I accepted a HCA offer today

[bulleface87]

Accepted an HCA residency but immediately regretting it. Is there anything I can do to get out of it? Can I cancel my position and just take a research year instead?

I would want to switch out after intern year at the latest even if that means I would have to repeat intern year at another facility.

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[MD46]

Pardon my ignorance but doesnt HCA residency still means its a residency training program which after 3 years or so allows you to practice?

Why do you want to cancel or switch out?

 

[NewYorkDoctors]

I have a friend who is attending a HCA residency in Plantation right now. sure it's a small community hospital but he tells me the census and I'm like wow that's chill.... he is a USIMG who had to scramble into this program. but he's having a good time and learning and working

plus he tells me his program's small hospital is getting a cardiology, GI, and pulmonary fellowship in the next few years (already in the works)

there is nephrology now (LOL)

https://hcahealthcaregme.com/locations/hca-florida-westside-hospital/internal-medicine-residency/

were you hoping for something other than what was advertised?

 

[NotAProgDirector]

Looking at your post history, you're a DO who applied to psych, got 10 interviews, and didn't match. Failed S1 so didn't report it, passed L1 with L2 score in the 500's.

Accepting a spot in SOAP comes with the same requirements as matching. You can't cancel the position unless some new life event in the last 12 hours has come up. And not sure that canceling anything will be of any benefit - a research year might help, but you might find you get less interviews next year.

Your best option is to go into this IM residency with a good attitude. You can look for psych PGY-2 positions, they are hard to find and word of mouth. You can start psych PGY-2 after IM PGY-1. Trying to get a "better" IM position is going to be a challenge while being in an IM PGY-1. Repeating your IM PGY-1 is misery.

Plan to complete your IM residency there. It may be much better than you expect. If it really is horrible, then you look for transfers (which are also difficult and word of mouth). Hopefully you find a niche in IM that you find fulfilling. Most IM docs don't want to care for patients with mixed psych/IM problems, so that's a possibility. Addiction care is another. Perhaps you will get lucky and find a Psych PGY-2 to transfer to. If you complete IM training and still want psych, you can look at trying to find a PGY-2 spot then also but have something to fall back upon.

 

[bulleface87]

I have a friend who is attending a HCA residency in Plantation right now. sure it's a small community hospital but he tells me the census and I'm like wow that's chill.... he is a USIMG who had to scramble into this program. but he's having a good time and learning and working

plus he tells me his program's small hospital is getting a cardiology, GI, and pulmonary fellowship in the next few years (already in the works)

there is nephrology now (LOL)

https://hcahealthcaregme.com/locations/hca-florida-westside-hospital/internal-medicine-residency/

were you hoping for something other than what was advertised?

Is it even worth doing a fellowship at an HCA program? I have heard that some places dont even hire HCA grads.

Looking at your post history, you're a DO who applied to psych, got 10 interviews, and didn't match. Failed S1 so didn't report it, passed L1 with L2 score in the 500's.

Accepting a spot in SOAP comes with the same requirements as matching. You can't cancel the position unless some new life event in the last 12 hours has come up. And not sure that canceling anything will be of any benefit - a research year might help, but you might find you get less interviews next year.

Your best option is to go into this IM residency with a good attitude. You can look for psych PGY-2 positions, they are hard to find and word of mouth. You can start psych PGY-2 after IM PGY-1. Trying to get a "better" IM position is going to be a challenge while being in an IM PGY-1. Repeating your IM PGY-1 is misery.

Plan to complete your IM residency there. It may be much better than you expect. If it really is horrible, then you look for transfers (which are also difficult and word of mouth). Hopefully you find a niche in IM that you find fulfilling. Most IM docs don't want to care for patients with mixed psych/IM problems, so that's a possibility. Addiction care is another. Perhaps you will get lucky and find a Psych PGY-2 to transfer to. If you complete IM training and still want psych, you can look at trying to find a PGY-2 spot then also but have something to fall back upon.

Could i not just triple apply to psych, IM, and FM next round and probably end up with something better than an HCA? I heard going to an HCA reduces your chances of getting a job and I just want to avoid that.

 

[NewYorkDoctors]

Is it even worth doing a fellowship at an HCA program? I have heard that some places dont even hire HCA grads.


