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I am an AMG. After medical school graduation, I was hospitalized several times for bipolar psychosis before receiving the correct diagnosis and treatment, which ended up costing me my residency (after my program found out I was admitted to a psych unit they insisted I see an outside psychiatrist who confirmed the initial diagnosis; because of this the program did not renew my contract). I did not complete intern year.

Fortunately I am now in full remission. After consultation with an attorney specializing in licensing matters I initially decided not to further pursue residency training due to anticipated difficulties with completing training and attaining a medical license, such as having to disclose complete medical records to the Board, potentially having to inform any future program of my illness and therefore being placed under a microscope, or the potential need for ongoing compliance with onerous Board recommendations.

I am currently stablely employed at a decent, medically tangential job, but still have the dream of pursuing medical training in IM. Counteracting this dream is the above fears of eventually not being able to practice because I'm denied a license by the Board for my past hospitalizations.

Assuming I match somewhere with gaps on my CV and 4 years since graduation (with a good medical school record), which I understand is not a guarantee, I would have to decide between my current, stable, job and going back to residency. Does anyone have any experience with how a State Medical Board would treat my situation? My treating psychiatrist would be able to attest to my current state of wellness, if that matters to a Board.

Any perspective this forum could offer on this issue would be helpful, and I will collate that information with further consultation with the attorney before arriving at the important decision on whether to apply again or give up, cut my losses, and move on.


Happy to answer questions, but will need to preserve my anonymity.
 
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Crayola227

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One of the biggest hurdles I can see is taking overnight call.

Can I ask if you're on any very sedating medications like Seroquel or if you're managed with something still powerful for preventing mania but not as sedating like lithium? I don't mean it as medical advice and you don't need to be specific. It makes a big difference if you're trying to practice or have overnights.

I've seen some bad things up close and personal in med school and residency with someone having to majorly cut back on or even skipping doses of some bipolar meds in order to function. How dangerous this is varies. If you're on meds that can affect you cognitively like olanzapine or quetiapine, the temptation will always be there. This isn't me trying to knock on anyone's adherence, it's a statement of fact about trying to be on certain meds for bipolar and read and write complex notes 24 hrs in a day.

There's also switching to a night float block and sleep getting changed up as well. This is going to be heavily influenced by how easily you can change your rhythms and be up all night and actually sleep all day. This is where being on a sedating med can potentially be more helpful.

Also any required shifts in the ED.

Depending on what your illness looks like, what meds you're on, and responses you've had, can be a huge piece of this, and to expect to get through residency's grueling hour/sleep changes without needing any medication adjustments.... that isn't always realistic. And there lies some more dangers and unknowns.

You are also probably aware there comes a point with BPAD where you don't feel yourself slipping off the boat if you know what I mean. That's the real danger.

To my knowledge one of the more onerous things a board can require is that you do regular urine or blood drug screens to prove compliance with your meds, and to see a psychiatrist of their choosing.

Any recreational drugs or even alcohol is probably going to be a big no-no too. If there's any history there, expect it to come up and also to perhaps be required to be a tee-totaler. This isn't an awful thing if you have bad BPAD, but it's a reality and some people resent not being able to have a monthly drink for a special occasion like a wedding.

Hopefully alcohol or other hasn't been a bigger part of the picture, or you can expect more monitoring, and you can read up about how onerous that can become.

In any case I can tell you right now everyone is going to be *very* interested in the circumstances of your mood episodes, what brought them on, what is preventing more of the same, and how you will cope with the challenges to sleep and rhythms we discussed, and do the required rotations.

You need a psychiatrist who is very intimate with your history and response, and is 100% in your corner, to answer this even more than the attorney's advice although I'm extremely pleased you're being advised by one about this.

There is one program I know of, years ago, boasted having a track that eliminated anything more than a 16 hr day. That was UC Riverside. Not sure if that's still true, where else may run that way, or chances of you getting a foot in that door. That's something to think about.

There is also how much the law requires you to disclose to an employer. They are going to want to know way more than they are legally entitled to, and you likely aren't going to have any luck withholding any info they want. Work with your attorney but know that you will need to be pretty forthcoming about things I've mentioned, rights or no rights.

The board, the attorney can help you with information management, which is limited but the most you'll be able to do will be with an attorney's help.

