Negative consequences of applying for deferment of matriculation for major trans-related surgery (vaginoplasty)?

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chayadoing

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I recently was accepted into an MD school in the NYC area. I also have a DO acceptance which is going to expire soon. Being a disadvantaged transgender applicant was a big part of my personal statement and my application (but a tiny part of my interviews, other than being socioeconomically disadvantaged). I am a non-traditional applicant and survived intense childhood trauma, domestic violence and homelessness to make it here. However, due to the course of the pandemic delaying both my surgery date and my application process, I now have a surgery date (with a popular and well-reputed surgeon who has a looooong waitlist 15-24 months out, i.e. it is not something easily re-scheduled) that falls right in the middle of my first semester of medical school. As someone who fought tooth and nail to get here, I now have to figure out how to sort out two of my biggest life goals.

The surgical team has known ahead of time I am applying to medical school (they even asked for my MCAT score, lol). After getting my acceptance, I reached out to the social worker on my surgical team and he strongly recommended that I not attempt to undergo vaginoplasty and medical school at the same time. For the uninitiated, the recovery process for the procedure is just as important to the surgery (so they emphasize to us) as well as the need to be on a four times a day q4h dilation schedule for the first 8 weeks (which makes a lot of common tasks, like commuting) difficult. I literally attended a 3-hour seminar on zoom organized by the surgical team (with dozens of other patients) who stressed how important it was to avoid physical exertion or even taking public transit during that period, so as not to rupture any suture lines, compromise depth, and cause other complications that will last us a lifetime. Hence I am no longer considering this option (just going ahead and doing my surgical procedure and first semester of medical school at the same time). This gives me two other options:

Option 1:
I think the surgeon would be very amenable to trading dates with someone who would be scheduled at the start of my 8-9 week summer break at my accepted school. I am currently leaning to this decision. However, the social worker hasn't gotten back to me about available push-forward dates yet. In addition, I think I can stretch financial aid (loans and hopefully grants) to help me cover living expenses during this time I cannot work. (I am very used to living frugally and I am paying way below market for rent compared to what the room and board estimate for cost of attendance.)

Option 2:
But if the social worker cannot find a suitable conflict-free date for me, I am also considering asking for a deferment from my top choice acceptance in part because recovery would be less rushed (which is important to me) and in part because I had so much overtime this pandemic that I might be income-ineligible for Medicaid and be forced to choose an employer-dependent plan or a marketplace plan less accepting of trans patients (my current managed health plan is tailor-designed for trans patients). I am worried that once I get on a school health insurance plan outside Medicaid that commercial insurance gatekeepers will just throw a lot of obstacles in my path to cover my surgical procedure, which I have waited a whole lifetime for. However, the financial pressures of having to continue to work after recovery (especially on my partner who I intend to marry and raise a family with eventually) and not being able to work during recovery (or receive financial aid) is a negative consideration for this option.

I am most worried that applying for deferment while mentioning my surgery date might lead to rescindence of admission, because I would be causing enough trouble with my request that they would rather give my spot to a waitlisted student. How likely is this outcome? Should I ask for deferment before or after committing to enroll at my top (accepted) choice?

When giving me advice, please keep in mind that I am transgender, low-income and survived a significant amount of interpersonal violence to get here. My FAFSA EFC is 0 and I have been on Medicaid for much of my adult life. I am hoping to avoid any advice that one would give to a wealthier student.

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Deferring for medical issues is an honest reason for a deferral.

I agree with your surgeon, do not try to do med school while you're recovering from major surgery.

They're not going to rescind your acceptance for asking for a deferral.
 
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Deferring for medical issues is an honest reason for a deferral.

I agree with your surgeon, do not try to do med school while you're recovering from major surgery.

They're not going to rescind your acceptance for asking for a deferral.
What would be the appropriate timeline to ask this? Immediately? I just submitted the refundable $100 deposit. Are there any general guidelines ?

I’m lighting candles for Shabbat imminently and will check on this thread tomorrow night.
 
