Is it too late to back out of my fellowship?

[seelee]

I am cross posting this in the Anesthesia thread as well.

I am a PGY-4 anesthesia resident in a midwest anesthesia program. I matched into the critical care fellowship at the same program.

Background details: I am married with several children. I deliberately only ranked residency programs that offered in house moonlighting to supplement my resident salary. I only ranked my home critical care program.

For decades our program has offered moonlighting options as follows:
1. Late duty moonlighting - covering the OR from 5-9pm for $65/hr
2. ICU moonlighting (available only to senior residents and fellows) - 7p to 7a in the ICU for $75 with a post call day.

I have been one of those residents who has taken every moonlighting opportunity I could in order to support my family. I applied for the fellowship with the understanding that I would be able to continue moonlighting.

Over the last several months, the department has been steadily cutting the ICU moonlighting shifts for residents. They are hiring more NPs and PAs to cover days and making residents cover overnight for no extra pay. This has left me and several others with higher student loan payments, higher taxes and strained budgets because the shifts are gone. Now there is talk about cutting the shifts for the fellows.

I feel like the rug is being pulled out from under me. I wanted the experience and training that the fellowship could offer but the moonlighting made it financially feasible. If that goes, then I could be in real trouble moneywise.

My wife wants me to cut and run. Still, I have never backed out of an agreement.

I have not signed a contract. I did participate in the SF Match. I have tried to find what my legal responsibility is here. Am I legally obligated to fulfill my fellowship? Can the hospital sue me if I tell them I can't do it? Can they keep me from graduating or prevent me from getting licensed? Can they keep me from getting employment?

Any advice for how to handle it? I am afraid that if I even bring it up, that it will brand me as a quitter or as someone who is unreliable. Even though I have always tried to go above and beyond without complaint.

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[kemper6036]

I am cross posting this in the Anesthesia thread as well.

I am a PGY-4 anesthesia resident in a midwest anesthesia program. I matched into the critical care fellowship at the same program.

Background details: I am married with several children. I deliberately only ranked residency programs that offered in house moonlighting to supplement my resident salary. I only ranked my home critical care program.

For decades our program has offered moonlighting options as follows:
1. Late duty moonlighting - covering the OR from 5-9pm for $65/hr
2. ICU moonlighting (available only to senior residents and fellows) - 7p to 7a in the ICU for $75 with a post call day.

I have been one of those residents who has taken every moonlighting opportunity I could in order to support my family. I applied for the fellowship with the understanding that I would be able to continue moonlighting.

Over the last several months, the department has been steadily cutting the ICU moonlighting shifts for residents. They are hiring more NPs and PAs to cover days and making residents cover overnight for no extra pay. This has left me and several others with higher student loan payments, higher taxes and strained budgets because the shifts are gone. Now there is talk about cutting the shifts for the fellows.

I feel like the rug is being pulled out from under me. I wanted the experience and training that the fellowship could offer but the moonlighting made it financially feasible. If that goes, then I could be in real trouble moneywise.

My wife wants me to cut and run. Still, I have never backed out of an agreement.

I have not signed a contract. I did participate in the SF Match. I have tried to find what my legal responsibility is here. Am I legally obligated to fulfill my fellowship? Can the hospital sue me if I tell them I can't do it? Can they keep me from graduating or prevent me from getting licensed? Can they keep me from getting employment?

Any advice for how to handle it? I am afraid that if I even bring it up, that it will brand me as a quitter or as someone who is unreliable. Even though I have always tried to go above and beyond without complaint.

have you tried talking to your future PD? maybe their are some arrangements that could be made and from your description it sounds like maybe the cutting back of moonlighting opportunities is focused towards the residents. regardless, i'm a GS chief who will be starting SCC fellowship next year with a similar family situation whose spouse will not be working next year...the thought of not having that extra income whether from moonlighting or her paycheck is sobering. good luck

 

[tartesos]

I am cross posting this in the Anesthesia thread as well.

I am a PGY-4 anesthesia resident in a midwest anesthesia program. I matched into the critical care fellowship at the same program.

