I failed out of residency. Is my medical career over?

[Residency_Fail]

I very unexpectedly SOAPed into FM after going to med school to do psych and only psych. Everything about the residency - the specialty, the location, the setting, region of the US, was wrong. In retrospect I should have gone unmatched. I was planning on transferring immediately (as in begin preparing day one of residency) or leaving ASAP after licensure.

A few months in, my physician parent killed himself. PGY1s are not eligible for FMLA and I could not afford unpaid leave. I became too depressed to function properly. I was very burnt out, depressed, morally injured and radiated misery everywhere I went. I could not meet the expectations under the circumstances so I was pushed to resign. I did not do anything concerning or unprofessional to lose the job. Horrible, horrible situation full of extremely difficult decisions under duress.

My lawyer says they would write a neutral letter confirming what I did or did not pass. It's more than a year of rotations in total, but I was not promoted. Passed Step 3.

I know I do not want to practice conventional medicine. If I can't do psych, I'd want to do med-spa, insurance work, etc but these positions all require licensure if not BC/BE.

* Is it possible to recover from this and get another spot elsewhere in TY or FM in a nice-ish urban-ish area? Living in a terrible location was a major mental health stressor. It doesn't have to be Disneyland - I just can't deal with drive-by shootings out my window.

* If I do 1 year of FM and pass, can I get into psych that way? What about occupational or whatever the easiest residency would be?

* Would it be remotely possible to get some or any credits for the time served?

* If none of this is possible, what do I do now career wise? I don't have any other skills or connections or degrees. Frankly I don't have anything besides the $400,000 paperweight of a medical degree. I've looked into the Associate Physician programs and those look worse than being a resident.

* Any other advice?

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[EthylMethylMan]

Were you doing well before things started going actively poorly? Do you have positive evals on your file? If you can show evidence that you were a good resident, but life events took a huge toll and led to declining performance, some place could potentially take you. Location-wise, I would not expect nice, and I’d be prepared for not even nice-ish.

Can’t comment on the rest as I’m not FM or psych.

 

[Residency_Fail]

I have a few good evaluations smattered around the residency file, which is otherwise mostly negative. I wasn't even reading my evaluations.

There was no up/down trend with residency evals because every month a FM residency has you on a very different service. Your learning in IM doesn't transfer to catching babies which doesn't transfer to Peds. The abrupt monthly transition across all the unrelated specialties was jarring and even now I don't know how everyone does this so easily.

I was fine in med school, lots of HP and H. I was a COVID student who was very gung ho about practicing psychiatry - I started residency with 2 weeks of IM experience. In total, in all of med school - 2 weeks due to all the cancellations. Transitioning to a hospitalist heavy medicine residency was very rough. I wanted to do outpatient psych with a focus on talk therapy and geared my whole 4th year to that. I don't think I did a procedure in all of medical school.

I can tolerate wrong specialty, I can tolerate not-nice***, I can tolerate 1 year (2 at most). I can't tolerate 3+ years of all of those stressors on top of regular residency stress at my age without a mental breakdown. Might it be best to do it in one of the states you get licensure after 1 year?

 

[ThoracicGuy]

I very unexpectedly SOAPed into FM after going to med school to do psych and only psych. Everything about the residency - the specialty, the location, the setting, region of the US, was wrong. In retrospect I should have gone unmatched. I was planning on transferring immediately (as in begin preparing day one of residency) or leaving ASAP after licensure.

A few months in, my physician parent killed himself. PGY1s are not eligible for FMLA and I could not afford unpaid leave. I became too depressed to function properly. I was very burnt out, depressed, morally injured and radiated misery everywhere I went. I could not meet the expectations under the circumstances so I was pushed to resign. I did not do anything concerning or unprofessional to lose the job. Horrible, horrible situation full of extremely difficult decisions under duress.

My lawyer says they would write a neutral letter confirming what I did or did not pass. It's more than a year of rotations in total, but I was not promoted. Passed Step 3.

I know I do not want to practice conventional medicine. If I can't do psych, I'd want to do med-spa, insurance work, etc but these positions all require licensure if not BC/BE.

