spot.

 

[HemeOncHopeful19]

To be fair, that's a decent start of a plan. Many institutions wont let you shadow due to COVID, but you can try. If you can get a place to allow you to shadow, that might be a way to get a spot.

I dunno, he forgot step 1 for any patient with an -oma is to call Oncology

“Hey we have ur patient here what u want us to do?”