Background details: I am married with several children. I deliberately only ranked residency programs that offered in house moonlighting to supplement my resident salary. I only ranked my home critical care program.

For decades our program has offered moonlighting options as follows:
1. Late duty moonlighting - covering the OR from 5-9pm for $65/hr
2. ICU moonlighting (available only to senior residents and fellows) - 7p to 7a in the ICU for $75 with a post call day.

I have been one of those residents who has taken every moonlighting opportunity I could in order to support my family. I applied for the fellowship with the understanding that I would be able to continue moonlighting.

Over the last several months, the department has been steadily cutting the ICU moonlighting shifts for residents. They are hiring more NPs and PAs to cover days and making residents cover overnight for no extra pay. This has left me and several others with higher student loan payments, higher taxes and strained budgets because the shifts are gone. Now there is talk about cutting the shifts for the fellows.

I feel like the rug is being pulled out from under me. I wanted the experience and training that the fellowship could offer but the moonlighting made it financially feasible. If that goes, then I could be in real trouble moneywise.

My wife wants me to cut and run. Still, I have never backed out of an agreement.

I have not signed a contract. I did participate in the SF Match. I have tried to find what my legal responsibility is here. Am I legally obligated to fulfill my fellowship? Can the hospital sue me if I tell them I can't do it? Can they keep me from graduating or prevent me from getting licensed? Can they keep me from getting employment?

Any advice for how to handle it? I am afraid that if I even bring it up, that it will brand me as a quitter or as someone who is unreliable. Even though I have always tried to go above and beyond without complaint.

Bear in mind that violating the match, may disqualify you from participating again in the future should you want to come back and do fellowship, it may be harder to find( that's for the NRMP et al).
You can talk to your PD and be blunt, "If I can`t moonlight I cant do this", and he may be able to work something out with you( maybe if all incoming fellows get together it would have more weight and they can block some days a month for you guys?).
Bear in mind you will be a fully licensed anesthesiologist by then, you can always find something to do( program needs to know, and duty hours cant be violated and all that jazz).
No, they can`t prevent you from getting licensed, but you do not want to burn your home institution, that will handle all your future credentialing, so if you want to bail or put the cards on the table, do it with plenty of time for them to find another candidate( like now).

I am sorry you are going through this, I couldn't have done my training without moonlighting... Good luck!

 

[kemper6036]

Bear in mind that violating the match, may disqualify you from participating again in the future should you want to come back and do fellowship, it may be harder to find( that's for the NRMP et al).
You can talk to your PD and be blunt, "If I can`t moonlight I cant do this", and he may be able to work something out with you( maybe if all incoming fellows get together it would have more weight and they can block some days a month for you guys?).
Bear in mind you will be a fully licensed anesthesiologist by then, you can always find something to do( program needs to know, and duty hours cant be violated and all that jazz).
No, they can`t prevent you from getting licensed, but you do not want to burn your home institution, that will handle all your future credentialing, so if you want to bail or put the cards on the table, do it with plenty of time for them to find another candidate( like now).

I am sorry you are going through this, I couldn't have done my training without moonlighting... Good luck!

good points about being a match violator and i agree, maybe some outside moonlighting might be an option depending on your schedule

 

[Raryn]

I am cross posting this in the Anesthesia thread as well.

I am a PGY-4 anesthesia resident in a midwest anesthesia program. I matched into the critical care fellowship at the same program.

Background details: I am married with several children. I deliberately only ranked residency programs that offered in house moonlighting to supplement my resident salary. I only ranked my home critical care program.

For decades our program has offered moonlighting options as follows:
1. Late duty moonlighting - covering the OR from 5-9pm for $65/hr
2. ICU moonlighting (available only to senior residents and fellows) - 7p to 7a in the ICU for $75 with a post call day.

I have been one of those residents who has taken every moonlighting opportunity I could in order to support my family. I applied for the fellowship with the understanding that I would be able to continue moonlighting.

