Licensing Questions

[funkmastahflex]

Hey all,

I'm switching from a surgical to non-surgical specialty after contract nonrenewal from a prior program. The cited reasons were primarily technical skills, but the official notification letter also included professionalism (this was just some minor stuff in peer evals, not the true reason for nonrenewal)

I've been accepted to a new program and haven't had much conversation with the PD about this since it didn't come up in the interview and there hasn't been much other communication between us (my reasons for leaving were that I wasn't happy in the field and more interested in the one I'm switching to, which were/are true). My questions are:

1. Since the prior issue was technical skill and that's no longer relevant in a nonsurgical field, should I tell the PD? If so, what's the best way to do so? (call/text/email?)
2. Should I mention the professionalism stuff, since it sounds scary even though it was really insignificant stuff likely tacked on at the end to strengthen the case for nonrenewal decision?
3. I intend to fully disclose everything in detail on the state licensing application. Does anyone know if the institution/program director have the ability to see the details of the information listed in the application form? Or do they just find out that I either have a license vs don't?
4. Any other advice/feedback is welcome (please be gentle)

Thanks in advance for your time and thoughts!

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[smq123]

Did you provide your new PD with the name of your old program? I’m assuming that your new PD spoke to your old PD already?

 

[funkmastahflex]

I provided letters of reference from chairman/PD but I don't know if they spoke. I suspect that they did not.

 

[j4pac]

You said non-renewal but then you mentioned your purpose of leaving. I’m confused maybe not enough coffee yet

 

[xffan624]

I provided letters of reference from chairman/PD but I don't know if they spoke. I suspect that they did not.

Then sorry I'm not understanding what the problem is. If they have a letter from the PD then likely have all the necessary information. They also have contact information from the PD if they want to obtain more information. You have no obligation to reemphasize the negative aspects of your departure to your new PD. Disclose in full on the licensing application for the new residency. None of the information on it should be a surprise to the new program.

Unless the non-renewal was a decision that was made after you matched to the new program. That would be relevant to the program director and honestly a jerk move by the old PD as they could have just let you leave without booting you out the door.

 

[hamstergang]

I too don't understand why you would plan to talk to your new PD about this now.

 

[funkmastahflex]

Thanks for the responses thus far everyone. A few clarifications:

Reason for leaving is both that I was unhappy and looking at switching specialties, and nonrenewal made it essentially a necessity rather than choice. So both things played into it.

I was contemplating reaching out now because I'm submitting licensing paperwork that will have all the details of the nonrenewal and I wasn't sure if that information would be shared with the department/PD or if the document submissions to the medical board remain confidential. Additionally, the new program also has forms that ask for information about nonrenewal that I will share, although likely in a more abbreviated manner. Not sure if that will make it on the new PD's desk either, but I wouldn't be surprised if it did.

I certainly see the argument to say nothing given the relatively late stage of events, and the onus being on the new PD to communicate with the old PD. I am now leaning towards going this route.

If anyone has any additional thoughts or differing perspective, would be much appreciated!

 

[gutonc]

Thanks for the responses thus far everyone. A few clarifications:

Reason for leaving is both that I was unhappy and looking at switching specialties, and nonrenewal made it essentially a necessity rather than choice. So both things played into it.

I was contemplating reaching out now because I'm submitting licensing paperwork that will have all the details of the nonrenewal and I wasn't sure if that information would be shared with the department/PD or if the document submissions to the medical board remain confidential. Additionally, the new program also has forms that ask for information about nonrenewal that I will share, although likely in a more abbreviated manner. Not sure if that will make it on the new PD's desk either, but I wouldn't be surprised if it did.

I certainly see the argument to say nothing given the relatively late stage of events, and the onus being on the new PD to communicate with the old PD. I am now leaning towards going this route.

If anyone has any additional thoughts or differing perspective, would be much appreciated!

Answer questions that you are explicitly asked truthfully. Say nothing else.

 

[Dral]

Unless the non-renewal was a decision that was made after you matched to the new program. That would be relevant to the program director and honestly a jerk move by the old PD as they could have just let you leave without booting you out the door.

OP, this is the gist of why we are all confused. If you could answer this, it would help a lot.

