- Joined
- Apr 29, 2013
- Messages
- 34
- Reaction score
- 43
I’ve waited almost a decade to write this.
When I graduated medical school, my calling was clear: psychiatry. I felt it deep in my bones—the pull toward the misunderstood, the marginalized, the ones we label but never listen to. But the door slammed shut early. I failed Step 2 CS on my first attempt. Whether it was discrimination from a standardized patient, my young appearance, or my inexperience as a second-year med student, I’ll never truly know. What I do know is that I passed it a month later—but the damage was permanent. A red flag on my ERAS. One that psychiatry programs didn’t forgive. I didn’t match. Many interviews but no takers back then, most citing a failed CS score…
It’s ironic now. That very exam—Step 2 CS—has since been abolished. The test that sidelined me would never even be seen by applicants today.
So I did what many of us do when our dreams are crushed: I kept moving.
I scrambled into Family Medicine. And from there, I became a hospitalist. I worked in ERs, managed open ICUs, became skilled in procedures, and made myself indispensable to the system. I saw it all—codes, sepsis, palliative transitions, emergency deliveries. I took call, covered holidays, picked up moonlighting shifts when no one else would. I wore every hat. Sometimes proudly. Sometimes resentfully. But always with the patient’s best interest at heart.
Still, something never left me.
That quiet voice, the one that whispered at 3am after a difficult case, or during a long post-shift drive home: “You were meant to be a psychiatrist.”
And while that calling stayed alive inside me, so did the rot of what medicine was becoming around me.
Let’s talk plainly. Because I’ve lived it:
Midlevel encroachment is real. And it’s dangerous.
It’s not about collaboration. It’s about substitution. I’ve personally been forced—under threat of job loss—to supervise nurse practitioners I’d never met. Signing off on charts for patients I didn’t evaluate. And if I refused? “We’ll find someone else who will.”
I’ve seen NPs treat DKA as dehydration. Prescribe stimulants and benzos together to elderly fall risks. Miss sepsis. Discharge patients who should’ve been admitted to the ICU. I’ve been the one called back to clean up the damage. Admit the patient. Call the family. Document the chaos. Bear the liability.
You cannot “supervise” six midlevels at once while running a code and admitting four more. It’s not supervision—it’s a shield for billing. It’s a lie. And patients are paying the price.
And it’s not just the midlevel model. It’s the entire system.
Let’s talk about how specialists treat family medicine doctors.
In the hospital, we are the backbone—yet we’re treated like the floorboards. We admit, we discharge, we coordinate care, we do the heavy lifting. And yet the tone is always the same from some specialists: condescension.
I’ve been talked down to by residents. Mocked by consultants. Sent notes that say “please manage all other issues,” as if I’m their unpaid intern. They round at 6am, leave by 7, and bill like they saved a life. Meanwhile, I’m chasing labs, doing goals-of-care with families, fighting insurance to get my patient a SNF bed, and supervising an NP who misread the echo.
I’ve been in rooms where I knew more than the specialist. But I stayed quiet. Because that’s what FM is expected to do: be grateful for the scraps.
And still—I endured. For years. Not because I accepted it. But because I felt responsible to patients, to nurses, to the team. And to be honest, I didn’t think I had any other choice.
But that voice never left: “You were meant to be a psychiatrist.”
This year—through nothing short of divine mercy—I matched. Into a PGY-2 psychiatry position. Over 150 applications. Three interviews. One “yes.” No recent psych rotations. No new letters. Old board scores.
But one program director saw me. Saw beyond the blemishes. Saw the fire. Saw the fight.
And I will never forget that.
I still have a few shifts left—hospitalist and ER. I can’t say where I matched just yet. But soon, I will walk into residency again. Older, maybe. But also stronger, wiser, and more driven than I ever was fresh out of med school.
This time, I walk in with purpose forged from pain. I walk in with a decade of real-world scars—earned on call, in codes, in silence. I walk in as someone who knows what it means to be discarded by the system, only to rise again.
The financial hit will be massive. I lived frugally for years in preparation. No new car. No lavish home. Just quiet saving and quiet hope. My wife supports this fully. Our children will grow up knowing that their father didn’t chase a paycheck—he chased his calling.
Psychiatry is not just about medications or diagnoses. It’s about presence. Humanity. Bearing witness. These are the patients most often left behind, criminalized, ignored. I have worn many hats in medicine—but I know this is the final one. The right one.
So, to any older grad, burned-out hospitalist, or unmatched physician reading this: It’s not over. As long as you’re breathing—it’s not over.
You’re not too old. Not too broken. Not too late.
You’re just getting started.
To my future patients: I’m ready.
To my program director: I won’t let you down.
To the system that tried to grind me down: I’m still here. And I’m not done yet.
God bless you all.