Over the last several months, the department has been steadily cutting the ICU moonlighting shifts for residents. They are hiring more NPs and PAs to cover days and making residents cover overnight for no extra pay. This has left me and several others with higher student loan payments, higher taxes and strained budgets because the shifts are gone. Now there is talk about cutting the shifts for the fellows.

I feel like the rug is being pulled out from under me. I wanted the experience and training that the fellowship could offer but the moonlighting made it financially feasible. If that goes, then I could be in real trouble moneywise.

My wife wants me to cut and run. Still, I have never backed out of an agreement.

I have not signed a contract. I did participate in the SF Match. I have tried to find what my legal responsibility is here. Am I legally obligated to fulfill my fellowship? Can the hospital sue me if I tell them I can't do it? Can they keep me from graduating or prevent me from getting licensed? Can they keep me from getting employment?

Any advice for how to handle it? I am afraid that if I even bring it up, that it will brand me as a quitter or as someone who is unreliable. Even though I have always tried to go above and beyond without complaint.

You could probably get at least double those hourly rates with outside moonlighting. Talk to your PD about whether this would be allowed.

 

[VentJockey]

Just tell them you ranked the program because you would be able to moonlight. If the moonlighting goes, you go. If they have a problem with it, I suggest you scorch the earth with them. I have a huge problem with any program, be it residency or fellowship, that interferes with their fully licensed residents ability to moonlight. Resident/Fellow salaries are already inadequate, and there is no reason for programs to stand in the way of their residents and fellows efforts to not live like animals. Honestly, if your program director is a decent human being he will talk to you can come up with a reasonable solution that works for everyone.

 

[Raryn]

Just tell them you ranked the program because you would be able to moonlight. If the moonlighting goes, you go. If they have a problem with it, I suggest you scorch the earth with them. I have a huge problem with any program, be it residency or fellowship, that interferes with their fully licensed residents ability to moonlight. Resident/Fellow salaries are already inadequate, and there is no reason for programs to stand in the way of their residents and fellows efforts to not live like animals. Honestly, if your program director is a decent human being he will talk to you can come up with a reasonable solution that works for everyone.

Well, "interferes with" is a bit of a strong statement.

I am in a light, mostly outpatient fellowship... but three months a year I'm on inpatient consults at our main hospitals, on 24/7 pager call, and can theoretically be called in at any time. I also only have the requisite 4 days off each of those inpatient months. Thus, when I am on that service, my PD forbids me from moonlighting. This "interferes" with my ability to make more money, but is entirely appropriate as I need to be available and I can't break duty hours (for which moonlighting counts) or the program could get in trouble.

Of course, I could lie and go make that money anyway... but I could do that even if the PD forbid moonlighting all the time.

Now the OP is a rising critical care fellow: It may be that the times available for moonlighting are much more heavily restricted than at my program. I don't have any clue how an anesthesiology critical care fellowship is structured, but from what I know about pulmonary/critical care, first year fellows might be running close to 80 hours a week or 4 days off a month for the majority of the year. Forbidding moonlighting is *still* reasonable in those circumstances. But it would also make sense to then allow it in the rare elective month or the later years of fellowship when the schedules are lighter.

Of course, if they had the time to moonlight before and the opportunity is just what is missing, that argument is moot... but I can't say programs should allow everyone to moonlight all the time.

 

[Hernandez]

Well, "interferes with" is a bit of a strong statement.

I am in a light, mostly outpatient fellowship... but three months a year I'm on inpatient consults at our main hospitals, on 24/7 pager call, and can theoretically be called in at any time. I also only have the requisite 4 days off each of those inpatient months.

I have no issues with long hours and working hard, but I have big issues with this set up.

 

[Raryn]

I have no issues with long hours and working hard, but I have big issues with this set up.

I'm not a critical care fellow, just came across this thread randomly. It's a pretty typical setup for the outpatient medical subspecialties (endocrine, rheum, heme onc, whatever). Over 2-3 years we spend most of our time in clinic/research/whatever with busier consult months thrown in. I spend 6 months a year exclusively outpatient, 3 months of heavy duty consults, and 3 months lighter consults at a community hospital.