#Non-Renewed Contract #PGY-1 #Advice #Family Medicine Residency

[Feenie]

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Hey everyone - wanted to share my experience and get some insight from others who might have been in similar situations.

I just completed my PGY-1 year at a rural family medicine program, but unfortunately my contract wasn't renewed. Before anyone asks - I left on good terms with the program. My assistant program director even wrote me a letter of recommendation, which I'm grateful for. Sometimes these things just don't work out for various reasons (program fit, personal circumstances, etc.).

Now I'm looking at reapplying for the upcoming match cycle and honestly feeling pretty anxious about my chances. I know having an incomplete residency on my record isn't ideal, but I'm hoping my positive departure and the LOR help demonstrate that this wasn't about competency issues.

My questions for the community:

• Has anyone successfully matched into FM after not completing a previous FM residency?
• How do program directors typically view candidates with this background?
• What types of programs should I be applying to this time around?
• Any specific advice for addressing this in my personal statement and interviews?

Finding mentorship during this process: One thing I really wish I had more of during my PGY-1 year was solid mentorship, and I think that might have made a difference in my experience. Now as I'm reapplying, I'm realizing how crucial it is to have someone guide me through this process.

For those who've been through similar situations - how did you find mentors during your gap year/reapplication process? I'm thinking I need someone who can:

• Help me reflect honestly on what went wrong and how to improve
• Guide my program selection strategy
• Review my application materials with fresh eyes
• Practice interviews and help me address the elephant in the room professionally

I'm not sure about the best approach or how to ask for this kind of intensive mentorship when I'm essentially starting over.
I'm really hoping to get back into training and complete what I started, but I know I need better support systems this time around.

Thanks in advance for any guidance.

 

[Apollyon]

I'm not FM, so, I only have one thing to say, and it's just point of fact: ABFM states the last 24 months of FM residency has to be in the same location/program. I mean, it's highly unlikely you'll transfer again. I'm just sayin'.

 

[comp1]

This is real rough and I feel for you. Unfortunately, we need more details before we can give advice. What happened? What is the PD going to put in this letter? Can the actual PD write a letter? Can you get any other letters of support?

 

[dozitgetchahi]

Hey everyone - wanted to share my experience and get some insight from others who might have been in similar situations.

I just completed my PGY-1 year at a rural family medicine program, but unfortunately my contract wasn't renewed. Before anyone asks - I left on good terms with the program. My assistant program director even wrote me a letter of recommendation, which I'm grateful for. Sometimes these things just don't work out for various reasons (program fit, personal circumstances, etc.).

Now I'm looking at reapplying for the upcoming match cycle and honestly feeling pretty anxious about my chances. I know having an incomplete residency on my record isn't ideal, but I'm hoping my positive departure and the LOR help demonstrate that this wasn't about competency issues.

My questions for the community:

• Has anyone successfully matched into FM after not completing a previous FM residency?
• How do program directors typically view candidates with this background?
• What types of programs should I be applying to this time around?
• Any specific advice for addressing this in my personal statement and interviews?

Finding mentorship during this process: One thing I really wish I had more of during my PGY-1 year was solid mentorship, and I think that might have made a difference in my experience. Now as I'm reapplying, I'm realizing how crucial it is to have someone guide me through this process.

For those who've been through similar situations - how did you find mentors during your gap year/reapplication process? I'm thinking I need someone who can:

• Help me reflect honestly on what went wrong and how to improve
• Guide my program selection strategy
• Review my application materials with fresh eyes
• Practice interviews and help me address the elephant in the room professionally

I'm not sure about the best approach or how to ask for this kind of intensive mentorship when I'm essentially starting over.
I'm really hoping to get back into training and complete what I started, but I know I need better support systems this time around.

Thanks in advance for any guidance.

So if they didn’t renew the contract and it wasn’t about competency issues, what happened? This makes it sound like some sort of personality problem on your part?

 

[shaggybill]

What is your old program director going to tell the new program director when they call? I doubt it's going to be "we derailed his/her career and created a huge barrier to continue training in this field because our program wasn't a good fit."

 

[Feenie]

This is real rough and I feel for you. Unfortunately, we need more details before we can give advice. What happened? What is the PD going to put in this letter? Can the actual PD write a letter? Can you get any other letters of support?