Could i not just triple apply to psych, IM, and FM next round and probably end up with something better than an HCA? I heard going to an HCA reduces your chances of getting a job and I just want to avoid that.

depends what kind of job you want?

anyone can get a job regardless where you trained...

but if you had in your heart desire to work in X city and Y hospital system and heard from Z that they blacklist HCA, then sure i guess find some alternative above as per ProgramDirector.

 

[chessknt]

What in the world do you think is missing from this residency that would warrant rolling the dice on being unmatched? Like are you financially set and throwing your entire medical career away is worth the benefit of finding a better program?

 

[NotAProgDirector]

Is it even worth doing a fellowship at an HCA program? I have heard that some places dont even hire HCA grads.


Could i not just triple apply to psych, IM, and FM next round and probably end up with something better than an HCA? I heard going to an HCA reduces your chances of getting a job and I just want to avoid that.

First, I am not convinced that an HCA residency will somehow get you blacklisted. There are plenty of places that won't care at all. Will you be getting a job at some big academic place? Maybe not -- but probably not at other places you'd be able to get a spot. And even then, some academic places may not care.

Applying again is not as easy as you suggest:

1. Many places will not be excited about considering you for another PGY-1. You've already done one, there's no reason to do it again.
2. You'll need a letter from your current PD to apply, realistically. There's no rule as such, but many places won't consider you without it, figuring that you're trying to hide a poor performance. What exactly do you plan to tell your PD?
3. How do you plan to get enough time off to interview for three different fields, when you have a full time job? Although your residency is likely to help support you should you apply to fellowship in your PGY-3, I doubt they will be as accommodating when you're applying to get a spot that's "better".
4. Match day is mid march. Many programs give out contracts before that. If you don't sign that contract, they can start trying to fill your PGY-2 spot. If they do that and you don't match anywhere, you end up with nothing and are now scrambling to find a PGY-2 IM spot.
5. GME funding is defined by your initial field. Since you have matched into IM, that's 3 years of full funding. If you were to get a psych PGY-2 or FM PGY-1, your last year would have decreased funding. Smaller community programs may care quite a bit about this (large academic programs will likely not).

 

[dozitgetchahi]

Is it even worth doing a fellowship at an HCA program? I have heard that some places dont even hire HCA grads.


Could i not just triple apply to psych, IM, and FM next round and probably end up with something better than an HCA? I heard going to an HCA reduces your chances of getting a job and I just want to avoid that.

You need to enroll in this residency and just finish it. You aren’t exactly in a position to negotiate. I promise you that the vast, vast majority of jobs (outside of navel-gazing academia) out there just want someone who has finished training in ANY residency/fellowship. (Especially for hospitalists…they just want warm bodies.) Get your training done and get on with your career. Applying again isn’t likely to go well for you.

 

[bulleface87]

What in the world do you think is missing from this residency that would warrant rolling the dice on being unmatched? Like are you financially set and throwing your entire medical career away is worth the benefit of finding a better program?

My main concern is not getting a job at the end of residency/not being adequately trained. I have read that HCAs dont train well considering they just care about profit and money. I feel i would be at so much peace if i matched a small community hospital instead of an HCA.

 

[gutonc]

My main concern is not getting a job at the end of residency/not being adequately trained. I have read that HCAs dont train well considering they just care about profit and money. I feel i would be at so much peace if i matched a small community hospital instead of an HCA.

Your options aren't what you think they are. Your options are essentially, "be at peace with your SOAPed program" or "be at peace with not ever practicing as a physician".

Lots of residencies provide training that is adequate to meet ACGME requirements but not necessarily adequate for the full breadth of practice you'll encounter in the future. That's life. You figure it out.

I understand that you're in the throes of grief about not matching in the first place and then SOAPing into a program you think is inferior. That's normal. Take some time to grieve it, then put on your big boy/girl pants and get to work.

 

[Ubba]

Exceptional circumstances aside, SOAPing into a comprehensive program is like taking a running leap from the Titanic and just making it into the last lifeboat drifting away. You have a ticket to the upper-middle-class life. You don't gamble with that.

 

[rockstar88]

My main concern is not getting a job at the end of residency/not being adequately trained. I have read that HCAs dont train well considering they just care about profit and money. I feel i would be at so much peace if i matched a small community hospital instead of an HCA.