But at the end of the day if you don't tell them everything they want, they can just deny your license. If you withhold any info they ask for and later it comes out, that can lead to big do-do. If they grant you a license, you basically cede any and all privacy as a lot of state boards have liberal leeway under the laws of the state to subpoena any and all your medical records, and HIPAA will not slow them down. I've seen this, so to any nay-sayers, you don't know what you're talking about or it's just your state.
 

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I'm not trying to discourage you in anyway. I don't know how much luck you'll have or not. There are some hard questions in your future, and a lot of it comes down to your history and how sensitive your illness is to relapse under conditions present in residency like sleep deprivation, and your ability to function on a medication regimen that keeps you safe.

I can envision resident training and attending practice in a number of fields being possible for most people with bipolar disorder or other conditions/disabilities, but I think the way things are insisted upon being done in the US makes it essentially impossible for many. That's a cause for another thread.

Also what recent clinical experience do you have? Have you been able to function in any way clinically? That is very difficult to do without a license but it's something programs and boards may want to see to feel comfortable letting you back in.

I truly, truly wish you the best of luck, and I sincerely hope you can find somewhere to give you a chance and support you to attendinghood. I have no doubt that you would be fine as an attending if you can only get through the drudgery of residency.

Feel free to PM me. I don't know everything about this but I know some.
 
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There is no answer to your question, because each board is different. And most boards have a training license for which the process / rules may be different than a full license. So there's no way to tell you what will happen, since each state will have a different process.

For residency, anyone who interviews you is likely to ask for details and check with the state board first -- as there's no point in matching you if you won't get licensed. Not all boards will review applications early. And there's no way for you to contact boards and find out.

In the end, if you decide to proceed you just apply and see what happens. I am concerned that you won't get many interviews. You will need to answer the "Do you expect any licensing problems?" question positively. You'll need to be upfront about what happened in your prior residency, and include a letter from them discussing your termination. You should avoid the five states with the most difficult licensing issues: CA, FL, MA, TX, and PA.
 
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There is no answer to your question, because each board is different. And most boards have a training license for which the process / rules may be different than a full license. So there's no way to tell you what will happen, since each state will have a different process.

For residency, anyone who interviews you is likely to ask for details and check with the state board first -- as there's no point in matching you if you won't get licensed. Not all boards will review applications early. And there's no way for you to contact boards and find out.

In the end, if you decide to proceed you just apply and see what happens. I am concerned that you won't get many interviews. You will need to answer the "Do you expect any licensing problems?" question positively. You'll need to be upfront about what happened in your prior residency, and include a letter from them discussing your termination. You should avoid the five states with the most difficult licensing issues: CA, FL, MA, TX, and PA.
My strategy would be to apply only in the 9 states that do not require a training license. Do you think interfacing with the board only after training would help my situation?

What do you mean that someone will check with the board first? You mean contact them with information about my scenario to see whether they would license me?

Can you go into more detail about what you mean by being upfront during interviews? How much would you disclose and is there any specific way you'd recommend to present the narrative during interviews? My fear is that programs wouldn't rank me if I shared the narrative in my original post. Do you think someone somewhere would be willing to rank me?
 
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NotAProgDirector

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You were let go from your residency program. I think you're going to need to be 100% up front in your application with your story. You can certainly just say you had a medical illness that you've now recovered from. But the story is going to come out -- either in getting licensed, or when onboarding with the program (which will require completion of a medical review / fitness for duty). Programs might balk at your history, and then you'd have nothing. I think you're better off disclosing up front -- that way you know that anyone who interviews you is seriously considering you.

The other choice is to keep it hidden. If your prior program just reports that you became ill and were not renewed, and no more than that, then it might not come up any further than that. Then if you match to a program, you could hope they are willing to onboard you, or perhaps even force them to do so because they matched you. I don't recommend that -- it will leave you fighting with your new program on day 1.

If there are 9 states that don't have any sort of training license at all, then that's perhaps a good option to target. What states are these?
 
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I think you're going to need to be 100% up front in your application with your story.
Can you be even more specific than this? Does this mean specifically saying that I had a mental illness which is now resolved? Or just an illness in general?
I think you're better off disclosing up front -- that way you know that anyone who interviews you is seriously considering you.
You mean in the application itself? The personal statement?
What states are these?
I do not know which states at this time except New York and that there are 8 others. I am currently researching which these are.