* Is it possible to recover from this and get another spot elsewhere in TY or FM in a nice-ish urban-ish area? Living in a terrible location was a major mental health stressor. It doesn't have to be Disneyland - I just can't deal with drive-by shootings out my window.

* If I do 1 year of FM and pass, can I get into psych that way? What about occupational or whatever the easiest residency would be?

* Would it be remotely possible to get some or any credits for the time served?

* If none of this is possible, what do I do now career wise? I don't have any other skills or connections or degrees. Frankly I don't have anything besides the $400,000 paperweight of a medical degree. I've looked into the Associate Physician programs and those look worse than being a resident.

* Any other advice?

I wouldn't expect that you could be picky about a future spot should you want one. Unfortunately since you did not get full credit, you aren't a candidate for Occupational or Preventive Medicine residencies. You could potentially get a prelim year somewhere and then try for OM/PM if that fits what you are interested in doing.

I wouldn't try to get any credit for prior time served. If you didn't get full credit so you could start as a PGY2, then it doesn't really matter. You need a fresh start.

Most of the jobs out there that people do find with only partial training seem to be fairly "conventional medicine" heavy. Anything from prison medicine to wound care jobs to general practitioner. If you can get through any FM training, barring finding a Psych program that would accept you, you could always look at doing a follow up residency in Psych afterwards. Yes, its more work and it may not be something you believe you could be able to do, but it is a potential pathway.

I don't see many other good options for that $400k debt, unfortunately.

 

[EthylMethylMan]

I have a few good evaluations smattered around the residency file, which is otherwise mostly negative. I wasn't even reading my evaluations.

There was no up/down trend with residency evals because every month a FM residency has you on a very different service. Your learning in IM doesn't transfer to catching babies which doesn't transfer to Peds. The abrupt monthly transition across all the unrelated specialties was jarring and even now I don't know how everyone does this so easily.

I was fine in med school, lots of HP and H. I was a COVID student who was very gung ho about practicing psychiatry - I started residency with 2 weeks of IM experience. In total, in all of med school - 2 weeks due to all the cancellations. Transitioning to a hospitalist heavy medicine residency was very rough. I wanted to do outpatient psych with a focus on talk therapy and geared my whole 4th year to that. I don't think I did a procedure in all of medical school.

I can tolerate wrong specialty, I can tolerate not-nice***, I can tolerate 1 year (2 at most). I can't tolerate 3+ years of all of those stressors on top of regular residency stress at my age without a mental breakdown. Might it be best to do it in one of the states you get licensure after 1 year?

Yeah, that does make it tougher. You could consider becoming an assistant physician, looks like Missouri and Arkansas offer that position (BECOME AN ASSISTANT PHYSICIAN — Association of Medical Doctor Assistant Physicians). Otherwise, maybe prison medicine or Indian Health Services.

 

[mistafab]

Unfortunately, barring poor match strategy, if you didn't match in psych the first time there is basically zero chance of getting into psych. Your only realistic shot is to complete a different residency, do well, graduate, then apply for a second residency in psych. Your SOAP only into FM then failing it is a kiss of death.

Pathology may be a fair option for you. If you apply for another program, I would apply as broadly as possible.

Another route is just to apply for a TY year somewhere just so you have training under your belt that was successfully completed before applying again. If you complete a TY year I believe many states would make you eligible for a license once it is completed. That may open doors even if you don't train in a specialty after that year. Just prepare and really check the culture of the place you are applying to because academic places especially are known to beat the snot out of TY interns.

 

[Residency_Fail]

Is there anywhere or anything I should target to maximize my chances at obtaining a cushy TY? Given my personal and family mental health history I have to be careful.

 

[EthylMethylMan]

Is there anywhere or anything I should target to maximize my chances at obtaining a cushy TY? Given my personal and family mental health history I have to be careful.

If you’re gonna apply, you gotta apply to everything. It’s a long shot, and there’s a real chance that even if you applied to every TY you could that you’d still not get a spot. Unfortunately you’re not in a position to be picky.

 

[Apollyon]

Is there anywhere or anything I should target to maximize my chances at obtaining a cushy TY? Given my personal and family mental health history I have to be careful.

Dude, "cushy"? Good luck with that.