I think a hospital needs to have enough volume and pathology to be accredited for a residency program. You're not going to see everything in your residency. You learn even as you practice as a fellow or a hospitalist. You could always do a hospitalist fellowship if you feel your training is inadequate. Giving up a spot that you scrambled to seems like something you'd regret later. A bird in hand is worth two in the bush.

 

[NewYorkDoctors]

Exceptional circumstances aside, SOAPing into a comprehensive program is like taking a running leap from the Titanic and just making it into the last lifeboat drifting away. You have a ticket to the upper-middle-class life. You don't gamble with that.

Agreed - Like jack told fabrizio , when you got nothing , you got nothing to lose ! OP can’t be criticizing that he / she didn’t win a first class ticket next door to rose

 

[Splenda88]

What in the world do you think is missing from this residency that would warrant rolling the dice on being unmatched? Like are you financially set and throwing your entire medical career away is worth the benefit of finding a better program?

It's kind of hard for me to understand med student sometimes. OP is willing to take the chance to throw away his/her career because he/she doesn't not want to attend an HCA residency. How does that even make sense? Unbelievable!

This is something I posted in the EM forum:

The difference between getting a medical license vs. not getting one is ENORMOUS. I have seen a good friend of mine graduated from a carib school who could not get into a US residency struggled as he was working as a patient care technician making < $15/hr from 2011-2014 in NJ.

He then found a 1-yr unaccredited ACGME internship in Puerto Rico, which allowed him to get a license there after a year. Fast forward. He has been working for Indian Health Service in the mainland making 200k+/yr plus 25k/yr student loan payment. He is already a millionaire in less than 10 yrs.

That is the difference between having ANY medical license vs. not having one.

 

[NewYorkDoctors]

It's kind of hard for me to understand med student sometimes. OP is willing to take the chance to throw away his/her career because he/she doesn't not want to attend an HCA residency. How does that even make sense? Unbelievable!

This is something I posted in the EM forum:

The difference between getting a medical license vs. not getting one is ENORMOUS. I have seen a good friend of mine graduated from a carib school who could not get into a US residency struggled as he was working as a patient care technician making < $15/hr from 2011-2014 in NJ.

He then found a 1-yr unaccredited ACGME internship in Puerto Rico, which allowed him to get a license there after a year. Fast forward. He has been working for Indian Health Service in the mainland making 200k+/yr plus 25k/yr student loan payment. He is already a millionaire in less than 10 yrs.

That is the difference between having ANY medical license vs. not having one.

nice

think about being a pro athlete

EVERYONE wants to be a pro athlete

sure an offensive lineman does not make maholmes money

sure a 12th man does not make lebron money

but way better than most of the population and you can always climb the ladder no matter how far low the rung you start

the key is to "get a foot into the door."


can't dream about being the next jordan, lebron brady maholmes withotu first getting through high school and collelge.

 

[bulleface87]

Thank you everyone, I appreciate your advice. I will move forward with a positive mindset and try to make the best of my experience.

 

[collegestud2013]

Accepted an HCA residency but immediately regretting it. Is there anything I can do to get out of it? Can I cancel my position and just take a research year instead?

I would want to switch out after intern year at the latest even if that means I would have to repeat intern year at another facility.

As others have said, would take the HCA residency spot for now. Your best shot at transferring out of the program based on ACGME transfer rules is between PGY1 and PGY2 years. You may be able to transfer int a Psych program if that's what you would still like to do at that point, though those spots are very few and in between. If your goal is to transfer to a more reputable IM program, it's also theoretically possible but difficult given your status as a DO and having failed Step 1. The 2 main potential reasons to transfer out of the HCA program after PGY1 year would be 1) the program is extremely malignant 2) you want to do competitive IM fellowship (in which case it will be very difficult in your situation regardless).

Your prospect at getting most community jobs afterwards should not be significantly hindered just because you came from a "no name" HCA community hospital, unless it is in a competitive location. However, yes some academic positions may look down upon it.

 

[bulleface87]

As others have said, would take the HCA residency spot for now. Your best shot at transferring out of the program based on ACGME transfer rules is between PGY1 and PGY2 years. You may be able to transfer int a Psych program if that's what you would still like to do at that point, though those spots are very few and in between. If your goal is to transfer to a more reputable IM program, it's also theoretically possible but difficult given your status as a DO and having failed Step 1. The 2 main potential reasons to transfer out of the HCA program after PGY1 year would be 1) the program is extremely malignant 2) you want to do competitive IM fellowship (in which case it will be very difficult in your situation regardless).