Do you think in general that a Board would license me at the end of all this? Although my problem was severe it's currently under excellent control. Do boards ever deny licenses for a diagnosis alone?

Similarly, do you think a PD would rank someone with mental illness if I were to be fully transparent? The stigma is so strong that I can easily envision this dropping me off rank lists.
 
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No, just abilify, very well-tolerated.

Will there be a separate issue with hospital credentialing down the line? How does this differ from applying for a license through the board?

No recent clinical experience.

What’s your relationship like with your medical school? Any peers now faculty that might be willing to take a chance on you?
 
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What’s your relationship like with your medical school?
It is what I would describe as fine. I have 1 mentor who knows about my illness and would go to bat for me. As of right now the school is unaware I had these issues after graduation.

Also, my medical school is in a state that has a training license, which works against me.

For further context, I am now 3 years out from my graduation.
 
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Can you be even more specific than this? Does this mean specifically saying that I had a mental illness which is now resolved? Or just an illness in general?

You mean in the application itself? The personal statement?

I do not know which states at this time except New York and that there are 8 others. I am currently researching which these are.

Do you think in general that a Board would license me at the end of all this? Although my problem was severe it's currently under excellent control. Do boards ever deny licenses for a diagnosis alone?

Similarly, do you think a PD would rank someone with mental illness if I were to be fully transparent? The stigma is so strong that I can easily envision this dropping me off rank lists.
I think you're going to face problems no matter what you do.

You could just state that you had a medical illness, and now you're better. But after 4 years of being out of medicine, and a vague story like that, I think programs may worry about what you're not telling them. And then if you match, you'd then need to fully disclose as part of the onboarding process, and it's possible that they might think you unfit to proceed, or place you under a microscope.

Or, you could fully disclose in your PS the whole story. I totally agree that the stigma is real. Programs are going to worry that you'll decompensate. Programs will decline to interview you, and you will drop on rank lists. But if you do match, at least you'd know that program is willing to go to bat for you.

That's where I see the trade off -- don't disclose, better chances of matching, but increased chances of matching at a program that feels you pulled the woll over their eyes, VS disclose, less chances of matching, but if you do match it's at a program that will support you. There's no clear "right" answer.

Unfortunately, 3 years out of any practice and with this issue, I worry that you won't get much interest either way. But it really can't hurt to try (except the cost of application).

If you do match and complete a residency, I don't expect any problems getting a full license. At that point your issues will be years in the past, and you'd have proven you remain stable in a residency program. Is there some chance that some state might refuse you? Sure. And might they require some sort on ongoing monitoring? Yes, that's possible too.

You haven't mentioned what field you're thinking about.
 
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Crayola227

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My strategy would be to apply only in the 9 states that do not require a training license. Do you think interfacing with the board only after training would help my situation?

What do you mean that someone will check with the board first? You mean contact them with information about my scenario to see whether they would license me?

Can you go into more detail about what you mean by being upfront during interviews? How much would you disclose and is there any specific way you'd recommend to present the narrative during interviews? My fear is that programs wouldn't rank me if I shared the narrative in my original post. Do you think someone somewhere would be willing to rank me?
You might want to broaden where you apply at some point if you don't get interviews. I know it costs. But no interviews means no matching (or you can try to scramble).

I would try to get in with a program that I thought might be supportive, and if you're lucky enough to rank just rank ones with no training license at the top, and ones that do lower down if you're concerned.

If you match, most likely your program is going to try to help as much as they can with the licensing portion with the board, but that assumes you match, and aPD brought up a good point about the questions about licensing coming up and that possibly they would want to check with the board first.

You can contact medical boards ahead of time to ask questions, but it's anyone's guess how helpful they are, or how much anonymity you can maintain in doing so. I would certainly email from a burner acct or call from a private number and see what I could find out. Then go from there if that approach failed to get any info anywhere.

Please do us the favor of letting us know which states don't require a training license if you figure that out.

If I were you, I would have a list of the 50 states and I would go through each one and do research to find out as much as possible about each to create the widest net I could. And contact the boards as I described for more info.

I personally think interfacing with any board is going to be better after successfully completing a residency. It can still be a long and onerous process, but you it will be easier for you to find a state that will license you although likely with some hoops, then trying to thread the double needle of a program accepting you and a board licensing you.

This is an all hands on deck situation.
 

Crayola227

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I think you're going to face problems no matter what you do.

