Mental Health Struggles Before Starting Residency

[Doctor Gregory House]

I owe several years to the military and this summer I will be starting at a military residency in a very competitive surgical subspecialty. Due to a multitude of reasons, I've been experiencing significant worsening struggles with my mental health over the last several weeks. I have a history of debilitating GAD and MDD for which I am on medication for, but since I have not officially started my active duty service yet I have elected to keep this part of my medical history to the civilian side only. I am getting clinical treatment but this current situation has made me extremely worried about the next several years of my life.

I want to know from the experienced members of this community what I should do moving forward with regard to establishing care in the military healthcare system once I start residency? And what would happen if, god forbid, I declined to a point where a leave of absence might be recommended? In my first year of medical school I had to be admitted as an inpatient for about a week because of mental health struggles. I've worked incredibly hard to get to this point but I'm scared of choosing between losing my mental health or losing my career in the process.

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[DeadCactus]

I lack the relevant experience and background to provide any advice I would trust. I'm sorry your going through this and glad you're seeking the support you need. Hopefully the right people chime in with some advice.

 

[HighPriest]

I can’t comment on everything here. What I can say is this:

-by and large military residencies are a bit more forgiving than civilian residencies. That is a stark generalization, but it is more often true than not. Certainly some military residencies are harder than some civilian counterparts, but comparing averages, you’re better off in the military than not.

-think about a potential leave of absence as two different processes: a leave of absence from an ACGME residency program, which will work just like any other program, and leave from military service. If you have a legitimate medical condition, both are reasonable. If you’re a good resident, people will probably try to help you when you need it. But of course, @$$holes show up everywhere without notice.

-what you definitely want to do is get established with a PCP as soon as you get to yo ur duty station. This will take some time. Make sure you have enough medication to last you a couple or a few months before you leave your current provider. You’ll usually have to see your PCP before seeing an actual mental health provider. Some of the PCPs will want to try to manage your care, some will not. Self-advocate. If you want to see a psychiatrist, tell them that. If you’re ok having them take a swing, that’s fine. But if you don’t say anything, you may not get what you want. Don’t be a dick, but let them know what you want and why. Maybe you don’t feel comfortable talking with someone you may work with on a daily basis and you want to be referred off post. You can ask for that. It could be denied, but often it won’t.
But you have to start getting those ducks in a row right away. Don’t wait for it to be a problem that’s effecting your residency.

-you may, or may not, want to give you program director a heads up. That’s a tough call. It’s your medical condition and so from an acgme standpoint it’s none of his business. From a military standpoint it’s his business if it’s influencing your ability to be at your duty station. If he/she is a good person they won’t use it against you. But you never know. I’d definitely feel that out for a while.

Any medical condition can make residency harder. But this doesn’t make it impossible. Take care of your health.

 

[backrow]

If there is a medical condition effecting your success during residency you can be placed on a Health Related Absence From Training (HRAFT) which will allow you to effectively “pause” residency while you receive care for a health reason. During this time your command will find a job for you that doesn’t involve patient care or residency obligations (for example in the research department or some admin job). You’ll still show up to work, but will show up to a job that has much flexibility allowing you to get to your appointments or other medical needs.

 

[HighPriest]

If there is a medical condition effecting your success during residency you can be placed on a Health Related Absence From Training (HRAFT) which will allow you to effectively “pause” residency while you receive care for a health reason. During this time your command will find a job for you that doesn’t involve patient care or residency obligations (for example in the research department or some admin job). You’ll still show up to work, but will show up to a job that has much flexibility allowing you to get to your appointments or other medical needs.

What if your illness is a need for speed?

 

[backrow]

What if your illness is a need for speed?

Then we just prescribe you more cowbell while you watch Top Gun 2.

 

[HighPriest]

Then we just prescribe you more cowbell while you watch Top Gun 2.

I have such mixed feelings about that.