Thank you! It has been one of the WORST feelings I've ever encountered in my life and I've been through some serious crap. To answer your question about more details regarding my predicament here is a summarized but important version of events:
- took a year off after graduating med school to do an MPH and attend to my dad who was rapidly declining secondary to Alzheimer's. I was so focused on the above 2 situations that I didn't stay as medically relevant. I did a 1 month observership in neurology and one month in internal medicine before applying to residency in 2024 but ofc that wasn't enough and I needed to catch up with the rest of my residents with respect to medical knowledge. I take full responsibility and accountability for my deficiencies. I worked like a dog, asked for constant feedback, studied quite a bit and was catching up with evaluations and faculty comments stating I was making improvements. However, I was placed on an at risk status at the end of November due to plateauing in my performance for, "too long". I remained on at risk status and continued to work really hard. I did NOT receive any worsening or concerning feedback during that time and all of a sudden I come back from a week's vacation to see my dad and I was pulled into a meeting and told that I was to be put on probation again, due to not being as good as my other interns. I hate to say this, but there were a couple of interns who I know were performing worse than me but I was on their radar. It was downhill from there and I had a SERIOUS target on my back and it was ROUGH!!! My mental health took a MAJOR hit and I did start performing worse. I didn't make any patient errors and my patients were not at risk as I continued to work really hard but I was so depressed that it showed and I knew I wasn't going to make it but continued to show up diligently and kept working. I was at risk of not having my contract renewed and I knew it and went and spoke to the PD and APD and very honestly said to them that if they didn't renew my contract I would be ok with that. In the end, this wasn't the right fit for me. The APD was my advisor and she stuck up for me like a hero.
I was blatantly honest with her and said I take accountability for my mistakes and not being the best version of myself and I know I got in my own way and I take accountability and responsibility for that.
I also had a very candid chat with my P.D about this.

In the end, my APD wrote me a nice LOR and my P.D said to me that he would be happy to speak to my future P.D and let them know that I'm a stand up person who had some catching up to do academically but never professionally, which funnily enough my P.D said to me, it's not the end of the world, lol.

Being Canadian, they didn't want to terminate my contract early as they were afraid I'd be sent back to Canada and they didn't want that. I told them I was fine with it and whatever they needed to do. Funnily enough they kept me on the payroll for the last 3 months until the end of my contract despite not having any resident responsibilities, which I thought was very nice of them.

I still have a great relationship with my APD and love her to pieces, we got along like gangbusters. Before I left my P.D sat me down and gave me some advice on being honest with my new residency applications.

To answer your last question, I received 2 other LOR's from faculty. One of the LOR's I never asked for, they volunteered and told me they were going to write me one and the other faculty LOR I asked for.

I've received some very candid responses on here and they've been very frank and to the point and I've been very open to them.

I appreciate any and every constructive feedback and suggestions.

So if they didn’t renew the contract and it wasn’t about competency issues, what happened? This makes it sound like some sort of personality problem on your part?

What is your old program director going to tell the new program director when they call? I doubt it's going to be "we derailed his/her career and created a huge barrier to continue training in this field because our program wasn't a good fit."

 

[EthylMethylMan]

Sorry for what you’ve been through. It sounds like it’s been a very hard couple of years. That said, it seems like it actually was competency issues. Your attendings primarily assess your knowledge through your clinical competence. You also say that you take full accountability, but you then also say that the program put “a target on [your] back”. Not trying to kick you while you’re down, but these are noteworthy discrepancies.

I’ll answer your questions to the best of my knowledge and brutally honestly. You’re gonna have to apply to every community FM program in the country. Programs that generally don’t have to SOAP would have no reason to take someone who previously did poorly in a residency over a fresh grad. You’ll need to be willing to go anywhere. As far as addressing the situation, be honest. Obviously leave out any language blaming the program explicitly or implicitly (e.g. no mention of targets on your back). Demonstrate that you’re working on things (read FM journals, textbooks, etc.).

Good luck. I’m not FM, but I think you can make it if you apply very broadly and demonstrate growth. Most people can probably empathize with your story, and FM is pretty non-competitive.

 

[NotAProgDirector]

With more details, we can be more directive with advice.

First, dealing with a parent with AD is incredibly difficult. It's a long slow process, and can be emotionally draining. First with the memory gaps so that conversations become increasingly difficult. Then they stop remembering whom newer people in their lives are - such as grandchildren. Then, they may not remember who you are. And all of this often with a change in personality. Somewhere along the line they simply are no longer the person you remember as a parent -- yet they still are your parent, and you have a responsibility to try to connect with them. It's a long, hard road.