Your prospect at getting most community jobs afterwards should not be significantly hindered just because you came from a "no name" HCA community hospital, unless it is in a competitive location. However, yes some academic positions may look down upon it.

What would be the chances of getting into pulm/CC or heme/onc with comlex only after doing a residency through HCA? My program has both in house.

 

[scoopdaboop]

What would be the chances of getting into pulm/CC or heme/onc with comlex only after doing a residency through HCA? My program has both in house.

Your chances are exponentially higher in house than out of house.

 

[dozitgetchahi]

What would be the chances of getting into pulm/CC or heme/onc with comlex only after doing a residency through HCA? My program has both in house.

If your program has both of those fellowships in house, then it’s not nearly as bad as you think. Chances at those fellowships will be much easier for you to get into.

 

[hotsaws]

What would be the chances of getting into pulm/CC or heme/onc with comlex only after doing a residency through HCA? My program has both in house.

There is a ton of information available on these forums and some data available through the NRMP if you want to sort of put some odds to it. In house is always going to be your best bet if you're a good resident. If you're hard working, reliable, and easy to get along with, then inhouse is much more likely to stick with a known commodity rather than outside people just because they outrank you on paper. Otherwise, getting into any fellowship is similar to getting into residency. I imagine not having USMLE scores will be a big obstacle since this is still a primary metric in ranking applicants. PDs will also look at how you performed in med school and residency, where you went to school and residency, letters of rec, and research. No use dwelling on the things you can't change. So, focus on being the best resident possible and pursuing research endeavors. If there's nothing going on at the hospital you train at, I hope there's an academic institution in your area. If there is, do all you can to get involved. Hey, worst case, you still finish as an internist and there are plenty of opportunities to make a good living any where in the country with that skill set.

My understanding of HCA programs and hospitals is that there's wide variability. My wife was an attending at a big HCA hospital and it was a large, busy hospital...although not a level 1 trauma. If you're doing IM in a hospital like that, I'm sure there's plenty of pathology and acuity to learn on. If you're at some smaller suburban hospital babysitting hip fractures and admitting acute pathology that dispos in 2 days, then your training, especially for something like pulm/cc or heme/onc, is probably subpar. It also depends on attendings. These HCA and other corporate type places are just starting programs where the attendings don't even want it (or at least a majority don't). My wife is currently at a place that is starting an EM residency and the majority of docs don't want anything to do with training residents. They don't want it interrupting their work flow and they don't want to be teaching attendings. I hope you're at a place where you have attendings that are motivated to teach residents.

 

[Lexdiamondz]

What would be the chances of getting into pulm/CC or heme/onc with comlex only after doing a residency through HCA? My program has both in house.

Dude, you have a board exam failure and had to SOAP into an HCA residency.

Count your blessings that you will already be on the road to a well-compensated career in medicine. Worry about matching competitive subspecialties for fellowship later.

 

[AlbinoHawk DO]

Accepted an HCA residency but immediately regretting it. Is there anything I can do to get out of it? Can I cancel my position and just take a research year instead?

I would want to switch out after intern year at the latest even if that means I would have to repeat intern year at another facility.

This would be a monumental mistake. You want to throw away a training position to maybe get another training position, or you want to repeat a year for no good reason. How about trying to be an adult and dealing with it? For all we know, this is a good training position. Believe it or not, not every HCA is a hellhole where they'll enslave you to your death

 

[AlbinoHawk DO]

What would be the chances of getting into pulm/CC or heme/onc with comlex only after doing a residency through HCA? My program has both in house.

Probably low. As low as if you turned down this training position and re-applied or transferred. You're not a candidate that would be highly sought after. You seem to have gotten over being psych rather quickly, so you'll get over not being pulm or heme/onc just as quickly too

 

[NewYorkDoctors]

dont put the poster down so hard.

i have known terrible med student who failed Step 1 (191 in 2009) and then ended up being an interventional cardiologist with "8 specialties."

