LOA for alcoholism treatment. How will this effect residency application?

[deleted826813]

I'm an M2. During my first year, one of the deans at my school scheduled time to speak one on one because my grades were close to failing. I've struggled with alcoholism for a long time and I explained this to the dean because I truly want to recover. He helped me get a therapist I've been seeing regularly. Recently this dean and I touched base again and he asked how my drinking is, and I told him the truth. Despite being an addict, something we both agree is a disease, I've been regularly drinking on the weekends and suppressing my desire to drink during the weekdays by attending daily AA meetings/weekly one on one therapy. After telling him this he was concerned and he recommended I take a leave of absence from now until later this year, where I'll pick back up to repeat my second year.

Some questions. How will a LOA for "medical reasons" effect my residency application? From the small amount of research I've done, it seems that it depends on how you address the LOA in your application/interviews. Is there a way to spin this so that it doesn't come out I had a drinking problem. Obviously that would be a red flag to residencies! Also, I am mainly interested in highly competitive specialties like diagnostic rads and dermatology. Assuming I have an application that supports me matching into these fields (high step scores, good post clinical grades, good letters, research), would my application be thrown to the side because of the LOA? Or would I at least have the chance to address it? If I get the chance to address it, would I have to be dishonest about why I took the LOA? (I wouldn't do this, just wondering if being honest would disqualify me from likely matching). Thank you so much for your advice!

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[deleted826813]

How would the medical licensing boards find out? I was under the impression that doing treatment and being forthright with my dean could actually reveal this problem to residency/the medical boards. This worries me, but I am doing it to help myself.. however, I at least felt the best way to avoid med licensing boards/residency finding out would be to not disclose to anyone and deal with my struggles on my own.

I feel like it is a good question to ask because if I can figure out a way to solve the alcohol problem without it effecting my future career that would be better than solving the alcohol problem with others and dealing with not being able to get a great residency/job.

 

[DO2015CA]

Like said above take this chance to address it. Residency is too stressful. If you have alcoholism without treatment it will send you off the deep end. It is a medical leave of absence so no you don’t have to disclose why. Just that it was for medical reasons and that it will not affect you going forward... but it might still. Residency is hard and the hours long. It will be unlikely you have time to go to AA multiple times per day just to not drink. By taking the leave of absence you have an opportunity to learn other coping mechanisms you will be able to use on the long days in residency

TL;DR I think it would be unwise for your future to not take the LOA regardless of how it will affect residency applications

 

[DO2015CA]

How would the medical licensing boards find out? I was under the impression that doing treatment and being forthright with my dean could actually reveal this problem to residency/the medical boards. This worries me, but I am doing it to help myself.. however, I at least felt the best way to avoid med licensing boards/residency finding out would be to not disclose to anyone and deal with my struggles on my own.

I feel like it is a good question to ask because if I can figure out a way to solve the alcohol problem without it effecting my future career that would be better than solving the alcohol problem with others and dealing with not being able to get a great residency/job.

If your dean puts it in your deans letter would be the only way residencies would find out. Medical boards will find out if you fall off the deep end in residency and mess stuff up or require a LOA there for rehab

 

[ciestar]

Watch where you apply for residency. Florida for example likes to ask highly intrusive questions (like have you EVER been in therapy, been treated for mental health stuff)

Regardless, you need to resolve this now.

 

[deleted826813]

My true fear is that when addressing why I took LOA most residencies will automatically say no. Why would any residency want a former addict?

 

[DO2015CA]

My true fear is that when addressing why I took LOA most residencies will automatically say no. Why would any residency want a former addict?

You are not required to state a reason. It’s medical leave is all. Medical privacy.

 

[ciestar]

My true fear is that when addressing why I took LOA most residencies will automatically say no. Why would any residency want a former addict?

You are not required to tell any program specific details.

 

[DO2015CA]

And because it’s medical privacy, I find it difficult to believe the dean puts alcohol problems in your letter. Especially if you heed his warning and you get help. It shows the mature thing to do. If you don’t then **** up you best believe that will be in your letter

 

[Cornfed101]

like have you EVER been in therapy, been treated for mental health stuff

That's insane...