 

[Crayola227]

Yeah, that does make it tougher. You could consider becoming an assistant physician, looks like Missouri and Arkansas offer that position (BECOME AN ASSISTANT PHYSICIAN — Association of Medical Doctor Assistant Physicians). Otherwise, maybe prison medicine or Indian Health Services.

Can people do prison medicine or indian health services without at least an unrestricted license which means at least an intern year completed? I didn't think they'd take only med school grads

 

[ThoracicGuy]

Is there anywhere or anything I should target to maximize my chances at obtaining a cushy TY? Given my personal and family mental health history I have to be careful.

If you want to have a chance to complete residency, you are going to have to be open to just about anything. You won't be able to be picky at all here. You are asking for a lifeline from a program.

If you don't have a mental health resource that you are working with, it would be recommended that you do get someone.

 

[EthylMethylMan]

Can people do prison medicine or indian health services without at least an unrestricted license which means at least an intern year completed? I didn't think they'd take only med school grads

Ah shoot, you’re right, forgot OP doesn’t have a year of training.

 

[gutonc]

Is there anywhere or anything I should target to maximize my chances at obtaining a cushy TY? Given my personal and family mental health history I have to be careful.

You need to get your own personal mental health in order before you do anything else in medicine. I'm sorry to hear about your and your family member's struggles with mental health. You need to get on top of that ASAP or the rest of your life, in or out of medicine, will be very problematic.

You haven't given a complete explanation for what really happened to you or your background, so it's going to be difficult to counsel you in any meaningful way. But if you failed to match in Psych (the details here matter a lot) and then SOAPed into a truly abusive FM program in a location that makes Port au Prince seem like Disneyland (I'm going to take you at your word on this), then the likelihood of you getting any other training program at all is very, very slim.

If you want to share some more details of your CV and your application history, we can try to offer you more useful information. But based on what little you've shared so far, I have to be honest with you and say that things look bleak.

 

[Iamnew2]

I very unexpectedly SOAPed into FM after going to med school to do psych and only psych. Everything about the residency - the specialty, the location, the setting, region of the US, was wrong. In retrospect I should have gone unmatched. I was planning on transferring immediately (as in begin preparing day one of residency) or leaving ASAP after licensure.

A few months in, my physician parent killed himself. PGY1s are not eligible for FMLA and I could not afford unpaid leave. I became too depressed to function properly. I was very burnt out, depressed, morally injured and radiated misery everywhere I went. I could not meet the expectations under the circumstances so I was pushed to resign. I did not do anything concerning or unprofessional to lose the job. Horrible, horrible situation full of extremely difficult decisions under duress.

My lawyer says they would write a neutral letter confirming what I did or did not pass. It's more than a year of rotations in total, but I was not promoted. Passed Step 3.

I know I do not want to practice conventional medicine. If I can't do psych, I'd want to do med-spa, insurance work, etc but these positions all require licensure if not BC/BE.

* Is it possible to recover from this and get another spot elsewhere in TY or FM in a nice-ish urban-ish area? Living in a terrible location was a major mental health stressor. It doesn't have to be Disneyland - I just can't deal with drive-by shootings out my window.

* If I do 1 year of FM and pass, can I get into psych that way? What about occupational or whatever the easiest residency would be?

* Would it be remotely possible to get some or any credits for the time served?

* If none of this is possible, what do I do now career wise? I don't have any other skills or connections or degrees. Frankly I don't have anything besides the $400,000 paperweight of a medical degree. I've looked into the Associate Physician programs and those look worse than being a resident.

* Any other advice?

First of all I have to say I am really really sorry about what happened to you - it has to be terribly tragic and I can only imagine the terrible toll on your mental health. Are you married, have any support from family, etc? I think it's important to have some level of support somewhere.
Poor location residency wise can make things difficult for sure - I know from personal experience.
I think it might be a challenge to do psych however I do think given your background and personal history showing resiliency in pursuing this path might not be a terrible idea.
I would say be open to other options out there but I would stay away from the more competitive residencies. FM does have a lot of options though even if it's not your ideal career path - I would see if you could possibly match into a better FM program somewhere or IM or occupational health if you are able to complete a prelim somewhere.
I think it will be an uphill battle but don't think it's impossible - I have known other people who have restarted in other residencies after not succeeding in the initial one.
I do agree with gutonc though that it's important to take care of your mental health first in order not to have a repeat failure.
again I am so sorry for what happened to you and how that must have affected you.