Heart Doctor in Orlando | Heart Specialist Winter Park, FL | Dr. Sharma

Raghav Sharma, MD, is an established pillar in the cardiology field and he specializes in Interventional and Endovascular Cardiology in Winter Park, FL.

www.heartwellcardiology.com

This person had a lot of family connections and was made chief resident PGY4 despite abysmal IM attending reviews. this person stayed in house for cardiology fellowship (no choice the cards program had to take the chief residents from the IM program here) and then went around the hospital at night mocking the ED doctors and ICU doctors with "you guy's cant do echos or read EKGs." lol.

i digress.

but if the OP works hard in residency, tries to get some case manuscripts published as a case report, case series, (not just ATs abstracts posters), some narrative review with the guidance of the PCCM faculty in the program... possibly have to work as a hospitalist for a year or two making more connections... applying for the IMG friendly (this OP is DO so not really IMG but HCA is an IMG tiered residency program I believe) pulmonary 2 yaer programs to start... then anything is possible

like that drake song... started from the bottom... so on so forth

 

[dozitgetchahi]

dont put the poster down so hard.

i have known terrible med student who failed Step 1 (191 in 2009) and then ended up being an interventional cardiologist with "8 specialties."

Heart Doctor in Orlando | Heart Specialist Winter Park, FL | Dr. Sharma

Raghav Sharma, MD, is an established pillar in the cardiology field and he specializes in Interventional and Endovascular Cardiology in Winter Park, FL.

www.heartwellcardiology.com

This person had a lot of family connections and was made chief resident PGY4 despite abysmal IM attending reviews. this person stayed in house for cardiology fellowship (no choice the cards program had to take the chief residents from the IM program here) and then went around the hospital at night mocking the ED doctors and ICU doctors with "you guy's cant do echos or read EKGs." lol.

i digress.

but if the OP works hard in residency, tries to get some case manuscripts published as a case report, case series, (not just ATs abstracts posters), some narrative review with the guidance of the PCCM faculty in the program... possibly have to work as a hospitalist for a year or two making more connections... applying for the IMG friendly (this OP is DO so not really IMG but HCA is an IMG tiered residency program I believe) pulmonary 2 yaer programs to start... then anything is possible

like that drake song... started from the bottom... so on so forth

I agree. It definitely happens.

Plus, the residency game is a bit different from med school. There are people who excel at one and not the other.

 

[hotsaws]

dont put the poster down so hard.

i have known terrible med student who failed Step 1 (191 in 2009) and then ended up being an interventional cardiologist with "8 specialties."

Heart Doctor in Orlando | Heart Specialist Winter Park, FL | Dr. Sharma

Raghav Sharma, MD, is an established pillar in the cardiology field and he specializes in Interventional and Endovascular Cardiology in Winter Park, FL.

www.heartwellcardiology.com

This person had a lot of family connections and was made chief resident PGY4 despite abysmal IM attending reviews. this person stayed in house for cardiology fellowship (no choice the cards program had to take the chief residents from the IM program here) and then went around the hospital at night mocking the ED doctors and ICU doctors with "you guy's cant do echos or read EKGs." lol.

i digress.

but if the OP works hard in residency, tries to get some case manuscripts published as a case report, case series, (not just ATs abstracts posters), some narrative review with the guidance of the PCCM faculty in the program... possibly have to work as a hospitalist for a year or two making more connections... applying for the IMG friendly (this OP is DO so not really IMG but HCA is an IMG tiered residency program I believe) pulmonary 2 yaer programs to start... then anything is possible

like that drake song... started from the bottom... so on so forth

I was going to be more harsh but I filtered mine. I'm not sure I should have. For one thing, if you're on SDN putting your stuff out there and asking for feedback, you'd benefit from honest, sometimes harsh, responses. We're not here to cheerlead and we certainly aren't doing anyone any favors by doing so. I see a few different types of posters: the humble bragger, the people genuinely looking for honest feedback to guide a decision, and the excessively panicked and/or neurotic.

The humble braggers can kick rocks, we're not impressed.

The ones looking for honest feedback can really benefit. I have students rotate with me and I will often ask them if they are fans of SDN (or if they even know about it). I tell them you need a good BS filter but there's really some valuable content. I've benefited from it since pre med days and now that I'm an attending, I try to offer my help where applicable.