 

[ciestar]

That's insane...

Oh, i know

 

[mistafab]

Stop worrying about school and go deal with this demon.

 

[DrMcLovin]

Wow, FL is pretty intrusive with mental health and addiction history. My recommendation is obviously to get help, but when the time comes look up each states medical licensing application during the match and interview season. I would also see as few providers as possible in case your state of interest requires the same amount of documentation as FL:

“If you answer “Yes” to any of the questions in this section, you are required to send the following items:

- A self-explanation providing accurate details that include name of all physicians, therapists, counselors, hospitals, institutions, and/or clinics where you received treatment and dates of treatment.

- A report directed to the Florida Board of Medicine from each treatment provider about your treatment, medications, and dates of treatment. If applicable, include all DSM III R/DSM IV/DSM IV-TR Axis I and II diagnosis(es) code(s), and admission and discharge summary(s).

A. In the last five years, have you been enrolled in, required to enter into, or participated in any drug or alcohol recovery program or impaired practitioner program for treatment of drug or alcohol abuse that occurred within the past five years?”

And somehow its still a mystery why physicians and students are reluctant to get help with their mental health....

 

[deleted480308]

My true fear is that when addressing why I took LOA most residencies will automatically say no. Why would any residency want a former addict?

You will never be a former addict. Ever. You need to cope with that to manage your life

 

[radsisrad]

Assuming that this is true alcoholism and not simply a case of a student who parties irresponsibly at the expense of grades...

As an (alcohol) addict, you have a serious physiological derangement that has the potential to wreak havoc on the entirety of your life.

Deal with this maturely and emphatically. I can't speak for PDs, but if I happened to know that an applicant had taken as rational a step as this, (s)he would rank more highly in my estimation.

 

[Osteosaur]

The thing is you don't want to give the dean cause for concern either, right?

The school seems pretty willing to work with you on this. I'd take it as a gift. Why don't you ask how your school has handled such things in the past? I think there is a fear (sometimes justified sometimes not) to view school administration as adversarial. In this case this guy seems to want to help you. Tread carefully.

 

[ciestar]

Wow, FL is pretty intrusive with mental health and addiction history. My recommendation is obviously to get help, but when the time comes look up each states medical licensing application during the match and interview season. I would also see as few providers as possible in case your state of interest requires the same amount of documentation as FL:

“If you answer “Yes” to any of the questions in this section, you are required to send the following items:

- A self-explanation providing accurate details that include name of all physicians, therapists, counselors, hospitals, institutions, and/or clinics where you received treatment and dates of treatment.

- A report directed to the Florida Board of Medicine from each treatment provider about your treatment, medications, and dates of treatment. If applicable, include all DSM III R/DSM IV/DSM IV-TR Axis I and II diagnosis(es) code(s), and admission and discharge summary(s).

A. In the last five years, have you been enrolled in, required to enter into, or participated in any drug or alcohol recovery program or impaired practitioner program for treatment of drug or alcohol abuse that occurred within the past five years?”

And somehow its still a mystery why physicians and students are reluctant to get help with their mental health....

Florida isnt alone in this. I forget what other states do this, but it sucks. Ive been on lamictal since undergrad and it keeps me stable. Too bad that can still be held against me.

 

[sloop]

Florida isnt alone in this. I forget what other states do this, but it sucks. Ive been on lamictal since undergrad and it keeps me stable. Too bad that can still be held against me.

FWIW, these types of questions very likely violate the ADA and several cases have held such.

Medical Licensure Questions About Mental Illness and Compliance with the Americans With Disabilities Act

Substantial numbers of medical students and physicians live with some form of mental illness. Over the years, many medical licensure boards have asked physician medical licensure applicants with Doctor of Medicine (MD) degrees intrusive questions about whether they have any psychiatric history...

jaapl.org

 

[deleted826813]

You will never be a former addict. Ever. You need to cope with that to manage your life

should have said recovering

 

[jdh71]

You will never be a former addict. Ever. You need to cope with that to manage your life

Oh that isn’t necessarily true.

The literature is full spontaneous remission of problem drinking. Contrary to AA (which I don’t have a big problem with, especially as a context for people to find FREE community and assist with sobriety as long as the spiritual aspect jives) pickles can and do become cucumbers again.