— A Reborn Physician
“The wound is the place where the Light enters you.” – Rumi
When I graduated medical school, my calling was clear: psychiatry. I felt it deep in my bones—the pull toward the misunderstood, the marginalized, the ones we label but never listen to. But the door slammed shut early. I failed Step 2 CS on my first attempt. Whether it was discrimination from a standardized patient, my young appearance, or my inexperience as a second-year med student, I’ll never truly know. What I do know is that I passed it a month later—but the damage was permanent. A red flag on my ERAS. One that psychiatry programs didn’t forgive. I didn’t match. Many interviews but no takers back then, most citing a failed CS score…
It’s ironic now. That very exam—Step 2 CS—has since been abolished. The test that sidelined me would never even be seen by applicants today.
So I did what many of us do when our dreams are crushed: I kept moving.
I scrambled into Family Medicine. And from there, I became a hospitalist. I worked in ERs, managed open ICUs, became skilled in procedures, and made myself indispensable to the system. I saw it all—codes, sepsis, palliative transitions, emergency deliveries. I took call, covered holidays, picked up moonlighting shifts when no one else would. I wore every hat. Sometimes proudly. Sometimes resentfully. But always with the patient’s best interest at heart.
Still, something never left me.
That quiet voice, the one that whispered at 3am after a difficult case, or during a long post-shift drive home: “You were meant to be a psychiatrist.”
And while that calling stayed alive inside me, so did the rot of what medicine was becoming around me.
Let’s talk plainly. Because I’ve lived it:
Midlevel encroachment is real. And it’s dangerous.
It’s not about collaboration. It’s about substitution. I’ve personally been forced—under threat of job loss—to supervise nurse practitioners I’d never met. Signing off on charts for patients I didn’t evaluate. And if I refused? “We’ll find someone else who will.”
I’ve seen NPs treat DKA as dehydration. Prescribe stimulants and benzos together to elderly fall risks. Miss sepsis. Discharge patients who should’ve been admitted to the ICU. I’ve been the one called back to clean up the damage. Admit the patient. Call the family. Document the chaos. Bear the liability.
You cannot “supervise” six midlevels at once while running a code and admitting four more. It’s not supervision—it’s a shield for billing. It’s a lie. And patients are paying the price.
And it’s not just the midlevel model. It’s the entire system.
Let’s talk about how specialists treat family medicine doctors.
In the hospital, we are the backbone—yet we’re treated like the floorboards. We admit, we discharge, we coordinate care, we do the heavy lifting. And yet the tone is always the same from some specialists: condescension.
I’ve been talked down to by residents. Mocked by consultants. Sent notes that say “please manage all other issues,” as if I’m their unpaid intern. They round at 6am, leave by 7, and bill like they saved a life. Meanwhile, I’m chasing labs, doing goals-of-care with families, fighting insurance to get my patient a SNF bed, and supervising an NP who misread the echo.
I’ve been in rooms where I knew more than the specialist. But I stayed quiet. Because that’s what FM is expected to do: be grateful for the scraps.
And still—I endured. For years. Not because I accepted it. But because I felt responsible to patients, to nurses, to the team. And to be honest, I didn’t think I had any other choice.
But that voice never left: “You were meant to be a psychiatrist.”
This year—through nothing short of divine mercy—I matched. Into a PGY-2 psychiatry position. Over 150 applications. Three interviews. One “yes.” No recent psych rotations. No new letters. Old board scores.
But one program director saw me. Saw beyond the blemishes. Saw the fire. Saw the fight.
And I will never forget that.
I still have a few shifts left—hospitalist and ER. I can’t say where I matched just yet. But soon, I will walk into residency again. Older, maybe. But also stronger, wiser, and more driven than I ever was fresh out of med school.
This time, I walk in with purpose forged from pain. I walk in with a decade of real-world scars—earned on call, in codes, in silence. I walk in as someone who knows what it means to be discarded by the system, only to rise again.
The financial hit will be massive. I lived frugally for years in preparation. No new car. No lavish home. Just quiet saving and quiet hope. My wife supports this fully. Our children will grow up knowing that their father didn’t chase a paycheck—he chased his calling.
Psychiatry is not just about medications or diagnoses. It’s about presence. Humanity. Bearing witness. These are the patients most often left behind, criminalized, ignored. I have worn many hats in medicine—but I know this is the final one. The right one.
So, to any older grad, burned-out hospitalist, or unmatched physician reading this: It’s not over. As long as you’re breathing—it’s not over.
You’re not too old. Not too broken. Not too late.
You’re just getting started.
To my future patients: I’m ready.
To my program director: I won’t let you down.
To the system that tried to grind me down: I’m still here. And I’m not done yet.
God bless you all.
— A Reborn Physician
“The wound is the place where the Light enters you.” – Rumi