If the decision of non-renewal was made before you matched to your new program, then your new program PD is likely aware and I wouldn't offer up anything more. If it ever comes up, you can say that you assumed it was in a letter or that they contacted your prior program.

If the choice to terminate you was made AFTER you matched or while you were in the process, then it may be more of a gray area. Either way, I'd say to probably just go with Gutonc's advise. On any licensing forms or in any conversations, just address anything you are asked of in a truthful concise manner.

 

[Iamnew2]

Thanks for the responses thus far everyone. A few clarifications:

Reason for leaving is both that I was unhappy and looking at switching specialties, and nonrenewal made it essentially a necessity rather than choice. So both things played into it.

I was contemplating reaching out now because I'm submitting licensing paperwork that will have all the details of the nonrenewal and I wasn't sure if that information would be shared with the department/PD or if the document submissions to the medical board remain confidential. Additionally, the new program also has forms that ask for information about nonrenewal that I will share, although likely in a more abbreviated manner. Not sure if that will make it on the new PD's desk either, but I wouldn't be surprised if it did.

I certainly see the argument to say nothing given the relatively late stage of events, and the onus being on the new PD to communicate with the old PD. I am now leaning towards going this route.

If anyone has any additional thoughts or differing perspective, would be much appreciated!

My rule of thumb-be honest but brief and concise. Neither the program nor the board want 10 pages of what happened. Say your contract was not renewed, if they ask why say lack of adequate surgical skills or whatever it was, and say there was a professionalism concern of "x" (your resident thought you were rude or you would come in late, etc). It should match what ur program said. I find it that more often than not professionalism concerns when a resident is wanted out. A lot of the professionalism issues that come up are pure garbage and not a cause for non renewal. Unless you truly are a terrible person or have awful work ethic it's unlikely that most residents truly would warrant non renewal over "professionalism." So subjective too.

 

[funkmastahflex]

Thank you guys, to answer the earlier question: The contract non-renewal decision was first made about 1.5 months before I interviewed for and was given the new position, however it was appealed and under review until about a month after I got the spot.

At that time, I rationalized not saying anything to the new PD since it wasn't a "sure thing" as the decision was under appeal. Hired a lawyer and later found out that appeals are almost universally bogus, and my case was no exception - the objective case for nonrenewal was very weak but the decision was still upheld. I agree with you lamnew2, the professionalism was based on two anonymous reviews submitted by the same resident and were never even discussed with me.

Do you all feel there's any reason/need to hire a lawyer for applying for an in-training license and should I expect significant delays? I'm in TX, I hear it's a particularly stringent state, but I'm going to try to get everything submitted at least 2 months before starting so hopefully that should be enough time since most people seem to apply 30 days or so before, at least from what the program coordinator told me.

Thanks again for the input everyone!

 

[Iamnew2]

Thank you guys, to answer the earlier question: The contract non-renewal decision was first made about 1.5 months before I interviewed for and was given the new position, however it was appealed and under review until about a month after I got the spot.

At that time, I rationalized not saying anything to the new PD since it wasn't a "sure thing" as the decision was under appeal. Hired a lawyer and later found out that appeals are almost universally bogus, and my case was no exception - the objective case for nonrenewal was very weak but the decision was still upheld. I agree with you lamnew2, the professionalism was based on two anonymous reviews submitted by the same resident and were never even discussed with me.

Do you all feel there's any reason/need to hire a lawyer for applying for an in-training license and should I expect significant delays? I'm in TX, I hear it's a particularly stringent state, but I'm going to try to get everything submitted at least 2 months before starting so hopefully that should be enough time since most people seem to apply 30 days or so before, at least from what the program coordinator told me.

Thanks again for the input everyone!

