How to present this "life situation" to residency directors.

[BrokeD*&KDoc]

Here goes...

Father of 2 children, one adolescent, one preteen, married for 17 years. Two weeks into the first clinical rotation of 3rd year my wife comes to me and states that her depression is bad enough to where she is considering checking herself into a mental hospital; MDD, GAD, PTSD originally diagnosed in 2020 and started on meds. I took an LOA starting in August 2022 to help her and the kids. During this time my two children were also struggling with mental health issues and seeing a therapist individually. My wife also started taking prerequisite classes for a medical program, so I figured while she goes to class, therapy and psychiatry I can run the kids around and support her academically. Fast forward a few months, and my children and wife appear to be doing well with therapy, so I petition to return in the beginning of 2023. Go through my first rotation without issue, during my second rotation my wife comes to the realization that she wants a divorce and my youngest daughter admitted to x2 suicide attempts at 12 and 18 months ago. Take my daughter to Children's hospital and she is 5150'd to an inpatient mental health hospital. I take my second LOA and work to get my daughter the help she needs (psychiatry, psychology, developmental peds). Things appear to be stabilizing, soon to be ex-wife is working through severe abuse from childhood trauma, youngest daughter is on medication that is stabilizing her depressive episodes, both of us are living in different apartments in the same complex and my father took an early retirement to help out with my family situation. Looking to restart August 2023 so I can still graduate one class behind.

My question how I should explain two separate LOA's? Because I am NOT telling a program director this **** show. I passed USMLE/COMLEX 1 on first try. Will be applying for pathology. Any advice would help.

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[DO2015CA]

Would say medical emergency for minor child and leave the condition vague. Talk about thinking you were in the clear to restart and a relapse happened so had to address it. Stable now for X months. Timeline checks out and you are good

 

[acapnial]

I think you should probably be honest. You will definitely have to explain it and if you seem evasive or like you're hiding the reason for the LOA's it might play out very badly. And if similar issues come up in residency, it would be far better to have a program that is understanding of the situation and willing to work with you and give you support. If you need your future PD to be flexible it'll go much better if they're not totally blindsided by this.

 

[Goro]

OP, I'll leave advice for my more learned colleagues, but having a nephew with mental health issues, I not only sympathize, I empathize.

Good luck!

 

[NotAProgDirector]

I think the above advice is solid. There's no reason to go into details if you do not wish to, and I don't think it will be much of a problem.

The bigger issue you'll be facing is geography. If you were to match somewhere else for residency, would you be comfortable moving? I expect not, and imagine how difficult this would be if you were a resident, 100's of miles away, and there's a crisis. Depending upon where you're located, getting a spot in the field you want and in the location you want can be a challenge.

 

[BrokeD*&KDoc]

I think the above advice is solid. There's no reason to go into details if you do not wish to, and I don't think it will be much of a problem.

The bigger issue you'll be facing is geography. If you were to match somewhere else for residency, would you be comfortable moving? I expect not, and imagine how difficult this would be if you were a resident, 100's of miles away, and there's a crisis. Depending upon where you're located, getting a spot in the field you want and in the location you want can be a challenge.

Your advice is sound. Since my education is paid for by the Veteran's Administration, I do not have to worry about school debt. Therefore, if I am unable to match near me or my family is unable/unwilling to go with me than I will not be attending residency. I will institute plan B and teach at a community college or utilize my degree in another fashion. Becoming a pathologist is very important to me, but I cannot live away from my children.

 

[DO2015CA]

Your advice is sound. Since my education is paid for by the Veteran's Administration, I do not have to worry about school debt. Therefore, if I am unable to match near me or my family is unable/unwilling to go with me than I will not be attending residency. I will institute plan B and teach at a community college or utilize my degree in another fashion. Becoming a pathologist is very important to me, but I cannot live away from my children.

Do you currently live by a pathology residency? They aren’t just everywhere like FM/IM are.

 

[BrokeD*&KDoc]

Do you currently live by a pathology residency? They aren’t just everywhere like FM/IM are.

Northern California

 

[DO2015CA]

Northern California

You pretty much have only have davis for pathology residency programs and then there is ucsf and Stanford in the bay. Compared to FM you would have Redding, a few in sac, a couple in stockton, Modesto, Fresno, and then multiple Bay Area ones. Same with IM

 

[wysdoc]

Your advice is sound. Since my education is paid for by the Veteran's Administration, I do not have to worry about school debt. Therefore, if I am unable to match near me or my family is unable/unwilling to go with me than I will not be attending residency. I will institute plan B and teach at a community college or utilize my degree in another fashion. Becoming a pathologist is very important to me, but I cannot live away from my children.

You have the helpful situation that your dad is willing to be there for you and your children, and maybe even move with you if you need to move for residency?