Regarding your training history and future plans, a few things. And I'm going to be very direct here - as I think it's something you need to hear.

You stated that you "started off behind", which certainly can happen when people take an LOA after medical school. But in my experience, most people who start behind get caught up. In general, it takes less than 12 months to learn intern level skills. Most people are ready to be PGY-2's between 6 and 9 months. If you start behind, the system is designed to have extra time in it to have you get caught up. So I think the problem here is much more than "you started behind", although that's likely part of it.

It is definitely true that being on remediation and under a microscope can cause a "doom loop". Your work is more closely scrutinized. That scrutiny can be unnearving and lead to nervousness and more errors. Errors that others might make and might be missed, or dismissed without concern, might be more seriously examined for you. And each discussion of your deficiencies can further amplify feelings of inadequacy. Of course, the opposite is also true -- sometimes being put under the microscope spurs people to perform their best. The difference between the two is some combination of the person and the process. A miserable. unsupportive system can wear down the best of people. In this case, from your description, it sounds like you were your own worst enemy. Some of it was mental health issues, and some appears to be a self defeatist attitude. Your program could have extended your PGY-1 year for longer than 12 months if they thought you were making forward progress.

You also mentioned that your program paid you for the last 3 months with no clinical duties. I am hoping this was done to get mental health help, or (perhaps) more family time (although it's unclear that will really help your situation). Because from a training standpoint, it's a bit of a disaster. You need more training and experience, not less. No training at all for 3 months (and now for another 2 months I assume) isn't great. Programs may worry you will lose ground from where you are, and start behind again.

You also mention being from Canada and possibly being sent home. I assume that means you were on a visa. You have no post history here, so impossible to know if you were on an OPT extension of an F, a J, or an H visa. Any work visa will end with the end of your position, so I assume you are back in Canada (or, I hope you have a valid US visa of some sort). Assuming any new visa would be a J, you will need a statement from your prior program that your performance was unacceptable -- else you cannot repeat a PGY level on a J visa. This shouldn't be hard, but you will need to make sure your application is clear about this.

So, steps forward:
You could look at an FM program in Canada. If you're flexible in where you're willing to go, there will be open spots in the 1st round of CaRMS for sure (and if you applied wisely, you might get a spot in the 1st round)

In the US, it won't be impossible, but it will be a challenge. You'll need a program willing to sponsor a visa and willing to consider someone whom didn't complete the PGY-1 year the first time. The question you are certain to be asked is "what will be different this time?". Your concerns above about teaching are not the issue -- it sounds like your program was very supportive, and I doubt more lectures would have helped your performance. Medicine (at least the bread and butter part) isn't really learned in lectures. So if I ask you, what's to stop you from underperforming in the next program if the issue this last time was the stress from your personal life, what would you respond? Because that sounds unchanged.

You absolutely do NOT know that other interns were worse than you. That kind of thinking needs to stop, now. You were not privy to their overall performance, evaluations, and assessments.

You mention that this program "wasn't the right fit". So what is the right fit?

 

[hamstergang]

You mention that this program "wasn't the right fit". So what is the right fit?

Yeah, reading the story just has me wondering: if the current program is willing to write OP such a nice LOR and think they should be given another chance, why won't they do it? Why would OP be more successful somewhere else than somewhere supportive that already knows them?

 

[abc123412]

Yeah, reading the story just has me wondering: if the current program is willing to write OP such a nice LOR and think they should be given another chance, why won't they do it? Why would OP be more successful somewhere else than somewhere supportive that already knows them?

My sentiments exactly.

Writing the original poster a favorable reference is at odds the program's decision to terminate the original poster.

It makes no sense.

How can they justify writing a favorable letter of reference while terminating the original poster?

It doesn't sound kosher to me.

Several years ago, an anesthesiology department chairman was successfully sued for writing an anesthesiologist in his practice a favorable reference despite being cognizant of said anesthesiologist's substance issue issues.

The anesthesiologist used the favorable reference to get a job elsewhere. At the new job, a bad patient outcome reportedly arose as a result of his untreated substance abuse issues.

The anesthesiology department chairperson who wrote him a favorable reference was sued on the grounds that he had written a falsely favorable letter to facilitate getting said anesthesiologist out of his department.

 

[NotAProgDirector]

Anesthesiologist Pays $8.2M for Praising Error-Prone Colleague - This

Anesthesiologist Pays $8.2M for Praising Error-Prone Colleague - This

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