I am not sure what the other resident said, however, resident evals are pure BS and I am highly against them. Residents in my opinion have no business evaluating one another and typically disputes or disagreements between residents are taken out against other residents on peer evals. So a complete joke. No resident should have another residents' career in their hands.
Tx is indeed stringent, moreso for permanent licenses, but likely also for training licenses. I would apply with as much time as you can, be honest but brief - again no one needs a dramatic 10 page recount. When lawyers get involved, things typically go to crap. I wouldn't unless something outrageous is happening. Lawyers have absolutely no clue about the medical system which is complex so you would be wasting your money in my opinion.
If you made a mistake you will have to own it apologize and let them know that it wont happen again and what steps you are taking to correct whatever.
In your case in particular if you were not good at technical skills (I assume surgery?), then just say something along those lines and how a non surgical specialty is a better fit since you dont' have to do that, etc etc.
It's hard in general for others to piece together something that has happened. It's common for both sides in a negative outcome to exaggerate or embezzle the truth to their convenience to some extent. If a little humbleness and reassurance does it I would go down that path. Again in my opinion lawyers typically make everthing complex and onerous and in medicine in particular they tend to have no clue about this.
The medical system as you know is also very particular - it doesn't matter what a court of law says in regards to the processes. I would agree that appeals are just a technicality, and I don't think I have ever heard of anyone winning on appeal. What would a lawyer argue - what your skills are better than what a surgical doctor would say? That you got an appeal option but that it was BS? Not a winning case sadly.
Also do you really want to stay in a program that doesn't want you there particularly in surgery? That would be a nightmare.
So use this unfortunate event to make yourself a better physician for your future patients and learn from whatever went wrong. You would be surprised of the number of physicians who have had a hiccup in their career and used it to become fantastic docs.

 

[Redpancreas]

Thank you guys, to answer the earlier question: The contract non-renewal decision was first made about 1.5 months before I interviewed for and was given the new position, however it was appealed and under review until about a month after I got the spot.

At that time, I rationalized not saying anything to the new PD since it wasn't a "sure thing" as the decision was under appeal. Hired a lawyer and later found out that appeals are almost universally bogus, and my case was no exception - the objective case for nonrenewal was very weak but the decision was still upheld. I agree with you lamnew2, the professionalism was based on two anonymous reviews submitted by the same resident and were never even discussed with me.

Do you all feel there's any reason/need to hire a lawyer for applying for an in-training license and should I expect significant delays? I'm in TX, I hear it's a particularly stringent state, but I'm going to try to get everything submitted at least 2 months before starting so hopefully that should be enough time since most people seem to apply 30 days or so before, at least from what the program coordinator told me.

Thanks again for the input everyone!

Holy ****! You were non-renewed prior to your interview to a new program and you didn't disclose that on your ERAS? Lol... I'm starting to wonder what the new PD was thinking by ranking you. What did he think was the reason for your transfer? An applicant can make up any story which is why having a PD letter is virtually a necessity when transferring. Well...what's done is done and you should feel blessed to be part of a new program even though you did it through these means. You have a clean slate at a new program. I would not call attention to anything that at your old program now, but if explicitly asked in any paperwork, be honest. Unless you needed credit from your old institution to continue at your new institution, there should be no issues. Physicians are some of the most susceptible people to anchoring bias in my opinion. Mentioning any of this is surely to put you under the microscope which is a terrible place to be no matter who you are.

 

[rokshana]

But make sure that at this new program, you don’t have “professional “ issues... knowledge issues can be fixed...professional issues are harder to fix... maybe it was BS...but it’s there...once is a fluke... 2 times... it will give pause.

 

[funkmastahflex]

Thanks for the responses everyone!

Holy ****! You were non-renewed prior to your interview to a new program and you didn't disclose that on your ERAS? Lol... I'm starting to wonder what the new PD was thinking by ranking you. What did he think was the reason for your transfer? An applicant can make up any story which is why having a PD letter is virtually a necessity when transferring. Well...what's done is done and you should feel blessed to be part of a new program even though you did it through these means. You have a clean slate at a new program. I would not call attention to anything that at your old program now, but if explicitly asked in any paperwork, be honest. Unless you needed credit from your old institution to continue at your new institution, there should be no issues. Physicians are some of the most susceptible people to anchoring bias in my opinion. Mentioning any of this is surely to put you under the microscope which is a terrible place to be no matter who you are.

I did not apply via ERAS and the reasons I provided for wanting to switch were true. Also, I was not really even asked much about why I was leaving.I assumed that there would be some communication between the new/old PD and that they would ask me about it at some point but it never happened...