 

[deleted826813]

Oh that isn’t necessarily true.

The literature is full spontaneous remission of problem drinking. Contrary to AA (which I don’t have a big problem with, especially as a context for people to find FREE community and assist with sobriety as long as the spiritual aspect jives) pickles can and do become cucumbers again.

What he means is if you truly have the disease, simply abstaining from drinking doesn't cure you. Years of not drinking wouldn't give a true addict the power to start drinking socially.

 

[jdh71]

What he means is if you truly have the disease, simply abstaining from drinking doesn't cure you. Years of not drinking wouldn't give a true addict the power to start drinking socially.

That isn’t what the literature shows though. Lots of people who at one point met criteria for dependence/addiction simply stop drinking that way and drink socially, usually after a period of sobriety, especially those who are younger problem drinkers.

 

[Cornfed101]

That isn’t what the literature shows though. Lots of people who at one point met criteria for dependence/addiction simply stop drinking that way and drink socially, usually after a period of sobriety, especially those who are younger problem drinkers.

But I hope you would never suggest that a recovering alcoholic drink socially "based on the literature." That seems asinine.

 

[jdh71]

But I hope you would never suggest that a recovering alcoholic drink socially "based on the literature." That seems asinine.

Would depend on a few things from my perspective but the literature simply doesn’t support that once an alcoholic always an alcoholic in quite a few cases. We either trust the observable phenomenon here as described in the scientific literature or, I guess we don’t? But if you don’t, then why not?

I mean no one ever HAS TO drink. Like literally ever. So if folks are simply fine like that why would one ever insist they socially drink. But if you’ve got someone who had a problem at one point in their life, have been sober for a long period of time, they’ve grown up and matured, stressors have changed, things like job and family are entrenched and important, and they are interested in a trial of social drinking? Doesn’t seem unreasonable based on what we know.

 

[GreenDuck12]

The thing is you don't want to give the dean cause for concern either, right?

The school seems pretty willing to work with you on this. I'd take it as a gift. Why don't you ask how your school has handled such things in the past? I think there is a fear (sometimes justified sometimes not) to view school administration as adversarial. In this case this guy seems to want to help you. Tread carefully.

I would like to echo this point. Bear in mind that I do not have experience with medical school administration or how Dean’s handle letters of recommendation however I do have experience writing and receiving letters of recommendation. I have found that when there is a concern about an applicant those writing the letters have a way of communicating that concern without necessarily being explicit for legal reasons. In this case I would be even more concerned given that the dean of your medical school likely has a relationship with residency programs that he or she would not be willing to jeopardize by giving a full throated endorsement of someone who isn’t taking their advice.

 

[GoSpursGo]

I'm an M2. During my first year, one of the deans at my school scheduled time to speak one on one because my grades were close to failing. I've struggled with alcoholism for a long time and I explained this to the dean because I truly want to recover. He helped me get a therapist I've been seeing regularly. Recently this dean and I touched base again and he asked how my drinking is, and I told him the truth. Despite being an addict, something we both agree is a disease, I've been regularly drinking on the weekends and suppressing my desire to drink during the weekdays by attending daily AA meetings/weekly one on one therapy. After telling him this he was concerned and he recommended I take a leave of absence from now until later this year, where I'll pick back up to repeat my second year.

Some questions. How will a LOA for "medical reasons" effect my residency application? From the small amount of research I've done, it seems that it depends on how you address the LOA in your application/interviews. Is there a way to spin this so that it doesn't come out I had a drinking problem. Obviously that would be a red flag to residencies! Also, I am mainly interested in highly competitive specialties like diagnostic rads and dermatology. Assuming I have an application that supports me matching into these fields (high step scores, good post clinical grades, good letters, research), would my application be thrown to the side because of the LOA? Or would I at least have the chance to address it? If I get the chance to address it, would I have to be dishonest about why I took the LOA? (I wouldn't do this, just wondering if being honest would disqualify me from likely matching). Thank you so much for your advice!

So I have a few questions. One, what prompted this "touching base again" meeting? Have your grades continued to be borderline, or have they improved?