You could just state that you had a medical illness, and now you're better. But after 4 years of being out of medicine, and a vague story like that, I think programs may worry about what you're not telling them. And then if you match, you'd then need to fully disclose as part of the onboarding process, and it's possible that they might think you unfit to proceed, or place you under a microscope.

Or, you could fully disclose in your PS the whole story. I totally agree that the stigma is real. Programs are going to worry that you'll decompensate. Programs will decline to interview you, and you will drop on rank lists. But if you do match, at least you'd know that program is willing to go to bat for you.

That's where I see the trade off -- don't disclose, better chances of matching, but increased chances of matching at a program that feels you pulled the woll over their eyes, VS disclose, less chances of matching, but if you do match it's at a program that will support you. There's no clear "right" answer.

Unfortunately, 3 years out of any practice and with this issue, I worry that you won't get much interest either way. But it really can't hurt to try (except the cost of application).

If you do match and complete a residency, I don't expect any problems getting a full license. At that point your issues will be years in the past, and you'd have proven you remain stable in a residency program. Is there some chance that some state might refuse you? Sure. And might they require some sort on ongoing monitoring? Yes, that's possible too.

You haven't mentioned what field you're thinking about.
They did, IM.
 

Crayola227

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I think you're going to face problems no matter what you do.

You could just state that you had a medical illness, and now you're better. But after 4 years of being out of medicine, and a vague story like that, I think programs may worry about what you're not telling them. And then if you match, you'd then need to fully disclose as part of the onboarding process, and it's possible that they might think you unfit to proceed, or place you under a microscope.

Or, you could fully disclose in your PS the whole story. I totally agree that the stigma is real. Programs are going to worry that you'll decompensate. Programs will decline to interview you, and you will drop on rank lists. But if you do match, at least you'd know that program is willing to go to bat for you.

That's where I see the trade off -- don't disclose, better chances of matching, but increased chances of matching at a program that feels you pulled the woll over their eyes, VS disclose, less chances of matching, but if you do match it's at a program that will support you. There's no clear "right" answer.

Unfortunately, 3 years out of any practice and with this issue, I worry that you won't get much interest either way. But it really can't hurt to try (except the cost of application).

If you do match and complete a residency, I don't expect any problems getting a full license. At that point your issues will be years in the past, and you'd have proven you remain stable in a residency program. Is there some chance that some state might refuse you? Sure. And might they require some sort on ongoing monitoring? Yes, that's possible too.

You haven't mentioned what field you're thinking about.
As far as being considered unfit after matching, I don't know how much luck the program will have with that.

Technically in the onboarding anything to do with the OP's health is kept confidential in HR, and details would not be passed along to the program beyond if the employee meets the essential job functions or not, with or without accommodation and what those accommodations might be if necessary.

My understanding is that it is HR that onboards and collects info on the health screening questionnaire, and would be the ones to determine if the OP meets the essential job functions or not. My understanding is that the program has little to do with this unless a problem is found in the onboarding process, and then they mostly are advising HR as to the essential job functions and what accommodations can be accommodated or not.

My understanding is at that point HR is called upon to consider the questionnaire and ask for further evaluation of the employee (by the employee's agents or HR's agents) to see if the employee can meet the essential job functions with or without reasonable accommodation.

The role of the program is in outlining the functions and being consulted about any accommodations. Where the program has power is in how they inform HR whether or not accommodations required can be made or not.

Perhaps this isn't universal, and certainly a program has a lot of influence over HR's decisions in onboarding.
 

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I'll echo the above. States vary in what they ask and how they ask it. Do they have a right to? Debatable. No, they shouldn't pry into your medical conditions, but they also have a duty to protect the public from someone who is impaired and they have no way of knowing who might be impaired without asking the questions.

Even if you got past licensing, I think IM would be a bad field for you. Maybe an outpatient based FM residency? Or psych? Or derm? Or path? The problem with IM is that at many hospitals, it's going to be hospital based with many overnight calls. With bipolar disorder dysregulating your sleep can trigger a relapse. You need a program that will accommodate you with as few overnights as possible and IM just can't do that because of the nature of the work. That's not medical advice, just a fact about bipolar disorder. Take it for what it's worth.

And by the way, I'm sorry your career was derailed. I think it's pretty cool and brave that you want to come back to medicine. I wish you well and hope you're able to.

I'll leave you with this regarding licensing.