I am not sure what the other resident said, however, resident evals are pure BS and I am highly against them. Residents in my opinion have no business evaluating one another and typically disputes or disagreements between residents are taken out against other residents on peer evals. So a complete joke. No resident should have another residents' career in their hands.
Tx is indeed stringent, moreso for permanent licenses, but likely also for training licenses. I would apply with as much time as you can, be honest but brief - again no one needs a dramatic 10 page recount. When lawyers get involved, things typically go to crap. I wouldn't unless something outrageous is happening. Lawyers have absolutely no clue about the medical system which is complex so you would be wasting your money in my opinion.
If you made a mistake you will have to own it apologize and let them know that it wont happen again and what steps you are taking to correct whatever.
In your case in particular if you were not good at technical skills (I assume surgery?), then just say something along those lines and how a non surgical specialty is a better fit since you dont' have to do that, etc etc.
It's hard in general for others to piece together something that has happened. It's common for both sides in a negative outcome to exaggerate or embezzle the truth to their convenience to some extent. If a little humbleness and reassurance does it I would go down that path. Again in my opinion lawyers typically make everthing complex and onerous and in medicine in particular they tend to have no clue about this.
The medical system as you know is also very particular - it doesn't matter what a court of law says in regards to the processes. I would agree that appeals are just a technicality, and I don't think I have ever heard of anyone winning on appeal. What would a lawyer argue - what your skills are better than what a surgical doctor would say? That you got an appeal option but that it was BS? Not a winning case sadly.
Also do you really want to stay in a program that doesn't want you there particularly in surgery? That would be a nightmare.
So use this unfortunate event to make yourself a better physician for your future patients and learn from whatever went wrong. You would be surprised of the number of physicians who have had a hiccup in their career and used it to become fantastic docs.

Thank you, that's a really helpful response. I will try to explain things as honestly/succinctly as possible and hope for the best. These recent experiences have really changed my perspective on the world/life quite a bit. I'll take your advice and learn/grow as much as possible.

 

[DJKitty]

I have a full Texas license, so the process for PIT permit may be different, but I will echo what others have said in that it is one of the most difficult state to get licensed in the US. Make sure you are completely honest on the paperwork and call the TMB if you have any questions about how to answer a question. If you make any mistake in the application, you will have to resubmit a completely new application and pay the application fee again. Texas has the Texas Medical Practice Act passed by the legislature that does not allow the TMB to accept any applications with errors, even if the error is explained and corrected in follow-up. The licensing process will take longer for you given your history and I would submit as soon as possible if your start date is 7/1. Good luck!

 

[Redpancreas]

I did not apply via ERAS and the reasons I provided for wanting to switch were true. Also, I was not really even asked much about why I was leaving.I assumed that there would be some communication between the new/old PD and that they would ask me about it at some point but it never happened...

If that's the case, it was the obligation of the new PD to communicate with the old PD. Answer all questions on paperwork appropriately BUT DO NOT mention anything unsolicited to anyone in your new program.

 

[Redpancreas]

I am not sure what the other resident said, however, resident evals are pure BS and I am highly against them. Residents in my opinion have no business evaluating one another and typically disputes or disagreements between residents are taken out against other residents on peer evals. So a complete joke. No resident should have another residents' career in their hands.

Not relevant to this case but I guess to anyone reading...Agreed that peer-peer resident evaluations are BS after maybe you're done with your first month as an intern. You're truly just asking for a situation where residents air out grievances for each other. It usually starts when one sees what they feel is an unfair eval and feels the need to retaliate. The Clinical Competency Committee (CCC) & Program Director (the ones making the decision to place on a PIP, put on probation, non-renew, or terminate) have discussions behind the scenes on what to do and it's really not much to do with what shows up in the peer evaluations. Quotes from these evaluations are just copied and pasted by your advisors to help you so if you see a PIP with XYZ comments from residents or faculty, don't assume that that's what's wrong. Ultimately, when a resident is in a PIP/Probation, etc. situation, it's very difficult for them to figure out exactly what's happening behind the scenes as the program won't be transparent with you in order to not expose their colleagues. The examples given to you will often seem cherry-picked as a product of being under a microscope. What is happening in a majority of these cases is that one or more people in leadership who're meant to be evaluating you see you as incapable/unprofessional and have anchored to death on that impression whether that's fair or not and can present a one-sided impression to the entire committee (a majority of which you will not have worked with) and without much of a counterweight, the committee won't have much else to say besides agreeing that "based on the information presented" XYZ should be the action we take for resident A.