...then there's the panicked and neurotic. They really need a dose of honesty and a reality check. This is one of the safest places for them to get that. If you come off terribly neurotic on this forum, then you probably come off like that in real life. It's not helping them. Some people are also just terribly uninformed, naive, or delusional (and sometimes quite arrogant/entitled, frankly). The feedback might hurt but it might prove beneficial in the long run.

 

[hotsaws]

In regard to the terrible student that is now interventional cards...yeah I knew some terrible students and residents too and the fact that some of them are out there independently practicing medicine is quite terrifying. I know some people that crawled their way into a field like interventional cards and I wouldn't want them cathing my dog, let alone me or my family. I'm sure we've all trained with people that would make us real nervous if we ended up sick in some hospital and found out that was the person managing our care.

I'm curious, for all the attendings out there, how do you choose doctors for you and your family? Especially proceduralists or maybe some other serious issues? Do you look at MD/DO/IMG status, where they trained, things like AOA, research, board issues, age, or anything like that? None of these are perfect metrics by any means but I certainly look at them. I may not care as much about say my kids' general pediatrician (that's also because my wife and I are both docs and capable of double checking or researching things pretty easily in that setting) but if my mom is looking to get her knee replaced or my dad just got diagnosed with some malignancy... I'm doing what I can to find the best available (which includes obviously meeting the doc and applying my own intuition after a conversation). Certainly the brightest students and residents or those with the best pedigrees aren't always the best docs, be it bedside manner, actual procedural capability, or even just being thorough with care. There's also a volume issue. The IC at Mayo probably doesn't cath the sickest hearts or nearly as many of them as the guy who's been working at county for just as long. This is quite tangential and probably could have been its own thread but just a random thought I had.

 

[NewYorkDoctors]

I take care of myself since I do still practice GIM (even if I am not the one talking to the patients see my other posts) . Technically you’re not supposed to do this but I’ve never found a logical reason why not ? I suppose the allure and risk of “therapeutic inertia “ is too great when one attempts to self manage or the risk of doing excessive inappropriate therapies . But I know my limits.

As for my family members , i try to find physicians that have a review of being receptive and open . They just need the communication side of things and I’ll read UTD and pubmed to fill in the blanks for them


as to your point to the OP of this thread, I hear ya. tough love is good at times

I just like to play good cop bad cop . see the entire neph is dead thread lol

 

[bulleface87]

Im fine with tough love. If it's something thats out of reach, that's fine. I was simply asking for whether I have a shot at pulm/cc or heme/onc or any other IM specialty. I know I am out for cards and GI.

 

[dozitgetchahi]

Im fine with tough love. If it's something thats out of reach, that's fine. I was simply asking for whether I have a shot at pulm/cc or heme/onc or any other IM specialty. I know I am out for cards and GI.

The answer is that it will be an uphill battle - but with those fellowships in house, the battle is a lot easier for you than it would be if you had to try to match somewhere outside your residency.

(The exception to this would be if those programs have a history of *not* taking in house contenders in favor of those from elsewhere (CCF cards, for instance, notoriously limits how many they match in house to only 1-2 a year or so).

The fact that some desirable fellowships are available in-house also means that this residency program is not nearly as bad for you as it could be. The worst community residencies (at least if you care about matching fellowships) are generally those that have zero in house fellowships.

Bottom line: you absolutely have a shot. Work hard, make a good name for yourself in the IM program, be the resident everyone respects. Maybe try to become a chief, if being a chief at your institution gives you a big leg up in matching those fellowships (sometimes it does, sometimes it doesn’t). Introduce yourself to leadership in those departments early on, try to get set up with some research there, etc etc. You can do it.

EDIT: and outside of cards, GI, pulm/CC or Heme/onc, chances are better.

Renal, ID, geri will take anyone that can fog a mirror.

Rheumatology and Endo are more competitive than before (esp rheum), but I think both are doable with effort.

Sleep, sports med etc are doable also.

 

[NewYorkDoctors]

I knew a resident FMG, went to a no name community IM residency with no fellowships in house
made connections through the cardiology attendings
did research
was not enough to get competitive cards fellowship but got the "preventative cardiology non ACGME fellowship." Did more research eventually got general cards. working on getting EP somewhere
if you want it you can get it

you may not get a glamorous manhattan ivory tower flelowship but you can definitely get it if you put in the time and effort