 
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you'd then need to fully disclose as part of the onboarding process, and it's possible that they might think you unfit to proceed, or place you under a microscope.
Are you certain I would need to disclose at the time of onboarding? Anyone have any advice on this?
 

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Are you certain I would need to disclose at the time of onboarding? Anyone have any advice on this?
Yes, they ask specific questions about what medications you take, which is part of the screening because they also do urine drug testing, although they don't generally look for most bipolar meds.

Lying about what controlled substances you take on a form like this is an awful idea.

They ask you about any and all health conditions and if there is anything that could impair you. Trying to hide a condition on these forms would not be a good idea, if it ever came out later you have basically voided all the terms of your employment with no recourse if they terminate you over it.

Huge risk when it's certainly possible for you to have an unforeseeable relapse or medication side effects that unmask what's going on.

Plus you might need accommodations to attend psych appts for med management. If you don't disclose it will be harder for you to get time off to see your psych, and you need to see one regularly (not medical advice as I'm about to explain....)

One thing you MUST do for your career is see a psychiatrist or other prescriber regularly, say at least once every 3 months if not more, NO MATTER WHAT. Meaning even if you are completely stable and even if no changes needed to your meds. This is because in the absence of having issues with your condition or meds, it also demonstrates adherence and that you independently seek oversight no matter what, even when well and not required you are seeking oversight. This history is ESSENTIAL to any board or hospital licensing or credentialing you.

It gives you a leg to stand on if they want to make problems for you, it can make the process smoother as they may not make a problem for you seeing your history, it can also give you what few means there might be to argue against more stringent monitoring or evals they might require.

I can't emphasize this enough. If you are a bipolar college or med student, or resident or attending physician, one of the best things you can do for your career is always see a mental health specialist for monitoring on a frequent basis. It does not establish that you're "sick" and need oversight. It establishes your adherence and that there is a safety net over you no one else has to enforce. This is huge because it proactively helps address a #1 concern about you.

Anyway that's a side rant. I don't recommened withholding any info in the onboarding process. But consult an attorney more familiar with employment and ADA law about the specifics.

Also, to have most ADA protections and to ever possibly allege employer discrimination over your health condition, they must be aware of your disability at the time. So keep in mind that while there are downsides to disclosing to anyone you don't have to, you have to disclose to HR and doing so will have some benefit, and not doing so has few upsides.
 
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You will need to disclose this to the institution as part of the onboarding process. In a place that's well run, your program will not be privy to the details.

The other way your program can find out is from the license application. Some state boards require you complete all the paperwork and turn it into your program --- and then they see your answers. But we covered this above, sounds like you're focusing on states without a training license.
 
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Do similar issues to getting a license crop up at any other point? Such as hospital credentialing?
 
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For what its worth OP, my program actually waived the overnight call requirement for a few people with legitimate medical disorders, disorders that would be provoked by lack of sleep. But im also in psychiatry which generally is a bit more forgiving than IM.

IM residency might be a bit intense for someone with bipolar, not that they couldnt do it, but im just thinking it may be a more difficult road. Have you considered other specialties?

Also firing you because you went to an inpatient psych facility, isnt that a violation of ADA or discrimination of some sort?
 
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FWIW, I trained in WA and knew someone with very similar experiences to yours, with no support from the prior program, who was able to get into a new program after several years out of medicine and graduate. She was very open from the start. I am not sure that psychiatry is any more accommodating than other specialties. We did have night float, but never Q4 call.

I knew someone else who switched out of medicine into psychiatry after being diagnosed. She was in training when call was worse than now.
 
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Do similar issues to getting a license crop up at any other point? Such as hospital credentialing?
Short answer is yes.

As someone who does hiring and credentialing, I will tell you that if your app came across my desk and showed that you'd been stable and well controlled for 5-10 years and had completed a residency without difficulty and had the support of your PD, I would have no problem saying yes to your privileges request.
 
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FWIW, I trained in WA and knew someone with very similar experiences to yours, with no support from the prior program, who was able to get into a new program after several years out of medicine and graduate. She was very open from the start. I am not sure that psychiatry is any more accommodating than other specialties. We did have night float, but never Q4 call.

I knew someone else who switched out of medicine into psychiatry after being diagnosed. She was in training when call was worse than now.

I think psychiatry, as a whole, is a lot more accommodating than medicine.
 
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