I wouldn't make light of addiction, but I think that @jdh71 has a point that there is a spectrum of drinking, and just because at one point you were an alcoholic doesn't NECESSARILY mean that the behavior you're currently engaging in is a problem. If you're unable to study and your grades are suffering, or you're routinely blacking out on the weekends, then yeah you probably need to just stop worrying about how this will affect your future application and take the time to get treatment. If you're doing well in class and the amount you're drinking isn't unhealthy... then only you can decide whether or not this amount of drinking would be damaging to your long-term health enough to warrant the LOA. Unfortunately, as others have said, there's probably no way that taking the LOA doesn't hurt you at some level, either in applying to residency or when you're applying for a medical license in several states. I don't think it's possible to quantify exactly how much it would harm your application.

One other caveat--if it would be possible to do some amount of research during this time where you're in treatment, that could help mitigate some of the damage that having to take this LOA would have on your application to some of these competitive specialties.

EDIT: One other question is whether the dean is actually giving you an OPTION of taking the LOA, or is trying to make it clear that he EXPECTS you to take the LOA or you'll be in trouble. If it's the latter... then yeah, you should probably strongly consider taking the LOA, as you don't want to lose the support of your dean.

FWIW, these types of questions very likely violate the ADA and several cases have held such.

Medical Licensure Questions About Mental Illness and Compliance with the Americans With Disabilities Act

Substantial numbers of medical students and physicians live with some form of mental illness. Over the years, many medical licensure boards have asked physician medical licensure applicants with Doctor of Medicine (MD) degrees intrusive questions about whether they have any psychiatric history...

jaapl.org

While your point is valid, I don't think anyone really wants to actually be the person to challenge these questions. So the fact that they may violate the ADA probably doesn't help the OP.

 

[DO2015CA]

I would like to echo this point. Bear in mind that I do not have experience with medical school administration or how Dean’s handle letters of recommendation however I do have experience writing and receiving letters of recommendation. I have found that when there is a concern about an applicant those writing the letters have a way of communicating that concern without necessarily being explicit for legal reasons. In this case I would be even more concerned given that the dean of your medical school likely has a relationship with residency programs that he or she would not be willing to jeopardize by giving a full throated endorsement of someone who isn’t taking their advice.

but if you take their advice then they will see it as maturity and they are more likely to give that full throated endorsement

 

[sloop]

While your point is valid, I don't think anyone really wants to actually be the person to challenge these questions. So the fact that they may violate the ADA probably doesn't help the OP.

I get that nobody wants to fight a legal battle for their license, but I disagree that the point isn't helpful.

One obvious response to the fact that some boards ask these questions is, as others have suggested, to let this problem dictate your decisions in life. I actually don't mean any judgment by this, as it may be the best and least intrusive course of action for some people.

The other is to recognize that these questions are probably illegal and apply for licensure wherever you like while being prepared to fight for your right to practice if it comes down to that. I'm not saying this is necessarily the best course of action, but it is an option.

Right now what we have in this thread is people simply complaining about the injustice. While I get that, the truth of our legal system is that we can't compel change to illegal, unjust practices like this unless some people are actually harmed by them. Generally, you actually have to be harmed to have a basis for bringing a civil case that would compel a change to a given practice. Of course that sucks for whoever is the unlucky person to incur the harm. Still, I think it's dumb to suggest that the only reasonable response for the person these questions would impact is to avoid those states asking such questions.

 

[GoSpursGo]

I get that nobody wants to fight a legal battle for their license, but I disagree that the point isn't helpful.

One obvious response to the fact that some boards ask these questions is, as others have suggested, to let this problem dictate your decisions in life. I actually don't mean any judgment by this, as it may be the best and least intrusive course of action for some people.

The other is to recognize that these questions are probably illegal and apply for licensure wherever you like while being prepared to fight for your right to practice if it comes down to that. I'm not saying this is necessarily the best course of action, but it is an option.

Right now what we have in this thread is people simply complaining about the injustice. While I get that, the truth of our legal system is that we can't compel change to illegal, unjust practices like this unless some people are actually harmed by them. Generally, you actually have to be harmed to have a basis for bringing a civil case that would compel a change to a given practice. Of course that sucks for whoever is the unlucky person to incur the harm. Still, I think it's dumb to suggest that the only reasonable response for the person these questions would impact is to avoid those states asking such questions.