 

[pgg]

I have a history of debilitating GAD and MDD for which I am on medication for, but since I have not officially started my active duty service yet I have elected to keep this part of my medical history to the civilian side only.

ohboy.jpeg

This was the wrong answer and may be a problem. It'll probably be fine, as the military is highly motivated to see you succeed at this point, but this was objectively contrary to the contract you signed when you entered the HPSP program. Your inpatient admission for a chronic medical condition can't really be blown off as no big deal from the military's perspective.

From the very first day you are commissioned into HPSP, you're obligated to keep the military informed of health conditions that may impact your ability to serve out your commitment. In virtually every case, if the condition is being treated and is controlled, the military will elect to keep on keepin' on, and continue. They want to see you succeed, and they want to get the doctor they're paying for. But you don't get to keep this kind of secret from the military.

Think of it from the military's perspective - imagine someone who starts HPSP in good health, but then gets his legs chopped off in a freak accident involving a blender and an iPhone power cord ... but he doesn't say anything to the military. The military keeps paying his tuition for the next 4 years. He manages to stay in school and graduate, but then the military finds out about his ambulation impairment and determines he's not fit for full duty. He will be processed out and handed a bill for all that tuition.

You're required to disclose this medical condition. Start with your HPSP point of contact. Lead with words to the effect of "I'm receiving treatment for ____, I'm doing well, graduating soon, looking forward to coming on active duty ___." You don't necessarily need to mention it to your future program director, though if you expect you will need reasonable accommodations while in training, you will eventually have to.

Again, the military is invested in you and wants to see you succeed (and get their $ worth out of you), so I have every expectation that things will be fine.


With regard to establishing care when you move to your new duty station (residency), easy enough, you'll just need a referral in the system from whoever your primary care manager is. You can probably get this started before checking in.

 

[HighPriest]

Yeah I missed that part. Not letting the military know at all is a bit of a potential issue.

 

[TheEarDoc]

ohboy.jpeg

This was the wrong answer and may be a problem. It'll probably be fine, as the military is highly motivated to see you succeed at this point, but this was objectively contrary to the contract you signed when you entered the HPSP program. Your inpatient admission for a chronic medical condition can't really be blown off as no big deal from the military's perspective.

From the very first day you are commissioned into HPSP, you're obligated to keep the military informed of health conditions that may impact your ability to serve out your commitment. In virtually every case, if the condition is being treated and is controlled, the military will elect to keep on keepin' on, and continue. They want to see you succeed, and they want to get the doctor they're paying for. But you don't get to keep this kind of secret from the military.

Think of it from the military's perspective - imagine someone who starts HPSP in good health, but then gets his legs chopped off in a freak accident involving a blender and an iPhone power cord ... but he doesn't say anything to the military. The military keeps paying his tuition for the next 4 years. He manages to stay in school and graduate, but then the military finds out about his ambulation impairment and determines he's not fit for full duty. He will be processed out and handed a bill for all that tuition.

You're required to disclose this medical condition. Start with your HPSP point of contact. Lead with words to the effect of "I'm receiving treatment for ____, I'm doing well, graduating soon, looking forward to coming on active duty ___." You don't necessarily need to mention it to your future program director, though if you expect you will need reasonable accommodations while in training, you will eventually have to.

Again, the military is invested in you and wants to see you succeed (and get their $ worth out of you), so I have every expectation that things will be fine.


With regard to establishing care when you move to your new duty station (residency), easy enough, you'll just need a referral in the system from whoever your primary care manager is. You can probably get this started before checking in.

This is spot on. You technically must be fit for duty and failing to disclose health conditions which may hinder your fitness for duty is going to be a problem for the military especially if you are hiding this and they find out. You could be on the hook for a lot of money and depending how upset someone gets could see far worse consequences.

As others have said, DOD invested in your education and it's in their best interest to get a good return on that investment and do what they can to get you through training and fulfill your contract, but when you hide stuff from Uncle Sam some tend to not take it well and bad things can happen.

Come clean now, work on your health, and let the chips fall as they may.