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Check if your accepted school has a chapter of the Medical Student Pride Alliance or BNGAP. Talk to the student affairs administrator in confidence or appropriate diversity administrator. I would do this as soon as possible if you have already established the timeline for your surgery and recovery. You should be fine with a deferral due to medical issues and should be advised how to disclose this to the appropriate admissions administrator and faculty members/deans.
 
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I am not sure if it would even be legal but if it was technically legal and they did it, a strongly worded letter from a lawyer would probably do the trick. If that fails, a good lawyer would go to the media
 
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I am not sure if it would even be legal but if it was technically legal and they did it, a strongly worded letter from a lawyer would probably do the trick. If that fails, a good lawyer would go to the media

Involving a lawyer before the OP even asks for a deferment from a school is pretty inflammatory and not the best strategy. OP, ask for the deferment. If you're sure you're going to this school then feel free to ask ASAP as it gives them more flexibility. The level of detail of the reason for the surgery you want to go into is up to you (most important is surgeon's recommendation that you not go to medical school during recovery and that it is a temporary and will be resolved by next year's matriculation date). I would think most schools would be fine with a one year deferment.

Key in all these interactions is don't devalue yourself or your application. They gave you the A. They want you. They will do what they can to have you as a student either this year or next.
 
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Involving a lawyer before the OP even asks for a deferment from a school is pretty inflammatory and not the best strategy. OP, ask for the deferment. If you're sure you're going to this school then feel free to ask ASAP as it gives them more flexibility. The level of detail of the reason for the surgery you want to go into is up to you (most important is surgeon's recommendation that you not go to medical school during recovery and that it is a temporary and will be resolved by next year's matriculation date). I would think most schools would be fine with a one year deferment.

Key in all these interactions is don't devalue yourself or your application. They gave you the A. They want you. They will do what they can to have you as a student either this year or next.
My bad,
I just reread my post and I meant to qualify the statement more like “I’m not even sure if would be legal [to rescind] but if they did rescind,”
 
What would be the appropriate timeline to ask this? Immediately? I just submitted the refundable $100 deposit. Are there any general guidelines ?

I’m lighting candles for Shabbat imminently and will check on this thread tomorrow night.
Suggest asking in the school-specific forum. I suggest scrubbing your posts to remove identifying info and just mention that you need surgery right before schools starts.
 
Update for any future trans applicants in my situation:

The social worker from surgical team was remarkably cordial*. Due to the length of the recovery process (8 weeks), the surgical team could not find me an alternate date that would fall in early June 2023 (I cannot blame them because they only perform this day-long procedure on a specific day of the week); any other patients on those tight alternate dates probably did not want to exchange dates with me (an earlier date) or weren't ready. The surgical team has a long waitlist, apparently 2-3 years as of present.

The team gave me a letter, which I attached to my email to the admissions committee. The turnaround time was rapid (five days from when I sent the email). The dean of admissions even personally wrote to me, to firstly notify me that it would take several days, then to confirm that I had received notice, and to reassure me of my process-related concerns.

--- long reflective rant ---

I hope you all will forgive my neuroticism. As a poor patient on Medicaid, I am not used to having my requests accommodated and processed with such quick turnaround time. Before the pandemic, staff from this highly-esteemed practice (at a prestigious hospital system) would not even return my calls inquiring about the status about one of my supporting clinical letters which I had turned in after my consult (out of three letters, all of them of attending status or higher; apparently none of them can be residents -- gatekeeping barriers cis people will never have to deal with), insurance approvals leading to confirmed surgery dates, etc.

I personally, will never forget how hard I fought to be at this point. Years ago when I was homeless and destitute (having had to run away from my family), being openly transgender in healthcare (as a patient, never mind a healthcare worker) was risky and dangerous. You only told your medical team when you had no choice -- unless they were an explicitly LGBT-friendly medical team, which applied to only a handful of clinics in the city. The one hospital that actually looked after queer people in the city (St Vincent's) shut down in 2010 -- it was only much later rebuilt by Northwell as Lenox Hill Greenwich Village (but without the affiliation with NYMC).