While again your point is valid, I don't think that's what the OP was asking about

 

[UWIdahoan]

Assuming that this is true alcoholism and not simply a case of a student who parties irresponsibly at the expense of grades...

As an (alcohol) addict, you have a serious physiological derangement that has the potential to wreak havoc on the entirety of your life.

Deal with this maturely and emphatically. I can't speak for PDs, but if I happened to know that an applicant had taken as rational a step as this, (s)he would rank more highly in my estimation.

Gotta say that I agree with the point above. They say that 1 in 4 people in medicine have or have had a problem with addiction. That basically means we all know someone affected. As someone that has known and worked with people like this, the fact that you decided to put in the work to get sober says a lot about you and I would be impressed. It would increase your chances with me. But as others have stated above, I don't think you have to share your reason for a medical LOA if you are nervous about it. I also think that a medical LOA is not looked upon as poorly as an academic one, although I don't know if this is differentiated in your application.

 

[DO2015CA]

Gotta say that I agree with the point above. They say that 1 in 4 people in medicine have or have had a problem with addiction. That basically means we all know someone affected. As someone that has known and worked with people like this, the fact that you decided to put in the work to get sober says a lot about you and I would be impressed. It would increase your chances with me. But as others have stated above, I don't think you have to share your reason for a medical LOA if you are nervous about it. I also think that a medical LOA is not looked upon as poorly as an academic one, although I don't know if this is differentiated in your application.

It may not be in the application but interviewers will ask and you can just say medical condition that will not be an ongoing problem

 

[michaelrack]

To the OP: you sealed your fate when you told the dean about your alcohol problems. Now you have no choice but to follow his recommendation (,take the loa) and hope he has mercy on you when it comes time for residency application

 

[hallowmann]

I'm an M2. During my first year, one of the deans at my school scheduled time to speak one on one because my grades were close to failing. I've struggled with alcoholism for a long time and I explained this to the dean because I truly want to recover. He helped me get a therapist I've been seeing regularly. Recently this dean and I touched base again and he asked how my drinking is, and I told him the truth. Despite being an addict, something we both agree is a disease, I've been regularly drinking on the weekends and suppressing my desire to drink during the weekdays by attending daily AA meetings/weekly one on one therapy. After telling him this he was concerned and he recommended I take a leave of absence from now until later this year, where I'll pick back up to repeat my second year.

Some questions. How will a LOA for "medical reasons" effect my residency application? From the small amount of research I've done, it seems that it depends on how you address the LOA in your application/interviews. Is there a way to spin this so that it doesn't come out I had a drinking problem. Obviously that would be a red flag to residencies! Also, I am mainly interested in highly competitive specialties like diagnostic rads and dermatology. Assuming I have an application that supports me matching into these fields (high step scores, good post clinical grades, good letters, research), would my application be thrown to the side because of the LOA? Or would I at least have the chance to address it? If I get the chance to address it, would I have to be dishonest about why I took the LOA? (I wouldn't do this, just wondering if being honest would disqualify me from likely matching). Thank you so much for your advice!

I agree with others that you're asking the wrong questions here. Are you going to be able to make it through the rest of medical school and residency without going to treatment? An LOA is going to hurt you, and if you truly want to do Derm, either way you'll need to do extremely well through med school. Honestly that may be out. As for DR, yeah you should be OK there.

The fact that your Dean is telling you this, it sounds more like you don't need to determine how the LOA will affect you, you need to take it and hope you can do well enough in the future to match well.

I think you did the right thing talking to your dean if that's what ultimately led you to address your drinking. Other posters on here make it seem like that was a mistake. It wasn't. You did the right thing if that was your way to be held accountable. Your long-term health and life are more important than whatever way an LOA will harm your app.

I will also say that plenty of people take LOAs and do just fine with matching. Just take things one step at a time, and this first step is getting treatment.