 

[Residency_Fail]

You need to get your own personal mental health in order before you do anything else in medicine. I'm sorry to hear about your and your family member's struggles with mental health. You need to get on top of that ASAP or the rest of your life, in or out of medicine, will be very problematic.

You haven't given a complete explanation for what really happened to you or your background, so it's going to be difficult to counsel you in any meaningful way. But if you failed to match in Psych (the details here matter a lot) and then SOAPed into a truly abusive FM program in a location that makes Port au Prince seem like Disneyland (I'm going to take you at your word on this), then the likelihood of you getting any other training program at all is very, very slim.

If you want to share some more details of your CV and your application history, we can try to offer you more useful information. But based on what little you've shared so far, I have to be honest with you and say that things look bleak.

1. I applied psych across the country from where I went to med school. I am not USMD and I took a LOA 2/2 COVID. Finally, I did not do as much interview prep as I should have and I didn't stand out much. When you're a DO with a somewhat forgettable application psych is not guaranteed. I know this because there were several others doing the exact same SOAP as me sitting next to me.

2. I am not concealing anything regarding dismissal and nor is there any motive to. I received negative evaluations, was not even aware of them as I had stopped reading evals during med school, and then tried to run out the clock on intern year doing the best I could under terrible circumstances to get my license and leave. I failed a rotation and they would not let me remediate until PGY2 or later, meaning I had to continue on. Virtually all of my med school evaluations were quite positive. It was a night-and-day difference entering residency.

Depression causes apathy, malaise and disinterest. We work (and are evaluated in) a social context. Looking interested as opposed to bored and/or on the verge of crying is a huge part of we are perceived as learners and doctors. How much your patients, peers and preceptors like you is extremely important to the job - and in order for them to like you, you have to like them and want to be there. There are places people do not want to be. Appearing happy, social and well adjusted at work is not trivial when you are living your worst nightmare.

Yes, I pursued mental health treatment. It is not a panacea.

Yeah, it's horrible and the career is probably over, but please do not make insinuations that I am concealing devastating revelations like drug addiction or misconduct. My life is not that interesting and I studied and worked way too hard for that.

 

[gutonc]

Yeah, it's horrible and the career is probably over, but please do not make insinuations that I am concealing devastating revelations like drug addiction or misconduct. My life is not that interesting and I studied and worked way too hard for that.

I was not insinuating anything. I was suggesting that we didn't have the full story (which we didn't) and that sharing it might help people here counsel you (which it hopefully will).

 

[NotAProgDirector]

This additional detail is helpful.

I received negative evaluations, was not even aware of them as I had stopped reading evals during med school, and then tried to run out the clock on intern year doing the best I could under terrible circumstances to get my license and leave.

I am certain that I'm not telling you anything you don't already know, but ignoring your evaluations is an enormous problem. It's likely a manifestation of your depression also. Going into a residency program with a "I'm going to transfer out or just complete one year" mentality is also a set up for disaster.

Depression causes apathy, malaise and disinterest. We work (and are evaluated in) a social context. Looking interested as opposed to bored and/or on the verge of crying is a huge part of we are perceived as learners and doctors. How much your patients, peers and preceptors like you is extremely important to the job - and in order for them to like you, you have to like them and want to be there. There are places people do not want to be. Appearing happy, social and well adjusted at work is not trivial when you are living your worst nightmare.

All of this is true. But it probably runs deeper -- chances are that because of your depression, you simply were not doing good work. It's unlikely you were actually terminated for just not being liked.

Yeah, it's horrible and the career is probably over

You've gotten yourself into a tough spot, with no easy way forward. But it's probably not a complete dead end. You could try to find yourself a new FM PGY-1. My recommendation would be to plan to start over completely and not try to get credit for time served. You mention that you were looking for an "nice-ish urban-ish" program. You would need to look at non-competitive geo locations. You're more likely to gain some traction at a rural nice program. A suburban program might also be possible. Once you get to the urban zone, you're likely to find that the "nice" programs are out of reach. if you're going to consider this at all, you need to commit to completing all three years. If you're looking for just an intern year so you can "do something else", then you should focus on prelim IM spots. TY spots tend to be more competitive and are likely out of reach.