 

[AlbinoHawk DO]

Your situation is not good. I think you can word things to simply say medical emergencies, but you could be asked for more details during interviews. The real problem here is that two-fold. One, it is the location you're in. While UCSF and UCD both have matched DOs, I don't think Stanford has. Second, and most important, I think that residencies will see you as a liability. You're the type of resident that may not be reliable because you could easily need more LOAs and encounter emergencies. This means attendings and residents will need to pick up the slack, schedules be modified, and you could end up needing to extend your training. In a sea of good applicants, it becomes easy to rank you lower. Your one positive is your veteran status, which most people rightfully see in a positive way. It's clear you're responsible and don't take these situations lightly

You should also consider applying to FM as backup. IM would likely be too heavy on your schedule. Most community FM programs tend to have better hours. You can always return and do pathology or simply quit after 1 year and be able to use that to get a license in another state (since CA now wants minimum 3-years for full license) and work for the Indian Health System (they accept any license)

Also, whatever you answer to your application, keep in mind it must be the same/similar to what you'll disclose to the medical board because they will ask about any LOA. Don't worry. It won't impact your licensing. It only impacts you when your LOA is forced due to behavioral problems

I sincerely wish you the best both professionally and personally

 

[Candidate2017]

Your advice is sound. Since my education is paid for by the Veteran's Administration, I do not have to worry about school debt. Therefore, if I am unable to match near me or my family is unable/unwilling to go with me than I will not be attending residency. I will institute plan B and teach at a community college or utilize my degree in another fashion.

A wise man once noted that families generally fall to the level of the lowest functioning member.

Your ex will struggle with whatever demons they grew up with, likely forever, and sets a low bar for your children to follow. Personally, I would feel an obligation to set a high bar and lead by example. That I will not let a dysfunctional spouse-parent keep me from achieving healthy relationships and professional goals.

Becoming a pathologist is very important to me, but I cannot live away from my children.

Unfortunately, where your children live will likely be up to your wife and her divorce lawyer, which you will probably be required to pay for.

 

[BrokeD*&KDoc]

I thank everyone for their input. The different perspectives help.

 

[Mad Jack]

Your advice is sound. Since my education is paid for by the Veteran's Administration, I do not have to worry about school debt. Therefore, if I am unable to match near me or my family is unable/unwilling to go with me than I will not be attending residency. I will institute plan B and teach at a community college or utilize my degree in another fashion. Becoming a pathologist is very important to me, but I cannot live away from my children.

Paid for by the VA because you're a veteran, or paid for by the VA in exchange for future service as part of the VA HPSP?

 

[BrokeD*&KDoc]

Paid for by the VA because you're a veteran, or paid for by the VA in exchange for future service as part of the VA HPSP?

Paid for because I am a veteran. No required service commitment.

 

[Adamm]

Your situation is not good. I think you can word things to simply say medical emergencies, but you could be asked for more details during interviews. The real problem here is that two-fold. One, it is the location you're in. While UCSF and UCD both have matched DOs, I don't think Stanford has. Second, and most important, I think that residencies will see you as a liability. You're the type of resident that may not be reliable because you could easily need more LOAs and encounter emergencies. This means attendings and residents will need to pick up the slack, schedules be modified, and you could end up needing to extend your training. In a sea of good applicants, it becomes easy to rank you lower. Your one positive is your veteran status, which most people rightfully see in a positive way. It's clear you're responsible and don't take these situations lightly

You should also consider applying to FM as backup. IM would likely be too heavy on your schedule. Most community FM programs tend to have better hours. You can always return and do pathology or simply quit after 1 year and be able to use that to get a license in another state (since CA now wants minimum 3-years for full license) and work for the Indian Health System (they accept any license)

Also, whatever you answer to your application, keep in mind it must be the same/similar to what you'll disclose to the medical board because they will ask about any LOA. Don't worry. It won't impact your licensing. It only impacts you when your LOA is forced due to behavioral problems

I sincerely wish you the best both professionally and personally

STANFORD has previously matched a DO in Pathology, Dr. A. Saleem. Not the average for them.

 

[BrokeD*&KDoc]

A little update...

My daughter is doing well. We found an intensive outpatient program that will take 11 years old, which was not an easy task. Between meds and therapy, we seem to be on the right track. My current LOA extends until January, so I am able to take her to all appointments and be there when she reintegrates back into traditional school. My ex-wife is also doing well and finally getting the help she needs while repairing the relationship she has with her children. I almost went through with withdrawing from school and going back to my previous line of work. Hopefully things will continue to progress in a positive direction over the next 2 years while I finish my 3rd and 4th years of medical school. While I would love to go into pathology, at this point I just want to finish my degree. I thank everyone for their input.