 

[Mass Effect]

It may not be in the application but interviewers will ask and you can just say medical condition that will not be an ongoing problem

Not that easy. I agree that the OP should not be focused on the future right now as addiction is real and delaying treatment only makes the problem worse. However, I think the OP should also know the facts. Is it possible they just ask and then let it go? Yes. Is it likely? No.

I took time off for a medical condition (a physical illness). It didn't come up in any interview. My Dean's letter simply stated medical leave. During credentialing, I had to supply documentation of that illness as well as my most current physical. They get away with this because they need to insure that you're fit to treat the public. Where it becomes an ADA violation is if they then deny your license despite being in recovery.

OP, I had a friend in med school who entered rehab during MS4 and had to be tied up with the state's physician health program (if you don't know about the PHPs, do some research. They'll scare the crap out of you and reaffirm the decision to take the LOA now before you're on their radar) and had to sign a contract for monitoring. For 5 years after rehab, the PHP could call him any morning and tell him to report for mandatory drug/alcohol testing. Even one slip would cost him his license. For the rest of his life, he has to answer the question on every state's licensing application: "have you ever been monitored by a PHP?" And if the answer is yes, you better believe you have to provide full documentation. In those cases, they may want all your records.

Moral of the story: don't mess around. If you truly have a problem with alcohol, nip it in the bud while it's contained and controlled. Don't risk being put through the above.

 

[DO2015CA]

Not that easy. I agree that the OP should not be focused on the future right now as addiction is real and delaying treatment only makes the problem worse. However, I think the OP should also know the facts. Is it possible they just ask and then let it go? Yes. Is it likely? No.

I took time off for a medical condition (a physical illness). It didn't come up in any interview. My Dean's letter simply stated medical leave. During credentialing, I had to supply documentation of that illness as well as my most current physical. They get away with this because they need to insure that you're fit to treat the public. Where it becomes an ADA violation is if they then deny your license despite being in recovery.

OP, I had a friend in med school who entered rehab during MS4 and had to be tied up with the state's physician health program (if you don't know about the PHPs, do some research. They'll scare the crap out of you and reaffirm the decision to take the LOA now before you're on their radar) and had to sign a contract for monitoring. For 5 years after rehab, the PHP could call him any morning and tell him to report for mandatory drug/alcohol testing. Even one slip would cost him his license. For the rest of his life, he has to answer the question on every state's licensing application: "have you ever been monitored by a PHP?" And if the answer is yes, you better believe you have to provide full documentation. In those cases, they may want all your records.

Moral of the story: don't mess around. If you truly have a problem with alcohol, nip it in the bud while it's contained and controlled. Don't risk being put through the above.

good education point. thanks. That is certainly crummy to have to deal with

 

[deleted826813]

Not that easy. I agree that the OP should not be focused on the future right now as addiction is real and delaying treatment only makes the problem worse. However, I think the OP should also know the facts. Is it possible they just ask and then let it go? Yes. Is it likely? No.

I took time off for a medical condition (a physical illness). It didn't come up in any interview. My Dean's letter simply stated medical leave. During credentialing, I had to supply documentation of that illness as well as my most current physical. They get away with this because they need to insure that you're fit to treat the public. Where it becomes an ADA violation is if they then deny your license despite being in recovery.

OP, I had a friend in med school who entered rehab during MS4 and had to be tied up with the state's physician health program (if you don't know about the PHPs, do some research. They'll scare the crap out of you and reaffirm the decision to take the LOA now before you're on their radar) and had to sign a contract for monitoring. For 5 years after rehab, the PHP could call him any morning and tell him to report for mandatory drug/alcohol testing. Even one slip would cost him his license. For the rest of his life, he has to answer the question on every state's licensing application: "have you ever been monitored by a PHP?" And if the answer is yes, you better believe you have to provide full documentation. In those cases, they may want all your records.

Moral of the story: don't mess around. If you truly have a problem with alcohol, nip it in the bud while it's contained and controlled. Don't risk being put through the above.

This is absolutely the truth. I do know about PHPs and my dean and I spoke about my concern being thrown to one originally. In my dean's words, "We are here to help you, not screw you." Hopefully administrators at other schools act similarly. I also believe that coming to them with my issues before messing up added to their willingness to give me a chance.