No matter what, you need your mental health in better shape. Internship will be busy, and it will be "traditional medicine".

Alternatively, you could try to find something to do with the training you have. As you've mentioned, it won't be easy. You'll need to forge your own path.

 

[dozitgetchahi]

This additional detail is helpful.


I am certain that I'm not telling you anything you don't already know, but ignoring your evaluations is an enormous problem. It's likely a manifestation of your depression also. Going into a residency program with a "I'm going to transfer out or just complete one year" mentality is also a set up for disaster.

All of this is true. But it probably runs deeper -- chances are that because of your depression, you simply were not doing good work. It's unlikely you were actually terminated for just not being liked.

You've gotten yourself into a tough spot, with no easy way forward. But it's probably not a complete dead end. You could try to find yourself a new FM PGY-1. My recommendation would be to plan to start over completely and not try to get credit for time served. You mention that you were looking for an "nice-ish urban-ish" program. You would need to look at non-competitive geo locations. You're more likely to gain some traction at a rural nice program. A suburban program might also be possible. Once you get to the urban zone, you're likely to find that the "nice" programs are out of reach. if you're going to consider this at all, you need to commit to completing all three years. If you're looking for just an intern year so you can "do something else", then you should focus on prelim IM spots. TY spots tend to be more competitive and are likely out of reach.

No matter what, you need your mental health in better shape. Internship will be busy, and it will be "traditional medicine".

Alternatively, you could try to find something to do with the training you have. As you've mentioned, it won't be easy. You'll need to forge your own path.

I agree with all this.

I also think that the fact that OP is a DO is an advantage in some ways. There are still lots of originally osteopathic (now mixed DO/MD, of course) programs around in specialties like IM, FM and psych. Some of these programs still have a preference for DOs, and in my experience these types of programs are more forgiving of DOs who had problems in one program but are looking to start over. (When I was a DO student, I encountered a surprising number of residents on rotations who had transferred or failed out of one program and ended up elsewhere. I clearly remember an OB resident who was on her *fourth* residency program - she had failed out of two places, and then her third residency shut down. She still found a place to finish training.)

My guess is that OP originally SOAPed into some sweatshop type “urban-ish” FM program…and then he had a typical sweatshop residency experience that ended in disaster. He may do better elsewhere, after he gets his mental health tuned up. I don’t think psych is out of the question either, especially at osteopathic psych programs that may be more sympathetic to DOs.

 

[doitalldoc]

if you did 1 year of internship, then that means you should be able to get a license as long as you complete Step 3. if you really want to do a med spa, you can sign up for medical aesthetician training like what a nurse or aesthetician would and work for a med spa clinic as a doc. at least you'll get some skills training for med spa and work as a doc. i worked w/ a physician who has a license but no board certification who found work at a med spa. she got OJT though.

 

[AlbinoHawk DO]

if you did 1 year of internship, then that means you should be able to get a license as long as you complete Step 3. if you really want to do a med spa, you can sign up for medical aesthetician training like what a nurse or aesthetician would and work for a med spa clinic as a doc. at least you'll get some skills training for med spa and work as a doc. i worked w/ a physician who has a license but no board certification who found work at a med spa. she got OJT though.

He won't be able to get a license because technically he did not "pass" the year. They might give him credit, but they aren't going to sign off on him being able to get an independent license.

OP, you need to revisit all this when you have a better frame of mind. You need to address your psych issues as obviously depression has played a big role in your inability to pass. If you don't, you'll continue down the wrong path. You're already setting yourself up for failure by saying all you want is a certain number of years or you must have a specific locations. Once you address your issues, you'll be able to see clearly that you are in a very precarious position, and that spending 3 years to become a board certified physician in any field is a small sacrifice for you to be able to dictate the rest of your career.

 

[Goro]

I was not insinuating anything. I was suggesting that we didn't have the full story (which we didn't) and that sharing it might help people here counsel you (which it hopefully will).

OP, you can use the confidential consult Forum if you are afraid of giving up too many details here.