Only after various (federal) Supreme Court rulings and various legal protections passed by the NY State legislature (and NYC local authorities) did the greater healthcare system actually start respecting trans people as patients. Only after the youth vote removed conservative Democratic incumbent holdouts in the NY State Senate (the same election year that AOC unseated Joe Crowley for NY 14th district) did the gender identity amendments to the NY State Human Rights Law pass in 2019, followed by the Bostock v. Clayton County SCOTUS ruling in 2020. Only then, did the greater healthcare system start respecting trans healthcare workers as employees. Before then, we were treated lower than dirt. I, along with other disadvantaged trans patients (many who were shelter friends), were routinely ghosted on by social workers who took months to get meaningful movement on our medical requests. Apparently what it takes for disadvantaged trans patients to get treated equally around here is to hold multiple medical school acceptances. lol

--- end long reflective rant ---
 
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Okay, since I'm effectively forced to take a gap year for medical reasons, but those medical reasons also make it slightly difficult to apply to most "cooler" medium-term endeavors, since basically I would be out of action from September to November, any advice on how to present my situation to employers and volunteer programs? Most meaningful volunteer programs I am interested in (ie. court-appointed special advocate for foster care youth) require a 12-month commitment.

I feel like I've gotten all the experience I need from my current full-time job (private ambulance work) and they will be reluctant to advance or promote me to a long-term supervisory role if they know I am going to medical school (which they know, since management wrote some of my letters of rec and were personally supportive.) I am ready to move to a more intellectually-stimulating position and use my MS in biochemistry, maybe for intensive benchwork or teaching. In addition, following the post-acute recovery period after surgery, my doctors are still going to recommend I work in a job that doesn't require lifting 125 pounds regularly. At the same time, I am not sure how to tell most prospective employers that I will be "gone" for two months this year and also gone for good after July of next year.

I am just wondering what admitted students forced to take a gap year prior to medical school for major surgery (etc.) usually tell prospective employers. I'm fairly capable of dealing with this situation by myself, but I was hoping to connect to other students in similar situations.
 
Since you’re school is already amenable to the deferment, I would try to make a plan like this:

Fall semester: stay in current city with your surgeon and focus on your recovery. Keep working your current job to pay the bills.

Spring semester: Once recovered (January/February?) move to the city where your school is and do work or volunteer or research activities there. I’m sure your school could help you plan this so you have the gig set up by the middle of fall and can just move and immediately start when you’re ready. That way, you’re using part of your gap year to get accustom to the new city, beginning to build relationships with faculty/admin at your new school, and developing activities for your CV that you can continue throughout medical school. To me, this is better than something you start in your current city and stop after ~6 months because you need to move.

I took some medical leaves of absence in undergrad, but continued to live in the same city as my school. This made it very easy to continue to same jobs and extracurricular activities, as well as maintain relationships with my deans and professors.

I would recommend speaking with someone in your school’s office of disability services. While I’m not calling you disabled, I think that office generally has the most experience with students who need to take medical leaves and therefore can help share what has worked for prior students.
 
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How was your MCAT? Clearly good enough to get you into at least one med school. Would you/could you consider MCAT tutoring with a corporation? You might also consider tutoring HS or college students in your subject areas of expertise. If you are in an area with affluent families, you can make very good money as a tutor. There is no heavy lifting and short-term assignments are not unusual or undesirable.
 
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So happy it's worked out for you so cleanly.

- another trans premed who would like to get the inverse surgery done prior to med school :)
 
How about scribing, OP?

I don't want to overstep my boundaries here because OPs situation is extremely unique, but I will stay that scribing (especially ED scribing) can be a physically taxing job. Especially when the computer stations are on wheels that have less direction than a Carib grad.
 
I don't want to overstep my boundaries here because OPs situation is extremely unique, but I will stay that scribing (especially ED scribing) can be a physically taxing job. Especially when the computer stations are on wheels that have less direction than a Carib grad.
I was thinking of when OP gets back on her feet.
 
hey i just want to say im also queer and have suffered a lot of abuse and youre an inspiration and thank you for sharing your story :)
 
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